DHA & ARA: A Personal Story

I was scheduled to appear on National Public Radio to discuss an exciting development for babies: for the first time DHA and ARA have been added to an infant formula in the US. As the moment approached, I once again read the scientific literature leading up to this advance (such as a recent study funded by the National Institute of Child Health and Development that found that infants fed Enfamil LIPIL scored about seven points higher on a 100-point scale on a test of mental development when they were toddlers, compared to those fed formula without DHA and ARA.

The same study showed improved vision equal to about one line on a vision chart. Not all studies were able to detect this striking benefit, but some do!). I was excited.

When the moment for the live show arrived, the host introduced me as someone working for the formula company, while at the same time asking his first question. My jaw dropped. I started answering the question, but my mind was stuck on his introduction. I could see how he made that assumption. The power of the message was blunted because I was distracted. The show was framed as a debate between the American Academy of Pediatrics and a formula company. And I was up all night last night thinking about it.

I’ve devoted my life as an advocate for kids. I’m proud to be a fellow of the American Academy of Pediatrics. Moreover, I come at the DHA/ARA story as a pediatrician and as a father.

Those of you who have read my writings, seen me in the office, or heard me speak know that I am a staunch advocate of breastfeeding. All four of my kids were breastfed.

But in 1996 when my youngest son was nursing, his mother found a lump in her breast. She continued to nurse even when she needed an open breast biopsy. She felt that the risk of a large scar was worth taking to be able to continue to nurse. Nevertheless, when the diagnosis came back stage III inflammatory breast cancer, the chemo had to start and the nursing had to stop.

We wanted the best possible formula for our son. I learned that the World Health Organization (also strongly supportive of breastfeeding) had recommended that DHA and ARA be added to formula. It was already in use in many countries around the world – but not available in the US, not available for my son.

I learned that DHA and ARA are the most prevalent long chain fatty acids in breast milk. They are also the most prevalent structural fats in the brain and in the retinas of breastfed babies. Babies fed conventional formulas make substitutions.

I reviewed the available literature, spoke with DHA advocate Dr. Frank Oski (former Chairman of Pediatrics at Johns Hopkins University), and began calling for the addition of DHA and ARA to infant formula in 1996.

For more than five years now this has been very important to me. I am a strong promoter of breastfeeding, but now I deeply want every baby who receives formula to receive the best formula possible.

For the last few months, I have been in contact with a formula company. I have received some support from Mead Johnson to help me educate parents about DHA and ARA – but I’m doing this because it is my message. I speak on behalf of children, not of companies.

And it is not just my message. Expert panels from the Food and Agriculture Organization/World Health Organization and Child Health Foundation have recommended the addition of DHA and ARA at the levels found in breast milk. Formula containing DHA and ARA has been fed to babies around the world for years. It is now being used in more than 60 countries including the United Kingdom. It has now made it through the rigorous FDA review process and Enfamil LIPIL is finally available in the US (on store shelves in February 2002). I’m grateful that Mead-Johnson had the foresight and commitment to invest in the research and development needed to make this possible.

The American Academy of Pediatrics has not yet recommended DHA and ARA. They have an important role that demands slow and deliberate consideration. They agree that DHA and ARA are normally found in breast milk. They agree that they are safe. They agree that formula containing them is at least as good and perhaps better than formula without. But they continue to weigh the evidence of lasting benefit. Their last official position on the subject was in 1998. One of the strengths of the AAP is its extremely careful review process. I support that. And I don’t want them to recommend DHA and ARA until they are certain.

But based on all of the evidence now available, if I had a baby today who needed formula I would certainly and without hesitation want that formula to contain DHA and ARA at the levels found in breast milk. And now it can. Truly, this is an exciting day for babies!

(And by the way, my wife is strong and healthy 6 years after her diagnosis, and continues to teach me important things about advocating for children)