Omega-3s are a type of polyunsaturated fatty acid found in every cell of your body. They're the bendy, flexible fats that keep things flowing smoothly, especially in cold environments. Think of them as the yoga instructors of the fat world, always encouraging your cells to stay limber and adaptable.
Every cell in your body is wrapped in a double layer of fatty acids, like a coat. The mix of fats in this coat determines how flexible or rigid the cell is. In a healthy adult, about 5-10% of the fats in red blood cell membranes are omega 3's.
Omega 3's are also known as essential fatty acids. There are two kinds; eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) that are important for ADHD. The third Omega you may have heard of is alpha-linolenic acid (ALA). It is found in very low amounts in fish, but in high amounts in flaxseeds, for example.
The brain contains high amounts of DHA compared to EPA. DHA is like the building blocks of your brain. It's abundant in brain cells, giving them the flexibility they need to send signals to each other. DHA is the longest and most flexible of the common omega-3s.
EPA, on the other hand, is the brain's firefighter, helping to reduce inflammation. EPA is despite not as plentiful in the brain is still important. Studies has shown to be more important than DHA in terms of improving symptoms in depression. So DHA is important for brain structures whereas EPA appears to be more important for brain signaling potentially. It likely comes down to EPA's anti-inflammatory superpowers. It's like EPA is the firefighter of the brain, cooling down inflammatory hotspots that might be contributing to mood issues.
Why are omega 3's important in ADHD
Studies have shown that Omega 3's run lower in the brains and bodies of individuals with ADHD compared to neurotypical individuals¹,². Another study showed that in teenagers with ADHD who ate similar amounts of omega 3's to neurotypical teenagers, the teenagers with ADHD had lower levels of DHA in their bodies. This suggests that in those with ADHD, the body has a hard time using and processing it¹,² compared to their neurotypical friends.
A randomized trial performed in 2008, (3) found something interesting: while omega-3s didn't help all children with ADHD, about a quarter of them showed a really positive response. It's as if omega-3s were a key that fit some locks but not others.
Omega 3 also helps with other conditions and may play a key role in the prevention of anxiety disorders. Research also suggests that they may act in a similar way to antipsychotics, typically used to treat irritability in children (as well as schizophrenia and psychosis) by restoring oxidative balance to the brain¹.
Benefits of omega 3 supplementation:
Omega 3 Dosages
The National Academy of Medicine has not established any dosing guidelines for DHA or EPA.
Current guidelines are for ALA only, as it is considered an ‘essential’ fatty acid, in other words, it is not something that animals can make in their bodies⁴. We can make DHA and EPA from ALA, however we don't do it very well and even healthy individuals without the metabolic complexities of ADHD would benefit from DHA and EPA supplementation.
The recommendations for DHA and EPA for ‘healthy’ individuals appear to be all over the place, with some guidelines suggesting 150-250mg (very conservative) of EPA and DHA per day⁵ while others suggesting ranges into the few thousands milligrams (few grams) per day.
Doses up to 4000 mg appear to be safe, but can cause tummy upset which is why it is best to stay in 2000-3000mg ballpark at most if you are considering the higher dosing.
The FDA recommends taking no more than 2000 mg of EPA and DHA combined from dietary supplements⁶, though they do not indicate if this is adult or child dosing, and this is not ADHD specific.
Early investigations, like the Bloch & Qawasmi study⁷ found a small but positive effect of omega-3s (especially EPA) on ADHD symptoms. This study looked at omega-3 doses up to 750mg per day.
A randomized trial³ used a daily dose of 558 mg of EPA and 174 mg of DHA. This is the study where one out of every 4 children with ADHD did well with omega 3's. They were taking the supplement daily for 6 months.
There’s some evidence of a small, positive effect on ADHD symptoms. Since omega-3 supplementation is very safe, and easily available, it’s worth trying in children with ADHD. Aim for at least 700mg / day of EPA as this appears to be more important than DHA in ADHD based on studies above.
Below are dosing guidelines from The ADHD and Autism Nutritional Supplement Handbook by Godbout Laake and Compart (2013). Here is what they recommend:
Age (years) | EPA (mg) | DHA (mg) | Total Omega 3 (mg) | Frequency |
2 - 5 | 200-400 | 200-400 | 400-800 | Daily with food |
6 - 10 | 500-650 | 400-500 | 900-1150 | Daily with food |
11 + | 500-800 | 500-650 | 1000-1450 | Daily with food |
The brand that I particularly like to use is Nordic Naturals. They do have a liquid form for children that does not smell or taste fishy, but is somewhat oily, so typically following with water or juice can helps wash away the oiliness. The liquid form is great in that it is good for children who cannot swallow capsules, and for those parents who want to be able to really control the dosing using a syringe.
Here is my recommendation: https://www.nordic.com/products/childrens-dha/?variant=39472184066232&&utm_source=adwords&utm_medium=ppc&utm_term=&utm_campaign=&hsa_ver=3&hsa_cam=17865437419&hsa_acc=5881632061&hsa_ad=&hsa_mt=&hsa_net=adwords&hsa_tgt=&hsa_kw=&hsa_src=x&hsa_grp=&gad_source=1&gclid=CjwKCAjwufq2BhAmEiwAnZqw8tv4dkLbjwTWlsBtHnHgvAXh0CrGrYoLqYst6KJ9zlXDwl6h4mY5oBoCN2AQAvD_BwE&gclsrc=aw.ds However, it does appear to have slightly more DHA than EPA (170mg EPA: 255 DHA per serving, more of less a 1:1 ratio), which isnt a deal breaker, but as you can see, even doubling of tripling the serving size doesnt give us the 700mg/day EPA recommended above.
The liquid is best suited to younger children ages 2-5 years old, but as soon as a child is older than 6 years old, I begin to recommend the adult version from the same brand in the gummy chew form (for those who still can't swallow capsules) or the soft gels for those who can swallow capsules. It does come in a liquid form too, but you will have to do some math as one 'serving size' gives is 2840mg Omegas, when we are looking for close to 1000mg, so you would draw up a little less than half to get the right dosing for ages 6-10 years: https://www.nordic.com/products/ultimate-omega/?variant=39472192192696
Gummies for children is also an option but check the supplement facts on the label as the amount of omega 3 can vary widely, and start as low as 82mg https://www.nordic.com/products/nordic-omega-3-gummies/?variant=39472190062776 which is too low given that the table above shows 400-800mg total omega 3's for ages 2-5 years old. The gummies that I recommend from Nordic Naturals that you can start using for ages 6 and above from Nordic Naturals is: https://www.nordic.com/products/ultimate-omega-gummy-chews/?variant=41406215749816 These chew gummies can even be cut in half and used for younger children to meet the numbers in the table above.
Read the supplement facts label and compared to the table above to calculate the dosing for your child based on their age. The website makes it really easy to read the supplement facts for each form of fish oil they sell.
Side effects and toxicity
Side effects are mild. These include unpleasant taste, bad breath, heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and smelly sweat. No toxicity noted but the FDA recommends taking no more than 2 grams (2000mg) daily in ‘healthy’ children.
Make sure that the Omega 3 you buy does not contain any vitamin A unless they need to be taking extra vitamin A. Vitamin A in large amounts can cause liver damage.
There has been some concern in the past that high dose Omega 3 might interfere with blood clotting causing bleeding and suppression immune function, but as long as you stay below 5g (5000mg) per day, it is deemed safe by the FDA⁴.
If your child is allergic to fish or shellfish, do not take Fish Oil. If they really don't like the fishiness of fish oil, you may want to use an algae based DHA supplement instead.
There has been some concern about Omega-3 supplements containing heavy metals such as mercury, but Omega-3 supplements have not been found to contain mercury⁴ as they undergo a purification process that removes any nasties. Overall a safe supplement worth trying in ASD.
Medications your child may be taking that Fish oil interacts with:
Warfarin/Coumadin. Can increasing bleeding time as it stops blood clotting properly.
Who should not take Fish oil without first talking to their health care provider?
Do not take if allergic to fish or shellfish
Those with blood clotting issues
This site is for general informational purposes only and does not constitute the giving of medical advice. The contents do not constitute the practice of medicine, nursing, or other professional health care services. No provider–patient relationship is formed. Please consult with your child's healthcare provider when considering supplementation for children.
Godbout Laake, D. & Compart, P. J. MD (2013) The ADHD and Autism Nutritional Supplement Handbook. Fair Winds Press. To purchase on Amazon click here.