What Is “Medical Food” for ADHD?

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Traditional treatment for ADHD usually involves medication—most often a stimulant. It also frequently uses some form of skills training or psychosocial intervention. That might involve life coaching, family counseling, education about ADHD, group therapy, couples therapy, behavioral modification or cognitive-behavioral therapy.

Stimulants, while effective for many symptoms of ADHD, are controversial because of their side effects, abuse potential and public concerns about possible clinician overreliance on them in treating children and adolescents.

Omega Fatty Acids and Medical Food

In the last few years another player has come on the scene called Vayarin. Vayarin is a “medical food” that, like medication, is prescribed by a doctor. Although it’s prescribed, Vayarin isn’t a medicine. It’s also not covered by insurance, and it costs about $60 a month out of pocket. It comes from the South Carolina-based company Vaya Pharma.

While Vayarin itself is relatively new, the science behind it really isn’t. The bases of Vayarin are omega fatty acids. Past research has been mixed, but suggests small but noticeable improvements in attention problems in kids with ADHD when they increased omega-3 or other similar fatty acids in their diets.

An Israeli research team found that the omega supplements seemed to reduce hyperactivity and behavioral problems in kids with ADHD (Manor, et al, 2012). Similarly, two Yale researchers reviewed multiple prior studies on omega fatty acids and ADHD, and they concluded that there was a “modest” but noticeable decline in ADHD symptoms in the participants across the studies.

Research on Vayarin itself is just beginning to come out.

One team of Texas researchers presented results at a conference last year on Vayarin and ADHD. They found that about 60% of the children who took it for three months noticed some benefit. However, only about 40% of the children who began Vayarin stayed with it for the whole three months (Nguyen et al., 2014). Given the usual lack of side effects for omega fatty acids, the drop-out rate is probably not due to intolerance. The researchers suggested that it might be related to the long time period it took to notice benefits of Vayarin. A separate multi-site study involving Vayarin versus placebo will be completed in 2017 looking at adults ages 18-55.

Considerations

So the research on Vayarin and omega fatty acids looks fairly positive so far. It’s also appealing to parents or adults themselves with ADHD who are concerned about the side effects of stimulants or who prefer a more naturalistic form of intervention. For example, a 2013 study by the same Israeli researchers mentioned above found few problems among kids taking omega-3 fatty acids over a 30-week period of study (Manor et al, 2013).

There are however a few things to consider when thinking about using Vayarin or similar omega fatty acids to manage ADHD in children and adults:

1. Most studies have shown a “modest” or “small but noticeable” improvement in ADHD symptoms with the omega fatty acids. That’s less dramatic than the effects of prescription medications on ADHD. If incorporated, Vayarin would most likely be a supplement to medication, rather than a replacement for medication, when treating ADHD.
2. As mentioned earlier, Vayarin is not covered by insurance and so the costs would need to be shouldered as out-of-pocket expenses.
3. Interestingly, most studies cited appear to use behavior rating scale and self-report symptom measures to assess the efficacy of Vayarin or the omega fatty acids. While these can be helpful, they are subjective and more prone to recall biases and expectations. A study looking at Vayarin with objective measures of cognitive symptoms often related to ADHD—like sustained attention, executive functions, processing speed, or multi-tasking—would lend more solid evidence of its treatment potential than basing it on just behavioral ratings and symptom inventories.
4. If omega fatty acids are helpful in managing ADHD, it’s not apparent to me why someone should shell out $60 a month for Vayarin rather than stocking up on omega fatty acid products from Sam’s Club or Costco. What would be particularly interesting would be a study that compares Vayarin against omega-3 fatty acids or something similar (rather than just a placebo), and that shows yet why Vayarin delivers more than just the separate omega fatty acids themselves.

References

Bloch, M., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 991-1000.

Manor, I., et al. (2012). The effect of phosphatidylserine containing omega3 fatty-acids on attention-deficit hyperactivity disorder symptoms in children: A double-blind placebo-controlled trial, followed by an open-label extension. European Psychiatry, 27, 335-342.

Manor, I., et al. (2013). Safety of phosphatidylserine containing omega3 fatty acids in ADHD children: A double-blind placebo-controlled trial followed by an open-label extension. European Psychiatry, 28, 386-391.

Nguyen, S., et al. (2014). Efficacy of EPA Enriched Phosphatidylserine-Omega-3 (Vayarin) on Children with ADHD [Abstract]. Neurology, 82, S P7.336.