When my daughter turned one and started drinking cow’s milk, I started to see DHA all over the place. Especially at Whole Foods. Milk with DHA. Eggs with DHA. Food packets with DHA. This really started to get to me – I had no idea what DHA was, but the people designing these packages sure made it look important.
Spoiler: DHA is a fatty acid found in fatty fish and breast milk. Learning this was a good start, but added to my anxiety about this topic: most experts recommend kids eat fish 2-3 times per week! and caution that the typical Western Diet does not contain enough DHA. But, experts also recommend that kids avoid fish high in mercury, which is poisonous in large amounts. AND, even in fatty fish, DHA levels can vary dramatically depending on whether fish were wild-caught or farm-raised and the species of fish. On top of all this were warnings that insufficient DHA in kids has been linked to ADHD, problems with vision, depression, and developmental delays.
Ah! So DHA is a critical nutrient that can only be obtained from very select (and expensive mind you) sources, and the wrong sources might poison my kid, cooking fish 2-3 times per week is logistically challenging, and my kid might not like eating the food that is the best source of DHA? Enough to freak me out.
Getting enough DHA from naturally occurring sources is challenging, to say the least. Suddenly all these foods with supplemental DHA were looking like mighty attractive purchases – the logic being … well, my daughter likes to drink milk. In fact, she drinks it every day. My daughter needs DHA. I get her a regular source of DHA by buying this milk fortified with DHA! But then there’s the whole anti-supplement argument, which goes something like: human beings should get their nutrients from whole foods (not to be confused with Whole Foods), not supplements, which are ‘unnatural’.
So, this post comes from the research and thinking I did to answer the question: should I give (should you give) my daughter (your kid) milk, eggs, or other foods fortified with DHA?
Note: one of the first places I started was our pediatrician’s office. I asked two different folks there – a doctor and a nurse practitioner. The answers? The doctor said, “I wish I had a good answer for you on that one.” The nurse practitioner said, “Eh, probably won’t hurt.”
What is DHA?
Let’s start with a definition. DHA (its full name is Docosahexaenoic acid) is an omega-3 fatty acid. DHA is the main structural component for several very important body parts: the brain, retinas, testicles and skin and is important to the early development of the brain, eyes and nervous system. The body naturally produces some DHA (especially by converting other fatty acids such as ALA), but this process must be supplemented with DHA we get from our diet because the turnover of DHA in the body is fast.
Natural Sources of DHA
Naturally-occurring DHA in the diet comes from three sources:
- human breastmilk
- fish oil
- Animal products made from animals who ate grass, though in much lower, and inconsistent, amounts
DHA in breastmilk is great news for babies who are breastfed: they’ll get all the DHA they need this way. (Some sources suggest that moms who are pregnant and breastfeeding should take a DHA supplement in addition to a prenatal vitamin, and experts seem to agree formula-fed infants should receive a formula with supplemental DHA.) The second source means eating cold-water oceanic fish (salmon, tuna, sardines, mackerel, herring, and many others). Let’s ignore the third source for now as it is so inconsistent and has low levels of DHA.
Does breast milk have DHA?
Yes. Human breast milk does contain DHA and other fatty acids that may be synthesized into DHA by babies. According to some studies, the concentration of DHA in breast milk does appear to be correlated with a mother’s diet – mothers who eat more seafood may have higher DHA levels.
There are two ways to procure DHA for supplements (or for the fortification of foods).
- Extract oil from cold water fatty fish, which will contain DHA and EPA, another important fatty acid.
- Extract DHA from seaweed or algae, which creates a vegetarian form of DHA, but no EPA (another Omega 3 fatty acid.
There are several important concerns with supplemental sources of DHA.
- The purity of the source: if fish oil is extracted from a fish with high levels of mercury, the oil will also contain mercury.
- Many supplements have other things added to them, and supplement manufacturers are not held to the high standards that a drug company is, so quality can vary widely.
- Some experts do not recommend DHA supplements that also contain EPA for infants and small children as they may upset the DHA/EPA balance during a child’s early development.
Let’s dive deeper into these three concerns.
The purity of the source: if fish oil is extracted from a fish with high levels of mercury, the oil will also contain mercury. In addition, many supplements have other things added to them, and supplement manufacturers are not held to the high standards that a drug company is, so quality can vary widely.
Some experts do not recommend DHA supplements that also contain EPA for infants and small children as they may upset the DHA/EPA balance during a child’s early development. Keep reading for more on this balance, and potentially upsetting it through ‘unnatural’ means.
As discussed in our superfoods for kids post, nutrition is a complex subject, and the full role of dietary DHA from natural or supplemental sources is not yet understood. The American Academy of Pediatrics has yet to take an official stance on supplemental DHA. Sources widely accepted as credible (the American Academy of Pediatrics, World Health Organization, etc.) agree wholeheartedly on the importance of DHA from naturally occurring sources, and seem to agree evidence points in the right direction to support supplemental DHA procured through infant formula. On the topic of supplemental DHA past formula age, these sources are more cautious. The NIH rates supplemental DHA as “possibly effective for” improving asthma symptoms, attention, mental function and behavior in kids with ADHD
So, what to do?
After much research, agonizing, and discussion, here’s where I landed:
1) There simply isn’t enough research out there to draw a definitive conclusion. That said, based on all the research I read there are a couple of steps I’m taking:
2) I’m not going to overdo it. If I wanted to I could buy milk, eggs, yogurt, baby food packets and much more all with supplemental DHA. I’m sticking to just milk with supplemental DHA (we buy Horizon Organic), and not obsessing over every single carton containing DHA (Whole Foods carries milk with DHA, Trader Joes does not, we shop at both).
3) I’m sticking with vegetarian sources of supplemental DHA. The University of Maryland article was the most prescriptive source I found on vegetarian vs. fish oil supplements for infants and small kids and recommended vegetarian sources.
4) Given the fact that supplemental DHA is far from a perfect solution, the argument that DHA from whole food (cold-water fatty fish) sources is hard to get, inconvenient, expensive, etc. so I’ll just use supplemental sources for my daughter is holding much less weight with me and has led to some creative ways to get more DHA from whole food sources: cooking and freezing, finding organic baby food packets with salmon, serving cold smoked salmon that requires no cooking and can be refrigerated for at least a few days (I’m getting my DHA this way too). I’ll be doing a post on how to get more fish in your child’s life down the road.
Hopefully, this has been helpful! Please let me know – paul[at]fathercraft.com, along with your thoughts and ideas. For more healthy eating for kids, check out our guide to superfoods for babies and kids.