Fish oil can be helpful in maintaining brain health at any point in life. Because different health concerns require different amounts of fish oil taken with different complementary nutritional supplements, I'll dive right into my recommendations for the use of fish oil for brain health.
Fish Oil for Treating ADHD in Children
How does fish oil help the brain in children? Low levels of omega-3 essential fatty acids, especially DHA, have long been associated with ADHD in children. Children whose mothers consumed more DHA during pregnancy not only are less likely to develop ADHD, they are more likely to speak fluently, show eye-hand coordination, and exert emotional control at age 7. But what if your child has ADHD? How do you use fish oil in treatment? The best evidence suggests that fish oil for kids who have ADHD works better when it is given with magnesium and zinc. A study of 810 children aged 5 to 12 in Germany found that taking this combination of supplements for 12 weeks:
- "Cured" about 30% of children who had been diagnosed with ADHD, or at least caused enough improvement that the children were no longer diagnosed as having ADHD,
- "Cured" about 70% of children who had been diagnosed with hyperactivity/impulsivity, at least enough that they no longer were diagnosed as as suffering hyperactivity/impulsivity,
- Reduced the number of children described as "loners,"
- Helped about 40% of children in the study fall asleep more rapidly and about 40% stay asleep longer during the night,
- With adverse reactions (nausea, diarrhea) in less than 2% of children in the study.
The researchers defined these measurements much more precisely than I am quoting them here. What I hope to convey is that these supplements can be extremely helpful, but they are not likely to be a cure-all. And the German researchers noted that without the magnesium and zinc supplementation, there probably would not be any improvement in sleep.
Many supplements marketed to parents of children with ADHD, such as Berry Calm Kids, don't contain magnesium and zinc. What are the right amounts of supplements for children with ADHD? For ADHD, you should give an omega 3's from an animal source. DHA (which is the only omega-3 essential fatty acid in microalgae supplements) does not work without EPA (found only in fish and krill oil). The amounts of essential fatty acids in krill oil are very low, so a chewable fish oil supplement for kids is best. It needs to provide at least:
- 200 mg of EPA,
- 20 mg of DHA,
- 40 mg of magnesium, and
- 2.5 mg of zinc
per day. If you happen to live in the European Union, you can get this exact combination from the children's chewable product called ESPRICO, which is made by Engelhard Arzneimittel GmBH & Co.KG. If you don't live in the EU, you should use:
- 8 Nordic Naturals Children's DHA Chewable Softgels (doubling the recommended dosage) and
- 1 Flintstone's Complete for children over 4.
This combination comes as close to ESPRICO as is possible without giving too much of some other ingredients in the Flintstone's formula. Don't give these supplements to children who are not at least 5 years of age. Start with one Nordic Naturals chewable a day and slowly increase to 8 as you are sure the product is not causing any stomach upset for your child. Other combinations may also work, and as we find them, they will be noted in the blog. DHA-only supplements, however, get fewer results in children who have ADHD.
DHA for Brain Development in Children
There also have been studies of essential fatty acids for the prevention of ADHD. While the essential fatty acid EPA seems to be important for treating ADHD, the essential fatty acid DHA seems to be important for preventing ADHD.
Dutch scientists tested umbilical cord blood of 300 babies for DHA content. They then followed the development of these children for 7 years. The children who had been exposed to the highest levels of DHA in the womb had the greatest verbal skills at age 7. They did not have higher IQs, but they tended to speak in longer sentences and to be more able to carry on conversations. They were less easily distracted from activities in which they chose to participate, and they had greater eye-hand coordination, making it easier to catch a ball or tie shoes. There were not enough children in the study to show that DHA "prevents" ADHD, but there is strong indication that it is probably helpful.
The least expensive source of DHA for expectant mothers is a high-DHA fish oil like xtend Life. There are also vegan DHA products, and special DHA products for women during pregnancy, but they cost about 5 times as much per dose. A daily dose of 600 mg of DHA is likely to be enough to make a difference, although there is no "recommended daily allowance" backed up by the scientific literature.
Fish Oil and Alzheimer's
It is really hard to devise a nutritional program to support people who have Alzheimer's. If you give someone who has Alzheimer's a product that causes stomach upset, then you have to deal with bathroom issues.
If you help a person with Alzheimer's get enough mobility back to leave the house but not enough focus back to come back home, then you can create a worse personal condition while improving symptoms of the disease. Keeping in mind that "improving" symptoms does not necessarily result in better quality of life, there have been three studies that found that the DHA component of fish oil can be helpful during the early stages of Alzheimer's disease.
People who have Alzheimer's disease and the APO?-4 gene don't usually respond to fish oil, but people who have Alzheimer's and don't have the gene may show some improvement. A typical effective dose is 2,000 of DHA per day. more information on fish oil for Alzheimer.
Fish Oil and Anxiety
Fish oil with the antioxidant astaxanthin seems to prevent damage to the forebrain in lab animals. The implication of these studies is that fish oil with astaxanthin (such as the Xtend-Life Premium and Ultra fish oils) would prevent anxiety in humans. That proposition has not been formally tested, but I would consider their products worth a try if anxiety is a concern.
Fish Oil and Bipolar Disorder
People who have bipolar disorder usually have unusually high numbers of receptors for the neurochemical acetylcholine. These receptors are activated by vanadium, and "calmed" by vitamin C. The amount of vitamin C needed to make a difference in the manic phase of bipolar disorder is relatively high-about 3 grams (3,000 mg) in a single dose. Vanadium supplements, of course, would aggravate the manic phase of bipolar disorder.
Omega-3 essential fatty acids are essential for neurons that transmit signals that control emotions. Omega-3 essential fatty acids in a daily dose of about 2,000 mg a day may help reduce depression, but you need a brand that is much higher in EPA than in DHA. This means a high-DHA brand like Xtend-Life is not best for people who have bipolar disorder. A product like Omega-Brite would be more appropriate. Find out more about fish oil and bipolar disorder.
Fish Oil and Major Depression
The supplement 5-HTP is likely to be much more helpful for major depression than fish oil. The kind of fish that helps major depression is high in EPA (like the Omega-Brite mentioned above). However, for major depression, more is not necessarily better. Taking 1500 to 2000 mg of EPA a day helps lift depressive symptoms, but taking more than 3000 mg of EPA usually makes them worse. A detailed discussion of fish oil for depression is here.
Fish Oil and Schizophrenia
The really useful supplement in most cases of schizophrenia is glycine. Taking 30 to 60 grams, not milligrams, of glycine every day sometimes relieves social withdrawal, apathy, and emotional flatness in schizophrenics who are otherwise controlled by medication. Fish oil may also help, but the essential fatty acid that is needed is EPA, not DHA. When schizophrenics take DHA, it cancels out the benefits of EPA. About 1,500 mg of EPA a day is optimal.
Fish Oil and Obsessive-Compulsive Disorder
I'll get right to the point: Fish oil doesn't help obsessive compulsive disorder. However, St. John's wort sometimes get better results than Paxil (paroxetine) or Prozac (fluoxetine). Don't take St. John's wort at the same time you take a prescription selective serotonin reuptake inhibitor (SSRI), as the combination may cause mania. I have read about 500 scientific studies on this topic, but here is a list of articles where you can start if you would like to read the science. I am happy to discuss any of these articles in the Comments Box.
- American Psychiatric Association (APA) Diagnostisches und Statistisches Manual Psychischer Storungen - Textrevision - DSM-IV-TR. In: Sab H et al, editor.Diagnostic and Statistical Manual of Mental Disorders - DSM-IV-TR.4. American Psychiatric Association, Washington, DC 2000. German version: Hogrefe, Gottingen; 2003.
- Appleton KM, Rogers PJ, Ness AR. Is there a role for n-3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials.Nutr Res Rev.2008;21:13-41. doi: 10.1017/S0954422408998620. .
- Arnold LE, Bozzolo H, Hollway J, Cook A, DiSilvestro RA, Bozzolo DR, Crowl L, Ramadan Y, Williams C. Serum zinc correlates with parent and teacher- rated inattention in children with attention-deficit/hyperactivity disorder.J Child Adolesc Psychopharmacol.2005;15:628-36. doi: 10.1089/cap.2005.15.628. .
- Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women.Biol Psychiatry.2005;58:679-685. doi: 10.1016/j.biopsych.2005.05.009. .
- Bourre JM. (a). Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 2: macronutrients.J Nutr Health Aging.2006. pp. 386-99. .
- Bourre JM. (b). Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients.JNutr Health Aging.2006;10:377-85. .
- Colter AL, Cutler C, Meckling KA. Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study.Nutr J.2008;7:8. doi: 10.1186/1475-2891-7-8. .
- Curtis LT, Patel K. Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review.J Altern Complement Med.2008;14:79-85. doi: 10.1089/acm.2007.0610. .
- de Seixas M, Müller U. Systematic review of national and international guidelines on ADHD.European Psychiatry.2009;24(Suppl 1):395. doi: 10.1016/S0924-9338(09)70628-5. .
- DiGirolamo AM, Ramirez-Zea M. Role of zinc in maternal and child mental health.Am J Clin Nutr.2009;89:940-945. doi: 10.3945/ajcn.2008.26692C. .
- Fanjiang G, Kleinman RE. Nutrition and performance in children.Curr Opin Clin Nutr Metab Care.2007;10:342-347. doi: 10.1097/MCO.0b013e3280523a9e. .
- Freemann MP, Hibbeln JR, Wisner KL, Davies JM, Mischoulon D, Peet M, Keck PE, Marangell LB, Richardson AJ, Lake J, Stoll AL. Omega-3-Fatty Acids: Evidence Basis for Treatment and Future Research in Psychiatry.J Clin Psychiatry.2006;67:1954-1967. doi: 10.4088/JCP.v67n1217. .
- Frolich J, Dopfner M. The treatment of Attention-Deficit/Hyperactivity Disorders with polyunsaturated fatty acids - an effective treatment alternative?Z Kinder Jugendpsychiatr Psychother.2008;36:109-116. doi: 10.1024/1422-49184.108.40.206. .
- Geppert J, Demmelmair H, Hornstra G, Koletzko B. Co-supplementation of healthy women with fish oil and evening primrose oil increases plasma docosahexaenoic acid, gamma-linolenic acid and dihomo-gamma-linolenic acid levels without reducing arachidonic acid concentrations.Br J Nutr.2008;99:360-369. doi: 10.1017/S0007114507801577. .
- Goodmann R. The Strength and Difficulties Questionnaire: A Research Note.Journal of Child Psychology and Psychiatry.1997;38:581-586. doi: 10.1111/j.1469-7610.1997.tb01545.x. .
- Hibbeln JR, Davis JM, Steer C. et al. Association between maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study.Lancet.2007;369:578-585. doi: 10.1016/S0140-6736(07)60277-3. .
- Hirayama S, Hamazaki T, Terasawa K. Effect of docosahexaenoic acid-containing food administration on symptoms of attention-deficit/hyperactivity disorder--a placebo-controlled double-blind study.European Journal of Clinical Nutrition.2004;58:467-473. doi: 10.1038/sj.ejcn.1601830. .
- Huss M, Holling H, Kurth BM, Schlack R. How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS)Eur Child Adolesc Psychiatry.2008;17(Suppl 1):52-58. doi: 10.1007/s00787-008-1006-z. .
- Johnson M, Ostlund S, Fransson G, Kadesjo B, Gillberg C. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents.J Atten Disord.2009;12:394-401. doi: 10.1177/1087054708316261. .
- Klasen H, Woerner W, Rothenberger A, Goodman R. German version of the Strength and Difficulties Questionnaire (SDQ-German) - Overview and evaluation of initial validation and normative results.Prax Kinderpsychol Kinderpsychiatr.2003;52:491-502. .
- Koletzko B, Beblo S, Demmelmair H, Hanebutt FL. Omega-3 LC-PUFA Supply and Neurological Outcomes in Children With Phenylketonuria (PKU)Journal of Pediatric Gastroenterology and Nutrition.2009;48:2-7. doi: 10.1097/MPG.0b013e3181977399. .
- Kris-Etherton PM, Taylor DS, Yu-Poth S. et al. Polyunsaturated fatty acids in the food chain in the United States.Am J Clin Nutr.2000;71:179-188. .
- Lavialle M, Champeil-Potokar G, Alessandri JM, Balasse L, Guesnet P, Papillon C, Pévet P, Vancassel S, Vivien-Roels B, Denis I. An (n-3) Polyunsaturated Fatty Acid-Deficient Diet Disturbs Daily Locomotor Activity, Melatonin Rhythm, and Striatal Dopamine in Syrian Hamsters.J Nutr.2008;138:1719-1724. .
- McNamara RK, Carlson SE. Role of omega-3 fatty acids in brain development and function: potential implications for the pathogenesis and prevention of psychopathology.Prostaglandins Leukot Essent Fatty Acids.2006;75:329-349. doi: 10.1016/j.plefa.2006.07.010. .
- Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali JP. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders.Magnes Res.2006;19:46-52. .
- Mousain-Bosc M, Roche M, Rapin J, Bali JP. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children.J Am Coll Nutr.2004;23:545-548. .
- Nogovitsina OR, Levitina EV. Neurological aspects of the clinical features, pathophysiology, and corrections of impairments in attention deficit hyperactivity disorder.Neurosci Behav Physiol.2007;37:199-202. doi: 10.1007/s11055-007-0001-z. .
- Peet M, Stokes C. Omega-3 fatty Acids in the Treatment of Psychiatric Disorders.Drugs.2005;65:1051-1059. doi: 10.2165/00003495-200565080-00002. .
- Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis.Am J Psychiatry.2007;164:942-48. doi: 10.1176/appi.ajp.164.6.942. .
- Ramakrishnan U, Imhoff-Kunsch B, DiGirolamo AM. Role of docosahexaenoic acid in maternal and child mental health.Am J Clin Nutr.2009;89(Suppl):958-962. doi: 10.3945/ajcn.2008.26692F. .
- Richardson AJ, Montgomery P. The Oxford Durham study: A randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder.Pediatrics.2005;115:1360-1366. doi: 10.1542/peds.2004-2164. .
- Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.Progress in Neuro-Psychopharmacology and Biological Psychiatry.2002;26:233-239. doi: 10.1016/S0278-5846(01)00254-8. .
- Richardson AJ, Ross MA. Fatty acid metabolism in neurodevelopmental disorder: a new perspective on associations beetween attention-deficit/hyperactivity disorder, dyslexia, dyspraxia and the autistic spectrum.Prostaglandins Leukot Essent Fatty Acids.2000;63:1-9. doi: 10.1054/plef.2000.0184. .
- Riediger ND, Othman RA, Suh M, Moghadasian MH. A systemic review of the roles of n-3 fatty acids in health and disease.J Am Diet Assoc.2009;109:668-679. doi: 10.1016/j.jada.2008.12.022. .
- Rucklidge JJ, Johnstone J, Kaplan BJ. Nutrient supplementation approaches in the treatment of ADHD.Expert Rev Neurother.2009;9:461-76. doi: 10.1586/ern.09.7. .
- Scheer FAJL, Czeisler CA. Melatonin, sleep, and circadian rhythms.Sleep Med Rev.2005;9:5-9. doi: 10.1016/j.smrv.2004.11.004. .
- Schmitt B, Strohle A, Watkinson BM, Hahn A. Wirkstoffe funktioneller Lebensmittel in der Prvention der Arteriosklerose.Ernahrungs-Umschau.2002;49:223-229. .
- Schnoll R, Burshteyn D, Cea-Aravena J. Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect.Appl Psychophysiol Biofeedback.2003;28:63-75. doi: 10.1023/A:1022321017467. .
- Schuchardt JP, Hahn A. Essenzielle Fettsauren und Hirnfunktion bei Kindern.Deutsche Apotheken Zeitung.2008;148:56-64. .
- Schuchardt JP, Huss M, Stauss-Grabo M, Hahn A. Significance of long-chain polyunsaturated fatty acids (PUFAs) for the development and behaviour of children.European Journal of Pediatrics.2009;169:149-164. doi: 10.1007/s00431-009-1035-8. .
- Sinn N, Bryan J, Wilson C. Cognitive effects of polyunsaturated fatty acids in children with attention deficit hyperactivity disorder symptoms: a randomised controlled trial.Prostaglandins Leukot Essent Fatty Acids.2008;78:311-26. doi: 10.1016/j.plefa.2008.04.004. .
- Sinn N, Wilson C. Dietary supplementation with highly unsaturated fatty acids: Implications for interventions with persons with mental retardation from research on infant cognitive development, ADHD, and other developmental disabilities.International Review of Research in Mental Retardation.2006;32:161-197.full_text. .
- Sinn N. Nutritional and dietary influences on attention deficit hyperactivity disorder.Nutr Rev.2008;66:558-568. doi: 10.1111/j.1753-4887.2008.00107.x. .
- Sorgi PJ, Hallowell EM, Hutchins HL, Sears B. 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.Nutr J.2007;6:16. doi: 10.1186/1475-2891-6-16. .
- Stevens LJ, Zental SS, Deck JL, Abate ML, Watkins BA, Lipp SR. et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder.American Journal of Clinical Nutrition.1995;62:761-768. .
- Stevens LJ, Zhang W, Peck L, Kuczek T, Mahon A. et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviours.Lipids.2003;38:1007-1021. doi: 10.1007/s11745-006-1155-0.
- Swanson JM, Nolan W, Pelham WE. The SNAP rating scale.Resources in Education.1982. .
- Tassoni D, Kaur G, Weisinger RS, Sinclair AJ. The role of eicosanoids in the brain.Asia Pac J Clin Nutr.2008;17(Suppl 1):220-228. .
- Uckardes Y, Ozmert EN, Unal F, Yurdakok K. Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children.Acta Paediatr.2009;98:731-736. doi: 10.1111/j.1651-2227.2008.01186.x.
- Vazir S, Nagalla B, Thangiah V. et al. Effect of micronutrient supplement on health and nutritional status of schoolchildren: mental function.Nutrition.2006;22(Suppl 1):26-32. doi: 10.1016/j.nut.2004.07.021.
- Voight RG, Llorente AM, Jensen CL, Fraley K, Berretta MC, Heird WC. A randomized, double-blind, placebocontrolled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder.Journal of Pediatrics.2001;139:189-196. doi: 10.1067/mpd.2001.116050.
- Yorbik O, Ozdag MF, Olgun A, Senol MG, Bek S, Akman S. Potential effects of zinc on information processing in boys with attention deficit hyperactivity disorder.Prog Neuropsychopharmacol Biol Psychiatry.2008;32:662-667. doi: 10.1016/j.pnpbp.2007.11.009.