Miralax: probably not the best solution for your child’s (or your) constipation

When it comes to constipation, natural practitioners hold that it is way under-diagnosed by conventional physicians. The way we see it, anything less than one bowel movement a day is unhealthy; but in medicine constipation is only considered a problem when it is severe. In these cases Miralax seems to be increasingly the drug of choice. But is it really a good solution?

Miralax has such a reassuring name that makes it sound like it is just the thing nature created for this problem. Fewer people might be willing to take it – or give it to their children – if they knew that the active ingredient is a chemical called polyethylene glycol (PEG), a close relative of ethylene glycol (antifreeze).  Why, you might ask, would something like antifreeze end up being used as a laxative?   Well, because it works, it is synthetic and can therefore be patented, and approval studies have not uncovered any dangers (in healthy adults).

The saving grace for PEG – at least in theory – is that it has a molecular weight of 3350, too large to be absorbed by a normal digestive tract.  Studies performed in healthy, non-constipated adults show that pretty much all the Miralax taken by mouth comes out at the opposite end, meaning that none of the PEG is absorbed.

However, in constipated adults (those who actually take the Miralax) some of the PEG is always absorbed, and studies have not been able to match the amount that is excreted to what is taken in. This, incidentally, confirms that individuals with constipation have an unhealthy and excessively porous intestinal tract. If some of the PEG is retained in the body the unanswered questions are where does it go, how long does it stay there and what does it do? You might also be wondering what happens to PEG in children, but the reality is that Miralax was not studied in children.

Perhaps the most disconcerting aspect of PEG is its well-known use in research laboratories. Here PEG is used to cause different cell lines to merge, forming new ìmutantî cells, or to facilitate viral infection of resistant cells. Under normal circumstances, a given virus can only infect certain types of cells because it needs a specific attachment site that is found only on some cells and not others. Add a little PEG to the mix and the virus can infect any cell type and no longer needs an attachment site to get in. To be fair, this characteristic of PEG has not been demonstrated in the human body, although that doesnít reassure me.

So if PEG and Miralax are out, what options do we have? The first and most obvious one is to find what is causing the constipation and correct it. By far the most common cause is food allergy or sensitivity and, among these, milk wins the contest by a long shot.

When avoiding milk or other foods doesnít help we must look for other possibilities. In some children, especially autistic children, constipation can be a result of yeast overgrowth, of willful retention, or of abnormal response to a natural impulse. What can we do? Here is a list of options that can help, but it is important to realize that when using natural treatments often a combination of remedies is better than any single one.

Fiber There are a variety of fiber types that can help. Soluble fiber tends to be more bulking but insoluble fiber also works sometimes. Among my favorite types are freshly ground flaxseeds, food grade cellulose, and glucomannan. This last one has the distinction of having been studied and found to be safe and effective to treat pediatric constipation (Pediatrics 2004; 113: e259-e264). In addition glucomannan also helps slow down carbohydrate absorption and stabilizes blood sugar, thus taking care of another common problem. Of course, prunes and prune juice are often very helpful too although they are also high in sugar.

Vitamin C As readers of this newsletter know I am a fan of vitamin C. Vitamin C can be taken in very high doses as an intestinal ìcleanseî but taking somewhat lesser amounts can help loosen stools. There isnít a single dose that is effective for everybody and you will need to find the amount that works for you.  To do so start with 1 or 2 grams per day (less in small children) and increase it by a gram or so every day until you achieve the desired result. Then stay at that daily level of intake, adjusting it as needed over time.

Magnesium Most people have heard of milk of magnesia, a form of magnesium sold as a laxative in drugstores. It is completely natural, safe, and it works very well, aside from a slightly unpleasant taste. Other forms of magnesium, including magnesium chloride, have a higher absorption rate. They may not be quite as effective as laxatives but they donít taste as bad, they are gentler and can help while at the same time also providing magnesium for the body.

Digestive enzymes and bile salts Bile salts are often referred to as the bodyís natural laxative.  In many cases constipation is a result of insufficient bile production. Bile salts can be obtained as a supplement, often in combination with digestive enzymes, and can be very effective for some people. For others, just taking a regular digestive enzyme without any bile salts in it is all that is needed.

Oils I am sure you’ve heard of mineral oil, although I don’t recommend it. Just regular fatty acid supplements like fish oil or evening primrose oil can be slightly laxative. To enhance this effect you may consider adding a tablespoon of olive oil to the mix.

Xylitol is a natural sugar substitute from birch trees that is very low in calories simply because the human body cannot digest it. A known side effect of xylitol is that it can cause loose stools, so some people put two and two together and started using it as a laxative, then told me it works very well. Itís probably OK although it wouldnít be my first choice because I worry that yeast and unhealthy bacteria may find it far easier to digest than we do.

Herbs Although I am all for herbal treatments, common herbs used for constipation should be used only on an occasional basis because they can be habit forming and irritating to the sensitive tissues lining the intestinal tract.

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