The Brain on Lipids: A Different Approach to Managing ADHD Through Nutrition
Recent research suggests complex lipid imbalances may be an underlying biological component of ADHD.
A recent study1 published in the journal Pediatrics supports a connection between lipids, specifically Omega-3 fatty acids, and attention-deficit hyperactivity disorder (ADHD). However, a deeper dive into the available research suggests that complex lipid imbalances need to be addressed.
Complexity of Diagnosis
The prevalence of ADHD in the U.S. has been rising steadily. Rates of ADHD diagnosis increased an average of three percent each year from 1997 to 2006 and an average of about five percent each year from 2003 to 2011, according to the Centers for Disease Control and Prevention (CDC)2. The disorder is often found alongside many other disorders related to behavior, learning or mood, including, but not limited to, oppositional defiant disorder and anxiety disorder3.
A Quick Lesson on Lipid Imbalances
The brain loves healthy fats (or lipids). In fact, the brain is one of the organs richest in lipid content. Lipid imbalances occur when there is a change in the amount of lipids found in the body resulting from a health condition, disorder, or disease. These causes lead to lower production of lipids or rapid breakdown of lipids that inhibits normal bodily function. These changes may lead to harmful processes4 that ultimately affect brain structure and function5. Various studies show that lipid imbalances are a factor associated with ADHD and other neurodevelopmental disorders, such as autistic and schizophrenic spectrum disorders6 7 8. Several studies demonstrate that patients with ADHD have lower levels of Omega-3s in their blood compared to individuals without the disorder9 10.
Researchers continue to test the efficacy of omega-3s, mainly in the form of triglycerides – commonly known as fish oil11 12 — as a nutritional approach to reducing ADHD-associated behaviors, including hyperactivity, restlessness, and emotional dysregulation. However, the data on the use of omega-3 fatty acids for ADHD is inconsistent, as some studies have shown a benefit and others have not. The inconclusive results generally reported for omega-3 fatty acids seems to suggest that supplying omega-3s alone may not be enough, as there may be additional lipid imbalances that are not being addressed. In addition, research suggests that delivering omega-3s in phospholipid form may reach the brain more efficiently than omega-3s delivered in triglyceride (or triacylglycerol) form13 14.
Phospholipids for the Management of ADHD
A study published in the American Journal of Clinical Nutrition found that omega-3s delivered in a phospholipid composition (specifically phosphatidylserine attached to omega-3s, or commonly known as “PS-Omega-3s”) resulted in a greater reduction of ADHD symptoms versus omega-3s delivered in the triglyceride form15. In another double blind, placebo-controlled study, PS-Omega-3s was shown to significantly improve ADHD behaviors, especially in children with more pronounced emotional dysregulation16. Emotional dysregulation is characterized by rapid, poorly controlled shifts in emotion, mood swings, and behavioral outbursts.
The current body of research suggests that modifications in brain cell membrane phospholipid composition may play a key role in various neuronal disorders, including ADHD. In addition, increasing intake of omega-3s from fish oil alone may not be sufficient to address complex lipid imbalances.
When exploring ways to safely manage ADHD behaviors, families should ask their physician about possible lipid imbalances and nutritional options to help rebalance the lipid levels in the brain.
1 Alejandra Ríos-Hernández, José A. Alda, Andreu Farran-Codina, Estrella Ferreira-García, Maria Izquierdo-Pulido. “The Mediterranean D|et and ADHD in Children and Adolescents.” Pediatrics, Jan 2017. e20162027. DOI: 10.1542/peds.2016-2027
2 Centers for Disease Control and Prevention. ADHD Data & Statistics. cdc.gov/ncbddd/adhd/data.html. Accessed December 19, 2013.
3 Green M, Wong M, Atkins D, et al. Diagnosis of Attention Deficit/Hyperactivity Disorder. Technical Review 3. Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research; 1999. AHCPR publication 99-0050.
4 Kosicek, M. and S. Hecimovic, Phospholipids and Alzheimer’s disease: alterations, mechanisms and potential biomarkers. Int J Mol Sci, 2013. 14(1): p. 1310-22.
5 Janssen, C.I. and A.J. Kiliaan, Long-chain polyunsaturated fatty acids (LCPUFA) from genesis to senescence: the influence of LCPUFA on neural development, aging, and neurodegeneration. Prog Lipid Res, 2014. 53: p. 1-17.
6 Brown, C.M. and D.W. Austin, Autistic disorder and phospholipids: A review. Prostaglandins Leukot Essent Fatty Acids, 2011. 84(1-2): p. 25-30
7 du Bois, T.M., C. Deng, and X.F. Huang, Membrane phospholipid composition, alterations in neurotransmitter systems. Prog Neuropsychopharmacol Biol Psychiatry, 2005. 29(6): p. 878-88.
8 Richardson, A.J. and M.A. Ross, Fatty acid metabolism in neurodevelopmental disorder: a new perspective on associations between attention-deficit/hyperactivity disorder, dyslexia, dyspraxia and the autistic spectrum. Prostaglandins Leukot Essent Fatty Acids, 2000. 63(1-2): p. 1-9.
9 Young, G.S., N.J. Maharaj, and J.A. Conquer, Blood phospholipid fatty acid analysis of adults with and without attention deficit/hyperactivity disorder. Lipids, 2004. 39(2): p. 117-23.
10 Antalis, C.J., et al., Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids, 2006. 75(4-5): p. 299-308.
11 Gillies D, Sinn JKh, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2012 Jul 11;(7):
12 Bloch, M.H. and Qawasmi A., Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry, 2011. 50(10): p. 991-1000.
13 Vaisman N, Pelled D., n-3 phosphatidylserine attenuated scopolamine-induced amnesia in middle-aged rats. Prog Neuropsychopharmacol Biol Psychiatry, 2009. 33(6):p. 952-9.
14 Liu L, Bartke N, Van Daele H, Lawrence P, Qin X, Park HG, et al. Higher efficacy of DHA provided as a phospholipid than as a triglyceride for brain DHA accretion in neonatal piglets. J Lipid Re,2014. 55:p. 531–9
15 Vaisman, N., et al., Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of n-3 fatty acids containing phospholipids. Am J Clin Nutr, 2008. 87(5): p. 1170-80.
16 Manor I, Magen A, Keidar D, et al. The effect of phosphatidylserine containing omega3 fatty-acids on attention-deficit hyperactivity disorder symptoms in children: a double-blind placebo-controlled trial, followed by an open-label extension. Eur Psychiatry, 2012. 27:p. 335-342.