Although many supporters of natural treatment for ADHD are quick to turn to omega 3 fatty acids (aka “fish oil”), a quick look at the supplement shelf at your favorite drug or grocery store can make a person’s head spin. Omega 3 fatty acids unfortunately fall into the category of “supplements” and are not as tightly regulated by the FDA as medications in terms of the claims made by their manufacturers. This article will help you understand dosage, side effects, and which criteria are important in selecting a fish oil supplement to fit your needs.
What are the side effects of omega 3 fatty acid supplements? Most people do not notice much, but common side effects, especially at higher doses, include a fishy aftertaste/burps and diarrhea/stomach upset. Less common side effects include raising LDL (aka “bad”) cholesterol (though without an increase in heart attacks), and prolonged bleeding.
Is the source of the omega 3 fatty acids all that critical? The main omega 3 fatty acids used by the brain are DHA and EPA. The body can make DHA and EPA from ALA (made by plants), but the process is very inefficient. Usually humans can only get significant amounts of DHA and EPA from algae or marine animals such as fatty fish and seals. Fish oil, krill oil, and algal oil are the most common omega 3 supplements on the market. Eggs and meat also contain DHA and EPA, but not in concentrations high enough to make supplements from them.
Omega 3 fatty acids are also available as prescription products regulated by the FDA as a drug, not a supplement. However, these preparations are only approved for use in prevention of heart and vascular (blood vessel) disease.
What about mercury, PCBs, and dioxin?
Fatty fish have a tendency to accumulate pollutants such as mercury, PCBs, and dioxins in their oil/fat. Mercury is not good for the brain. PCBs and dioxins can possibly cause of number of problems such as diabetes, thyroid disorders, and cancer. People taking the large doses of fish oil recommended for treatment of ADHD should check the label to make sure their supplement is certified free of mercury, PCBs and dioxins.
Is EPA or DHA more important? Different studies and different experts in the field will give different answers. The take away lesson is that we do not know for sure whether omega 3 supplementation helps ADHD, and we know even less about whether EPA or DHA (or both) are necessary.
Is omega 6 necessary? Existing studies have looked at either omega 3’s by themselves or omega 3s in combination with omega 6s. There is no right answer as poor trial design has made sound conclusions impossible. Experts are divided because some trials of omega 3s combined with omega 6s have demonstrated an effect in treating ADHD (although whether the effect was a valid one, not due to chance, is not known), but omega 6’s have been demonstrated to have opposite effects to omega 3’s in clinical trials which have been done investigating heart health.
What doses should be given? The research does not give a definite answer but experts are recommending at target dose of 300-600mg omega 3/30-60mg omega 6 daily for children, and 1-3 mg of DHA for adults. In order to avoid excessive side effects, most authorities recommend starting at a lower dose and increasing gradually to the target dose.
How long until I see an effect? Most clinical trials that have demonstrated an effect have run for 8-12 weeks or longer. Most experts recommend at least a 2 to 3 month trial at an adequate dose.
Are there any other things I should be aware of? Since many omega 3 supplements were developed for other health issues besides ADHD, some supplements may contain additives which may worsen symptoms of ADHD. For example, some supplements may contain gluten, artificial flavoring, or glucose (sugar). Check the ingredients list on the bottle to be sure.
Gummies and gelatin softgels can sometimes melt or become stuck together in summer heat. Our family has never had this occur to such an extent that the supplement was unusable, but if you order your medications online and a heatwave hits, it may be an issue. In such situations, it may be best to order the summer’s supply before it gets very hot, or buy from a brick and mortar store and keep the product cold in your car until you can store it someplace cool at home.
Bloch, M. H., and A. Qawasmi. “Omega-3 Fatty Acid Supplementation for the Treatment of Children with Attention-deficit/hyperactivitydisorder Symptomatology: Systematic Review and Meta-analysis.” Journal of the American Academy of Child and Adolescent Psychiatry 50.10 (2011): 991-1000. Print.
Covington, Maggie B. “Omega-3 Fatty Acids.” American Family Physician 70.1 (2004): 133-40. Print.
Millichap, J. G., and Michelle M. Yee. “The Diet Factor in Attention-Deficit/Hyperactivity Disorder.” Pediatrics 129.2 (2012): 330-37. Print.
Sinn, Natalie, Catherine Milte, and Peter R. C. Howe. “Oiling the Brain: A Review of Randomized Controlled Trials of Omega-3 Fatty Acids in Psychopathology across the Lifespan.” Nutrients 2.2 (2010): 128-70. Print.