ARI Publication 40 – 2013 Version

slow in humans. There have been some reports that children with autism respond poorly to flax
seed oil, so we generally recommend fish oil instead.

Cod liver oil (or other fish liver oil) is a good source of omega-3 fatty acids, and also provides good
amounts of vitamin A and vitamin D. However, vitamin A intake from all supplements should not
greatly exceed the RDA intake (see vitamin/mineral section) for extended periods, since excess
amounts will be stored in the liver and could affect liver function. (Carotenes are pre-vitamin A and
are not a problem.)

Testing: The level of essential fatty acids can be measured in the red blood cell membrane.
However, because most people in the US have low levels of omega-3’s, it is desirable to reach levels
at the top of the “normal” range. Also, it is better to measure the absolute amount of each fatty
acid, rather than just the percentage of each.

ARI Survey of Parent Ratings of Treatment Efficacy:

Safety:

One unpublished study by Audhya of 400 children with autism found that about 1-2% had a severe
behavioral reaction to fish oil within a few days, resulting in extreme behavioral problems. These
symptoms disappeared within a few days after stopping intake. Blood testing revealed that these
children had a carnitine deficiency (see section on Carnitine), which is needed to carry long-chain
fatty acids into the mitochondria, and to transport short and medium chain fatty acids out of the
mitochondria. Supplementation with low dose carnitine (about 200 mg/day) allowed the children to
tolerate fish oil without any problem. Since the major source of carnitine is beef and pork, people
who avoid those foods may want to start with very low doses of fish oil, and if there is a problem
add a carnitine supplement or eat beef or pork regularly.

Research:

There are a huge number of scientific studies showing that humans need EFAs, and that most
people in the US do not consume enough. As mentioned above, 4 studies found that children with
autism have lower levels of omega-3 fatty acids than do typical children, many of whom are not
consuming enough.

There have been nine treatment studies for children/adults with autism, six positive and three
inconclusive or negative. Most of the studies have been short, and did not pre-screen for children
with low EFA levels. It is likely that fish oil will be most beneficial to children who do not eat fish
regularly, and it could be that long treatment (12 months) is needed for full benefits to be
observed.

Positive studies:

A 90-day open trial of essential fatty acids in 18 children with autism found significant increases in
language and learning skills.
Patrick L and Salik R, The Effect ofEssential FattyAcid Supplementation on Language Development and
Learning Skills in Autism andAsperger’s syndrome. Autism/Asperger’s Digest: Research Article –
Jan/Feb 2005.
One unpublished study by Adams et al. found that 2 months supplementation of fish oil (rich in
DHA) led to significant improvements in sociability and other areas, especially in children and adults
who consumed 0-1 servings of fish/month.

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