Positive Health Online

It has been estimated that between 5 and 10 percent of the population have behavioural difficulties,[1] with many youngsters so diagnosed displaying delayed language development, poor social skills and a lack of co-ordination.

Christopher concentrating on his maths at the local Kumon Maths Centre

It has been estimated that between 5 and 10 percent of the population have behavioural difficulties,[1] with many youngsters so diagnosed displaying delayed language development, poor social skills and a lack of co-ordination. They experience failure from an early age, become isolated and may suffer from bullying. Such children are of average or above average intelligence, but have problems with spelling and handwriting even though reading may not be a problem. In other words, these children display those 'symptoms' characterized by the term dyspraxia. This, and other conditions such as dyslexia, attention deficit hyperactivity disorder (ADHD) and possibly autism in some cases have a high comorbidity (35-40%),[1] making it reasonable to assume some sort of common external influence.

An increasingly important external factor is that of nutrition.[2] Everything we eat and drink is made up of chemicals, and as chemicals have a direct impact on both body and mind, it would seem reasonable that nutrition would impact upon our behaviour and our perception. One area of investigation that I have found to offer a good outcome for some children is that of essential fatty acids, because of the role they play in our development and well-being.

Essential fatty acids (EFAs) are polyunsaturated and mono-unsaturated fatty acids that cannot be produced by the body and must therefore be obtained in our diet. EFAs fall into two main groups, Omega-3s and Omega-6s (although there is a group of Omega-9s which have a cholesterol- lowering effect). The Omega-6 group of oils are readily available in such foods as safflower and sunflower oil and we are therefore not likely to be deficient in them. The Omega-3s occur naturally in fish, wheat germ, flaxseed oil, nuts and seeds and to a lesser degree in navy beans and oatmeal. It can be seen then that because the mainstream western diet has excluded these sources in recent years, getting the right balance of Omega-3 EFAs has become more problematical.

To see how these EFAs can help with developmental disorders we must first answer the following questions: Firstly, why are EFAs helpful? Next, where are EFAs helping? Lastly, what can we do about it?

Why are EFAs helpful?

We have long known that one of the Omega-3 oils, eicosapentaenoic acid (EPA) strengthens the cardiovascular system, lowering a person's risk of developing heart disease and helping to keep arteries clean. However recent research has highlighted another Omega-3 EFA, found in abundance in fish oil, called docosahexaenoic acid or DHA, and its relationship to brain function and vision.[3]

In the 1980s and 90s a considerable amount of research focused upon the importance of maternal diet and its relationship with feeding problems in new-born infants.[4,5] With the increased survival rate amongst pre-term babies, it was also crucial to find a pre-term formula[6] that would not disadvantage those infants who were not being breast-fed.[5] Research findings demonstrated that DHA (a long-chain polyunsaturated fat) found in breast milk was the key to improving development throughout pregnancy and beyond, and in particular the crucial four-week period after birth.[7,8] We know then that DHA is crucial for our development, but why?

Where are EFAs helping?

The human brain is 60 percent fat, of which 25 percent is DHA. This increases to between three and five times its normal level in the crucial growth spurt periods during the fifth week of pregnancy and in the last trimester.[9] Crucially, DHA coats the receptor sites of our brain cells and is a prime modulator in retinal performance as well as specific brain functions such as memory, attending ability, speech, and specific motor skills; those same indicators of neurological immaturity found in those with behavioural difficulties. A lack of DHA therefore manifests in varying degrees of developmental disorders.

What can we do about it?

It is certain then that DHA, an Omega-3 EFA, is crucial to us from the moment of conception, throughout our growth in the womb, in infancy and beyond. We cannot manufacture it and must therefore ensure a continuing supply in our diet. A lack of DHA leads to developmental immaturity that can affect us throughout our lives.[10,11] There is, however, something that we can do about it, and studies have shown that increasing dietary DHA can lead to significant improvements. In one study involving 600 children and young adults with developmental difficulties, it was discovered that of those children who did not appear to follow the usual pattern of early development, 70% had significant feeding problems from birth.[1] As a result of this study, many of the children and young adults subsequently used DHA supplements in their diets. Some parents reported immediate improvements in their children's co-ordination and ability to process information. The study does give one note of caution; when children and adults have shown elevated levels of electrical activity (diagnosed epilepsy), the introduction of long-chain polyunsaturated fatty acids into their diets has resulted in an increased number of seizures.

A fine study by Dr Jacqueline Story[12] demonstrated the link between DHA supplementation and dyslexia in adults. For one month, dyslexic patients were given a daily dose of 480mg DHA. These patients showed a significant improvement in both dark adaptation (night vision) and central processing performance.

Such studies demonstrate that we can do something to help redress the balance when things go wrong. There is a strong causal link between the Omega-3 group of EFAs, our development and our well-being. Dietary DHA has been shown to give significant improvements to co-ordination and the ability to process information.[1] Further, the addition of EPA and vitamin E has been shown to enhance the effects of DHA.[12] Research also shows the importance of a good, clean source of these essential fatty acids and vitamins. When choosing a supplement, try to find one that contains high levels of DHA, and in addition contains EPA and vitamin E. In this way you will ensure a balanced intake that will work well together and give good absorption. Most Omega-3 fatty acids are extracted from fish oil, so add more seafood to your diet. Ensure your seafood is fresh, comes from a clean source, and is as natural and pure as possible. This may sound a little strange, but fish (and fish oil capsules) from polluted water or fish that has been processed in some way will probably not be a good source of EFAs.

Lastly, do not expect miracles but find some way in which to measure any improvement and keep a written record. This could be a simple writing exercise repeated each week, motor co-ordination practice like balancing on one foot, concentrating on a simple task and observations about general well-being.

Case Study

Christopher (see photo at top of page) is 8 years old. He was born at 37 weeks and weighed 8lb 9oz. As Christopher was demanding to be fed every 2 hours, his mother was advised to stop breast-feeding after 3 weeks.

Since then Christopher had regular antibiotics as an infant for ear infections, spells of wheezing but was not asthmatic, occasional outbreaks of mild eczema, an allergy to strawberries and an overall sensitive digestive system. Early attempts at dietary intervention included a few foods diet. This caused great stress to Christopher's body with no clear outcome.

Christopher also has a history of hyperactivity, poor concentration, aggressive and disruptive behaviour (including swearing) and finds it difficult to cope with groups. He has no difficulty with fine or gross motor co-ordination, has a reading age (accuracy and comprehension) well above his chronological age and his numeracy skills, although slightly low, are within the average range of ability.

He has been diagnosed as having 'Attention Deficit Hyperactivity Disorder' (ADHD) and has been treated with Methylphenidate Hydrochloride (Ritalin) since 1997.

I saw Christopher and his mum in August 1999 and we discussed his diet, moods, stress factors and well-being at some length. Christopher has a sweet tooth, and although his diet is very good there are some food items that could be eliminated or reduced. As well as a suspected leaky gut, Christopher demonstrated possible allergic reactions to as yet unidentified food sources (apart from the strawberries). I say 'possible' because I did not want to ignore the possibility of stress factors.

I recommended that three areas should be addressed:

First a detox in order address a leaky gut, the possibility of Candida albicans and to enable the gut to absorb nutrients more efficiently. Second, small dietary changes to eliminate the main allergens, control blood sugars and improve the gut. Third, supplements to balance the immune system, increase the amount of essential nutrients from a known clean source and, most importantly, boost the intake of DHA.

Detox: To gently cleanse Christopher's gut and enable it to work more efficiently I gave aloe-vera gel, starting at 1 teaspoon twice a day and building up to 1 tablespoon twice a day. I use a pure, organic aloe-vera gel as I find that the juices are not sufficiently concentrated to be effective. (This needs careful monitoring and the amount should be reduced and then slowly increased if stools get too loose).Water intake is also increased.

Diet: Eliminate dairy products as much as possible and remove 'fast releasing carbohydrates' including sugar, grapes, sweet drinks and very refined foods such as white bread and breakfast cereals (rapid sugar jolts contribute greatly to hyperactivity). Increase intake of organic foods.

Supplements: Essential fatty acids DHA and EPA with vitamin E (an antioxidant which prevents the breakdown of essential fatty acids). I use 1 high dose capsule from a guaranteed clean source (containing 150mg DHA, 225mg EPA with added vitamin E) three times a day. In addition Christopher was placed on a children's bioavailable multivitamin and mineral formula and a dose of phytonutrients which include green barley, alfalfa and wheatgrass.

Monitoring: Christopher was asked to fill in a 'feelings' chart several times a day and his handwriting, moods and concentration span were monitored (see example).

Outcome: The first thing that Christopher's parents noticed was a drastic reduction in swearing (within 1 week). He now tolerates some foods which would normally have upset his 'sensitive bowel' (within 3 months). His handwriting started and continues to improve as does his concentration span. Christopher reports feeling better in himself and is enjoying organic food. Minimizing those fast sugar-releasing carbohydrates has helped reduce his mood swings.

Conclusion: Christopher is a sensitive, intelligent child with a good sense of humour and very caring parents. A holistic look at diet (lack of DHA in diet, inefficient and sensitive gut, blood sugar balance, boost in immune system, mood swings) has given Christopher and his parents more control over ADHD and a better understanding of what they can do to help overcome it.

References

1. Portwood M. Developmental Dyspraxia: Identification and Intervention. (2nd Edn). London: David Fulerton Publishers. 1999.
2. Crawford MA. The rationale for pre-pregnancy supplementation in high risk women of reproductive age. Asia Pacific Journal of Clinical Nutrition 5(4): Section 3. 1996.
3. Farquharson J, Cherry EC, Abbasi KA, Patrick WJA. Effect of diet on the fatty acid composition of the major phospholipids in infant cerebral cortex. Archives of Disease in Childhood 72: 198-203. 1996.
4. Lucas A et al. Early diet in pre-term babies and developmental status in infancy. Archives of Disease in Childhood 64: 1578. 1989.
5. Lucas A et al. Breast milk and subsequent intelligence quotient in children born prematurely. Lancet 339: 261-4. 1992.
6. Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid composition of brain, retinal and erythrocytes in breast- and formula-fed infants. American Journal Clinical Nutrition 60: 189-94. 1994.
7. Makrides M et al. Are long chain polyunsaturated fatty acids essential nutrients in infancy? Lancet 345: 1463-67. 1995.
8. Makrides M, Neumann MA, Gibson RA. Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. European Journal of Clinical Nutrition 50: 352-57. 1996.
9. Agostani C et al. Docosahexaenoic acid states and developmental quotient of healthy term infants. Lancet 346: 638. 1995.
10. Stevens L et al. Essential Fatty Acid metabolism in boys with Attention Deficit Hyperactivity Disorder. Amer. Journal of Clinical Nutrition 62: 761-8. 1995.
11. Stevens L et al. Omega-3 Fatty Acids in boys with behaviour, learning and health problems. Physiology & Behaviour 59: 915-20. 1996.
12. Stordy BJ. Benefits of docosahexaenoic acid supplements to dark adaptation in dyslexics. Lancet 346: 385. 1995.