Essential fatty acids and mental health
- Polyunsaturated fatty acids (PUFAs) (omega 3 and 6 fatty acids) are necessary for normal development and function of the brain.
Essential fatty acids and ADHD
- Omega 3 fatty acids and their metabolites help regulate inflammation, neuroinflammation, and neurotransmission (Larrieu, & Layé, 2018).
- The concentrations of certain omega-3 and omega-6 fatty acids were significantly lower in children with ADHD than in healthy controls (Gaby, 2011).
- Children with ADHD have lower blood levels of long-chain omega-3 fatty acids than control children (Antalis et al. 2006).
Lower DHA concentrations in children were found to be associated with (Montgomery 2013):
- Reduced working memory performance
- More oppositional behavior and emotional lability
- Poorer reading ability
ADHD and SNPs
- Children with ADHD are 60% more likely to have a Single Nucleotide Polymorphism (SNP, a change in one nucleotide in DNA) for fatty acid desaturase 2 (FADS2) gene (Brookes 2006).
- This SNP results in less omega-3’s being incorporated into the cell membrane, which potentially explains why low omega-3 concentrations have been seen in ADHD subjects who do not lack dietary omega-3 intake (Brookes 2006).
EPA, DHA, and Omega 6 and ADHD
- The ratio of omega 3 to omega 6 fatty acids is important in ensuring proper function of the body. Too much omega 6 compared to omega 3 has been shown to negatively affect health. However, too little omega 6 is also a problem.
- Adolescents with ADHD had lower total omega-3 fatty acids, lower DHA levels, higher linoleic acid levels, and a lower omega-3:omega-6 ratio than controls. This ratio still was seen despite no difference in consumption of fatty acids (Colter et al 2008).
- Higher Omega-6 levels predicted poorer reading, vocabulary, spelling, and attention in children with ADHD (Milte 2011).
- Higher levels of EPA, DHA, and total Omega-3s were associated with better reading skills (Milte 2011).
- A potential block in converting linoleic acid to gamma-linolenic acid (GLA) by the enzyme delta-6-desaturase was seen in boys with ADHD, suggesting a possible mechanism (Gaby, 2011).
Reasons for EFA deficiencies
- Inadequate dietary intake
- Poor absorption
- Deficiencies of nutrients required for EFA metabolism
- Issues with metabolism that cause decreased incorporation of, or increased removal of, fatty acids from cell membranes
Top EPA and DHA (omega 3) food sources by serving size
- herring, pacific
- salmon, chinook
- sardines, pacific
- salmon, atlantic
- oysters, pacific
Comprehensive food list:
Table 4. Food Sources of EPA (20:5n-3) and DHA (22:6n-3) (Office of Dietary Supplements, n.d.)
Top α-Linolenic Acid (omega 3) food sources by serving size
- flax seed oil
- chia seeds
- flax seeds ground
Comprehensive food list:
Table 3. Food Sources of α-Linolenic Acid (18:3n-3) (Office of Dietary Supplements, n.d.)
Top Linoleic Acid (omega-6) sources by serving size
- safflower oil
- sunflower seeds
- pine nuts
- sunflower oil
Comprehensive food list: Table 2. Food Sources of Linoleic Acid (18:2n-6)
(Office of Dietary Supplements, n.d.)
Commonly suggested amounts for dietary fatty acid consumption:
- cold water fish – 2 to 3 times a week, or
- flaxseed oil – 2 to 6 tbsp daily, or
- ground flax seed – 2 tbsp daily
Flaxseed oil may have negative effects in about 3% people, including: hypomania, mania, behaviour changes. (Prousky, 2015)
Referenced Dietary Intakes
Adequate Intakes for Alpha linolenic acid (Omega 3) (g/day) (Institute of Medicine, 2002)
Adolescents (14–18 years): 1.6 (M) 1.1 (F)
Adults (19 years and older): 1.6 (M) 1.1 (F)
Recommendations for long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (mg/day) (European Food Safety Authority, 2009)
Adults: 250 mg/day (M+F)
Supplementing omega 3 fatty acids
- Supplementation of omega 3 fatty acids seems beneficial for addressing depression (Bruinsma & Taren, 2000).
- Amounts of omega 3 fatty acids used in practice and research range from 1–4 g/day of combined EPA and DHA, in divided doses.
- Fish oil and E-EPA are generally well tolerated, but may cause gastrointestinal side effects in some individuals (Gaby)
- Long-term supplementation with EPA and DHA should be accompanied by a vitamin E supplement (Gaby), as polyunsaturated fatty acids increase vitamin E requirements in the body.
EPA and DHA supplementation and ADHD
- 7.5-10g/day of omega-3 fatty acids showed significant positive impact in the treatment of ADHD (Sorgi et al 2007; Germano et al 2007).
- Treatment with 650mg DHA + 650mg EPA improved attention in both ADHD children and healthy controls (Bos 2015).
- Significant improvements in inattention, hyperactivity, oppositional/defiant behavior, and conduct disorder were seen when children with ADHD received 10.8 grams EPA and 5.4 grams DHA daily for 8 weeks (Sorgi 2007).
- Reduction in Omega-6:Omega-3 ratio (AA:EPA) positively correlated with severity of illness (Sorgi 2007).
- Supplementation with DHA has also been shown to increase attention and reduce symptom severity in ADHD (McNamara 2009).
EPA, DHA, and Omega 6 Supplementation in ADHD
- Children with ADHD symptoms were given 558 mg EPA + 174 mg DHA, + 60 mg gamma linoleic acid (GLA) daily for 3 months. Significant improvements were seen in reading, spelling, and behaviour, that maintained or improved in progress with continued treatment (Richardson & Montgomery 2005).
Omega-3 & Omega-6 Treatment Reduce Medication Dose
- Fatty acid supplements may permit lower doses of medications (Barragan et al 2014):
- Greater change of total and hyperactivity- impulsivity scores
- Less frequent side effects
For patients who do not respond to omega-3 fatty acids, a trial of evening primrose oil (omega 6) could be considered (Gaby, 2011)
It can take over 10 weeks to recover unsaturated fatty acid levels in chronically deficient individuals (Bourre et al 1993)
SAFETY, SIDE EFFECTS
- Common side effects of high dose EPA and DHA supplementation include heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and odoriferous sweat
- The European Food Safety Authority considers long-term consumption of EPA and DHA supplements at combined doses of up to about 5 g/day appears to be safe.
- The FDA recommends not exceeding 3 g/day EPA and DHA combined, with up to 2 g/day from dietary supplements (Office of Dietary Supplements, n.d.).
OMEGA 3 FATTY ACIDS AND MEDICATIONS
- Use caution when supplementing omega 3 fatty acids while taking blood-thinning medications, or blood-sugar issues (Essential fatty acids, 2014).
Bruinsma, K. A., & Taren, D. L. (2000). Dieting, Essential Fatty Acid Intake, and Depression. Nutrition Reviews, 58(4), 98–108. https://doi.org/10.1111/j.1753-4887.2000.tb07539.x
Essential Fatty Acids. (2014, April 28). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids
European Food Safety Authority. Labelling reference intake values for n-3 and n-6 polyunsaturated fatty acids. (2009, July 10). https://www.efsa.europa.eu/en/efsajournal/pub/1176
Institute of Medicine. (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. https://doi.org/10.17226/10490
Larrieu, T., & Layé, S. (2018). Food for Mood: Relevance of Nutritional Omega-3 Fatty Acids for Depression and Anxiety. Frontiers in Physiology, 9. https://doi.org/10.3389/fphys.2018.01047
Office of Dietary Supplements—Omega-3 Fatty Acids. (n.d.). Retrieved October 29, 2020, from https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
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Sorgi, P. J., Hallowell, E. M., Hutchins, H. L., & Sears, B. (2007). 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. Nutrition Journal, 6, 16. https://doi.org/10.1186/1475-2891-6-16