Omega-3 and ADHD in Children

Written by Dr. Steve Chaney on . Posted in current health articles, Drugs and Health, Health Current Events, Supplements and Health

Author: Dr. Stephen Chaney

 

Sometimes I write articles pointing out the fallacies in the headlines you’ve been reading. Other times I write articles because major studies have provided a definitive test of a current paradigm. And sometimes I write articles about small studies that have the potential to change existing omgega-3 and adhd in childrenparadigms. This week’s article falls in the latter category. This week’s article is on omega-3 and ADHD in children.  More precisely,  I’m going to review a study looking at the role of the omega-3s DHA and EPA in reducing ADHD symptoms.

Amid growing concern about the side effects and overuse of the stimulant medications used to treat ADHD symptoms in children, many parents have been looking for natural approaches for controlling ADHD symptoms. One of the most popular natural approaches has been omega-3 supplements, primarily the long chain omega-3s, DHA and EPA.

However, not everyone agrees that DHA and EPA are effective for reducing ADHD symptoms. Here is a brief summary of what we know:

  • Children with ADHD and learning difficulties generally have lower tissue levels of DHA and EPA than children without those deficits.
  • Animal studies show that DHA-deficient diets decrease neuron size and are associated with hyperactive and compulsive behavior.
  • Some clinical studies have reported a significant decrease in ADHD symptoms when children were given omega-3 supplements, while other studies found no effect of omega-3 supplementation on ADHD symptoms. This has led to considerable confusion as to the value of omega-3 supplementation in children with ADHD.

However, recent studies have led to a certain amount of clarity about omega-3 and ADHD in children. In particular:

  • Two recent meta-analyses of all high quality published studies have concluded that omega-3 supplements have a beneficial effect on ADHD symptoms, but the effect is relatively small (Bloch and Qawasmi, Journal of the American Academy of Child and Adolescent Psychiatry, 50: omega-3s991-1000, 2011; Sonuga-Burke et al. American Journal of Psychiatry, 170: 275-289, 2013).
  • One recent study showed that when omega-3 supplementation was combined with a stimulant medication, it improved the effectiveness of the medication, which allowed physicians to decrease the amount of medication they prescribed (Barragan et al, Journal of Attention Disorders, doi: 1177/1087054713518239, 2014).
  • Previous studies have shown that omega-3 supplementation is most effective in the children who are the most deficient in DHA and EPA at the beginning of the study. This is no surprise.

However,what you may not know is that many otherwise healthy children in this country have at least some degree of DHA and EPA deficiency. That’s because major food sources of EPA and DHA, such as salmon and sardines, are not most kid’s favorite foods.

Do Omega-3s Improve Attention Span In Children?

The most recent study (Bos et al, Neuropsychopharmacolgy, 40: 2298-2306, 2015) was a double blind, placebo controlled study looking at the effectiveness of omega-3 supplementation in reducing ADHD symptoms in boys between 8 and 14 years old. It differed significantly from most previous studies in that:

  • It included a matched group of boys who had not been diagnosed with ADHD.
  • It used a 1:1 ratio of DHA to EPA, which resulted in a greater intake of DHA than in many of the previous studies.

The study included 40 boys, aged 8-14, who had been diagnosed with ADHD and 39 matched controls who did not have ADHD. Both groups were either given margarine containing 650 mg/day of both DHA and EPA or a placebo margarine containing an equal amount of monounsaturated fatty acids for 16 weeks. Compliance with the study was measured in terms of the amount of margarine consumed and the levels of DHA and EPA found in cells obtained by a cheek swab. ADHD symptoms (particularly attention span, rule-breaking behavior and aggression) were assessed on the basis of standardized parent-rated child behavior assessments. The results of the study were:

  • At the start of the study, the children with ADHD scored higher on all measures of ADHD symptoms. No surprise here.
  • can foods cause adhd in kidsThe children with the lowest omega-3 levels at the beginning of the study scored highest on all measures of ADHD symptoms. This is also not surprising given the results of previous studies.
  • Omega-3 supplementation increased attention span in boys with ADHD, and the improvement in attention span correlated with an increase in omega-3 status. No improvement was seen in other symptoms of ADHD (rule-breaking behavior and aggression).

Since different studies tend to use different symptom assessments to measure the severity of ADHD, this may explain why some of the previous studies on omega-3s and ADHD symptoms have come up empty. The authors also suggested that some previous studies may have come up empty because the omega-3 supplements they used were low in DHA.

What Is The Significance Of This Study?

Because this study included a control group of boys without ADHD, it offers a whole new perspective on the importance of omega-3s for children. For example, this study showed:

  • Omega-3 supplementation improved attention span equally well in boys with and without ADHD. This is perhaps not surprising. If you have ever had a child in the 8 to 14 year old range, you know their attention span could stand a bit of improvement.

However, when you think about it, this study represents a potential paradigm shift in how we think about omega-3s and childhood behavior. The real significance of this studyis that it suggests that omega-3 supplementation may be beneficial for any child with poor attention span, not just for children with ADHD. This interpretation would be fully consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

 

The Bottom Line

  • Previous studies have suggested that the long chain omega-3 fatty acids DHA and EPA are modestly effective at improving ADHD symptoms in children, and that they are most effective in children with the lowest omega-3 status at the beginning of the studies.
  • The current study showed that supplementation with DHA and EPA improved attention span in boys aged 8-14 with ADHD, but did not improve other ADHD symptoms such a rule-breaking behavior and aggression.

What does this mean to you if you have a child with ADHD?

  • If the ADHD symptoms are mild and mostly relate to attention span or learning skills, omega-3 supplementation alone may be enough to make a difference. Based on this study you might want to choose an omega-3 supplement that is rich in DHA.
  • If the ADHD symptoms are severe, you will probably need to include omega-3 supplementation as part of a more holistic natural approach for controlling the symptoms.
  • Finally, if a holistic natural approach is just too difficult to manage, the good news is that recent studies suggest that omega-3 supplementation makes ADHD medications more effective, which means your child’s physician may be able to reduce the dose of medication if you include omega-3 supplementation along with the medication.

This study was unique in that it also included a control group of 8-14 year old boys without ADHD and found that omega-3 supplementation was equally effective at improving attention span in children without ADHD.

  • This is a single study, but if it is replicated by future studies it suggests that we may need to change our paradigm. What we have been thinking about omega-3 supplementation for children may be all wrong. Perhaps we should stop thinking of it as a supplement that might help with ADHD symptoms and start thinking of it as a supplement that might help children improve their attention span and mental focus whether they have been diagnosed with ADHD or not. This would certainly be consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

One final thought:

  • This study was performed with boys because they are more prone to ADHD symptoms than girls. However, based on numerous previous studies it is safe to assume that it is likely to apply equally well to girls with and without ADHD.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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