Omega-3s
What are Omega-3s?
Omega-3 fatty acids are essential nutrients that are anti-inflammatory and important for brain and heart health. They have the most research of all fatty acids in connection to autism. Certain studies show a variety of improvements including social interaction, repetitive and restricted interests, behaviors, stereotypy, lethargy, improved nonverbal intellectual ability, restlessness, agitation, irritability, and self-injurious behaviors.
Omega-3s are especially important for brain health, attention, and focus. They have also been linked with reducing inflammation [1], supporting brain development [2], and improving mental health. [3]
There are four types of omega-3s (see below)
The omega-3/omega-6 ratio can be a helpful health factor. It’s ideal to have a higher ratio of omega-3s from the diet than omega-6s, as omega-3s are anti-inflammatory while omega-6s are pro-inflammatory. To our knowledge, the optimal ratio has not been defined.
While fish is the best source of omega-3s, they are not the original source of the nutrient. In fact, omega-3s are originally synthesized by microalgae, not by the fish. When fish consume phytoplankton that consumed microalgae, they accumulate the omega-3s in their tissues. [4]
Types of Omega-3s
There are 4 Types of Omega-3s:
Eicosapentaenoic Acid (EPA)
EPA is known to be very anti-inflammatory, and can promote a healthy omega-3/omega-6 ratio. It may be more efficient in reducing cellular inflammation than DHA. [5]
May be more indicated than DHA in mood disorders. [5]
Makes hormones that help regulate the immune system, blood clotting, inflammation, and blood pressure, [1]
Already in the form our bodies can use, making it easier to absorb.
Docosahexaenoic Acid (DHA)
Essential for growth and brain development. [4]
DHA is quantitatively the most important omega-3 polyunsaturated fatty acid in the brain. [5]
DHA is present in both the retina of the eyes and the brain. DHA levels in the retina are complete by birth, but brain levels continue throughout the first 2 years after birth.
May be more indicated than EPA in neurodegenerative disorders. [5]
Already in the form our bodies can use, making it easier to absorb.
Docosapentaenoic Acid (DPA)
The research on DPA is the most lacking, but growing.
This is the third most common omega-3 found in fish oil, following EPA and DHA.
Most fish oils contain at least a small amount of DPA, but it may just be listed as “Other Omega-3s” on the label.
Alpha-Linolenic Acid (ALA)
ALA must be converted to EPA or DHA to be used by the body.
ALA is the omega 3 found in plant sources, but only about 5% is converted to EPA and less than 0.5% is converted to DHA. [6]
To get enough omega 3’s using only plant sources, you’ll need to consume a wide variety of sources.
Food Sources of Omega-3s
See more on oils in the Oils note.
Animal-based sources:
Plant-based sources:
Plant oils such as flaxseed oil
Walnuts
Algae
Algal oil is derived from algae and is one of the few vegan sources of EPA and DHA. It can be taken in supplement form and is a good substitute for fish oil if you’re following a strict vegetarian or vegan diets
Recommended Intake
The established Dietary Reference Intake (DRI) for total omega-3s (as ALA) is:
700 mg for children ages 1-3
900 mg for children ages 4-8
1200 mg for males ages 9-13
1000 mg for females ages 9-13
1600 mg for males ages 14-18
1100 mg for females ages 14-18
For children with ASD, a dose of double the DRI is usually recommended, though higher levels are commonly used. Beware of using too high of a dose, as fish oil can be a blood thinner. It’s recommended to discontinue the use of fish oil 7 days before any medical or dental procedure, as it can cause additional bleeding.
Deficiency
Deficiency of omega-3s can be common in children with autism. Symptoms include:
Rough, scaly skin (or a red & itchy rash)
Brain fog and deficits in concentration
Fatigue & weakness
Problems with nails and hair
Sleep issues
Cardiovascular concerns (increased risk for heart disease)
Difficult menstrual cycles for women
Toxicity
While omega-3s can be beneficial for your health, taking too much isn’t necessarily a good thing. The Food and Drug Administration (FDA) claims that omega-3 supplements with EPA + DHA are safe if the dose doesn’t exceed 3,000 mg/day for adults, though according to the European Food Safety Authority, omega-3 fatty acid supplements can be safely consumed at doses up to 5,000 mg daily for adults. To our knowledge, there is no level established for children, though it’s safe to assume it is less than the adult values. It’s best to consult with your healthcare provider to prescribe the appropriate daily dosage.
Supplements
For supplementing with omega-3s, see the fish oil note
For plant-based options of omega-3s, consider algae oil for the highest omega-3 content
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Omega-3 & Autism in the Research
Omega-3 Deficiency
A deficiency or an insufficient intake of omega-3 fatty acids can cause abnormal development of the nervous system in childhood, resulting in loss of concentration, hyperactivity, dyslexia, dyspraxia and autism [7]
ADHD and ASD share genetic and nutritional interactions, like a deficiency in Omega-3 fatty acids during brain development. [8]
Populations with ASD have lower omega-3 status and supplementation can potentially improve some ASD symptoms. Further research with large sample size and adequate study duration is warranted to confirm the efficacy of omega-3 fatty acids. [9]
Benefits of Omega-3s
Omega-3s have been linked with reducing inflammation, supporting brain development, and improving mental health. [1-3]
Omega-3 Intake
Most children who are picky eaters do not eat foods rich in omega-3 fatty acids, a vital nutrient for the brain
One study argues that neurodevelopmental conditions are a direct link to the deficiency of Omega-3 fatty acids in the diet. Increase in fish and seafood is recommended. [10]
Omega-3 Supplementation
Compared with the typically developing population, ASD populations had lower DHA, EPA, and arachidonic acid, and higher total omega-6 to omega-3 ratio. [9]
Compared with placebo, omega-3s social interaction and repetitive and restricted interests and behaviors. [9]
Some research shows that supplementation of Omega-3 fatty acids can affect inflammation reactions within individuals with ASD. [11]
Children in the omega-3 fatty acid group had a greater reduction in hyperactivity, but the difference was not statistically significant. This study found statistically significant improvements in the ω-3 PUFA group in the stereotypy and lethargy subscales of the ABC. [12]
Using a protocol including vitamin/mineral supplement, essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet significantly improved nonverbal intellectual ability in the treatment group compared to the non-treatment group. [13]
In a case-study of a 23-year-old male with ASD with a 12-month history of episodes of restlessness, agitation, irritability, oppositional and self-injurious behaviors, supplementation with omega-3 and vitamin D remarkably improved his ASD symptoms throughout a 24-month follow-up period. Before starting, laboratory tests documented a markedly altered omega-6/omega-3 balance, along with a vitamin D deficiency, as assessed by serum levels of 25-hydroxyvitamin D. [14]
Maternal Intake of Omega-3s
Supplementation with Omega-3 fatty acids during pregnancy had no effect on the risk for developing ASD or ADHD. [15]
The Omega-3 levels of mothers, both before and during pregnancy, are shown to have no effect on the risk of ASD. [19]
Conflicting Research - Beneficial or Not?
Although an optimal balance in n-3/n-6 long-chain polyunsaturated fatty acid ratio is important for proper neurodevelopment and cognitive functions, results from randomized controlled trials are controversial and do not confirm any useful effect of supplementation on development of preterm and term infants. [17]
Some research studies reject that omega-3 supplementation is beneficial for individuals with ASD. [18]
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[2] Innis SM. Dietary omega 3 fatty acids and the developing brain. Brain Res. 2008;1237:35-43. doi:10.1016/j.brainres.2008.08.078
[3] Dinan T, Siggins L, Scully P, O'Brien S, Ross P, Stanton C. Investigating the inflammatory phenotype of major depression: focus on cytokines and polyunsaturated fatty acids. J Psychiatr Res. 2009;43(4):471-476. doi:10.1016/j.jpsychires.2008.06.003
[4] Harris WS. Omega-3 fatty acids. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:577-86.
[5] Dyall SC. Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA. Front Aging Neurosci. 2015;7:52. Published 2015 Apr 21. doi:10.3389/fnagi.2015.00052
[6] Plourde M, Cunnane SC. Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements [published correction appears in Appl Physiol Nutr Metab. 2008 Feb;33(1):228-9]. Appl Physiol Nutr Metab. 2007;32(4):619-634. doi:10.1139/H07-034
[7] Kawicka A, Regulska-Ilow B. How nutritional status, diet and dietary supplements can affect autism. A review. Rocz Panstw Zakl Hig. 2013;64(1):1-12.
[8] Field SS. Interaction of genes and nutritional factors in the etiology of autism and attention deficit/hyperactivity disorders: a case control study. Med Hypotheses. 2014;82(6):654-61.
[9] Mazahery H, Stonehouse W, Delshad M, et al. Relationship between Long Chain n-3 Polyunsaturated Fatty Acids and Autism Spectrum Disorder: Systematic Review and Meta-Analysis of Case-Control and Randomised Controlled Trials. Nutrients. 2017;9(2):155. Published 2017 Feb 19. doi:10.3390/nu9020155
[10] Saugstad LF. Infantile autism: a chronic psychosis since infancy due to synaptic pruning of the supplementary motor area. Nutr Health. 2011;20(3-4):171-82.
[11] De felice C, Cortelazzo A, Signorini C, et al. Effects of ω-3 polyunsaturated fatty acids on plasma proteome in Rett syndrome. Mediators Inflamm. 2013;2013:723269.
[12] Bent S., Hendren R.L., Zandi T., Law K., Choi J., Widjaja F., Kalb L., Nestle J., Law P. Internet-Based, Randomized, Controlled Trial of Omega-3 Fatty Acids for Hyperactivity in Autism. J. Am. Acad. Child Adolesc. Psychiatry. 2014;53:658–666. doi: 10.1016/j.jaac.2014.01.018.
[13] Adams JB, Audhya T, Geis E, et al. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial. Nutrients. 2018;10(3):369. Published 2018 Mar 17. doi:10.3390/nu10030369
[14] Infante M, Sears B, Rizzo AM, et al. Omega-3 PUFAs and vitamin D co-supplementation as a safe-effective therapeutic approach for core symptoms of autism spectrum disorder: case report and literature review. Nutr Neurosci. 2020;23(10):779-790. doi:10.1080/1028415X.2018.1557385
[15] Newberry SJ, Chung M, Booth M, et al. Omega-3 Fatty Acids and Maternal and Child Health: An Updated Systematic Review. Evid Rep Technol Assess (Full Rep). 2016;(224):1-826.
[16] Steenweg-de graaff J, Tiemeier H, Ghassabian A, et al. Maternal Fatty Acid Status During Pregnancy and Child Autistic Traits: The Generation R Study. Am J Epidemiol. 2016;183(9):792-9.
[17] Assisi A, Banzi R, Buonocore C, et al. Fish oil and mental health: the role of n-3 long-chain polyunsaturated fatty acids in cognitive development and neurological disorders. Int Clin Psychopharmacol. 2006;21(6):319-336. doi:10.1097/01.yic.0000224790.98534.11
[18] Horvath A, Łukasik J, Szajewska H. ω-3 Fatty Acid Supplementation Does Not Affect Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis. J Nutr. 2017;147(3):367-376. doi:10.3945/jn.116.242354
