Your online resource for objective ADHD information

Introduction

Whether you have only recently learned that you have ADHD or you know someone with this condition, you’ll find information on here to keep you updated with developments in the treatment field, including medical research and health news. Our ongoing dialogue with our customers enables us to keep providing you with information and support. Look out for our monthly enews (sign up here) and articles from leading experts in the field. You can find general health information on our blog where you’ll find our articles from our in-house nutritionists as well as guest practitioners, events and webinar information and our media cuttings archive.

Symptoms

Attention-deficit hyperactivity disorder (ADHD) and attention-deficit disorder (ADD) refer to a range of problem behaviours generally associated with poor attention span. Symptoms include restlessness, hyperactivity and inattentiveness, often leading to problems with academic achievement, both in terms of language and literacy skills, as well as a reduced ability to cope with certain social situations.

Core symptoms include an inability to remain attentive or to concentrate, the propensity to become very easily distracted, as well as the display of inappropriate levels of activity and impulsivity. The activity is sometimes characterised by fidgeting and general restlessness; the impulsivity can present itself as inappropriate speech (i.e. blurting out words when it is not suitable to do so) or hitting out. Children with ADHD may be unable to sit still or pay attention in the classroom, for example.

In general, ADHD is a persisting disorder with many children continuing to have significant difficulties in adulthood. ADHD is thought to affect about 3–9% of school age children and young people in the UK, and about 2% of adults worldwide.

Causes

The causes of ADHD are still somewhat unclear, although it is believed that a combination of genetic, environmental and dietary factors all contribute to risk. Scientists will often use twin studies to evaluate genetic links to many disorders and diseases. For example, if one identical twin has ADHD, it is more likely that the other will also have, or later develop, symptoms as well. Whilst this genetic link is becoming clearer, it is unlikely that one gene alone is responsible but that ADHD is caused in part by several genes, which all make a small contribution to the onset of this disorder. ADHD is a condition which falls within a class of disorders termed ‘neurodevelopmental disorders’.

Simply put, neurodevelopmental disorders are due to an impairment of the growth and development of the brain or central nervous system. Some of the genes which are thought to contribute to the development of ADHD are genes that control certain types of neurotransmitters (chemicals involved in signalling between nerve cells in the brain). Defects in one or more of these genes may contribute to a greater risk of developing ADHD. Two well-studied genes are those that control the production of dopamine and noradrenaline, levels of which are often low in ADHD. Both of these neurotransmitters are heavily involved in behaviour. It’s not all about our genes, of course. It appears that people with ADHD can have abnormalities in certain areas of the brain which control activities associated with self-control and result in the core symptoms of ADHD – hyperactivity, impulsiveness and inattention.

To summarise, it is thought that an imbalance of some of the neurotransmitter chemicals in the brain and changes in the structure of areas of the brain play a key role in ADHD.

Environmental factors

These are factors that are associated with a higher risk of ADHD but do not involve our genes – in other words we do not inherit an increased disposition. Environmental factors in ADHD could include complications during pregnancy, at birth or shortly after birth. Increasing exposure to toxic chemicals is also thought to play a role in ADHD risk. For example, smoking, drinking alcohol or use of drugs during pregnancy, or even high levels of stress whilst pregnant, can all affect the development of the baby’s brain.

Fatty acids

Fatty acids are fundamental to our health and well-being as they are essential constituents of every living cell in the human body. EPA is an omega-3 fatty acid, which derives from oily fish. GLA is a unique omega-6 fatty acid, derived from virgin evening primrose oil characterised by its ability to shuttle the normally inflammatory omega-6 pathway to an anti-inflammatory route. Combining GLA with EPA therefore has dual benefits, and deficiencies in these important fatty acids can impact negatively on various aspects of our health;  communication between the cells may be affected which, in the case of the dopamine pathway, could impact on functions such as attention and concentration – both being fundamental factors in ADHD.

Some studies have found that children with ADHD have lower levels of long-chain fatty acids than other children. It is suggested that individuals with ADHD may not obtain sufficient levels from food, or they lack the enzyme that converts short-chain fatty acids from foods we eat to the important eicosanoid-producing fatty acids (EPA and DHA in particular, which can be directly sourced from oily fish). Another hypothesis is that the turnover of these long-chain fatty acids is elevated and the body cannot replenish them at a fast enough rate. Direct supplementation is therefore a sensible way to overcome both possibilities: either an inability to produce them physiologically or an increase in their turnover necessitates higher intake of these essential nutrients.

As low omega-3 levels are associated with low levels of dopamine, a neurotransmitter known to be dysfunctional in ADHD, supplementing any imbalances or deficiencies may improve behavioural and learning difficulties associated with the condition. Studies are supporting this approach, with results suggesting that by supplementing the diet of a child with ADHD with purified fish oil, improvements are seen in relation to inattention, hyperactivity and impulsivity, when compared to a placebo. What appears to be most interesting, however, is that the overall evidence from different randomised, placebo-controlled, double-blind studies shows that EPA, rather than DHA, may be the omega-3 fatty acid most effective in tackling the symptoms of ADHD.

Prevention or treatment of a fatty acid deficiency may be dealt with by taking a fatty acid supplement that is rich in EPA and GLA. Although DHA plays an important structural role in the brain, taking pure EPA without DHA will not impact negatively on DHA levels, as DHA is made endogenously (within the body) directly from EPA stores.  Unlike EPA, DHA stores remain relatively stable but clinical research shows that in the case of ADHD, the higher the ratio of EPA to DHA in a supplement, the more effective the supplement becomes (Bloch & Qawasmi 2011).

Defining EPA as the active ingredient within fish oils has helped clarify why many omega supplements have simply failed to worked.  As such, EPA is now becoming a recognised add-on or alternative treatment where pharmaceuticals may not always be optional or functional.  Interestingly, the addition of the anti-inflammatory omega-6 fatty acid GLA further enhances the actions of EPA, offering additional benefits to a treatment regime.

Pilot trial highlights co-therapy potential of Vegepa E-EPA 70

Clinical evidence published in the Journal of Child Neurology demonstrated positive outcomes with Vegepa E-EPA 70 in children with ADHD, all of whom were resistant to treatment with methylphenidate, commonly known as Ritalin. 81.2% showed statistically significant improvements in restlessness, 87.5% in aggressiveness and 70.8% in anger control.  Furthermore, 83.3% showed statistically significant improvements in cooperation with both parents and teachers, with 77.1% of children showing improved educational functioning and academic performance.

Recommendation

With its high EPA content we recommend our original patented formula, Vegepa E-EPA 70.

  • Children below six years should take 1 capsule daily.
  • Children aged six years and over should take 2 capsules daily.

For children who have difficult swallowing capsules, we recommend Vegepa E-EPA 70 Orange Chewables. These are sugar-free, naturally flavoured with orange oil and free from salicylates (chemicals found in oranges and orange products which can trigger ADHD symptoms). The paste inside these chewable capsules may also be mixed into yoghurt.

  • Children aged three to six years should take two capsules daily.
  • Children aged six years and over should take 4-6 capsules daily.

References

Bloch MH & Qawasmi A. (2011) Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child Adolescent Psychiatry 50:991-1000.

Curtis LT & Patel K. (2008) Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review. Journal of Alternative and Complement Medicine 14:79-85.

Perera H, Jeewandara KC, Seneviratne S & Guruge C. (2012) Combined Omega-3 and Omega-6 supplementation in children with attention deficit hyperactivity disorder refractory to methylphenidate treatment: a double-blind placebo-controlled study.  Journal of Child Neurology 27:747-753.

Puri BK. (2005) Attention-Deficit Hyperactivity Disorder – A Natural Way to Treat ADHD, (Hammersmith Press, London) ISBN 1-905140-01-0.

Richardson AJ. (2000) Fatty acid metabolism in neurodevelopmental disorder: a new perspective on associations between attention-deficit hyperactivity disorder, dyslexia, dyspraxia and the autistic spectrum.  Prostaglandins Leukotrienes & Essential Fatty Acids 63:1-9.

Richardson AJ. (2001) Fatty Acids in Dyslexia, Dyspraxia, ADHD and the Autistic Spectrum. Nutrition Practitioner 3:18-24.

Richardson AJ. (2012) Review: ω-3 fatty acids produce a small improvement in ADHD symptoms in children compared with placebo. Evidence Based Mental Health 15:46-47

Richardson AJ & Montgomery P. (2005)  The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics 115:1360-6.

Richardson AJ & Puri BK. (2000) The potential role of fatty acids in attention-deficit/hyperactivity disorder. Prostaglandins Leukotrienes & Essential Fatty Acids 63:79-87. Review.

Richardson AJ & Puri BK. (2002) A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Progress in Neuropsychopharmacology & Biolomedical Psychiatry 26:233-9.

Richardson AJ & Ross MA.  (2000) Fatty acid metabolism in neurodevelopmental disorder: a new perspective on associations between attention-deficit/hyperactivity disorder, dyslexia, dyspraxia and the autistic spectrum. Prostaglandins Leukotrienes & Essential Fatty Acids 63:1-9. Review.

Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC &  Heird WC. (2001) A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. Journal of Pediatrics 139:189-96.