Last week I wrote about the Konstantin Monastyrsky and the poor application of science and the use of mostly anecdote in his ideas as to what the human diet should be. Through most of my research on his ideas, it didn’t have much basis in science, although it didn’t seem like he was purposely being misleading. It also didn’t seem his ideas had much harm, as the diet he proposes is one that would be more or less healthy from what I can tell. However, Mr. Monastyrsky seems to have an agenda of anti-science when one looks deeper into his website.
The piece on his website that really shocked me with its misleading information was one claiming MiraLAX is causing neuropsychiatric events. MiraLAX is a mild laxative made from Polyethylene Glycol 3350. The compound is sold by many companies, with MiraLAX being the most common or at least the most recognized brand name. The appeal is it is a non-stimulant and works by drawing water into the colon and is passed out rather than being absorbed into the body. Although not approved for use in children, it is very commonly prescribed to children with problems with constipation because it is effective and the low occurrence of side effects. However, much like other things we give to kids to improve their health, the hysteria has started and some parents are looking for any reason to panic about giving it to their kids. Mr. Monastyrsky seems to have bought into feeding the hysteria.
Mr. Monastyrsky subtitles the article with the following quote:
Getting mad or forgetful after taking a laxative? Well, according to the US Food and Drug Administration that’s exactly what certain best-selling laxatives can do to you.
This is wrong! The FDA did put MiraLAX on its watch list after receiving reports of a possible reaction. It is the FDA’s job to look at those events and decide what should be done about them. Their investigation revealed no connection could be found, and thus the FDA found no action was necessary (Mr. Monastyrsky conveniently ignores this part). Connecting symptoms to a drug which has not shown to be connected in any way is not only wrong, it could actually be harmful in that you could scare people from taking a drug which otherwise would bring them relief for symptoms they are having.
Mr. Monastyrsky continues by explaining how polyethylene glycol (PEG) is a polymer chain made up of ethylene glycol. From there the article is either conjecture or completely fabricated. While using the term fabricated is strong, I have no other way to describe it. While explaining how PEG is made, he links to the OSHA information on the monomer ethylene glycol which states:
Ethylene glycol is chemically broken down in the body into toxic compounds. It and its toxic byproducts first affect the central nervous system (CNS), then the heart, and finally the kidneys. Ingestion of sufficient amounts can be fatal.
This is true. Here’s what is misleading about it: when one ingests PEG, you are not ingesting ethylene glycol. So the effects of the monomer have nothing to do with the polymer. Although not a polymer, salt is a compound which is made of constituents that would be dangerous to ingest in their separate form. Compounds and polymers have properties different than their constituents. It is misleading to try to claim otherwise. Mr. Monastyrsky also injects within that quote a dose which he claims causes these effects. The dose he claims is “as little as 30 mL.” However, according the the MSDS for ethylene glycol, the lowest published toxic dose for humans is 15 mg/kg. This means to be toxic at 30 mL, the human would have to weigh just over 5 pounds.
The article then goes on to try to explain “neuropsychiatric events.” He defines them as “neurologic disorders of the central and peripheral nervous systems such as autism, dementia, depression, schizophrenia, multiple sclerosis, Alzheimer’s and Parkinson’s diseases, and similar others,” and then links to Merck’s list of neurological disorders which doesn’t even include some of those on the list. Also a huge red flag – listing autism first. Don’t worry, we will get to his audacious claim that PEG is causing autism in a moment. He then states:
These conditions result from PEG’s direct (through cellular damage) and indirect (through malnutrition of essential micronutrients) neurotoxicity. No surprise there considering the quotation above [referring to the quotation on ethylene glycol, the monomer].
There is no evidence of either of these results.
He does cite complications with PEG outside of neurotoxicity. He first cites nephrotoxicity, which is damage to the kidneys. However, the link provided as evidence is one that explains how ethylene glycol (again, the monomer) causes kidney damage, not the polymer PEG. He also cites examples of urticaria, which is an allergic reaction. However, these reactions have not showed up in formal studies, but in case studies of patients who were ingesting a solution of PEG and electrolytes in preparation for surgery. The molecular weight of the PEG used is often different in these solutions, and none of the case studies I looked at seemed to point out the PEG as the issue. He also points out esophageal perforations, which again stemmed from the PEG-electrolyte solution, and only in case studies. Surely these would be areas to study, and have been since the early 1990s. There are no widespread occurrences in either case.
This is probably a good point to interject the safety studies that have been done on PEG. PEG comes in a number of forms, designated by their molecular weight. The one used as a laxative is PEG 3350. However, many other forms exist and are used in a variety of ways, including in skin creams, toothpaste, and as an anti-foaming agent in food. It is also used in gene therapy applications, blood banking, and many other uses. It has been well studied. A 2007 look at the studies done on various PEG molecules concluded:
Literature data indicate that the polyethylene glycol (PEG) associated with a biological molecule should provide no extra concern because the exposure-toxicity relationship of PEG in animals and humans has been thoroughly investigated and metabolism/excretion of PEG is well understood.
The studies show that even if administered intravenously, the higher molecular weights has a high percentage that passed out through the urine unchanged. Orally, various weights were absorbed differently through the intestine:
The absorption of PEG by the oral route is molecular weight-dependent. Urinary recovery data for PEG400 indicate that 50 to 60% of PEG with this molecular weight is absorbed from the intestine. For PEG1000, oral absorption in humans is approximately 10%. The oral absorption of PEG6000 is very low, because no PEG could be found in urine after oral administration.
Thus, again, absorption is molecular weight dependent. Based on these studies, far less than 10% of PEG 3350 will make it into the blood. It is important to also note that the metabolism of PEG compounds happens mostly on lower weight compounds, and the pathway is well known. The study says:
The metabolism of PEG itself is simple and involves the oxidation of the alcohol groups present on the PEG to a carboxylic acid…Evidence from studies with PEG400 indicate that ethylene glycol is not formed as a metabolite of PEG in humans.
PEG cannot be connected to its monomer in any way when ingested. Very little makes it out of the intestine, and very little of that little is metabolized. Any of it that is metabolized is not metabolized into its monomer form. So any attempt to connect it to that cause is not science – it is bogus.
As we progress past the isolated cases, Mr. Monastyrsky takes some very large leaps to try and connect MiraLAX and autism. Here is his first statement on how he thinks they are connected:
Technically, PEG is an osmotic laxative. Because of this property, it blocks the absorption of nutrients in the small intestine. Its extended use may result in severe malnutrition-related disorders, particularly in young children and older adults. Autism is one such disorder. It may take only two weeks of an acute iron or iodine deficiency to cause autism in a child younger than two.
This raises a couple of interesting points. First, if as he earlier claimed that somehow PEG is blocking all nutrients. Second, he is making the claim that autism is caused by an iron or iodine deficiency in young children. His first claim of blocking some nutrients is true. But not to a great extent. Eating fruits and vegetables can also “block” some nutrients to a certain extent. The “blocking” in either case is not to an extent where it would cause malnutrition, except perhaps in a case where there is a more serious underlying disease. That’s why it is important to talk to your doctor about this issue before starting you or your children on a treatment – to check for a more serious cause of your digestive issues.
The autism link is one that just baffled me. Mr. Monastyrsky links to a couple of studies in this claim, so I looked at them to see if the science is sound. It turns out, at least from the abstract, the science is good. However, it has no connection to giving a child MiraLAX. Instead, it was a study on thyroid hormones during pregnancy and a possible connection to autism. It looked at animal models where changes to the brain development of a fetus happened when thyroid function was decreased in the mother, and then correlated higher incidence of autism with higher rates of thyroid disrupting compounds in the environment. Even the abstract points out the shortcomings, and instead points out a possible direction for further research. How Mr. Monastyrsky equates the first trimester of pregnancy with a child having constipation problems is simply mystifying. Someone with his educational background should not be prone to such a mistake, and it would seem to me he is championing his cause and purposely making these bad scientific connections to do so. It goes beyond an honest mistake.
His second connection he tries to make is with autism and iron. Again, the abstract tells us all we need to know. The study wasn’t if iron deficiency caused autism. It showed that autistic kids had a higher than normal incidence of iron deficiency and anemia. The kids already were diagnosed as autistic. Having an autistic child myself, I know that there are times when he gets engrossed in something he can forget that he is hungry or that he needs to eat. This is just anecdotal, but I can see where an autistic child could easily become deficient in various nutrients just on that account alone. But we now know autism has a strong genetic component, and has little to do with any exposures once the child is born.
He continues with this claim:
The use of laxatives is particularly common throughout pregnancy. It’s entirely possible that ethylene glycol molecules penetrate the placenta and cause neurological damage in fetuses. Infants may be equally affected via breast milk, or milk supply may be poor quality or too low. And that’s on top of the maternal malnutrition and neurological damages I’ve described above.
Notably, MiraLAX was introduced back in 1999, about the same time the epidemic of autism began sweeping across the United States in earnest. It doesn’t take a PhD in epidemiology to infer a possible connection between these two happenings.
Again, we know ethylene glycol is not a by-product of the metabolism of PEG. Very little of PEG 3350 is metabolized because of the molecule’s size. Secondly, we should all be familiar with the notion that correlation does not equal causation – as many saw in this graphic showing the correlation of organic food sales and autism. It is bogus to make such a ludicrous claim.
Finally, Mr. Monastyrsky spends a few paragraphs making an emotional plea to “spread the word” about the “evil drug companies” and the “terrible effects of this drug.” He begs people to link to his article. Oh, and by the way…he just happens to have a “safe and natural” alternative in a diet you can follow by buying his books! In his words:
Adding insult to injury, after getting nuked with an abdominal CT scanto “diagnose” constipation and, then hooked on MiraLAX by the very doctors expected to protect [a child's] health, [a child] may end up autistic and cancer-prone for the rest of her life.
All that said, I am not yelling “fire” here for the sake of making a point. To the contrary — this site provides safe, effective, and natural solutions for resolving the nastiest kinds of “constipations,” and I hope you’ll use them.
Now he throws in cancer on top of autism just to be extra scary. He really is willfully ignoring what science has told us.
PEG has been around for 60+ years, and the studies on its safety date back to the 1950s. Certainly we should always exercise caution and investigate possible links to harm any time we are willfully ingesting large amounts of any product. We also should always weigh out any risks to the benefits. PEG 3350 has been shown to be safe and effective. Certainly check with your doctor before starting a treatment for a digestive issue to make sure you don’t have a more serious problem. Provided it is just a typical constipation, PEG 3350 might be one solution to discuss with your doctor.
Mr. Monastyrsky should be ashamed to publish such an article on his site. Not only is it false and misleading, it seems almost willful in its negligence of reporting connections of PEG to its monomer, a connection to autism, and using an emotional plea to sell his own products. Hopefully in some way, I can reduce the harm he is doing.