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1998;43:315-19), and a recent double-blind, placebo-controlled Stevens and his team also showed that both clinical signs and study has shown the benefits of omega-3 fatty acids on the short- blood biochemical indices of fatty acid deficiency were signifi- term course of illness in bipolar disorder (Stoll, A.I. et al., Arch. cantly associated with the severity of reported behavioural prob- Gen. Psychiatry 1999;56:407-12). lems and the incidence of learning and health problems (Stevens, Poor motor coordination is frequently observed in those with LJ. et al., Physiol. Behav. 1996;59:915-20). ADHD and, similarly, "soft" neurological signs such as motor Another team (Bekaroglu, M. et al., J. Child Psychol. overflow movements are also relatively common (Denckla, M.B. Psychiatry 1996;37:225-7) has reported that the mean serum free et al., Arch. Neurol. 1978;42:228-31). fatty acid level in 48 ADHD children was significantly lower than Movement disorders in the general population are associated in 45 matched controls. A further, significant correlation was with deficiencies in LC-PUFAs (Nilsson, A. et al., PLEFA found between zinc and free fatty acid levels in the ADHD 1996;55:83-7) and thus poor motor coordination would be children. consistent with a lack of fatty acids. Early studies of GLA supplementation showed only equivocal ADHD's observed overlap with dyslexia or modest benefits (Arnold, L.E. et al., (see above) appears to be stronger for atten- Biol. Psychiatry 1989;25:222-8) probably tional disorder without overt hyperactivity because, as Richardson and Puri suggest than for the mainly hyperkinetic form (PLEFA 2000, op. cit.), n-3 rather than n-6 (Dykman, R.A., Ackerman, P.T., J. Learn. fatty acid deficiency is more relevant in Disabil. 1991;24:96-103). The shared fea- ADHD and because of the short treatment tures include particular problems in specific duration. Recent research indicates that aspects of visual and cognitive function LC-PUFA levels in the brain may take up (Conners, C.K., in Ravlidis, G., ed., ao A . to three months to recover from a chronic Perspectives on Dyslexia Vol. 1, Wiley, Deficiency in fatty acids deficiency state (Bourre, J.-M. et al., Chichester, 1990:163-95). Deficiency in has been proposed as PLEFA 1993;4:171-80), and this must been fatty acids has been proposed as contribut- . . . taken into account in future studies. ing to dyslexia, and there is growing evi- contributing to dyslexia, At a National Institutes of Health special dence that supplementation can help allevi- and there is growing workshop on omega-3 essential fatty acids ate aspects of the disorder (Stordy, B.J., 2000, op. cit.). and psychiatric disorders, held in Bethesda, Maryland, on September 2-3, 1998, J. R. Burgess (1998) from the Purdue team presented preliminary results of a double-blind trial with ADHD chil- dren with clinical signs of fatty acid deficiency. They found that supple- mentation with a combination of DHA, EPA, AA and DGLA (weight- ed in favour of the n-3 fatty acids) successfully changed the blood fatty acid profile of ADHD children, from which followed reductions in ADHD symptoms. However, another double-blind trial showed no benefits from supple- menting with pure DHA (Voight, R., evidence that supplementation can help alleviate aspects of the disorder. Evidence of EFA deficiency or abnormality in ADHD In an early study, Michell and his colleagues found lower plasma levels of DGLA, AA and DHA in 44 ADHD children compared with 45 matched controls (Clin. Pediatr. 1987;26:406-11). They also found that significantly more of 48 ADHD children com- pared with 49 age- and sex-matched controls suffered from polydypsia and polyuria as well as health prob- lems and language, learning and read- ing difficulties. NIH, Bethesda, 1998). Richardson and Puri (p. 84) suggest that More recently, studies at Purdue University have provided fur- one reason may be that DHA alone is ineffective and that other ther confirmation of abnormal fatty acid metabolism in ADHD. fatty acids, especially EPA, may account for the Purdue study's A team led by Stevens (Am. J. Clin. Nutr. 1995;62:761-8) found positive findings. They also point to the differences in subject that, compared with 43 normal controls, 53 ADHD boys: selection; the Purdue study selected children based on prior indi- * were less likely to have been breast-fed (breast milk contains cations of fatty acid deficiency, while no such pre-treatment the pre-formed LC-PUFAs such as AA and DHA, whereas most _ indices were used in the other, which adopted very strict exclu- formulas do not); sion criteria, excluding any co-morbidity and ensuring that the * were more likely to suffer from allergies and other health sample consisted of children with "pure" ADHD diagnoses. problems (already known to be linked with EFA deficiency); To investigate the importance of EPA, Richardson is currently * showed clinical signs of EFA deficiency (excessive thirst, fre- involved in a study of the effects of supplementing ADHD chil- quent urination, dry skin and hair, and soft or brittle nails); dren with Eye Q (www.equazen.com), a product that contains a * had reduced blood levels of certain LC-PUFAs (especially 4:1 ratio of EPA to DGHA. Results may be available by the end AA, EPA and DHA) but not their EFA precursors; of the year. + had an adequate dietary intake of the EFA precursors. The results support the hypothesis of EFA abnormalities in Zinc status and colourings/heavy metal toxicity ADHD and confirm that the problem lies in the conversion of Complementing Richardson's research on direct nutrition, work EFAs to LC-PUFAs. Some 40% of ADHD children had a raised by Dr Neil Ward, in the Chemistry Department at the University frequency of clinical fatty acid deficiency signs compared with of Surrey and adviser to the HACSG, and others has emphasised only 9% of controls. the critical importance of maintaining adequate zinc levels and has been proposed as contributing to dyslexia, and there is growing evidence that supplementation can help alleviate aspects of the disorder. Zinc status and colourings/heavy metal toxicity Complementing Richardson's research on direct nutrition, work by Dr Neil Ward, in the Chemistry Department at the University of Surrey and adviser to the HACSG, and others has emphasised the critical importance of maintaining adequate zinc levels and NEXUS = 23 Deficiency in fatty acids OCTOBER — NOVEMBER 2001 www.nexusmagazine.com