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Date: | Fri, 16 Dec 2005 08:09:35 EST |
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Kathy and others have described some common side effects of formula
supplemented with DHA/ARA. Spitting up and runny bowel movements are an adverse
effect of these ingredients and as such should be reported every time you see it
to the FDA's MedWatch program at _www.fda.gov_ (http://www.fda.gov) . This
should also be reported to the manufacturer each time you see a baby with the
particular side effect. These side effects happen in a subgroup of babies who do
not tolerate algal and fungal sources of fats. It reminds me of what happens
to some adults when they consume olestra in snack foods. Olestra caused the
same type of side effects and for awhile the FDA required that this side
effect be mentioned on the product label to warn consumers of possible diarrhea
and uncontrollable fecal leakage. Snack food makers pressured the FDA to
remove the warning because it was bad for sales, so now these products just list
olestra in their ingredient list, and woe to the person who is sensitive to
this stuff and doesn't read the label!
In my opinion we are seeing a similar pattern with DHA/ARA supplemented
formula. Mead Johnson supplements Enfamil products with almost double the amount
that some of the other formula makers use, so it is not surprising to see
adverse effects in some babies. Their clinical studies usually eliminated babies
who had side effects so they never bothered to report this in their published
data. All formula labels should contain a message to parents that some
babies react poorly to DHA/ARA supplements. Clinicians should also be made aware
of this side effect as it could cause incorrect evaluation of infants' intake,
mistaken assurances that the baby is getting enough, and a skewed assessment
of babies with GI or weight gain problems. We don't know if fat soluble
vitamins are also lost through a constantly runny stool and how much pain the
baby may be in.
As Kathy has pointed out, we really need to ask how much formula a breastfed
baby is receiving when we assess diaper counts. A poorly feeding baby with
runny stools is a set up for dehydration, jaundice, and poor weight gain.
Marsha Walker, RN, IBCLC
Weston, MA
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