Could Toxic Chemicals Lower Our Child’s IQ?

April 11, 2023 by Dr. Steve Chaney

Is The Science Solid?

Author: Dr. Stephen Chaney

As Earth Day approaches, our thoughts turn to our environment. Most of the concern is with global warming, and rightly so. But should we be concerned about the effects of toxic chemicals in our environment on our health – or, more importantly the health of our children?

The short answer is, “Maybe.” But let’s delve a little deeper.

In a past issue of “Health Tips From the Professor” I examined the evidence suggesting that toxic chemicals in the home could cause childhood asthma. That is alarming because asthma can predispose individuals to other diseases and affects quality of life.

But what if that were only the tip of the iceberg? For example, a recent headline stated: “More Toxic Chemicals [In Our Environment] Are Damaging Children’s Brains”. If that headline is true, it’s downright scary.

The authors of this study suggested that toxic chemicals which are abundant in our environment can cause decreases in IQ and aggressive or hyperactive behavior in children – and that those changes may be permanent.

The Study Behind The Headlines

The paper that generated the headlines (Grandjean & Landrigan, The Lancet Neurology, 13: 330-338, 2014) was a review of the literature, not an actual clinical study.

Based on published clinical studies, the authors identified 11 chemicals commonly found in the environment as developmental neurotoxins (toxins that interfere with normal brain development) based.

This finding compares with 6 developmental neurotoxins that they were able to identify in a similar study in 2006.

The authors were not claiming that the number or amount of neurotoxic chemicals changed between 2006 and 2014. They were saying that science has advanced to the point where we can classify six more chemicals that have been in our environment for years as developmental neurotoxins.

Even more worrisome, the authors postulate that many more environmental neurotoxins remain undiscovered, and these environmental neurotoxins come from many sources.

Some are industrial pollutants.

Some are persistent groundwater contaminants.

Some are insecticides and herbicides used in agriculture.

Some are found in common household products and furnishings.

Could Toxic Chemicals Lower Our Child’s IQ?

To answer that question, you need to look at some of the studies they cited in their review. For example:

Elevated blood lead levels in children are associated with as much as a 7-point decrease in IQ (Lamphear et al, Environmental Health Perspectives, 113: 894-899, 2005).

The effects of many of the neurotoxic chemicals they identified on IQ were difficult to quantify. However, the authors estimated that average exposure of US children to just 3 of the best studied chemical neurotoxins (lead, methylmercury, and organophosphate pesticides) was sufficient to lower their average IQ by 1.6 points.

The authors spoke of the environmental neurotoxins they identified as representing a “silent pandemic of a chemical brain drain” that could cost the US economy billions of dollars.

One of the blog posts I read on this topic summarized the consequences in a very graphic manner. It said:

If one child’s IQ is reduced by 5 points, it doesn’t appear to make a big difference. For example, that child might be:

A little slower to learn.
A little shorter of attention.
A little less successful at tests and at work.

That might result in $90,000 in lost lifetime earnings.

However, if the average IQ of every child in the US were decreased by 5 points, the effect becomes significant:

Only half as many members of the next generation would be “intellectually gifted”.
Twice as many of the next generation would be “intellectually impaired”.
Lost productivity could be in the billions.

Of course, statements like that are a bit over the top. Drs. Grandjean and Landrigan did not claim that the net effect of the chemicals they identified was a 5-point drop in IQ. Nor did they claim that all US children were affected equally.

Still, it’s enough to make you think.

Are Toxic Chemicals Causing Behavior Problems?

The authors cited numerous studies linking the chemical neurotoxins they identified to aggression and hyperactivity. But perhaps the most compelling reason to suspect that environmental chemicals may be affecting brain development is the spiraling incidence of developmental disorders such as autism and ADHD. For example:

Autism has increased by 78% since 2007 and now affects 1 of 88 eight-year-old children.

ADHD has increased by 43% since 2003 and now affects 11% of children aged 4-17.

Some of this increase could be due to better diagnosis of these conditions, but nobody believes that all of it is due to improved diagnosis. The authors claim that much of this increase is likely due to environmental exposure to the kinds of developmental neurotoxins they identified.

Is The Science Solid?

Of course, you have seen these kinds of warnings before. Is this crazy talk, or is it something you should take seriously? What is the truth? Is the science solid?

The problem is this is a very difficult area of research. You can’t do a gold standard double-blind, placebo-controlled clinical trial. Nobody in their right mind would give one group of children toxic chemicals and the other group a placebo.

The studies cited in this paper were mostly population studies. Basically, this means that they compared children with exposure to certain toxic chemicals to a control group that was as similar as possible to the first group except that their exposure to the toxic chemicals was less.

The limitation of this kind of study is obvious. We are usually comparing children from different locations or of different backgrounds. We almost never know if we have controlled for all possible variables so that the groups are truly identical.

Consequently, it becomes important to ask how many studies come to the same conclusion. For some of the toxic chemicals, such as lead, methylmercury, and organophosphate pesticides, the weight of evidence is very strong. For some of the newer additions to their list of developmental neurotoxins, it is clear that the chemicals have neurotoxic properties, but the significance of those effects on the developing human brain are hard to quantify at this point.

So, rather than ask, “Is this true?”, we should ask, “What if it were true?” The consequences of lowered IQ and developmental behavioral problems are so significant that it may not make sense to wait until we have unassailable scientific evidence before we act.

We don’t need to panic. The science isn’t that strong. But we should take sensible precautions. The developmental neurotoxins identified in this study come from many sources. Here are the sources and sensible precautions we can take.

Some are industrial pollutants. For these, we need to lobby for better environmental regulation.

Some are persistent groundwater contaminants. For these we need to drink purified water whenever possible.

Some are insecticides and herbicides used in agriculture. For these we need to buy organic, locally grown produce whenever possible.

Some are found in common household products and furnishings. For these we need to become educated label readers and use non-toxic products in our home whenever possible.

The Bottom Line:

1) A recent review claims that there is a good scientific basis for classifying at least 11 environmental chemicals as developmental neurotoxins that are likely to reduce IQ and contribute to behavioral problems in US children.

2) The science behind the claims in this review is solid, but not iron clad. This is an area of science where it is virtually impossible to come up with a definitive conclusion.

3) However, there are times when we need to simply ask ourselves: “What if it were true?” The consequences of lowered IQ and developmental behavioral problems are so significant that it may not make sense to wait until we have unassailable scientific evidence before we act.

4) We all need to be guardians of our personal environment. The article above identifies practical steps each of us can take.

For more details and to learn what practical steps you can take to reduce your family’s exposure to toxic chemicals, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Vitamin D And ADHD

August 2, 2022 by Dr. Steve Chaney

Can ADHD Be Prevented?

Author: Dr. Stephen Chaney

If you are pregnant, or of childbearing age, should you be supplementing with vitamin D? Increasingly, the answer appears to be yes.

Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

- 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).

- 25% of pregnant women have insufficient vitamin D status (30-49 nmol/L).

In short, that means around 1/3 of pregnant women in the US have insufficient or deficient levels of vitamin D. The effect of inadequate vitamin D during pregnancy is not just an academic question.

2) The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently concluded that supplementation with vitamin D reduces the risk of significant complications during pregnancy.

3) Another recent study found that inadequate vitamin D status during pregnancy delayed several neurodevelopmental milestones in early childhood, including gross motor skills, fine motor skills, and social development.

If neurodevelopmental milestones are affected, what about ADHD? Here the evidence is not as clear. Some studies have concluded that vitamin D deficiency during pregnancy increases the risk of ADHD in the offspring. Other studies have concluded there is no effect of vitamin D deficiency on ADHD.

Why the discrepancy between studies?

Most of the previous studies have been small. Simply put, there were too few children in the study to make statistically reliable conclusions.
Most of the studies measured maternal 25-hydroxyvitamin D levels in the third trimester or in chord blood at birth. However, it is during early pregnancy that critical steps in the development of the nervous system take place.

Thus, there is a critical need for larger studies that measure maternal vitamin D status in the first trimester of pregnancy. This study (M Sucksdorff et al, Journal of the American Academy of Child & Adolescent Psychiatry, 60: 142-151, 2021) was designed to fill that need.

How Was The Study Done?

This study compared 1,067 Finnish children born between 1998 and 1999 who were subsequently diagnosed with ADHD and 1,067 matched controls without ADHD. There were several reasons for choosing this experimental group.

Finland is among the northernmost European countries, so sun exposure during the winter is significantly less than for the United States and most other European countries. This time period also preceded the universal supplementation with vitamin D for pregnant women that was instituted in 2004.

Consequently, maternal 25-hydroxyvitamin D levels were significantly lower than in most other countries. This means that a significant percentage of pregnant women were deficient in vitamin D, something not seen in most other studies. For example:

49% of pregnant women in Finland were deficient in vitamin D (25-hydoxyvitamin D <30 nmol/L) compared to 8-11% in the United States.

33% of pregnant women in Finland had insufficient vitamin D status (25-hydroxyvitamin D 30-49.9 nmol/L) compared to 25% in the United States.

Finland, like many European countries, keeps detailed health records on its citizens. For example:

- The Finnish Prenatal Study collected data, including maternal 25-hydroxyvitamin D levels during the first trimester), for all live births between 1991 and 2005.

- The Care Register for Health Care recorded, among other things, all diagnoses of ADHD through 2011.

Thus, this study avoided the limitations of earlier studies. It was ideally positioned to compare maternal 25-hydroxyvitamin D levels during the first trimester of pregnancy with a subsequent diagnosis of ADHD in the offspring. The long-term follow-up was important to this study because the average age of ADHD diagnosis was 7 years (range = 2-14 years).

Vitamin D And ADHD

Does maternal vitamin D affect ADHD in the offspring? The answer to this question appears to be a clear, yes.

If you divide maternal vitamin D levels into quintiles:

Offspring of mothers in the lowest vitamin D quintile (25-hydroxyvitamin D of 7.5-21.9 nmol/L) were 53% more likely to develop ADHD than offspring of mothers in the highest vitamin D quintile (49.5-132.5 nmol/L).

When you divide maternal vitamin D levels by the standard designations of deficient (<30 nmol/L), insufficient (30-49.9 nmol/L), and sufficient (≥50 nmol/L):

Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

Can ADHD Be Prevented?

I realize that this is an emotionally charged title. If you have a child with ADHD, the last thing I want is for you to feel guilty about something you may not have done. So, let me start by acknowledging that there are genetic and environmental risk factors for ADHD that you cannot control. That means you could have done everything right during pregnancy and still have a child who develops ADHD.

Having said that, let’s examine things that can be done to reduce the risk of giving birth to a child who will develop ADHD, starting with vitamin D. There are two aspects of this study that are important to keep in mind.

#1: The increased risk of giving birth to a child who develops ADHD was only seen for women who were vitamin D deficient. While vitamin D deficiency is only found in 8-11% of pregnant mothers in the United States, that is an average number. It is more useful to ask who is most likely to be vitamin D deficient in this country. For example:

Fatty fish and vitamin D-fortified dairy products are the most important food sources of vitamin D. Fatty fish are not everyone’s favorite and may be too expensive for those on a tight budget. Many people are lactose intolerant or avoid milk for other reasons. If you are not eating these foods, you may not be getting enough vitamin D from your diet. This is particularly true for vegans.

If you have darker colored skin, you may have trouble making enough vitamin D from sunlight. If you are also lactose intolerant, you are in double trouble with respect to vitamin D sufficiency.

Obesity affects the distribution of vitamin D in the body. So, if you are overweight, you may have low 25-hydroxyvitamin D levels in your blood.

The vitamin D RDA for pregnant and lactating women is 600 IU, but many multivitamin and prenatal supplements only provide 400 IU. If you are pregnant or of childbearing age, it is a good idea to look for a multivitamin or prenatal supplement that provides at least 600 IU, especially if you are in one of the high risk groups listed above.

Some experts recommend 2,000 to 4,000 IU of supplemental vitamin D. I would not recommend exceeding that amount without discussing it with your health care provider first.

Finally, for reasons we do not understand, some people have a difficult time converting vitamin D to the active 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in their bodies. If you are pregnant or of childbearing age, it is a good idea to have your blood 25-hydroxyvitamin D levels determined and discuss with your health care provider how much vitamin D you should be taking. Many people need more than 600 IU to reach vitamin D sufficiency status.

#2: Maternal vitamin D deficiency has a relatively small effect (34%) on the risk of the offspring developing ADHD. That means assuring adequate vitamin D status during pregnancy should be part of a holistic approach for reducing ADHD risk. Other factors to consider are:

Low maternal folate and omega-3 status.

Smoking, drug, and alcohol use.

Obesity.

Sodas and highly processed foods.

Alone, each of these factors has a small and uncertain influence on the risk of your child developing ADHD. Together, they may play a significant role in determining your child’s risk of developing ADHD.

In closing, there are three take-home lessons I want to leave you with:

The first is that there is no “magic bullet”. There is no single action you can take during pregnancy that will dramatically reduce your risk of giving birth to a child who will develop ADHD. Improving your vitamin D, folate, and omega-3 status; avoiding cigarettes, drugs, and alcohol; achieving a healthy weight; and eating a healthy diet are all part of a holistic approach for reducing the risk of your child developing ADHD.

2) The second is that we should not think of these actions solely in terms of reducing ADHD risk. Each of these actions will lead to a healthier pregnancy and a healthier child in many other ways.

3) Finally, if you have a child with ADHD and would like to reduce the symptoms without drugs, I recommend this article.

The Bottom Line

A recent study looked at the correlation between maternal vitamin D status during the first trimester of pregnancy and the risk of ADHD in the offspring. The study found:

Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

In the article above I discuss what this study means for you and other factors that increase the risk of giving birth to a child who will develop ADHD.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Maternal Vitamin D Affect Childhood ADHD?

July 7, 2020 by Dr. Steve Chaney

Can ADHD Be Prevented?

If you are pregnant, or of childbearing age, should you be supplementing with vitamin D? Increasingly, the answer appears to be yes.

1) Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

- 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).

- 25% of pregnant women have insufficient vitamin D status (30-49 nmol/L).

In short, that means around 1/3 of pregnant women in the US have insufficient or deficient levels of vitamin D. The effect of inadequate vitamin D during pregnancy is not just an academic question.

Why the discrepancy between studies?

Most of the previous studies have been small. Simply put, there were too few children in the study to make statistically reliable conclusions.

Most of the studies measured maternal 25-hydroxyvitamin D levels in the third trimester or in chord blood at birth. However, it is during early pregnancy that critical steps in the development of the nervous system take place.

How Was The Study Done?

Finland is among the northernmost European countries, so sun exposure during the winter is significantly less than for the United States and most other European countries. This time period also preceded the universal supplementation with vitamin D for pregnant women that was instituted in 2004.

- 49% of pregnant women in Finland were deficient in vitamin D (25-hydoxyvitamin D <30 nmol/L) compared to 8-11% in the United States.

- 33% of pregnant women in Finland had insufficient vitamin D status (25-hydroxyvitamin D 30-49.9 nmol/L) compared to 25% in the United States.

Finland, like many European countries, keeps detailed health records on its citizens. For example:

- The Finnish Prenatal Study collected data, including maternal 25-hydroxyvitamin D levels during the first trimester), for all live births between 1991 and 2005.

- The Care Register for Health Care recorded, among other things, all diagnoses of ADHD through 2011.

Thus, this study was ideally positioned to compare maternal 25-hydroxyvitamin D levels during the first trimester of pregnancy with a subsequent diagnosis of ADHD in the offspring. The long-term follow-up was important to this study because the average age of ADHD diagnosis was 7 years (range = 2-14 years).

Does Maternal Vitamin D Affect Childhood ADHD?

The answer to this question appears to be a clear, yes.

If you divide maternal vitamin D levels into quintiles:

Offspring of mothers in the lowest vitamin D quintile (25-hydroxyvitamin D of 7.5-21.9 nmol/L) were 53% more likely to develop ADHD than offspring of mothers in the highest vitamin D quintile (49.5-132.5 nmol/L).

When you divide maternal vitamin D levels by the standard designations of deficient (<30 nmol/L), insufficient (30-49.9 nmol/L), and sufficient (≥50 nmol/L):

Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

Can ADHD Be Prevented?

Fatty fish and vitamin D-fortified dairy products are the most important food sources of vitamin D. Fatty fish are not everyone’s favorite and may be too expensive for those on a tight budget. Many people are lactose intolerant or avoid milk for other reasons. If you are not eating these foods, you may not be getting enough vitamin D from your diet. This is particularly true for vegans.

If you have darker colored skin, you may have trouble making enough vitamin D from sunlight. If you are also lactose intolerant, you are in double trouble with respect to vitamin D sufficiency.

Obesity affects the distribution of vitamin D in the body. So, if you are overweight, you may have low 25-hydroxyvitamin D levels in your blood.

The vitamin D RDA for pregnant and lactating women is 600 IU, but many multivitamin and prenatal supplements only provide 400 IU. If you are pregnant or of childbearing age, it is a good idea to look for a multivitamin or prenatal supplement that provides at least 600 IU, especially if you are in one of the high risk groups listed above.

Some experts recommend 2,000 to 4,000 IU of supplemental vitamin D. I would not recommend exceeding that amount without discussing it with your health care provider first.

Finally, for reasons we do not understand, some people have a difficult time converting vitamin D to the active 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in their bodies. If you are pregnant or of childbearing age, it is a good idea to have your blood 25-hydroxyvitamin D levels determined and discuss with your health care provider how much vitamin D you should be taking. Many people need more than 600 IU to reach vitamin D sufficiency status.

Low maternal folate and omega-3 status.

Smoking, drug, and alcohol use.

Obesity.

Sodas and highly processed foods.

In closing, there are three take-home lessons I want to leave you with:

1) The first is that there is no “magic bullet”. There is no single action you can take during pregnancy that will dramatically reduce your risk of giving birth to a child who will develop ADHD. Improving your vitamin D, folate, and omega-3 status; avoiding cigarettes, drugs, and alcohol; achieving a healthy weight; and eating a healthy diet are all part of a holistic approach for reducing the risk of your child developing ADHD.

2) The second is that we should not think of these actions solely in terms of reducing ADHD risk. Each of these actions will lead to a healthier pregnancy and a healthier child in many other ways.

3) Finally, if you have a child with ADHD and would like to reduce the symptoms without drugs, I recommend this article.

The Bottom Line

A recent study looked at the correlation between maternal vitamin D status during the first trimester of pregnancy and the risk of ADHD in the offspring. The study found:

Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

In the article above I discuss what this study means for you and other factors that increase the risk of giving birth to a child who will develop ADHD.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What Supplements Help Mental Health?

January 14, 2020 by Dr. Steve Chaney

Do Omega-3s Reduce Depression?

Author: Dr. Stephen Chaney

We are in the midst of a mental health crisis. According to the latest statistics:

· 19% of adults in the United States have some form of mental illness.

· 16.5% of youth ages 6-17 have some form of mental illness.

· The 5 most commonly diagnosed forms of mental illness are anxiety, depression, post-traumatic stress disorder, bipolar disease, and ADHD.

Even worse, mental illness appears to be increasing at an alarming rate among young people. For example:

· Between 2005 and 2017 depression increased 52% among adolescents.

· Between 2002 and 2017 depression increased 63% in young adults.

· Between 1999 and 2014 suicides have increased 24% in young adults. In the past few years suicides have been increasing by 2% a year in this group.

Much has been written about the cause of this alarming increase in mental illness. The short answer is that we don’t really know. But the most pressing question is what do we do about it?

The medical profession relies on powerful drugs to treat the symptoms of mental illness. These drugs don’t cure the illness. They simply keep the symptoms under control. Plus, if you have ever listened closely to the advertisements for these drugs on TV, you realize that they all have serious side effects that adversely affect your quality of life.

My “favorite” example is drugs for anxiety and depression. You are told that one of the side effects is “suicidal thoughts”. That means that the very drug someone could be prescribed to prevent suicides might actually increase their risk of suicide. Why would anyone take such a drug?

If drugs are so dangerous, what about supplements? Do they provide a safe, natural alternative for reducing the symptoms of mental illness? Some supplement companies claim their products cure mental illness. Are their claims true or are they just trying to empty your wallet?

How is a consumer to know which of these supplement claims are true and which are bogus? Fortunately, an international team of scientists has scoured the literature to find out which supplements have been proven to reduce mental health symptoms.

How Was The Study Done?

This was a massive study (J. Firth et al, World Psychiatry, 18: 308-324, 2019. It was a meta-review of 33 meta-analyses of randomized, placebo-controlled trials with a total of 10,951 subjects. The clinical trials included in this analysis analyzed the effect of 12 nutrients, either alone or in combination with standard drug treatment, on symptoms associated with 10 common mental disorders.

To help you understand the power of this meta-review, let me start by defining the term “meta-analysis”. A meta-analysis combines the data from multiple clinical studies to increase the statistical power of the data. Meta-analyses are considered to be the gold standard of evidence-based evidence.

However, not all meta-analyses are equally strong. They suffer from the “Garbage-In, Garbage-Out” phenomenon. Simply put, they are only as strong as the weakest clinical studies included in their analysis.

That is the strength of this meta-review. It did not simply combine the data from all 33 meta-analyses. It used stringent criteria to evaluate the quality of each meta-analysis and weighted the data appropriately.

What Supplements Help Mental Health?

The strongest evidence was for omega-3 supplements. In the worlds of the authors:

· “Across 13 independent randomized control clinical trials in 1,233 people with major depression, omega-3 supplements reduced depressive symptoms significantly.”

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

o There was no evidence of publication bias in these studies. This is a very important consideration. Publication bias means that only studies with a positive effect were published while studies showing no effect were withheld from publication. That makes the effect look much more positive than it really is. The fact there was no evidence of publication bias strengthens this conclusion.

o Omega-3 supplements were more effective when used in combination with antidepressant drugs, but there was some evidence of publication bias in those studies.

· “Across 16 randomized control clinical trials reporting on ADHD symptom domains, significant benefits were observed for both hyperactivity/impulsivity and inattention.”

· Omega-3s had no significant effect on schizophrenia or bipolar disorder other than a mild reduction in depressive symptoms.

There was strong, but not definitive, evidence for folic acid and methylfolate supplements for depression.

· When used in conjunction with antidepressants both folic acid and methylfolate supplements “…were associated with significantly greater reductions in depressive symptoms compared to placebo, although there was large heterogeneity between trials.”

· The largest effects were observed with high dose methylfolate. In the words of the authors: “Two randomized control clinical trials examining a high dose (15 mg/day) of methylfolate administered in combination with antidepressants found moderate-to-large benefits for depressive symptoms.” However, to put this into perspective:

o 15 mg/day is 3,750% of the RDA. This is a pharmacological dose and should only be administered under the care of a physician.

o A smaller dose of 7.5 mg/day is ineffective.

o No comparison was made with folic acid at this dose, so we do not know whether folic acid would be equally effective.

· The authors concluded that there is emerging evidence for positive effects of vitamin D (>1,500 IU/day) for major depressive disorders and N-acetylcysteine (2-3 gm/day) in combination with drugs for mood disorders and schizophrenia. The term “emerging evidence” means there have been several recent studies reporting positive results, but more research is needed.

· The authors did not find evidence supporting the use of other vitamin and mineral supplements (E, C, zinc, magnesium, and inositol) for treating mental health disorders.

· The authors did not find enough high-quality studies to support claims about the effects of prebiotics or probiotics on mental health disorders.

Do Omega-3s Reduce Depression?

The evidence supporting the effectiveness of omega-3s in reducing symptoms of depression is strong. In the words of the authors: “The nutritional intervention with the strongest evidentiary support is omega-3, in particular EPA. Multiple meta-analyses have demonstrated that it has significant effects in people with depression, including high-quality meta-analyses with good confidence in findings…”

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· Depression can be a serious disease. If you just feel a little blue from time to time, try increasing your omega-3 intake. However, if you have major depression, don’t make changes to your treatment plan without consulting your physician.

· The best results were obtained when omega-3s were used in combination with antidepressants. This should be your starting point.

· Ideally, adding omega-3s to your treatment plan will allow your doctor to reduce or eliminate the drugs you are taking. That would have the benefit of reducing side effects associated with the drugs. However, I would like to re-emphasize this is a decision to take in consultation with your doctor. [My only caveat is if your doctor is unwilling to even consider natural approaches like omega-3 supplementation, it might be time to find a new doctor.]

· Finally, omega-3 supplementation is only one aspect of a holistic approach to good mental health. A healthy diet, exercise, supplementation, and stress reduction techniques all work together to keep your mind in tip-top shape.

The Bottom Line

There are lots of supplements on the market promising to cure depression and other serious mental health issues. Are they effective or are the claims bogus? Fortunately, a recent meta-review of 33 meta-analyses of high-quality clinical trials has answered that question. Here is their conclusion:

· The evidence is strongest for omega-3s and depression.

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

· There is fairly strong evidence for folate/folic acid supplements and depression, although there was large heterogeneity between trials.

· There is emerging evidence for vitamin D (>1,500 IU/day) and depression and N-acetylcysteine (2-3 gm/day) for depression and schizophrenia.

· Evidence for other supplements is currently inconclusive.

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· The best results were obtained when omega-3s were used in combination with antidepressants. That should be your starting point.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Omega-3 Supplements Reduce ADHD Symptoms?

December 3, 2019 by Dr. Steve Chaney

Will The Omega-3 Controversy Continue?

The prevalence of ADHD has increased dramatically in the last couple of decades. One study reported that the percentage of children diagnosed with ADHD has increased by 42% between 2003 and 2011. Another study reported an increase of 67% between 1997 and 2015. Currently, 10-12% of American schoolchildren are diagnosed with ADHD. That amounts to around 6 million children with ADHD, at a cost to taxpayers of over $45 billion.

An estimated 65% of children with ADHD are taking medications to control their symptoms. Unfortunately, those medications don’t work for 20-40% of patients with ADHD. Even worse, ADHD medications come with serious side effects like loss of appetite and delayed growth, sleep disorders, nausea & stomach pains, headaches, moodiness and irritability.

Even more worrisome is that many children say they “just don’t feel right” while they are on the drugs. Finally, there is the unintended message we are sending our children that drugs are the solution to their problems.

It is no wonder that millions of parents are looking for more natural solutions for their child’s ADHD. One of the most popular natural approaches is supplementation with omega-3s. But do omega-3 supplements work, or is this just another myth created by supplement companies to lighten your wallet?

The scientific evidence is conflicting. Some clinical studies support the efficacy of omega-3 supplements for reducing ADHD symptoms. Other studies claim they have no benefit.

In today’s issue of “Health Tips From The Professor”, I review a recent meta-analysis (JP-C Chang et al, Neuropsychopharmacology, 43: 534-545, 2018) that attempts to provide a definitive answer to this question.

How Was The Study Done?

This study was designed to answer three questions:

1) Does omega-3 supplementation reduce ADHD symptoms?

2) Does omega-3 supplementation improve cognitive skills in children with ADHD?

3) Is there an association between omega-3 status and ADHD?

Previous meta-analyses on these topics had design flaws such as:

· Including both children and adult subjects.

· Including subjects with diagnosis other than ADHD.

· Including trials that supplemented with vitamins and other nutrients in addition to omega-3s.

The authors of this study tried to avoid these limitations by using the following criteria for the studies that were included in their meta-analysis.

1) The studies were randomized, double-blind, placebo-controlled trials of omega-3 supplementation with DHA and EPA alone or in combination.

2) The participants were school-aged children (4-12 years) and adolescents (13-17 years) who had a diagnosis of ADHD.

3) The study measured the effect of omega-3 supplementation on clinical symptoms of ADHD or measures of cognitive performance (omission errors, commission errors, forward memory, backward memory, and information processing).

4) The studies were large enough to measure statistically significant differences.

5) The studies were published in peer-reviewed journals.

With these criteria there were:

· Seven studies with 534 children looking at the effect of omega-3 supplementation on ADHD symptoms.

· Three studies with 214 children looking at the effect of omega-3 supplementation on cognitive performance.

· Twenty studies with 1276 children looking at the association between omega-3 status and ADHD.

Do Omega-3 Supplements Reduce ADHD Symptoms?

The results of this meta-analysis were as follows:

1) Omega-3 supplementation significantly reduced ADHD symptoms reported by parents.

2) Omega-3 supplementation significantly improved cognitive measures associated with attention span (omission and commission errors). [Note: Omission errors consist of leaving important information out of an answer. Commission errors consist of including incorrect information in an answer.]

· Omega-3 supplementation did not improve cognitive measures associated with memory and information processing. This has also been reported in most previous studies.

· The best way to think of this is that children with ADHD are fully capable of learning their schoolwork. However, they may have trouble demonstrating what they have learned on exams because of omission and commission errors.

· In this context, omega-3 supplementation may help them perform better on exams and reduce test-taking anxiety.

3) For hyperactivity, only studies with EPA dosages of 500 mg per day or greater showed a significant reduction in symptoms.

4) Children diagnosed with ADHD have lower levels of DHA, EPA, and total omega-3s.

The authors concluded: “In summary, there is evidence that omega-3 supplementation … improves clinical symptoms and cognitive performances in children and adolescents with ADHD, and that these youth have a deficiency in omega-3 levels. Our findings provide further support to the rationale for using omega-3s as a treatment option for ADHD.”

They also said: “Our paper shows that EPA supplementation dosage >500 mg should be considered when treating youth with ADHD, especially those with predominantly hyperactivity/impulsivity presentation.”

Will The Omega-3 Controversy Continue?

This is an excellent study, but it is unlikely to be the final word on this subject. That is because there is a fundamental flaw in all previous studies on this important subject, including the ones included in this meta-analysis.

In the words of the authors: “In terms of ‘personalized medicine’, it is tempting to speculate that a subpopulation of youth with ADHD and low levels of omega-3s may respond better to omega-3 supplementation, but there are no studies to date attempting this approach.”

Until studies of omega-3 supplementation and ADHD symptoms include measures of omega-3 status before and after supplementation, those studies are likely to continue giving conflicting results. That is because:

· If most of the children in the study have low omega-3 status, we are likely to see a positive effect of omega-3 supplementation on ADHD symptoms.

· If most of the children in the study have high omega-3 status, we are likely to see a negative effect of omega-3 supplementation on ADHD symptoms.

What Does This Study Mean For You?

While this study is unlikely to end the omega-3 controversy, it is a very well-designed study that combines the results of multiple double-blind, placebo-controlled clinical trials. In short, it is a very strong study.

Omega-3s have no side effects and multiple health benefits. If your child suffers from ADHD, omega-3 supplementation is worth a try.

However, we need to keep omega-3 supplementation in perspective:

· Not every child with ADHD will respond to omega-3 supplementation.

· Omega-3s alone are likely to reduce, but not eliminate, the symptoms.

· There are other natural approaches that should be considered.

You will find details on omega-3s and other natural approaches for reducing ADHD symptoms in an earlier issue of “Health Tips From The Professor”.

The Bottom Line

A recent meta-analysis looked at the effect of omega-3 supplementatation on ADHD symptoms. Here is a brief summary of the data:

1) Omega-3 supplementation significantly reduced ADHD symptoms reported by parents.

· Omega-3 supplementation did not improve cognitive measures associated with memory and information processing. This has also been reported in most previous studies.

· In this context, omega-3 supplementation may help them perform better on exams and reduce test-taking anxiety.

3) For hyperactivity, only studies with EPA dosages of 500 mg per day or greater showed a significant reduction in symptoms.

4) Children diagnosed with ADHD have lower levels of DHA, EPA, and total omega-3s.

For more details on the study and a perspective on omega-3 supplementation compared to other natural approaches for reducing ADHD symptoms, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Can Fish Oil Make Children Smarter?

May 20, 2014 by Dr. Steve Chaney

When Do Omega-3 Supplements Make Sense?

Author: Dr. Stephen Chaney

We know that the omega-3 fatty acids found in fish oil are critically important for brain development. But will they really help our kids learn better? Some studies suggest that they do, while other studies have come up empty. Why is this? More importantly, what does it mean for your children? Will fish oil supplements help or not?

I’ve selected today’s study (Portillo-Reyes et al, Research in Developmental Disabilities, 35: 861-870, 2014) because it sheds some light on those important questions.

Can Fish Oil Make Children Smarter?

This study looked at the effect of supplementation for 3 months with 360 mg of EPA + DHA on cognitive function of malnourished Mexican children, ages 8-12 years old. The children came from poor neighborhoods where foods rich in omega-3 fatty acids were seldom available. Low intake of omega-3 fatty acids was confirmed by a food frequency survey.

Cognition was assessed based on a battery of 16 standardized cognition tests at the beginning of the study and again 3 months later.

The results were fairly clear cut. The children receiving the fish oil supplements showed significant gains in mental processing speed, visual-motor coordination, perceptual integration, attention span and executive function compared to children receiving a placebo. In case you were wondering, the first three most strongly affect a child’s ability to learn and last two affect their tendency to display ADHD symptoms.

What Is the Significance of This Study?

There are a lot of things not to like about the study:

It was a small study (59 children total)
Blood levels of omega-3 fatty acids were not determined.
It was a short term study (12 months would have been better).
Measuring the ability to learn is difficult. Experts in the field differ about which cognitive tests are best. I’m not taking a position on the adequacy of the tests they were using because that is not my area of expertise.
Because it was done in a poor region of Mexico, one could argue that its applicability to children in this country is uncertain.

So why even mention this study? That’s because it illustrates an important principle – one that is often ignored in the design and interpretation of clinical studies.

Simply put, the principle is that not everyone will benefit equally from supplementation. It is the malnourished and the sick who will benefit most. When you focus your clinical studies on those groups you are most likely to observe a benefit of supplementation. When you focus your study on well nourished, healthy individuals it will be much more difficult to observe any benefit. And if you perform a meta-analysis of all studies, without evaluating the studies on the basis of need – nutrition status and health status – benefits will also be much more difficult to demonstrate.

This study is just one example of that principle. In an earlier “Health Tips From the Professor” (Can DHA Help Johnny Read?) I reported on a study looking at the effect of DHA supplementation on reading ability of English schoolchildren. In that study, it was the children who were most deficient in DHA and started with the lowest reading skills who benefitted most from DHA supplementation.

What does all of this mean to you?

If you are a parent, you may be asking if a study done with Mexican children eating poor diets has any relevance for your kids. In today’s world of pop tarts and pizza it just might. Most children don’t order sardines on their pizza. As a consequence, many American children don’t get enough omega-3 fatty acids in their diet.

Should your children be getting more omega-3s in their diet? A recent study concluded that most American children only get 20-40 mg/day of DHA from their diet. So if your child’s food preferences don’t include salmon, sardines and the like – and if your child is experiencing learning issues or problems with ADHD, you might consider adding fish oil supplements to their diet. There’s no need to megadose. The international standard is around 200 mg/day of DHA for children 7 or older.

If you are one of those people who is confused by conflicting headlines about the benefits of supplementation, you may want to look at the studies behind those headlines and ask if supplementation would have been likely to provide any benefit in the subjects studied.

The Bottom Line:

1) A recent study reported that supplementation with fish oil significantly improved learning skills in children consuming a diet that was deficient in omega-3 fatty acids.

2) If your children are not consuming foods rich in omega-3 fatty acids such as coldwater fish, you might wish to make sure that they are getting adequate levels of omega-3 fatty acids in their diet. Most experts recommend around 200 mg/day for children over 7.

3) This study also illustrates the principle that supplementation is most likely to be of demonstrable benefit to those who have the worst diets and the greatest need. That doesn’t mean that supplementation won’t benefit everyone, but it does mean that it may be difficult to prove the value of supplementation in healthy people consuming a good diet.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Artificial Colors Cause Hyperactivity?

April 29, 2014 by Dr. Steve Chaney

Color Them Hyperactive

Author: Dr. Stephen Chaney

Each year between 3 and 10% of school aged children are diagnosed with attention deficit/hyperactivity disorder (ADHD), also known as hyperactivity.

Most of these children are currently being treated with drugs. And these drugs have side effects – ranging from relatively minor (loss of appetite, weight loss, insomnia and mood swings) to major (suicidal thoughts, psychotic behavior and drug abuse).

So it is only natural for parents to ask whether there is a more natural approach that they could follow and, more specifically, whether diet could make a difference.

The Feingold Diet And Hyperactivity

To answer that question let’s start by looking at just one aspects of children’s diets – the increasing prevalence of artificial food colors and preservatives in the diet. The average child today is consuming over 10 pounds of food additives every year!

The idea that food additives – specifically artificial colors and preservatives – might be responsible for hyperactivity was first raised by Dr. Ben Feingold over 30 years ago. He devised the Feingold Diet – a diet that was free of artificial food colors, preservatives
and other artificial food additives.

Some small scale clinical studies suggested that the diet might be successful and millions of parents used the diet for their hyperactive children with great success.

But the medical authorities pooh-poohed the Feingold Diet. They pointed out that when parents are putting their child on a special diet they are also giving that child more attention – and it might be the parent’s increased attention that decreased the child’s hyperactive behavior.

They also pointed out when you eliminate food additives from the diet you are decreasing the “junk” food and increasing fresh fruits and vegetables – in short the child’s diet is much healthier.

So eventually the Feingold Diet lost popularity – but the idea that artificial food colors & preservatives might trigger hyperactivity has refused to go away.

Do Artificial Colors Cause Hyperactivity?

In fact, a couple of recent studies have substantially strengthened the link between artificial ingredients and hyperactivity.

The first study was a meta-analysis of 15 previous studies looking at the effect of artificial food colors and preservatives on hyperactivity (Journal of Developmental & Behavioral Pediatrics, 25: 423-434, 2004).

This meta-analysis concluded that artificial food colors & preservatives caused an increase in hyperactivity in 28% of the children tested.

Almost all of the children in those previous studies were selected for the study because they had been diagnosed as hyperactive (ADHD). However, a more recent study looked at 297 children from Southampton England who had not been diagnosed as hyperactive (Lancet, 370: 1560-1567, 2007).

After an 8 week elimination phase in which artificial food colors and preservatives were removed from their diets, they were given a one week challenge consisting of fruit juice containing one of two different mixtures of four artificial food colors and the preservative sodium benzoate or a placebo.

The amount of artificial food colors and sodium benzoate in the fruit juice drinks was designed to match the average amount found in the English diet (which isn’t all that different from the American diet).

Once again, the results were clear. The amount of artificial food colors and preservatives found in the typical child’s diet is enough to trigger hyperactivity in many children.

The Bottom Line

So what does that mean to you if you have a hyperactive child? Could the simple act of eliminating artificial colors, flavors & preservatives from your child’s diet eliminate hyperactivity and give you back that calm, sweet child that you love?

The available data suggest that removing artificial food additives from your child’s diet can make a difference in their behavior, but I tend to side with experts who suggest that a holistic approach is best.
Eliminating food additives from your child’s diet is important, but also make sure the diet is a healthy one, that your child is getting all of the nutrients that they need and that they are getting all of the attention and support that they need.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Toxic Chemicals Lowering Our IQ?

February 25, 2014 by Dr. Steve Chaney

Is Chemical Brain Drain A Pandemic?

Author: Dr. Stephen Chaney

But, what if that were only the tip of the iceberg? For example, a recent headline stated: “More Toxic Chemicals [In Our Environment] Are Damaging Children’s Brains”. If that headline is true, it’s downright scary.

The Study Behind The Headlines

The paper that generated the headlines (Grandjean & Landrigan, The Lancet Neurology, 13: 330-338, 2014) was a review of the literature, not an actual clinical study.

Based on published clinical studies, the authors identified 12 chemicals commonly found in the environment as developmental neurotoxins (toxins that interfere with normal brain development) based. [If you would like to find out what those “Dirty Dozen” chemicals are and where they are found, click here.]

This finding compares with 6 developmental neurotoxins that they were able to identify in a similar study in 2006.

The authors were not claiming that the number or amount of toxic chemicals changed between 2006 and 2014. They were saying that science has advanced to the point where we can classify six more chemicals that have been in our environment for years as developmental neurotoxins.

Even more worrisome, the authors postulate that many more environmental neurotoxins remain undiscovered.

Are Toxic Chemicals Lowering Our IQ?

To answer that question, you need to look at some of the studies they cited in their review. For example:

Elevated blood lead levels in children are associated with as much as a 7 point decrease in IQ (Lamphear et al, Environmental Health Perspectives, 113: 894-899, 2005).

Elevated fluoride levels in drinking water are also associated with as much as a 7 point decrease in IQ (Choi et al, Environmental Health Perspectives, 120: 1362-1368, 2012).

The effects of many of the toxic chemicals on IQ were difficult to quantify, but the authors estimated that exposure of US children to just 3 of the chemicals (lead, methymercury and organophosphate pesticides) was sufficient to lower their average IQ by 1.6 points.

What Are The Potential Consequences?

The authors spoke of the environmental neurotoxins they identified as representing a “silent pandemic of a chemical brain drain” that could cost the US economy billions of dollars.

One of the blog posts I read on this topic summarized the consequences in a very graphic manner. It said:

If one child’s IQ is reduced by 5 points, it doesn’t appear to make a big difference. For example, that child might be:

A little slower to learn
A little shorter of attention
A little less successful at tests and at work

That might result in $90,000 in lost lifetime earnings

However, if the average IQ of every child in the US were decreased by 5 points, the effect becomes significant:

Only half as many members of the next generation would be “intellectually gifted”.
Twice as many of the next generation would be “intellectually impaired”
Lost productivity could be in the billions

Of course, statements like that are a bit over the top. Drs. Grandjean and Landrigan did not claim that the net effect of the chemicals they identified was a 5 point drop in IQ. Nor did they claim that all US children were affected equally.

Still, it’s enough to make you think.

Are Toxic Chemicals Causing Behavior Problems?

Autism has increased by 78% since 2007 and now affects 1 of 88 eight year old children.

ADHD has increased by 43% since 2003 and now affects 11% of children age 4-17.

Is The Science Solid?

This is a difficult area of research. You can’t do the gold standard double-blind, placebo-controlled clinical trial. Nobody in their right mind would give one group of children toxic chemicals and the other group a placebo.

The studies cited in this paper were mostly population studies. Basically this means that they compared children with exposure to certain toxic chemicals to a control group that was as similar as possible to the first group except that their exposure to the toxic chemicals was less.

As a consequence it becomes important to ask how many studies come to the same conclusion. For some of the toxic chemicals, such as lead, methymercury and organophosphate pesticides, the weight of evidence is very strong. For some of the newer additions to their list of developmental neurotoxins, it is pretty clear that the chemicals have neurotoxic properties, but the significance of those effects on the developing human brain are hard to quantify at this point.

The Bottom Line:

1) A recent review claims that there is a good scientific basis for classifying at least 12 environmental chemicals as developmental neurotoxins that are likely to reduce IQ and contribute to behavioral problems in US children. [If you would like to find out what those “Dirty Dozen” chemicals are and where they are found, click here.]

2) The science behind the claims in this review is solid, but not iron-clad.

4) We all need to be guardians of our personal environment. But, it is not easy. The “Dirty Dozen” chemicals identified in this study come from many sources:

Some are industrial pollutants. For those, we need lobby for better environmental regulation.

Some are persistent groundwater contaminants. For those we need to drink purified water whenever possible.

Some are insecticides and herbicides used in agriculture. For those we need to buy organic, locally grown produce when feasible.

Some are found in common household products and furnishings. For those we need to become educated label readers and use non-toxic products in our home whenever possible.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

The Dirty Dozen

February 25, 2014 by Dr. Steve Chaney

Environmental Toxins That Affect Brain Development

Author: Dr. Stephen Chaney

In a recent review, Drs. Grandjean and Landrigan (The Lancet Neurology, 13: 330-338, 2014) identified 12 toxic chemicals which are abundant in our environment and are developmental neurotoxins.

These are all chemicals that damage brain development. They can cause decreases in IQ and aggressive or hyperactive behavior in children – and that those changes may be permanent.

Let’s look at these developmental neurotoxins and where they are found.

The Dirty Dozen

In their review Grandjean & Landrigan identified 6 developmental neurotoxins that were known in 2006, and 6 more chemicals that have been confirmed to be developmental neurotoxins between 2006 and 2023.

Developmental Neurotoxins Known in 2006 and their sources:

Lead

Main Sources: paint, gasoline, solder and consumer products such as toys & jewelry

Current status: Lead has been banned in paint since 1978 and from gasoline since 1996. Millions of houses still contain lead paint. Other current sources are inexpensive toys and costume jewelry imported from China and other countries without tight regulations.
The EPA estimates that 1 million children in the US are affected by elevated lead levels.

Methylmercury

Main Sources: discharges into air & water from coal-burning power plants, mining, pulp & paper industries.

Polychorinated biphenyls (PCBs)

Main Sources: transformers and many commercial products

Current status: Banned in 1979, but continues to be a common environmental contaminant because this group of chemicals is very long-lived.

Arsenic:

Main Sources: extraction of metals from rock (smelting), algaecides, herbicides, pesticides and pressure-treated wood.

Current status: Pressure treated wood banned in 2003 for residential use. Still found in some playgrounds and older buildings.

Toluene:

Main Sources: gasoline. It is also a solvent for paints, paint thinners, spot removers, adhesives, antifreeze, & some consumer products like fingernail polish removers.

Current status: Common in consumer products. Read labels and make sure windows are open if you use.

Developmental Neurotoxins Identified Since 2006 and their sources:

Manganese

Main Sources: municipal wastewater discharge, emissions generated during alloy, steel & iron production, emissions from burning of fuel additives

Flouride

Main Sources: naturally elevated in groundwater in certain regions, added to municipal water supply, most bottled beverages and toothpaste.

The American Academy of Pediatrics has warned that children drinking fluoridated water, fluoridated beverages, using fluoridated toothpaste and receiving fluoride treatments for their teeth may be receiving excess fluoride.

Chlorpyrifos

Main Sources: insecticide

Current status: Banned for use in homes in 2001. Still one of the most widely used insecticides in agriculture.

DDT

Main Sources: insecticide

Current status: Banned for use in this country in 1972. DDT and its breakdown products still found in our water supply. DDT still in use in agriculture and insect control in some countries.

Trichloroethylene (TCE)

Main Sources: widely used in dry cleaning fabrics, the textile industry and metal degreasing

Current status: Found in groundwater due to discharge from factories and dry cleaners.

Polybrominated diphenyl ethers (PBDEs)

Main Sources: flame retardants – used in building materials, electronics, mattresses & household furniture, plastics, polyurethane foams & textiles.

Current status: Readily leached into the environment. Found in dust, water, food & human breast milk

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Omega-3 Fatty Acids And Brain Health

December 3, 2013 by Dr. Steve Chaney

Is it How Much You Eat, or How Much You Keep?

Author: Dr. Stephen Chaney

Why do some studies conclude that omega-3 fatty acids are essential for a strong mind, a strong heart and will wipe out inflammation – while other studies suggest that they are ineffective? The simple answer is that nobody really knows.

However, in the process of reviewing two recent studies on omega-3 fatty acids and brain health I made an interesting observation that offers a possible explanation for the discrepancies between studies. And if my hypothesis is correct, it suggests that the design of many of the previous studies with omega-3 fatty acids is faulty.

Omega-3 Fatty Acids And Brain Health

The first study (J.K. Virtanen et al, J Am Heart Assoc, 2013, 2:e000305 doi: 10.1161/JAHA.113.000305) looked at the effect of omega-3 fatty acids on brain function in older adults (>65 years old). It concluded that high omega-3 levels were associated with better white matter grade and a 40% reduction in subclinical infarcts (Sorry for the technical jargon – but both of those are good things in terms of brain function for those of us who are getting a bit older).

The second study (C. M. Milte et al, J of Attention Disorders, 2013, doi: 10.1177/1087054713510562) looked at the effect of omega-3 fatty acids on children (ages 6-13) with ADHD. It concluded that high omega-3 levels were associated with improved spelling and attention and reduced oppositional behavior, hyperactivity, cognitive problems and inattention.

What Is The Common Thread In These Studies?

Why, you might ask, am I comparing a study in the elderly, where the concern is retention of cognitive skills, with a study on ADHD in children?

That’s because there is a very important common thread in those two studies. It wasn’t the amount of omega-3 fatty acids in their diet that counted. It was the levels of omega-3 fatty acids in their blood that made the difference.

The first study included a detailed dietary history to estimate the habitual intake of omega-3 fatty acids in the participants.

There was no correlation between estimated dietary intake of omega-3 fatty acids and any measure of brain function in those older adults.

However, there was a strong correlation between blood levels of omega-3s and brain health in that population group.

The second study was actually a placebo controlled intervention study in which the children were given 1 gm/day of either omega-3 fatty acids or omega-6 fatty acids.

Once again, there was no correlation between dietary intake of omega-3 or omega-6 fatty acids and any outcome related to ADHD.

However, there was a strong correlation between blood levels of omega-3 fatty acids or omega-3/omega-6 ratio and improvement in multiple measures of ADHD.

How Could The Effect of Dietary Intake And Blood Levels Of Omega-3s Be So Different?

Both studies were relatively small and suffered from some technical limitations, but the most likely explanations are:

Inaccurate recall of the participants as to what they eat on a habitual basis. (study 1)

Individual differences in the ability of participants to convert short chain omega-3 fatty acids (found in foods such as canola oil, flaxseed oil and walnuts) to the beneficial long chain fatty acids (found in cold water fish). (study 1)

Poor compliance in taking the supplements. (study 2)

Why Are These Studies Important?

The most important insight to come out of both of these studies is that it is essential to actually measure blood levels of omega-3 fatty acids and not just rely on dietary intake or supplementation for a valid clinical trial.

That’s a concern because blood measurements of omega-3 fatty acids are expensive and have not been a part of many of the clinical studies that have been performed to date. Even the largest, best designed clinical study is worthless if the dietary recalls aren’t accurate or people don’t take their capsules.

We need to go back and reevaluate many of the clinical studies that have been published.

We need to ask:

Are their conclusions valid?

Did some studies fail to show that omega-3s were effective simply because they only measured dietary intake and not how much of the omega-3s actually accumulated in the blood?

The Bottom Line

High blood levels of omega-3s in the blood correlated with improved brain health in the elderly and reduced ADHD symptoms in children

These studies were small, but they are consistent with a number of other studies that have come to similar conclusions.

Blood levels of omega-3s are better predictors than dietary intake for evaluating the health benefits of omega-3 fatty acids.

Many previous studies that failed to find an effect of omega-3 fatty acids on brain health, heart health or inflammation did not actually measure blood levels of the omega-3 fatty acids. These studies should be reevaluated.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.