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LE Magazine July 2006

DHA and the Developing Brain

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


Excitement about the health benefits of omega-3 fatty acids such as DHA has been somewhat tempered by growing concern about mercury contamination in fish that contain high levels of these nutrients. Conflicting reports have left many consumers confused.

A recent analysis concluded that the health benefits of fish consumption for older adults at risk for heart and circulatory diseases outweigh the risk.35 However, because of the negative impact of even small amounts of mercury on children’s IQ and development, the same study recommended that pregnant and nursing mothers, as well as mothers of school-aged children, select other sources of DHA, such as certified mercury-free DHA supplements.

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.


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