Vitamin Levels and constipation

[Manaan2]

I’m sure this info is already covered somewhere so apologies for posting a repeat; my 6 year old daughter is newly diagnosed with celiac and we are thankful for all the info on this site!  We’re looking for thoughts and suggestions regarding the following:

Constipation continues even now that we are 6 months gluten free.  Consistently low vitamin d levels with consistent borderline high calcium pre and post gluten free.  Doctors have had her on MiraLAX 1 cap/day since she was 3.  We desperately want to end the MiraLAX.  Has been dairy free for 3.5 months as well.  Doctor recently recommended 2000 IUs vitamin d/day so will be starting that as soon as we find an appropriate vitamin.  Iron levels still just above low end of normal range.  Ferritin is also on low end of normal range.  Pre gluten free diet, iron was high and ferritin a bit lower than now.  Any suggestions for what to look into regarding the ongoing constipation? Stoops have been sandy/grainy her entire life.  She has always eaten a diet with minimal processed foods and high in fruits and vegetables (we are a bit crazy with our kids’ diets). GI does not have any recommendations regarding constipation.   Trying to get into another GI for second opinion since she has been on MiraLAX for so long.  Thanks to all that read.  

[trents]

I would try a magnesium supplement as low magnesium can contribute to constipation. And dairy is one of the main sources of magnesium in our diets, something you have recently eliminate from her diet. Magnesium Citrate or Magnesium glycinate are much better absorbed than the more common magnesium oxide supplement.

[Scott Adams]

I'm not a medical professional, but I can offer some general suggestions that you may consider discussing with your healthcare provider:

Consult a Pediatric Gastroenterologist: Since your daughter has been on MiraLAX for an extended period and constipation persists, seeking a second opinion from a different pediatric gastroenterologist is a good step. A specialist may have additional insights and recommendations.

Evaluate Fiber Intake: Ensure your daughter's gluten-free diet includes an adequate amount of fiber from naturally gluten-free sources like fruits, vegetables, and gluten-free grains. Adequate fiber intake can contribute to regular bowel movements.

Hydration: Encourage sufficient water intake. Dehydration can contribute to constipation, so ensuring she stays well-hydrated is important.

Probiotics: Probiotics may help promote gut health. Discuss with your healthcare provider if adding a pediatric-friendly probiotic might be beneficial.

Food Sensitivities: While your daughter is already gluten-free and dairy-free, consider exploring if there are any other specific food sensitivities that might be contributing to her symptoms. This could involve working with a healthcare provider or dietitian.

Thyroid Function: In some cases, thyroid function can influence bowel movements. You might want to discuss with your healthcare provider whether checking thyroid function is appropriate.

Physical Activity: Encourage regular physical activity, as exercise can support healthy digestion.

[Manaan2]

Thank you to everyone for your thoughtful responses!  It’s all very helpful and gives us some strategies to try while we wait to get another GI and dietician opinion.  Some of these things we can start working with our primary pediatrician on right away.  Thanks again.

[Wheatwacked]

Inulin is a nondigestible oligosaccharide which seems to regulate the intestinal transit and the stool consistency and frequency, and to modulate the immune response. Moreover, inulin is considered a prebiotic, characterized as ‘functional fiber. Inulin-type fructans have been used in infants and children because of their prebiotic potential to modulate the intestinal flora and influence the innate and adaptive immune response favorably.  Might be a better choice than MiraLax.

Choline is a bowel motility promoter which is appropriate for use for constipation  Adequate Intake for 4 to 8 year old is 250 mg (2 hard boiled eggs a day).  Safe upper limit is 1000 mg a day for 4-8 year old.  Choline NIH Fact Sheet for Health Professionals

Cherry or Grape flavored liquid magnesium citrate in a glass of water or juice. Magnesium RDA for 4-8 year olds is 130 mg. A half ounce of magnesium citrate has 145 mg.  It is already a liquid so no pill, less irritation and better absorption. I like the taste.  For constipation in 6 to 12 year olds max dose is 3 to 6 fl. oz. a day. Works in 1/2 to 6 hours. About $2.50 for a 10 ounce bottle.  Produces a soft formed stool, and relaxes and loosens the bowels, typically used over a protracted periodIt's been in use for years longer than Miralax (2006 OTC labeled dosing applies to adults and children 17 years and older for up to 7 days,). Forms of magnesium most commonly reported to cause diarrhea include magnesium carbonate, chloride, gluconate, and oxide. Magnesium NIH Fact Sheet for Health Professionals

PipingRock.com has liquid vitamin D for babies. 5 drops is 2000 IU. Put it in the mag citrate daily drink. $6.49 bottle has ~365 drops.

Here is a really good article on Vitamin D in Children’s Health.

• For every 100 IU intake of vitamin D3, serum levels increase by 1 ng/mL when given over 3 to 4 months.
• Vitamin D experts advocate targeting 25(OH)D levels of 40 to 70 ng/mL to achieve the optimal skeletal function without toxicity.

 

[shadycharacter]

Dairy is an important source of iodine. Perhaps check if her diet contains enough? Low iodine may cause constipation if it affects thyroid hormons (which consist mostly of iodine). Also, there are some vegetables that can affect the uptake and/or use of iodine in the body. This could matter if someone is low or borderline low on iodine. Sweet potatoes and the cabbage family are reported to have this effect. (Google goitrogens for more info.) 

 

https://pubmed.ncbi.nlm.nih.gov/29221567/#:~:text=Milk iodine concentrations in industrialized,type of farming and processing.

"Milk and dairy products are major iodine sources in industrialized countries. However, consumption of milk and dairy, as well as their iodine concentrations, vary widely, making them an unpredictable iodine source. Milk iodine concentrations in industrialized countries range from 33 to 534 μg/L and are influenced by the iodine intake of dairy cows, goitrogen intake, milk yield, season, teat dipping with iodine-containing disinfectants, type of farming and processing. We estimate milk and dairy contribute ≈13-64% of the recommended daily iodine intake based on country-specific food intake data."

 

[Wheatwacked]

Have you considered having the whole family remove gluten?  When my son was diagnosed at weaning in 1976 it was recommended by his doctor. We declined.  Worst mistake.  Life would have been so much better. We both had symptoms, dismissed as normal, that went away when I started GFD at 63.  Some from early childhood.

It would avoid the "Do as I say" certain to rear its head; and make cross contamination less likely.

Some research estimates as high as 2 in 5 (40%).

"While sisters and daughters of index patient had the highest risk of having celiac disease (1 in 7 and 1 in 8, respectively), the risk was 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers, and 1 in 33 in fathers. There were also differences in the pooled prevalence of celiac disease in FDRs according to their geographic location." Risk of Celiac Disease in the First- and Second-Degree Relatives

https://www.celiac.com/articles.html/what-are-the-symptoms-of-celiac-disease-r1090

[Manaan2]

2 hours ago, Wheatwacked said:

Have you considered having the whole family remove gluten?  When my son was diagnosed at weaning in 1976 it was recommended by his doctor. We declined.  Worst mistake.  Life would have been so much better. We both had symptoms, dismissed as normal, that went away when I started GFD at 63.  Some from early childhood.

It would avoid the "Do as I say" certain to rear its head; and make cross contamination less likely.

Some research estimates as high as 2 in 5 (40%).

"While sisters and daughters of index patient had the highest risk of having celiac disease (1 in 7 and 1 in 8, respectively), the risk was 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers, and 1 in 33 in fathers. There were also differences in the pooled prevalence of celiac disease in FDRs according to their geographic location." Risk of Celiac Disease in the First- and Second-Degree Relatives

https://www.celiac.com/articles.html/what-are-the-symptoms-of-celiac-disease-r1090

Thank you for the reply, articles and resources.  We all went gluten free immediately because I was too concerned about cross contamination.  So far bloodwork is clear for the rest of us in the family.  The pediatric GI had recommended we all test immediately.   

[Manaan2]

8 hours ago, Wheatwacked said:

Inulin is a nondigestible oligosaccharide which seems to regulate the intestinal transit and the stool consistency and frequency, and to modulate the immune response. Moreover, inulin is considered a prebiotic, characterized as ‘functional fiber. Inulin-type fructans have been used in infants and children because of their prebiotic potential to modulate the intestinal flora and influence the innate and adaptive immune response favorably.  Might be a better choice than MiraLax.

Choline is a bowel motility promoter which is appropriate for use for constipation  Adequate Intake for 4 to 8 year old is 250 mg (2 hard boiled eggs a day).  Safe upper limit is 1000 mg a day for 4-8 year old.  Choline NIH Fact Sheet for Health Professionals

Cherry or Grape flavored liquid magnesium citrate in a glass of water or juice. Magnesium RDA for 4-8 year olds is 130 mg. A half ounce of magnesium citrate has 145 mg.  It is already a liquid so no pill, less irritation and better absorption. I like the taste.  For constipation in 6 to 12 year olds max dose is 3 to 6 fl. oz. a day. Works in 1/2 to 6 hours. About $2.50 for a 10 ounce bottle.  Produces a soft formed stool, and relaxes and loosens the bowels, typically used over a protracted periodIt's been in use for years longer than Miralax (2006 OTC labeled dosing applies to adults and children 17 years and older for up to 7 days,). Forms of magnesium most commonly reported to cause diarrhea include magnesium carbonate, chloride, gluconate, and oxide. Magnesium NIH Fact Sheet for Health Professionals

PipingRock.com has liquid vitamin D for babies. 5 drops is 2000 IU. Put it in the mag citrate daily drink. $6.49 bottle has ~365 drops.

Here is a really good article on Vitamin D in Children’s Health.

• For every 100 IU intake of vitamin D3, serum levels increase by 1 ng/mL when given over 3 to 4 months.
• Vitamin D experts advocate targeting 25(OH)D levels of 40 to 70 ng/mL to achieve the optimal skeletal function without toxicity.

 

Can’t thank you enough for this information.  We are definitely going to try one of these alternatives and the GI wasn’t able to answer any of our questions related to the vitamin d info that you provided.  I’m researching as fast as I can while also trying to stay sane and enjoy life.  All this info is incredibly helpful for our daughter’s progression and the overall mental health of our family.  Thanks again.

[Manaan2]

3 hours ago, shadycharacter said:

Dairy is an important source of iodine. Perhaps check if her diet contains enough? Low iodine may cause constipation if it affects thyroid hormons (which consist mostly of iodine). Also, there are some vegetables that can affect the uptake and/or use of iodine in the body. This could matter if someone is low or borderline low on iodine. Sweet potatoes and the cabbage family are reported to have this effect. (Google goitrogens for more info.) 

 

https://pubmed.ncbi.nlm.nih.gov/29221567/#:~:text=Milk iodine concentrations in industrialized,type of farming and processing.

"Milk and dairy products are major iodine sources in industrialized countries. However, consumption of milk and dairy, as well as their iodine concentrations, vary widely, making them an unpredictable iodine source. Milk iodine concentrations in industrialized countries range from 33 to 534 μg/L and are influenced by the iodine intake of dairy cows, goitrogen intake, milk yield, season, teat dipping with iodine-containing disinfectants, type of farming and processing. We estimate milk and dairy contribute ≈13-64% of the recommended daily iodine intake based on country-specific food intake data."

 

I didn’t even think about iodine levels when we removed dairy.  We will definitely get those levels tested.  We always use Himalayan salt in cooking so that reduced her intake even more.  Thank you! 

[Scott Adams]

I eat pure seaweed sheets as snacks to get more iodine in my diet. Just be sure they don't include soy sauce and are just pure seaweed and salt. I try to get brands that are made in South Korea or Japan, and here in California they are sold in large packages on snack pack sizes in Costco.

[KennaH]

22 hours ago, Manaan2 said:

I’m sure this info is already covered somewhere so apologies for posting a repeat; my 6 year old daughter is newly diagnosed with celiac and we are thankful for all the info on this site!  We’re looking for thoughts and suggestions regarding the following:

Constipation continues even now that we are 6 months gluten free.  Consistently low vitamin d levels with consistent borderline high calcium pre and post gluten free.  Doctors have had her on MiraLAX 1 cap/day since she was 3.  We desperately want to end the MiraLAX.  Has been dairy free for 3.5 months as well.  Doctor recently recommended 2000 IUs vitamin d/day so will be starting that as soon as we find an appropriate vitamin.  Iron levels still just above low end of normal range.  Ferritin is also on low end of normal range.  Pre gluten free diet, iron was high and ferritin a bit lower than now.  Any suggestions for what to look into regarding the ongoing constipation? Stoops have been sandy/grainy her entire life.  She has always eaten a diet with minimal processed foods and high in fruits and vegetables (we are a bit crazy with our kids’ diets). GI does not have any recommendations regarding constipation.   Trying to get into another GI for second opinion since she has been on MiraLAX for so long.  Thanks to all that read.  

I am diagnosed celiac with IBS constipation although I was told IBS can change from constipation to diarrhea. I eat gluten free and FODMAP diet. I no longer need to take fiber or miralax except in extreme situations. I still suffer from some abdominal pain and going to bathroom at time but much better. Always try to stay hydrated. 

[Celiac16]

@Manaan2 hi Manaan, this is going to sound very random but vitamin b1, thiamine, helped me with constipation. It can also cause anemia if low (so can other b vitamins so a b complex or multivitamin could help, probably a good safety net too). My pediatrician had me take a multivitamin when I was diagnosed as a kid too just to cover all the bases.

[Manaan2]

Thank you! This is great information and perfect timing because we have our first appointment for a second opinion tomorrow.