Posts Tagged ‘children’

Can Fish Oil Make Children Smarter?

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues, Supplements and Health

When Do Omega-3 Supplements Make Sense?

Author: Dr. Stephen Chaney

Confused ChildWe know that the omega-3 fatty acids found in fish oil are critically important for brain development. But will they really help our kids learn better? Some studies suggest that they do, while other studies have come up empty. Why is this? More importantly, what does it mean for your children? Will fish oil supplements help or not?

I’ve selected today’s study (Portillo-Reyes et al, Research in Developmental Disabilities, 35: 861-870, 2014) because it sheds some light on those important questions.

Can Fish Oil Make Children Smarter?

This study looked at the effect of supplementation for 3 months with 360 mg of EPA + DHA on cognitive function of malnourished Mexican children, ages 8-12 years old. The children came from poor neighborhoods where foods rich in omega-3 fatty acids were seldom available. Low intake of omega-3 fatty acids was confirmed by a food frequency survey.

Cognition was assessed based on a battery of 16 standardized cognition tests at the beginning of the study and again 3 months later.

The results were fairly clear cut. The children receiving the fish oil supplements showed significant gains in mental processing speed, visual-motor coordination, perceptual integration, attention span and executive function compared to children receiving a placebo. In case you were wondering, the first three most strongly affect a child’s ability to learn and last two affect their tendency to display ADHD symptoms.

What Is the Significance of This Study?

There are a lot of things not to like about the study:

  • It was a small study (59 children total)
  • Blood levels of omega-3 fatty acids were not determined.
  • It was a short term study (12 months would have been better).
  • Measuring the ability to learn is difficult. Experts in the field differ about which cognitive tests are best. I’m not taking a position on the adequacy of the tests they were using because that is not my area of expertise.
  • Because it was done in a poor region of Mexico, one could argue that its applicability to children in this country is uncertain.

 

So why even mention this study? That’s because it illustrates an important principle – one that is often ignored in the design and interpretation of clinical studies.

Simply put, the principle is that not everyone will benefit equally from supplementation. It is the malnourished and the sick who will benefit most. When you focus your clinical studies on those groups you are most likely to observe a benefit of supplementation. When you focus your study on well nourished, healthy individuals it will be much more difficult to observe any benefit. And if you perform a meta-analysis of all studies, without evaluating the studies on the basis of need – nutrition status and health status – benefits will also be much more difficult to demonstrate.

This study is just one example of that principle. In an earlier “Health Tips From the Professor” (Can DHA Help Johnny Read?) I reported on a study looking at the effect of DHA supplementation on reading ability of English schoolchildren. In that study, it was the children who were most deficient in DHA and started with the lowest reading skills who benefitted most from DHA supplementation.

What does all of this mean to you?

  • If you are a parent, you may be asking if a study done with Mexican children eating poor diets has any relevance for your kids. In today’s world of pop tarts and pizza it just might. Most children don’t order sardines on their pizza. As a consequence, many American children don’t get enough omega-3 fatty acids in their diet.
  • Should your children be getting more omega-3s in their diet? A recent study concluded that most American children only get 20-40 mg/day of DHA from their diet. So if your child’s food preferences don’t include salmon, sardines and the like – and if your child is experiencing learning issues or problems with ADHD, you might consider adding fish oil supplements to their diet. There’s no need to megadose. The international standard is around 200 mg/day of DHA for children 7 or older.
  • If you are one of those people who is confused by conflicting headlines about the benefits of supplementation, you may want to look at the studies behind those headlines and ask if supplementation would have been likely to provide any benefit in the subjects studied.

The Bottom Line:

1)     A recent study reported that supplementation with fish oil significantly improved learning skills in children consuming a diet that was deficient in omega-3 fatty acids.

2)     If your children are not consuming foods rich in omega-3 fatty acids such as coldwater fish, you might wish to make sure that they are getting adequate levels of omega-3 fatty acids in their diet. Most experts recommend around 200 mg/day for children over 7.

3)     This study also illustrates the principle that supplementation is most likely to be of demonstrable benefit to those who have the worst diets and the greatest need. That doesn’t mean that supplementation won’t benefit everyone, but it does mean that it may be difficult to prove the value of supplementation in healthy people consuming a good diet.

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.

 

Could Omega-3s Improve Reading Skills?

Written by Dr. Steve Chaney on . Posted in Issues, Supplements and Health

Can DHA  Help Johnny Read?

Author: Dr. Stephen Chaney

Child-Reading-BookIf you are like most parents, you want to do everything you can to assure that your kids have the skills they need to succeed in school, and reading probably tops the list of necessary skills. If your child is reading below their age level, could something as simple as better nutrition improve their reading ability?

Recent studies have shown that the omega-3 fatty acids, especially DHA, play a very important role in normal brain function – especially memory, focus, concentration, and attention span.

I have shared with you previous studies which have shown that optimal DHA intake in pregnant women plays an important role in the early mental development of their children. On the other end of the age spectrum, studies have shown that optimal omega-3 fatty acid intake in older adults can delay cognitive decline.

I have also shared with you studies showing that omega-3 fatty acid supplementation in children with ADD and ADHD significantly reduce their symptoms. What about children without hyperactivity? Could omega-3 fatty acids affect their ability to learn?

Many Children Are Deficient in Omega-3 Fatty Acids

The Food and Nutrition Board has not yet set US standards for DHA intake, but the international standard is 200 mg for children 7 years old and older. Unfortunately, cod liver oil is a thing of the past, and foods rich in DHA are not particularly popular with children. Consequently, most children in this country are only getting around 20-40 mg of DHA per day.

And that shows up in their blood levels of omega-3 fatty acids. A recent study in England looked at blood levels of omega-3 fatty acids in 493 seven to nine year olds with below average reading performance who were enrolled in Oxfordshire primary schools (P. Montgomery et al, PLoS ONE, doi: 10.1371/journal.pone.0066697).

All of them had low blood levels of omega-3 fatty acids (both DHA and EPA), and the blood levels of omega-3 fatty acids were directly related to their reading ability. In non-scientific language that simply means that those with the poorest reading abilities had the lowest blood levels of omega-3 fatty acids.

This study is particularly significant because another study by the same group showing that DHA supplementation improved reading skills in underperforming children.

Could Omega-3s Improve Reading Skills?

This study (Richardson et al., PLoS ONE 7: e43909.doi:10.1371/journal.pone.0043909) looked at 362 normal 7-9 year old children enrolled in mainstream primary schools in Oxfordshire, England.

These children were all reading at significantly below the average for their grade levels. The study excluded children with specific medical difficulties that might affect their ability to read, children who were already taking medications expected to affect behavior or learning, children for whom English was not their first language, and children who were already eating fish more than twice a week or taking omega-3 supplements.

The children were given either supplements containing 600 mg of DHA per day or a placebo containing corn and soybean oil. At the end of 16 weeks the children were rescored on a standardized reading test.

Reading-ScoresThe results were quite interesting. When the scientists looked at children reading in the lower third of their class, the affect of DHA on their ability to read was non-significant. However, when they looked at the children who were performing in the bottom 20% of their class with respect to reading, DHA supplementation resulted in a 20% improvement in their reading score. And when they looked at children in the bottom 10% of their class with respect to reading, DHA supplementation resulted in a 50% increase in reading scores. These changes were highly significant.

To put this in perspective, the children performing in the bottom 20% of their class improved their reading efficiency by around 0.8 months with respect to their normal reading age, and the children in the bottom 10% of their class improved their reading efficiency by around 1.9 months with respect to their normal reading age.

Strengths and Weaknesses of The Studies

 

On The Minus Side:

  • First and foremost we must remember that nutrition is only one of many factors that can affect reading performance in children. You shouldn’t think of DHA as a magic bullet that will cure your child’s reading problems by itself.
  • This is a single pair of studies that need to be replicated.
  • This study does not establish the optimal dose of DHA needed to improve reading in underperforming children. Until dose response studies have been done we don’t know whether 600 mg is needed or whether simply making sure that the children reach the recommended 200 mg per day of DHA would be sufficient.

On The Plus Side:

  • Both of these were very well controlled studies, and they complemented each other perfectly.  One study showed that students with the poorest reading ability had the lowest blood levels of DHA. The other study showed that children with the poorest reading ability experienced the greatest improvement with DHA supplementation.
  • These studies were not done with third world children. They were studies with normal, healthy children in a prosperous European country.
  • These studies are fully consistent with previous studies looking at the effects of DHA on cognition in children.

The Bottom Line

What does this study mean for parents whose children may be struggling with their reading in school?

  • The lead author concluded: “We have shown that in the mainstream, general population, something as simple as DHA can benefit reading abilities in underperforming children.”
  • It’s perhaps not that ironclad yet. But if your kid or grandkid is reading below their grade level, DHA supplementation is both safe and inexpensive. It’s worth giving it a try.

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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Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, 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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