Something’s Fishy


OK, it’s a goofy title, but kudos to the NY Times for a relatively-balanced article on fish oils for kids in this week’s special "Well" section.

The New York Times
September 15, 2008

Feeling Good About Fish Oil


A FEW months ago, while sharing a
hotel room with him during a family trip, Melissa Jump noticed that her
4-year-old son was grinding his teeth at night. He had recently
developed some other unnerving routines, too — organizing and
reorganizing the pillows on his bed, covering his ears to block out
noise (even the flushing of a toilet) and refusing to get in the car or
go anywhere without his blanket.

Her pediatrician’s recommendation? A nutritional supplement
(inositol, sometimes referred to as B-8) and large doses of fish oil.

“I saw a difference within a week,” Mrs. Jump said of her son, who
now takes a teaspoon of fish oil, containing omega-3 fatty acids,
daily. “He’s more chill; he can roll with things more. He asks about
his blanket every once in a while, but it’s no big deal.”

Like many other doctors, the Jumps’ pediatrician, Dr. Sandy Newmark,
who practices integrative medicine in Tucson, Ariz., acknowledges that
research on fish oil therapies is limited. There isn’t even a consensus
about what the optimal doses and appropriate combinations are for
polyunsaturated fatty acids like the omega-3s. But many parents
concerned about the side effects of conventional medications are
turning to fish oil first, to treat not just mood disorders but also a
variety of learning and developmental problems, including autism,
and, most notably, attention
deficit hyperactivity disorder
, or A.D.H.D.

Fish oil contains long-chain polyunsaturated fatty acids; most
important are the omega-3 fatty acid docosahexaenoic acid, or DHA,
believed to play a central role in the development of the infant brain
and nervous system, and eicosapentaenoic acid, or EPA. Studies have
consistently found that children with A.D.H.D. have low blood levels of
DHA, which is in short supply in the Western diet
generally, and a small number of recent clinical trials have reported
improvements in children’s learning and behavioral problems after fish
oil therapy.

Some health care practitioners say fish oil therapy can improve
children’s attention and focus, and studies of adults have found it may
alleviate depression.
But many doctors who prescribe it use it as just one component of a
comprehensive treatment program, and many prescribe fish oil in
addition to medication, not instead of it.

“Grandma was right: cod liver oil is good for you,” said Dr. Edward
Hallowell, founder of the Hallowell Center for Cognitive and Emotional
Health in Sudbury, Mass., and an author of several books on A.D.H.D. as
well as the director of a small pilot study on fish oil. But though he
routinely recommends it, he said, “It takes more than fish oil to cure

Dr. Lawrence D. Rosen, a pediatrician who practices integrative
medicine in Oradell, N.J., said that some families were using fish oil
along with nutritional supplements, vitamins
and various educational and behavioral interventions, and that their
children were able to function well without medication. But, he
acknowledged, “These are generally not the kids who have severe
behavioral difficulties or incredible hyperactivity.”

Treatment with fish oil alone is controversial. Dr. Betsy Busch, an
A.D.H.D. specialist who wrote a commentary on the topic last year, said
that while she has been intrigued by the potential of fatty acid
supplementation, it’s premature to substitute fish oil for known,
effective medications.

“There’s too much going on for us not to want to pursue this idea,
but right now we’ve got a sort of hodgepodge of information,” said Dr.
Busch, whose commentary on fatty acid supplementation, “Fishy,
Fascinating and Far From Clear,” was published last year in The Journal
of Developmental and Behavioral Pediatrics.

“If fish oil is being prescribed in a way that delays a child’s
access to treatments we know are effective, I think that’s not a good
moral decision. If you’ve got the ability to improve a child’s quality
of life, I think that’s a responsibility you can’t turn your back on
just because fish oil seems so exciting.”

STUDIES on fish oil therapy have had mixed results. A clinical trial
in Australia, published last year in The Journal of Developmental and
Behavioral Pediatrics, found improvements in parents’ ratings of their
children’s hyperactivity and inattention, but no difference in
teachers’ assessments. Meanwhile, the Oxford-Durham study in Britain,
published in the journal Pediatrics in 2005, reported remarkable
improvements in reading and spelling among children treated with
omega-3 fatty acids.

“The therapy improved their inattention, in particular, and seemed
to allow them to concentrate and stay on task better,” said Paul
Montgomery, an author of the Oxford-Durham study.

But neither of these studies involved children with a clear A.D.H.D.
diagnosis, and an earlier 2001 clinical trial carried out at the Mayo Clinic, involving
children formally diagnosed with A.D.H.D., found no decrease in
symptoms after four months of therapy.

Other unresolved questions have to do with the appropriate doses of
fish oil as well as the optimal ratio of omega-3 to omega-6
polyunsaturated fatty acids.

Most health care providers suggest 1,000 milligrams of combined DHA
and EPA daily for a child, and up to 2,000 milligrams for an adult, but
they say they adjust the amounts depending on weight. Some experts
recommend higher doses to get the full therapeutic effect, but there
are risks. Fish oil is a blood thinner and can interfere with clotting
and cause excessive bleeding, which can be dangerous. Doctors say
anyone with a family history of a bleeding disorder should avoid it.

Mercury contamination is also a concern, doctors say, and parents
should make sure to purchase only purified pharmaceutical-grade fish
oil. They emphasize that patients should take fish oil only under the
supervision of a health care provider, and that they should remember to
inform all their health care providers that they are taking it.
Treatment should be stopped several weeks before elective surgery or
even a minor procedure like a tooth extraction.

“Talk with your pediatrician,” Dr. Hallowell said. “This is all
uncharted territory.”

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