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State of the Art
Journal of Perinatology (2006) 26, 359–365. doi:10.1038/sj.jp.7211519; published online 4 May 2006
Time for an oil check: the role of essential omega-3 fatty acids in maternal and pediatric health
There are no conflicting interests. No funding has been provided for any part of this work.
S J Genuis1 and G K Schwalfenberg2
1Faculty of Medicine-OB/GYN, University of Alberta, Edmonton, AB, Canada
2Department of Family Medicine, Misericordia Health Facility, Edmonton, AB, Canada
Correspondence: Dr SJ Genuis, Faculty of Medicine-OB/GYN, University of Alberta, 2935-66 Street, Edmonton, AB, Canada T6K 4C1. E-mail: sgenuis@ualberta.ca
Received 1 February 2006; Revised 29 March 2006; Accepted 5 April 2006; Published online 4 May 2006.
Top of pageAbstract
Deficiency of omega-3 fatty acids (3FAs) is an often unrecognized determinant of clinical disease; the adequate availability of these essential nutrients may prevent affliction or facilitate health restoration in some pregnant women and developing offspring. The human organism requires specific nutrients in order to carry out the molecular processes within cells and tissues and it is well established that 3FAs are essential lipids necessary for various physiological functions. Accordingly, to achieve optimal health for patients, care givers should be familiar with clinical aspects of nutritional science, including the assessment of nutritional status and judicious use of nutrient supplementation. In view of the mounting evidence implicating 3FA deficiency as a determinant of various maternal and pediatric afflictions, physicians should consider recommending purified fish oil supplementation during pregnancy and lactation. Furthermore, 3FA supplementation may be indicated in selected pediatric situations to promote optimal health among children.
ADHD is one such effect of omega-3 deficiency.
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A fascinating study has been published in the May issue (vol. 115 no. 5 pages 1360-1366) of the journal Pediatrics: The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder
. Pediatrics is an extremely prestigious journal in the medical world and only publishes the best of the best articles so this is a very significant event! The author Alexandra Richardson has published other outstanding research articles about essential fatty acids and behavior. For more information about her work go to www.fabresearch.org.
Essential fatty acids (EFAs) are extremely important molecules of “good” fats that must be consumed in our diet because our bodies cannot make them. They help form the cell membrane of all cells in the body and are precursors to important molecules called "eicosanoids" that help cells communicate with their neighboring cells. You may have read about essential omega-3 fatty acids but they play major roles in heart disease and some other psychiatric disorders. These omega-3 essential fatty acids, EPA and DHA, are especially important in normal brain function. For more information about EFAs just scrolll way down until you find the 3 articles about EFAs and behavior.
Richardson and her co-workers recruited 117 children with Developmental Coordination Disorder (DCD). This disorder severely affects about 5% of the school age population. Children with DCD have impairment of their motor functions—in other words, they have trouble throwing and catching balls and other related activities and have problems with small muscle coordination in their fingers which affects their handwriting and related skills. They have trouble at school, home and with their peers. DCD shows substantial overlap with ADHD, dyslexia and autism. Treatment options are few for these children.
Richardson divided the 117 recruited children who had DCD into 2 treatment groups. One group received 6 placebo capsules a day that contained only olive oil. Olive oil doesn’t contain EFAs to any degree so it would be expected not to have any affect. The other group took 6 capsules a day of a mixture of omega-3 and omega-6 fatty acids. The daily dose provided 558 mg of EPA and 174 mg of DHA and 60 mg of GLA, an omega-6 fatty acid. It also contained 9.6 mg of alpha-tocopherol, the natural form of vitamin E. The fatty acids are found in fish oil and evening primrose oil. Both groups took the capsules for 3 months. No one actively working with the children knew which group each child was in. At the end of 3 months, the group that had taken the placebo was switched to the active form and both groups continued for another 3 months.
Here’s what they discovered: Those who took the olive oil capsules did not improve. The motor skills of those who took the real EFA supplement did not improve. However, their ADHD-related symptoms improved dramatically. These included hyperactivity, restless and impulsive behaviors, and inattention! Their symptoms of opposition, cognitive problems and anxiety also improved significantly! They also performed significantly better on spelling and reading tests! The children reported no adverse side effects!!
The authors commented, “The optimal dosage and combination of fatty acids are at present unknown.” Researchers believe that both the actual amounts of EPA, DHA and GLA are critical and the ratio of EPA to DHA (about 3 to1 in the supplement they used) is also extremely important. This study has important implications for treating children with ADD/ADHD. Research into the mechanism of action and the various combinations of EFAs that are optimal is essential to helping these childre. At some point, one obvious next step for research is to conduct a study similar to this one but with children who are primarily ADD/ADHD.
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Diet & Behavior Part II: Food Sensitivities
At some point, you may have said to your doctor, “You know, every time Billy eats chocolate his behavior is much worse.” And your doctor replied, “Oh, that’s impossible. There’s no connection. The idea that specific foods can alter behavior was just a fad in the 1970s that’s been disproved. Diet has nothing to do with ADHD.” It’s true that most early studies in the 1970s did not prove that this connection was true. However, well-designed studies reported in the middle 1980s and 1990s in first-rate medical journals such as Lancet, Pediatrics, Journal of Pediatrics, Archives of Diseases of Childhood, Annals of Allergy, and the European Journal of Pediatrics have reported that food sensitivities are a major factor for many children with ADHD. Why doesn’t your doctor know that? Well, doctors are deluged with massive amounts of information and can’t read every medical journal. Besides, doctors are well trained in diseases and drugs but poorly trained in nutrition.
The new studies that were undertaken in the 1980s had certain features in common. Children with ADHD were put on a diet that consisted of only a few hypoallergenic foods. The children were carefully followed by dieticians and doctors. If a child improved on this diet, suspected foods were returned to his diet one food per day and any reactions were noted. Children who reacted to one or more foods joined a double-blind, placebo-controlled trial where the suspected foods were hidden in “safe” foods and reactions were noted.
In the first study, reported in Lancet in 1985, researchers treated 76 children with a few foods diet. Sixty-two children (80%) improved on this diet! Artificial colors and preservatives were the most common culprits (79%), but no child was sensitive to these alone. Other common foods that caused reactions were soy (72%), milk (64%), chocolate (58%), wheat (49%) and sugar (16%). A double-blind placebo-controlled trial followed. Suspected foods caused significantly more behavior problems and physical complaints than the control foods.
In a similar study published in Archives of Diseases of Childhood in Childhood in 1993, 78 hyperactive children were placed on a few foods diet. Seventy-six percent improved! Artificial colors and flavors, chocolate, milk, oranges and cheese were the most common offenders. When double-blind challenges were performed, the suspected foods caused significantly more changes in behavior than foods that acted as placebos.
In another study reported in Annals of Allergy in 1994, 26 children completed a two-week open elimination diet that avoided dairy products, wheat, corn, yeast, soy, citrus, egg, chocolate, peanuts, artificial colors and preservatives. Seventy-three percent of the children improved on this diet. Many of these children (79%) had a history of allergy. In a double-blind, controlled study, suspected foods caused significantly more behavioral changes than placebo.
In 1997 a similarly designed study was reported in the European Journal of Pediatrics. But this time a topographic electroencephalogram (EEG) mapping of brain electrical activity was used to track any brain wave changes from baseline and again after provoking foods were returned to the diet. A significant change in a brain wave was noted in one area of the brain during consumption of provoking foods. The researchers concluded, “These data support the hypothesis that in a subgroup of children with ADHD certain foods may not only influence clinical symptoms but may also alter brain electrical activity.”
May: Diet & Behavior
Part 1: Artificial Colors &
Behavior
In 1975 California allergist Dr. Benjamin Feingold hypothesized that symptoms of hyperactivity (ADHD) were related to intake of artificial colors and flavors and certain natural foods containing salicylates (apples, berries, cherries, cucumbers, oranges, peaches, tomato, etc). He published his interesting observations in his groundbreaking book “Why Your Child is Hyperactive.” The Feingold diet became popular with many families who had hyperactive children. They formed a large national support group, The Feingold Association of the U.S., which continues today and has many local support chapters. However, a number of scientific studies in the late 1970s and early 1980s failed to find the diet effective for most of the hyperactive children studied. Pediatricians, psychologists and nutritionists became convinced that diet had nothing to do with behavior, and this belief persists today even though there is overwhelming evidence that diet does affect behavior!
Scientific Studies
Not all the research in those early years was negative and several important studies were reported in the early 1980s. One research team investigated objective measures of learning in hyperactive children and control children who were given food dyes in a double-blind crossover study. They reported that the hyperactive children performed more poorly on the days they were given the food dyes than on the day they were given the placebo. The control children showed no differences in learning between the food dyes and the placebo. The researchers reported these finding in Science, one of the most highly respected journals in the world!1
In another interesting study published in 1982 a research group studied physiological changes in hyperactive children who were given food additives (including Red #40) in a double-blind crossover study. They found that physiological changes in the EEG (a measure of central nervous system activity) and heart rate (a measure of autonomic nervous system activity) were more pronounced in the hyperactive children but not the controls when given food dyes. 2
In 1985 researchers changed the design of their experiments by giving hyperactive children a low-allergenic diet consisting of just a few foods. Now they began to see startling results! In one such study 76 hyperactive children were put on the hypoallergenic diet. Sixty-two children improved on this diet! Then foods were returned to the diet and any reactions noted. Then the families were given the opportunity to participate in a double-blind, placebo-controlled study in which suspected foods were hidden in other foods. Of the children tested for the artificial colors, 79% reacted to the artificial colors and flavors.3 This report was published in the widely acclaimed British journal, Lancet. In 1993 in another similar study 59 of 78 children improved on a low allergenic diet. Seventy percent were sensitive to artificial colors and flavors! These results were published in Archives of Diseases in Childhood.4
In 1994 in yet another study researchers in Australia reported the effects of yellow dye #5 (tartrazine) on hyperactive children in a double-blind placebo-controlled study in Annals of Allergy. Two hundred suspected hyperactive children participated in an open study where all artificial colors were eliminated from their diets for 6 weeks. One-hundred and fifty parents reported behavioral improvements in their children. Then 23 “suspected reactors” participated in a double-blind placebo-controlled study of the effects of tartrazine (yellow dye #6). Twenty-one of these children clearly reacted to the yellow dye when it was administered in capsules but did not react to identically appearing capsules without dye. Behavioral changes associated with the intake of the yellow dye included:
Irritability
Restlessness
Sleep disturbances
The more dye the children ingested the longer the reaction lasted. Younger children, ages 2 to 6, experienced “constant crying, tantrums, irritability, restlessness, and severe sleep disturbances.” The older children, ages 7 to 14, were “irritable, aimlessly active, lacked self-control, whiny and unhappy.” Although other dyes were not studied in this particular study, the effects are probably similar as they are chemically derived from petroleum and have related chemical structures.5
Here’s one last study in which scientists studied the mapping of brain electrical activity in children with ADHD who were known to react to certain foods and food additives. Using an EEG mapping technique they reported that the ADHD children showed altered brain activity when given artificial colors in a placebo-controlled fashion.6
You may be asking, “What about normal children. Is there any evidence that they react to artificial colors? The answer is a resounding “Yes” as reported by researchers who studied 3 year old children even those without hyperactive behavior. There were significant reductions in hyperactive behavior during the first week when artificial colors and sodium benzoate were removed from the diet. During the challenge phase there were significantly greater increases in the hyperactive behavior during the artificial color and preservative challenge than with the placebo based on parental reports. These effects were not influenced by the presence or absence of hyperactivity or by the presence or absence of allergy! The researchers concluded, “There is a general adverse effect of artificial food colourings and sodium benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment.”7
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Do you really believe there was no nutritional differences between yourself and your sisters? Sorry robbie, but you over-simplfy topics far too much. 
the best source for omega 3 is flax seeds.
