I think that one thing that those of here can agree on is that the human body exists in a delicate balance of homeostasis, upsetting the balance of particular elements can have negative repercussions for the body. It's one of the reasons that we advocate for human milk for human beings, because we understand the delicate balance of the human body and have a respect for it. Here is one study I found to support the idea that taking large doses of lecithin (which largely converts to a form of choline in our bodies) can inhibit the absorption of free fatty acids and bile salts (which break down fats). 


Lipids. 1976 Dec;11(12):830-2.
Lecithin inhibits fatty acid and bile salt absorption from rat small intestine in vivo.
Saunders DR, Sillery J.
Abstract
During digestion of a fatty meal, long chain free fatty acids (FFA) and lecithin are among the lipids solubilized in intestinal contents as mixed micelles with bile salts. We hypothesized that if lecithin were not hydrolyzed, the mixed micelles would be abnormal, and absorption of FFA and bile salts would be depressed. To test this hypothesis, isolated segments of rat small intestine were infused in vivo with micellar solutions of 2 mMolar linoleic acid and 10 mMolar taurocholate to which was added 3 mMolar 1-palmitoyl, 2-oleoyl lecithin (a common lecithin in bile and food), or 1-palmitoyl lysolecithin (the hydrolytic product of lecithin). Absorption of FFA and bile salt was measured under steady state conditions using a single-pass technique.Lecithin depressed the rate of FFA absorption by 40% (p less than 0.025) in jejunal and ileal segments whereas lysolecithin was associated with normal rates of FFA absorption. Lecithin also reduced taurocholate
 absorption from the ileum by 30% (p less than 0.05). These data support the idea that lecithin may depress FFA and bile salt absorption from the small intestine in pancreatic insufficiency.
http://www.ncbi.nlm.nih.gov/pubmed/1011937


I know many of us have suggested lecithin for years for our patients with plugged ducts, seemingly without problems. But usually most women will take lecithin in smaller doses and for a shorter time period than my patient did. The RDA for lecithin is about 425 mg, she was taking about 10 times that, before her milk supply was even established.  We should also keep in mind, I think, that there are no large studies showing its safety in large or small doses, or whether there is any effect on the mother's milk supply or infant's growth. Lecithin converts largely to choline in our bodies which can have some negative side effects in large doses. There are many other studies which support the idea that lecithin and choline inhibit cholesterol absorption, something else that is very essential for breastfeeding babies, and key in the absorption nutrients and vitamins, such as Vitamin D. In Europe, choline is a popular natural treatment to reduce cholesterol
 levels.

Likely taking a lower dose for a week during a episode of plugged ducts for an established breastfeeding couple, would have little to no effect on the baby. However, if it did reduce the infant's absorption of fats, and the baby was fussier and wanted to nurse more frequently that week, how many of us would associate it with the lecithin? I would probably just chalk it up to a growth spurt. I'm just pointing out that really we don't have any studies showing it's safety in large doses, so we might want to be cautious before recommending very large doses, especially long-term to mothers of newborns. Sometimes we can over do a good thing. 

Although it is not scientific, both mother and baby seem to be doing much better off of the lecithin. The mother's nausea, abdominal upset and pounding heart beat have stopped, however, she continues to have excessive sweating. I spoke with her today and she said that breastfeeding is going much, much better. She is breastfeeding sometimes with and sometimes without the SNS, pumping and giving supplemental EBM and formula at SNS. She feels baby seems more satisfied with both EBM and with her breast, and is beginning to reduce formula and increase EBM, and continue weight checks. If this works and she is able to taper off the formula, it will be the first baby is the last 3 that she will be able to exclusively breastfeed again. Fingers crossed!

Thanks for all your help,

Tricia Shamblin, RN, IBCLC

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