Originally Published in ADDitude Magazine
Most people who have been diagnosed with ADHD have heard all about the benefits of omega-3 fatty acids for managing symptoms. But the book Finally Focused shows that omega-3s are even more brain-friendly than you thought.
By James M. Greenblatt, M.D., Bill Gottlieb, CHC
There’s a reason why the American Psychiatric Association recommends that every man, woman, and child in America eat fish — particularly fatty fish, like salmon and tuna — two or more times a week. And why they also recommend that people with “impulse control disorders,” like attention deficit disorder (ADHD or ADD), supplement their daily diets with at least 1 gram of fish oil. The reason: Omega-3 fatty acids really do help brains, particularly ADHD ones, function better.
The Right Fat to Optimize the Brain
Sixty percent of your brain is composed of fat — which means that your brain depends on a steady supply of dietary fat for its health and wellbeing. Specifically, it depends on essential fatty acids (EFA), the building blocks of fat. Fatty fish and fish oil supply two of the most important essential fatty acids for your brain: EPA, or eicosapentaenoic acid; and DHA, or docosahexaenoic acid. Both fatty acids are omega-3s, a chemical label indicating the placement of carbon atoms in a fat molecule. But omega is also the Greek word for great—because when enough omega-3 is doing its work, it does a great job of protecting your brain. But if levels are low:
- The outer covering (membrane) of brain cells (neurons) degenerates.
- Neurons make less serotonin, a neurotransmitter that helps control mental activity and mood.
- Cellular receptors for the neurotransmitter dopamine become malformed, which results in lower dopamine levels.
- Dendrites, the branching extensions that channel messages into and out of neurons, make fewer branches.
- There are fewer synapses, the bridges between neurons.
In short, just about every aspect of neurotransmission — the movement of information from brain cell to brain cell that supports every thought, emotion, and action — is affected by omega-3s. Omega-3s also protect the brain by decreasing low-grade inflammation, the chronic cellular fire that can singe brain cells.
Bottom line: A deficiency of omega-3s is bad news for a child’s or adult’s brain. Our hunter-gatherer ancestors ate a diet with a ratio of about 2 to 1 omega-6s to omega-3s. Today, we eat a diet with the ratio of 15 to 1. This double whammy — a barrage of omega-6s and a paucity of omega-3s — is a little-recognized factor in the symptoms of ADHD.
Little-recognized by doctors but not by scientists. There have been more studies conducted on the link between ADHD and omega-3s than on any other nutrient. Let’s look at some of the best research.
The Power of Omega-3s to Affect the Brain
From prevention to treatment, omega-3s play a key role in ADHD.
- Eating fewer omega-3s increases the risk of developing ADHD. In a study of nearly 200 schoolchildren, those who ate a diet low in omega-3s had a 31 percent higher risk of being diagnosed with ADHD.
- Children diagnosed with ADHD have lower blood levels of omega-3s. Blood levels of omega-3s in children with ADHD are, on average, 38 percent lower than in children who don’t have the disorder, according to an analysis of nine studies by researchers at Oregon Health & Science University. In a study of 493 schoolchildren, those with lower blood levels of DHA had more defiance, hostility, mood swings, and learning difficulties. And a study from English scientists showed that children with ADHD and low levels of omega-3s had poor “emotion processing” (the ability to understand and respond to emotions) and poor emotion regulation.
- Low omega-3s in children with ADHD may be genetic. Remember, ADHD is not a behavioral problem. It’s a medical disorder, usually with a genetic component that creates a shortfall of dopamine, norepinephrine, and serotonin. Scientists at MRC Social, Genetic & Developmental Psychiatry Centrein London decided to find out if the genetic profile of ADHD extended to essential fatty acids. They studied 180 children with ADHD and 180 without the disorder, and found that the ADHD children had a 60 to 70 percent greater likelihood of a variation in a gene necessary to metabolize fatty acids.
- Disorderly brain waves—with low omega-3s. ADHD children with low blood levels of DHA have a type of disorderly brain activity linked to ADHD, according to a study in the journal Neuropharmacology.
Studies That Show Omega-3 Benefits for ADHD Brains
- Supplementing with omega-3s eases hyperactivity. Analyzing data from 16 studies on ADHD and omega-3s, researchers at Oregon Health & Science University found that supplementing the diet with omega-3s consistently lessens hyperactivity, as evaluated by parents and teachers. “There is sufficient evidence to consider omega-3 fatty acids as a possible supplement to established [medication and behavioral] therapies” in ADHD, the researchers concluded in the journal Clinical Psychology Review.
- Less inattention, less hyperactivity, less disobedience, less hostility — and better spelling, too. These were among the symptom-relieving benefits experienced by children with ADHD who took an omega-3 supplement every day for four months, according to Australian researchers.
- Better memory, better learning. Studying 95 children diagnosed with ADHD, German researchers found that supplementing with omega-3s improved “working memory” — the short-term recall that is key to learning.
- Putting sleeping problems to bed — with omega-3s. Israeli researchers studied 78 ADHD children (ages nine to 12) with sleep problems, giving them either an omega-3/omega-6 supplement or a placebo. (The supplement contained gamma-linoleic acid, or GLA, an omega-6 essential fatty acid found in evening primrose oil, borage oil, and currant oil.) After 10 weeks, the children taking the supplement slept better, were less fatigued during the day, and were better able to cooperate with others.
Does Your Child Need an Omega-3 Supplement?
Parents often ask me: “Does my child need to take an omega-3 supplement?” Unfortunately, that isn’t always an easy question to answer. For one thing, there are no clear, overt signs of an omega-3 deficiency, as there are with other nutrients like magnesium (sleep problems, anxiety, and constipation). My clinical experience has shown that months or years of taking a high-dose omega-3 supplement (more than four grams a day) can actually create an imbalance in essential fatty acids. Too much of the omega-3s DHA and EPA can drive down levels of the omega-6 GLA.
That doesn’t mean there aren’t any telltale signs of a deficiency of essential fatty acids. A child with frequent thirst, frequent urination, and/or allergies is likely to need a high dose (above two grams daily) of omega-3s. A child with a skin disorder — eczema or “chicken skin” (the bumps that dermatologists call keratosis pilaris) — may have a GLA deficiency and need supplementation.
The Best No-Test Strategy for Supplementation
If your child doesn’t have any overt signs of an omega-3 deficiency, and you and your doctor don’t plan to test for a deficiency, I suggest that your child take a daily fish oil supplement that supplies a total of one to two grams of DHA and EPA. In my practice, I use a supplement that combines EPA/DHA and GLA, for a total of three grams per day of essential fatty acids. If the supplement you choose contains 800 mg of EPA, 400 mg of DHA, and 100 mg of GLA per capsule or serving size, you would take it two to three times daily.
Adapted from Finally Focused: The Breakthrough Natural Treatment Plan for ADHD that Restores Attention, Minimizes Hyperactivity, and Helps Eliminate Drug Side Effects. Copyright © 2017 by JAMES GREENBLATT, M.D., and BILL GOTTLIEB, CHC. Published by Harmony Books, an imprint of Penguin Random House LLC.
Add Omega-3s and Subtract Sugar for Better Behavior
Some experts think that chronic sugar intake causes ADHD, but my clinical experience with thousands of children with ADHD doesn’t confirm that. But sugar does contribute to the symptoms of ADHD in many children — and cutting back on sugar usually helps.
If you can help your child with ADHD reduce or remove sugar-sweetened beverages (SSBs) — soft drinks, fruit drinks, sports drinks, energy drinks — you’ll reduce or remove the largest source of sugar in her diet. A recent study by the Yale School of Public Health found that the risk of hyperactivity and inattention increased by 14 percent for each sweetened beverage consumed daily.
Research shows that keeping your child’s blood sugar balanced is the key factor in keeping his brain and behavior balanced. Do your best to get your child to eat protein-rich foods—nut butters, whole-grain bread, lean meat, and so on — throughout the day. That steady supply of slow-digesting protein will help keep blood glucose levels steady. Some sample foods include nut butters; whole-grain bread; eggs; Greek yogurt; lean chicken, turkey, or tuna; hummus; and protein-fortified cereals that are low in sugar.
Turbocharge Omega-3s—with Phosphatidylserine
Parents who give their child with ADHD omega-3 supplements often ask me what else they can do to help. A supplement I often suggest is phosphatidylserine (PS).
This nutritional compound is a type of phospholipid, a fat that helps form the outer covering (membrane) of cells, including brain cells. Neurons with healthy membranes do a better job of communicating with each other—resulting in more balanced emotions and better behavior.
Studies show that adding PS to omega-3s improves ADHD symptoms, but it can work by itself. Children who took PS alone had better attention, less impulsivity and restlessness, and better short-term memory. My recommendation is 200 to 300 mg. daily of PS, in 100 mg. doses, taken at two or three meals. (Example: 100 mg. at breakfast and 100 mg. at dinner.)