Iron Fortified Formula and Constipation

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Any pregnant woman with iron deficiency anemia knows that one of the common

side effects of iron supplementation (even from the amounts of iron in some

prenatal vitamins) is constipation. The medical profression readily admits

that iron supplementation can cause constipation in women, especially if the

does is high - over 30 mg per day.

What puzzles me is that the medical profression for the most part adamantly

denies that iron fortification of infant formula can cause constipation.

I weighed 100 lbs my first pregnancy and the iron supplement I was

prescribed caused horrible constipation. Now take an infant weighing 10

lbs, whose digestive tract is immature, and give him formula that fortified

with 12 mg iron per liter (the USA average). Most infants drink 1-2 liters

per day; that's 12-24mg iron! I cannot believe that the increased amount of

mostly unassimable iron in infants cannot cause constipation. Dr. Sears

(see quote below - btw he offers some great " natural " tips for dealing with

constipation in infants) has the courage to admit that sometimes mother

knows best even when that knowledge conflicts with the most quoted studies

done on iron fortification of formulas. For what it's worth, human

breastmilk has about 1 mg iron per liter and it is probably 100% assimable.

Infants who are exclusively breastfed until 6 months need no extra iron

until at least 9 months of age and by that time most are on solid foods that

can contribute any extra iron required.

Anyway, I am a firm believer that iron fortification can cause severe

constipation in an infant. I babysat for my sister's formula fed twins who

were severely constipated. They had hard little pellets similar (sorry for

being graphic) to what I experienced when I took iron supplements. Check

out Dr. Sears' recommendations - especially the flax seed oil.

" Iron supplements cause constipation in some women, especially if the dose

is high (over 30 mg per day). Constipation will often improve if the amount

of supplemental iron taken is reduced or if smaller doses of iron are taken

at one time. Women with good iron levels and a healthy diet do not need to

take iron supplements at all. "

Nutritional Aids for Constipation in Pregnancy

http://my.webmd.com/content/article/1680.50957

The following quote is from the American Academy of Pediatrics Policy

Statement on Iron Fortification of Infant Formulas. The AAP is very

supportive of iron-fortified formulas and thinks low-iron formulas should be

taken off the American market.

" The concentration of iron in human milk is approximately 20% of that found

in low-iron cow milk formula (0.3 mg/L vs 1.5 mg/L). The low-iron formulas

produced in the United States contain a range of 1.5 mg/L to 4.5 mg/L of

iron, well below the cutoff of 6.7 mg/L as defined by the FDA. The Infant

Formula Act required that formulas fortified with greater than 6.7 mg/L of

iron be labeled " with iron. "

Iron found in human milk is far more bioavailable, resulting in much lower

rates of iron-deficiency anemia compared with low-iron cow milk formula.

Greater than 50% of iron from human milk is absorbed compared with 7% to 12%

of iron from cow milk-derived formula and from less than 1% to 7% absorbed

from soy formula.

A controlled study by Oski(23) and a double-blind crossover study by

et al(24) compared iron-fortified and low-iron formulas and found no

differences in prevalence of fussiness, cramping, colic, gastroesophageal

reflux, or flatulence. Moreover, therapeutic iron up to 6 mg/kg per day

given to infants is well-tolerated.(25)

In the United States, iron concentrations of iron-fortified formulas range

from 10 mg/L to 12 mg/L. In Europe, infant formula tends to contain 4 mg/L

to 7 mg/L of iron. "

http://www.aap.org/policy/RE9865.html

Excellent recommendations from Dr. Sears' website:

http://askdrsears.com/html/8/T081100.asp

CONSTIPATION IN INFANTS UNDER A YEAR

In addition to the above general tips for preventing and treating

constipation at all ages, try these infant-specific tips:

If formula-feeding, experiment with different formulas to find which one is

most intestinal-friendly.

Feed baby smaller amounts of formula more frequently, which gives the

intestines a better chance to properly digest the formula. An easier rule of

thumb is to feed half as much twice as often.

Delay introduction of solid foods, especially more constipating ones, such

as rice and bananas.

Instead of rice cereal, try barley cereal. Good starter high-fiber foods for

constipated infants are pureed pears and prunes.

Ease the passage of stools using glycerin suppositories or liquid glycerin

(as described above).

Add one teaspoon of flax oil once a day mixed into baby cereal or baby's

bottle.

Watch for about-to-go signs. As soon as your baby begins to grunt, grimace,

look bloated, or show signs of straining, quickly insert a glycerin

suppository to ease the passage. [ine adds: one of my sisters who had

severely constipated twins used a Q-tip covered with a lubricant such as

Unpetroleum Jelly to stimulate evacuation of the bowels.)

The Bath and Bowel Movement Technique

Here is a Sears' family trick that helped us ease the passage of stools in

several of our constipated babies. Although it's messy, it works. Immerse

your baby in a warm bath so that the water is around chest-high. When your

baby is relaxed in the bath, massage baby's abdomen and get ready for the

mudslide.

CONSTIPATION AND IRON-FORTIFIED FORMULA

Before rushing to attribute your baby's constipation to the iron in the

formula, you may be interested to know that controlled studies performed by

the late Dr. Oski, Professor and Chairman of the Department of

Pediatrics at Hopkins Medical School, showed that iron-fortified

formulas do not cause constipation any more than formulas without iron.

On the other hand, scientific research and mothers' first-hand observations

sometimes clash. Even in our pediatric practice, a mother occasionally tells

us she's absolutely certain that iron causes constipation. Yet, your baby

does need an iron-fortified formula. Low-iron formulas simply don't provide

adequate amounts of iron, resulting in anemia , between the ages of six to

twelve months.

If you're certain an iron-fortified formula contributes to constipation, use

all the treatments recommended. If baby is still constipated, try using a

low- iron formula for two months. Then, once your baby's intestines are more

mature and his toleration increases, you can switch back to a non-fortified

formula.