#762: Dr. Elisa Song - How to Protect Your Kids from Chronic Illness

Today we are very honored to have Dr. Elisa Song on. She is amazing. If you guys do not follow her, please do so on Instagram. I heard her on a podcast a few months ago and reached out to her and thankfully my, my message made it through. Probably all the other messages in the DMs because I know a lot of them get lost. You probably thought the poop queen. Who is this weird chick?

Well, it definitely, definitely intrigued me. I'm like, I gotta look. I love poop.

So very, very excited to have you here. Thank you so much for joining us and we'll just let you introduce yourself to our listeners. And for those who don't know who you are, if you can share a little bit of your backstory, that would be great.

When you look good, you feel good.

Uh huh.

That's the only way I feel. You should coulda, woulda never did it for you gotta do it for the love do it for the culture Feel it in your soul Life like a roller coaster got its ups and its downs but you gotta keep going, keep going don't stop when you still got motion Stay dedicated daily devotion.

Yeah. Well, thanks for having me guys. I'm honored to be here with the poop queen and the hormone queen. So I am an integrated pediatrician, pediatric functional medicine expert. I started my integrated pediatric practice back in 2004. So I've been at this for a while. It was long before there were many integrative docs and there's still not enough, but, but I was really on my own for a lot of figuring it out, but so glad for this path. I actually went straight from my conventional training at UCSF into really knowing that I wanted to practice more of an integrative functional medicine approach. And so that's how I opened up my practice and it just expanded, exploded. I remember back in 2000, finishing up residency and talking with some of my attendings and my friends who were going off and doing all the things, all the conventional things and working at practices and they were listening to what my plans were and they nodded and they're like, yeah, okay, maybe there'll be some demand for that. We'll see. And back then I remember one of my attendings told me, yeah, you know what, if you see, see even just a handful of kids with autism in your career, that's gonna be a lot. I so remember that because when I opened up my practice, hung up my shingle and said I was open just through word of mouth, it spread like wildfire. And all of a sudden I was just flooded with parents of kids on the autism spectrum looking for help. I'm like, oh, my gosh. Wow. This is not just the rare thing that I was told. It was in residency and then from there seeing more and more severe eczema or kids who were getting sick all the time. An explosion in autoimmunity and mental health. And it's. I've been really blessed to be able to take care of kids from that root cause integrative perspective. And as the practice grew, I'm still a solo practitioner, and it just was really. It was time to bring this information more online out to parents who don't necessarily have an integrated pediatrician near them. So that's when I started Healthy Kids, Happy Kids, which was. I started back in 2016. And so that's been a labor of love, just educating, doing math master classes, doing podcasts like this, and which then propelled me into writing and publishing my book earlier this year. So that's been quite a journey. But I love it. I love that I can get this information out there.

I love it, too. And I would say in terms of just the book aspect, so for me, I'm the person that I want to be able to flip and highlight and write things down and make notes. I know that they obviously have it on audible and some other things, but just with what you share, I found it so valuable to be able to highlight and write and take notes for anybody who may be old school like me with that aspect. So. So talk to us a little bit about, I would say, some of the scary stats that are really plaguing our children today. I believe that one of the stats you shared that really has just stuck with me from Dr. Prout's show was the autoimmune in, I believe you said ages 12 through 19 is the number one population that we're identifying autoimmune conditions for. And my heart broke, to be honest with you. That's when I was diagnosed with my first autoimmune condition, which was children's ra. And it was honestly diagnosed off symptoms. All the tests were negative and stuff. They looked at a lot of other things too, as well as Lyme and blah, blah. But then in my 20s, I was diagnosed with Hashis. And so when you said that, I was like, oh my gosh, like, I was one of those stats years ago. So I'd love to hear for parents who think that this stuff is just their kid. They're alone. We talk to moms all the time who feel like they have no support and they don't even know who to talk to because their pediatricians are just like, come back in three months. We don't know.

Yeah, yeah, definitely not alone. This was. We actually don't really know the true actual numbers of kids with chronic disease. I remember this is now numbers from the CDC not too long ago, just a few years back, saying that a little under one in two kids now has at least one chronic disease. When you go back to 2017, 2016, back then those numbers actually were quoted as being higher. And I can't believe that the numbers actually went down. And what, what we see now is that at least, and I say at least because we don't. Again, we don't know the true numbers. One in five kids has a diagnosis of eczema. And this is not including the kids who have maybe the eczema patches here and there that don't actually get a quote, diagnosis, but their skin's just not that buttery soft, baby soft skin that they should have. One in 10 kids has asthma. One in 10 kids has ADHD, food allergies. I'm talking anaphylactic food allergies. Crazy on the rise. I didn't actually. I mean, I hardly remember writing a prescription for an EpiPen when I was in residency. And now it's 1 in 12 or 1 in 13 kids has life threatening anaphylactic food allergies. That's really alarming when we think about the mental health crisis. By the time kids are teenagers, our girls especially really are facing this emergency of anxiety and depression. And teenage girls now, one in three has seriously thought of suicide. And that to me, as a mom of a, of a teen right now I'm really, I don't want to hover too much, but I'm watching just to see what are the signs that I don't want to miss. You mentioned autoimmunity, and there was one study that looked at different age groups through the decades, starting from about the 1980s through the early 2000s. And what they found in each time period studied, every single age group had a rise in, in autoimmunity as measured by a very non specific autoimmune marker called an AN for the listeners. That stands for auto antinuclear antibody. It doesn't tell you what autoimmune disease you have, but it's a little canary in the coal mine, a little red flag saying, hey, there's something going on. Your immune system's not happy. The age group, as you said, that had the fastest rise in positive ana rates were our 12 to 19 year olds. They doubled from the 1980s to the early 90s and then again tripled into the early 2000s. And we have to remember if you with our immune system we can have, this is children and adults can have autoimmune antibodies for decades before any autoimmune illness actually becomes clinically apparent. You could have diabetes markers or you could have arthritis markers, but nobody's checking conventionally. Nobody's really routinely checking. I check now in a and a, in my tweens and teens because I want to know and if it's positive, even though that can be a little bit nerve wracking as a parent and as a kid, a lot of kids don't necessarily understand what that means. But for a parent, you're like, oh my gosh, my kid is tipping over into autoimmunity. I let parents and kids know this is a great opportunity because there's no autoimmune disease yet that's been diagnosed. So this is a great opportunity then to look under the hood and see what's going on in your body, your immune system, your gut, your brain that we can now optimize to so that we can prevent these autoimmune illnesses from happening.

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So it is, it's time to do something. It's about time. It's been decades in the making and there's been all of these sort of intermittent alarm bells rung, but it really is time. We need to make sure that our kids can thrive.

Yeah, all of these things going on and what are you seeing as major contributions? We think the vaccine schedule has exploded to so many different things that we're putting into our children's bodies at such a young age. Our food industry is not helping the social media stress on children. All of the things that we experience, the gut microbiome and not having as many children maybe breastfed. What do you see as maybe the big, I don't know if you can even do like top three, top five drivers of all of these Things that are just getting out of control.

Yeah, I do think, and if for your listeners are familiar with functional medicine and that Hippocrates is credited with saying that all disease starts in the gut, when we think about children especially, they're developing immune systems and they're developing brains and their hormones and metabolic system systems that really does start in their gut microbiome. So I think we can really think about all roads do lead back to the microbiome. There's a very highly regarded pediatric gastroenterologist, Dr. Alessio Fasano in Boston, and he's done really the landmark research behind celiac disease, gluten intolerance and children, and has brought that to the awareness. And he's credited with saying the gut is not like Las Vegas. What happens in the gut does not stay in the gut because the gut microbiome has these far reaching connections to virtually every single organ system in our body and our brain. And so when we think about, well, what are the factors then in our modern world that can disrupt the gut microbiome? There are many. The way that kids are born, C sections, antibiotics. I would say the overuse and inappropriate use of antibiotics is really one of the number one factors in gut microbiome disruption at all ages. And for a lot of moms going into pregnancy, they don't even realize how disruptive their gut microbiomes are. And so even if you have a vaginal birth and you're breastfeeding and doing all the quote, right things, if we're not supporting her microbiome and her gut and her vaginal microbiomes, then we're not starting off your baby's microbiome necessarily on the best footing. And it's not just the moms. The dads have a role here too, because there's even research now that the paternal microbiome before conception actually can affect pregnancy outcomes, birth outcomes and even later life outcomes. So it's this fascinating sort of imprinting that occurs. Antibiotics and medication overuse. Because there are many medications besides antibiotics that disrupt the gut microbiome. I would say the number two is psychological stress. Psychological stress is really our most important chronic microbiome disruptor. And chronic psychological stress has been shown to disrupt the small intestinal lining, trigger leaky gut, increase zonulin levels within one hour. And that's just insidious. Many of us don't even realize how on a day to day basis we're just living in this heightened stress response. And number three, I would say it's the environmental toxins Right. And that includes the food we're eating. So it's interesting, many of these environmental and food toxins, when we look at them at the heart, they are microbiome disruptors. There's this one fascinating article that I was reading on endocrine disruptors and forever chemicals, and this paper really goes into how all of them are known microbiome disruptors. And it's probably that as the main reason that there's disruption to the gut hormone, gut liver access, that wreaks havoc on boys and girls, developing sex hormones. And then later on, as adults, men and women, we have all of these issues.

Would you agree that our food, in terms of this is where I think about, from a gut health perspective, we lack so much diversity. Right? Because many years ago, ancestors were growing their own foods, they were eating all these beautiful colors, eating off the land. Right. And now we see that everything is basically pale and boxed, and we really do. And I talk about this a lot just in terms of the best thing to do for your gut microbiome is eat a diverse diet that's rich in antioxidants and animal proteins and things like that. Would you agree with that? And what would you say to the person out there who's, I'm pregnant right now and what should I be doing? Cause I didn't do any preparation work because I know there's a large population that don't realize, and we've discussed this on our podcast, but we pass down two generations, our microbiome to our babies. And so seeding that microbiome, and dads too, like you said, is really important. But most importantly, I feel really passionate about this currently in my third trimester. But even for some of my followers that have said things to me, you gotta get diversity in and give that baby the good nourishment and don't sit there and eat your Twinkies and Ho Hos, because that's the only thing that sounds good.

Yeah. Yeah. Diversity is so important. And when we think about it, first I'll step back and say, you know, if you're a mom listening and you didn't know, like we were talking offline, there's things that I didn't know when I was pregnant with Kenzie that I knew when I was pregnant with Bode and I wish I had done with Kenzie. And there are things that I know now that I didn't know when I was pregnant with either of them. And I'm like, oh, my gosh, why did. And I know that you can't Go back in time and change that. We can only move forward. And even if your kids are already born and you're thinking of all the things that may have disrupted their microbiomes and they have this or that health concern, that's why we do what we do, you guys and I, right? We do this work because we can optimize gut microbiomes. We can shift health back towards an optimal, resilient health pattern. And it's just the knowing, because a lot of people don't know to look at the gut. I have kids who come in with eczema or teenagers with anxiety or adhd, and their poops look perfect. And I want to do a poop test. And the parents are like. And the kids are like, what? My poops is fine. I don't have any gut issues. I'm like, yeah, this is why. So this is the knowing. But for a mom who's pregnant right now, and let's say you didn't know or have the opportunity to do the preconception work and really clean up your gut microbiome, what I would say right now is think about food. And I can't remember who said this, but I love it. That food is information, right? Food really is a way to inform form our body, our brain, our immune system, our. Even our genes how to work. And we want that information to be positive information so that they all work for us now. Every single different color of the rainbow, every single different, different kinds of whole grains and nuts and seeds and animal proteins and those fruits and vegetables, all of that has different information that feeds our microbiome and feeds our brain and really gives us a unique pattern that our body can then follow. And when we think about the world's ecosystem, as you said, with poor farming and agricultural practices, we are now down to a point where the entire world is losing its ecological biodiversity and that is destroying the Earth. We can see that it is actually harming our Earth's ecosystem and harming the ability of the Earth to sustain us. And when we think about it, our gut microbiome is an entire ecosystem inside us. It's one of our biggest and most important ecosystems. And it's not just the bugs. The bugs are part of it. That's a microbiota, but it's a whole ecosystem and their genes, that kind of neighborhood and that garden that's growing inside us. And as that loses diversity and as the foods that we eat lose the diversity to nourish a diverse population, and our gut microbiome can no longer do the job that they, it needs to do to help us. And so we really want to think about it that way. So I would say for a mom who's pregnant right now, just really try to have as much diversity as possible. And color counts. If you like your, if you like cauliflower, okay, then at the farmer's market, if they have some purple cauliflower, pick that up. That's a different phytonutrient, has different properties and different benefits. Or if you are, if your kids are really into nut butters, mix it up. It's not just the cashew butter, but try some macadamia nut butter and pumpkin seed butter. Each of those is going to have some different benefits. So the more we can do that and besides the fact too when we're pregnant, it's really interesting they found that babies all, everything that you eat, part of that, the broken down parts are going to get through the placenta.

Right.

And through the umbilical cord. And they found that babies make different swallowing motions on ultrasounds depending on what moms are eating. And it is true, I mean that the, what moms eat during pregnancy and even while they're nursing can influence what your baby wants to eat. So if you want, if you're fast forwarding when your kid's a toddler and you're like, I really want them to be varied eaters and adventurous eaters, well, do that when you're pregnant and do that when you're nursing.

Outside of diet diversity, what other actionable steps. I know in your book you talk about a few what other actionable steps do you recommend for people, people to try to keep a healthy, flourishing gut microbiome kind of environment and garden.

Yeah, yeah. So I would say the thing that is not that a lot of people don't think of necessarily incorporating too much into their diet is fermented foods. So one of the things fermented foods are so great during pregnancy and even once your baby starts solids, you could a little kraut juice and you're just having a little. Fermented foods incorporated in one study out of Stanford found that fermented foods actually increased microbiome diversity even better than fiber. Now fiber had tons of benefits that improved the function of the microbiome. But if we want to increase the diversity. Now the other thing as moms, pregnant moms, often if you have a little toddler in tow or you're working or just life gets busy and it's not necessarily going to be easy to home cook everything and I don't Home cook everything from scratch. I wouldn't be honest if I didn't say I don't love some of my Trader Joe's and my Whole Foods go tos, right. That make life really easy. However, when we're buying packaged foods and it is so important to be very savvy label readers and teach that to our kids. So there's a whole section in the book that talk about how to be a gut hero Food label Detective. Because there are all the things that we look for. We can look for organic, we can look for maybe high fiber, high protein, gluten free, whatever else we're looking for. But when we turn the package over, there's a couple of things I'm particularly wary of. Food emulsifiers. So emulsifiers are gonna be found in things like your protein bars, your favorite protein bar, or sauces like barbecue sauces or salad dressings, ice creams that you might be craving in the middle of the night. And it's not gonna say emulsifier on the label. What it will say are things like xanthan gum, carrageenan mono and diglycerides. So I look for those because those have been found to be correlated in certain countries. The more the use of food emulsifier, the higher the rates of autoimmunity. Now it's just correlation. But these emulsif have been found to disrupt the gut microbiome, cause gut dysbiosis and also increase the likelihood of leaky gut. We want to make sure we keep those out. And I would say the sugars can creep in. And that's where really as a woman we don't want to have more than about 25 grams of added sugar in a day. So just being aware that most adults even doing their best and thinking that they're having quote, low sugar are actually not because sugar is just going to be hiding inside so many different foods like the multigrain seeded toast that you're eating for breakfast or that vanilla Greek yogurt that you're having in the morning. So that's from a food perspective there may, there is a role for supplementation. And I think during pregnancy, ideally you would have your blood levels measured. And it's not necessarily going to be conventional to have all of these tested. But while you're getting your prenatal labs done, I definitely recommend now I think most obs are checking a 25 hydroxy vitamin D, but some aren't. So making sure you check your vitamin D levels and when your OB calls you and says oh, your Vitamin D level is normal. Don't just take that at face value, just ask, hey, can I know what the exact value is? Can I see my paperwork? Because we know in functional medicine, normal is not always optimal.

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And optimal vitamin D levels during pregnancy in the mom can definitely influence for the better your baby's brain development, your baby's immune development, your even your baby's hormone development later on in life. And so optimizing what's an optimal level if you go to quest the normal range for vitamin D is probably going to be listed as anywhere from about 20 to 100, which is a pretty wide range when you're pregnant. I want I for my moms in my practice, I would love for them to be at least 60 or 80 to 100. I'm just way on the upper end because there's so many benefits to your developing baby in utero. And once they're born, magnesium and zinc are also an iron are very important for fetal development and so making sure that those are also in the optimal range. Asking to check a ferritin, a red blood cell zinc, a red blood cell magnesium and then even if you're already pregnant, I think this is the perfect time to take a look at your microbiome and see was there anything that needs to be adjusted so you can do a vaginal swab to make sure your vaginal microbiome is healthy in preparation for a vaginal birth and the baby's gonna get exposed to all of your vaginal flora. And then also a gut microbiome test to make sure your gut microbiome is in order because that sets a stage for the baby's first exposure in life if they're vaginally birthed, and to have the best start in life. And so there may be some probiotics that I recommend. If there's any element of gut irritation or leakiness we don't do. I don't recommend any detox protocols while you're pregnant or nursing because any toxins that we have stored in us will get excreted through the placenta and through your breast milk. This is not the time to do detox. If you're preconception, great, do the detox then and then get pregnant. But right now it's just more about optimizing.

I'm just curious. I met with Tiny Health last week. I don't know if you've heard about them, and I was. Normally we use a few different. Different tests either from Vibrance or GI Mapper, whatever. But any thoughts there? Have you used them or what is your preferred microbiome test?

Okay, so full disclosure, I am the chief medical officer of Tiny Health and I actually help them. So I actually help them develop the protest. Okay, so a couple of things with. And the reason why now, because up until recently, we didn't have many options and we had to. We have some great tests out there, right? A lot of people use the GI effects from Genova or GI Map from Diagnostic Solutions or Doctors Data Comprehensive Stool Analysis. And I've used those for decades now. So they're great tests. The difference is that those tests still rely on qpcr. So they're amplifying certain sequences of your microbiota, your microorganisms, to find them. And as we all remember from. Maybe we all don't. It's like a blip in time. Right. But we never want to repeat that. But we are all now familiar with what a PCR test is right from our pandemic days. And we all remember the time when the question was, how many times was it amplified? Are we looking for a tiny little amount of something that then gets amplified and becomes this bigger deal? When really in the context of your overall microbiota, it's really such a small amount that it's not that clinically relevant? And what Tiny Health uses and a couple of other tests use is shotgun metagenomics, which is a way to sequence the. Basically the genetic material from every single microorganism that we have sequenced to date and get the relative proportions of exactly how much is there. Now. The reason why I love Tiny Health, because as a pediatrician, they're the only company right now that has age specific ranges. And that is very important. When you are looking at your newborn's microbiome, their microbiome looks very different at 1 month of age than it even does at 6 to 12 months of age or 4 years of age or in your tween and teen years. And we're going to find. And they're invested in the research, right? They're so invested in growing these clinical databases of norms so that we know, like, we know that girls and boys, once they start going through puberty, their microbiomes start to look very different, right? And the sex hormones play a big role in that. We need to know what is a normal boy's microbiome during puberty, What's a normal girl's microbiome during puberty? Same thing. Premenopause and postmenopause as women, our microbiomes start to look different. If you're a 54 year old post menopausal woman, you know, if we're trying to get your microbiome back to where it was when you were in your 20s, maybe that's actually not appropriate. So Tiny Health is discovering all that. And with kids in particular, one thing that a lot of people are really fascinated to learn is that as an adult or as an older kid and teen and tween, we want a lot of microbiome diversity. We want a lot of different microorganisms, a lot of different kinds of microorganisms, a lot of different species and strains. Now for babies, we don't want a lot of diversity at all. So a baby in the early, from 0 to 12 months of age actually very appropriate to have 80 to 100% of their microbiome be completely bifidobacteria species. Right. For an adult, that's somewhere on the order of we don't want more than about maybe 8 to 10%. And so it's really important. So up until now, really up until a couple years ago when Tiny Health came out, I was looking at microbial analysis that was more relevant for older kids and adults and trying to shift things based on that. But now we have more data, so I think it's fascinating. Tenny also has a vaginal swab test as well, so that you can optimize that, because there are different strains of probiotics that can help optimize a woman's vaginal floor, too.

Yeah, it was fascinating. I really resonate with them. The mom and I have similar backstories. I had an emergency C section with my first. It was a wild situation. My doctor actually told me last week. We've not had that situation in our practice since Marcus five years ago. I had something called HELP syndrome, as well as intrauterine growth restrictions. Anyways, sharing with her, I am doing a planned C section. After much back and forth, just a lot of kind of trauma from that birth. And so we were talking about the C section that the mom went through and why she developed Tiny Health and baby's microbiome testing that I'll be doing and the. The postpartum days with him. So I'm really excited. I didn't know that at all that you. I didn't bring that up for any reason other than just ask your thoughts on it. But you did say something. And I'm. I've been doing a pediatric course through the SIBO doctor, too. I'm curious, what are your thoughts then, on all these probiotics? I've always shied away, even with my son, unless there was a reason. Because you mentioned we don't want a lot of the diversity there. Right. You want a lot of that bifidobacterium. So if you're using a probiotic, obviously based upon the testing from Tiny Health, it'll be very specific. But for people just in general.

Right.

We ask. I'm sure you get asked about probiotics all the time. I do. Which one do you recommend? And we have to look at the strain. Strain specific. What are your thoughts there?

Yeah, I love that question. And when people have asked me, what over the past decades as an integrated pediatrician, what has changed the most in the way I practice? And I would say one of the biggest differences is that I used to say that I thought all people would benefit from a daily probiotic, and that's actually no longer true because there have been cases, and I see it on testing, where you're taking probiotics and a lot of them, and in our culture, it's always this idea that more is better. So you're throwing in trillions of colonies, and you can have a situation where you're crowding out your native microbiota with the probiotics that you're taking. And here's the thing. As we move forward in microbiome science, we're just at the tip of the iceberg. I just. I can't wait for this day where we're going to really be able to identify, based on, like, your genetics, your ethnic background, the kinds of foods you eat, what is the best microbiome for you, because your microbiome that's optimal for you is likely going to be very different than microbiome microbiome with my Korean heritage. Right. And that's okay. It's okay to be different. We want to know that. We want to know what makes us unique. And it doesn't make sense then, with the trillions of different microorganisms in our gut, that there would be any probiotic, even with 16 different strains, that would be adequate and should, that should be taken on a daily basis. So I do take it situation by situation. I. I really emphasize the importance of using that food as medicine. Getting in your whole gut, rainbow, thinking about all the ways that we can create microbiome magic every single day, whether it's with the foods we're eating or the lifestyle that we're living, and then using, as you said, probiotics that have more targeted strains, depending on what we're trying to treat. Like right now, as we speak, it's the middle of winter and there's colds and flu starting. And there have been two probiotic strains that have been identified as, when given to kids during the months of winter to reduce the incidences of fevers, respiratory infections, missed days of school. That's awesome. But these are two specific strains, and so you can find them in certain probiotics, but you need to look for those strains. And those are the strains that I have in my immune probiotic, but it's meant for immune system support. We also have other strains that we know are really good for recovering the microbiome after, let's say, antibiotics or after some big insult like Halloween candy, whatever it is, right. Whatever quote hits your microbiome is taken. There are probiotic strains that have been found to help restore the microbiome. And so then we might use those. And then there's a whole other class of probiotics called psychobiotics, which I don't necessarily like that term, but it's a term to mean that they actually help from a psychiatric standpoint, because these are probiotic strains that have been demonstrated to improve and optimize the levels of neurotransmitters like serotonin or dopamine or gaba and or to reduce our cortisol stress response. So if you have a really anxious teen, or let's say you're going, like, after your baby's born, you're feeling a lot of anxiety then it would be perfectly great to start a probiotic that has these psychobiotics in there. Right. And sometimes medications are necessary but this would be. Why not try the strains that have been shown to help with the cortisol stress response. Lots of different potentials there but it is really. You want to look, be more guided, be more targeted. It's just I don't necessarily think people should take. That's not true. I do think most people should take vitamin D every day because most people aren't, aren't sufficient. That's one area and probably an omega 3 because most people don't get enough fish and seafood in their diet. Those are things that. Yeah, unless you are really living that Mediterranean diet life, you probably need a little more omegas in your diet as a supplement.

We just got the Metagenix kids dha little soft gels. They taste like bubble gum. My son loves them like nice because it's. I didn't want to do like more gummies with some of the synthetic things. So you mentioned vitamins, vitamin D there and then I'm sure Becca has some questions too. But having my son Ethan now around Christmas time soon, I've been looking at different kind of like vitamin D creams or like baby drops. Do you go as low as zero to six months here where you're talking about? Yeah, if you're in the Midwest we'll get outside, we will get cold exposure. It's good for babies too. My sister, I have shared this before but in Copenhagen, Denmark, my nieces and nephews, they were on the porch, they were getting all the good exposure to the weather. But do you recommend that for that infant category? And if you do do. I'm seeing different creams out there and then I'm seeing obviously like the drop form that would be added to like your breast milk or something like that.

Yeah. I haven't had a lot of experience and also great outcomes with the transdermals with the creams. So I tend to not use the topicals even with things like low dose naltrexone. For my kids with autoimmunity, I still use the oral form so I would use the drops. Now the recommendation from the American Academy of Pediatrics is to have all breastfed babies get vitamin D supplementation. And so why is that? Why not formula fed babies? It's because formula is fortified with vitamin D and a lot of women who are nursing are deficient in vitamin D. So really if moms are sufficient in optimizing their Vitamin D levels, there probably isn't a need to supplement, right? But again most, I would say the general population, not those of you guys listening here, but the general population probably is not aware of what their vitamin D level is. And so that's where the recommendation came from. So in general for babies I would do, you could do the four. The baby drops tend to come in 400 IUs. Metagenics has a 400 IU one Carlson's Nordic Naturals. So 400 IUs daily and you could do that with your formula fed baby too. But it is going to be more important if you are a nursing mom and you're not quite sure if your vitamin D levels are optimized, then we want to have the baby get some extra vitamin D. Now what's fascinating is that the recommendations for vitamin D levels stop at a thousand IUs daily. That's considered 2000 is considered a lot. And really when we think about what most people, kids and adults need to optimize their vitamin D levels in general, once vitamin D levels are optimized, I go with about a maintenance dose of about a thousand IUs per 25 pounds of body weight until we get to about 100 pounds pounds, let's say a 50 year, 50 pound 8 year old, I'm going to be giving her 2000 IUs of vitamin D daily or a teenager who is 150 pounds they're going to get 5000 IUs of vitamin D and I will pair that with K2. But I've never as I've checked lab work, never seen any kiddo with those guidelines become vitamin D toxic. And that is, that is one of the. On the flip side I've seen kids who need way more than that to actually get to optimal levels. And that's where testing can be really help. Even if your kids, even if it's the middle of the summer, your kids are out every single day swimming and running around and you're getting this golden tan, you're like oh, they're getting tons of vitamin D through the sun. Even then when I check kids levels, virtually all of them need a little extra supplementation.

Interesting. And we know genetically not everyone converts vitamin D from the sun very well. Not everyone has the CO factors to help with vitamin D absorption and utilization. And so, so that does make sense in terms of conventional versus holistic or functional route. When do you do what? And I know that's probably a really broad question but I think one of the big things obviously that we see and we've talked about is so many parents, as soon as their kid gets sick, it's, I'm taking them to the doctor. Can I get an antibiotic? Can I get. They, they have this cough that won't go away, right? Fevers and wanting to always get fevers down and, and when that can become a problem. So I think maybe we can keep it to like those few examples of like antibiotics necessity, timeframe, when and what to do with fevers. I know on your website you have some options for getting fevers down. And fevers are a natural way the body heals itself, right? We don't always want to force a fever down. You want your kid to be comfortable and not be miserable. But would love your thoughts on when you use what and what overused the most. Maybe antibiotics, probably.

When we think about we can start with fevers because that's often the start of the viral infection that kind of lands you into wanting to go to the doctor's office or urgent care. And as you said, fever is our body's natural and healthy inflammatory response to fighting the virus, to clearing it out. And in the process of creating inflammation to clear out the virus, sometimes you'll get a fever, sometimes you get chills, sometimes all these symptoms occur. You get the runny nose or the sore throat, and those are the symptoms of your body trying to do its thing, trying to push this thing out. And fever reducers like Tylenol and Motrin. So acetaminophen and ibuprofen have been found to. When we artificially suppress the fever, think about the fact that you're now not allowing your child's body or your body to do what it's really trying to do. And so fever reducers have been found to prolong the duration of illness of symptoms. And one study even found that it could increase the viral shedding from your nose. And so you're sicker for longer. And by the way, you're potentially more contagious. So we have to be mindful of that. The other thing that we have to be mindful of is that acetaminophen can put a stress on the liver and deplete a very important antioxidant. In fact, our master antioxidant called glutathione. Now, glutathione is essential for rapid recovery from infections. We want to make sure that we're not depleting our glutathione. If you do use Tylenol, then I recommend Epsom salt baths to improve, increase your glutathione levels and you can even give a little extra glutathione supplement. Ibuprofen, on the other hand, has been found to disrupt the gut microbiome as much as antibiotics. And so we have to think about that too, because I used to say this is another shift. I used to say, you know what? If you're going to give anything for the fever, give the ibuprofen instead of the Tylenol because the Tylenol depletes the glutathione. When I read that ibuprofen can disrupt the microbiome, I'm like, then we just have to go into both mindfully, right? Whatever you choose, I probably still go for the ibuprofen. Because ibuprofen, if you're doing it for symptom relief, and I'm saying relief, it doesn't. You don't have to get the fever down to normal. You do not want your kids feeling so great after the ibuprofen that they're running around jumping on the trampoline, right? They are supposed to be couch potatoes, right? But enough so that they can sleep comfortably enough that they can drink and stay hydrated, then fine. That is when I might use it. Although there's so many natural tools. In part four of my book, I go through the top 25 conditions in kids. Fever, colds and flus, coughs, sore throats, eczema, sleep problems, anxiety, and my integrative functional medicine approach. And so you'll learn, if you were to call at 2 in the morning, my kid has a fever, what do I do? Cause kids always get sick in the middle of the night, right? So you can flip to the back and see exactly what I would recommend. What homeopathic medicines, what acupressure points are there, essential oils to use, any supplements, and also some guidelines on when to call the doctor. Because as a parent, that's our biggest thing. It's okay, we wanna try all these natural things, But I also wanna know, okay, when is this really getting serious? Now, that's with fever. Now, antibiotics, antibiotics are such an important issue that I wrote a whole chapter on, it's literally an entire chapter called what Every Parent and Practitioner Should Know About Antibiotics. And there's a couple of different levels of concern here. We have our big public health level, where by 2050, the World Health Organization and different experts are predicting that antibiotic resistance is going to be a leading cause of death worldwide. Antibiotics were one of the most important public health discoveries of the 20th century. And now to go back to the Dark ages, where a simple Skin infection or an ear infection could become life threatening. We cannot go back to that. So we need to practice really good antibiotic stewardship. The other part is more individualized. This is more on a personal health level, where we know the antibiotics will instantly disrupt your microbiome. And they're not selective. They can kill all the good stuff right along with the bad stuff. And in fact, in fact, some antibiotics will preferentially kill the good microbiota and preserve some of the bad stuff, which is why we see C. Diff infections after antibiotics, because that's somehow been able to survive and develop antibiotic resistance. And so from that standpoint and understanding that each round of antibiotics may increase your risk for anxiety and depression, right? This is for kids and adults. Each round of antibiotics can tip your immune system over more easily, maybe into autoimmunity or for babies into eczema, asthma, allergies. That we want to make sure that if we're using antibiotics, we are using them when they're absolutely necessary and when they are used, that we know how to restore your microbiome so that we don't have any downstream effects. And this is also true even for kiddos who've had antibiotics maybe years in the past. You can still restore their microbiome. Right. And there's still steps that we can take. But in the immediate, if you have a kid who has, let's say, a strep throat and they're taking antibiotics, all right, I would say in that case, yeah, take the antibiotics, right? That is, in my. My boat, that would be a necessary course of antibiotics. But then we restore the microbiome. The key is knowing what's necessary. Right? And that's the hard part. As a parent, that's really hard. So I do give some guidelines on. There's six questions to ask on really trying to assess whether or not an antibiotic is necessary. And the number one question, I'll give you guys the number one question. The number one question to ask whether it's your pediatrician or your or the ER doc is to ask, hey, doc, is this antibiotic really necessary? Now, that might seem like an inane question, but it's very important because if you can imagine at some urgent cares or ears, they're seeing a patient every five minutes, and the fastest thing is just to write the prescription. And there are parents, not you guys listening, but there are parents who they go to the ER because their only goal is to walk out with a prescription, right? And so if you simply ask the question, it makes the doctor the Nurse practitioner or the prescribing practitioners. Pause and realize, okay, you're not one of those parents that just want to walk out the door with a script. Right. You want to be a little bit more judicious about it. Because some studies have shown that doctors are twice as likely to write a prescription for antibiotics even if they don't think it's necessary for, like, a viral infection, if they believe that the patient wants a prescription, prescription. So we have to put the brakes on that and just raise the awareness to the prescriber. Okay. That's not me. I will take them if they're necessary. But I want to know, is it really necessary?

Yeah. I've been fortunate. Thinking back, I've come across pediatricians, and I don't think my daughter's ever been on antibiotics. She's three. The only time she's ever really been really sick was rsv, which obviously is awful, but it's a viral infection. And then I've had other pediatricians that have told me, like, like, I could give you one, but I don't want to. And so there are good pediatricians out there, including.

Absolutely.

That really do. I think it is starting to become more and more known now how damaging they are long term. And so hopefully more and more people are questioning it, obviously. Go get your book. Everyone listening. I actually, I. I love that because I had moms on. Have you ever heard of the book Moms on Call? Okay. They have the moms on call. Zero to six months. Six to 12 months. And they do.

Oh, yeah. Yes, I have. Yeah.

Yeah. So I. But it's a little bit more conventionally based and for a more holistic based. I feel like you're the moms on call for holistic based moms.

And there's your next book idea, by the way.

That's right. That's right.

You can take it all the way from Tiny Health zero to mom's uncle. She gave that to me when I had Marcus and it was by the different age groups.

It's just helpful.

But yeah, I have yours and a few other now for the pediatrician because, yeah, my son, I try to get him as much as we can holistic. Cause again, when he was little, I didn't know better. And he had antibiotics for ear infections and then tubes that just moved the virus and all that stuff. So anyways, this has been so great. We could talk to you all day long, but 100%, go get her book. And it's worth every penny. Let our listeners know where they can find you. And our last question that we always wrap up the podcast is, if you had one thing to shout from the mountain top for everyone to hear, what would that be?

Wow. I would say the one thing that I would shout out is there's always hope, that there's always a way to move forward, no matter what's going on in your life. And I've seen lots of families and we've been in some really kind of dark places. And, you know, you just. You have to just keep moving forward because there is always hope. I love that.

I love that. So where can our listeners find you and connect with you?

Yeah.

So my website is HealthyKidsHappyKids.com and that's where you can sign up for my newsletter. I try to send, like, you guys, I'm a mom and we're all busy, right? So I don't like to send out fluff. I always think whenever I send something out, whether it's a newsletter or a social post, I always think, is this. Will I have spent five minutes of my time reading this and come out feeling like I learned something or gained something of value or had a good laugh.

Right?

It's gotta bring value, otherwise I'm not gonna share it. So that's healthykidshappykids.com and then my Instagram is healthykidshappykids. And my book you can actually find anywhere, pretty much anywhere books are sold, of course, Amazon, but I'm getting pictures. I actually just got a photo from one of my friends who was traveling to. Gosh. I wanna say she was traveling to Austria and found my book in the bookshelf there. But I'm fine. A lot of parents are saying, oh, it's in our local, like, a little bookstore. So, of course, I love supporting the indoor bookstores. But, yeah, Amazon, Barnes and Noble, Walmart, Target Online, you can find it there as well. I love it.

And congratulations to you as well.

After many years.

20 years in practice, you said, right? 2004.

Yes, yes. That this is my life's work and I know my husband's going to kill me if I write another book. We'll see. It may be in the cards, but not yet.

That is awesome. Again, thank you so much for your time today. We've enjoyed every minute of it and can't wait to share this with our listeners.

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