Olestra (Olean) Report Form ~ Center for Science in the Public Interest

Olestra (Olean) Report Form

Thanks for visiting the Center for Science in the Public Interest's (CSPI) on-line olestra report form. CSPI is a non-profit health-advocacy organization based in Washington, D.C. CSPI, along with other organizations and many scientific experts, has opposed the use of olestra (Olean). Thanks for taking the time to fill out the report form, which will only take a few minutes. CSPI evaluates and forwards each report to the U.S. Food and Drug Administration (without any identifying information). Your report will be very helpful in understanding the extent of problems caused by olestra and in protecting other consumers.

First Name	Last Name
Age	Sex
Address
City
State	ZIP
What is your occupation (clerk, student, professional, etc.)
E-mail address	Telephone (area code/number)
Did you suffer gastrointestinal problems after eating snack foods made with olestra? Yes No
When did you eat the olestra snack(s) that caused the problem(s)? (date and time)
How long after eating the olestra snack(s) did your problems start? Hour(s) Minutes
When did the problems end? (date and time)
Or do they still persist? Yes No
Did your problems occur after eating olestra snacks on only one day or for more than one day? (number of days)

Please identify your problems, and rank the severity of each symptom experienced as either:

None = Did not experience the symptom.
Mild = Normal activity unimpaired.
Moderate = Normal activity impaired.
Severe = Unable to perform normal activities.

Diarrhea (excessive frequency of very loose or watery stools that are extremely difficult or impossible to control)
None Mild Moderate Severe

Couldn't control bowels; soiled clothing: Yes No

Loose stools (a bowel movement that is easier to pass than normal, but is not watery or unformed)
None Mild Moderate Severe

Nausea
None Mild Moderate Severe

Fecal urgency (strong urge to go to the toilet)
None Mild Moderate Severe

Flatulence/Gas
None Mild Moderate Severe

Abdominal cramps
None Mild Moderate Severe

Vomiting
None Mild Moderate Severe

Yellow-orange stains in underwear
None Mild Moderate Severe

Greasy stools
None Mild Moderate Severe

Oil in toilet
None Mild Moderate Severe

Other

Please give any additional details you think may be important.

After the problem(s) stopped, did you eat olestra again, Yes No
and did you get problems again? Yes No

Which problem(s) reoccurred?

Did the package bear a label that states that "olestra may cause abdominal cramping and loose stools ....."? (please look carefully) Yes No

Would you have eaten the chips if there had been such a notice?
Yes No
Would you have linked your symptoms to the chips faster if there had been a notice?
Yes No

Which olestra snack food did you eat when you got gastrointestinal problems?

Brand/Product

Package Size

How much did you eat?

Procter and Gamble's Fat Free Pringles	small = 1.7 oz. can regular = 6.5 oz.	a few chips; 17 chips; 1/4 package; 1/2 package; whole package
Original
Barbecue
Sour Cream & Onion

Frito-Lay LIGHT Chips	small = 3/4 oz. bag medium = 6 oz. large = 13 to 15 oz.	a few chips; 17 chips; 1/4 package; 1/2 package; whole package
Lay's Light Original
Lay's Light KC Masterpiece BBQ
Doritos Light Nacho Cheese
Ruffles Light Original
Ruffles Light Cheddar & Sour Cream
Tostitos Light Restaurant Style

Do you have a history of gastrointestinal problems?

Yes No If yes, please specify:

Did you have the flu, allergy, or other illness that might have explained your problems?

Yes No If yes, please specify:

Where/when did the problems occur (work, school, driving, shopping, etc.)

Did you experience any safety problems, inconvenience, or embarrassment due to the problems? Yes No

Please describe what happened:

Did you seek professional medical help? Yes No

Did you have to visit a hospital emergency room? Yes No

What was the diagnosis?

Were you given or prescribed any medication?

Yes No If yes, please specify?

Would you eat olestra products again? Yes No

Did you contact Procter & Gamble or Frito-Lay after your experience? Yes No

What was their response?

Would you be willing to speak to the press or public about your experience with olestra? Yes No

Where did you hear about this web site?