32: Supporting Teen Immune and Mental Health with Holistic Pediatrician, Dr. Elisa Song

Foreign. Welcome to the Integrative Women's Health Podcast. I'm your host, Dr. Jessica Drummond and I am so thrilled to have you here as we dive into today's episode. As always, innovating and integrating in the world of women's health. And just as a reminder, the content in this podcast episode is no substitute for for medical advice, diagnosis or treatment from your medical or licensed health care team. While myself and many of my guests are licensed health care professionals, we are not your licensed health care professional. So you want to get advice on your unique circumstances, diagnostic recommendations, treatment recommendations from your home medical team. Enjoy the episode. Let's innovate and integrate together. Hi and welcome back. I am so excited today to introduce you to my dear friend, Dr. Elisa Song. We are going to talk about her brand new book, Healthy Kids, Happy Kids. Anyone with children, grandchildren, watching children, absolutely need to have a copy of this resource because it's a very comprehensive resource for how to healthfully help your kids build resilience on all fronts, physical and emotional health and not just about food. And really with a very evidence based background. Dr. Lisa Song is an integrated pediatrician. She's trained at Harvard and nyu. She has deep experience in practice. She's also a mom of two middle school kids. One's actually entering high school now. We talk in this episode a lot about teen girl and boy health because I work with a lot of teenagers with endometriosis and chronic pain and long Covid and increasingly I think we have the tools to manage all of these things, younger and younger, better and better, but they're not the standard of care. You're not going to find this everywhere. You're going to rarely find this in fact, because most pediatricians are in an overwhelmed, overworked primary care model. So Dr. Song is trying to shortcut this for parents and other people working with kids and teenagers. There are so many gems in this episode. If you have a child, you care about a child, you have any influence over any children or teenagers. This episode is for you. And let's meet up again on the other side where we talk about a few of those key clinical pearls that you can take to your practice right away. Hi everyone. Welcome back to the Integrative Women's Health Podcast. I'm thrilled, thrilled to be here today with my friend and brilliant colleague and author of this new and fantastic book, Healthy kids, happy kids, Dr. Elisa Song. And as you've heard, she is extremely accomplished. But more importantly, I think she's a busy working mom of kids and now teenagers and has that personal experience as well as deep professional experience. So welcome, Dr. Song.

Oh, thank you, Jessica. I absolutely know the struggles of having the tweens and teens and so rewarding on so many levels. But yeah, it's a different stage of life, right?

Absolutely. So your book is so focused in the beginning, I think on the most important thing that we have to help our kids do right now in this age of toxicity, of stress, of excessive device time, less movement time, less outside time. And it's that we're always talking about integrative women's health and this sort of overlap between the different physiologic systems, nervous system, immune system, endocrine system, digestive system. And you start with some very family and kid friendly ways to optimize to digestive and gut microbiome health. Can you highlight a few of the key hacks for that? Because that's the key to nervous system and immune health as well.

That's right, yeah. I mean, the first section of the book really goes into for kids and teens and parents who are not yet quite familiar with how important the gut microbiome is for kids, everything, I mean, this is the same holds true for women and for men. Right. But just lays down some of the science so that I'm all about educating and empowering kids and teens as well. So I've had teens read sections of the book and have some aha. Moments of, oh, okay, my skin is not how I want it to be. Wow. Maybe I should think about my gut microbiome. So understanding the microbiome immune system connection, the gut brain connection, gut skin, gut hormones, all of that especially important for our teenage girls and our young women. And so one of the things that I never like to do as a mom is give you just one more thing to do in the day. Right. I mean, we're all so busy. And so when I think about creating what I call microbiome magic, it's really with the five things that we're already doing every single day. So these are things that I don't want kids and teens or parents to think, oh, it's another thing I have to add on to my to do list. These are five things you're already doing. You already have to eat and drink and breathe and move and sleep and. But if we learn how to do them in a microbiome centric way, in a way that nourishes our microbiome with the understanding that our microbiome, one of their sole jobs is to keep us healthy and happy, then we can Reframe how we're doing those things. So the first chapters five and six really dive into how do we nourish our microbiome. Chapter two is called Breathe, and it's all about how do we engage our vagus nerve to really connect and optimize our gut brain, brain connection and then how we sleep, how we move and how we hydrate all impact our microbiome. And what's fascinating is that each of these things has been shown to optimize our gut microbiome, take the nourish out, even independent of diet. So how we engage our vagus nerve and we have mindful moments, we take time to really understand how to breathe with our diaphragm fully instead of up shallow with our shoulders. We take moments to just pause and congratulate ourselves and shift our kind of negative mindset to a positive mindset. All of those things can optimize your gut microbiome diversity and function independent of what we're eating. So for some parents and for some kids, changing diet is one of the hardest, most daunting things. If you are a mom of little kids who are super picky, or even if you have a teen who's super picky, it's stressful. And then as a teenager and you're talking to them about sugar and diets and all the things that they've heard already and they give you that eye roll, then. All right, well, first just read this part because I want you to understand, you know, why we talk about this thing as a family. But then let's try something different. Right? Let's understand how your sleep affects your microbiome and how your microbiome, remember, if it's not balanced, that's going to contribute to horrible period cramps or really, you know, not great skin or not vibrant, shiny hair. And think about how we're going to nourish your microbiome in all the different ways.

Yes, I love that. And I really like your approach. That's more additive. One of the things as a nutritionist I'm always very careful of with teenage girls and my own daughters is that perspective of restriction because their bigger risk is disordered eating. Right. So like, for example, last night I was reviewing your book and we were having dinner and I said to my 13 year old, I was like, okay, okay, how many different colors and vegetables and plants and things do we have here? Because you're talking about a really additive approach, like 30 different plants a week or 30 plants. And we counted the plate and it was like seven. So I was like, look, that's not overwhelming if in one meal, having a salad and some roasted zucchini, you're hitting like a third of what you even need to do practically.

That's right. You know, I give a lot of practical tips like that. So one of the things, I mean, we have to know where we're starting from, right? And sometimes, you know, the place we're starting from, most often it's not where we want to end up. Right. So we just need to know without judgment. Right. And many families are pleasantly surprised when they do an inventory like that. Wow, there's actually seven plants in this dish. I didn't realize that. Right. And when we think about plants, well, plants serve as a fuel for your beneficial bacteria. The probiotics in your microbiome, so they help to feed and nourish, act as prebiotics. Now, the, what I call microbiome champions those include the fiber in your fruits and vegetables and legumes and whole. But also the color counts, too. Each of the different colors of the rainbow provides a different phytonutrient, a different color superpower that actually nourishes our microbiome. And then, of course, we have fermented foods, which have so many benefits beyond just the probiotic content. So when we take our plant inventory for a meal and you just count, no judgment, and you just see. And then one strategy is just to think about, you know, how can I make this meal pop with plants on purpose? And just think about, how do I add just one more plant, Right? And that could be a spice. Like, let's say you're making some roasted bell peppers. Well, when you take it out from the oven, why not, you know, sprinkle some chopped cilantro on it or, you know, add a dash of turmeric on it. I mean, that counts as a plant, right? But if we're not thinking about, well, how do I make it pop? We might not think about what's in our cupboard, that I can just have one more thing here. And I've had little kids have so much fun with making it pop and kind of ask their parents, like, oh, are we making this meal pop too? So really fun. And then for our teenagers, one of the things that really, I think is just so insidious and has crept into sometimes daily life are sugar sweetened beverages. So, you know, these Boba teas and Starbucks, and it just becomes, you know, what used to be maybe like, oh, on a weekend, let's all go out and we'll get an ice Cream sundae or, you know, have a little treat. Right. But it's become for many kids, this, this after sports practice, oh, we're gonna go to Starbucks, you know, get a Frappuccino and becomes a 3, 4, 5, sometimes 7 day a week habit when we think about, you know, the grams of added sugar. Now, I'm not one for, you know, counting and rigorously because again, we don't want kids fixated on the exact numbers. But again, when we first do, it's just kind of like, you know, just knowing where you're starting from. Do a sugar inventory just to see like how many grams of added sugar is my kid. Me as a grownup, am I having in a day, a very normal day. Right. Don't change anything about it. And most people are going to be really shocked that, wow, I'm having like three, four, maybe five times the amount of added sugar in a day that I'm supposed to have. You know, for instance, as a woman, you know, we really shouldn't have more than about 25 grams of added sugar in a day. That's about six teaspoons of added sugar. Right. But when we think about, there's one Starbucks mocha Frappuccino, something drink, it has 54 grams of added sugar. 54 grams of added sugar, which is, it's over 10, is it 14 teaspoons. Right. So if we help our kids think about it in teaspoons, it makes it a little bit easier because we all know what a teaspoon is. We don't necessarily know what a gram is. Right. And not to say never ever any sugar, but it's just for kids to open their eyes and realize, wow, it just become this part of every day. And it's so much easier to drink, you know, 10 teaspoons of sugar in one sitting than imagining spooning 10 teaspoons of sugar in one sitting. And if kids can understand the impact of the added sugars on their microbiome, on their brain health, their mood, their learning, their focus, their skin, it does make it a little easier to say, you know what, okay, today I really want that boba tea with my friends. I. But, you know, tomorrow I'm going to choose something different. You know, I'll choose flavored sparkling water instead. Right. So it's all about trying to have that balance.

Yeah. And I've found with my own daughters that that is really key, that there's this sense of agency around choosing things because they will make them feel better and not having to be like a hundred percent of the time. But maybe like you said, it's more like once or twice a month or once a week. We do this not every single day. And what are the alternatives, I think are so, so helpful?

Well, what you just said is so key, right? So first, you know, just kind of understanding and just, you know, I think for teenager, one thing that really helps them kind of, you know, have that aha moment is when we think about the fact that really from a health and longevity standpoint, we don't want more than about six teaspoons of sugar per day for most kids. And the average teenager today has 34 teaspoons of sugar in a day, right? And so a lot of kids are like, there is no way I'm having 34 teaspoons of sugar. Well, let's just do the math, because the food industry is making it so easy, right? But then it's not enough to stop there, because we need to give our teenagers alternatives. We need to help them understand how to make those swaps so that they can go out and hang out with their friends and eat with them and drink with them, yet if we equip them with the knowledge of how to make different choices, even in that moment. So, like, when they go to the grocery store, I mean, my son, now he's 12 and a half, and he's been going downtown with his friends. I mean, started through the pandemic, a way to connect and regroup. And it's continued so every Wednesday after school. I mean, sometimes I do cringe at the choices, you know, his friends and sometimes even he makes. But now one of the most important skills that we can teach our kids and our teens and our young adult children and even ourselves, is to learn how to read food labels in a way that we can make these choices that serve our brains and our microbiomes. And so if we teach them how to make these swaps, and in the book I go through, you know, I give an example of, you know, a favorite chip for a lot of my son's friends is Takis, which are these rolled, you know, hot, fiery tortilla chips, right? But if you look at the ingredients, just take a look and you'll see. I mean, one of the first things it says is artificial. So we teach kids, well, what does artificial mean? Why on earth would you want to put something fake into your body? Right? So that's one thing. But then if they learn to really assess the ingredients, they can learn how to make their swaps. Or if they're at the grocery store, all right, Instead of choosing the Takis. Well, if they're Trader Joe's, okay, they're rolled corn tortilla chips. The chili lime ones are a better option. What's even better is if they're at Safeway, pick up the bag of Siete Fuego tortilla chips, right? So they can learn how to make these swaps, whether it's the chips or the drinks, right? These hydration drinks that are low sugar or no sugar and full of junk like prime and, you know, all of these other things. If they learn how to, you know, make a change, it empowers them. It feels like, okay, well, I'm making this decision. And they can also participate in whatever social activities. So, you know, the prime is another. Like that bomb prime hydration drink or the Gatorade or the whatever. And a lot of these companies, they've moved away from dyes, and they say, you know, dye free and sugar free. So kids think, wow, that's awesome. So you just teach everyone, you never look at the front of the label. You immediately turn it over. And even these artificial sweeteners are really going to wreak havoc on your brain and your microbiome. And so my son was like, as any typical kid, like, mom, but I really want it. And I said, okay, well, let's take a look and see. Can we find other options? Because we were in the store, and so, you know, he went to the refrigerated section and he looked at labels. He's like, hey, mom, how about this? And it was a really cool bottle, a cool can, right? And it was. I don't know. So it was like a lemonade kind of a drink. And I'm like, hmm, okay, let me take a look. So it did have, I think, 4 grams of added sugar. Fine. But nothing else. That was terrible. And I looked at the can, and it looked really cool. It was actually called Liquid Death. I don't know if anybody's ever. I don't know if anybody's ever seen that, but they're really cool bottles, these cans. And he's like, I would totally love to drink this, and I'd be fine with this over prime. I'm like, great, me too. Right? So it's just making it really practical. Once they learn how to do that for themselves, then you can feel confident when they're off to college and making their own choices or when they're living as young adults, you know, for the first time in their own apartments, cooking for themselves, you know, that they can choose packaged foods and easy foods that still are going to be nourishing.

Yeah, that has been one source of, I guess, positive in my kids in that my older daughter's now just finished her sophomore year in college, and so she lives with four other girls in an apartment or three other girls. And so she had enough cooking skills to like cook dinner for them. They go to the grocery store once a week. They can live on a grocery budget. They're not constantly eating like fast food and that sort of thing. And it's not to say they never do that, but they have the skill set and she's helping them learn. And, you know, I think we forget that our kids need to learn how to do these things in the same way they have to learn how to do everything else when they start to be off on their own. So let's circle back a bit to talk about, I think one of the biggest challenges I see in my patients. We work with a lot of teens and young adult girls who. Girls and women who have endometriosis or pelvic pain or period issues, pcos, pmdd, this sort of thing that does track back to the gut microbiome in all of those cases, actually at some level. And I see a lot of anxiety in my teenage clients. What are some of the things that we might not be thinking about in terms of medications they may be on or just habits? Many of them live in very high stress, kind of like high productivity, competitive kinds of communities, which I know you're not unfamiliar with living in the San Francisco area. So how can we help our teen girls navigate anxiety?

Yeah, well, I mean, a few things to kind of unpack there. I mean, we know that even before the pandemic, our kids had a mental health crisis. I mean, this is not a new phenomena. I mean, even before the pandemic, suicide has been the top, you know, number two leading cause of death for our youth. I mean, our 15 to 24 year olds, through the pandemic, especially for teenage girls, that has worsened. Unfortunately, one of the latest numbers looking at teenage girls specifically found that around one in three teenage girls has seriously thought of suicide. One in four has actually thought of a plan, and one in ten has actually gone on to try. And so, you know, we need to open our eyes to this. And it's not just our teenagers. It goes way down to even, you know, five year olds, eight year olds who are in the emergency room with suicidal ideation. I mean, we can think about all the different factors. And of course, there's never just one factor. You know, if anyone's for parents who have read Jonathan Haidt's the Anxious Generation. You know, the whole rewiring with our phones and social media, especially for our young women. But if you have a teenage girl or, you know, a young 20s, young adult daughter, it's not that that ship has sailed in terms of, you know, pulling back on the social media and phones, but you can't ungive a phone, you know, at that age, right. If your child is eight and they have a phone, I would say I would strongly consider ungiving that if it's a smartphone, you know, because there's just so much data now on the social emotional harms. And it's not just our girls, it's our boys too. In fact, they looked at a group of for boys, it's mostly video games and found that the microbiomes of kids who game more frequently, more hours, actually this was college age kids than fewer hours had different microbiomes. Now, is it just the games? Probably not. It's probably also the fact that when you're gaming, you're not moving your body, right? And gaming also comes along with a lot of sometimes junk food and chips and just mindless snacking, right? So who knows, but it is there, right? And for our teenage girls in particular, when they're struggling with anxiety and mental health concerns and they're struggling with horrible skin and period cramps and the PCOS and the endometriosis, atroposis, we need to step back and recognize that so much of that is really stemming from gut microbiome imbalance. And you know, we know, for instance, with hormones, right. As your audience is familiar with our microbiome, if we have the right balance of microbiome, many of our gut microbes are responsible for how we process our estrogens and, you know, detoxify and clear and eliminate inflammatory or not the right kind of estrogen. We need a balance right now. We know there's nothing that's good or bad, it's just the balance, right? But our hormones, our metabolic systems, even our blood sugar regulation requires a healthy microbiome. Same thing with our brain. You know, many listeners have heard that, you know, 80, 90% of our serotonin, which is the one of the neurotransmitters that's implicated in managing stress, sleep, you know, anxiety, depression, perceptive thoughts, right? 90% is made by our gut microbiome if we have the right microbes. But if we have an imbalance, there's no way that your daughter's microbiome is going to make enough Serotonin or GABA or vitamin B12 or, you know, acetylcholine. All of these amazing factors that your daughter needs. Right. And so when we think about what happens from a conventional model, and there is a time and a place for medications, but we have to understand the unintended side consequences. Right? So for many kids, one of the things that led them down this road might be a history of repeated antibiotics when they were younger. And we know there's a large study in Denmark that looked at antibiotic use in mother, infant, pairs and children, infants, and found that, you know, antibiotic use in infancy significantly increase the risk, sometimes by up to 50% of, of virtually every single mental health disorder by the time those kids were older. Older kids are teenagers. And even from adult studies, we know even just one round of antibiotics can increase the risk of anxiety and depression and mental health concerns. And the more the rounds of antibiotics, the higher the risk. So this is in the literature, but why is that? It's because of disruption of the gut microbiome. So if your child or your teenager is on antibiotics, how many of them are on low dose doxycycline for their acne? Right. And they're suffering from anxiety as well, or pcos. And you have to think, all right, let's have a discussion with your child. I'm never going to say go off the medications. You want to be supervised by the prescribing physician. At the same time, knowing that if we help support their microbiome while they're on those antibiotics, it can help to balance out so many other things. Now, our teenagers may also be on a lot of other medications that also are known to disrupt the microbiome, like ssri, antidepressant and antianxiety medications. Right. Like the birth control pill. Right. Like reflux medications or steroids. So all of these different things can have an impact on the microbiome. And so if your teenager is on multiple of them, they might feel better temporarily. But we often hear, and I often see in the practice, but eventually it stops working. We see that in adults too. You know, the antidepressant, the SSRI for the first month, maybe even the first year, okay. Really helps to take the edge off. Great. Sometimes we need that, and then eventually it stops working. But what happens with SSRIs or even birth control pills? It's the disruption to the gut microbiome and also the depletion of important nutrients like your B12 and folate that we need for those neurotransmitters and for Healthy detoxification and all of that. So I don't want this to sound overwhelming. We just need to know, okay, this is where you're starting from. If your daughter is on these medications. All right, you know, we'll keep them on for now and work on some of the underlying imbalances and potentially some of the underlying root causes so that eventually perhaps they'll be able to wean off some of these medications, or maybe they'll stay on those medications, but they'll have more of a chance that they're going to work for them and that your child will find the relief that they're looking for.

Yeah. And when you meet someone at that level. So if I'm working with someone who has endometriosis and. Or PMDD and or pcos, and they are maybe on one or more of these medications, sometimes we actually start with what you were talking about at the beginning, away from food and away from everything else, like starting to learn mindfulness strategies and more physical movement and things that are kind of additive in a positive way, rather than being like, we have to cut this and stop this and come right off these medications.

Absolutely.

That can feel overwhelming. Plus, it kind of pulls the rug out of. From under people because a lot of times they're using food for some emotional support, for some social connection. And so I think if we can start looking in those other parts of those five things you were talking about, you know, that movement and connection, it gives people like a rug to stand on before we start slowly taking away the medications as they need them less and less.

You know, I think one of the things starting with the mindfulness piece and with the connection piece is I think that is one of the most important foundations, one of the most important life skills that we can, you know, give to our teenagers. I mean, starting from the time they're toddlers and, like, so frustrated with the thing.

Right.

And as we support our children and our teens in that way, I also really emphasize that this is not a woo woo kind of optional concept. Right. I make it very concrete because our teenagers now, they are super savvy. They are looking stuff up and they're bringing research to me and they're having sometimes frustrating conversations. But they're great opportunities to, you know, teach them about the source of the information. Right. That they're getting some ideas from and also how to read research papers with more of a critical eye. So I love these opportunities, and I love kids to have that inquisitive, questioning mind. And they're being taught that in School, which is great, but that means, on some level, a little less tolerance for fluff, right? And we've seen this through the pandemic, right? Where's the science? Follow the science. I want the evidence. And I can barely post something on Instagram without someone saying, well, I'd like the resources, right? And it's like, great. And yet, if we don't know how to be savvy about reading the resources and, you know, really making it our own, it sometimes is not as helpful. But when we talk about vagus nerve, when I talk about vagus nerve and the power of, you know, mindfulness, I put it into, you know, very clear, more scientific terms and let them know. Look, when we're working on our vagus nerve, we know that one of the best predictors of current and future health is how well your vagus nerve is functioning, is how optimal something called heart rate variability is, which some teenagers are familiar with because they're using their whoop to track their exercise. If they're really into athletics and they can see, oh, or even my apple watch tracks something called heart rate variability. Well, it is so important. And when we think about the benefits of optimizing your heart rate variability and giving your vagus nerve some muscles, what I tell kids and teens and parents is that, you know, the effect of feeling calm and focused and in the zone. I love that. I want everyone to feel that. That, to me, is an amazing side effect. The real benefit is what's going on underneath with reducing chronic inflammation, regulating your immune response, balancing your hormones, regulating your blood sugar, you know, managing your stress response, all of that. And so, you know, when kids and adults recognize that psychological stress can also directly cause leaky gut and trigger microbiome imbalance and create as much inflammation as any infection or environmental toxin or, you know, physical injury, then we can place vagus nerve work up on one of our most important prescriptions. And that is something, you know, as kids go through life and as we as adults go through life, that's something that we can learn how to do every single day, really, at no cost. Right? It's not an extra supplement. It's not saying, oh, you know, and we don't have to buy the next fancy, you know, vagus nerve device, like, you might need that to start with. And certainly I've had kids use, you know, some vagus nerve devices to just more passively learn what it feels like to engage your vagus nerve because you're just so much in the sympathetic all the time. But once we learn how to engage our vagus nerve. You can do that anywhere, anytime. And it really is the key to getting well if you have some health concerns. It is also the key to staying well. Because I know that many people have had the experience as grownups. I see this in my practice with kids where we get them well, they're quote, in remission and then maybe six months down the road, a year or two later, things start to come back. Right. Because we haven't changed one of the core factors that helps regulate our inflammatory response and ultimately, you know, our health outcomes.

Yeah, absolutely. I think how we do that in terms of, you know, kids, as you say, they like gadgets now we do the same thing. We track HRV with Garmin, Oura ring, whoop apple, watch whatever they have or whatever we give to them. And then they can see the power of things that otherwise feel a little bit woo woo. Like you said, like whether it's. You talk in the book about acupressure and acupuncture and homeopathy, which I find very powerful for teen girls with both anxiety and menstrual symptoms. And honestly, hot flashes, one of the best things for menopause. But also things like essential oils or petting dogs or nature exposure or the breath work. Like these are, I think, an important skill set that people should be learning as kids and practicing and evolving and using. Because you're right, when that neuroendocrine, neuroimmune coordination of the vagus nerve from the brain and the nervous system to all of the systems is not maintained. And I've been talking about this kind of with people our age who remember sort of when our communication was not always just like texting and like Snapchat and things like that, but you actually would like sit on your friends and next to your friends and like chat. Like when I was in grad school, we used to get together and like watch Grey's Anatomy and like lay on the floor and you know, so when people have this like stress that, you know, we have that bucket theory for toxins, right? Like if there's too much in the bucket and you can't release it, it's like gets overflowing. But I think of stress as like a tire being full of air. And then we used to just let the air out a little bit at a time with chit chatting with a friend. Or, you know, we used to like run the stairs for exercise, but we'd be talking the whole time. Or, you know, you'd be kind of like laying with your friends and just even like you wouldn't even have to be touching, but there's just sort of this like restful position where you just like let go of a little stress. A little stress. And we do that now more officially with trauma release shaking exercises, which are great, but it's like we used to just do that a lot, all the time.

Yeah, it's true.

And you know, we've lost some of that. The kids don't just ride their bikes to their friends where they would kind of like get a two minute blowing off of steam in a way that we used to have all the time. Does that make sense?

Absolutely. And you know, here's the thing we know, you know, even through the pandemic, the power of community and how social isolation is. It's a big risk factor for decline later in life. And so, you know, with this grand social experiment with these cell phones now that are ubiquitous and we've never had any, you know, long term studies on brain development and socio emotional and immune and you know, physiologic outcomes, there are more, more coming, Right? But unfortunately for many of our teenagers, they're kind of right in the middle of this experiment. Right? But one of the larger studies that looked at screen time use and found that any screen time use did actually significantly increase depression and even suicidal thinking anything over more than five hours was a big jump. Right? And our kids, and even us as adults, if you look at your screen time use, many are well above five hours. And a lot of kids think there's no way it's five hours. But you know what? Now it's this, you know, when it's waiting to get into the school doors, right. You know, if the doors are locked, instead of just sitting there hanging, chatting, you're like on the phone, right? I mean these kids are there not communicating and talking or if you're waiting to get your school lunch and you're waiting in line instead of, instead of again just sitting there chatting, hanging out with whoever happens to be next to you. Everyone's on their phone. So it sees we're grabbing minutes at a time that all add up even as adults, right. And in this study, what they found, there were some things that were actually protective because it's not enough to say, oh, it's causing all this harm. We need as moms proactive, you know, positive measures. That's why I'm all about solutions and hope. I mean we don't want to just do be all doom and gloom. So one of the most important factors was in person Communication, right? Face to face communication. And so, you know, like you said, just hanging out, like just sitting on a park bench, just like gabbing, or maybe not just even gabbing all the time, but just having a moment together, right? So face to face. So that was one. Another one was being on a sports team. That's community as well, right? It's also moving your bodies and all of that, right. The third one was really interesting because this study is a little bit older, but the third one was reading print news, which I'm like, who picks up, you know, a journal now? I mean, I love it, right? I love when I'm at the airport and I pick up a magazine and I'm like, oh, I'm flipping through and I'm actually reading something in my hands. I mean, sure, I have books on Kindle that are easy to transport, but there's nothing like holding a book in your hands and actually reading it. So anyhow, those are the three factors. But I think the more face to face and you know, even with boys too, the communication, that is what is so important. And you know, as we think about the other factor I think nowadays with stress is many of us and you know, our kids by that same token have really lost a lot of our stress tolerance.

Right?

And what I mean by that is, you know, for many kids and teenagers, when I ask them, they expect that stress and anxiety is just a part of life. And oh, so and so is on medications. Of course I'm going to be on medications and view every single setback, anxious moment, stress as really bad. Oh my gosh, I'm so stressed, right? It's like, well, stress is, as we think about it. And that's why I spent some, you know, good chunk of time in the book just really explaining that stress is a physiologic response. It's just your body's response to getting ready for something. I mean, in the past it was that saber toothed tiger, right? But now it's like, okay, getting ready for a test or getting ready to get up and go in the morning or getting ready for whatever, right? So stress in and of itself is not a, quote, bad thing all the time. And in our quest to have no stress, be happy all the time, you know, avoid, make life really easy for our kids, we've inadvertently, unfortunately lost many opportunities to continually build up stress resilience. And so when a bigger stress comes along, it's like, oh my gosh, I don't know how to handle it because I've never had to deal with the frustration of, I mean, this is a small example, but my daughter, you know, she forgot her recorder for her school, you know, the elective. And then she was in sixth grade. And so we were at school dropping off, she's like, oh my gosh, I forgot my recorder. She's like crying. And I was like, I wanted to go back home and get the recorder, but I couldn't. I was late to work. And I'm like, I'm sorry, honey. Right. And so. But guess what? She never forgot her recorder again.

Yeah, yeah.

I mean, it's little things like that. And guess what? She survived not having her recorder. Right. And feeling, oh my gosh, you know, I can't believe I forgot that. And I'm just gonna have to sit here, do something different while all my friends are playing the recorder. All right? But she managed, right? And so then the next time she's like, all right, I'm not gonna forget. And it wasn't the end of the world like I thought it was going to be.

Yeah. I think that's such a key skill we've got to help these kids learn in middle school. I mean, my daughter too, like, anytime her friend was mad at her or she was having some kind of social disagreement, it was as if like life was over. And so many, many times we had to be like, well, remember this has happened before and you're gonna be friends again in a couple days. She's feeling upset right now, but because they're so immediately all the time connected, it's like if they don't get that dopamine hit of the right kind of text or the right kind of connection, you're right. They have to practice the skill set of being frustrated, having discomfort, being embarrassed. It's huge. But I have seen now having, you know, for giving parents some hope, I have seen now with my daughters in eighth grade and having done that now with a lot of practice and discomfort for me as the parent and the mom for sure, is that it's our instinct, as you said, to try to like, make it easier for them. But if I can sit there and tolerate her discomfort while she's feeling that way, it actually teaches her this resilience. And now two years later, we're seeing much more self resilience. But I think it's hard as parents when you're like, okay, nevermind, I'll fix it, I'll go home, I'll change my day, I'll bring the recorder. But if we don't do that again and again and again, it does teach them they have that strength. So. Well, before we wrap up, I do want to talk about one other thing that you address briefly in the book. So you talk about the most common things that kids have and the top one is like the crud. Right. So that's like any virus.

Yes, Any, any junk. Right, that, that we go through any.

Viral infection, any, sometimes a bacterial infection. And so for me though, having had this deep and educational experience with COVID and long Covid, I know a lot about COVID and I'm sure you do too, just being in a primary care practice. So we now see that the data shows that Covid is different from the other crud. Well, not in everyone, but in a pretty high percentage of kids. Somewhere between 10 and 40% of kids will go on with each COVID infection to have long Covid. And we know for you and I, in functional medicine, functional nutrition, integrative medicine, we know that it's not wildly different from all of our other post viral, post infectious syndromes, like post Lyme or Epstein Barr, things like that, but for kids. So I've actually recently been working with a couple of teen boys and I don't, I don't see a lot of men and boys. I mostly see girls and women, as you would guess, but boys with pretty significant long Covid. And the biggest challenge I have there, and I'm wondering what you're doing in this practice, in your practice, is because long Covid, it's a series of things. It's mast cell activation syndrome, it's dysautonomia, it's me cfs. But the intense chronic fatigue and the chronic pain and the like instability of the organ systems and the viral persistence. These kids, like, when it with adults, I can help them go from like, okay, you're so debilitated. We have to be patient. We have to sit with the discomfort while we're healing. We have to take these little baby steps to retrain the nervous system that you're safe and you're healing. A lot of vagus work work, a lot of, you know, gut healing work. But it's hard because when I explain it to my adult clients, it's like you're going to eventually get on this upward spiral of healing. It's not the upward straight line of healing. It's like up and down. But with teens and kids like that are so sick, how do you get them started on that? Because it's like their parents, how can they do it? How can their families do it? They get really stuck with such Intense symptoms.

Yeah. Well, I mean, the fortunate thing is, at least in the younger population, I mean, rarely. Rarely have I seen long Covid. And I think for at least in my population, the. One of the biggest shifts in terms of when you have the crud or when you're getting sick is from a natural, you know, integrative pediatric standpoint, you want to jump on things right away, right? There's no kind of, oh, let's wait and see symptoms. No, I mean, if you're starting to get a little sniffle or sore throat or a headache or whatever it is, and you know there's something going on, you don't know exactly what, well, you jump on it, and I give, you know, recommendations. I mean, there's. There's an African bush herb called pelargonium, which is great. You know, you add up your vitamin D. There's some great homeopathics to take. So for a lot of my kids, they just get over things very quickly.

Right?

But then, you know, the long Covid is more common in the teenage population. And I have one kiddo right now who's actually, he's headed off to college, but he was a competitive baseball player. And I think, you know, for adults and for our teenagers who are go, go, go, it's also, you know, I mean, little kids have the time to just sit and sleep and miss school and recover and, you know, do all the things that it takes, but when we don't, we know how. I guess the right word would be toxic, you know, mitotoxic. The SARS CoV2 virus is what a strain it puts on your mitochondria, that if we're not supporting mitochondrial recovery, we're not going to help with immediate recovery. Right. And so I always check mitomarkers for kids. With our kids, like, I'm just thinking about this one kiddo in particular, I try to work with the main symptoms and try to give a quick little win at first. Right. And so for him, it was the fatigue after practice, because he was still practicing, Right. I mean, he's had a, like, professional baseball route. Right. And so, you know, at first, just really piling on the adrenal and the mitochondrial supports to give him a little bit more energy, a little more hope that, okay, I can get a little bit better. Right. And then it's just unraveling, you know, trying to do the research and figuring out what is the element of mast cell activation. We did a lot of vagus nerve work. And for teenagers, this is where some of the passive Work really is more helpful. So whether it's with. I don't have any stock in any of these companies, but, you know, an Apollo Neuro or Tru Vega. We did red light therapy for him, you know, got a big panel which really, really helped him. He could feel his recovery after exercise improve. Immediately after starting the red light panel.

Do you remember what the frequency that you use? Like 660. Was it lower or higher?

It was lower. It was lower. Yep. And, you know, I think he was there for maybe 15, 20 minutes.

Yeah, like once a day or every other day, something like that.

Yep, we started every other day and then we did, you know, once a day. And you know, again, for teenagers, hard to be as consistent, but when they see that there's benefit, it's a little bit more empowering. I mean, I think his dad used the red light more than him eventually.

Right.

Because his dad felt so good with it. Right. But yeah, I mean, it's understanding also I think that for many people who, as you said, a lot of people with long Covid are the ones who are the higher performing, you know, just, you know, on the go, go, go, used to being at the top of their game, you know, all the time. And so it's really giving yourself that graduation grace to know, you know, what, like, getting really sick and needing time to recover doesn't mean there's anything wrong with me. Like, I'm not like lesser of an athlete or whatever, you know, because of this and not blaming yourself because I think in the beginning of COVID there was just weird time. It was just a strange time. Right. But now we know, okay, everyone is going to respond differently sometimes surprisingly. But I do think for patients, if you can really allow yourself the time and the space instead of just go, go, go and thinking, okay, I'm just gonna get over this at some point, that your recovery is gonna be put on a path of healing a little bit more quickly.

Yeah, I think that's very helpful. My experience is the same. The kids I'm seeing teenagers are high performing. Most are athletes. We're used to being very healthy, very fit, very active, very cognitively on top of it. And, you know, we know Covid can live in the body actively reproducing for up to well. The studies are more than two years old now and they're still seeing it. So in a way, what's going on is the immune system hasn't been able to find and clear all of it in as long as it takes. And as you said along the way, it's like causing all this damage, mitochondrial and immune and vagal. And so I think it's a useful tip for parents and especially the kids who are feeling really hopeless, that to know that you will recover. I actually do believe that at this point, having experienced this myself, although it might take a couple of years even, but kids are more pliable, if you will.

Well, yeah, there's less to mop up from before.

Yeah, right. But it is the ones that are really used to achieving and that are very high achieving athletes that it makes it so hard to slow them down.

It's really hard. Yeah. Well, and it's just like for kiddos who have, let's say, sprained their ankle, right. And they want to get right back on, I'm like, you know what? You will get back on the field faster, for longer if you give your ankle time to fully heal. Because otherwise you go right back out injured again, then you're out for another couple weeks, you go back, you injured again, maybe you injure it worse, and then now you're out for the whole season as opposed to taking the time to fully heal. And then at least you can come go back at least for part of the season, you know, full force and ready to go. The other population of kiddos that you know can have trouble with COVID are kids who already have pans or pandas or sometimes develop like a pans type picture, even if they didn't have a before. So I also look really closely at the neuropsychiatric symptoms that can arise. You know, that in the early days these neuropsychiatric symptoms were not associated with COVID And so, you know, after many case reports and now recognizing that for kids and teens having these onset of anxiety or ocd or eating restriction or cognitive and handwriting decline, all that very similar to a pans picture, that Covid can absolutely be a trigger. Or if your kids already have pans, already have immune dysregulation, then they can have a flare in their symptoms. With COVID infections, what's interesting is I don't see that with all of my pans kids. So I'm trying to figure out, well, what is the difference there, like which kids are the ones who are going to flare and which kids aren't. But just, you know, being really attuned to that because for some parents, they don't necessarily recognize that maybe some of the mood changes that are lasting a little bit longer, you know, after the other symptoms go away, like the physical symptoms go away or just maybe a little slower thinking and they're forgetting some of their math concepts that they were so on top of. Right. That that could be Covid related.

Yeah, absolutely. That's super helpful insights. I think parents, you know, certainly with kids with long Covid, the kids themselves, but the parents for sure just need these little sprinkles of hope because the reality is, is that there's not a lot. And, you know, even the conventional long Covid centers don't have this mindset of how to fully recover. And it can be really devastating. So thank you for sharing that. Thank you for writing this fantastic book. Everyone, go get this. If you have kids, you definitely need this book. I mean, there's so many resources.

Yeah, grandkids. I have a lot of grandparents that are like, are loving, kind of redoing their pantry for their kids and thinking about, you know, what treats they want to give them that are actually nourishing their kids, their grandkids too.

That's fantastic. So thank you for this, thank you for your work and thank you for being here today to share all of this with our community and let me know where they can find you.

Yeah, well, thanks for having me on. I love chatting with you. And as we were saying before we started, it's been way too long. So I hope to see you in person soon.

Yes. And so where can they find you?

Yeah, you can find me at, on my website, healthykidshappykids.com and also I'm most active on Instagram and that's healthykidshappykids.

Great. All right, thank you, Dr. Song. Thank you so much everyone. And we'll see you next week. That was such a great conversation with my dear friend, Dr. Elisa Song. I think I want you to take away from this is our kids are under stress or so now than it may have passed when we were children, but there are always stressors. And so one of the things that I love about this book and Dr. Song's perspective is that we're taught tools to help our kids and our clients and our clients kids. Our clients who are kids and teens have for resilience. Nourishment tools, movement tools, mindfulness tools, nervous system regulation tools. So pick one of those tools, get better at it yourself, practice it more yourself and then see if you can teach it to one more resilience we can bring in into this community. Clients, our patients. Our clients and patients. Children. Children we're raising children we're around teaching them the skill set of health. Resilience, Nervous system resilience, nervous system regulation is probably one of the most important things we can do as a society. We can't eliminate improve. There's something for you this week. I can't wait to see you back here next week. Have a great week. Thank you so much for joining me today for this episode of the Integrative Women's Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or Follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let's innovate and integrate in the world of women's health.