Beware of new Research on Omega 3 Supplements

If you seen articles on a recent study about Omega 3 supplements and ADHD please be aware that some of the reporting is rather misleading. This study was a twelve week study of 92 children and teens with ADHD between the ages of 6 and 18 who were given high doses of the omega-3 fatty acid eicosapentaenoic acid (EPA) or a placebo.

Many of the articles, which were obviously spun off the researcher’s media release, included statements such as:

“Omega-3 fish oil supplements can improve attention in children with attention deficit hyperactivity disorder (ADHD) just as much as drug treatments, but only in those whose blood levels of omega-3 are low, trial results showed on Wednesday.” ^[i]

“The results showed that of the participants who received the supplement, those who had the lowest levels of EPA in their blood showed improved focused attention and vigilance. “ ^[ii]

“Our results suggest that fish oil supplements are at least as effective as conventional pharmacological treatments among those children with ADHD who have omega-3 deficiency,” said Dr Jane Chang, co-lead researcher at King’s College London.[iii]

I read these articles with great interest since at CADDAC we frequently receive calls from parents asking about Omega 3 supplements as a treatment for ADHD and it has been a while since any significant research findings have been reported. But, while reading the various articles that popped up in my Goggle Alerts, alarm bells started ringing in my head. The quotes seemed to be an overstatement of the findings. This can occur when a researcher is eager to promote their research findings, whether significant or not. It is then compounded by media who do not have the expertise to question the research methodology or results, but simply regurgitate the media release.

This is of great interest to me because I frequently have these type of research claims quoted to me by those with little expertise in the field of ADHD or by those with an agenda to discredit ADHD. Or, others may be interested in promoting a treatment that is not backed by good, peer reviewed, large scale, duplicatable research. So, I did some more digging and came across two excellent articles that told a more complete storey about the research methodology and how the quoted research findings were obtained.

The fist article Here's The Real Truth About Treating ADHD With Omega-3 Fish Oil Pills does an excellent job at summing up past research. 

• Results of a review of 10 placebo-controlled trials in 2013 showed mixed results. Two studies showed a significant benefit; while 6 showed no benefit at all, and 2 indicated some benefits on certain rating scales.
• A more recent review in 2017 of 16 studies showed 13 studies indicated some minimal benefits in ADHD symptoms, including hyperactivity, impulsivity and inattention as well as other mild benefits in visual learning, word reading, and memory. However, improvement while modest may require taking high doses for months.
• In 2018 another review warned medical practitioners not to reinforce the idea that Omega 3 supplements can replace other treatments that have shown greater benefits.  

It also helped to put the study’s claims into perspective by including a statement by the authors admitting that more research is definitely required before these supplements can be recommended as a treatment for ADHD.

However, there is an even more interesting article, Despite Claims, EPA Supplement Does Not Improve ADHD Symptoms in Youth which looks at the complex and questionable process the researchers used to find the results they were looking for.

I will share a few of the highlights of the researchers’ process outlined in this article, but I strongly suggest that you read the article in its entirety if you are interested in learning about how ADHD research can be manipulated and then spun in the media.

Apparently after finding little difference between the placebo and the Omega supplement treatment group’s functioning, except for one showing a benefit for the placebo treatment, the researchers started to break down the results into subscales. The author of this article, Peter Simons points out that this could be considered over-testing to create the desired outcomes the researchers were looking for since none of these tests were included in the initial study design.

Out of the 34 subscale tests that were analyzed two tests favoured the placebo and one test favoured the EPA supplement. The other 31 tests showed no difference between EPA and placebo.

I strongly suggest that you read Mr. Simon’s entire article if you are interested in the further sub scaling of tests and possible flaws in the research analysis, but at the end of a very long convoluted process the researchers found something they could use.  

At the end of his article Peter Simon shows us how the researchers were able to come up with their media statements. The researchers broke the subjects into those with lower and higher pre-existing EPA levels. There was no explanation as to what normal levels for children at a certain age would be and if the children in each group varied in age, but the researchers found that when grouped into EPA levels:

• Youth with low and intermediate EPA levels had no difference in ADHD scores and emotion/social functioning scores, whether they took the EPA supplement or the placebo
• But, 5 subscales showed that youth did better on placebo if they had high EPA levels and 2 subscales indicated that they did better on the Omega supplements if they had low EPA levels
• While 27 subscales reported that youth did exactly the same whether they took EPA or a placebo no matter what their EPA levels were.

These results hardly seem to warrant the quote, “"Our study sets an important precedent for other nutritional interventions, and we can start bringing the benefits of 'personalized psychiatry' to children with ADHD." By Professor Carmine M. Pariante.

I took the time to really look into this study for two reasons, my own curiosity and to better inform our stakeholders. However, I chose to write about it because this type of misleading reporting by both the researchers and the media causes great harm to the ADHD community and the validity of ADHD research in general.  

Heidi Bernhardt

[i] https://www.thechronicleherald.ca/news/world/omega-3-oils-boost-attention-as-much-as-adhd-drugs-in-some-children-378192/

[ii] https://www.medicalnewstoday.com/articles/327083.php#1

[iii] https://www.sciencefocus.com/news/omega-3-fish-oil-can-reduce-adhd-symptoms/