Docosahexaenoic acid (DHA)

Uses

Attention-Deficit Hyperactivity Disorder (ADHD)

Because children need omega-3 fatty acids for their brains to develop properly, researchers have examined whether fish oil might reduce ADHD symptoms. So far, results have been mixed.

Depression

Although some studies show that fish oil reduces symptoms of depression, it is not clear whether DHA by itself has the same effect. Other studies suggest EPA improves depression.

Heart Disease

Fish oil appears to help improve outcomes for people who already have heart disease. It may also lower the risk for developing heart disease. Omega-3 fatty acids found in fish oil help lower triglycerides (fats in the blood), lower blood pressure, reduce the risk of blood clots, improve the health of arteries, and reduce the amount of arterial plaque, which narrows arteries and causes heart disease. The American Heart Association recommends eating fish, particularly fatty fish, at least 2 times per week. Fatty fish include salmon, herring, lake trout, sardines and albacore tuna. People who already have heart disease may need fish oil supplements in addition to adding more fish to their diet. Ask your doctor if fish oil supplements are right for you.

Infant Development

DHA plays a crucial role in the growth and development of the central nervous system, as well as visual functioning in infants. Breastfed babies with healthy mothers should get enough DHA in breast milk.

Rheumatoid Arthritis

Several small studies found that fish oil may help reduce symptoms and inflammation linked with rheumatoid arthritis. However, it does not stop joint damage from getting worse.

Menstrual Pain

Fish oil seems to reduce the pain of menstrual cramps when taken on a regular basis (not just when menstruating).

Raynaud Syndrome

Several studies show that high doses (12 g) of fish oil can reduce sensitivity to cold in the fingers and toes of people with Raynaud syndrome. Doses this high should be taken only under a doctor's supervision.

Lupus

Preliminary studies suggest that fish oil may reduce the fatigue and joint pain associated with lupus.

Dietary Sources

DHA is found in cold-water, fatty fish, including salmon, tuna (bluefin tuna have up to 5 times more DHA than other types of tuna), sardines, shellfish, and herring.

Some of these fish have low levels of mercury. However, the FDA says that eating several servings of fish each week poses no risk to healthy people and offers many health benefits.

Women who are pregnant or planning to become pregnant should not eat king mackerel, shark, swordfish, and tilefish. They should also eat no more than 6 oz. per week of white albacore tuna.

To make sure you get fish oil supplements that are not contaminated with mercury, read labels carefully and check for purity, ask your doctor to help you find the best quality DHA supplement.

If the mother is healthy, breastfed babies should get enough DHA from breast milk. Infant formula may or may not have any DHA. Read labels carefully.

Available Forms

DHA is available as a supplement in two common forms:

• Fish oil capsules, which has both DHA and EPA (eicosapentaenoic acid), another omega-3 fatty acid
• DHA from algae, which has no EPA

How to Take It

Pediatric

• Babies who are breastfed should get enough DHA if their mothers are getting enough DHA in her diet. Some infant formula also has added DHA.

Adult

• Most studies have used 1,000 to 2,500 mg of DHA per day.
• In the diet: 2 to 3 servings of fatty fish per week, which equals 1,250 mg EPA and DHA per day.
• Fish oil supplements: 3,000 to 4,000 mg standardized fish oils per day. Read the label to check levels of DHA and EPA, which are not the same as mg of fish oil. People who take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, or people who have hemophilia should check with their doctors for a safe dose.
• Pregnant women: Ask your doctor if a DHA supplement is right for you, and only use products designed for pregnant women.
• DHA supplements from algae: 200 mg per day

Some fish oil supplements also have added vitamin E to maintain freshness.

Precautions

Fish oil capsules have both DHA and EPA. Supplements with EPA may not be recommended for infants or small children because they upset the balance between DHA and EPA during early development. Pregnant women should talk to their doctor before taking fish oil supplements.

Fish oil capsules may cause minor side effects, such as loose stools, stomach upset, and belching.

They may slightly increase the risk of bleeding. If you take blood-thinning medication, talk to your doctor before taking fish oil.

Fish oil may lower blood pressure. If you already take medication to lower blood pressure, talk to your doctor before taking fish oil.

Possible Interactions

Blood pressure medication: DHA may lower blood pressure, so it could make the effects of prescription blood pressure medication stronger. That could raise the risk of having low blood pressure.

Blood-thinners (anticoagulants and antiplatelets): EPA in fish oil supplements may increase bleeding time, so fish oil could make the effects of these drugs stronger. That does not seem to be true of DHA by itself. Blood thinners include warfarin (Coumadin), clopidogrel (Plavix), and aspirin.

Diabetes medications: Theoretically, fish oil supplements may lower blood sugar levels and could make the effects of diabetes drugs stronger. If you have diabetes, talk to your doctor before taking fish oil.

Aspirin: Combined with aspirin, fish oil could help treat some forms of heart disease, however, this combination may also increase the risk of bleeding. Talk to your doctor to see if this combination is right for you.

Cyclosporine: Omega-3 fatty acids may reduce some of the side effects of cyclosporine, which is often used to stop rejection after an organ transplant. Talk to your doctor before adding any new herbs or supplements to the medication you already take.

Supporting Research

Carlson SE, Colombo J, Gajewski BJ, et al. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013;97(4):808-15.

Demonty I, Chan YM, Pelled D, Jones PJ. Fish-oil esters of plant sterols improve the lipid profile of dyslipidemic subjects more than do fish-oil or sunflower oil esters of plant sterols. Am J Clin Nutr. 2006 Dec;84(6):1534-42.

Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment at 21/2 years following fish oil supplementation in pregnancy: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed. 2008 Jan;93(1):F45-50. [Epub ahead of print]

Fatty fish consumption and ischemic heart disease mortality in older adults: The cardiovascular heart study. Presented at the American Heart Association's 41st annual conference on cardiovascular disease epidemiology and prevention. AHA. 2001.

Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007;129:210-23.

Harper CR, Jacobson TA. The fats of life: the role of omega-3 fatty acids in the prevention of coronary heart disease. Arch Intern Med. 2001;161(18):2185-2192.

Innis SM. Dietary omega 3 fatty acids and the developing brain. Brain Res. 2008 Sep 9. [Epub ahead of print]

Iso H, Rexrode KM, Stampfer MJ, Manson JE, Colditz GA, Speizer FE et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA. 2001;285(3):304-312.

Jacobson TA. Role of n-3 fatty acids in the treatment of hypertriglyceridemia and cardiovascular disease. Am J Clin Nutr. 2008 Jun;87(6):1981S-90S.

Jeschke MG, Herndon DN, Ebener C, Barrow RE, Jauch KW. Nutritional intervention high in vitamins, protein, amino acids, and omega-3 fatty acids improves protein metabolism during the hypermetabolic state after thermal injury. Arch Surg. 2001;136:1301-1306.

Juhl A, Marniemi J, Huupponen R, Virtanen A, Rastas M, Ronnemaa T. Effects of diet and simvistatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men; a randomized controlled trial. JAMA. 2002;2887(5):598-605.

Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzare TL. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease. Circulation. 2001;103:1823.

Kromhout D. Omega-3 fatty acids and coronary heart disease. The final verdict? Curr Opin Lipidol. 2012 Dec;23(6):554-9. doi: 10.1097/MOL.0b013e328359515f.

Leaf A. Historical overview of n-3 fatty acids and coronary heart disease. Am J Clin Nutr. 2008 Jun;87(6):1978S-80S.

Leggieri E, De Biase RV, Savi D, Zullo S, Halili I, Quattrucci S. Clinical effects of diet supplementation with DHA in pediatric patients suffering from cystic fibrosis. Minerva Pediatr. 2013;65(4):389-98.

Mabile L, Piolot A, Boulet L, Fortin LJ, Doyle N, Rodriquez C, et al. Moderate intake of omega-3 fatty acids is associated with stable erythrocyte resistance to oxidative stress in hypertriglyceridemic subjects. Am J Clin Nutr. 2001;7494):449-456.

Mori TA. Omega-3 fatty acids and hypertension in humans. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):842-6. Review.

Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006 Oct 18;296(15):1885-99. Review.

Oken E, Radesky JS, Wright RO, Bellinger DC, Amarasiriwardena CJ, Kleinman KP, et al. Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. Am J Epidemiol. 2008 May 15;167(10):1171-81.

Olsen SF, Secher NJ. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. BMJ. 2002;324(7335):447-451.

Politi P, Cena H, Comelli M, Marrone G, Allegri C, et al. Behavioral effects of omega-3 Fatty Acid supplementation in young adults with severe autism: an open label study. Arch Med Res. 2008 Oct;39(7):682-5.

Pomponi M, Janiri L, La Torre G, et al. Plasma levels of n-3 fatty acids in bipolar patients: deficit restricted to DHA. J Psychiatr Res. 2013;4793):337-42.

Saravanan P, Davidson NC, Schmidt EB, Calder PC. Cardiovascular effects of marine omega-3 fatty acids. Lancet. 2010 Aug 14;376(9740):540-50. Review.

Stanke-Labesque F, Molière P, Bessard J, Laville M, Véricel E, Lagarde M. Effect of dietary supplementation with increasing doses of docosahexaenoic acid on neutrophil lipid composition and leukotriene production in human healthy volunteers. Br J Nutr. 2008 Oct;100(4):829-33. Epub 2008 Feb 28.

Stonehouse W, Conlon CA, Prodd J, et al. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial. Am J Clin Nutr. 2013;97(5):1134-43.

Sun Q, Ma J, Campos H, Rexrode KM, Albert CM, Mozaffarian D, Hu FB. Blood concentrations of individual long-chain n-3 fatty acids and risk of nonfatal myocardial infarction. Am J Clin Nutr. 2008 Jul;88(1):216-23.