31 - Gut health and recovering from antibiotics with Dr Elisa Song

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Hello, everybody.

Welcome back to another episode of Boob to Food, the podcast.

Hello, Kate.

How, I want to say, how's your week been? But we're sitting next to each other in Melbourne, which is exciting, having a baby moon.

Yeah, it's been a lovely, very romantic baby moon.

Yeah, we. We are here for work, but I say, quote, unquote, work, because it's been about three hours of work and the rest leisure. But anyway, I mean, it has felt.

Busier than I expected. I feel like there's been a lot of getting around and like it's.

It's been lovely waddling around.

Yes.

Poor Kate packed one pair of shoes brand new and has had blisters combined with 35 week pregnant.

Yeah.

Elliot.

Yeah, yeah.

My pace has definitely slowed us down.

But we're here interviewing. Yeah, we've had three interviews, which is cool. So keep your eye out for some great interviews that we've done here in Melbourne because they're always nice to do in person and we just wanted an excuse to get away.

Well, I did anyway.

But yeah, so it's been nice wining and dining, no kids three nights away.

Although I can't sleep, so I'm not going home feeling refreshed at all. I've been every night awake. So, anyway, fun times, still being lovely, still being nice.

It's just nice traveling with our kids. Everything's nice, even the plane, the car rides, so peaceful when you really have.

To think about yourself.

I know.

Pack a small bag. Yeah, yeah, it's been great.

So we probably don't have too Much to share.

Apart from that, this week? No. Anything else you want to share? It was interesting actually, because today's episode we're interviewing Dr. Elisa Song, who is a integrative pediatrician. We talk a little bit about gut health and this week I nearly had to put Will on antibiotics. And I was thinking, oh, this is timely because we have a gut health episode which we're talking about all today. Recovering from antibiotics. Yeah. And yeah, just supporting our little one's gut in general because he had a perforated eardrum, so he's been leaking pus out of his ear for about 10 days straight now. But I think I managed to avoid the antibiotics. Still don't take my medical advice at all with this, but he was completely fine. Asymptomatic.

Yeah.

And so just to give them for that, just seemed like, I don't know. It was recommended by the doctor, but I just, I don't know, thought they weren't necessary.

So I did. That's a tricky one.

And I mean the script if I needed it.

Yeah.

And if he went downhill, but he didn't. And we seem to have gotten through the other end of it now, so.

And we do chat about that with Dr. Song in the podcast as well, that, you know, antibiotics, when they are indicated and necessary, they can be really important.

Definitely.

And at the same time they're often over prescribed and overused. So there are many situations there. You don't necessarily need to go to them straight away. But anyway, we'll get into that in the podcast episode. I should also flag that if our audio is bad now, it's not bad for the whole episode.

We're just sitting on the floor in.

Our hotel room recording this intro without a microphone.

Yeah, we use the one for the, for the episode. But yeah, as we've alluded with interviewing today, Dr. Elisa Song, she's an integrative pediatrician, pediatric functional medicine expert, and a mum to two children. In her integrative pediatric practice, she's helped thousands of kids get to the root causes of their health concerns and helped their parents understand how to help their children thrive body, mind and spirit. By integrating conventional pediatrics with Functional Medicine.

Dr. Song also created Healthy Kids, Happy Kids, a holistic online pediatric resource to help practitioners and parents bridge the gap between conventional and integrate integrative pediatrics with an evidence based approach. She really is such a wealth of knowledge and has a specific passion about the microbiome. So we were lucky to pick her. Her brain. And we hope you Enjoy.

Well, welcome Dr. Elisa Song to Boob to food the podcast. We are so excited to have you here today and to pick your brain on all things the microbiome and antibiotics and recovering from antibiotics. But before we jump in, if people haven't come across your amazing work, can you just tell us a little bit about who you are and who's in your family, what it is that you do?

Yeah. So I am an integrated pediatrician. So I've shifted from calling myself a holistic pediatrician because in reality, all pediatricians should be holistic. We should all, as pediatricians, take the child in front of us in the context of their family and their friends and their communities and their schools. When I say integrated pediatrics, it really is a way of.

I mean, I say, I don't throw the baby out with the bathwater. I take my conventional training at Stanford and ucsf. I know what the serious conditions are, when to refer to specialists into the er and when it's appropriate to write those prescriptions. But I also, recognizing some of the unintended and negative consequences of some of these medical interventions, integrate more holistic complementary therapies, which used to be called alternative medicine, but really shouldn't be alternative. So it's really, you know, I integrate conventional pediatrics with homeopathy, herbal medicines, functional nutrition, essential oils. I do acupuncture in the office for babies and children and teens, and I teach parents how to use acupressure points. So it's really. I feel like it's the best of all worlds and can really help children more fully. And, of course, there's so many other modalities out there that I think brings so much value. And I have my team of referrals, you know, to ayurvedic practitioners and chiropractors and to osteopathic physicians. There's not one practitioner that can do it all. And so you really do need that collective village. And in my home, I have my husband and my two kids, and they're. They're not so little anymore, but they're still little. They're little at heart still, which I'm grateful for. They are almost 12 and 13.

And they teach me every day some of the new slang that I should know and also how to educate and inform kids of all ages. So I'm grateful to have them.

Are you a pro on TikTok because of them?

Oh, gosh. You know, my kids don't have social media, so not. Not yet. I figure I will wait until it's absolutely. Yeah, I don't think it's ever Absolutely necessary. But I will wait, you know, until I can no longer keep them off of it. But they know all the memes and, you know. Yeah, they definitely teach me all about what's, what's cool and what's not cool and what things I should say that are out or in. So.

Once they're at that age that they are on social media, they could be a little. Yeah, first time job.

Yeah, Social media manager.

Yeah, I'm sure, I'm sure there'll be my social media managers at some point.

Every time a new social media like threads came out. Yeah, a couple weeks ago. And I'm like, oh, now I've got to learn another one. I know, just got a handle on this one.

Start to feel my age with all of those things.

Cool.

But we're here to chat to you today about all things gut health. So we hear, you know, a lot about gut health and supporting gut health, but can you just briefly explain what is that?

What is gut health? Yeah. And so, you know, many people may have heard that Hippocrates is credited with saying, who knows if he actually did, but he's credited with saying that all disease starts in the gut. And I really like to flip that and talk about how all health starts in the gut so that we can really focus on what thriving means, what it really means to be healthy. But when we talk about the gut, we're really talking about the gut microbiome. And the gut microbiome is our ecosystem in our gut that comprises the hundreds of trillions of microorganisms that live in our gut, which many people are aware of, probiotics, and so the beneficial bacteria that live in our gut. But we have a community of viruses, of beneficial yeast, of parasites that all, you know, should coexist and I should say should be beneficial for us. It's just that in our modern world, there are so many forces that disrupt our gut microbiota. So the microbiota are the organisms in our gut. And the microbiome, as I said, is really that ecosystem and that interface of the gut microbiome, the gut microbes that then interface with our human cells. And when we think about, we have over 10 times as many microorganism cells, microcellular components than we have human cells. And so we really have to think who's running the show here? Who's really orchestrating how we, how our health and how we think even, and how our health and our immune system function. You know, over 70% of our immune system resides in our gut and our gut Microbiota plays such a critical role in how our gut and our immune system develop and how our brain develops. So when we're talking about gut health, it really is the gut microbiome and how the gut microbiome interfaces with all of our organ systems to really manifest as, as signs of health or signs of disease.

And where does that gut health start? So, you know, I know that we talk a lot about birth and like the mode of delivery, but is it, is it prior to that or where would we start to see things develop?

Yeah, you know, I would say, you know, I used to say, well, it starts with mom mama's gut microbiome. It really starts with both parents gut microbiomes. It's not, you know, dads are not off the hook here. But the health of our microbiome, meaning us as parents, the health of our collective microbiomes, the male parent and the female parent before conception, is really key in shaping our baby's gut microbiome. There's a lot of what's called epigenetic imprinting that occurs at the sperm level and at the egg level and in fact at the time same sperm level, that may be even more important preconception. And that has to do with the father's gut microbiome. In fact, they found that paternal exercise and grandparents grandfather's stress can affect the baby's gut microbiome. So it's fascinating what can be handed down and it really has to do with how we're living as a whole. But what we know more about is really how mother's gut microbiome and her vaginal microbiome impact babies microbiome from birth. And so, you know, we used to think, and the consensus still is for the most part that babies gut microbiomes are fairly quote, sterile when they're born, meaning that they're born really without much of a gut microbiota, you know, in terms of the composition and how babies are born. When they're vaginally birthed, they get exposed to mom's vaginal and gut microbiome microbiota, you know, through the vaginal delivery. If they're born by C section and they're exposed more to skin bacteria and to, you know, the surgeon's bacteria. Also, how babies are fed, whether they're breastfed or formula fed or both, and when solids are started, can also impact that baby's developing gut microbiome. And what's really important to recognize is the baby's gut microbiome is rapidly shifting, just like their brain development is Rapidly shifting in that first two and a half to three years of age, there's an explosion in microbial microbial diversity and microbial composition. And.

That rapid change in the gut microbiome composition mirrors a rapid change in brain development and synaptic connection. We used to think it was the brain maybe that was developing that was influencing the microbiome development, but it really probably is the microbiome development that is shaping babies brain development even more.

When we're talking about what those influences are, the reason why, why breast milk is so important, and I know your listeners know this, but you know, there's so many components of breast milk. Probably most importantly when we're talking about gut microbiome development is what are called HMOs or human milk oligosaccharides. And breast milk has hundreds of these human milk oligosaccharides. The most predominant one is called 2fl or 2ficosalactose. And these human milk oligosaccharides preferentially support the growth and colonization of beneficial microbes, those probiotics, especially bifidobacteria species, which are so important for baby's immune system development and brain development, and preferentially kick out some of the pathogenic or not such good bacteria that we don't want in your baby's gut. And so knowing that or recognizing that many formula manufacturers are trying to incorporate, at least the better manufacturers are trying to incorporate these human milk oligosaccharide analogs. So manufactured 2 FL or another HMO called LNNT. So really trying to get closer to the benefits of human breast milk.

Because while we know that breast is best, I mean, there are going to be times where sometimes we need to support our babies in other ways and where some formula might be needed. And so really want to try to mimic the benefits of breast milk as much as possible.

Going back to the mode of delivery, have you done much research or heard much about vaginal seeding for a cesarean?

Yeah, I think that the vaginal seating holds a lot of promise. Now, the studies were small and currently the American, it's acog, American College of Obstetrics and Gynecology doesn't recommend vaginal seating.

More in terms of the potential risk of introducing pathogenic flora if maybe perhaps moms have, you know, abnormal vaginal bacteria or microbes. However, that being said, you know, babies were birthed through the vaginal canal, they would be exposed to all of that. And so with vaginal seating, where, you know, gauze is placed into the vagina and held there for a period of time. And then the baby, as soon as babies are born by C section, the baby is swabbed. You know, eyes, mouth, mouth, nose, rectum, vagina, the girl, and so just swabbed all over and seeded with the vaginal flora that then hopefully will help the baby to colonize that beneficial bacteria early on, as opposed to the skin, staph bacteria and other bacteria that we might see that we do see more commonly in C section birth babies. And so seating has a lot of problems because in these small studies, the microbiome of those babies were by C section and seeded had microbiomes that were much more similar to vaginally birthed babies. Now, there are some other considerations, though, even for vaginally birthed babies. If mothers received antibiotics during the delivery or, you know, even not necessarily during the delivery, but maybe during the pregnancy or sinus infection or urinary tract infection that may have altered her vaginal and gut flora enough that then, you know, even being birthed through the, through the vaginal canal is not going to be as optimal a start in life for the baby's gut microbiome as possible. So we need to take that into account, too.

Yeah, there's so many parts at play. But it's definitely interesting, the research coming out about the seating. And I know at work, I'm a midwife, but like, they. It was getting more and more rec.

Not recommended.

Routine.

No, not routine. The patients were coming, the mothers were requested. Requested, not recommended. Requested. And it was still, you know, it's obviously such new research and such a gray area, and some of the surgeons were quite happy to accommodate it, and some were a little bit more cautious around it. But, yeah, it's really interesting the, the research coming out around that.

I mean, I just, I think that the, the potential for harm is so low and the potential for benefit is so high that, you know, I think as long as moms are counseled about the potential risks. The other thing, you know, that I just, you know, I always pause, you know, as we kind of talk about the effect of a, of a disrupted gut microbiome for baby's future development and future health, is just to tell moms listening that no matter where you're starting from, I mean, even if your baby was born by cesarean and even if your baby was formula fed or you or baby received antibiotics at some point, we can always move forward. I mean, this is why we're doing these podcast interviews, right? Because there's always a way to move forward and improve Gut health improve your, your child's gut microbiome. No matter where, where they're starting from and even if they have health concerns that may be associated with that disrupted gut microbiome, it's really important to know there' always a path forward. And so, you know, and then I also, you know, think too I have parents, children in the practice who were, you know, vaginally birth mothers, ate a really clean diet, you know, they were taking their prenatals and probiotics during pregnancy and exclusively breastfed. And still babies are developing eczema or asthma or certain or certain health concerns that we might not necessarily expect. You know, if everything, all conditions seem to quote, perfect. But what's really, you know, what one study that was fascinating to me was.

When we looked at, there was a, you know, a pathologist way back, I mean 100 years ago who actually looked at the gut microbiomes of babies who were breastfed and formula fed at the time with whatever formula was available back then, and found that breastfed babies had almost excess exclusively bifidobacteria probiotic species in their gut and really not much else compared to formula fed babies who had other bacterial species in their gut. When we look at the gut microbiomes of our modern babies are exclusively breastfed babies of today, their gut microbiomes look much more like the microbiomes of the formula fed babies of a century ago. So we still need to really work on prioritizing the gut health and the gut microbiome of our babies. No matter, no matter, you know, the, the birth circumstance or, or how you're feeding your babies.

So interesting, isn't it? And I, I think it really speaks to the fact that like, you know, we even as people and we think like we're kind of the, the organism and we're looking at our individual gut health, but it's really like a whole society and an environment that we're looking at that has factors, factors that influence that as well. And, and I really like to remind, like I, I see in my clinic a lot of women who, they feel such the, like the weight of responsibility for being the person who's going to have the effect on their offspring's gut microbiome. And it's like no, no, no, this is a joint responsibility like you and your partner and then you, and yeah, literally the environment that you live in can have such a big influence. So, so yeah, I love what you say that there's always something that we can do and we don't have to feel weighed down by, you know, maybe we've done. There's not a wrong thing to do, but, like, done something that's had a negative impact on our child's gut. It's, it's just not that black and white. It's so multifactorial.

Yeah. And I'm so grateful for you saying that because it is true. You know, when something goes wrong with your child's health as a mom, I mean, the, the first thing you do is rack your brain on, you know, what did I do wrong? What could I have done differently? And it doesn't help that, you know, looking at the studies, if, you know, moms took antibiotics or you, you know, you had a C section birth or, you know, you weren't able to breastfeed, you feel like, oh, my gosh, I, I mean, that was me. I did that. And like I said, there's so many other horses like you said. I mean, it really is, it's. It's a societal change that needs to happen if we're really going to help our kids thrive. And I mean, at so many levels. I mean, just Australia, I feel like the food in Australia when we went was just so much cleaner than what we get here in the, in the U.S. but it's just atrocious, you know, how, how we're allowing our kids to, to, to grow and the food that we're allowing, you know, kids to consume and be sold to babies and to kids, marketed to them. And so, so, yeah, we need, we need a global change.

And so what are some proactive things that we can do? You know, if all sort of circumstances are working in our favor, like, what would be some things we can proactively do to support the gut health of our infants or our children and ourselves? I guess.

Yeah. I mean, this is for the whole family, right? Because when we, when we do one thing, I mean, I, I should back up and say it should be for the whole family, because as mamas, a lot of times we, you know, we'll prioritize our babies and our kids to the detriment of our own health. You know, we don't, we don't necessarily practice what we preach and force sleep for ourselves or outdoor time or exercise. So it's really for the whole family. And, you know, what I talk with kids and parents about are really, what are the ways that we can create microbiome magic, Right? I mean, there's so many things that we can do, and there's so many things that we can do just by making some simple shifts in how we're living and how we're eating, they don't have to be huge grand changes. And when it comes to really supporting the microbiome and creating this microbiome magic.

So many of the principles are really simple and we just have to understand how important they are. So when I talk about what kind of food support the gut microbiome, I talk about really the, the three Fs just to kind of have it really be clear and easily easy to remember. So you know, think of, think of the whole gut rainbow as a 3F part. And so the first F is fiber, right? Fiber is, these are, these are the components in plant based foods that feed our probiotics. So a lot of people take probiotic supplements. That's one of the fastest growing industries, you know, in the supplement world. World. But if we don't imagine throwing, you know, some tomato seeds into the ground and walking away. No, you don't feed the soil in nutrients, no water, no sunshine, and you want to, and you expect to come back in two weeks and find these perfectly beautiful, juicy little tomato plants growing. It's not going to work. I mean, it's not like Jack's, you know, magic beans. You know, you really, you need more. And so we need to feed if we want the good stuff that to grow in our gut, we need to feed the good stuff. And the good bugs grow on fiber on those prebiotic fibers. So just by eating more plants, how do I get more plants into every meal? Right? And just thinking about that and the foods that pack the biggest fiber punch that often aren't a regular enough part of our kids diet are legumes. So beans, you know, lentils, garbanzo beans, you know, kidney beans, black beans, I mean, whatever kind of beans. But the more you can get those, and if you're, if your children are not really yet into beans, and I say yet because even if your kids are very selective, they can get there. We just keep trying. But you can grind up, you know, garbanzo beans and just make for chickpea flour, buy organic chickpea flour and throw that into your, your oatmeal or your soups or sprinkle it onto your salads or throw it into your smoothies or other ways that you can get in that fiber without necessarily having them have a huge bowl of, you know, chickpeas or, or hummus if they're not, you know, yet into hummus. So getting in more plants now there's a magic number that's thrown around, you know, 30, 30 different plants per week. Right. And that was based on a very large.

Study that looked at, I think it was maybe 11,000 in stool studies and found that people who ate more than the cutoff was doing more than 30 plants per week, had a much more diverse gut microbiome and a much healthier, you know, gut microbiome functioning than those who ate less than 10 plants per week. And so just. And, and when you think about 30 plants, you might think, how am I going to get 30 plants in today? But, you know, there you can do it if you're really mindful and intentional about it.

Is that 30 different plants or 30.

30 different plants? 30 different plants, yeah.

So, well, and, you know, so as I. As for my kids, we'll think about. Okay, if we have, let's say we have chili, right? And we have. We'll put in. We like using a three bean, you know, garbanzo, black beans and.

Kidney beans in our chili. And then we'll cut up carrots and zucchini and bell peppers. That's six plants right there. And then we'll have it maybe topped over brown rice. That's seven plants. So it all adds up, right? You can kind of. And then let's say in the morning you have a smoothie and you put some spinach in there and some blackberries and you put some, you know, banana. What else might you put in? Yeah, some almonds in there. Right. That's 10 plants just in one day. So it sounds daunting, but when you break it down, you think each meal, how can it just add a few more plants in there? It's. It's achievable, right. For families, you just work solely into it.

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And I think also it's like, it's not, you know, 30 vegetables, 30 different veggies, like, you're including, like, even, like, fruit, salt oats is like.

Absolutely, yeah. Plants mean, you know, anything.

Yeah, yeah, yeah.

Anything that grows out of the ground.

That's right. So. Right. So your whole grains, your nuts and seeds, your legumes, you know, and of course, your fruits and vegetables. So it's a wide range. So.

And.

And the key is really, when we talk about 30, is to try to vary it up. So, you know, if your kids love hot cereal for breakfast in the morning. So maybe one day you have oatmeal, but then the next day you have a multigrain with maybe quinoa and some millet in there, and just try to mix that up. And then the second F is phytonutrients. Now, I know phytonutrients sources the ph, but it sounds like enough. So just phytonutrients. So what does that mean? That's where the color comes in, because each different color has a different benefit on our microbiome and on our immune health and on our brain health. So try to get that color. And when we think about color. So, you know, if your children love broccoli and carrots, but that's really kind of all the vegetables they eat, it still counts. If you have purple broccoli and green broccoli, and you have the yellow carrots and the orange carrots and the purple carrots, I mean, that still is a different color. So even just mixing up the color of the same vegetable that they like, that still counts. And then the final F is fermented foods. And this is maybe one of the hardest cells for children, apart from yogurt. Now, and many of the kids that I see my practice who have more chronic or persistent health concerns, they don't tolerate too much dairy or maybe not much at all. And so they may not be having a lot of yogurt or cow's milk yogurt in their diets. But there are other non dairy yogurt options.

But you know, that fork full of sauerkraut or kraut juice or kombucha or kefir, that actually is probably even more beneficial in terms of optimizing increasing your gut microbiome diversity, the kinds of organisms in your gut, than fiber alone. There was a study out of Stanford just, I think it was last year, that compared college students to up the fiber in their diet or up the fermented foods in their diet. And the group in the fermented foods, they had a much more significant increase, increase in their gut microbial diversity. Now of course, the fiber, the, the students who increase their fiber, they still had benefits. The benefits were seen in more of the gut microbiome functioning. Yeah, but fermented foods are, you know, every cult, almost every culture is some sort of, of a fermented food. So if we can figure out how to get that in, I mean Indian food, there's idlis and doses. I mean there's so many ways that we can get fermented food that's not just, just here, have some sauerkraut. Because that's a little bit more of a stretch for most kids. Although I have one family where they started giving sauerkraut and kraut juice from the time their babies were infants. And it's their favorite food. So yeah, it can happen.

Our family, we actually, my son, he's always been really into pickles and ferments and like anything fermented. And when he was probably maybe 18 months old or a touch older, we did a photo shoot for a beautiful local company who does like amazing ferments. And the issue was getting him to stop. So I reckon drank about 500 mils of beetroot kvass in this like, you know, two hour photo shoot, polished off half a jar of sauerkraut and then too much of a good thing is not necessarily good. We did have some diary.

Yeah, absolutely.

But that was excessive consumption. But that's always been a big favorite in our household.

What's your opinion then? Or what does the research say around like probiotic supplements versus fermented foods?

Really great question. And you know, I actually haven't seen a head to head study on that. I, I mean that would be a great study. There are studies looking at colonization after probiotic supplementation and you know, probiotic supplements who have been shown to help colonize the gut. Now, there was one interesting study that looked at, you know, after antibiotics they took, they took several different groups of patients. One group they did no intervention. One group, they gave a probiotic supplement. Another group, they did a fecal transplant, which is not readily available for most people just yet. So the group in the fecal transplant plant, they have the most rapid restoration of their gut microbiome after antibiotics. But this one study found that the group that had no intervention restored their gut microbiome faster than the probiotic intervention. Now, that study has been criticized and it wasn't a very big study and there were no prebiotics given either. So I do think that that makes a big difference. And there are many more studies that show that after antibiotics, probiotics, supplementation can be really helpful in restoring the gut microbiome. The, the biggest factor though is now as the research just explodes on probiotics and the different strains, there really seems to be more benefit if we can be very specific about the strains that we're using. So it's not just a matter. I used to say just get a probiotic that has as many different colonies, different strains as you can with as many different colony forming units or CFUs as possible. But as you just said, more isn't always better. Right? It's probably more about having the right strains to support post antibiotic gut microbiome recovery or vaginal flora if you've just had a UTI or.

Skin, if you have eczema or your brain, if you have ADHD or anxiety. So now there are more companies are really trying to put onto the market strain specific probiotics. Up until that, up until, you know, we have that really nailed down. And of course with the hundreds of trillions of microorganisms in there, we have so many more strains to identify. But for now, I think, you know, just really focusing on a broader spectrum, as many different probiotic strains as you can for now, if you've had antibiotics is an appropriate way to go. But, but really you do need prebiotics and we do need to work on restoring the health of the gut microbiome. Remember, the gut microbiome is not just about the bugs in the gut, it's about the whole ecosystem in the gut. So it's not just about the probiotics, it's about so much more than that.

Actually moving on to the topic of antibiotics, because I know this is something that we get a lot of questions around and antibiotics can obviously be really life saving and really crucial when, and you know, used Properly, but we know not only are they knocking out the bad bugs, they're also having an impact on those beneficial microorganisms as well. Can you explain a little bit to the listeners what exactly happens to our microbiome when we take an antibiotic?

Yeah, so that's a great question because I, I.

I remember when, when a mom asked me that, I, I, I had to step back and think, oh, it's not that obvious to everyone, right? And you know, so antibiotics, the first thing that we want parents to understand is that antibiotics kill bacteria and that is it. They do not kill viruses. And the vast majority of acute infections that children experience are due to viruses. And so we also know that antibiotics, while, yes, they absolutely can be life saving, and as a pediatrician, I have prescribed antibiotics, but we know that up to 70% of antibiotics prescribed for children in some studies are inappropriately prescribed, up to 70% inappropriately prescribed for things like viruses. So, you know, a mom comes in, child is sick, and clearly there's a cold running around the family or maybe a flu like illness. Antibiotics aren't going to do anything for that. So, so we need to understand first when antibiotics are appropriate or not appropriate. And antibiotics, they're not smart. I mean, they don't have a homing system just for the bad bacteria. They indiscriminately kill whatever bacteria is around. And so they will kill the pathogenic bacteria if that's there that we want to kill, hopefully. But they also will, will kill beneficial bacteria. And in fact, some antibiotics have been shown to have more of a predisposition to kill the beneficial bacteria and preserve some pathogenic bacteria like Clostridia, which is why we can see C. Diff after some bacterial, some antibiotic courses. And so that is something that we have to really be aware of, that when we take an antibiotic, hopefully first it's not necessary. And so you ask, ask your doc that, hey, doctor, is this really necessary? And you do want to ask that, not in a, you know, adversarial way, but just, you know, I really would like to preserve antibiotics for when they're absolutely necessary. Is this a case where it is, you know, what would happen if I waited for my child? And the reason to ask that is because some studies have shown that physicians are much more likely to prescribe an antibiotic if they believe that you want a prescription for an antibiotic, even if they don't necessarily believe that the antibiotic will help. So just by asking the question opens the door for that physician to understand that you're not one of the parents coming in there saying, I really want an antibiotic now. You want judicious antibiotic use. And that's so important now because by 20, 2050, some experts expect that antibiotic resistance is going to be a leading cause of death worldwide. And that is frightening. You know, simple bacterial infections might become life threatening because we are inappropriately using antibiotics and creating antibiotic resistance.

So can you just briefly explain what antibiotics resistance is? Because I think a lot of people probably won't know what, what, what that is or that antibiotics can cause that.

Yeah. So, you know, this is, it's such an important public health concern because we have, of course, our, our own individual health. And that's, that's where, you know, the impact of the antibiotics on your baby's gut microbiome or your microbiome really is important to understand. On another note, too, what, what I also want parents to understand is that we have microbiomes everywhere, not just our, our gut. I've already, we've already talked about the vaginal microbiome, but our skin has its own microbiome. Our eyeballs have their own microbiome, even our hearts and our brains. And so, you know, and those, the microbiome surrounding all of our organ systems. We want them to be healthy and to have the right kinds of organisms, not the pathogenic ones. And so antibiotics can also disrupt those microbiomes. We know much less about those microbiomes than we know the gut microbiome, but that research is emerging. But when antibiotics are inappropriately used, or sometimes if they're started and stopped too early and bacteria are fully killed, which is why I say, if you're going to take an antibiotic, complete the course that's recommended. Don't stop early, as soon as you start feeling better. But it can select out for bacteria, bacteria that don't get killed by those antibiotics and create these bugs that are then resistant to that antibiotic or other antibiotics and really select out for these super bacteria that are becoming resistant to being killed by virtually any antibiotic now that we have on the market.

And, you know, I just saw an article last week on a call for manufacturers to make more antibiotics to kill these superbugs. And I'm like, well, why don't we think a little outside the box and think, are there other ways maybe that we could treat infections that don't necessarily require antibiotics? I mean, reaching into our naturopathic toolkit, right. That can be very effective and not as disruptive to the microbiome. Microbiomes in and on us and also.

Learn how to then support the gut microbiome in a healthier way so that we don't confer these antibiotic resistant genes. Because what's fascinating is, and we could talk about the microbiome gene connection, but.

The genetic material in us is we have, I mean, I don't even know how many, you know, trillions more copies of genes that are bacterial than human. And so we have this epigenetic connection between our microbiome and what genes are turned on or off and help us stay healthy or not healthy. And so these bacteria in our gut can also transmit these antibiotic resistant genes. And so, you know, we just, there's so many different layers to this. But bottom line, yes, antibiotics can be life saving. However, we also need to understand the unintended consequences of their use on the disruption of the gut microbiome and developing antibiotic resistance and know how to then support our gut microbiome so that we can, can mitigate those problems in the long run.

And so what practical tips would you give parents who their children have had antibiotics for whatever reason? What would you say to do for your next steps? And a timeline too, I guess, like when would you start, say, probiotic treatment or something like that?

So the first thing is to, when your child is prescribed an antibiotic, just to, you know, a lot of, I, I'm sure a lot of families who are following you, a lot of families who follow me, they really, they want to avoid antibiotics, you know, whenever possible and are sometimes devastated, you know, when an antibiotic is prescribed. So, you know, if your doctor tells you and you have a great relationship and you understand that the antibiotics are really, truly necessary in that moment, then you just breathe and you take the antibiotic. You just know that it's doing the good that it should be doing. And then we start, I would start a probiotic supplement alongside the antibiotic, meaning at the same time that you're taking the antibiotic and for at least a month or two afterwards, because it can take, you know, up to a month or longer for the gut microbiome to be restored. Now you just want to take that probiotic supplement at least an hour or two away from the antibiotic dose so that it has some time to get in and start to colonize your child's gut microbiome, taking a prebiotic supplement, or better yet, take a prebiotic supplement, which is often in the probiotic supplement, and also really, really, you know, just, just double down on getting in the fiber in those plants in your child's diet and, and getting in fermented foods. What's really interesting with fermented foods is that, you know, we, meaning, you know, the researchers used to think that probiotics, fermented foods, the benefit was in the probiotic content, you know, giving you all the good gut bugs. But it's so much more than that. Fermented foods contain what are called postbiotics, which these postbiotics are probably actually why probiotics are beneficial for us. So what are postbiotics? They are, when probiotics eat and ferment prebiotics, they create these beneficial compounds called postbiotics. And postbiotics are now considered probably one of the master regulators of our health. And these postbiotics include things like butyrate, you know, beneficial short chain fatty acid and things like gaba, which we think of as a neurotransmitter. But when you have your sauerkraut or when you have, have some kimchi, there's actually gaba in there. Which is why fermented foods have been found to help with social anxieties, right? For maybe the calming effects. And so really making sure that we're getting in the prebiotics, the fiber, the plant based foods, the probiotics through your fermented foods and also through probiotic supplementation. And while we're trying to help our child's gut micro recover from antibiotics, we also want to keep out anything that is further disruptive to your gut. Microbiome. Right. That's really important too. So you know, these, these microbiome mischief makers that I, you know, talk to, teach parents and kids about, but you know, they can be in our everyday foods. And so you know, if you're eating completely home cooked, no packages and then you don't have to worry so much about these, these microbiome mischief makers that are our foods. But when you're eating, you know, packaged foods and there are some, you know, healthier packaged foods that you can choose, but you just want to be savvy about what you choose. And so the number, I guess there, there are several things to avoid, but one of the number one things to avoid are these, these food additives that are, that are emulsifiers. So you'll see them as, you know, carrageenan or.

Mono and diglycerides.

Some of the gums, like xanthan gum, although you know, like guar gum actually does have some prebiotic benefit. But there, there are these, these emulsifiers, you're not going to see it as emulsifiers again. You're going to see them as carrageenan or, you know, mono and diglycerides that have been shown to directly disrupt the gut microbiome and also directly cause something called leaky gut. You know, just, just alone. And so we want to keep those out. You know, just look at your packaged foods, be savvy about weight, what you're choosing. Choose minimally processed foods where you recognize all the ingredients on the label and you want to buy organic as much as possible.

Glyphosate, or the pesticide that's used in non organic foods, was initially patented as an antibiotic. And so when we eat non organic foods, we can be inadvertently disrupting our gut. Microsoft microbiome further. And glyphosate has also been found to directly cause damage to the small intestinal linings and also cause leaky gut as well. So it's about what you put in and also about what you keep out. And then in the healing process, we also want to think about one of the other major disruptors to our gut microbiome, which is psychological stress. Stress. And, you know, where antibiotics are the single biggest, most important acute disruptor to our gut microbiomes. Psychological stress is our most important chronic disruptor to our children's and our gut microbiome. So learning how to practice mindfulness and.

Meditation, engaging our vagus nerve, that's an essential part of not just restoring your microbiome after antibiotics or other medications that also disrupt the gut microbiome, but also in creating a resilient gut microbiome that is resistant to being disrupted in the first place.

It's so fascinating. I'm trying not to get too jumpy and excited over here because I've done that in previous episodes when the guest has been speaking my language and Luca.

Made a video of me jumping out.

Of my seat with excitement.

But I just love everything you're saying. And, you know, I think it, it can be really empowering to know that, like I always say to patients, you know, we've got to do what we've got to do. And so, like you say, if you've been prescribed the antibiotic and you're like, oh, I was really trying to avoid that, it's okay, because we have these amazing tools that can help us to recover and that we have seen that the body does have this incredible ability to recover, when we do provide the right environment and the right building blocks to support it in that direction, would you say, like, what would be some, I guess, signs or symptoms to look out for that Perhaps your child's gut microbiome is not quite where you want it to be.

So.

Really, just about anything, you know, when we, when we think about, you know, how your child's gut microbiome influences, you know, their. There are different organ systems. There's the gut immune system connection that we've already touched upon. But your child's gut microbiome, especially in those early years, there's one really large study is almost 800,000 children. And they looked at infants who were given antibiotics or antacid medications, because antacid medications also majorly disrupt the gut microbiome. So these infants were given antibiotics or antacid medications in the first six months of life. Life. And were found to have a significantly increased risk of virtually every single allergic disease by the time they were four years of age. And that includes things like asthma, eczema, hay fever, anaphylactic food allergies, hives. So there's that gut immune system connection. We also have the gut brain connection, where as we talk about engaging our vagus nerve, there's the vagus nerve, for listeners who aren't familiar, is that information superhighway that connects the brain to the gut, but most people don't realize is that 80% of the communication occurs from the gut to the brain. And how your gut microbiome develops and the kinds of organisms in there can actually influence your baby's behaviors and moods and even iq on some level, our gut microbiome is responsible, responsible for creating the vast majority of many of our neurotransmitters, including serotonin, which helps us feel calm and relaxed and helps us with sleep. And another study looking at antibiotics given to children as toddlers found that in those children there was also a significantly increased risk of mental health concerns. By the time those kids were older or teenagers, the risk was higher when those Anorex were given in the first six months of life. And the more rounds of antibiotics, the higher the risk. So this is not, you know, this is not to scare parents. It's just. It's just to understand, you know, this. This is what we know. And highlights the importance again, of if your child has anxiety or depression or adhd, it's not just about looking at their brain. You have to look at their gut. If your child has eczema or asthma or constantly getting sick, it's not just about, oh, what's going on in their immune system or what kind of allergies do they have, it's about looking in their gut. So whatever persistent concern that Your child has, you know, we can, we can almost always look to the gut and see that there's, that there is a foundation there. Autoimmunity is on the rise in all age groups. Groups, but especially in our teenagers. And I see children, infants with, who are diagnosed with autoimmune diseases like Crohn's disease or juvenile arthritis. And we know that certain abnormal gut bacteria can predispose to autoimmunity. And so even for children who are diagnosed with.

Crohn's disease, juvenile arthritis, with lupus, with Hashimoto's thyroiditis, we do need to look at the gut to see what it, where is that, you know, where is that child's gut microbiome at in terms of the bacteria or the, or the pathogenic organisms that are living there? And so, you know, when we say, well, what signs are there? What, what signs does your child have that might tip off a parent to start looking at their gut microbiome? It's really virtually any concern. Concern.

Yeah, I think often people think it's like, oh, but their bowel is moving regularly. Or like it's, you know, not those really obvious like bowel symptoms. But it's not necessarily that clear cut. It can be these more systemic and more chronic conditions that are popping up. So, yes, there's so much to it. I feel like we could pick your brain forever and we'll definitely have to pick your brain again. But thank you, thank you so much for your time today, Dr. Song. It's really been such a pleasure to share your wisdom with our audience and we'll make sure that we link in the show notes where everybody can find you. And you've got a book coming out in the new year about exactly this topic, don't you?

Exactly.

This topic is in February of 2024, so just be on the lookout for it. I'm not sure when it will make it to Australia, but hopefully soon.

Yes, well, we'll definitely make sure to share that as well when it arrives. But thank you so much again for all of your wisdom and everything that you do.

Oh, thank you so much for having me. It was my, my honor to be here.

We hope you loved today's episode. If you still feel like you need some additional support or if you need further guidance around which strain specific probiotic is right for you or your child, then don't forget we have our online clinic with a team of incredible and experienced naturopaths and nutritionists who can help, help to guide you. Visit boobtofood.comclinic to book your appointment or find out more.