DHA and the Developing BrainJuly 2006
By Julius G. Goepp, MD
DHA Supplementation After Delivery
The importance of adequate DHA intake for women does not end with the birth of a healthy baby. DHA continues to accumulate in the brains of infants and young children through at least the second year of life;25 however, human infants may have a limited ability to synthesize DHA, making them dependent on dietary sources such as breast milk, formula, or DHA supplements.26
It has long been known that breast-feeding is superior to formula-feeding for many reasons, not the least of which is that breast-fed infants have higher IQs and more advanced cognition than do bottle-fed babies.27,28 It is now becoming clear that one of the reasons for this difference may be that breast milk normally contains DHA; until recently, formula has not contained DHA.
Like the placenta, the milk-producing apparatus in the human breast routinely extracts DHA and other brain-nourishing fatty acids from the mother’s blood in preference to other fats, delivering the highest possible amounts to the breast-fed infant. Again, this effect can occur at the expense of the mother’s own DHA supplies if steady intake is not assured. The DHA content of the maternal diet is the most important factor determining how much DHA is found in breast milk. Some experts have raised concerns that the consumption of otherwise healthy low-fat diets by women of reproductive age could reduce the amount of DHA available to them during pregnancy and lactation.8
Breast-milk content and fat composition reflect maternal plasma lipid profiles, which themselves depend on maternal diet and supplementation.29 Given the known low levels of DHA in most women’s diets, this observation strongly suggests that DHA supplementation in nursing mothers is critical to optimizing brain development in their infants.
DHA supplementation of nursing mothers increases the DHA content in their milk and in infant red blood cells,20 which is associated with enhanced visual acuity at four months30,31 and early language development in breast-fed infants.25 High maternal DHA intake is also associated with improved long-term growth in breast-fed children.22
A direct relationship between breast milk DHA content and childhood IQ was demonstrated in 2004.27 Breast milk was analyzed for fatty acid composition at one and three months of age, and children’s IQ scores were measured at 6.5 years of age. Longer duration of breast-feeding and higher ratios of DHA to arachidonic acid (a precursor to DHA) were associated with higher total IQ scores in these school-aged children.
The beneficial effects of early DHA consumption last well beyond the period of supplementation. A 1998 study demonstrated that infant performance on a problem-solving test (related to later IQ scores) at 10 months was superior in a group of infants who had received DHA-supplemented formulas from birth to four months.26 These results again demonstrate the importance of early DHA supplementation for long-term brain development and function.
Adding DHA to infant formula produces dramatic results. A 1995 study measured developmental quotient (an early surrogate measure of IQ) at four months of age in a group of infants who received normal (unsupplemented) formula, DHA-supplemented formula, or breast milk. The developmental quotient of the DHA-supplemented and breast-fed infants was significantly higher than that of infants who were fed the unsupplemented formula.4 Plasma, red blood cell, and brain lipid levels of DHA are lower in infants whose diets do not contain DHA. In infants who are fed DHA-supplemented formulas, clear advantages have been demonstrated in visual acuity at two and four months of age, and in neurodevelopmental status at 12-18 months of age.29 Companies that manufacture infant formula are now rushing to catch up with breast milk by adding DHA to their products.32
A randomized clinical trial in 2000 demonstrated a mean increase of seven points on the Mental Development Index of the Bayley Scale of Infant Development in infants who received DHA-supplemented formula for the first 17 weeks of life.33 These infants showed superior performance on both the cognitive and motor sub-scales of the Mental Development Index. The same investigators later showed that DHA supplementation enhanced visual acuity (as measured by visual evoked potential) and must be continued beyond six weeks of age to have maximum benefit.34
DHA’s Effects on Behavior After Infancy
DHA’s importance in prenatal and infant brain development—and its impact on IQ, other measures of cognition, and vision—are no longer in question. However, behavioral scientists are now discovering that DHA supplementation in older children, teens, and even adults can have powerful and beneficial effects on behavior, mood, and learning.
In animal studies, deprivation of omega-3 fatty acids such as DHA increases depression and aggression.36 Scientists have recently hypothesized that decreased consumption of omega-3 fatty acids could be a risk factor for human depression and suicide, and some evidence from human volunteer studies suggests that increased intake of these fats can reduce impulsive and aggressive behavior.37 These findings make biochemical sense because DHA is important in mitigating the human stress response through its role in regulating stress mediators such as catecholamines (epinephrine and norepinephrine) and pro-inflammatory cytokines.38
In randomized, controlled trials, DHA supplementation was recently shown to prevent increased age-related aggression among girls aged 9-12,39 and to reduce perceived stress among high-stress adults.38 As its benefits become more evident, fish oil supplementation is becoming increasingly routine in many adolescent behavioral care facilities. In communication with Life Extension, Tiesha D. Johnson, RN, BSN, a staff nurse at a large psychiatric and behavioral center for children and adolescents in western New York, noted that fish oil is prescribed regularly to children with impulse-control and attention disorders.
Attention deficit hyperactivity disorder (ADHD) in children may be related to deficiencies or excessive breakdown of DHA and related lipids.40 Adults with ADHD symptoms have lower blood DHA levels than do healthy controls.41 Low plasma DHA levels have also been associated with other neuro-psychiatric conditions, including Alzheimer’s disease, schizophrenia, and depression, and studies of DHA supplementation show that DHA holds promise in improving these conditions.42
Early studies of DHA supplementation in children with ADHD produced conflicting results, though all found DHA to be safe and well tolerated.43,44 In 2005, however, Alex Richardson and his colleagues at Oxford University demonstrated the success of DHA supplementation in a group of schoolchildren with developmental coordination disorder.5 This condition affects up to 5% of school-aged children and is closely related to other common disorders such as dyslexia and ADHD. In Richardson’s randomized, controlled trial of 117 children aged 5-12, supplementation with omega-3 fatty acids produced significant improvements in reading, spelling, and behavior.
Omega-3 fatty acid status has a powerful influence on a host of other adult behavioral and psychiatric conditions. A recent study demonstrated that cocaine addicts with higher baseline DHA levels were less likely to relapse than were those with lower levels.45 Adult women with borderline personality disorder who received omega-3 fatty acid supplements had diminished aggression and less severe depressive symptoms than controls.46 Finally, elderly adult white-collar workers who received DHA supplements experienced significantly decreased aggression compared to subjects who received placebo.47
DHA’s stunning success in enhancing brain development and childhood IQ is likely to be a topic of intense study for decades. Fish oil really is “brain food,” and thanks to the availability of toxin-free DHA supplements, expectant mothers can provide its benefits to their future offspring with great confidence. Moreover, a veritable ocean of research confirms that fish oil offers profound benefits for mental health and well-being throughout infancy and adolescence, and all the way through adulthood.
Julius G. Goepp, MD, is a pediatrician with additional certification in pediatric emergency medicine. He received his MD from the University of Maryland and is currently Senior Consultant at Lupine Creative Consulting, Inc., in Rochester, NY.
1. Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE. Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the secondary prevention of otitis media in young children: pilot research. Ann Otol Rhinol Laryngol. 2002 Jul;111(7 Pt 1):642-52.
2. Lovegrove JA, Brooks CN, Murphy MC, Gould BJ, Williams CM. Use of manufactured foods enriched with fish oils as a means of increasing long-chain n-3 polyunsaturated fatty acid intake. Br J Nutr. 1997 Aug;78(2):223-36.
3. Decsi T, Koletzko B. N-3 fatty acids and pregnancy outcomes. Curr Opin Clin Nutr Metab Care. 2005 Mar;8(2):161-6.
4. Agostoni C, Trojan S, Bellu R, Riva E, Giovannini M. Neurodevelopmental quotient of healthy term infants at 4 months and feeding practice: the role of long-chain polyunsaturated fatty acids. Pediatr Res. 1995 Aug;38(2):262-6.
5. Richardson AJ, Montgomery P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 2005 May;115(5):1360-6.
6. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics. 2003 Jan;111(1):e39-e44.
7. Denomme J, Stark KD, Holub BJ. Directly quantitated dietary (n-3) fatty acid intakes of pregnant Canadian women are lower than current dietary recommendations. J Nutr. 2005 Feb;135(2):206-11.
8. Innis SM. Polyunsaturated fatty acids in human milk: an essential role in infant development. Adv Exp Med Biol. 2004;554:27-43.
9. Innis SM. Essential fatty acid transfer and fetal development. Placenta. 2005 Apr;26 Suppl AS70-5.
10. Innis SM, Elias SL. Intakes of essential n-6 and n-3 polyunsaturated fatty acids among pregnant Canadian women. Am J Clin Nutr. 2003 Feb;77(2):473-8.
11. Bowen RA, Clandinin MT. Dietary low linolenic acid compared with docosahexaenoic acid alter synaptic plasma membrane phospholipid fatty acid composition and sodium-potassium ATPase kinetics in developing rats. J Neurochem. 2002 Nov;83(4):764-74.
12. Haubner LY, Stockard JE, Saste MD, et al. Maternal dietary docosahexanoic acid content affects the rat pup auditory system. Brain Res Bull. 2002 May;58(1):1-5.
13. Schiefermeier M, Yavin E. n-3 Deficient and docosahexaenoic acid-enriched diets during critical periods of the developing prenatal rat brain. J Lipid Res. 2002 Jan;43(1):124-31.
14. Hamilton L, Greiner R, Salem N, Jr., Kim HY. n-3 fatty acid deficiency decreases phosphatidylserine accumulation selectively in neuronal tissues. Lipids. 2000 Aug;35(8):863-9.
15. Neuringer M, Connor WE, Lin DS, Barstad L, Luck S. Biochemical and functional effects of prenatal and postnatal omega 3 fatty acid deficiency on retina and brain in rhesus monkeys. Proc Natl Acad Sci USA. 1986 Jun;83(11):4021-5.
16. Anderson GJ, Neuringer M, Lin DS, Connor WE. Can prenatal N-3 fatty acid deficiency be completely reversed after birth? Effects on retinal and brain biochemistry and visual function in rhesus monkeys. Pediatr Res. 2005 Nov;58(5):865-72.
17. Hogyes E, Nyakas C, Kiliaan A, et al. Neuroprotective effect of developmental docosahexaenoic acid supplement against excitotoxic brain damage in infant rats. Neuroscience. 2003;119(4):999-1012.
18. Smuts CM, Huang M, Mundy D, et al. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol. 2003 Mar;101(3):469-79.
19. Cheruku SR, Montgomery-Downs HE, Farkas SL, Thoman EB, Lammi-Keefe CJ. Higher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am J Clin Nutr. 2002 Sep;76(3):608-13.
20. Helland IB, Saugstad OD, Smith L, et al. Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women. Pediatrics. 2001 Nov;108(5):E82.
21. Cohen JT, Bellinger DC, Connor WE, Shaywitz BA. A quantitative analysis of prenatal intake of n-3 polyunsaturated fatty acids and cognitive development. Am J Prev Med. 2005 Nov;29(4):366-74.
22. Lauritzen L, Hoppe C, Straarup EM, Michaelsen KF. Maternal fish oil supplementation in lactation and growth during the first 2.5 years of life. Pediatr Res. 2005 Aug;58(2):235-42.
23. Malcolm CA, McCulloch DL, Montgomery C, Shepherd A, Weaver LT. Maternal docosahexaenoic acid supplementation during pregnancy and visual evoked potential development in term infants: a double blind, prospective, randomised trial. Arch Dis Child Fetal Neonatal Ed. 2003 Sep;88(5):F383-90.
24. Malcolm CA, Hamilton R, McCulloch DL, Montgomery C, Weaver LT. Scotopic electroretinogram in term infants born of mothers supplemented with docosahexaenoic acid during pregnancy. Invest Ophthalmol Vis Sci. 2003 Aug;44(8):3685-91.
25. Lauritzen L, Jorgensen MH, Olsen SF, Straarup EM, Michaelsen KF. Maternal fish oil supplementation in lactation: effect on developmental outcome in breast-fed infants. Reprod Nutr Dev. 2005 Sep;45(5):535-47.
26. Willatts P, Forsyth JS, DiModugno MK, Varma S, Colvin M. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet. 1998 Aug 29;352(9129):688-91.
27. Gustafsson PA, Duchen K, Birberg U, Karlsson T. Breastfeeding, very long polyunsaturated fatty acids (PUFA) and IQ at 6 1/2 years of age. Acta Paediatr. 2004 Oct;93(10):1280-7.
28. Auestad N, Scott DT, Janowsky JS, et al. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003 Sep;112(3 Pt 1):e177-83.
29. Heird WC. The role of polyunsaturated fatty acids in term and preterm infants and breastfeeding mothers. Pediatr Clin North Am. 2001 Feb;48(1):173-88.
30. Lauritzen L, Jorgensen MH, Mikkelsen TB, et al. Maternal fish oil supplementation in lactation: effect on visual acuity and n-3 fatty acid content of infant erythrocytes. Lipids. 2004 Mar;39(3):195-206.
31. Carlson SE, Ford AJ, Werkman SH, Peeples JM, Koo WW. Visual acuity and fatty acid status of term infants fed human milk and formulas with and without docosahexaenoate and arachidonate from egg yolk lecithin. Pediatr Res. 1996 May;39(5):882-8.
32. Heird WC, Lapillonne A. The role of essential fatty acids in development. Annu Rev Nutr. 2005;25:549-71.
33. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol. 2000 Mar;42(3):174-81.
34. Birch EE, Hoffman DR, Castaneda YS, et al. A randomized controlled trial of long-chain polyunsaturated fatty acid supplementation of formula in term infants after weaning at 6 wk of age. Am J Clin Nutr. 2002 Mar;75(3):570-80.
35. Foran JA, Good DH, Carpenter DO, et al. Quantitative analysis of the benefits and risks of consuming farmed and wild salmon. J Nutr. 2005 Nov;135(11):2639-43.
36. DeMar JC, Jr., Ma K, Bell JM, et al. One generation of n-3 polyunsaturated fatty acid deprivation increases depression and aggression test scores in rats. J Lipid Res. 2006 Jan;47(1):172-80.
37. Brunner J, Parhofer KG, Schwandt P, Bronisch T. Cholesterol, omega-3 fatty acids, and suicide risk: empirical evidence and pathophysiological hypotheses. Fortschr Neurol Psychiatr. 2001 Oct;69(10):460-7.
38. Bradbury J, Myers SP, Oliver C. An adaptogenic role for omega-3 fatty acids in stress; a randomised placebo controlled double blind intervention study (pilot) [ISRCTN22569553]. Nutr J. 2004 Nov 28;320.
39. Itomura M, Hamazaki K, Sawazaki S, et al. The effect of fish oil on physical aggression in schoolchildren—a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005 Mar;16(3):163-71.
40. Ross BM, McKenzie I, Glen I, Bennett CP. Increased levels of ethane, a non-invasive marker of n-3 fatty acid oxidation, in breath of children with attention deficit hyperactivity disorder. Nutr Neurosci. 2003 Oct;6(5):277-81.
41. Young GS, Maharaj NJ, Conquer JA. Blood phospholipid fatty acid analysis of adults with and without attention deficit/hyperactivity disorder. Lipids. 2004 Feb;39(2):117-23.
42. Young G, Conquer J. Omega-3 fatty acids and neuropsychiatric disorders. Reprod Nutr Dev. 2005 Jan;45(1):1-28.
43. Hirayama S, Hamazaki T, Terasawa K. Effect of docosahexaenoic acid-containing food administration on symptoms of attention-deficit/hyperactivity disorder - a placebo-controlled double-blind study. Eur J Clin Nutr. 2004 Mar;58(3):467-73.
44. Horrocks LA, Yeo YK. Health benefits of docosahexaenoic acid (DHA). Pharmacol Res. 1999 Sep;40(3):211-25.
45. Buydens-Branch, Branchey M, McMakin DL, Hibbeln JR. Polyunsaturated fatty acid status and relapse vulnerability in cocaine addicts. Psychiatry Res. 2003 Aug 30;120(1):29-35.
46. Zanarini MC, Frankenburg FR. Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167-9.
47. Hamazak T, Thienprasert A, Kheovichai K, et al. The effect of docosahexaenoic acid on aggression in elderly Thai subjects—a placebo-controlled double-blind study. Nutr Neurosci. 2002 Feb;5(1):37-41.