Monday, September 01, 2008
Can essential fatty acids help children with Attention Deficit Hyperactivity Disorder (ADHD)?

The long summer holidays have ended and children are heading back into their classrooms.  Over the last few years the press have been giving increasing coverage to a condition known as ADHD (attention deficit hyperactivity disorder).  Today I would like to write about essential fatty acids, one of the many nutritional aspects associated with the condition. 


The following facts were provided by a fantastic charity – Food for the Brain(1) – a non-profit educational charity, created by a group of nutritionists, doctors, psychiatrists, psychologists, teachers and scientists to promote the link between nutrition and mental health.

 
-Children with ADHD often have three basic problems, they can't pay attention, they are hyperactive and they act on impulse.
-It is estimated that up to 5% of school-age children in England and Wales have ADHD – representing around 67,000 children.
-In a class of 30 children there will be one or two children with ADHD.
-Boys seem more likely to have ADHD than girls.
-In the UK, between three and nine boys are diagnosed with ADHD for every girl diagnosed, this may be because boys and girls tend to have different symptoms of ADHD.
-Inattention is more common among girls while hyperactivity is more common among boys.  A boy who is hyperactive (shouting, running about and getting into trouble) may be more noticeable than a girl who is inattentive (daydreaming, forgetful and easily distracted).
-It is estimated that between 30% and 70% of children with ADHD continue to exhibit symptoms in the adult years.


In this blog post I am going to concentrate on the potential usefulness of long chain omega 3 fatty acids (EPA and DHA found in oily fish such as salmon, mackerel, sardines) in the management of ADHD.  These essential fatty acids are crucial to brain development and brain function and increasing evidence indicates that deficiencies or metabolic imbalances of these fatty acids might be associated with childhood developmental and psychiatric disorders including ADHD. Omega-3 are often lacking in modern diets and as I will discuss here, preliminary evidence suggests that supplementation may well be helpful in the management of ADHD and linked behavioural and learning difficulties (such as dyslexia and dysphraxia).


Children with ADHD are often found to have nutrient deficiencies, especially in essential fatty acids(2,3,4). Common symptoms of deficiency may include dry, flaky skin, frequent urination and excessive thirst.  However, symptoms vary or may be absent altogether.


Clinical trials with nutrients and behaviour problems are not easy to conduct as the diagnosis and tracking relies on behavioural criteria and trials do not allow for individual tailoring of treatments.  The data for nutritional management of ADHD is still preliminary but growing rapidly.  Personally I see the links as being exceptionally strong and I know that many other health professionals feel the same way as I do.  The brain needs optimal nutrition to function effectively.  If we are not getting enough vitamins, minerals and essential fatty acids from our diets then we are bound not to be at our best!


One of the leading researchers into learning/behavioural difficulties and nutritional supplementation in the UK is Dr Alexandra Richardson.  Dr Richardson is an inspiration and I have been privileged enough to hear her speak on a number of occasions.  In 2002 she published a paper(5) which detailed a small trial conducted with 41 children, aged 8-12, who had specific learning difficulties (mainly dyslexia) who also showed ADHD features.  The children were given essential fatty acid supplements or a placebo for 12 weeks.  After 12 weeks cognitive (learning/mental) problems and behaviour problems were significantly lower for the group treated with fatty acids.  This small pilot study paved the way for further small studies which all indicate the importance of essential fatty acids in the management of behavioural problems(6,7,8,9).  Unfortunately large scale trials are still needed but funding is notoriously difficult to find for nutritional intervention trials (compared with drug trials). 


Dr Richardson wrote a review paper(10) detailing current thinking around essential fatty acids in childhood developmental and psychiatric disorders.  In it she details the fact that long chain omega-3 fatty acids (EPA and DHA) are often lacking in our diets and that evidence has built up to suggest that deficiencies and/or imbalances are associated with childhood developmental and psychiatric disorders including ADHD, dyslexia, dyspraxia, and autistic spectrum disorders.  The current evidence seems very supportive of dietary supplementation with these fatty acids, particularly EPA (eicosapentaenoic acid).  Dr Richardson stresses the need for large-scale studies to determine optimal treatment formulations and doses and the need to develop ways of identifying individuals most likely to benefit.  She points out “Childhood developmental and psychiatric disorders clearly reflect multifactorial influences, but the study of LC-PUFA [long chain polyunsaturated fatty acids] and their metabolism could offer important new approaches to their early identification and management

 

Omega 3 fatty acid supplementation will not help all children affected by ADHD.  However, omega 3 fatty acids are beneficial to health for a number of reasons (which I frequently mention in my blog posts) and, as many of us do not consume oily fish regularly (at least twice per week as a minimum), supplementation seems prudent to make up for the dietary lack. 


A daily supplement providing around 300-500mg of EPA and 250mg of DHA may be worth trying.  The appropriate dose for the improvement of mood and cognition varies.  Some of the trials with ADHD used up to 1000mg EPA.  The quality of the supplement also needs consideration as fish oils may be contaminated with heavy metal residues e.g. mercury.  Supplements containing Vitamin E or C are worthwhile as these vitamins prevent the oil from oxidation (going rancid).  High dose fish liver oils are not recommended as these contain large amounts of vitamin D and A which can be toxic if taken in excess.   


There are many other nutritional factors (vitamins and minerals) associated with ADHD and related conditions and I hope to cover these important topics in time.  Any dietary interventions with children needs to be closely monitored and I would suggest speaking with your GP or health professional before embarking on a regimen.  Dietary interventions are to be viewed as complementary to any other management approaches.  Individual cases need individually tailored treatment. 

Please visit the Food For The Brain website for more ideas and information. 


(1)www.foodforthebrain.org
(2)Burgess JR et al.  2000.  Long-chain polyunsaturated fatty acids in children with attention deficit hyperactivity disorder.  American Journal of Clinical Nutrition.  71(1):327-330.
(3)Mitchell EA, et al.  1987.  Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr.  26:406-411
(4)Stevens LJ et al.  1995.  Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr.  62:761-768
(5)A. Richardson and B. Puri.  2002.  A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.  Prog Neuropsychopharmacol Biol Psychiatry, Vol 26(2):233-9
(6)Colter AL et al.  2008.  Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J.14;7:8.
(7)Johnson M et al.  2008.  Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents.  J Atten Disord.  Apr 30. [Epub ahead of print]
(8)Sinn N, Bryan J.  2007.  Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. J Dev Behav Pediatr.28(2):82-91.
(9)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.
Sorgi PJ et al.  2007.  Nutr J. 13;6:16.
(10)Richardson AJ.  2004. Long-chain polyunsaturated fatty acids in childhood developmental and psychiatric disorders.  Lipids. 39(12):1215-22.

Written by Ani Kowal

Monday, September 01, 2008 7:25:03 AM (GMT Standard Time, UTC+00:00)  #    Comments [4] Trackback 
Monday, September 01, 2008 9:23:35 PM (GMT Standard Time, UTC+00:00)
This is wonderful information and we are finding that virtually all of us need those good fats. But in addition to adding these nutrients, parents of children with ADHD should also begin subtracting...subtracting the worst of the synthetic additives such as food dyes. The study from the University of Southampton showed that a modest dose of dyes and the preservative sodium benzoate caused ADHD-type behaviors in all kids, not only those with a prior diagnosis.
Here in the US the non-profit Feingold Association has long been helping families get rid of those additives and substitute delicious, healthy food. (www.feingold.org) In the UK the Hyperactive Children's Support Group has been doing this for nearly as long.
Good fats and good food are a real recipe for success for our kids!
Tuesday, September 02, 2008 7:17:55 AM (GMT Standard Time, UTC+00:00)
Dear Jane,

Thank you so much for your comments. There is an array of information that I would like to cover with respect to ADHD and I hope to be able to do this over time! The Feingold Association is one that I am familiar with and their work on food additives is impressive. 'Real' food is certainly something that I have no trouble promoting!!!

There is an organisiation here in the UK called 'Natural Justice' (http://www.naturaljustice.org.uk/) which looks at nutrition and social behaviour (not just ADHD). The director, Bernard Gesch, is a wonderful scientist and speaker who is really trying to emphasise the importance of nutrition for behavioural support. They state the following: "The underlying thesis is simple: the brain needs to be nourished like all other parts of the body, and it is vital to consider the nutritional needs of the brain as a key factor in governing behaviour. We believe that there is insufficient emphasis of the brain’s nutritional needs in generally accepted standards of dietary adequacy".

Good fats and good food - a real recipe for success for all of us!

With my kindest wishes
Ani
Ani
Friday, September 05, 2008 12:44:21 PM (GMT Standard Time, UTC+00:00)
Hi Ani

It’s interesting that you suggest that omega acids can have a potentially positive impact on ADHD.

In my experience, the intake of Omega-6 and Omega-3 is primarily associated with a decreased risk of cardiovascular disease – something which is obviously a massive problem amongst adults worldwide and especially in the UK.

Natural sources of essential fatty acids are good at giving us a helping hand to reduce high cholesterol concentrations.

Cold-pressed hemp seed oil such as GOOD OIL is a great source of Omegas and when consumed in even small amounts (10ml) per day it will make a substantial contribution to the intake of essential fatty acids which are required for good health. Compared with other culinary oils it is also low in saturated fatty acids.

You may also know that current national and international dietary recommendations for the prevention of cardiovascular disease recommend decreasing the intake of saturated fatty acids in order to lower blood cholesterol concentrations.

If you want to find out more about the nutritional attributes of Cold Pressed Hemp Seed Oil, a recent study by Professor Tom Sanders and Dr Fiona Lewis of the Nutritional Sciences Division at King’s College, London can be found here: Good Oil Kings Report

I should disclose that GOOD OIL is a client of mine and so if you’d like to sample some of their product, drop me an email and I’ll send you some over to try (that also includes you, Jane).

Keep up the good work!

Rax

Friday, September 05, 2008 1:42:39 PM (GMT Standard Time, UTC+00:00)
Dear Rax,

Thank you for the comment - as you will see from many of my previous posts Omega 3 fatty acids seem to be important for the prevention of numerous conditions. Trial results and scientific papers on the benefits of omega 3 fatty acids are being published all the time and I imagine this will continue for years to come! The omega 3 family of fats really are essential for our optimal health.

Best regards
Ani
Ani
Comments are closed.