is Miralax bad for you?

by Catherine Saint Louis from The New York Times:

Since it was first introduced 13 years ago, a drug called Miralax — an odorless, tasteless laxative that can be easily diluted in orange juice or water — has become a staple in many American households.

But the way many families use Miralax and its many generic equivalents has strayed far from its original intent. The Food and Drug Administration approved the drug for use only by adults, and for only seven days at a time.

Instead, Miralax has become a long-term solution for childhood constipation — a problem that can be troubling not just physically, but also emotionally — rather than a short-term fix so that parents can change their children’s diets to include more fruits and vegetables.

“I’ve had kids on it daily for years,” said Dr. Scott W. Cohen, a pediatrician in Beverly Hills, Calif., adding that he will generally refer them to a specialist in prolonged cases. For children with chronic constipation who are not being helped by dietary changes, “We literally give it like water.”

No studies have shown that the drug’s active ingredient — polyethylene glycol 3350, or PEG — has severe side effects. But there is a growing chorus of questions about why it has been used and prescribed for children for so many years.

Last week, for example, the Empire State Consumer Project, a New York consumer group, sent a citizen petition to the F.D.A. on behalf of parents concerned about the increase in so-called adverse events related to PEG that health professionals and consumers have reported to the F.D.A. over the past decade.

The warning label on Miralax does not reflect a known risk to children. It means only that no long-term studies that meet the F.D.A.’s standards have been conducted on children using Miralax and its generic counterparts, which work by drawing water into the colon. However, discussion groups on many Web sites suggest that thousands of parents have questions and concerns about it, including the effects of long-term use.

Down syndrome: Nutrient-dense foods are best

from Daily Nation by Sona Parmar Mukherjee:
I seem to be seeing a lot of children since I reopened the clinic and yesterday, I saw a little girl with Down syndrome.

Down syndrome is a condition where a baby is born with an extra 21st chromosome. Most experts believe that this extra chromosome changes the normal development of the brain, which then leads to various mental and physical problems. It’s because of this that children like Juliet tend to be at a higher risk of certain health concerns.

The first is something that you probably wouldn’t have expected: children with Down syndrome are more likely to be overweight. They tend to burn calories at a slower rate and many are diagnosed with an under-active thyroid (which can further contribute to weight gain).

The best way to avoid unnecessary weight gain is to feed children nutrient-dense “real” foods and limit junk foods. As a rule of thumb, buy food that is grown rather than manufactured; so, plenty of fruit and vegetables. Since digestive issues are common in children with Down syndrome, a truly digestible diet can go a long way in preventing or treating yeast and/or constipation issues as soon as they appear.

Another common digestive issue is GERD or gastroesophageal reflux disease. Symptoms range from heartburn and sore throat, to regurgitation and chest pain. Common trigger foods include citrus fruits and foods high in sugars and fat (chips, biscuits, ice cream, fatty meat).

Children with Down syndrome are also more likely to suffer from a gluten intolerance or coeliac disease. Gluten is a protein found in wheat, barley, oats and rye, and an intolerance to it causes damage to the lining of the small intestine, which in turn affects absorption of vital nutrients.

For this reason, it’s best to wait until a child’s digestive system is more developed before introducing these foods, usually around 18-24 months. You may find keeping a food diary invaluable during this time. (Diarrhoea, stomach ache, bloating, irritability, rashes and mouth sores are possible symptoms.)

Gluten aside, some research in the US has shown that most children with Down syndrome are also lactose-intolerant, and do better on a milk-free diet. Dairy produce also increases the production of mucous, which can increase nasal congestion and the tendency to bronchial infections, both of which are more prevalent in children with this condition.

As I explained to Juliet’s parents, the idea is to create a good nutritional foundation. As Juliet grows and becomes more independent, she’ll have to be able make the right food choices on her own.

If you have an older child (Juliet is six years old), start slowly, making subtle changes to their diet. A total overhaul is likely to lead to resistance, whereas small, gradual changes will make it easier both on the child and the rest of the family.

Postscript: It is generally accepted that Down syndrome is a fait accompli, that little can be done to help the situation. It’s just a matter of accepting your child for who s/he is.

Enter the work of a small group of motivated parents and doctors in the US and Canada. They claim to have shown that if nutritional intervention is started early enough, growth rates and cognitive development could be normalised, and many of the physical and mental features of Down syndrome partially prevented or improved. If you would like more information on this, please do get in touch.

The writer is a clinical nutritionist and certified by the Nutritional Therapy Council in the UK. Please direct any questions about family nutrition to her on living@nutritionbysona.com