Raising omega-3 levels and omega-3/omega-6 ratio into Japanese range yields positive results in in pilot study
by Craig Weatherby
Judging by most prior studies, marine omega-3s from fish appear likely to aid children with attention deficit and hyperactivity disorders and related learning problems.
Last year we reported on studies from the United Kingdom and Australia that seem to support the efficacy of omega-3s (See “New Findings Support Omega-3s’ Ability to Aid Kids with Attention Disorders”).
- "Zone" books author funds small pilot clinical trial testing high doses of omega-3s in kids with ADHD.
- Doses were adjusted halfway through to achieve “Japan-like” blood levels and ratios of omega-3s and omega-6s.
- Results support positive population-study findings and warrant follow-up study in larger, controlled trials.
And last March, the authors of a joint US-UK study involving almost 9,000 British families concluded that the children of mothers who ate more fish than is advised under US guidelines—12 oz per week; a ceiling intended to limit mercury intake—scored higher on tests of intelligence, social and verbal skills, and showed greater physical dexterity, compared with the children of mother who ate less fish than US guidelines allow.
The outcomes of that study affirmed that the rewards of higher maternal fish intake outweigh any risks posed by fish-borne mercury: a result that could be due in part to the mercury-binding effects of selenium, an essential element of which ocean fish are the richest sources: see "'Seafood Mineral May Boost Seniors’ Strength", in this issue.
The March, 2007 report was lead-authored by Cmdr Joe Hibbeln, MD, Senior Clinical Investigator at the National Institute on Alcohol Abuse and Alcoholism, who’s seen omega-3s produce dramatic changes in omega-3-poor patients with diverse cognitive, mood, behavior, and attention deficits.
Agency's retrodgrade attitudes retard nutritional advances
Public health agencies remain reluctant to promote omega-3s for kids, because, despite generally positive results, the outcomes of clinical trials testing omega-3s in children with ADHD have been mixed... possibly because of the varying blends and doses of fatty acids used.
When the UK's Food Standards Agency (FSA) reviewed the available evidence last year, it found insufficient grounds to warrant an official recommendation that all British school children receive omega-3 supplements.
Britain's FSA said that in many cases, the extant studies were insufficiently rigorous in methodology and reporting, and failed to account for possible “confounders”, such as nutritional or environmental factors that might have skewed the results.
But given the overwhelming body of evidence proving the importance of omega-3s to brain function and mood, their benefits to heart and overall health, and the well-documented inadequacy of Americans’ omega-3 intake, official reluctance seems retrograde.
And the failure of America's federal health bureaucracy to urge higher omega-3 and fish intake among kids actually runs counter to official policy. In 2003, the US Office of Magnagement and Budget directed Federal health agencies to promote higher omega-3 consumption by Americans (“Whitehouse Favors Fish Fats”).
Small pilot study boosts omega-3s in ADD
The results of a small, uncontrolled trial from America supports the hypothesis that omega-3s can reduce symptoms of ADHD, and we hope that they prompt funding of larger, placebo-controlled trials.
The new uncontrolled pilot study was funded by the Inflammation Research Foundation, established by Barry Sears, Ph.D.
Omega-3 DHA in gray matter:
Why it matters to mental status
Omega-3s—especially DHA—are essential to brain cell function, with this particular marine omega-3 constituting a large percentage of the brain’s mass, which consists of about 60 percent fat.
Animals with low brain levels of DHA have alterations in the dopamine systems of the central nervous system: changes similar those believed to occur in ADHD and schizophrenia.
Several studies have found that, compared with healthy counterparts, children and adolescents with ADHD have lower blood levels—hence lower brain levels—of omega-3 DHA as well as symptoms of omega-3 deficiency. (Antalis CJ et al 2006).
Children and adolescents with ADHD also have lower-than-average blood levels of omega-6 arachidonic acid (AA)—which is also essential to proper brain function—and higher-than-average levels of saturated fats.
(The US FDA has approved addition of omega-3 DHA and omega-6 AA—both of which are natural constituents of human breast milk—to infant formulas to help ensure optimal brain development.)
However, it is not clear whether low blood (and brain) levels of omega-3 DHA are a cause or effect of ADHD, since the dietary intakes of omega-3s in young people with ADHD do not generally differ substantially from their healthy counterparts.
Dr. Sears authored the highly influential bestseller Enter the Zone, and a series of subsequent “zone” books about diet and health, all of which stress the importance of redressing Americans’ extreme omega-3/omega-6 intake imbalance.
The nine children in the study—six boys and three girls, aged eight to 16—were patients at the Hallowell Center in Sudbury, Massachusetts, and were under treatment for ADHD (Sorgi PJ et al 2007).
All the participating children had an established relationship with the psychiatrist involved in the study.
With the psychiatrist’s approval, three of the kids discontinued their stimulant medication voluntarily prior to the start of the study. The remainder continued with their treatment regime for the duration of the eight-week study.
The children consumed two tablespoons (30mL) of a liquid fish oil concentrate supplied by Dr. Sears’ Inflammation Research Foundation, which provided 16.2g of omega-3 fatty acids (10.8g EPA and 5.4g DHA) per day.
Note: The liquid omega-3 supplement used in the trial is made and marketed by Dr. Sears’ company, of which Dr. Hallowell is an employee: economic interests that must be taken into account.
Kids' omega-3 doses tweaked to achieve “Japanese” blood levels
This study was marked by an attempt to adjust the children's fatty acid intake to achieve roughly equal omega-6/omega-3 ratios.
This was done to bring the omega-6/omega-3 ratios in the children's blood much closer to the ratios found in Japan, where omega-3 intake is much higher than here, omega-6 intake is much lower, and ADHD is considerably less common.
The omega-3 dose was adjusted after week four, based on the omega-6/omega-3 ratio in the children’s blood, to keep the proportions of omega-3s and omega-6s roughly equal. (The average American child consumes far more omega-6s than omega-3s, with a resulting bodily imbalance.)
The participants’ parents or guardians were phoned once per week to monitor adherence and check for any adverse effects of the EPA/DHA concentrates.
The children and at least one parent or guardian met with the psychiatrist at three time points: the start of study, at week four, and at the conclusion (week eight).
At the initial visit, the participants were advised to follow a “healthy diet” that encouraged fruits, vegetables and balanced meals and snacks.
At each of the three meetings, a psychiatrist conducted behavioral assessments, and blood was drawn for fatty acid analysis. Critically, this doctor was unaware of the children’s degree of compliance with the omega-3 supplement regimen or their medications.
A standard ADHD symptom checklist (ADHD SC-4) was used to monitor behavioral changes at each meeting.
Positive results support efficacy of omega-3 supplements
The researchers reported that at the end of the study, the children’s’ blood levels of omega-3s (EPA and DHA) were significantly higher, while the omega-6/omega-3 ratio in the plasma was lower (i.e., better).
More importantly, the kids’ behavior improved substantially.
The testing psychiatrist reported significant improvements in behavior, including inattention, hyperactivity, oppositional/defiant behavior, and conduct disorder.
And Dr. Sears’ team reported finding a significant correlation between the reduction in a child’s omega-6/omega-3 ratio and his or her score on the “severity of illness” checklist.
The findings of this small pilot study suggest that high-dose omega-3 supplements may improve behavior in children with ADHD.
We should note that lower doses of omega-3s can raise a person's blood levels into the same range, over a longer period of time. Presumably, as in many other omega-3 studies, the authors used high doses because they needed to raise blood levels quickly enough to detect any results before the study ended.
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- Burgess JR, Stevens L, Zhang W, Peck L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr. 2000 Jan;71(1 Suppl):327S-30S. Review.
- Chalon S, Delion-Vancassel S, Belzung C, Guilloteau D, Leguisquet AM, Besnard JC, Durand G. Dietary fish oil affects monoaminergic neurotransmission and behavior in rats. J Nutr. 1998 Dec;128(12):2512-9.
- Chalon S, Vancassel S, Zimmer L, Guilloteau D, Durand G. Polyunsaturated fatty acids and cerebral function: focus on monoaminergic neurotransmission. Lipids. 2001 Sep;36(9):937-44. Review.
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- Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. The Lancet 2007; 369:578-585.
- Sorgi PJ, Hallowell EM, Hutchins HL, Sears B. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutr J. 2007 Jul 13;6(1):16 [Epub ahead of print]
- Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr. 1995 Oct;62(4):761-8.
- Zimmer L, Vancassel S, Cantagrel S, Breton P, Delamanche S, Guilloteau D, Durand G, Chalon S. The dopamine mesocorticolimbic pathway is affected by deficiency in n-3 polyunsaturated fatty acids. Am J Clin Nutr. 2002 Apr;75(4):662-7.