Natural vs medical – Omega-3s vs Ritalin for ADHD

Anorexia, insomnia, social withdrawal, irritability, abnormal thinking, developmental delay, rapid heartbeat, high blood pressure, stomach ache, vomiting . . . These are just some of the side-effects associated with methylphenidate, better known as Ritalin, the standard drug treatment for attention-deficit/hyperactivity disorder, or ADHD.1

So, parents looking for a safer solution will be happy to hear that supplements of omega-3s – essential fatty acids found naturally in fish and flaxseed oil – are showing promise as an effective treatment for ADHD symptoms like inattention, hyperactivity and impulsivity.

Fat facts

Along with omega-6s, omega-3s make up a group of essential fatty acids called ‘long-chain polyunsaturated fatty acids’ (LC-PUFAs) – ‘essential’ because they can’t be synthesized by the body alone and need to be obtained through dietary sources.

Fish and seafood are the main sources of omega-3s, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are crucial for the eyes and brain, while omega-6s like gamma-linolenic acid (GLA) are mainly found in plant oils like hemp and borage oils.

Studies have repeatedly shown that children with ADHD and other behavioural disorders have significantly lower levels of these fatty acids, especially the omega-3s.2 This has led scientists to try to work out whether fatty-acid supplements can help.

Clinical trials

In one study of 132 children by Australia’s leading government research body, the Commonwealth Scientific and Industrial Research Organization (CSIRO) Division of Human Nutrition, those supplementing with LC-PUFAs showed “significant improvements” in parent ratings of ADHD-related behaviour, such as inattention, hyperactivity and impulsivity, compared with children given a placebo.

The supplement they took was Equazen’s Eye Q™, containing 400 mg of fish oil and 100 mg of evening primrose oil – with the active ingredients EPA (93 mg), DHA (29 mg), GLA (10 mg) and vitamin E (1.8 mg) – in every capsule.3 The same supplement was also effective for improving reading, spelling and behaviour in an earlier study of children with learning and behavioural problems.4

According to the Australian researchers, the beneficial effects seen in the Eye Q trials was comparable to that of methylphenidate.3–5

In fact, one trial actually pitted omega-3 supplements and methylphenidate head to head, and reported that the fatty-acid supplement and the drug were equally effective for reducing symptoms of ADHD – and both were better than the placebo.6

Conflicting evidence

But not all studies agree, and some have found fatty acids not to work for ADHD. Yet, according to a recent review of 10 high-quality trials involving nearly 700 children, omega-3 supplements, especially those with high doses of EPA, are an effective treatment for ADHD – albeit not as effective as drug therapy, the researchers said. Still, given the lack of adverse effects, they suggest that omega-3s are a useful alternative treatment for families wanting to keep their children drug-free.7

Harms vs benefits

More recently, though, a review by the prestigious Cochrane Collaboration has called into question the efficacy of good old methylphenidate, the drug most commonly prescribed for ADHD. Indeed, they found the quality of studies showing that the drug works were “very poor”, making it tricky to interpret the results. “We cannot say for sure whether taking methylphenidate will improve the lives of children and adolescents with ADHD,” they concluded.8

What’s more, methylphenidate has failed to show any beneficial effects beyond four weeks of use.9

With the high cost of negative effects to pay for such questionable benefits, omega-3s certainly appear to be the better option.

Fish-oil fears?

Long-term supplementation with fatty acids appears to be safe, with only minor side-effects like nausea being reported.1 Nevertheless, two studies suggest that taking mega-doses of fatty acids for a long time may cause oxidative damage to red blood cells, which is known to play a role in common conditions like heart disease, stroke and cancer.2

The doses causing these possible ill effects were very high – 4,100 mg/day of EPA and 3,600 mg/day in the first study, and 1,680 mg/day of EPA and 720 mg/day of DHA in the second one – and considerably higher than the amounts used in the Eye Q studies. So, as long as you stick to a sensible dose (try six capsules per day of 500 mg of fish oil for 12 weeks, then reduce the dose to just two or three capsules per day), there shouldn’t be a problem.

And don’t forget that many supplements include the antioxidant vitamin E to counteract the possible damaging effects of free radicals with fish-oil supplementation. Eye Q, for instance, contains 1.8 mg of vitamin E per capsule, although you may wish to add extra vitamin E as studies suggest that 200 mg daily (around 100 IU) can protect against the risk.3

Diabetics should also add garlic or pectin to their regime to mitigate any changes in glucose control that may be caused by fish-oil supplementation.

If you prefer to use plant sources of omega-3s, bear in mind that this will be in the form of alpha-linolenic acid (ALA), which needs to be converted into EPA and DHA before it can be used by the body. Some people are genetically unable to make this conversion, whereas others may lack the necessary nutrients in their diets needed for conversion.

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Fish-oil fears?

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