Reflux: Treating the Problem Not the Symptoms

Both Jett and Oliver had silent reflux and I didn't know it until Jett was 5 years old and Oliver 2 years old! Of course I feel terrible! Many of their symptoms I attributed to other things so they suffered, silently for years. Neither child has slept a full night through EVER -- but, last night -- they both slept through the night for the first time! 

Keeping in mind that acid reflux is because of LOW stomach acid and bacterial overgrowth, the cure is so simple. I just added a tablespoon of apple cider vinegar in their straw cups with lots of coconut water and a bit of stevia so it wasn't so sour. And they SLEPT THROUGH THE NIGHT!! I'll be adding a tablespoon of ACV in their drinks so that they can sip it throughout the day. Most people make sure their child drinks ACV an a hour before every meal. To address the overgrowth, probiotics are important. I list my favorites below. The last step is reducing carbohydrate intake. (See Get rid of GERD forever in 3 steps for details.)

Poor thyroid function is also a common reason for those with DS to have reflux. For Jett, his thyroid was properly treated so I had to go to the next steps. 

How did I miss this?

Jett's clues:

• Displeasure when placed in a reclining position (One of his reflexes wasn't integrated so when I fixed that, he seemed fine on his back.)
• Arching neck and back after eating (Most noticeable at restaurants because at home, I didn't think about "how it looks from the outside" as I did in a public.)
• Poor sleeping habits – typically with frequent waking
• Arching neck with head back during sleeping (Thought maybe it helped open his airways to breath better at night.)

Oliver's clues:

• constant crying as a baby (attributed it to his PTSD)
• irritability (PTSD)
• frequent hiccups early on (the hospital said it was nothing--I thought maybe stress)
• frequent waking (PTSD)
• wanting to eat constantly because that helps soothe/decrease the pain (thought it was his mycoplasma infection or candida overgrowth)
• Swallowing problems – gagging/choking/coughing (again, PTSD, was able to fix with an MNRI technique)
• Arching neck and back during or after eating 
• wanting to nurse all night long/ drink constantly because that helps soothe/decrease the pain (thought it was his PTSD)
• occasional blood in his stool :(

What damage can reflux do?

In addition to wanting to get rid of the above symptoms, which are uncomfortable or downright painful, reflux can actually do some damage so it needs to be treated right away. Eventually it can cause inflammation and bleeding in the esophagus.  

Nutritional Ways to Treat Reflux  
 
As I mentioned, here's a great step by step guide.

And an excerpt from Weston. A. Price:  

Cultured foods and beverages will support the development of a healthy intestinal flora, and help break the candida cycle; these lactofermented foods will also supply enzymes to support digestion. Often, however, those suffering from acid reflux and related digestive problems find that they need additional help, especially at first. There are many fine probiotic and enzyme supplements that you can take to get you started in your healing journey.

Products Andi likes

Fermented foods are an easy way to add healthy microbes into your child's diet. Jett loves fermented ketchup, beet sauerkraut and raw goat keifer. Oliver like "salad" sauerkraut and coconut milk keifer and coconut or raw sheep's milk yogurt.  These are the enzymes and probiotics I like:
 
Enzymes 

Nutrivene Daily Enzymes
Digest Spectrum
TriEnza Enzymes

Probiotics

Prescript Assist

Nature's Way Primadophilus Reuteri
Dr. Mercola's Complete Probiotics

Get $10 off your first VitaCost vitamin order

Learn More

The following is by guest blogger, Kris Benson, mom to Chase, 9 months old who is doing very well. In fact, he started crawling on hands and knees at 7 months old! But Kris has also had to face many challenges that come with the diagnosis. One of which is reflux. Lucky for us, Kris has taken the time to share what she has learned in two informative blog posts. Oh, and she happens to be a professional writer! Be sure to check out part one: Reflux in Down syndrome.

Reflux is not CAUSED by excess stomach acid

Everyone associates reflux with excess stomach acid. And if that is the cause, then it makes sense that if you take medication to reduce stomach acid, you should reduce reflux. But it really only addresses the pain/discomfort associated with reflux.

A better way to think about this is reflux is (usually) CAUSED by the LES muscle not closing when it should. By reducing the stomach acid, you are not treating the cause of the reflux (failure of LES to close properly), but merely the consequence of reflux (stomach acid/food forced back into the esophagus). The reasoning for the antacid medication is that less stomach acid in esophagus = less pain and less chance of damage.

And that might be fine – if your child’s LES problem resolves quickly and everything starts working great. A short term reduction of stomach acid will most likely prevent the pain and damage caused by the reflux. However, the acid reduction may be causing more problems than it is preventing.

Low stomach acid is a problem too

At 3 months old, my son was diagnosed with “Silent Reflux” and put on Zantac with a TBD end date. When that stopped controlling his pain, they switched him to Prevacid and he has been on that for almost 6 months already with no end in sight. It seems to control his pain well and when it doesn’t, I have found that Mylanta and/or Mylicon treat his immediate pain.

At 9 months, he is only 14 lbs, rarely hungry, doesn’t sleep through the night, has severe constipation, and feedings are a constant struggle. He only eats 4-5 oz at a time, so I have to fortify his breastmilk with powered formula and must continue the night feedings in order to get enough calories into him each day. He’s been diagnosed with failure to thrive twice (for both times the doctors upped his reflux medication and threatened us with a feeding tube, which is major surgery and just a band-aid – it does not treat the cause of the poor feeding at all – and often causes severe feeding aversion and other complications.)

I believe that it is actually the acid reducing medication my son is on that prevents him from being able to properly digest his food.

This is causing a cascade of problems:

· He’s not hungry often enough. If his food is not fully digested in a timely manner, then food stays in his stomach longer, making him feel full longer, so he’s usually just not hungry. That makes he doesn’t eat enough and every feeding becomes a struggle.

· Gas build up causes pain and reflux. This bad digestion also causes gases to build up in his stomach causing extreme bloating, cramping, and pain that is easily mistaken for reflux and can also help cause reflux. He is constantly trying to stretch his torso – throwing his head back and arching his back to try to relieve the pain. This makes feeding painful and increases feeding problems. It also makes him wake up frequently and not want to be placed on his stomach or back. He has started sleeping on his side because of this gas problem.

· Nutrient absorption is reduced. Once the improperly digested food does leave his stomach, nutrient absorption is reduced because they have not been released from the food. This adds to slow growth and insufficient nutrient levels and calorie uptake.

· Increases constipation. Also, the poorly broken down food takes longer to travel through the intestine, causing more water to be absorbed from it making my child “super” constipated. This makes the whole system backed up and he’s uncomfortable, starts “holding it” because it hurts to poop, and can cause even more problems.

All of these compounding problems result in a poorly functioning GI system that could be causing my son’s eating and growth problems.

(http://articles.mercola.com/sites/articles/archive/2009/04/25/news-flash-acid-reflux-caused-by-too-little-acid-not-too-much.aspx)

Treating the Problem Not the Symptoms

I do not believe that he is still suffering from reflux, but rather low stomach acid that is causing symptoms that present like reflux. Even though he’s been on the Prevacid for so long, he still has some symptoms of reflux and I l have to treat occasionally with Mylanta. Interestingly, Mylanta is an antacid and anti-gas medication. I think that I may have been treating gas problems that have presented like reflux.

Over the past month, I have slowly weaned my son off of the Prevacid. He has been free of antacid medication for over a week now. I have added 1 tsp of Miralax 3x a day to treat his severe constipation and keep things going through his system more quickly. (Note: Kris doesn't use Miralax anymore, she uses Vitamin C, if necessary, see Constipation: Causes and Cures ). I have also added an increased dose of Nutrivene digestive enzymes – 1/2 to 3/4 capsule 2-3 times a day – to help him digest his food more completely and more quickly. 

He tends to get gas build up in his stomach extremely easily and quickly. I let him stretch out across my body when feeding and give him Mylicon as necessary. Just today, I was trying to figure out why his diaper seemed to be gigantic on him and realized it was because his bloated budda belly was finally gone!

He is starting to be hungrier more often and is eating more at each meal. I am hoping that this will lead to better sleep at night and more rapid weight gain and make him a happier and healthier boy in general.

Note: Overexpression of GABA, a common problem in people with DS, can cause reflux, both acid and nonacid in the esophagus.  Taking ginkgo to control overexpression of GABA may therefore help with reflux. See Ginkgo: The Hows and Whys for Down Syndrome for details. -Andi

Sources

http://www.webmd.com/heartburn-gerd/guide/complications-untreated-gerd

Related Posts

 

Reflux in Down syndrome
Constipation: Causes and Cures

Ginkgo: The Hows and Whys for Down Syndrome
TriEnza Enzymes
Probiotics
How to Teach Your Baby to Self Feed 

Thyroid & DS Go Hand in Hand

Celiac Disease & Down Syndrome

The Heart & Down Syndrome

Immunizations

Anemia Causes & Cures

Heal the Gut, Heal the Child

Natural Ways to Help with ADD & Hyperactivity

Cystic Fibrosis of Pancreas and Down Syndrome

Stimulating Growth

Antibiotics: Alternatives & What to Avoid

Pregnant & Nursing Moms Need Choline to Help Baby

Reflux in Down syndrome

Guest blogger, Kris Benson, is mom to Chase, 9 months old. I first met them at a local (terrible) free annual clinic for children with Down syndrome. I spotted her adorable, bright-eyed one month old baby and immediately thought of Jett.

Chase is doing great, in fact, he started crawling on hands and knees at 7 months old!! But Kris has had to face many challenges that come with the diagnosis. One of which is reflux. Lucky for us, Kris has taken the time to share what she has learned in two informative blog posts. Oh, and did I mention that she's a professional writer? (Score!) Be sure to check out part two: Reflux: Treating the Problem Not the Symptoms.

What is Reflux?

Reflux occurs when the contents of the stomach go back up into the esophagus, which usually results in “spitting up” or more forceful vomiting. There is a ring of muscles, called the Lower Esophageal Sphincter (LES), located at the base of the esophagus and top of stomach that opens and closes to allow food to enter and stay in the stomach. Reflux can happen with this ring of muscles is either not developed enough or too loose to close completely (this is fairly common and explains why infants grow out of reflux) or the muscle opens to release gas after the meal and stomach contents are just ejected into the esophagus as well. Compounding the sphincter problem is that an infant has a shorter esophagus and is lying down more of the time.

Most babies have at least a little reflux within the first 1-3 months. It is more prevalent in preemies and, of course, in babies with DS (probably due to a higher likelihood of reduced tone and/or underdeveloped of the LES) Reflux usually goes away by itself anywhere from 6-12 months. But it can last longer. 

There are several kinds of reflux:

Gastroesophageal Reflux (GER): Most reflux is GER. Ranges from reflux material just entering the bottom of the esophagus to spitting up and projectile vomiting. 

Gastro-Esophageal Reflux Disease (GERD): GER becomes GERD when reflux causes troublesome symptoms and/or complications. Complications are considered to be failure to thrive, slow growth, feeding and/or oral aversions, esophagitis, Barrett’s Esophagus (lining of esophagus is permanently damaged – this is pretty uncommon) even chronic sinusitis, wheezing, pneumonia, and other respiratory problems. 

Extraesophageal Reflux (EER): When reflux reaches up into hypopharyx, nasopharyx, oropharynx, larynx, or trachea.

Laryngopharyngeal Reflux (LPR) (aka Silent Reflux): GER, EER, and/or GERD without the frequent spitting up/vomiting. Fewer symptoms present.

Doctors push for immediate use of antacids because they claim that chronic reflux can lead to contact ulcers, recurrent ear infections, scarring to throat and voice box, or even cancer called adenocarcinoma of the esophagus. This is not advisable.

Potential symptoms

A baby can have several, one, or maybe even none of these symptoms:

· Constant and/or sudden crying or colic-like symptoms
· Displeasure / pain when placed in a reclining position
· Arching neck and back during or after eating
· Irritability
· Wet burps or frequent hiccups
· Poor sleeping habits – typically with frequent waking
· Chronic hoarse voice
· Noisy breathing and possibly apnea
· Refusing food or accepting only a little despite being hungry OR wanting to eat constantly because that helps soothe/decrease the pain
· Food/oral aversions
· Swallowing problems – gagging/choking/coughing
· Repeated swallowing
· Spitting up and/or vomiting
· Post nasal drip
· Blood in stool

Things that might help control reflux

· Add a thickener like gluten free oatmeal to the bottle (if the milk is heavier/thicker, it might not reflux up into the esophagus as easily or as often).

· Feed the baby in a more upright position (ears above mouth).

· Reposition yourself and the baby to let the baby stretch out as much as possible when feeding (see picture) – not bent at the waist crunched in the crook of your arm.

· Feed baby smaller more frequent meals to avoid overstuffing the stomach making it easier for food to reflux out of it.

· Keep child upright (and calm!) for minimum 30 minutes after eating.

· Put child to sleep on left side.

· Put a wedge in the bed so child sleeps on an incline.

I have a wedge in my son’s crib and always start him off on it, but he inevitably slides down it until he is a crumpled ball at the bottom or ends up parallel to it. There is a wedge/sling combo that you can buy (I have seriously considered it, but never bought it) to keep the baby on the wedge. The website even notes that insurance may cover the cost of the item if ordered by a hospital or doctor.

http://www.pollywogbaby.com/item--tucker-wedge--TuckerWedge.html.

You can also just buy the sling and elevate one end of your mattress: http://www.pollywogbaby.com/item--tucker-sling--CribSling.html

I have often fed my son while he’s lying on a wedge in his crib because he ate more and seemed more comfortable. Now that he’s older I position him so that his head is in the crook of my arm and his body stretches across my torso. It keeps him more upright and more stretched out.

Tests:

Reflux is frequently diagnosed just based on parental reports of symptoms, but there are a few tests to confirm:

Barium Swallow Study (aka Upper GI): They mix a small amount of barium into the child’s food/milk and feed it to him while taking a series of fluoroscopic x-rays over about 15 minutes to track the barium’s path. You can get a false negative during this test because your child has to be having the reflux during the test. My son had this done and they actually tracked the barium going back up the esophagus a little bit, so reflux was confirmed.

pH Monitoring: A thin tube is inserted through the nose into the esophagus and left there for 24 hours. The tube measures the amount of acid that reaches the esophagus and the frequency of the problem. This can help determine if any respiratory problems are triggered by reflux.

Upper Endoscopy: This test can reveal the extent of damage caused by reflux. A flexible tube with lights and a camera is inserted into the child’s mouth into the esophagus, stomach, and duodenum, which is the first part of the small intestine. The doctor can take biopsies at different locations. This is the test to confirm Barrett’s Esophagus.

Reflux Medications:

There are 3 classes of medications: Antacids, Histamine-2 (H2) receptor antagonists, and Proton pump inhibitors (PPI).

Antacids: Maalox and Mylanta. These work great for immediate but short-term relief of symptoms. These neutralize the acid in the stomach rapidly but only last a few hours. These are not advisable for infants and children.

H2 Blockers: Zantac (randitine), Tagamet (cimetidine), Pepcid (famotidine), and Axid (nizatidine). H2 signals the stomach to make acid. Therefore, blocking the H2 receptors in acid producing cells in the stomach blocks the production of stomach acid. This category of drugs works within one hour and only lasts up to 12 hours. Also, most babies develop an insensitivity to this drug anywhere between 2 weeks to a few months and it ceases to control the pain from reflux. 

PPI: Prevacid (lansoprazole), Nexium (esomeprazole), Prilosec (omeprazole), Aciphex (rabeprazole), and Protonix (pantoprazole). These reduce the production of acid in the stomach by acting on the cells in the stomach wall (called proton pumps) that make and release the acid. This is the newest category of reflux medication. It takes about 2 weeks to build up enough in your child’s system to be effective – the doctor will probably recommend staying on an antacid and/or H2 blocker until this kicks in. I believe lansoprazole is the only one that they give to infants, but not positive about that. 

Both the H2 blocker and the PPI medications require a prescription for a special compounded dosage for infants and needs to be refrigerated. There is a lot of debate that these medications become less effective after 2 weeks and they always write the prescription for a month. There is something called “Prevacid Fast Tabs” that you can get and dissolve yourself as needed, but according to my GI doctor, your child has to be over 16 lbs and my son is still nowhere near that.

***The H2 Blockers and PPI medications are very strong medications and you should never stop either cold turkey. It is necessary to wean off of these medications extremely slowly – over a month or more and always under the care of a doctor – because going off of either of there too quickly can cause a massive overproduction of acid which can be extremely painful and potentially damaging.***

Part 2: Reflux: Treating the Problem Not the Symptoms

Note: Overexpression of GABA, a common problem in people with DS, can cause reflux, both acid and nonacid in the esophagus.  Taking ginkgo to control overexpression of GABA may therefore help with reflux. See Ginkgo: The Hows and Whys for Down Syndrome for details. -Andi 

Nutritional Ways to Treat Reflux

http://www.westonaprice.org/digestive-disorders/acid-reflux-a-red-flag

Related Posts

Reflux: Treating the Problem Not the Symptoms

Ginkgo: The Hows and Whys for Down Syndrome

Alzheimer's Disease & DS: Connection and Treatment

Thyroid & DS Go Hand in Hand

Celiac Disease & Down Syndrome

The Heart & Down Syndrome

Immunizations

Anemia Causes & Cures

Heal the Gut, Heal the Child

Natural Ways to Help with ADD & Hyperactivity

Cystic Fibrosis of Pancreas and Down's Syndrome

Stimulating Growth

Antibiotics: Alternatives & What to Avoid

Pregnant & Nursing Moms Need Choline to Help Baby

Cure for Down Syndrome?

Anemia Causes & Cures

Iron is very important because it is responsible for transporting oxygen to muscles and organs, including your brain. But don't supplement your child with Down syndrome iron unless your child's blood tests show low iron. (And even then, I'd give these strategies a good try before adding an iron supplement.)

Iron and Down Syndrome (from Down Syndrome: What You CAN Do edited by Kim & Qadoshyah Fish)

Iron is a “double-edged” sword. It is very important for life and growth, but it can also cause serious problems in children with DS. Do not give your child additional iron unless s/he has proven iron deficiency anemia. Iron increases the Fenton reaction and thus lipid peroxidation. It also aids in oxidative stress and damage. Oxidative stress is already increased in DS. [More detailed explanation follows in the article below by Ginger Houston-Ludlam.] Additionally, excess iron is often stored in the brain and may contribute to long-term CNS (central nervous system) dysfunction.

So, supplementing with iron just in case is not advised. See Biochemistry 101: Iron by Ginger Houston-Ludlam for more details on iron problems in the DS population. 

What about eating food high in iron? No, with our kid's immature digestive system, that does not guarantee adequate iron absorption.

What can you do to safely increase iron levels?

Rule out/treat Astro-esophageal reflux, Celiac Disease, hypothyroidism and hypoxia -- all of which has an effect on the body's ability to process iron. (More info below in excerpts from Down Syndrome: What You CAN Do.)
 
The International Journal for Vitamin and Nutrition Research has published multiple studies supporting the supplementation of vitamin C with dietary iron to increase the bioavailability of non-heme iron. The amount of absorption is directly proportionate to the amount of vitamin C taken.

So before you supplement with iron, look to vitamin C to help the body better assimilate the iron that it is getting. Foods rich in vitamin C such as papaya, orange, cantaloupe, broccoli, brussel sprouts, raw green peppers, grapefruit, strawberries, etc. can be as effective as meat meals in improving iron absorption. (Go easy on the broccoli and brussels sprouts because they can mess with thyroid function.) Read: Vitamin C to find out how best to use Vitamin C supplements.

"In one of the earliest human studies, adult subjects maintained on vitamin A deficient diets developed anemia despite adequate iron intake. The anemia responded to vitamin A but not to iron supplementation…..Vitamin A supplementation of deficient children resulted in a significant increase in hemoglobin, hematocrit, and serum iron." http://www.ilsi.org/.../IVACG_vitA_iron_interactions.pdf  A word of caution: kids with DS have difficulty with vitamin A supplementation if they thyroid is not properly supported. Avoid the forms of retinal and beta carotene. Instead, look to getting vitamin A through fish oils.


Folate/folic acid and or B12 deficiency also can be a factor in production and/or function of red blood cells which can lead to anemia. See "Red blood cells and DS" below.

"Avoiding phytates and oxalates may help. These can interfere with iron absorption from the gut, but the research is not conclusive on this subject. Phytates are found in bran and whole grains. Oxalates are high in nut and nut butters, beets and beet greens, tea, strawberries, gelatin, rhubarb, spinach, chocolate and wheat bran. Most of these foods are the very substance of a vegetarian diet." -- Joanne Larsen, Ask the Dietitian http://www.dietitian.com/iron.html (When I added green tea extract to Jett's supplementation, his iron went from 24 to 11. Not sure if there is a direct correlation, but something to consider.)

Avoiding milk could also solve the problem. According to Joanne Larsen, Ask the Dietitian http://www.dietitian.com/iron.html: "A diet high in milk or milk products can increase iron deficiency because these are high protein, low iron foods. Soy beverages are high in iron (also iron fortified infant soy formulas)." But soy should be avoided for our kids because it interferes with thyroid function. Better alternatives would be flaxseed milk or coconut milk. (Almond milk is high in phytates or oxalates so wouldn't be a good choice either.)
Longvida Curcumin and Green Tea Extract can chelate iron, so consider that when supplementing. 
 
Symptoms

Weakness, a haggard look, fatigue, lack of energy, tired looking eyes, shortness of breath, dull and poor memory, headache, premature wrinkles and dizziness on exertion are some of the indications of anemia. Symptoms of iron deficiency anemia include fatigue, pale skin, weakness, shortness of breath, headache, dizziness or lightheadedness, cold hands and feet, irritability, tongue inflammation or soreness, brittle nails, fast heartbeat, and poor appetite

Normal Range

The normal range of ferritin in children increases as they age. In children between the ages of 1 and 5 years, the normal range is 6 to 24 ng/mL. But, 20 is optimal. In children between 5 and 9 years of age, the normal range increases to 10 to 55 ng/mL. These levels continue to increase into adulthood, at which point they can be up to 200 ng/mL.

For iron and iron enhancing products, see the DS Day to Day amazon Store.

Instead of iron supplements, you may want to try these first:

Liquid chlorophyll by World Organics. ($6-7) It does not contain Fe, but because the chlorophyll molecule is similar to hemoglobin, it can quickly, raise the Fe level (much less than the standard 6 weeks for Fe supplements).

Organic Black Strap Molasses (see below for detailed info)
Organic/Grass Fed Beef Liver

Supplemental Sources of Iron

If your child is iron deficient and your doctor advises supplementation, here's info about the different kinds. 

Important: Iron supplements should not be taken within four hours of thyroid medication or else the thyroid medications will not work properly.

Iron Bisglycinate, is a non constipating iron supplement. Brands include

Solgar Gentle Iron
Solgar Chelated Iron
Now Foods Iron

Floradix 
The absorption rate of Floradix (liquid iron gluconate) is twenty-five per cent compared to solid iron tablets that have an absorption rate of two to ten per cent. Floradix provides maximum absorption by using the most highly absorbable form of iron, iron gluconate. Floradix also contains B vitamins and vitamin C to enhance absorption, herbal extracts to increase digestion, and fruit juices to ensure proper stomach acidity. So it is non-constipating. But it does have high natural sugar content with 5g of sugars per serving.

Spatone
Spatone costs $19.95 for a 28-sachet box. If your total order exceeds $50, there is free shipping and handling. If your total order is less than $50, there will be a $7.95 charge added.

Unfortunately, iron supplements such as Spatone often cause constipation. To offset that side effect, take a look at the post: http://dsdaytoday.blogspot.com/2011/10/constipation-causes-and-cures.html and drink plenty of water.

Increasing Iron Through Diet

From HealthCastle.com

Absorption of iron from food is influenced by multiple factors. One important factor being the form of the iron. Heme Iron, found in animal sources, is highly available for absorption. Non-heme iron on the other hand, found in vegetable sources, is less available. Iron rich foods of an iron rich diet are listed below:
Iron Rich Foods containing Heme Iron

Excellent Sources:

• Clams
• Pork Liver
• Oysters
• Chicken Liver
• Mussels
• Beef Liver

Good Sources:

• Beef
• Shrimp
• Sardines
• Turkey

Iron Rich Foods containing Non-Heme Iron

Excellent Sources:

• Enriched breakfast cereals (to be avoided because of added synthetic folic acid)
• Cooked beans and lentils (make sure they are soaked before cooking)
• Pumpkin seeds
• Black strap Molasses

Good Sources:

• Canned beans (avoid canned goods because of aluminum, if you must, only use cans from Eden organic, they use BPA free lining)
• Baked potato with skin
• Enriched pasta
• Canned asparagus

The absorption of Non-heme iron can be improved when a source of heme iron is consumed in the same meal. In addition, the iron absorption-enhancing foods can also increase the absorption of non-heme iron. While some food items can enhance iron absorption, some can inhibit or interfere iron absorption. Avoid pairing these iron-inhibiting foods when you're eating the iron-rich foods in the same meal.

Red blood cells and DS

from The Guide to Good Health for Teens and Adults with Down Syndrome by Brian Chicoine M.D. & Dennis McGuire Ph.D:

"Abnormal lab Results- MCV One lab test in which results are commonly elevated in people with DS is the MCV....if red blood cells are released from the bone marrow before they mature, the cells will be larger and the MCV will be elevated.

It is thought that red blood cells are often released early from the bone marrow of people with DS. One theory is that rbcs die more quickly in people with DS so less mature cells are released in order to replace them. Another theory is that there is an abnormality in folic acid metabolism in people with DS that may lead to larger rbcs.

An elevated MCV is generally not considered an abnormality that requires additional assessment in a person with DS so long as he has a normal blood count (hemoglobin and hematocrit) (that is, he is not anemic)......"

------

Anemia Home Remedies: Best Natural Cures

If anemia is diagnosed and no other disease is associated with it, then the following home remedies for anemia may be useful:

Figs
Eat four dried figs daily for a month and continue thereafter for another month if results are to your satisfaction.


Citrus Fruit
Due to high Vitamin C content, eat one orange or tangerine daily.


Beets
Beets are very a potent treatment for anemia. Beet juice is full of natural minerals like potassium, phosphorus, calcium, sulfur, iodine, iron and copper. It also contains vitamins B1, B2, B6, niacin, and vitamin P. Beets are very helpful in curing anemia. Beet juice contains potassium, phosphorus, calcium, sulphur, iodine, iron, copper, carbohydrates, protein, fat, vitamins B1, B2, B6, niacin, and vitamin P. With their high iron content, beets help in the formation of red blood cells.

Cabbage
Drink 1/2 glass of white cabbage juice on an empty stomach twice daily.

Lettuce
Eat 100 gm lettuce twice daily, chew well.

Spinach
Eat various preparations made of spinach daily or extract 1/2 cup of spinach juice for daily consumption.

 Astro-esophageal reflux and Anemia 
 from the book, Down Syndrome, What You CAN Do:

This occurs when food that had already passed into the stomach and beyond comes back up into the Esophagus and may be vomited up. Most healthy people experience this from time to time. It is more common in babies because their food is liquid and therefore more easily brought back they spend less of their time upright the muscle at the top of the stomach that should prevent this is not yet well established. Some also have a hiatus hernia where the top part of the stomach is pushed just above the diaphragm into the chest. Babies with Down syndrome are more likely to have reflux, probably because the muscles of the stomach and esophagus that work to push food along seem to work less effectively. Symptoms may be very mild and merely a nuisance. Simple measures mentioned above may help. However, vomiting may be considerable and the child may not gain weight. In addition, the acid contents of the stomach irritate the lower esophagus causing discomfort, and sometimes bleeding from the esophageal wall. This can cause anemia. In these cases, medical treatment is necessary. Several different kinds of medicine are used, often in combination. They work in a number of ways - by preventing the stomach contents flowing back, by neutralizing the stomach acid and by improving the gastrointestinal motility. Very occasionally, these measures won't be sufficient and an operation to tighten up the junction between the esophagus and stomach will be necessary.

--------

Celiac Disease  
from Down Syndrome, What You CAN Do

This is a condition in which the bowels are unable to absorb particular nutrients from food. This can cause the body to run short of some nutrients, and the stools to be abnormal. Possible malabsorption of a number of different vitamins and minerals has been described in Down syndrome from time to time. However, the evidence for this is inconsistent and whether the malabsorption leads to any health problems is uncertain.

There is, however, one important type of malabsorption that is more common in Down syndrome called Celiac Disease. In this, the body develops an allergy to part of a protein called gluten, which is found in wheat and some other cereal grains. Symptoms include poor growth, abnormal stools (diarrhea, frothy, foul smelling or bulky stools are typical), swollen stomach, tiredness and irritability. Anemia may also result. Special blood tests are available which may help with diagnosis, but a jejunal biopsy may be necessary. In this test a small tube is swallowed, and a sample of the wall of the jejunum is removed for examination under a microscope. Treatment is by special diet excluding gluten. This should he supervised by a dietitian....

Thyroid & Anemia
from Down Syndrome, What You CAN Do

The adverse effects of abnormal thyroid function are well-known. An under active thyroid gland leads to cognitive impairment, increased risk of coronary artery heart disease from hypercholesterolemia (14), dry skin, constipation, and anemia.

Folic Acid
from Down Syndrome, What You CAN Do

Folic Acid is particularly important in the population of people with Down syndrome. It is needed for the synthesis of DNA and RNA, which are the building blocks of cells. Folic Acid also helps prevent changes to the DNA that could lead to cancer. It is also needed in both children and adults to be able to make normal red blood cells and prevent anemia. Read about the best types of folic acid for the DS population:  Why B12 & Folinic Acid

Piracetam and Hypoxia
from Down Syndrome, What You CAN Do

Hypoxia is a condition of low oxygen levels in the tissues. Hypoxia can be caused by lack of oxygen in the air (hypobaric or high-altitude conditions), decreased oxygen carrying capacity of the blood (anemia or carbon monoxide toxicity), by impaired circulation (ischemia, heart attacks, blood clots, etc.), or other causes.

For decades piracetam has been studied as an anti-hypoxia agent. This may have special application to DS due to developmental delays in the closing of the heart muscle wall between the right and left sides of the heart. This results in the mixing of blood from the right side of the heart (which pumps oxygen-depleted blood to the lungs) with blood on the left (which pumps oxygenated blood to the rest of the body). This effectively diminishes oxygen delivery capacity and exposes affected individuals to some degree of chronic hypoxia.

Hypoxia has an adverse effect on cognitive functioning, which piracetam effectively prevents [see SDN v1n10].
Hypoxia is also associated with increased lipid peroxidation, which is inhibited by piracetam and antioxidants [Nagornev et al., 1996]. This effectively increases human resistance to high altitude. In aged patients with ischemic heart disease, the combination of piracetam and tocopherol acetate (vitamin E) provides better control of angina pain, increases exercise tolerance, and positively influences hemodynamic measurements [Pimenov et al., 1997]. These observations confirmed earlier work [Pimenov et al., 1992].

Hypobaric hypoxia of pregnant rats causes memory impairment and learning delays (in both passive and active tasks) in newborn pups. Postnatal piracetam (200mg/kg/day) in the second and third weeks of life partially corrected behavioral disturbances and physical development, but not adaptive behavior, caused by this prenatal hypoxia [Trufimov et al., 1993].

The adverse role that oxidative stress can play in cognitive functioning can also be blocked by piracetam. Craniocerebral trauma in rabbits causes 1) increased free radical activity, 2) decreased antioxidant function, and 3) increased lipid peroxidation throughout the brain. These effects are prevented by piracetam or amphetamine (which are stimulants), but not by phenobarbitol (a CNS depressant) [Promyslov and Demchuk, 1995]. The lack of any direct antioxidant effect of piracetam or amphetamine in an in vitro model suggests that the antioxidant effect is entirely mediated by secondary metabolic effects of these compounds.

Helpful Website

If your child has anemia this is a great web page: https://sites.google.com/site/superdownsyndrome/sleep/iron

Sources

http://www.livestrong.com/article/195055-does-vitamin-c-increase-iron-absorption/#ixzz29ff0A5NK

http://www.livestrong.com/article/207206-normal-ferritin-levels-for-children/#ixzz1JWkDsED8

Down Syndrome: What You CAN Do edited by Kim & Qadoshyah Fish

The Guide to Good Health for Teens and Adults with Down Syndrome by Brian Chicoine M.D. & Dennis McGuire Ph.D 

HealthCastle.com 

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