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oil per 10 kg of body weight which on average gave a dose of about 8.5 g/day of an oil containing 84 % omega-3 fatty acids and a ratio of EPA/DHA of about 2. Attention was focused on the ratio of arachidonic acid (AA) to EPA in the blood samples. This ratio is viewed as a measure of inflammatory status and as well is a related to the dietary omega- 6/omega-3 ratio. Before supplementation, the AA/EPA ratio for those with ADHD was about 41 whereas for the controls it was about 28, the difference being significant. Supplementation reduced the ratio to about 4 in the ADHD group and this was accompanied by significant improvement in measures of inattention and hyperactivity. The authors suggest that the results may indicate a

to controls is consistent with a study of Antgalis et al (Prostaglandins, Leukotrienes and Essential Fatty Acids, 2006;75:299-08) where it was found that in ADHD patients, this ratio was 36% higher than in controls. The diagnostic utility of this ratio remains to be studied but these results are suggestive.

The reader is referred to Barry Sears’ book The Anti-inflammation Zone for a general discussion of the AA/EPA ratio which he calls the “Silent Inflammation Profile.” The implications of a high ratio go well beyond ADHD and related disorders, and is important for all age groups. In Canada, at least one nationwide clinical laboratory offers an

assay that measures this ratio.

connection fluidity and this ratio. considered

between ADHD and cell membrane architecture, both of which depend on

They also suggest the ratio be as a marker to support ADHD diagnosis










assumption. Germano, M. et al. Plasma, Red Blood Cells Phospholipids and Clinical Evaluation after Long Chain Omega-3 Supplementation in Children with Attention Deficit Hyperactivity Disorder. Nutritional Neurosciences, 2007, Vol. 10, No. 1-2, pp. 1-9.

Editor’s comments: In a recent review regarding 0mega-3 fatty acids and ADHD (International Review of Psychiatry, 2006;18(2):155-72), Richardson lists five randomized, controlled trials of the effect of omega-3 supplementation on ADHD and related developmental disorders in children. Three yielded positive results but the daily amounts of EPA arranged from 80 mg to 558 mg and DHA

ranged from 174 mg to 480 mg.

Compared to the

study of Germano, these are very low doses.







primarily or exclusively with DHA. The author points out that this is consistent with other studies suggesting that EPA may be more efficient than DHA in treating functional disturbances of attention, cognition or mood. More studies are needed to assess the dose-benefit relationship. However, the impact of very large doses of fish oil on the AA/EPA ratio has been studied by Young et al (Reproductive Nutrition and Development, 2005;45:549-58). By using 39 g/day of an oil containing 92% EPA and DHA for 12 weeks, the AA/EPA ratio dropped by almost 92%, and the final ratio was 1.4 which is on a par with populations that consume large amounts of fish. Some would have real trouble taking 39 g/day of fish oil!




A randomized clinical trial of the effect of omega-3 supplementation on ADHD symptoms has recently reported. It involved 103 Australian children (74% boys) between the ages of 7 and 12 years. The children had all been diagnosed with ADHD and had scores two standard deviations or more above the general population on the Conners abbreviated ADHD Index, a standard ADHD assessment tool. The trial participants were randomized to receive either placebo capsules (palm oil), fatty acid capsules (providing 560 mg/day of EPA, 175 mg/day of DHA, 60 mg/day of gamma-linolenic acid, and 10 mg/day of vitamin E), or fatty acid capsules

  • +

    a multivitamin tablet containing low (RDA)

amounts of vitamin and minerals.

After 15 weeks all children were given fatty acid capsules + daily multivitamin for a further 15 weeks. They were evaluated for ADHD symptoms after 15 and 30 weeks. At 15 weeks their scores on the Conners Parent Rating Scale were significantly reduced in regard to hyperactivity, inattention and impulsivity, and improvement was also noted in the sub-scores for perfectionism and social problems. There was no indication that adding the multivitamin to the fatty acid regimen had any additional benefits. Improvements continued until the end of the trial at week 30 at which time 40-50% of the treated children showed improvements corresponding to at least one standard deviation on the Conners ADHD Index. This improvement is equivalent to, or slightly better than, the improvement observed after 4

weeks of treatment methylphenidate (Ritalin).



The observation of Germano that the AA/EPA ratio was significantly elevated in ADHD patients relative

According to Canadian researchers who performed a meta-analysis of 62 randomized trials of Ritalin, there is no evidence that this drug is effective

International Health News

November 2007

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