#277 Anxiety in kids, antibiotic use, and self regulation for kids with Dr. Elisa Song, integrative

We are not teaching our child skills for resilience psychologically, physically or immunologically. It's all tied together because psychological stress creates the same amount of inflammation as physical stress or infectious stress or toxic stress.

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All right, today on the Less stress slide, I have Dr. Lisa Song, who is an integrative pediatrician, a pediatric functional medicine expert, and mom to two thriving children. In her integrative pediatric practice, Whole Family Wellness, she's helped thousands of kids get to the root cause of their health concerns and help their parents understand how to help their children thrive body, mind and spirit. By integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine and essential oils, Dr. Song created healthy Kids, Happy Kids as an online holistic pediatric resource to help practitioners and parents bridge the gap between conventional and integrative pediatrics with an evidence based pediatrician backed approach. And we're so happy you do that. Thank you and welcome, Dr. Song.

Thank you, Krista. I'm honored to be here.

So I was just telling you off air that, you know, we've had other pediatricians but I feel like you don't get enough opportunity to pick a pediatrician's brain or to talk through all the things. And we were also developing, discussing, I was sharing that. I feel in years of working with kids that there's three main ways that stuff presents and you'll hear that a lot of the topics kind of go under this umbrella. It seems like when kids have stuff going on, it affects their mood. Longer term it affects their skin. Right. Like it's 1 in 5 or it affects maybe the parent is noticing GI stuff or something with that. So those are the big ones in addition to probably other things you see in your office. So I'm glad we're going to cover a little bit of all of that today.

Yeah, absolutely.

But will you tell us a little bit about how? I think it's really amazing and interesting when people decide to get trained conventionally and then say this isn't working for me. I don't really like it. I want to do something different. How did that transition happen? Especially in a time where everyone else has those. A lot of people are having those same feelings.

Yeah, it's interesting because a lot of people come to integrative medicine, functional medicine, because maybe they've had a health concern where conventional medicine has failed them or they have a family member where that's been the case. And that's a. Actually not my story. I mean, knock on wood, right? I mean, thankfully, you know, I've been healthy, my children have been healthy. But I actually, you know, when I was in college at Stanford, this is long before I even thought I was going to be a doctor. I knew I wanted to work with kids. And I stumbled upon this conference. This is now I'm going to date myself. It is back in the late 80s and it was conference of the American Holistic Medical association, which isn't even around anymore. It's a. It's been taken over by a different umbrella. So whatever got into me as a junior to go to this conference, I did. And my mind was just blown. I mean, I grew up in a medical household. My mom was an OB gyn, and I didn't see anything in conventional medicine that I really wanted to do. So I told my mom, nah, I'm not going the med school route. I'm going to be a lawyer. Right. Or I'm going to be a teacher. I'm going to be a public rights advocate for children, a civil rights advocate. And people took the lsat. So I went to this conference and my mind was blown. There were speakers who were just getting known, so Joan Borisenko from Boston, Andrew Weil, Deepak Chopra. I mean, these names that were just starting to become known. And I was like, oh, my gosh, what is this thing called natural medicine and integrative medicine? It wasn't even called integrative then. It was called alternative. Right. And so that really kind of lit a fire into me thinking, well, maybe there's another way to practice that medicine. Now I can work with kids. So I got applications to basir, you know, in Seattle, as a. To consider being a naturopathic doctor. Nobody knew what that was at that time. My mom would have supported me, but, you know, it just wasn't super encouraged. So that's how I found myself in medical school, conventional medical school. But every step along the way, I had this integrated mindset. The American Medical Student Association. I helped create a holistic, you know, medical student arm to that. In residency at ucsf, I chose to do Electives that I created on holistic approaches to juvenile arthritis. I mean, really amazing. And then I finished residency, and I was like, I don't know what I want to do.

Right?

Like, I don't want to be in the hospital. I also didn't really see in private practice what I wanted to do, because it was crazy, right? You're seeing 20, 30, somebody's 40 patients in a day, and all you're doing is writing prescription after prescription after prescription for AmoxyStrong or, you know, whatever other medicine. And again, luck would have it, I stumbled upon this Food as Medicine conference, and I said, I'm gonna go see what it's about. And again, mind blown. I heard about functional medicine. What is this thing? This was early 2000s, and the keynote speaker was Mark Hyman. I was like, all right, this is it. So when I actually ventured into opening up my private practice, it was with this in mind. I took functional medicine courses. I took homeopathy courses. I took acupunct or, you know, essential oil courses. I was just like, I need to know all of the things that can help our kids, because conventional pediatrics is not doing everything we want it to do. It's great at some things, but it's not great at helping kids thrive. So, I mean, that's kind of how I landed here. And I'm so glad. I just. I wouldn't practice any other way.

Yeah. How long have you had your private practice?

So I opened up this practice in 2004. So it's been about 18 years now. Almost 20 years. And this was back when, I mean, there still is such a lack of pediatric functional medicine training. And back then, I mean, I was one of the handful across the country that was doing pediatric functional medicine, so it felt really lonely at times. So I'm so glad that, I mean, you are spreading the word, you know, doing podcasts like this and really getting information out to practitioners and parents who really now are aware that there's another way, but need more solid education, information on how to do that.

Yeah, for sure. Oh, what I heard there was a lot of blazing your own trail. Not gonna lie. You're. Like I said, I created my own elective so I could do the things I wanted. And that's wonderful. I have an intern like that as well, who right now she's doing this elective because otherwise, where else would she get it? So, all right, so, you know, on the thought of mood, skin, and gi, let's actually start with kind of a really challenging one, which is with anxiety Child anxiety. So what some of the first things that you think about when someone comes into your office and mom is like, this kid is stressed or anxious or there's probably quite a spectrum there. Where does your brain go first? What do you do first?

Well, and as I'm sure most of the listeners are aware of, you know, in functional medicine, we always look at the gut first. And this is, you know, regardless of whether there are any actual gut symptoms. Most kids don't actually, though, a lot of kids have no idea how often they're pooping or what their poop looks like. But, you know, even without apparent gut symptoms, whether it's, you know, skin or immune system issues or brain mood issues, we always look at the gut first. And, you know, for anxiety, this is especially important. Well, let's back up and just really just, you know, say that. Acknowledge that there's been a mental health crisis in our children for, I mean, for decades. Right. You know, the pandemic, there's a mental health emergency declared mid pandemic. It's been there this whole time. Right. You know, we just now are maybe, maybe waking up to it. I hope that this doesn't fall to the wayside, you know, like it too often does. But, you know, now, even before the pandemic, by the time kids are 18 years of age, it's anticipated that one in two are diagnosed with any mental health disorder. So one in two and suicide for our kids, 15 and up, even 12 and up, it's the second leading cause of death. Second leading cause of death. And this is only behind accidental injury, which often has to do, you know, with mental health concerns. And this is far above any infectious disease that we can think of. Far above. And so. And these mental health concerns, they start in childhood, right? They don't just start all of a sudden when your kid's a teenager, you can see some warning signs even early on. And one of the risk factors is having had antibiotics as a kid. In fact, having had antibiotics as a toddler can increase your risk of psychiatric conditions by up to 50% by the time you're an older kid or a teenager. So we always look to see, is there gut imbalance? Is there something called gut dysbiosis with abnormal bugs in the gut? Because that absolutely needs to be corrected first with an understanding that 90% of our neurotransmitters, especially serotonin, which is involved in relaxation, managing anxiety, sleep, 90% of that is made by our gut microbes. So we need to make sure we have healthy gut microbes if we are going to really make a shift in your child's mood and behaviors. Right. Regardless of what's going on.

Hey, I just wanted to take a.

Quick pause to let you know that I've released a brand new training called the four Step Blueprint to Clear skin and Food sensitivities. Because last year I kept seeing the same problems in my industry. More restriction, more supplements, more testing, but not more healing. So I burned down how I was practicing again and rebuilt my entire process around what was actually working for clients. Just trimming out the excess and doing what works. What emerged were four simple, really powerful steps that consistently help people reduce symptoms by about 50% or more in just a few months without adding more stress or cutting more foods. I put this training out into the world a couple of weeks ago and the feedback has been honestly incredible. People message me inside the training with their questions and I respond to every single one. And the notes I've gotten are lovely and beautiful. So this feels like my part in changing healthcare and giving you the tools to heal yourself and know exactly how to do it again. If you ever need to, if you want to watch it, just go to kristabigler.com forward/blueprint. Again, that's christabigler.com forward slash blueprint. All right, back to the episode.

For sure. So it takes a couple of months to really maybe see all the shifts that you'd like to see in the gut. I think, I mean, I think that's a reasonable amount.

Oh, at least, yeah.

Maybe a few weeks, you start to see some changes. A couple of months is a reasonable timeline to invest, maybe three, four months overall. Reasonable timeline to invest to rebalance gut dysbiosis. But two questions. You said there are warning signs for later anxiety, so I wanna hear about some of those warning signs. And then after that, what do you do next after addressing gut dysbiosis?

So in terms of warning signs, I mean, this is, I guess I should say let's step back and think about, you know, what we consider anxiety, you know, and what, consider stress. Because in this, in our modern world, the words anxiety and the word stress are thrown around like candy, right? It's like, oh, I'm so anxious today. Oh, I have so much stress. What we have to remember as parents, and this is it takes for us as parents to recognize how we are responding to stress and quote anxiety, how we manage that ourselves. Because stress has become basically a four letter word in our society, right? Stress by itself is not a negative or a bad thing. Stress Is our body's response to a particular threat, right? What we perceive as a threat, whether it's a deadline that's do you know, for a project or homework or whether it's friend drama or whether it's a baseball tournament that's about to happen, right. It's just a physiologic response. And there is something called the peak performance curve, where when we have too little stress, we're not performing, we're apathetic, we're disinterested, we lack motivation. This is what can happen when we bubble wrap our children too much, try to avoid every single stressor. We want to make life so happy for them that we don't want them to ever be unhappy or worried. There is a problem with that because if you never have that little bit of stress, you never get motivated and you also never learn how to overcome challenges. You view every challenge as an obstacle that must be avoided, right? Then as we get a little bit more stress, right, that physiologic response, that deadline happens. We all have had this experience, we have this stressor, we have a deadline, you know, we have a problem, and then we're on, we are in the zone, we're focused, we get it done, right? And then when that deadline, that thing is done, that stressors resolved, we've overcome it, then we get back down to, you know, lower level of stress. When we have too much stress, it's all the time. We have deadlines all the time. We have, you know, friend drama, social stress, social media all the time. Then we get to the curve where there's too much stress and, and we lose performance again. But this time we're burnt out, we're irritable, you know, we're tired, we just can't get up and do anything. Right? So stress can be healthy, just like inflammation, right? Inflammation isn't a bad word. Inflammation is our body's natural response to fighting something, right? Whether it's an infection or an environmental toxin, we need that inflammation to help resolve whatever's going on. But when inflammation is too high or too sustained and chronic, that's when we see problems. So I think by shifting that, you know, when we see ourselves trying to avoid every single stressor for us and our children, you know, when we see our children unable to manage any frustration as a toddler, you know, that, you know, putting the circle into the square peg and, you know, just having huge meltdowns or we find ourselves saying, oh honey, let me do it for you, and fixing everything, right? We are not teaching Our child skills for resilience psychologically, physically or immunologically, it's all tied together because psychological stress creates the same amount of inflammation as physical stress or infectious stress or toxic stress. So that's one thing we just, we need to just make sure that we are not using avoidance as our, you know, guiding coping mechanism. Right.

I love.

And so, and, and when we think about it, you know, as we think about what can help them sustain that, there's a couple things. Right. So the what next? Right. So we know most kids with anxiety or mood disorders or behavioral concerns not even diagnosed with anything. You're just worried about, you know, their mood, you're worried about their behaviors. It's, it's interfering with their social relationships and school progress or whatever it is, you know. Yes, we look at that gut, but that's a longer term road in functional medicine, integrative medicine, when we're trying to really, truly heal from the inside out, it's not a quick fix, right? It's not like you could take, you know, an Ativan or Xanax and then all of a sudden you're relaxed. Right. That is temporary, that's short. There's a time and a place for that, right. If needed. Right. When kids are in crisis, when adults are in crisis, we might need that quick fix, but we need the long term healing so that you're not constantly going back and forth forth from crisis to crisis. So we look at the gut, we look at the vagus nerve, right? Now, what we're talking about, that stress, that normal, healthy stress response, right. In our world, we have so many constant stressors that keep our sympathetic nervous system activated. Our fight, flight or freeze response, it is always on the go. Our sympathetic nervous system has plenty of muscles, right. When we think about muscle memory, what doesn't get a workout enough is our vagus nerve, that autonomic parasympathetic nervous system response that balances out the sympathetic. So we have to every day think about how are we going to give our parasympathetic vagus nerve response more exercise so that we can balance out the sympathetic. So that's also absolutely so important. We can start that even when kids are toddlers. But this is something as parents we need to start doing as well, so we can model that, show our kids how to do that. I love that. Right.

I was going to ask what recommendations you make for vagus nerve stimulation and I always feel like an efficacious dose looks like this. And it takes about three weeks to see that Change from that. And there's so many free things we can do for vagus nerve stimulation. But do you ever have them use devices or tools for vagus nerve stimulation to try to get to this point? Yes, because that can help it stronger.

Yeah, 100%. So there are things and you know, I would say starting with, you know, when kids are toddlers and you know, as your kids get older, we want to do these things, as you said every day that, that really the only cost is time and it's the best investment you'll ever make with your time, right? So just learning how to do diaphragmatic belly breathing, right? Let's just sit together. You know, you're five minutes on your way to school, right? As you're. A lot of great things can happen on your drive to school or your walk to school. School, a lot of amazing things, right? So you can spend, you know, five minutes even as you're driving. You know, while we're driving, let's just, you know, have some silence and let's practice our belly breathing. You know, we're going to breathe, imagine a balloon filling up in our belly as we're breathing in, keeping our shoulders down. And as you exhale, you're going to imagine that balloon deflating. Remember, keep your shoulders down so we're not breathing with our upper chest, right? You can do that in that drive to school or as you're walking to school. We do our belly breathing, right? Practicing mindful moments. And this is one of my favorite because the ability to stop and notice what's around you and notice what's going on inside you doesn't take a lot of time. But that mindful moment is that it creates that ability to self regulate no matter what's going on, which is so important for success. In fact, self regulation is one of the markers for success, you know, as teenagers and as adults, right? You have to stop and think before you do or say something that you regret, right? That is so important. But how do we do that? And again, on the way to school, you know, driving or walking, you just, you do something called a five senses meditation. But what I tell, I explain to kids and parents is stop, look and listen, right? Because we all learn that when we're crossing the street, you stop, you look around, are there any cars coming? Then you listen for cars and you go, so the stop, look and listen. When we stop, we give ourselves permission right then and there to stop what we're doing, right? Whether it's, you know, talking mile a minute or walking to School, you know, while we're looking at our phones, right? We stop and then we look. And look means using all of your five senses to notice what is going on around you. We close our eyes first because our visual stimulation is our most powerful, that we use all the time. And we allow our other senses to. To first come up to the surface. So as we close our eyes, just say, you know, honey, what do you hear? You know, let's take a moment. Do you notice the birds chirping in the tree? Or did you hear that airplane flying overhead? What do you smell, right? Is it the fresh cut grass? Maybe it's, you know, the barbecue in the backyard, right? You know, notice what you taste in your mouth. Is it the minty toothpaste that you just brush your teeth with? What do you feel on your skin? You know, is it the tag on the back of your shirt? Is it the wind blowing your hair? And then finally open your eyes and then notice what you see. And you will see things that you hadn't noticed before because you're too busy, right? Is it the dandelion that you were just about to step on that you might want to pick and blow, right? And make a wish? And then the final listen, right? Stop, look and listen. When we listen, we take that moment to integrate all of that. Listen to what our body and mind are feeling in that moment. Two minutes of your time. So these are things we can do every single day. We can practice gratitude every single day. And that engages your vagus nerve. So what I would want parents and practitioners to recognize is it's these little moments when we are practicing our vagus nerve work that make a huge difference. It doesn't have to be fancy hours, long meditation, you know, silent retreats, fancy stimulators. It's a little things that count. Because our vagus nerve needs to know how to get back into that state at any moment, right? And yet there are times when kids are really going through, you know, huge periods of stress, crisis, you know, emotional trauma, where we just need to passively engage their vagus nerve for them, right? And for older kids, too, who are just not into sitting still and have, you know, doing a 10 minute, 15 minute, 30 minute guided meditation or breathing meditation with an app, right? Don't like to use the word meditation because for a lot of kids, they roll their eyes, do meditation. I did that in school. Right. So. But you know, we really want to consider it brain exercise, right? Vagus nerve work. It's so much more than beyond what we envisioned meditation to Be this is something that we all need to do. So I do use some devices as a practitioner. I might do ear acupuncture, do some ear electrostim to target. There's a branch of the vagus nerve that goes right through the earth. Right. That's why ear acupuncture can be so successful. And there are little devices. There's a little stimulation device that I give sometimes I've given to parents and taught them how to use exactly where the points are to stimulate. So that's one option I love. And you know, Krista can see this, but we're on audio. But I wear my Apollo neuro device all the time. And you can. There are different settings that stimulate your vagus nerve, improve something called heart rate variability. Now heart rate variability, as some of you know, is one of our best measures for optimal vagus nerve function. We want to optimize our heart rate variability. And this Apollo Neuro device that sends little vibrations to your skin has been found to improve heart rate variability. And I know because I track it with my aura ring and for sure it makes a huge difference. And I've had kids, I just spoke with a kid yesterday who, you know, has an ADD and anxiety and you know, his teachers, when he doesn't wear the Apollo nerve, they stop and say you should get it because it really helps. Right. So there are some passive ways that we can actually do it. Our vagus nerve, for sure.

Awesome. Thank you so much for sharing that. And that felt so nice to stop and talk about bringing awareness into the parasympathetic nervous system and honestly saying that we can be the start of the change for kids with anxiety. And I. It takes a lot of skill building. You know, you are just not successful on hour one, day one week one, all the time. But it's continually practice on your own and modeling that. And I hear that similar message echoed from different practitioners that I interview. So, you know, good advice stacks so.

Yeah, well. And sometimes you want that quicker win too.

Right.

As you said, you know, it can take two to three weeks to start noticing a difference. Takes two to three months to solidify the improvements and then another, you know, long while to really make it sick. Right.

And I think when you are not doing those things, it's. You have to think of it just like a muscle that it will atrophy and you will go. You will slip backwards.

Absolutely, absolutely.

I love how you brought up self regulation too. I think that's such a thing that I had awareness around. I mean, some examples of self Regulation can being around food and just feeling like you have to eat everything in that time or for me it was speaking really quickly and having to slow that down a lot, trying to jam so much into things. But those are. There's so many opportunities or, or ways to look at our own self regulation and awareness as our first best friend.

But absolutely the other, you know, just a few quick tips for parents who have anxious children. There's a series of books by Dr. Dawn Huebner. H U E B N E R She's an amazing child psychologist. I'm lucky enough to call her a friend now. And she has a whole series of books that they're basically self help books for kids to teach them cognitive behavioral tools to manage, recognize when their stress is getting overwhelming, stop that and manage it. So her original series were the what to do series. So what to do when you worry too much.

So they're children's books.

Children's books, yeah. That you can work with them. For older kids and teens, Outsmarting Worry is a great, you know, workbook. You know, it's really quick, easy. I use the tools in both of these them so that's a great resource. And you know, if you're just needing to stop the process just when you're in that fight or flight, sometimes we just need to break that. Not even sometimes you need to get out of that fight or flight mode before your brain, your child's brain can access any tools we're trying to teach them. So you know, using things like L theanine right at dose up pretty high for kids, magnesium, vitamin D. Getting those in, optimizing those can help your kids break out of that fight or flight. I would say the two things that I would start with immediately for more immediate results are going to be theanine and magnese. But there are others, you know, working with your functional medicine practitioners. See, but we do need those. See I'm not going to say that doing the vagus nerve work will automatically shift your kids into a less anxious, you know, well balanced child. It takes work but we need to be able to have them access the work and do the work. And so you know, really looking at some of the things that will give some quicker win. Mm.

So I think you brought this up a little bit already but just to acknowledge medications and I think this, you said it kind of depends on the severity and sometimes you need that quick win to get to a stable place.

Yeah. Right.

Before you can work on some of these underlying things. Any other things we should think about when Thinking about medications for mood stuff and anxiety and mental health.

Yeah. And, you know, some of you listening, you know, you might already be on or your child might already be on medications, and there's no, you know, blaming or shaming with that. Right. The concern with the SSRIs, the serotonin selective reuptake inhibitors in particular that are most commonly used for depression and anxiety in children, is that there are black box warnings on them for kids and teens. And there can be an increased risk of suicidality initially. So we need to monitor our kids very closely for that. Then we want to think about how is this SSRI working when you have your two neurons, brain cells that are communicating, one will release serotonin into the space between the neurons called the synapse, and then the other will take it up. Right. What the SSRIs do, they inhibit that reuptake of serotonin. So they keep serotonin in between those synapses for longer. So your brain thinks there's more serotonin than there actually is. Right. SSRIs can work really well in the beginning. The experience that many men have though, is eventually the SSRI stops working. It just. It fails. Right. This is for kids and adults, or sometimes it doesn't work at all. Right. That's in the vast majority of kids eventually. Right. It just won't work. Now when we think about why that's happening, one of the reasons is, well, you need nutrients to actually make serotonin for the SSRI to even act on. If your body, if your gut microbiome isn't healed and you're not making a lot of serotonin, there's just, eventually your brain runs out of it. There's not going to be a lot in your brain, in the synapses to even make a difference. You also need all the, you know, there are certain nutrients that your body needs to promote optimal serotonin response and production, like vitamin B6. Right. And all your methylation factors. And so, you know, we want to think, you know, if your child is at the point where you're thinking they really need an ssri, we still want to do that work to support their healthy serotonin levels. We still want to do the gut work, and we still need to give them the tools to manage their stress in a healthy, productive way so that they don't always necessarily need the ssri. Right. Using a medication, it's basically trying to manage symptoms, but not giving your child tools to manage and throw thrive through adulthood. So it has to be a Multi pronged approach.

Man, we could have ended it there and then just done a total part two. But I want to, it was so beautiful. I want to go through some of these somewhat rapid fire questions from clients, from audience members that come up so often with kids kind of switching gears a little bit after this beautiful treatment of anxiety and mental health in children. So one thing you said to bridge this is that these skills that you build are going to cross over to immune resiliency as well, overall resilience. And I think that's a gorgeous definition as I continue to ask every guest, like, tell me your definition of terrain. And I feel like that was a bit of your definition of, of terrain partially. So there's a few different questions. And so some have to, has to do with like blood work, immune support. Recurrent infections. Let me start with recurrent infections. A lot of kids are experiencing recurrent infections like uti, ear infections or other commonly recur recurring infections. What are you thinking about?

Well, I, you know, it still comes back to the gut, right. I don't, I don't want to sound redundant, but you know, sometimes there's just. You got to go back to the gut. And the reason is it's always helpful to understand the reason, right? Because I can say tell my kids and tell, you know, the parents in my practice. Well, we're going to work on the gut now because it's so important for your immune system. But you want to understand why if you're going to really make it a priority. And so what I have kids and parents think about are, you know, just notice your tonsils, right? We all were born with tonsils. Tonsils are part of our lymphatic system, a really important part of our immune system. What we also want to recognize is that our entire GI tract is lined with these tonsil like patches called our Peyer's patches. And those Peyer's patches make up 70% of our immune system. Right. We have more of our immune system lies in our gut than in our bloodstream. Right. We always think of our white blood cells and our, you know, our neutrophils and all of our other immune cells that are in our bloodstream, but they're actually the heart of our immune system lies in our gut. And those Peyer's patches communicate directly with the immune system in our blood. To decide is what we're experiencing a friend, can we just ignore it? Right. Is it faux? Do we need to go on the attack? If fight it and if it's an infection, kill it or do we not know what to do and we attack the wrong thing? That's what happens in autoimmunity, right? We think this piece of whatever is we're exposed to is something to be attacked, but it actually looks very similar to something in us, let's say our thyroid, right? And then we start developing thyroid antibodies. What's, what's alarming is, you know, there's been a long range study of something called ana, antinuclear antibodies, very nonspecific autoimmune marker. And these researchers tracked ANA levels across different populations. The population that had the most rapid growth in the percentage of people who are positive ANA were our teenagers, right? Our teenagers are developing these signs of autoimmunity long before they develop autoimmune disease. So we need to be aware of this. And so we start with the gut and we make the gut happy, right? We want to feed our gut microbes, all of those units, amazing nutrients. I mean, fiber really is. I mean, we can talk about fiber. You know, so we're blue in the face, but, you know, we have a fiber gap. I mean, 70 to 90% of kids and adults don't get enough fiber. Is what our probiotics need to feed themselves, right? Act as prebiotics, but also for metabolize those fibers into butyrate and into all of these amazing nutrients that support our immune system and actually support our genes, right? Our microbes. And how our microbes metabolize the foods we eat can shift our epigenetics. So it's just. So we always start with the gut, no matter what's going on.

I want to point out a couple things. One is that I have a great fiber episode that I'll make sure lands before this, because we can have kind of like when you say meditation, we have preconceived notions about fiber and what is well tolerated, depending on what happens in the gut. So we go through that all in that episode. And then the other thing I want to say that I think is worth mentioning is that now that the gut has been popular for at least 20 years, really, I don't know if you see this, but I'm seeing like such a shift where people think that they've already addressed the gut or they've had some testing done and it didn't show something. And so there's just a, a bit of a disparity in gaps between how different people do different things, different testing, how we read that, how we address it. So, you know, if at first you don't succeed, try Again, I would say yeah.

And I love that. I'm so glad you pointed that out because it is true. I mean, you can barely pick up even a conventional journal or even the newspaper. Well, nobody picks up the newspaper anymore. But, you know, on your newsfeed, right? Online, and not see something about probiotics or microbiome this or gut that. And so it's become more and more mainstream to think about, you know, the gut and how that affects our health. And as you said, so many people go through the gut work. They've. I've cheated my gut to say dysbiosis, I've worked on my leaky gut, but I'm still not feeling well or I feel well temporarily. And I keep going back, right? My kids have, you know, my kids went into remission from the juvenile arthritis after their gut repair. And. But it's coming back now that there's another antibiotic course or stress. So the key is really, I mean, when we're talking about resilience, we need to have gut resilience, right? We can do anything, everything we want. You know, throw tons of money and supplements at testing and healing our gut. And we can heal the gut, right? We know how to do that. But the key is to keep it there and keep it resilient. Right? And sometimes you can't get to that healing place. What's really required, this is absolutely required, is the vagus nerve to kick it into gear in order to keep our gut in that healthy state. So that's where this piece and in functional medicine, you know, when I started training, do my functional medicine training back in like 2002, 2003, it was called the 4R program, right? The 4R program to heal leaky gut, remove, replace, reinoculate and repair. Those four. Right. They're still the foundations, right? But now, I mean, thankfully, there's this recognition that the piece that we actually need is the fifth R. And I think the fifth R really and truly is the most important R if we're going to have ultimate thriving and resilience. And that fifth R is rebalancing, restoring that gut brain connection, right? The mind body connection. It's not optional. And unfortunately, it's what most functional medicine practitioners are not as well versed in. Right? And I don't mean because we can all say, go use the, you know, the Insight timer app, go take a yoga class. That's not enough, Right. We need to really impart that this piece is as important or maybe more important than any of the other four Rs, that you're doing. Right. So I'm so grateful that, you know, ifm really changed. I added that fifth R. But we're still not doing enough to hone in, you know, to hammer it to parents and kids and practitioners that this is not an optional I'll do it when I feel better. This is, we must do this in order to feel better and to stay feeling better.

I couldn't really agree more. That's like at least half of the conversation, if not more. That is the reason we go backwards most of the time. Like you said, there can be some a new course of antibiotics or a new point of infection. But if immune resilience looks good, which the main reason it doesn't look good is under some kind of over stress. Right. Some. You know, so we're poor vagus nerve or poor parasympathetic nervous system exercise if we want to be fancy. Right. And that's a great way to say it because that makes us like, oh, okay. It's not just like this four letter word that I've heard over and over and over. And that word doesn't even mean anything to me.

Yeah.

And I think that's the other thing. I think most of the rest of these questions boil down to gut reflux, and that's in kids. It's the gut. Allergies start with the gut. Eczema start with the gut. Really the only last one, you know, you brought up thyroid. Do you see thyroid being a big issue in pediatrics?

Yes, for sure. I mean, adrenals also are an under recognized problem for a lot of kids. And they go hand in hand. Right, yeah. You know, I'll tell parents and kids to think about, you know, the adrenals are. Think of your body, they're like a car. The adrenals are your gas tank. The thyroid is what's pushing down on the gas pedal. So we need both. Right. But we can't keep pushing on the gas pedal and supporting your thyroid if we're not continually filling up a tank. And so oftentimes I'll start with adrenal support. I love ashwagandha for kids. Ashwagandha for kids pregnant, you know, pregnancy, love, postpartum 100%. Ashwagandha can support, of course, adrenals, but also thyroid and also supports blood sugar regulation. Because that is the other piece. Right. When we're talking about what is inflammatory to our children today, of course, psychological, persistent, chronic, toxic, psychological stress, I would say is one of the top inflammatory sources for our children. Another top is Sugar. Right? Sugar and ultra processed food. And so if we recognize those and, you know, work on those, no matter what's going on, you're going to see improvement. And this is for yourself, too, as a parent, listening. Right. If you just really mindfully. And I'm not going to say tell you to say never, no to the sugar, because that's not going to work. Right. Any mom with kids, it's going to backfire. Right. You need to teach the kids the why. Right. You know, when they have the sugar or when they have that. I always think about the rainbow frappuccino thing. Right. That's just so horrible with all those artificial colors and preservatives in it. When they have that, then just have them again. Take that mindful moment. Pay attention to how their body and their brain feels afterwards, immediately. And then that night and even the next day. Right. Notice how their skin looks or how accurate their basketball shot was or how well they rehearsed their lines in their school play. Whatever is important to them, have them notice if they're performing, forming and achieving their best, whatever that is for them, you know, after eating these foods or not having those foods and having stronger foods. Right. And then they can make those decisions. We need to empower kids with not just a, well, I'm not doing it because mom told me not to. I'm doing this because I know I have prom in a week. I want my skin clear, so I'm not going to have that sugary, you know, fake thing. Right. Or, you know, I have my violin rehearsal coming up, and I know my brain thinks better. You know, I get less anxious about performing for me when I don't have those. Those things. Right. We want them to make those connections for the rest of their life.

Oh, absolutely. You can help cultivate awareness in someone. And kids are just like adults. We do love a little instant gratification. I know my daughter, we did a little experiment around her last menstrual cycle, and she's like, so is that something I could do all the time? And I was like, that would be fine. And it was just cute because it was like a more instant gratification. And that's why she was interested. We're all like that, you know, we're human. So I do want to ask this last question because it does come up all the time. What's your advice to parents? And what about immune support when there's been antibiotic overuse?

Yeah. So the first thing when we think about antibiotics is there is a time and a place for antibiotics, for sure, right? Antibiotics can save lives. And, you know, I have prescribed antibiotics. Of course, I prescribe them way less now that I know how to use my homeopathy, essential oils, herbal medicine. In fact, ear infections, earaches are the number one reason for a visit to the pediatrician's office. And in the last nearly 20 years, being in practice in an integrative way, I mean, I could probably count on the fingers of, like, both my hands the times I've had to use antibiotics for ear. Which is awesome, right? So first we need to know, when are they really necessary? Are there other options? What can we do to support your child's immune system so that perhaps they don't, you know, get so many infections that then lead to bacterial infections. So, I mean, those vitamin D, number one, right? Optimizing those levels. Think vitamin C. Oftentimes I'll recommend kids supplement those through the wintertime. Then, you know, when kids do need antibiotics and when they need that, because up to 70% of antibiotics prescribed to kids are inappropriately prescribed. And we are at the point now we're just in. By 2050, antibiotic resistance is expected to be one of the leading causes of death in the world. So we need to judiciously use antibiotics. There's a movement for antibiotic stewardship, just like we have, you know, global, you know, environmental stewardship. This is really important. But when antibiotics are necessary, Antibiotics are the biggest disruptor to our gut microbiome, the most important. And so we want to make sure, yes, you can take the probiotics 100%. But probiotics aren't just. It's not like throwing, you know, Jack's magic beans onto the ground. And all of a sudden you have this beautiful beanstalk grow up. You need the nutrients to feed those probiotics. Even if there's a prebiotic in that probiotic, you have to get the fiber in. You know, you have to get the phytonutrients and all those colors of the rainbow. They're going to feed your good gut bugs. If your child is up for it, get those fermented foods in. Because a recent study found that fermented foods actually increase the diversity and number of beneficial bacterial species in your gut than fiber does. Fiber has amazing benefits in improving your metabolic markers in your gut. But it was fermented foods that actually won out. So getting those in, getting in fatty fish, of course, you know, wild, make sure it's sustainable, make sure it's low mercury. But fish oils, omega 3s have been found also to not just support the gut lining, but also act as prebiotics, you know, even olive oil. So getting in all that rich, you know, really moving towards that Mediterranean diet, if that, if you. I don't like to prescribe to particular diets, right. But you want to get in those healthy fats and nourish your gut microbiome. Get in bone broth, you know, that's such a rich source of glutamine and collagen to help support your gut lining. You may need to take a little extra glutamine, a little extra zinc during this time for gut repair. So there's so much we can do if your child has been on antibiotics or I'll also say antacid medications, right? Because that's another big, big, big microbiome disruptor, especially early on in life, where we know that antibiotics and antacid medication use in the first six months of life can significantly increase your child's risk of virtually every single allergic disease by the time they're four. So this is anaphylaxis, eczema, allergy, hay fever, hives. So at that point, when they're little, itty bitty ones, right, you might not be getting in all the supplements, but you could certainly get in probiotics into them. You can get in omegas into them even at that early stage. As you're introducing foods, be mindful of really making sure they're getting in all those rich sources of fiber, getting in this, phytonutrients. And as a mom, if you're, if you're nursing, make sure that your gut is healthy because your gut microbiome, your breast glands also have their own microbiome. We want to pass on all those good gut bugs to get into your baby as well.

And if you ever feel like you listen to this and said, I wish I'd have known this before. Hindsight is always 2020 when something happens. And so there's always things we can.

Do to help 100%. That is always. You know, I do hesitate sometimes to think about, you know, what happens when kids are babies or, you know, how they're born or how they're fed or when they got antibiotic use. That just tells your child's story. Okay? So we need to look back, we tell their story so we know how to move forward. But it's so important to not sit there and dwell in, you know, guilt or anger or frustration. You didn't know, right? Your doctor probably didn't know. We only know what we know at the time. And it's really through no fault of your own that your child might be in the state that they're right now. But now you're here, right, listening to Krista, listening to this podcast. You're listening, you're doing the work. And we move forward there because we can always move forward. It might take a little longer than if you started younger. That's okay, right? But we can always move forward. Yeah.

Thank you so much for the work that you do and for coming on today. Where can people find you online?

So the best place to find me is either my blog, my website, healthykidshappykids.com and then also on Instagram and Facebook. Instagram is healthykidshappykids, and then you can find me on Facebook as well. So that's where I post. I have articles, I have social posts. I don't post a ton, but when I post, I'd like to make them juicy and meaty and full of information.

So, yeah, she's a great person to follow. Thank you so much for coming on.

Oh, thank you for having me.

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