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There is no doubt that obtaining omega 3 fatty acids from diet or supplements has many health benefits. In addition to their many applications, omega 3 supplements are popularly used as a complementary treatment for ADHD symptoms.
However, randomized control studies results are still conflicting and haven’t shown significant improvements in ADHD symptoms.
Facts related to Omega 3 and ADHD
There are a few links between omega 3 and ADHD that are not disputed by scientists.
- People (children and adults) with ADHD have lower omega 3 (especially DHA) levels in their blood, compared to their healthy peers. (1, 2, 3)
It is thought to be due to a few factors, such as poor diet and issues with the metabolism of fatty acids in people with ADHD.
- ADHD symptoms, such as hyperactivity, impulsiveness and lack of attention, are associated with low DHA and EPA blood levels. (4, 5)
- Omega 3s play a crucial role in human brain development. (6)
- DHA (one of the omega 3 subtypes) is essential in forming new neurons in the brain (neurogenesis), communication between neurons (neurotransmission), and protection against oxidative stress in the brain. (7)
- Omega 3 fatty acids, an essential component of the brain, are lower in people with ADHD and are associated with some of the symptoms of ADHD.
Studies on the effects of omega 3 fatty acids in ADHD treatment are conflicting
These facts became the basis of some theories on how omega 3s relate to ADHD symptoms.
To prove these theories, in the last decade, many studies were performed using various combinations of EPA, DHA and omega 6 fatty acids.
The studies brought conflicting results. It is still not clear, if supplementing children or adults with polyunsaturated fatty acids actually improves the symptoms of ADHD.
About half of the clinical trials show that omega 3s have small to moderate effects on ADHD symptoms. The other half of the trials didn’t find these supplements to be effective. (8)
The discrepancy in the results are due to different methodologies, dosages, omega 3 subtypes, combinations used, size and duration of the trials.
There are also different interpretations of these clinical trials results by different authors of systematic reviews.
As a result, the effects of supplementation with omega 3 on ADHD symptoms are not confirmed, although trials that show positive results are more convincing. See why in the sections below.
One study showed that flaxseed oil supplementation equivalent to 200mg of alpha linolenic acid (ALA), together with vitamin C, is associated with an increased level of red blood cell count (RBC), and a significant reduction of total hyperactivity scores of ADHD children. (9)
This study, however, had a few issues, (lack of a control group, relying only on the parents’ reports, and using a combination of the supplement with vitamin C) which made it impossible to draw any definite conclusions.
A more recent, randomized controlled double-blind study showed that supplementing children with 1 g of ALA did not reduce the ADHD symptoms significantly. This study concluded that there is a need of more research, with higher dosages and alternative methods of administering the oil. (10)
- Half of the studies on omega 3 supplementation show that it is ineffective on ADHD symptoms, but the other half of the studies show a small improvement.
- Supplementing with 1 g of ALA hasn’t been shown to be effective, although more studies with higher dosages are recommended.
Studies showing positive results of omega 3s on ADHD symptoms
The positive studies tend to be larger and longer.
They use more than 50 people and have a minimum duration of 15 weeks. The supplements studied consist of a mixture of DHA and EPA.
Omega 3s are shown to improve the common ADHD symptoms, such as restlessness, aggression, inattention, academic performance, impulsiveness, and cooperation with parents and teachers.
However, the studies show that there is no improvement in distractibility. Most of the effects take place after six months of treatment. (11)
It is suggested that essential fatty acid supplementation may be more effective as an addition to medications in those children who show response to medications.
In this case, a mixture of 300-600mg/day of omega 3 and 30-60mg/day of omega 6 fatty acids is recommended for at least two to three months.
The following are some examples of systematic reviews which conclude that there are positive results:
A 2017 systematic review and meta-analysis of clinical trials has shown a positive association between taking omega 3 supplements and improvements in ADHD symptoms.
Supplementation with these omega 3 fatty acids has been concluded to be effective in the improvement of the clinical symptoms and cognitive performance in children and adolescents with ADHD. The studies show that these omega 3 fatty acids are effective, not only as a part of therapy using other medications, but also on its own (monotherapy). (14)
A 2015 review showed that supplementing with gama-linolenic acid (GLA) and EPA significantly improved inattention, but not hyperactive and impulsive behavior. (15)
A 2014 review showed a small improvement in ADHD symptoms. (1)
Another 2014 review showed that the supplementation of ADHD children with fish oils and diet that restricts certain foods can improve the symptoms of ADHD. (16)
A 2013 review showed a small but reliable improvement in ADHD symptoms in children. (17)
A review in 2011 showed that higher doses of EPA were modestly effective in ADHD treatment. (18)
- Studies showing positive results of omega 3 supplementation are longer and involve more participants.
- Some studies show that a mix of omega 6 with EPA and DHA may have better results.
- Omega 3s seem to be effective in improving symptoms, such as restlessness, aggression, inattention, academic performance, impulsiveness and cooperation with parents and teachers.
Studies showing no effects of omega 3 on ADHD
Studies that don’t show a statistically significant impact of omega 3s on ADHD symptoms, tend to be small and short.
They use a small number of participants (<50) and are shorter than 15 weeks in duration. Many of these studies use either DHA or EPA alone and don’t use placebo groups.
Examples of systematic reviews showing no association between omega 3 and ADHD:
A 2016 systematic review concluded that the supplementation with omega 3s during pregnancy or in the early stages of infancy has no effect on ADHD symptoms. (19)
A review in 2015 concluded that there is no improvement in cognitive performance in ADHD groups. (20)
A 2012 review showed that parents and teachers haven’t noticed significant improvements in ADHD symptoms of children with omega 3 supplementation. (21)
- Studies showing no improvements (or insignificant) of ADHD symptoms from taking omega 3s are smaller and shorter.
More evidence needed on treatment of ADHD with omega 3
Although the available positive results on supplementing with a combination of DHA, EPA and possibly omega 6 are more convincing, more trials for stronger evidence are needed. They should be: (15)
- long term (at least 6 months),
- large (in terms of number of participants),
- double blind
- using both DHA and EPA.
- using a mix of omega 3 and omega 6
The evidence supporting the effectiveness of omega 3 on ADHD symptoms reduction is still weak. However, supplementing with DHA and EPA certainly won’t be harmful, especially in cases of DHA deficiency.
On the contrary, DHA and EPA are known for their multitude of health benefits and supplementing with these omega 3s is safe, cheap and easy. It can be used while awaiting more clinical trials. (22, 23)
- More good quality, large, long term and double-blind clinical trials on people of various ages, and different dosages and combination of fatty acids are needed to strengthen the evidence.
- People with DHA deficiency may benefit from supplementation, regardless of the presence of ADHD.
NUTRITION FACTS VS NUTRITION MYTHS
You will find a summary of the most common nutrition myths and evidence-based nutrition facts here.