One of my favorite past times at work when I get a few minutes to myself is to sit down and read the free pediatric publications that land on my desk and rip them to shreds. I'm telling you, it's ENDLESS entertainment for a functional medicine provider who actually REVERSES DISEASE rather than medicating every child that walks through the door. The article Guideline adherence required to address constipation concerns in the Infectious Diseases in Children publication did NOT let me down this month. You can see the original article here: https://www.healio.com/pediatrics/gastrointestinal-conditions/news/print/infectious-diseases-in-children/%7Bca4f7cc1-ce29-4479-b534-b440be75c626%7D/guideline-adherence-required-to-address-constipation-concerns.
I'll give you a brief synopsis of the article and highlight the hilarity for you:
1. They give a good brief overview of the scope of pediatric constipation as a common complaint. They state that it is cause for 3% of primary care visits, and 10 to 25% of all GI specialist visits, costing the American healthcare system 3 times more than patients without constipation. Let's just think about this for a second- how much money is it costing the healthcare system because people can't poop?!? A LOT. You'd think that medicine as a whole, and pediatricians as a group, would sit back and ponder why such a large portion of the population has constipation in the first place. That's never addressed here.
2. They literally point out: "We usually see constipation occur during the introduction of whole milk around 1 year..."
Ok seriously? I mean you just inadvertently named THE BIGGEST culprit of constipation- diet, as well as pointing out one of the two foods most well known for causing constipation: dairy and wheat! However, literally nowhere do you mention in the article that you should do a trial off dairy to see if it alleviates constipation, even though you name it as the cause of onset!!
Dairy has an allowable amount of pus in it. Gross huh? It's the "great mucous maker". It takes three weeks to offload enough dairy proteins to see a difference in symptoms. Everyone tends to try to implode about 2 weeks in to no cheese, however if you are really trying to figure something you, make sure you go that extra week! The other biggest culprit is wheat, or the gluten in wheat. Gluten is "glue" after all. If coming off dairy doesn't do that trick, THEN ALSO come off of wheat. It takes SIX WEEKS to offload enough gluten proteins to do your due diligence. Don't vacillate back and forth and waste a bunch of time. You can always come off both and reintroduce one at a time about a week apart and see what shakes out... or doesn't.
3. Then we have the cherry on the sundae quote next. I just can't get over this one. I literally was caught by my staff guffawing out loud from my office while laughing and trying to stifle expletives all at the same time. (Don't worry! They figured out pretty quickly I must be perusing my stack of mail on my desk!). This guy takes the cake. Dr. Barrett H. Barnes, MD states, " There have been several posts about people accidentally eating too many sugar-free gummy bears. There is sugar alcohol in those gummies that can cause diarrhea, so parents could give children these candies knowing that it could potentially loosen their stool." You can't make this stuff up folks! They place it earlier in the article as a stand out quote like this is eye opening, genius stuff. I mean where are you in your career as a physician when you've resorted to AND THEN ARE QUOTED LIKE A GENIUS for shoving a bunch of chemical laden gummy bears down kids' throats to get them to take a crap?!?!
(Examples of pictures I like to clip out and tape to my door to entertain others.)
4. One of the first things this article points out is that the category 1 recommendation by the governing group of people who make constipation their thing ( NASHAGAN) is medications, and that unfortunately pediatricians aren't using this for their frontline defense. They literally are "slapping the hands" of pediatricians for not moving straight to laxatives. They then do bring up the recent problems brought to light about Miralax: "Although many doctors have prescribed Miralax in children it is not approved by the FDA for use in this population. Off-label use has recently raised concerns among parents, because some have observed neuropsychiatric issues- anger and aggression, mood swings and paranoia- in their children after prolonged use." . They then go on to poo poo the concern stating that medications are used for off label use all the time, that nobody has been able to prove it was the miralax that caused these symptoms (despite a whole gaggle of parents coming forward with complaints), and Dr. Thomas Ciecierga says, "Miralax is probably the most commonly used laxative in the world... a life-saver for us in the pediatric GI field for a very long time.". So in other words- yeah- we here all these parents complaining, but we don't care, because this works and is easy, and it's too much work to have to actually use our brains on this subject. NEXT!
5. At the end of the article they discuss some more natural options such as provided juice for the high sorbitol to aide with stooling. They also quote the previous doctor for "claiming" that increasing the amount of fruits and vegetables in the diet to increase fiber intake can "prevent" constipation. Really? I mean- how about we all eat the food God gave us: meats, fruits, vegetables, nuts, seeds, beans, lentils, etc and all go about our lives easily crapping?? We are now going to allow doctors to discuss other doctors "claiming" that eating real food can help us poop, like it sounds a little fishy? Am I in the twilight zone here?? You guys are going to discuss guidelines for constipation and stick to the meds while discounting that food could be the issue? Pick one guys. Either putting something in your mouth helps you poop or it doesn't. If putting medications in your mouth can help you poop, then putting FOOD in your mouth can help you poop too.
6. Lastly they discuss some alternative remedies. They discuss Senna Tea (like Smooth Move Tea- works great by the way!) and call it "homeopathic". Please have a clue what you are writing about before you publish it. Senna Tea is HERBAL, it is NOT homeopathic. They of course then go on to say that homeopathic remedies may be "risky", because the other ingredients in the mixture aren't regulated and we should be trying an alternative "child friendly" solution instead. This is followed up by blasting probiotics! They say- "the inclusion of pre- or probiotics has not been supported by NASPHAGAN. According to the organization, current evidence does not corroborate the use of these bacteria in children to prevent or treat constipation, and pediatricians should not recommend theses as a treatment.". Miralax= safe. Probiotics= not safe. Got that? Ok good.
Let's summarize this: Constipation is a growing problem, and we don't care or know why. Start milk for EVERYONE, even though we realize it starts constipation. Do NOT change diet! Anything natural is unsafe and stupid hogwash. Candy is definitely a good treatment. Make sure you use pharmaceuticals and have people spend lots of money while taking medications for prolonged periods of time, rather than actually fixing the root of the problem.
Simple list of reversing constipation:
1. Whole Foods diet. Remove excessive carbs and bananas. May need to a trial off wheat and dairy as described above.
2. Probiotics before bed. Multistrain, refrigerated, not grown on dairy. Easy examples of products to find that aren't junk would be Garden of Life or Klaire labs. The side effect of too much probiotic is pooping, so knock yourself out.
3. WATER. You have to have water to make stool. You should drink 1/2 of your body weight in ounces of water a day. (i.e. if you weigh 160lbs, drink 80 oz a day). Add 20+ ounces for sweating.
4. Senna is in fact very helpful. You can find "smooth move tea" almost anywhere.
5. Homeopathic remedy for constipation. Nux Vomica or Bryonia Alba. You can always look up a protocol by Joette Calabrese to find one specific to your symptoms.
6. If history of abdominal surgeries, consider structural issues and find a body work specialist who deals with scars.
7. Chiropractic care to insure appropriate nerve signaling in the body.
There are obviously more complicated situations, but these area a good place to start! And for heaven's sake, demand more form you doctor! Ok? This is just COMPLETELY UNACCEPTABLE.
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