Summer can provide more time for parents to interact with and even observe their children or teenagers. Since most students are out of school in the summer, the summer months can also be a low-risk time to consider the use of food supplements as a supplemental way to treat symptoms of attentional or mood disorders. This article will speak to these considerations with a focus on omega 3 fatty acid supplements.
Omega 3 fatty acid supplements such as fish oil, krill oil and flaxseed oil have gotten much attention in the past few years for their reported benefits, including reported improvements in mental health and brain functioning. As with all claims for benefits of nutritional supplements, it is important to look at the data supporting these claims with a critical eye. The manufacturers of nutritional supplements are allowed to make virtually any claim on their labels and in their advertising with no supporting data at all, so long as they indicate in the small type that the claims have not been clinically verified. Consequently, manufacturers have no motivation to do actual studies to verify or disprove these claims. As a result, most studies done on nutritional supplements have small budgets and include small numbers of subjects. Small studies have difficulty proving any effect to statistical significance unless the effect is very strong and is evident in a large percentage of the subjects. Modest effects and effects that are only evident in a small subset of subjects are difficult to demonstrate.
In contrast to the above trends, there have been enough studies now on the omega 3 fatty acid supplements to begin drawing some conclusions. Many people are familiar with these supplements due to the established benefits they have shown in decreasing triglyceride levels and increasing HDL cholesterol (so called “good cholesterol”) levels and the implications this may have for long-term heart attack and stroke risk. Claims have been made for them as well in the areas of helping with cognitive functioning and memory, improving mood, and helping with ADHD symptoms.
Studies on the relationship between omega 3 fatty acid supplements and memory/cognitive functioning have shown mixed results. Researchers have found mostly positive findings when studying pregnant women and mothers of newborns and non-demented elderly patients, all of whom demonstrated modest benefits. Studies that have looked for correlations between omega 3 fatty acid supplements and cognitive functioning/memory in older children and most of adulthood have been more mixed. Some studies reported slight benefit and some did not show any benefit.
Studies looking at possible benefits for people with mood disorders and those who are at high risk for developing schizophrenia have been relatively few in number and small in size, but have suggested some mild benefit.
The trials of omega 3’s in children with ADHD have been more numerous but often small in size, with many not showing statistically significant benefit. A study published in October 2011, however, combined the data from ten previously published studies bringing the total number of children in the studies to 699. With this larger sample size, researchers found a modest benefit in ADHD symptoms and a very good tolerability profile. In this analysis, the EPA component of the omega 3 supplement correlated with the degree of benefit seen.
The overall data about the omega 3 fatty acid supplements in mental health issues suggests that they have modest benefits for ADHD symptoms and may have slight benefits for cognitive functioning, memory, and control of mood disorders. They are well tolerated. They can have positive benefits on triglyceride and HDL cholesterol levels, which can counteract the adverse effects of the mood stabilizing and atypical antipsychotic medications in some patients. Given the very low risk of negative effects with omega 3 fatty acids, they are a reasonable option to try for many patients even though the benefits are likely to be only modest and are not certain in some areas. They are likely to be an addition to, not a replacement for, other treatments. The doses studied in these trials varied, but were typically between 1000 and 1500 mg in school-aged children and between 1000 and 3000 mg in older adolescents and adults. The data suggest, as is almost always the case, that more is not always better; some studies show less benefit and most show no additional benefit at higher doses. In the omega 3 fatty acids, excessive doses can also lead to loose and greasy stools.
References
- Bloch MH, Qawasmi A. (2011 October) Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 50(10):991-1000.
- Kohlboeck G, Glaser C, Tiesler C, Demmelmair H, Standl M, Romanos M, Koletzko B, Lehmann I, Heinrich J; LISAplus Study Group. (2011 December) Effect of fatty acid status in cord blood serum on children’s behavioral difficulties at 10 y of age: results from the LISAplus Study. Am J Clin Nutr. 94(6):1592-9.
- Milte CM, Parletta N, Buckley JD, Coates AM, Young RM, Howe PR. (2012 June) Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: A randomized controlled trial. Nutrition. 28(6):670-7. Epub 2012 Apr 25.
- Colombo J, Carlson SE, Cheatham CL, Fitzgerald-Gustafson KM, Kepler A, Doty T. (2011 October) Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention. Pediatr Res. 70(4):406-10.
- Gustafsson PA, Birberg-Thornberg U, Duchén K, Landgren M, Malmberg K, Pelling H, Strandvik B, Karlsson T. (2010 October) EPA supplementation improves teacher-rated behaviour and oppositional symptoms in children with ADHD. Acta Paediatr. 99(10):1540-9.
- Drover JR, Hoffman DR, Castañeda YS, Morale SE, Garfield S, Wheaton DH, Birch EE. (2011 March) Cognitive function in 18-month-old term infants of the DIAMOND study: a randomized, controlled clinical trial with multiple dietary levels of docosahexaenoic acid. Early Hum Dev. 87(3):223-30.
- Westerberg AC, Schei R, Henriksen C, Smith L, Veierød MB, Drevon CA, Iversen PO. (2011 January) Attention among very low birth weight infants following early supplementation with docosahexaenoic and arachidonic acid. Acta Paediatr. 100(1):47-52.
- Boucher O, Burden MJ, Muckle G, Saint-Amour D, Ayotte P, Dewailly E, Nelson CA, Jacobson SA, Jacobson JL. (2011) Neurophysiologic and neurobehavioral evidence of beneficial effects of prenatal omega-3 fatty acid intake on memory function at school age. Am J Clin Nutr 93:1025–37.
- Karr JE, Grindstaff TR, Alexander JE. (2012 January) Omega-3 polyunsaturated fatty acids and cognition in a college-aged population. Exp Clin Psychopharmacol. 2012 Jan 16. [Epub ahead of print].
