Nutrition & Low Muscle Tone
by Kelly Dorfman, M. S.
Low muscle tone, or hypotonia, is one of the physical problems often associated with developmental delays. Children can have generalized hypotonia or it may affect just speciﬁc areas such as the hands or upper body. It is clinically signiﬁcant because in severe cases the muscles are literally too weak to perform important tasks such as holding a pencil or sitting without slumping in a chair. In milder cases, stamina or precision are affected. For example, children with severe hypotonia of the hands are reluctant or sloppy writers whose interest in writing or drawing declines in direct correlation with the severity of the low tone. When the concerns are milder, youngsters may try to overcompensate for difﬁculties by holding pencils too hard and causing cramps or creating blisters.
There are two possible causes of hypotonia. Occupational therapists content that the vestibular system imbalances are to blame. The vestibular system is the primitive sensory system that is responsible for gravitational stability. The ability to walk down a ﬂight of stairs while carrying a load of laundry is a tribute to the gravitational stability provided by a well-functioning vestibular system. People described as clumsy or children with difﬁculty climbing or riding bicycles often have vestibular issues. Good muscle development (or how your body pushes against gravity) is also considered a marker of vestibular development.
From a nutritional perspective, hypotonia represents the poor delivery of nutrients to the muscles. Diet represents what is consumed, but nutrition is what the tissues actually get. When soft muscles are present, there is a big gap between diet and nutrition. The muscles, suffering from nutrient deprivation, remain underdeveloped, or if strong, become fatigued easily. Congenital hypotonia is not the same as being out of shape. Those born with low tone can improve their condition but the tendency will remain. That is, if two people exercise exactly the same amount, the one with hypotonia will have less muscle development as a result.
If the delivery of nutrients is inefﬁcient, there are two basic strategies to better manage the situation; increase the amount of nutrients available for transport and try to regulate the naturally sluggish dispatch system.
Those with hypotonia tend to love sweets as they are a quick form of energy for tired muscles, but in the long run, a diet high in empty calories worsens the deﬁcit. Controlling the intake of concentrated sugars (candies, sodas, juice, desserts) is the ﬁrst step followed by the usage of a comprehensive multiple vitamins and minerals. Because even a perfect diet will not be enough for someone with poor nutrient distribution, extra nutrients will assure that minimum requirements are met. The use of supplemental nutrients is a long term management tactic, not a quick ﬁx. Once there are plenty of general nutrients to deliver, one can attempt to strengthen assimilation and usage of nutrients with more sophisticated measures. Digestive enzymes, carnitine, and co-enzyme Q-I0 all may help.
Digestive enzymes aid the breakdown and assimilation of food. If used too aggressively, they cause stomach cramps and loose stools. They are given with meals, preferably lunch and dinner, as the body‘s strongest capacity for digestion is in the morning and so they are less needed then. Vegetable-based enzymes, such as Prevail Children‘s Digestion, are gentlest. In addition to low tone, those who do best with enzymes tend to be picky eaters, have digestive complaints such as stomach aches and/or have constipation or diarrhea.
- Carnitine: (or L-carnitine, the active form) is critical for regulating fat burning (i.e. energy availability) in muscles. L-carnitine is made by the liver from the amino acids methionin" and lysine with the help of vitamins C, B-6 and niacin. Dietary sources are muscle and organ meats. There is no carnitine in vegetables, fruit, or grains. In diseases with muscle deterioration, carnitine almost always helps and low carnitine is often a marker. Those with low tone may likewise beneﬁt from carnitine even though their situation is not as profound. L-carnitine is non-toxic and 500-1000mg is a typical dose range.
- CoQ10: The body cannot use food directly for energy but must convert it to an energy holding compound called ATP. There is only enough ATP stored in the body to provide energy for about 5-8 seconds of non-stop strenuous activity, so it must be constantly re-generated using co-enzyme Q-I0 (or ubiquinone). Co-enzyme Q-I0 nutritional supplementation would, therefore, be important for muscle performance and stamina. One preliminary study found co-enzyme Q-I0 improved muscle work capacity in normal volunteers. Studies also show that co-enzyme Q-I0, appears to improve immune function. The beginning dose range for co-enzyme Q-l0 (like L-carnitine, a nontoxic substance) is usually 30-60 mg. L-carnitine and co-enzyme Q-I0 can be taken safely together with a multiple vitamin to aid in their utilization.
For speciﬁc information on supplements for your child, always confer with a health care professional.[Initially published in New Developments: Volume 2, Number 4 - Spring, 1997]