What consumers need to know about choosing and using Omega-3 or Omega-6 fatty-acid supplements for ADHD

Polyunsaturated fatty acid (PUFA) supplementation, such as fish oil, is not an FDA-approved treatment for ADHD. The evidence for its effect on ADHD is mixed. Two recent meta-analyses (careful statistical review of many studies) concluded that it has a small benefit for ADHD symptoms, but another review concluded “there is little evidence that PUFA supplementation provides any benefit for the symptoms of ADHD in children and adolescents.” Obviously further research is needed. The evidence currently available suggests the following:

• Any benefit from fatty acid supplementation is relatively modest compared to treatment with prescription medication that is FDA-approved for treating ADHD.
• Any benefit takes 3 months to accrue.
• PUFAs are essential fatty acids, necessary to health. Like vitamins and minerals, only small amounts per day are needed. There may be some risk to large amounts, especially if not accompanied by antioxidant vitamins such as E and C.
• There are two kinds of essential fatty acids: omega-3 and omega-6. Most modern diets have plenty of omega-6, but omega-3 is relatively scarce.
• The 3 main omega-3 PUFAs are EPA (20 carbons long), DHA (22 carbons long), and alpha-linolenic acid (ALA, 18 carbons). The first two are mainly found in marine oils (fish, krill, seal, whale). ALA is in some vegetable oils, such as flaxseed oil.
• Theoretically, human metabolism should be able to make EPA and DHA from ALA, but there is some suspicion that some persons have a deficiency in that metabolism. Therefore, the emphasis has been on taking EPA and DHA directly.
• The most promising results have been with a combination of EPA, DHA, and one of the omega-6 PUFAs called gamma-linolenic acid (GLA). But the most important of these may be EPA. One meta-analysis found a dose-response for EPA.
• Not all PUFA supplements are the same. Formulations differ in the proportions of the various fatty acids.
• Moderate amounts of omega 3 PUFAs may be good for cardiovascular and general health even if it does not help ADHD.
• There are two ways to get EPA and DHA omega-3 fatty acids: by eating oily wild ocean fish 3 times a week or by taking daily marine oil supplements. There are cautions for each way.
• If eating fish is the chosen means, it is important to make sure it is wild ocean fish, not farm-raised. Farm-raised fish, even if farmed in the ocean, is low in omega-3 PUFAs. There is some risk of mercury contamination in ocean fish, depending on geographic source. Deep-fried fish carries a risk of the trans fats from frying, so broiling, grilling, roasting, or even boiling are preferred.
• If supplementation is the chosen means, the oil should be free of mercury. Check the label to see if it is marked “mercury-free,” “refined to eliminate mercury,” or “USP.” You may also see one of these two quality seals indicating it is free of major contaminants.
• If fish oil is used, body oil is preferred over liver oil (since liver oil has less omega-3 fats and more saturated oils).
• Though cod liver oil is high in omega-3 fatty acids, it is not recommended as a supplement because of concerns about excess amounts of vitamin A and D. Likewise, flax seed oil also contains high levels of omega-3 fatty acids; but, it is not the recommended form of fatty acid supplement for children with ADHD.

(1) EPA = eicosapentaenoic acid
(2) DHA = docosahexaenoic acid
(3) GLA = gamma-linolenic acid

Revised: May 2013