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11 June 2006 - The Independent - Brain food: Why the Government wants your child to take Omega-3, the fish oil supplement

A tiny daily capsule can have a dramatic effect on pupils who usually play up in class, improving behaviour and work. Now all youngsters may be given them. Marie Woolf and Jeremy Laurance report

FAB RESEARCH COMMENT:

by Alex Richardson

Omega-3 pills for all schoolchildren?

It's very good to see that our Education Minister appears to be taking seriously the evidence that food and diet can affect behaviour and learning. But if the government really wants to improve children's nutrition, then some sensible places to start would include*

  • restricting food advertising to children
  • taking action to remove toxic trans fats from food in the UK (found in partially hydrogenated vegetable oils, and an ingredient in numerous foods and snacks)
  • banning certain artificial food colourings which (like trans fats) have absolutely no nutritional value, and which can have detrimental effects on some children's behaviour as shown by rigorously controlled trials.
  • improving the current (lack of) knowledge of both parents and children concerning food and diet, and how this affects physical and mental health.
  • Funding proper research to establish the optimum levels of essential nutrients like omega-3. (Currently there are not even any official recommendations for the daily intake of these vital fats - although international scientific experts now recommend around 500mg of EPA and DHA per day for the general population simply to maintain heart health).(1)

In this article, we're told that the government is seriously considering giving 'omega-3 supplements' to schoolchildren en masse. Omega-3 are vital nutrients that must be obtained from the diet, and some of these special fats (EPA and DHA from fish oils) are absolutely essential to brain development and function. They are also often lacking from children's (and adults') diets in the UK.

FAB Research scientists have carried out the leading studies showing that omega-3 can improve behaviour and learning in SOME children. But it's very important that the real evidence isn't overstated. To date, only a handful of properly controlled trials have yet been done to find out if supplementing children's diets with EPA and DHA can improve their behaviour and learning.(2)

  • Crucially, no peer-reviewed, published trials have yet involved unselected schoolchildren. All of the proper trials have involved children with specific behavioural and learning difficulties like ADHD, dyslexia or dyspraxia. What's more, only 3 of the 5 properly controlled trials on these groups of children have shown any clear benefits - although our Oxford-Durham Trial (the largest so far) did show some remarkable improvements in both behaviour and learning,(3) and these urgently need following up.
  • Unfortunately, most of the supposed 'studies' we keep hearing about in the media are little more than company advertisements. Free fish oils are simply given to children, with no placebo-comparison group included, and miraculous 'improvements' are then reported, along with lots of individual anecdotes to illustrate these (just as in the Independent article here). Nothing whatsoever can be concluded from these surveys, because there is no attempt to control for the hundreds of other confounding factors that could explain the apparent 'benefits'.

The Oxford researchers who carried out the Oxford-Durham trial have already designed the large-scale school study that's now needed, and FAB Research is actively seeking the funding needed to carry this out. The FAB-Oxford trial will investigate the effects of increasing omega-3 intake on unselected primary school children in a rigorous randomised, double-blind, placebo-controlled trial. We have schools ready and willing to help. All we need is the funding.

It is also worth emphasising again that the best possible source of all essential nutrients is from food, not from supplements - although the latter are usually needed for double-blind trials, as they are for some individuals simply for practical reasons.

If the government is now considering spending taxpayers' money on expensive supplements for all school children, why not do the proper research first? We'd be more than happy to help. And if you'd like to see more proper research rather than media hype, and think you could help us in any way, please get in touch!

*The rationale for all of these recommendations is explained in my book They Are What You Feed Them - published next week by Harper Thorson. All author royalties from the book have been donated to FAB Research.

This book is written primarily for parents - but I've also included detailed references and notes, so that sceptical doctors and other health professionals shouldn't be able to dismiss it out of hand). It explains in clear, non-technical language the real research evidence that food and diet can affect children's behaviour and learning. It also provides practical advice on how parents can start feeding themselves and their children better. While food supplements are sometimes necessary, there can be no question that the best way to get essential nutrients is always from a well-balanced diet.

(1) See the International Society for the Study of Fatty Acids and Lipids (ISSFAL) and the UK Joint Health Claims Initiative (JHCI) recommendations. Both are based on expert scientific reviews of the existing evidence that EPA and DHA can help to maintain cardiovascular health. At present, there is insufficient good quality evidence to make similar recommendations for brain and behaviour - but more research in this area is now precisely what is needed.

(2) Richardson, A.J. Omega-3 fatty acids in ADHD and related neurodevelopmental disorders. Int Rev Psychiat, 2006, 18(2) 155-172.
(3) Richardson, A.J. and Montgomery, P. The Oxford-Durham Study: a randomized controlled trial of dietary supplementation with fatty acids in children with developmental coordinaton disorder. Paediatrics 2005, 115(5), 1360-1366

Schoolchildren are to be given fish oil supplements to boost their brain power and improve their behaviour and ability to concentrate under plans being considered by the Government.

Health professionals fear that youngsters do not get enough Omega-3 in a daily diet dominated by modern convenience foods. Increasingly, they believe a lack of these nutrients can contribute to poor learning, disorder and violence in the classroom.

Now government experts are to examine whether daily doses of fish oil in capsule or liquid form might help to improve classroom behaviour and exam results.

The Food Standards Agency, the Government's advisory body on food, is conducting a major review into the effect of Omega-3 fish oil supplements on children's behaviour.

Alan Johnson, the Secretary of State for Education, who recently met the chef Jamie Oliver to discuss nutrition in schools, has asked to see the results. "The Food Standards Agency is currently conducting a systematic review of research looking at the effect of nutrition and diet on performance and behaviour of children in schools," he said. "This includes investigating studies that have used Omega-3 and -6 fish oil supplements in schools. While this work is not yet concluded, we will of course examine its results with interest.

"The Government is committed to ensuring that children are provided with the healthy food and nutrients they require during the school day, not just to aid their physical health, but to ensure they can study hard and behave well."

Omega-3 fatty acids play a crucial role in brain-cell development. Almost half the fat from which the brain is built is made up of one of the Omega-3s - docosahexaenoic acid (DHA).

The richest source is oily fish, sardines, salmon and mackerel in particular, but these are not popular with children. So more and more parents are giving their children fish oil supplements, extracted and refined from such fish. Post-war baby boomers were dosed with cod-liver oil when they were growing up in the 1940s and 1950s, to supplement a diet limited by rationing.

The idea of providing such supplements again is backed by a growing body of scientific evidence. A new report, due out this week, says there has been an 80 per cent decline in the average intake of fatty acids over the past century.

According to the report in the London-based Journal of Perinatology, the evidence for the health benefits is so strong that formula foods for babies should now have fatty acid supplements: "The health and well-being of the child in the short and long term appears to be improved by the availability of adequate amounts of Omega-3 during foetal and postnatal development. Deficiency is a common problem and may be a contributing factor for certain maternal and paediatric health problems.''

One of the country's leading authorities on the subject, the neuroscientist Professor John Stein, of Magdalen College, Oxford, said yesterday that supplements of Omega-3 had a clear effect on children's brain function in trials carried out by him.

He has joined forces with his brother, the fish restaurateur and chef Rick Stein, to promote the message. In Washington last month, at a charity fundraiser, the chef prepared a seven-course meal using oily fish while his brother gave a lecture on its health benefits.

"I have done many trials going back 10 years," said Professor Stein. "The most striking thing is the ability to concentrate. It doesn't change the fundamental intelligence of children. But if you can't concentrate and are fidgeting all the time it's hard to study."

Educational psychologists have recently put this to the test with a number of trials of the supplements around the country. Daily supplements of Omega-3, they found, helped children with their standards of behaviour and learning ability.

A trial involving eight- and nine-year-olds who received a daily dose at Newhall Park primary school in Bradford, resulted in a transformation. Since it started last September, some 81 per cent showed improvements in reading, 67 per cent in writing and 74 per cent in maths.

Trials in deprived areas of Co Durham over the past two years found that the essential fatty acids, administered in liquid and capsule form, produced an instant improvement in the concentration levels of children, from toddlers to teenagers.

John Clare, deputy headmaster of Greenfield School in Newton Aycliffe, Durham, saw the results of a trial with 20 pre-teens and teens. "They were far better than expected," he said. "There were clear indications of improvement - the biggest being the ability to concentrate. Many of them (the pupils) had formal diagnoses of Attention Deficit Hyperactivity Disorder. All of them complained of learning difficulties.

"They had three tablets, three times a day. After three months we tested them and there were significant improvements. The marks were much better. It made a significant impact."

One of the beneficiaries was Mark Hall, 14, a formerly disruptive pupil who found it difficult to concentrate in class. Even his mother said he was "a bit hyper" and couldn't stay still for long. Along with 20 other children at his Co Durham secondary school, he was given three fish oil supplements every day for one term. The transformation was dramatic, according to his teachers. His grades have gone up and his ability to pay attention in class was improved visibly. Now 16 and still taking the fish oil capsules, he is studying for his GCSEs and has a place at college to study tourism.

"I found they really did help me focus," Mark said. "My grades have improved. Before, I was easily distracted. Anything could catch my attention. I find school easier now."

His mother Lorraine, 44, added: "He has calmed down a lot. He is doing really well and is not disruptive or being the class clown any more. He is doing six GCSEs. Mark was a bit hyper. Now at school his concentration level is much better. He is going on to college. I am very proud of him."

Dr Madeleine Portwood, a senior educational psychologist at Durham local education authority, who conducted the trials, said the effects on pre-school children who were showing developmental difficulties were startling: "The children were given approximately a 500mg supplement of Omega-3. The children's concentration improved. Children who were on average six months behind made seven and a half months' progress in the five months they took the supplements."

Lord Winston, the TV presenter and fertility pioneer, is already convinced. He has fronted advertisements for St Ivel Advance, which is supplemented with Omega-3 and marketed as "clever milk".

He has been criticised by some of his colleagues, but he says he was convinced a long time ago by the research that supplements could provide some benefit to some children. In his BBC series Child of our Time he highlighted the results of the study in Durham.

But other scientists are not so convinced. They warn that supplements often don't have the same effect as the foods from which they are extracted.

They are also expensive - with a retail cost from 40p to £1.20 a day for the recommended dose of half a gram. The Department for Education would be able to negotiate a greatly reduced price for a bulk order, they say, but investing the same cash in extra books or computers might boost school performance more.

And the British Nutrition Foundation expressed concern this weekend about proposals to give schoolchildren supplements, saying research into the health benefits was "still highly speculative".

Rebecca Foster, a nutritionist, asked: "Is it right to be supplementing people when there isn't strong evidence? This is still a really new area."

The Food Standards Agency said ministers would have the final say on whether to give the fish oil capsules to children: "It will be up to the Department for Education and Skills, the Schools Foods Trust and education departments to consider the implications of the findings."

Additional reporting by Roger Dobson

Morgan's story: 'Concentration levels have gone through the roof'

Morgan Crabtree, eight, from Bradford, was a clever primary school pupil who did well in subjects she enjoyed, such as reading. But she was easily distracted and, according to her mother, found any excuse not to do her homework. She was also prone to throwing tantrums and became bored quickly.

Her mother, Lindsey, a 33-year-old civil servant, was worried about leaving Morgan at home with her brothers, Joshua, 12, and Kian, five, fearing she might misbehave. But after six months of being given a daily spoonful of a supplement called Smart Omega 3 at her school, her "concentration levels have gone through the roof".

In an experiment, partly sponsored by a pharmacist, at Newhall Park primary school in Bradford last autumn, she and her classmates were given the liquid fish oil supplements.

Her mother was sceptical and, initially, saw no change in her behaviour. After a few months, however, she began to see benefits from the treatment. Morgan's ability to form sentences increased and her school reports have been very complimentary.

Teachers acknowledged the changes this year when she was singled out for praise at a school parents' evening.

"The difference is amazing," said her mother. "Before, she would do anything except her homework. Now she's totally different. She will come home and pick up a pen and start drawing. She amuses herself. Her marks have gone up and her writing is better. My whole family has noticed her concentration levels have improved. She has calmed down a lot. Now I don't have any problems about leaving her with her brothers."

Morgan is still taking the supplements at school, and Mrs Crabtree gives her a spoonful of Smart Omega 3 every day. She has just started another of her children on the supplement, hoping to get the same results.