Sunday, March 20, 2011

ADHD and Omega 3

I did get a chance to read over some interesting papers yesterday. Unfortunately, my home computer stopped working yesterday while I was on twitter. That's probably the universe telling me something. Our interventions seem unable to bring the dead PC back to life. So I'm a little cranky. Also, since it is more difficult to link things on the iPad, it will probably take me a few days to link the papers. In the mean time, you are just going to have to take my word for it. What do you think - is a Macbook is really worth it?

It will not surprise you to know that folks have been looking at the O6:O3 ratio in ADHD - as researchers have been looking at the same thing in depressive disorders and other psychiatric disorders. It may also not surprise you to learn that much of the early research is fairly useless, as ADHD was not defined rigorously and things like medicine, IQ, and education were not always controlled for. However, since 2007, more meaningful work has been done, and several smallish studies have found similar trends to the previous research. The punch line is that folks with ADHD tend to have significantly higher O6:O3 ratios in their bodies than folks without the disorder. Also, kids and young adults with ADHD have lower DHA.

When O3 supplementation has been tried (typically just DHA or EPA and DHA), it has been a bit of a bust (just like the trials with Alzheimer's and several of the trials with depression). Some parents and teacher ratings noted less temper tantrums and better ability to pay attention, but more objective ratings (such as cognitive testing) and independent raters of behavior didn't notice any difference. It is important to keep in mind that O3 supplementation trials have always been more successful in milder and earlier forms of illness - mild cognitive impairment, depressive disorders not complicated with anxiety. Also, to my knowledge decreasing O6 at the same time has never been studied. In addition, while sometimes the placebos are soybean oil or something like that, other times olive oil is used, and there is some evidence that oleic acid might also have beneficial effects on behavior and mood. ADHD strikes young and sticks around. Therefore it is a tough disorder that is in part hard-wired, and in my mind, *just* O3 supplementation is unlikely to be of much benefit.

One more very interesting thing to keep in mind - at least in these studies, overall the diets of the ADHD kids did not differ significantly from the control kids (diets were typically measured with 1-3 day diet logs, so take from that what you will). So the control kids ate just as much O6 and just as little O3 as the ADHD kids. In the study of young adults, the ADHD kids were significantly more likely to take a vitamin pill, and their micronutrient profile on blood testing was actually better or not different than the controls with respect to magnesium levels, iron, folate, zinc, B6, B12, etc. Independent studies of many of those micronutrients showed benefit for ADHD in kids who were deficient in small trials also. Yet despite the similarity in diet, the ADHD kids still had more O6 hanging around in the body, and less O3.

Some other interesting things popped up while reading these papers. In one study, the researchers looked for signs of "essential fatty acid deficiency." People who are too low in PUFAs in general will have dry mouth, thirst, frequent urination, dry and flaky skin, brittle nails, and dandruff. Sure enough, kids with ADHD were more likely to have these symptoms, and the kids with these symptoms had a more out-of-whack O6-O3 ratio and less DHA in the body. Their out-of-whack ratios also responded more robustly to dietary supplementation with DHA than the kids who didn't have symptoms of essential fatty acid deficiency. However, the absolute levels of essential fatty acids in these kids weren't, in the strict sense, deficient, despite the symptoms.

How do we pull all this information together? Well, in my mind, something very important is going on in a subset of kids with ADHD and their needs for PUFAs, and their utilization of them. DHA is vital for neuroplasticity, proper nerve communication, and nerve repair. Once more you will not be surprised that kids and young adults with ADHD have signs of inflammation - higher ferritin, higher IL-1, etc. etc. etc. The inflammatory process may also change PUFA metabolism or utilization, while the PUFA ratio could affect how the inflammatory process is played out. One small study showed that families with an allele of a gene that was super-robust at making a form of the inflammatory cytokine IL-1 had much higher rates of ADHD. It would make sense that certain families are genetically more prone to brain insults caused, perhaps, by lifelong DHA deficiency or O6 excess while the brain is developing. Or it could mean that some of these families have problems with how O6 and O3 are transported or stored or something, so even sufficient amounts in the diet don't add up to enough for them.

We also should keep in mind that the only large dietary study (a dietary pattern study in Australia, and we know that dietary pattern studies may be more problematic than they are worth) showed a higher risk of ADHD in folks who ate a Western diet. Also, boys in the Australian study and in these O6:O3 studies trended towards being more affected by diets or out of whack ratios, and benefited more from supplementation than girls.

Clearly this issue is a rich area for more research. In the meantime, it doesn't hurt to get enough O3 (particularly DHA). If you eat higher fat, enough O6 will naturally come along for the ride, so no eating extra O6 either.

Next week - one or more posts cleaned up and migrated to Psychology Today, updating this post to add references, and who knows what will come down the line so far as papers and new stuff. And probably, a new computer. Sigh.

20 comments:

  1. I went Mac in 94 and never turned back. Love 'em! I've tended to replace mine every 3 or so years just because of the change in technology.

    Here's an article I found that has some good info re the different Mac platforms:

    http://www.pbcentral.com/blog/2010/10/27/macbook-air-vs-13%E2%80%9D-macbook-pro-vs-macbook-vs-ipad-which-is-the-ideal-mobile-computer/

    I just got my iPad2, so am planning on picking up one of those cases with the keyboard embedded for travel purposes.

    My current Macbook is a little over two years old, so I'll probably not upgrade the laptop soon, but you never know ... new tech is always calling ;).

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  2. damn.. just lost another comment post on this blog. is there a comment time-out or something here?

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  3. No official time out I'm aware of, though blogger can be a pain - whenever I put through a longish one I always copy it to the clipboard before I post it just in case. Wish I started with wordpress but too late now.

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  4. Great post. Although not ADHD, Omega-3 supplementation was the first thing we tried for our son's autism and we were quite surprised. He was still autistic but he started to have eye contact with us, his babbling sounded more normal, etc. So I spent lunchbreaks digging in PubMed at all of the conditions omega-3 has been of some help. It helps with so many inflammation related issues/illnesses. I have a few links (just scroll past the post to the links if you are interested).
    http://mrsedsresearchandrecipes.blogspot.com/search/label/Omega-3

    http://mrsedsresearchandrecipes.blogspot.com/p/foodmental-health.html

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  5. Once you go Mac...

    Love my MacBook. If you can swing it, the 15" pro with the faster processor, most RAM and matte screen is worth it. Though my 13" is just fine and handles everything beautifully.

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  6. w-3 (apologies for the latin 'omega' but can't find a way to post Greek characters) like many things is an area crying out for some large-scale, good quality trials for lots of different things. Paul Amminger's 2007 study of w-3 for autism is a good start (for autism) and adds to the various studies looking at ADHD, dyslexa, developmental co-ordination disorder/dyspraxia, etc. Problem with many of these studies is the different formulations and dosages used and assessed (including other things added to the dosage form like excipients such as vitamin E - any effect?), making it difficult to compare what ratio of EPA:DHA is best suited and the optimal dose (if there is universally one). Also the other omegas (w-9) in olive oil for example and their impact need more attention. I think also as a population we are all pretty deficient in w-3 given our modern day foodfests. Assuming we were once an aquatic species later evolving to reside near the sea as early hunter-gatherers, it makes perfect sense that we should all have a good nutritional intake of w-3 also knowing how such fats impact on things like neuronal development. One final point: there is some preliminary evidence that some of the more shadowy parts of society (i.e. crime) might have a link to poor diet and fatty acid deficiency (see work of Bernard Gesch and co at Oxford University circa. 2002).

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  7. > ADHD strikes young and sticks around. Therefore it is a
    > tough disorder that is in part hard-wired, and in my mind,
    > *just* O3 supplementation is unlikely to be of much benefit.

    Just wondered what you think about Stephanie Seneff's speculations
    on ADHD?

    http://people.csail.mit.edu/seneff/adhd_low_fat_diet.htm

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  8. i have now a macbook air. it is the finest piece of computing equipment i've ever used. this includes many that i built myself in the past and many supermachines back when i worked in computer science.

    as to the diet and adhd. hagglet #2 is a bit of a rabblerouser. not so much add, but just ON all the time and rather impulsive. in other words, a normal boy. however, i can tell you, with a fair degree of accuracy, what they were eating at school, when it was high gluten and when there was PUFA. it was the same with #1. if they get all whacked on gluten grains and veggie oil they are F&$#ing lunatics. if i feed them grassfed, gluten free, etc. they stay pretty chill. this year, we started exclusively sending #1 with lunch from home at school and her behavior is LOADS better.

    there is nothing about neolithic dietary agents that would surprise me anymore.

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  9. Paul - there was an interesting news article in Science about prisoner research and micronutrient/omega 3 supplementation. The study appeared to be ongoing but I need to look for some actual papers. It was noted that the young men's diet prior to incarceration tended to completely lack fish. ZERO, and magnesium amounts were also minuscule. Very interesting.

    Sackot - I really like Seneff's articles (especially like her Alzheimer's one). I'm not sure I buy the abnormally efficient glucose metabolism mechanism of ADHD - I think Neolithic agents of disease combined with genetic vulnerability to the resulting inflammation makes more sense. I certainly agree with her contention that the sugar angle has not been studied - it was attempted with small trials of sugar compared to aspartame, and never really followed up after that. One, no clue how you double blind aspartame vs sugar as kids would certainly notice the difference, and aspartame has been linked (though I haven't looked at the papers myself) to hyperactivity... In short, I think the sugar issue was dismissed out of hand way to early - of course, if you don't eat sugar and you don't eat fat and you can't eat more than 30% protein, what do you eat? The potato diet? I guess. Seneff and I have somewhat different ideas about the pathophysiology, but either way, we recommend the same sort of diets!

    (oh, that link didn't work for me for some reason, but it is easy to fond googling seneff, MIT, ADHD)

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  10. I think I'm decided on my new machine.

    Dan - it really is striking. Sometimes I can't help but look at the USDA recs for toddlers and shiver. One of the reasons I picked the current preschool is because I supply all the food she gets. Teacher told me that none of the kids in her class has food allergies. That must be a reportable event, nowadays.

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  11. (too many grammar errors and spelling issues! Blame the iPad)

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  12. Mrs Ed - thank you for the links! And I think, yes, in individual cases omega 3 can make a huge difference - as a population just adding fish oil to the mix is likely to be more a preventative measure for many diseases than a curative one.

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  13. I think the angle of neolithic diseases of the mother pre pregnancy and during the pregnancy needs looking into. We in medicine have always looked for clues to diseases in the host who has them. And for this disease we have not had much luck. DNA methylation and acetylation of histone proteins in Mom with low DHA levels and low levels of vitamin D maybe the perfect epigenetic storm for many of the diseases we see in neurobiology. Epigenetic mechanisms include DNA methylation, histone modifications, nucleosome repositioning, higher order chromatin remodeling, non-coding RNAs, and RNA and DNA editing. RNA is centrally involved in directing these processes, implying that the transcriptional state of the cell is the primary determinant of epigenetic memory. It is clear that the epigenetic state is a central regulator of cellular development and activation. The epigenome is influenced by environmental factors throughout life. Enter neolithic agents of disease. Nutritional factors can have profound effects on the expression of specific genes by epigenetic modification, and these may be passed on to subsequent generations with potentially detrimental effects.

    Dr. K

    http://www.ncbi.nlm.nih.gov/pubmed/18673005

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  14. Thanks Emily. I can't claim to be an authority on patterns of offending and nutrition but there is quite a bit on the topic already. Bernard Gesch's study in the British Journal of Psychiatry can be viewed here for free:
    http://bjp.rcpsych.org/cgi/content/full/181/1/22
    From what I gather there is some evidence to suggest that people with ADHD are disproportionately more likely to having dealings with the criminal justice system as per this document recently published in BMC Psychiatry (thank heavens for open-access!):
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050801/pdf/1471-244X-11-32.pdf
    I don't want to sweep everyone with ADHD with the same brush I might add (many people with ADHD do not end up anywhere near the clink).
    I suppose the suggestion is that those with ADHD (or a sub-group) who exhibit offending behaviour might benefit from better nutrition for their ADHD symptoms which might then have a knock-on effect on whether they offend or not. Obviously this takes no account of the personal, psychological and social factors why people offend in the first-place particularly in these times of austerity (which is itself a considerable motivator of offending behaviour).
    Quite a puzzle.

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  15. MacBook worth it? I've had several MacBook Pro type of laptops and I switched to MacBook Air (11 inch). I never looked back. I also have two PC laptops which I try to avoid using. That should tell you something. I strongly recommend the MBA unless you're doing lots of audio or video editing. Have a blog about this: http://rodeocleanair.com

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  16. Excellent blog post. I have adhd and my phsychiatrist actually prescribed omega-3 supplements for me. I thought it was a bit odd, but there isn't much time to ask questions during a 10-15 minute med check, so I didn't say anything. And honestly, I never really took them. Now I have more of an understanding of why my doctor chose to prescribe them...now I'll take them.

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  17. "What do you think - is a Macbook is really worth it?"

    You know you want to do this. There is no route back!

    Peter

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  18. John - I agree. You might want to look at my schizophrenia round up blog post - also ADHD and mom's serotonin deficiency (check the map - I can copy/paste into the comment field on the iPad with the links)

    Paul - thanks for the links - that really is an amazing study, and yet I never heard anything about it, and it came out when I was in residency. Feed prisoners a multi with some minerals and fish oil, and behavior improves, striking, eh? I have a friend who is a forensic psychiatrist - I'll definitely be sending that one to her. (though I'm hopeful,she knows about it)

    Thanks, Jerry!

    Melinda - the DHA and EPA are important

    Peter - you are an exceptionally wise person :)

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  19. Hi,
    I used to teach Paleo based nutrition to Personal Trainers (over here in the UK) and studied this area quite heavily.
    There is another way to view ADHD, and that is to not look at it as a disease, but instead with a view that we are all hard wired slightly differently...some of us who still have a very recent hunter/gatherer gene pool are wired up to be more alert and ready for a hunt, there-for in a modern society can find it difficult to fit in and concentrate. Whilst others who have a good 10,000 years worth of farmers gene pool in them will find it much easier to concentrate in this modern worlds requirements, yet at the same time will have lost many of the genetic ability that enables them to be a good hunter.
    As you can probably tell..I feel that I fit in to one of those categories much more than the other so maybe my genetic ancestors have only very recently in their history started to become farmers?
    Had I been born 20 years later (I'm now 43 by the way) I'm almost certain that I would have been labelled with ADHD at school, but 30 or so years ago (thankfully)I was only labelled with being naughty and having difficulty with reading. I was very lucky that I had parents who spent a huge amount of extra time with me every evening to ensure I had the skills necessary to get through school.
    I hope this post does'nt end up sounding like a rant, but my interest in diet/health/adhd led me to read many books and I believe there is a strong connection (in evolutionary terms) between many of them.
    A guy called Thom Hartmann (an expert in this field) has written many books on the subject, one of them called "Attention deficit disorder - a different perception" is a must and very interesting read for anyone interested in this subject.
    I'd be really interested to hear your views if you had any time to read this book.
    I'm contactable on malc@thecabin.uk.com if anyone wishes to discuss further and I hope this post is useful and could possibly lead to further research.
    Cheers

    Malc

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  20. Thanks for this! Would be very helpful for my study about health supplements. I would recommend this blog site of yours to my fellow classmates and our professors. Great!

    - Jasmine Howard, USA

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