An article titled “Feeling Good About Fish Oil” appeared last week in The New York Times.
Several customers wrote to ask our opinion, so we decided to offer our take on the article. The report began with the story of a 4-year-old boy who began grinding his teeth at night and displaying obsessive behaviors to an “unnerving” degree.
The boy's pediatrician—Sandy Newmark, M.D., of Tucson, Arizona—recommended two supplements.
The first was inositol: a body chemical required for various nervous system functions, low levels of which are associated with depression and obsessive-compulsive disorders.
Dr. Newmark also recommended a daily teaspoon of fish oil, for its omega-3 fatty acids. (One teaspoon holds about 4,000 mg of fish oil.)
The Times article quoted the boy's mother, Melissa Jump: “I saw a difference within a week. He's more chill; he can roll with things more. He asks about his blanket every once in a while, but it's no big deal.”
As Dr. Newmark says on his Web site, “…we recognize that there are times when stimulants such as Ritalin are necessary. Even in those cases, alternative ADHD approaches may support the child and minimize the dose of medication or side-effects.”
(Coincidentally, Vital Choice supports the Weil Foundation, which in turn supports the University of Arizona's Program in Integrative Medicine, where Dr. Newmark completed a two-year fellowship under program founder Andrew Weil, M.D.)
Signs of promise within a clouded picture
As Times reporter Roni Caryn Rabin wrote, “…many parents concerned about the side effects of conventional medications are turning to fish oil first, to treat not just mood disorders but also a variety of learning and developmental problems, including autism, dyslexia and, most notably, attention deficit hyperactivity disorder, or A.D.H.D.”
She spoke with Dr. Lawrence D. Rosen, who practices integrative medicine in Oradell, New Jersey, who told her that some children do well on fish oil and other nutritional supplements plus educational and behavioral aid, without medication.
But, as he told Ms. Rabin, “These are generally not the kids who have severe behavioral difficulties or incredible hyperactivity.”
Neither of the other two doctors interviewed expected that by itself, taking fish oil is likely to prove a consistently effective stand-alone treatment for ADHD, given individual variations in the condition's severity and possible causes.
As every literature review finds, there's promising (albeit mixed) clinical evidence, and plausible biological reasons why omega-3s in fish oil might help affected kids' brains function better.
The Times story featured these points about fish oil for ADHD.
And recent scientific review papers on the subject agree that we need to know much more about the interactions between dietary omega-3s and genetic, nutritional, or environmental variables.
The small, weak, inconclusive body of clinical ADHD research on omega-3s is typical of nutrition-disease interaction research, almost all of which is designed and performed at universities to answer basic biology questions.
Generally speaking, only large pharmaceutical companies can afford the $200 million-plus process of proving the efficacy and safety of a proposed treatment to the FDA… whose approval is required to make and advertise enormously profitable disease-treatment claims.
Basic science supports an optimistic stance
Of the two vital omega-3s in fish oil—DHA and EPA—the one most closely associated with brain function is DHA.
In fact, DHA constitutes about 15 percent of the total weight of human brains (20 percent of infants' brains), and about 60 percent of the brain's cell membranes.
The DHA in cell membranes accounts for their unique fluidity.
And both omega-3s exert an astonishing range of influences, including regulation of neurotransmitters and gene transcription. They also serve as the precursors of the anti-inflammatory immune-system agent called autocoids, including some recently discovered compounds (neuroprotectins and resolvins) that may have particular importance to brain function.
In the developing brain, DHA stimulates nerve growth, and it accumulates preferentially in areas of high growth and activity (e.g., synaptic cell membranes, synaptic vesicles, astrocytes, myelin, and mitochondrial membranes).
And low levels of omega-3 DHA in children are linked strongly to increased risk of attention-deficit/hyperactivity problems.
Given its equally wide range of influences, there are good reasons to suspect that omega-3 EPA might positively influence attention deficit/hyperactivity tendencies in distinct ways as well.
Two recent studies support call for more research
Three years ago, we reported the results of a British clinical study that tested the effects of a supplement containing 80 percent fish oil in 117 children suffering from an attention-behavior disorder.
As the authors wrote, “Results showed… significant improvements in reading, spelling, and behavior for active treatment versus placebo during 3 months of treatment in parallel groups… [and] children continuing with active treatment maintained or improved their progress.”
(See “UK Study Finds Fish Oil Benefits Kids with Cognitive Defictits”. Note: The supplement used in this trial contained 20% evening primrose oil, which is high in an omega-6 fatty acid called GLA… see our sidebar titled “Why would an omega-6 help kids' brains?”)
Last year, we summarized an Australian clinical trial that produced mixed results: surveyed parents reported positive changes in their kids, but teachers did not (See “Findings Support Omega-3s' Ability to Aid Kids with Attention Disorders").
The evidence on fish oil and ADHD: Tantalizing but inconclusive
Alex Richardson, M.D., of Oxford University is a leading world researcher in the field of nutrition and diet.
She's a leader of the famous, ongoing Oxford-Durham study, which has included some of the most rigorous trials—and encouraging results—regarding the effects of omega-3s on child development. (See her biography and bibliography at Food and Behaviour Research, the UK charity she co-founded.)
Dr. Richardson has conducted several clinical trials testing omega-3s in child development and attention disorders, including one in which supplementation with omega-3s produced clear benefits in 41 children with ADHD: “…supplementation with [omega-3s] appears to reduce ADHD-related symptoms in children with specific learning difficulties” (Richardson AJ, Puri BK 2002).
It's worth quoting these key points from Dr. Richardson's clear-eyed review of the scientific literature (Richardson AJ 2006):
The Times article quoted Tufts University pediatric health expert Elizabeth Busch, M.D., who put her finger on the evidentiary problem in a recent literature review:
“Because of the variety of subjects and inconsistencies in methodology, this growing literature lacks cohesiveness and is more tantalizing than persuasive” (Busch B 2007).
Since 2000, there have been seven published studies in children that looked at ADHD-related behavioral outcomes following fish oil treatment, and their deficiencies and inconsistencies make it impossible to draw clear conclusions:
And when the Canadian authors of a July 2005 report—funded by the U.S. National Institutes of Health—examined the available studies relating to pediatric ADHD, they could not come to any definitive conclusions concerning the value of omega-3s as a primary or adjunct treatment for ADHD (Schachter H et al. 2005)
What's the future of omega-3s in ADHD?
We still know relatively little about the different effects of the two key omega-3s (EPA and DHA) and the varying effects of different blends of omega-3s and omega-6s.
These important questions remain unanswered:
Sadly, only drug companies have the resources to run the several large-scale, long-term trials needed to settle these key questions… and, if warranted, gain FDA approval of fish oil as a treatment for ADHD or related disorders.
But because drug companies cannot patent omega-3s, they have little or no motive to spend the $200 million-plus it would take to gain FDA approval of fish oil as an ADHD drug.
What's needed is a taxpayer-funded program to test natural products like omega-3s and vitamin D as treatments for, and/or preventive allies against, common diseases.
The NIH has long had a program to fund nutrition-disease studies at universities around the U.S., but it is not designed to answer the practical questions.
Americans should demand that Congress fund this urgent unmet need.
In the meantime, one thing seems certain: fish oil is safe, and unlikely to do harm.
So it makes sense for parents of affected children to discuss fish oil with their pediatrician as an initial or adjunct approach.