Ep. 360 Raising Resilient Kids: Insights from Holistic Pediatrician, Dr. Elisa Song

Welcome to Everyday Wellness Podcast. I'm your host, nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today I had the honor of connecting with my friend and integrative pediatrician and pediatric functional medicine expert, Dr. Elisa Song. She is a Stanford, NYU and UCSF trained integrative pediatrician and she's the author of the Healthy Kids Happy Kids book.

Today we dove into kids in crisis.

The role of the butterfly effect, especially as it pertains to teens and young adults, the importance of the gut microbiome, why antibiotics are not benign, and the resultant global public health crisis, when to use antibiotics judiciously, myths around antibiotics. We touched on things like pans and pandas, as well as rheumatic fever, how to address our children's gut microbiome after antibiotic therapy, the importance of the vagus nerve and heart rate variability, the impact of sugar, the importance of food labels, the role of glyphosate and other forever chemicals, and last but not least, addressing constipation in children.

This is an invaluable conversation.

I wish I had had this book when my children were younger. It'll be an invaluable book and resource for parents, grandparents and those that love children. Welcome my friends. So good to have you on the podcast. And as I've said before, I can't think of a better pediatrician, colleague and friend to have on to share with my community. It's such a pleasure to have you on today.

Oh, I'm so honored and excited I get to see you, even if virtually so. This is. I have so much gratitude for you.

Absolutely. And you know, I think over the past 20 plus years you and I have seen huge shifts in medicine and certainly you working with a predominantly pediatric population, what are the things that have really shifted for you in terms of how healthy your patients are? What are the trends that you've been experiencing because you do such a beautiful job in your book talking about how kids are in crisis and I It's a perfect way to kind of segue into this conversation today.

Yeah, well, so I started my integrated pediatric practice in 2004 and prior to that, I mean I was in med school in the late 90s and mid-90s and my pediatric residency at UCSF I finished in 2000. So that was a while ago. And I distinctly remember when I was in my developmental pediatric rotation at ucsf. I remember my attending telling me, you know, what we were observing and, you know, talking with a parent and child who had autism. And my attending said, you know, look, if you see a handful of kids with autism in your career, that's going to be a lot. This was in 1999, right? And there was no such thing as type 2 diabetes in the way it was called. It was called adult onset diabetes. We didn't see children with type 2 diabetes, and there wasn't this thing called metabolic syndrome. And sure, kids had eczema, but their eczema was treated with maybe 1%, 2% hydrocortisone. Maybe you had to go a little stronger on the steroid scale to try ampsinolone. But I remember being told, never, ever, ever put steroid creams in the diaper area and never, ever put anything stronger than like a 0.5 or a 1% on the face. And fast forward now with 1 in 5 kids with eczema, I mean, oh, my goodness, it's, you know, we're getting into stronger and stronger, not just steroids, but in some kids, these chemotherapy agents, these immunosuppressant agents, and we're just getting to the point where, you know, we're having to hit these things harder and harder. And so instead of saying, well, what's the next drug I can develop? We have to think, well, how did our kids get here in the first place? And is there something we can do so that if they're on medications, maybe they're not on them for life? Or if they're on medications, how do we mitigate some of the side effects of the medications? Or how do we prevent them from being on medications in the first place? And so that's where I'm at now. I am fortunate that my practice as an integrated pediatric practice, it goes both ways. I see, well, kids who parents are already committed to, to uncovering the root causes of why kids are so sick and inflamed today. So they tend to be more on the well side than, I think, most general practices. But then I see some of the sickest of the sick, which, you know, who have been searching for answers from, you know, their conventional specialists and just not. Their kids aren't getting better, they're not thriving. So it is time to wake up now.

Yeah. And I think on so many levels, and I've been very open on the podcast that my oldest son, Jack, who's now 18 at four months old, developed eczema. And I knew enough to know that it was beyond just a skin issue. And the traditionally trained allopathic pediatrician, who was a very good physician, you know, just kept prescribing steroids. And I kept asking, could it be something else? You know, he's exclusively breastfed. Is it something I'm eating? Could he have a food allergy? And it was always kind of like, oh, Cynthia, kids just don't have a lot of food allergies. Little did I know my son had anaphylactic reactions to peanuts and tree nuts and has not outgrown his allergies. And we've been able to navigate food choices and going to restaurants and. And eating out. But in many ways, I always credit Jack for opening up my eyes that there was more to health than kind of our traditional allopathic paradigm, which has its place. Let me be very clear. But I think for you, you have such a unique perspective because you've been in medicine for 25 plus years. What are some of the other things that you have been seeing with greater frequency? I know that it seems as if when I used to volunteer in the kids classrooms, I would say easily half the boys were on add, ADHD medications. It seemed like every kid had an inhaler because they had some type of bronchospastic propensity. And then even with the mental health crisis that we're seeing on so many levels, you as a clinician having kind of a bird's eye view into the shifts and changes that have occurred, I'm sure that it's probably incredibly troubling. Do you feel that a lot of the families that you're working with, that they understand that there are these contributory factors that impact their children's health, like the nutrition and the sleep and the stress management, do you feel like that has gotten easier to talk to them about, or do you still feel like there's bit of resistance?

You know, I will say it's perhaps not resistance so much as just the awareness and the firm belief in it. Because we all know sleep can affect you. What you eat can affect you. But if we realize how much. And the reason I wrote the book is because I really want to open up not just parents eyes, but also practitioners eyes, to how significant our choices are on our microbiomes, our children's microbiomes, and how that can have ripple effects to every other organ system in their body, like the skin or the brain or their hormones, their metabolic, you know, systems. And it is so important. And, you know, with these numbers, I mean, now the statistics from The CDC and they are old. These are, there are estimates that maybe around 40% or at least one in two kids has some sort of a chronic diagnosis. Now when we say chronic diagnosis, what does that mean? We know, you know, maybe one in three to five kids has eczema. You know, one in five kids, you know, will have ADHD. One in 10 kids will have asthma. As you said, as you noted, around 1 in 13 in some reports have autoimmunity. I mean arch. Many of your listeners have had brushes with autoimmunity or continue to. And there is a very non specific autoimmune marker in your blood called an A, N A, an antinuclear antibody. And one of the most alarming studies that I found, there was a research group that looked at through the years ANA positivity rates by age group and the age group with the fastest rise in ANA positivity were our 12 to 18 year olds. These are our kids. From the 80s to the 90s they doubled in rates and now they've tripled in rates again. And so, you know, this is, to me it's a red flag. It's a huge canary in the coal mine saying look, you could have an ANA positive blood test. It doesn't mean you have any autoimmune condition just yet. So they're not going to be put into the 40% that has a chronic diagnosis. However, that is a huge red flag that if we don't interven then they may be headed towards any number of autoimmune illnesses. And what I tell parents, because it can be kind of frightening to see, oh my gosh, my kid has a positive ANA or they have X, Y and Z markers, you know, on their tests. And I tell them, look, this is actually a moment to celebrate because now we know before your kid has a diagnosis. Just like the incredible, you know, epidemic and rise in kids with pre diabetes, even athletes I'm seeing with you know, high insulin, high fasting blood sugars, they're heading towards diabetes. And I let them know, look, this is the best news that we can get because now we can kind of go back, figure out what led you to this place, figure out some of your triggers and then identify how can we move forward so that you don't develop diabetes, you don't develop autoimmunity, you don't develop X, Y and Z. And so I mean that is, there's so much nowadays, I think fear out there. You see all the social media posts about don't put this in your mouth, don't Put this on your skin. This is toxic. And yes, we need to know that, and we need to know what to do with that information. Right. Why I wrote the book because there's. I'm a mom. I don't want to just sit here living in fear and feeling like I have to keep my kids in, you know, lonely little bubble. I want to know how can we live in this modern world, understand the things that, that impact their health, minimize the, you know, the quote, toxins that we can. We're not going to be 100% zero exposure. These forever chemicals, sorry, are everywhere. So how do we then help our kids thrive in this modern world and have the knowledge to move forward when they're teenagers, college students, or young adults on their own or parents of their own?

Yeah. And I think that reframe is so important because I think, well, meaning people on social media or on podcasts end up scaring people, scaring parents. I mean, I have teenagers and I feel like prior to them being teens, it was a whole lot easier to navigate food choices, nutritional choices. Now, oftentimes, they're not always with my husband and I. And you have to kind of hope that all of the good lessons you have taught them that it's kind of sunk in, even if they're not admitting it to you at the time. So I think that reframe of helping people understand that we do live in a. A fairly toxic world, but that doesn't mean we can't continue to make good choices that ultimately will, you know, push us into a direction where we're going to be healthier than most others. And so you mentioned in the book, and I love the butterfly effect, and I'd love to kind of identify what this is and how people can understand that we're all interconnected. It's not like each one of us as a family is alone on an island, that we are connected to one another quite significantly and then, you know, kind of loop in the gut microbiome, which I know is a large focus of the book, and it's obviously something I love discussing on the podcast. But helping parents understand the choices that we're helping to make for them as they're growing and becoming young adults, has a large impact on, you know, how they will go on to live. Live healthy lives.

Yeah. So, you know, I will tell you one gap in our health and wellness. You know, literature outreach is our, our teenagers. Right. Our preteens and our teens and our young adults sort of as moms, we have this, you know, we're Reading all the books, you know, we're the parenting books, the wellness books. But then all of a sudden they hit this pre puberty, puberty stage and we're like, okay, now what? Right? Because it's not just about us anymore. It's really and truly about them, which, you know, we want to take that opportunity to empower them. And I will tell you this book. I had one mom whose son is. He's either a junior or senior this year, and he's an athlete, he's a football player. He read parts of the book with her and started making different choices. He started changing. You know what he chose? He still hung, you know, went out with his friends, hung out after football practice and games, but he chose differently. Instead of getting, you know, the mocha chip, whatever, frappuccino with the, you know, 52 grams of added sugar, he thought about it and maybe he did choose that sometimes, but at least he knew what he was choosing and how he could make different choices around that. And so that's what I want, you know, that. I mean, my high schoolers in the practice who are going off to college now, and they're asking me really astute questions, you know, when they're looking at a supplement. Like, you know, I have a kid who. I mean, gaming is. It's a thing, right? And so, you know, what's fascinating is the gaming supplement industry is exploding. These nootropics for these gamers, you know, how do you get your brain on? And so, I mean, thankfully, this kid who's 14, 15, asked me about the supplement he saw, obviously, you know, targeted marketing. And it's this neon green powdery, has sucralose, has acid sulfate, potassium, and yet the other ingredients, it has carnitine, it has phosphatidylcholine, it has CoQ10. I mean, it has a lot of the supplements that I would recommend for, you know, nootropic support, neurologic support for a kid. So I said, look, I'm all for reaching your goals. Let's take a look at these ingredients and understand what this acid sulfate, potassium and these sucraloses are artificial sweeteners due to your brain and to your microbiome, and let's see if we can find some other solutions. So I love that. And I think when you frame for kids, you know, little toddlers, all the way up to teenagers, even for adults, when you frame how our choices affect our microbiome and how important our microbiome is for our brains, immune systems, hormones, et cetera, even our Epigenetic potentials. It makes it a little easier. It's just like for moms, it's so much easier for us to make those choices when we know it's going to help our kids. If we know our choices are going to affect this whole ecosystem inside us that actually is helping to support us, it does frame it a little differently. I do think it helps. So you know, when we think about, you know, you mentioned the butterfly effect. There was a, I believe from MIT, Dr. Lorenz, a meteorologist who coined this butterfly effect. And I actually don't know if he coined it or if it just kind of came afterwards, but he made this comment, you know, he was doing all these statistical analyses about these tiny shifts that could happen in the atmosphere and the environment and you know, is credited with saying, you know, a comment something to the effect of, you know, if a butterfly flaps its wings in Austin, Texas, could that set off a tornado in Taiwan? And so the calculations showed, yeah, it actually could, right? This tiny little change, and that's the same thing with our microbiome. A tiny little shift, for worse or for better, can set in motion this ripple effect for positive lasting benefits on your hpa, your hypothalamic pituitary, adrenal stress response, your hormones as your developing through puberty and your thyroid, you're developing immune system. And really I think for us as parents, so importantly our children's developing brains in the toddler years and also in these preteen teen years because there's this explosion of change in our gut microbiota, the diversity and function, you know, composition that occurs in our toddler years that drives the changes in our toddlers brains, our babies brains. But you know, the same thing is happening in our preteen teenage brains. So we have that additional opportunity and so understanding that foundation and understanding and you know, a lot of people want to know the science, they want to know maybe they're on board, but partner isn't on board or their kids aren't. So I give a lot of the research on how the microbiome truly for children and teenagers whose brains and immune systems are continuing to develop, how that shift can occur again for better or for worse. And we get to choose, you know, we get to choose a lot of it and what direction we want to take.

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And I think it's so interesting because certainly when we train there was no discussion about the gut microbiome. And yet in the last five to 10 years there's been an explosion of research and focus on this. And it makes so much sense that things we put into our bodies have a huge net impact on the health of our gut microbiome. And fully understanding that it has far reaching implications, far more than I think the average person understands. And I think I would be remiss if we didn't discuss a very big topic which is antibiotics. You and I both know that sometimes they're used judiciously, sometimes they are not. I think think for many parents who, when you're in the stage where you can't leave your kids at home if they're sick and you're working and how stressful that can be. I know that colleagues of mine that were pediatricians would sometimes say they felt pressured to prescribe when it was probably something viral. But let's talk about how antibiotics impact the gut microbiome quite significantly.

So, you know, I this is such an important issue on so many levels, on a global public health level and also on that individual patient level and so important that there's actually an entire chapter. It's chapter 10 in my book. It's called what Every Parent and Practitioner Should Know About Antibiotics. Because on a global public health level, we are at the point where antibiotic resistance could become a leading cause of death by 2050. That's right around the corner. And that could be so frightening from, you know, really acknowledging that antibiotics are one of the greatest public health inventions of the 20th century. And now we're in the 21st century, where we may not have antibiotics that could treat a simple ear infection or, you know, a strep throat. I mean, that is. We should all be raising the alarm, not just practitioners and public health people, all of us. And then, as you said, you know, there in some studies, up to 70% of antibiotics prescribed for children are inappropriately prescribed. Prescribed for things like viral infections, or maybe they're a little broader spectrum, a little stronger than they need to be. And, you know, one thing that you said, that in some cases, it's not necessarily the pediatrician just kind of, you know, writing the prescriptions. Although I will say, straight out of residency, I was moonlighting in an urgent care, and I was seeing literally, like, one patient every, like, five minutes, eight minutes. It was crazy. I didn't have time to pee because every time I went to the bathroom or even get a sip of water, I'd see 10 more charts stack up. So I'm like, I just kind. Kind of plow through. And it's all you could do to just kind of get your head above water. And in that situation, if a kid comes in with an earach and you really want to talk to them about, you know, waiting and watching for 72 hours, and here are the signs. And, you know, if you have an integrated pediatrician, here are some options for using things like garlic oil that has as evidence, you know, to back it up. You don't have time. And so there's that. And then, you know, get this. In one study, they found that. That physicians are maybe up to twice as likely prescribe an antibiotic prescription if they think the patient wants one. And so simply by you, as a parent or a child, saying, you know, I want to discuss this. I'm not the one that. Who wants just to walk out with a script, because there are some parents like that, you know, I am the parent or the child who I want to know. I want to ask, are there options? What are the side effects? How do I mitigate the side effects? And then as an individual, when we understand the impact of antibiotics on our microbiome, it does make it easier to feel confident asking those questions, because, you know, just a couple of studies that I'm gonna pause and just say, as a mom, if you go back and think, oh, my gosh, this was my child, this happened, we can't undo the past. And I know there's plenty of mama guilt that will always be around, you know, no matter how old your kids are, it's gonna come back. But, you know, it's really important to just know this. We need to know the story of how your child or teenager or young adult, young adult child got to where they are. But. But one study that looked at over 800,000, or almost 800,000 children, and followed them from birth to about four years of age, found that antibiotics, or even antacid medications, two major microbiome disrupting medications given in the first six months of life, could significantly increase the risk, maybe even double the risk of virtually every single allergic disease, including eczema, asthma, hay fever, hives, and anaphylactic food allergies, which, when I was training in residency, I mean, hardly a patient who needed an EpiPen, and now there are shortages, right? And so, and then another set. And this even includes, unfortunately, you know, in utero exposure. So sometimes parents will say, well, they didn't have antibiotics. But, you know, you received antibiotics while you were pregnant for UTI or a sinus infection or just like with my son, Bode, you know, I was group B strep positive, so I received antibiotics around the delivery. So that does impact. And so we need to know that and educate OBGYNs, you know, and pediatricians and parents moving forward. Another study in Denmark, which is keeps amazing, these amazing databases for research, found that they looked at mother infant pairs and followed these children and found that antibiotics, even in utero, at any point in life, in this child's life, could increase the risk of virtually any mental health concern by up to 50% when they were older kids or teenagers. We know that by the time in the U.S. kids are 18, 1 in 2 is gonna have a mental health diagnosis. I mean, that's like every other kid in your kid's high school class, right? And the highest risk was when those antibiotics were received before six months of age, showing you the priming effect, you know, that foundational effect. But the higher the, the more rounds of antibiotics, the greater the risk as well. We see this in adult studies, too. It's in the literature. So like you said before, there is a time for medications. We are firmly grounded in our conventional medicine medicine training. We need that. And yet now, from an integrative functional medicine standpoint, we need to understand, look, antibiotics are there for a reason. Now we know all of these unintended consequences on their microbiomes. How do we get the benefits from the antibiotics and know how to mop up and restore the microbiome disruption that will occur not just after antibiotics, but after a whole host of other medications. So that is where, you know, we can really have an integrative approach and not throw the baby out with the bathwater. Now, on the other, you know, in part four of my book, I give. I use homeopathy essential oils. I have one right here to kind of perk me up, you know, acupressure points, herbal medicines. So that instead of the waiting and watching supportive care approach that we have in conventional pediatrics, which basically means there's not much you can do except to, you know, of course, hug and cuddle your kid, give them fluids, and just wait it out. There are so many natural remedies that can help your kids actually get better faster and. And potentially help you avoid the need for antibiotics or know that if antibiotics are needed, they really were needed.

Yeah, I think it's so helpful, first and foremost to acknowledge that we can't change the past. So as an example for listeners, I had two breech kids, I had two C sections. They give antibiotics before you deliver, even if you're not laboring for a long period of time. And so learning now that the antibiotics I received, which is kind of standard of care, y. You know, could potentially have impacted both of my kids before they were ever born. And then also understanding that there's a time and a place for antibiotic therapy, there's also adjunct of care that you do a beautiful job discussing in the book. Now, for the benefit of listeners who might be curious, what are some of the signs that an antibiotic is warranted? What are some of the most obvious things to you as a pediatrician that you're like, these are no brainers. These are clearly circumstances where antibiotics are indicated. As someone who had spent a lot of time working in cardiology, I think a lot about strep, But I'm sure there are other diagnoses that for you, there's no question that someone warrants an antibiotic to be used judiciously.

Yeah, that's such a great question. And I'll tell you two indications that are not necessarily an indication. Number one is the height of the fever, because some viruses and some kids just run hot, hot, hot. Right. I mean, my daughter, when she would get viral infections when she was younger, and even now, she'd be sitting there looking at me. I mean, chatting like she was fine, but her cheeks would be bright red and she'd have maybe a little runny nose, and I would take her temperature and be like, oh, my gosh, you're 104.5. Right. And so that, you know, we cannot tell by the height of the fever what, how sick your kids are because kids tend to run hot. And also whether it's viral or bacterial, there's just no way the other, you know, in terms of talking about strep. There is also no way that I can look in your throat, even if it's the most horrible red swollen tonsils with pus covering your tonsils. I cannot tell just by looking whether it's strep or mono sore throat or any number of other viral pharyngitis, you know, contributors. So that is not necessarily an indication. You have to ask for a culture. You have to ask for, you know, a strep test to confirm. Because I've had some patients who on the weekends will go to urgent care and, you know, call me, page me and say, you know, my, my kid was diagnosed with strep. And I'll say, how? And let's say, well, the doc said, oh, he can just tell by looking. There's no way. I'm sorry, guys. The most, like the most awful throats that I've seen have been viral, whether it's hand, foot and mouth, which is so sad, right? Or mono.

Right.

Or viruses. So you can't tell now. However, if it is strep, I do treat with antibiotics and for a variety of different reasons. You know, strep throat can actually go away on its own even without treatment. I mean, you don't need antibiotics necessarily. Now the reason we treat though is because, because from a cardiology standpoint, as Cynthia was, was alluding to, there is a very rare condition called rheumatic fever that is that can affect your heart and be permanent and life and well, lifelong is permanent, but be permanent and fairly devastating and so much more common in countries like Africa. We don't see it that much in the States anymore. However, we know that a 10 day course of antibiotics will prevent rheumatic fever from happening. Really important. It's, you know, it's also for me now it's so interesting how our immune systems changed because we're, we've gone from, you know, in the past. So when I was starting out in medical school, there were more cases of rheumatic fever as that serious complication from strep. But we also saw quite a bit of autoimmune kidney disease, something called post strep glomerulonephritis. And so that was, you know, we would see the elevated anti streptolysin O and the asl and then we need antibiotics and all the images, immune workup and the treatments. Now we're not even seeing post Strep kidney disease as an autoimmune phenomena. What we are seeing is pandas, which, you know, for some of you listeners, you may know it's either a sudden or sometimes it's a little bit more subacute onset after strep of ocd, tics, separation anxiety, food aversions, handwriting, fine motor decline, cognitive fog. Very frightening if you're going through this. That is now our autoimmune reaction that kids are having to strep. And it's pand, stands for pediatric Acute onset Neuropsychiatric disorders associated with strep. We know that any number of toxins and other infections can cause this too, in which case it's called pans, Pediatric Acute onset neuropsychiatric syndromes. So whether it's PANDAS or pans, you know, if it's strep, I don't. I've seen too many kids with pandas. I do not want that on any kid. If we can prevent it, and we can prevent it by immediately jumping on that with antibiotics. Now, other than that, you know, an ear infection is not necessarily an indication for an antibiotic. There are clinical clues, though. So if your child has a fever for more than about four or five days, I want to know about it because it could still be viral. I've had some viruses last have seven days of fever, but it's a sign that, you know, most viruses, the fever resolves after about four or five days. If your child has a cold or some viral infection and they're getting better, better, better, fever is resolved and. And then boom, another fever hits. Okay, that's a sign that maybe bacteria has come and it's a super infection. I mean, it's not nothing great about it, but it means that this bacteria has taken the opportunity to infect. And so that's a typical story for pneumonia, where kids are. Have a cough and a cold and it's a virus, a flu virus. And, you know, they have a fever for five days, they're getting better, and then all of a sudden on day seven, they start coughing again and a fever comes back. That definitely makes me think, think this could be bacterial. So. And I give a whole host of other indications to really think about and know when an antibiotic really might be appropriate. Because, you know, as we, as we've said, there is absolutely a time and a place.

Yeah. And it's so interesting because obviously the advent of antibiotics had a profound impact on health and longevity. And there's no judgment when I say this, but I think over gosh, the last 25 years, I've just seen more and more and more antibiotic resistant organisms. You know, a lot of my clinical experience was working in hospitals and we had, you know, mrsa, vre. We had a whole constellation of drug resistant organisms. And patients would have to be in isolation, you would have to call in, you know, multiple consults with infectious disease to try to find this obscure, very expensive antibiotic that could treat their infections. So those concerns are warranted. But it's very helpful that you were able to kind of identify key things that can clue parents into. Like, this may now be a time when they need to see the pediatrician. I need to touch base with the pediatrician. So let's say that someone appropriately is prescribed antibiotic therapy. What are some of the things that you work into your treatment protocols with your patients that are helpful for restoring that gut microbiome? Because I think everyone's probably listening to, like, how many times has my kid been prescribed antibiotics? What are the things I need to do proactively? So what are some of the things that we need to be thinking about as parents?

Well, and, you know, I also want to just, you know, just as we can't really, we can't go back in time, I really want everyone to understand, you know, from an integrated pediatric standpoint, even for my own children, you know, when Kenzie was two to three weeks of age, she did get antibiotics for a urinary tract infection. We don't mess with infections. When babies are under one month of age, even up to maybe under three months of age, there's not a lot of wiggle room. I mean, infections can get serious pretty quickly. And my son at, you know, between four and five weeks of age, there was strep going around this family wedding that we had been to, and of course he didn't get strep throat. It's interesting. Little kids don't tend to get strep throat. They get it elsewhere. But all of a sudden he had this. I mean, it's kind of gross, this green drainage from his ear. Like, what the heck is going on? At first I thought, oh, it's nothing. But then my sister's like, it's coming back. So we took him to urgent care. And I asked my friend who was working there, I'm like, can you just send a culture? Because I didn't want to be my own baby's pediatrician. Right. And it grew out group A strep. I was, I've never seen it before. I'm like, okay, my Kids are here to teach me, right? So both my kids had antibiotics, and so I did, at that point, fortunately, understand the impact of the gut microbiome and how this could influence their future health. But even if you didn't, even if you're listening now, and your kids have had, you know, four or five different antibiotics, or let's say, you know, they're on other medications currently, as a teenager that we know disrupt the gut microbiome sometimes, you know, in some studies as much as antibiotics, like. Well, of course, many teens are on, you know, doxycycline for their. For their acne. Right. A low dose. Low dose doesn't matter. It still disrupts the microbiome. They're on a birth control pill, which also disrupts the gut microbiome because they have horrible period cramps and they have a lot of anxiety. So they're on an SSRI like Lexapro, that also disrupts the gut microbiome. So we're all, you know, they're on these medications that may be absolutely needed and helping them in the moment. But over time, what we see, what I see in my teenagers who are on these meds, they stop working as well. And so the ssri, it stopped working. And now what? Right now we go on to the next medication and the birth control pill, which disrupts the microbiome and also depletes your B vitamins, can be contributing to the worsening anxiety and, of course, the antibiotic. And so we just. This is. It's about telling your child's story. It's about kind of unraveling the pieces to see, oh, wow, I didn't realize all of that could be impacting what's going on. But when we know, we can say, look, these medications, she's doing well on them, or, you know, he's doing well on them, or he's doing okay on them, but we're not going to take them off right now. How do we. We keep their microbiome resilient? Or if it's been in the past, how do we restore it? And we can do that at any stage. So even if it's been 10 years, you know, since their antibiotic, when you were pregnant or, you know, delivering, we can still. The longer it's been, it does get a little bit harder, you know, to shift things. It's just like adults, you know, if as adults, if they've been working with you on some of their dysbiosis issues, we know it can take a while. Or if you have Candida, oh, yay. It's gone for like two months and then it comes back, right? And so, you know, we just. But the younger you start and your kids are like this open book, right? We can absolutely. So the foundations, it's not just about throwing a hundred gazillion colonies of probiotics into your gut. That is actually one of the biggest changes, shifts that I have made over the past maybe, you know, five years in my thinking about probiotics and the research around restoring your microbiome. Because we often think, of course in America, more is better. And so we, we get these mega doses. And it's really not about the mega doses. In fact, sometimes mega doses might crowd out and prevent your native beneficial flora from coming back. And so, and it, you know, I tell kids, look, it is not like Jack's magic bean sucks. You can't just throw them on the ground, walk away and expect this amazing magic bean suck to grow. They need an ecosystem to call their home. They need a neighborhood that they want to set up, say, hey, I'd like to move in there and I want to bring all my good neighbors with me and stay. It's really about that. And so how do we do that? I mean, I talk about the five things for creating microbiome magic, but, you know, that is, you know, one of the things I'm going to say they're all important. The two most important things I think that, you know, we can teach our kids is how do we think about nourishing our microbiome to nourish ourselves. Right? And, you know, what kind of foods do we want to get in? One of the things that we want to be savvy about keeping mind in, out to the extent possible. And then the second thing is how do we on a daily basis engage our vagus nerve to regulate our, our nervous system? Because that foundation of the gut brain connection via the vagus nerve will set your kids up and set their microbiomes up for success, no matter what life throws their way.

I think it's so important because I'm sure many people listening have heard the nutrition piece. There's clearly some foods that will disrupt the health of our gut, gut, microbiome. There are others that will be beneficial. The vagus nerve may not be as familiarized with my community. And I'll just share the story that when I first met you five years ago, you were talking about heart math and you were talking about heart rate variability and you were talking about the vagus nerve, and it left a really indelible impression on me. So for the benefit of listeners who may perhaps not be as, as familiarized with the role of the vagus nerve and why that's so important, let's spend a couple minutes talking about this because this applies to adults as well. This is something that, you know, working in clinical cardiology, I can't tell you how many people had a dysregulated vagus nerve or they had a vagotomy. Sometimes the nerve is cut and the net impact on the body is quite significant and profound. But let's talk a little bit about the vagus nerve and heart rate variability because, because they're both very, very important to understand.

This is really and truly the microbiome and the vagus nerve are my two favorite topics to talk about because I feel, because they're so important and you know, the research, you know, as you said, on the microbiome has really been exploding in the last five years, even the research around the vagus nerve. And you know, many in your audience listening right now, you've probably heard of the vagus nerve because it's kind of having its day, right? But, but we have to understand it because it's not just about, you know, wearing the devices and the gimmicks that will, you know, improve your heart rate variability. Those can help. I wear one, you know, just to help support me. Because I mean, every day we have forces that are really impacting our vagus nerve's ability to kind of kick in. But it is about the work that we can do to engage our vagus nerve every day. So, you know, just to back up, we have, you know, a part of our nervous system, it's called the autonomic nervous system, that's involuntary. You know, it's our part that controls our. There's a sympathetic arm to our autonomic nervous system. So the sympathetic nervous system, as many know, it's responsible for our fight or flight. Pupils dilated, we get a little sweaty where our muscles contract, we start breathing more shallowly and we're getting ready for something, right? I mean, we've all heard of the proverbial saber tooth tiger. Only now in our modern world, kids and adults, we have a saber toothed tiger attacking us almost every moment of the day. We're late for school. You know, we have a soccer tournament. I have to give a speech in front of class. Class, my kid just. My friend just texted me something awful and I just saw this horrible social media post, right? I mean, all these like, or, you know, we're late for work or I Have to pack the kids, lunch. I have to do the this and then that. So, you know, every moment, we're like our sympathetic nervous systems, and many of us, it's. Our sympathetic nervous system is just on all the time, and we don't even realize it. You know, if you round a corner and your kids suddenly pop in front of you and you're like, you know, if you really just jump and you're not just like, oh, hey, Kenzie, you know, you're activated, right? And so our sympathetic nervous system gets a ton of exercise every day when in our normal, healthy state, we want our sympathetic nervous system to kick in appropriately. Just like. As your listeners know, inflammation is not a blanket bad thing. It's when it's persistent and chronic that it is. Stress is not a blanket negative thing. We need stress to fight infections to get motivated. But it's just that it's up here, chronic and persistent. And normally, what happens when we have a stressor. I'm stuck in traffic, I'm late for work. You know, then you get to work, and you're not late. Your parasympathetic nervous system and your vagus nerve kick in and say, you know what? You're okay, let's get back to the rest. Digest and heal. Calm state. Well, this parasympathetic vagus nerve response is just. It's like down here all the time. It's not getting any exercise because we're not engaging it purposefully. And we need to start doing that now. We can assess now your vagus nerve functioning in a variety of ways. And a lot of people may wear an aura ring or your apple watch can do the same thing. And heart rate variability is what it sounds like. So I'll have even kids or parents in the office. I'll have them find their pulse on their neck and just notice when I'm explaining what heart rate variability is, you notice what the rate is. And now you take a. Let's say it's kind of like this. And you take a slow breath in and then you exhale slowly. Oh, wait, sorry, let's do that backwards. You take a slow breath in and then you exhale slowly. So you're, you're. Your heart rate is variable depending on whether you're breathing in or breathing out. It should speed up when you're breathing in. It should slow down when you're breathing out. That is normal, appropriate heart rate variability. When we're stressed, it's just boom, boom, boom, boom, boom, boom, boom. Fast and constant. Right? And what's Fascinating is there's a cardiologist in Germany who. I'll send you the paper. I think you would love it, Cynthia. It just floored me because we know our microbiomes have historically changed over the the past century, from the time when we could measure our microbiome. But Even since the 80s, this cardiologist in Germany has been monitoring kids heart rate variabilities, mostly because he has kids with adhd, they come in for the ekg, and so he's been monitoring. And so he has historical controls of kids without ADHD and with adhd. And he's found that over the decades their heart rate variability is significantly lower, which I am going to guess is absolutely true for adults. And why heart rate variability? Heart rate variability is one of the best predictors of current and future health. The best predictors. And when it comes to our microbiome, why is engaging our vagus nerve and improving heart rate variability so important? Because there's one study in children where improving heart rate variability with things like gratitude or, you know, know, walking in nature, hugging, gargling, you know, singing, you know, all the things that we can do that actually are free to engage your vagus nerve. Improving heart rate variability was found to improve their microbial microbiome functioning and diversity independent of diet. And so if your kids are, you know, really selective or maybe they're going out with their friends and you're just kind of cringing at what they're eating when they're out with their friends. If we help them engage their vagus nerve nerve every day, that's helping their microbiome. It's so key. And this intimate gut brain connection, this information superhighway that is from the microbiome to your brain, you know, 80 to 90% of that communication occurs from your microbiome to your brain via this vagus nerve. So whichever way you're going, you still need to engage the vagus nerve. And when you engage the vagus nerve, you're going to help your microbiome and you're going to help your brain.

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I think this is so important because as someone who has teenagers who are not always eating at home, helping them understand why it feels so good to connect with nature. Take the dogs for a walk. You know, we have two dogs in the house and we talk about the role of like oxytocin when they're hugging their pets and how that can be helpful for lowering cortisol and addressing stress. So big takeaway for fan for parents, maybe those of us who have older kids and are sometimes wondering what they're eating when they're outside the house, understanding that the health of our vagus nerve and heart rate variability can trump a lot of other choices that they make. So certainly one of those things that I think is really helpful. Now I would love to touch on two more topics before we kind of wrap up today because there were a lot of questions that came in around sh sugar. We know that our children now are consuming way more sugar than they did 50, 60, 100 years ago. How do we navigate this? Because there is sugar that proliferates in condiments and so many products that are marketed to children. How do you proactively address this with your patients, your own children? Because it is such a huge issue and kids palates are so sensitized to sugar now Sometimes it's challenging to get them to drink things without sugar in them.

Yeah. So I'm just, I wanna look up the latest numbers for you because it is astounding how much sugar is not just kids, it's adults too. And, you know, the thing with the sugar is that it has really infiltrated virtually everything that we're eating. Virtually everything when we look at. And this is why part of, you know, one of the most important, important things that I think in the book kids and teenagers and adults can take away from is how to read food labels like a gut hero. You know, how do you be that gut hero food label detective that can really assess what am I actually putting into my body? Because that is, you know, with all of these fancy code words for strawberry flavoring when you realize there's probably 50 different chemicals that goes into that. We want to be savvy now. I mean, there was certainly candy and sugar when you and I were kids. We had soda pop, I mean, you know, all that. Right, right. But what we didn't have was this daily constant access to these sugar sweetened beverages. I think that that is one of the biggest, biggest factors in why I'm seeing so many children. These children and teenagers with pre diabetes markers in their blood work, even if they're slim, they look fit. They look fit on the outside. They're exercising, working out every day. And then I check their lab work and their fasting insulin is maybe 17 or 18. They have hemoglobin and eight, right? Yes. Wow. Just for the listeners. And we would like it under five, you know, or under. But, you know, it is crazy. So they, and you know, maybe they have fasting blood sugars that are just butting up against, you know, 9900 or maybe over. This needs to be, we really need to, you know, sound the alarm bell because these kids are not the picture of who we think of as having diabetes. These are kids who are look fit and yet on the inside, they're metabolically unfit and unwell and they're heading towards a lifetime of virtually every single chronic disease. Because we know that blood sugar and insulin dysregulation is one of the foundations for setting the stage for chronic inflammation. So really important now, you know, a hundred years ago, the average American ate about two teaspoons of added sugar a day. Because you need some, you know, some bread in your yeast to make the, you know, yeast rise. And, you know, of course there were some tricks, treats, but two teaspoons, fast forward now, adults have on average about 19 teaspoons of sugar a day. Teenagers have 34 teaspoons of added sugar a day on average. That comes out to, you know, 143 grams about, if you do the calculation, about 4.2 grams per teaspoon. And so when you think about 143 grams that your kids are having, that's about six times as much added sugar sugar that the American Heart association recommends for kids 2 to 18. They recommend no more than 25 grams. So I just present this to kids and families because they just have to understand where they're starting from. And one of the most important things you can do is, you know, without judgment, just do a sugar inventory. I have a sugar inventory, a daily sugar inventory that you can just look and see, Just look at your packages, actually look at the nutrition facts on the boba tea that you're getting and just write down how much added sugar you're getting. And I give some tips and tricks on how to think about that. And then just see how much over. And then we think about how do we make those switches, how do we make those gut hero swaps so that, you know, I can still go out with my friends and go to boba guys, but what am I going to choose, right? Or, you know, maybe I'm going to have the boba guys, you know, whatever jasmine strawberry thing, you know, that has 42 grams of sugar. But I'm going to make really different choices for the next couple of days to even it out, right? And so, you know, we just want to. We don't want to say never ever. That's not the reality. But, you know, sugar sweetened beverages make up about half of the sugar calories for adults and kids. And a lot of adults, too. I mean, I used before I thought about this. I went on my way to work going, oh, I'm going to get myself, you know, a vanilla latte or, you know, something. Something blended. Didn't even think about it, right? And, you know, as I was on a typical day before I really started reading every single food label and thinking about how to positively make these choices, not, you know, in a depriving, you know, shameful way, but, you know, I did this sugar inventory for a typical day for Kenzie and Bode, and I was floored. And I share this with you because this was me even as a practicing holistic pediatrician, they were having 81 grams of added sugar. 81 grams. And that was on a day that, you know, I thought they were eating really clean. And I thought, okay, so now we can have a little treat of, you know, a scoop of ice cream at the end of the day, right? Like, oh, my gosh, they've had their, quote, treats all day long. And so it's just when we. It's kind of like, you know, when you're trying to lose weight or, you know, get to be more metabolically fit, you don't necessarily want to step on the scale, but. But you have to. You got to know where you're starting from. You got to know not just your weight, but, you know, your lean muscle mass and your. I mean, all the things are. Because we know it's not about weight. It's about how metabolically fit we are on the inside. But you have to know where you're starting from. And it's the same thing with sugar. You have to know where you're starting from. So, you know that it's. What I try to do in the book is just, you know, obviously I don't want kids or families to feel ashamed at all, because I've been there. Like, I've done that, and you. But I want eyes wide open. I want informed choices, and I want parents and kids to feel empowered.

And it's really the most important message. And thank you for your transparency. I just about fell over last week. My kids, like most Southern kids, love sweetened iced tea, and one of them brought home a bottle of sweet and iced tea. And I just looked at the label, and I didn't want to make a big deal about it, but I just said, I just want you to be aware, if you look at how much carbohydrate and sugars are in this, it was like 40 gram. It was like 40 grams in this small bottle. And. And I just said, understand that when your body processes it, if it's fructose, it's processed very differently than other types of sugars. And so we had this whole kind of interesting conversation. I just said, there's no judgment, but I just want you to build awareness. Now, last thing I want to kind of touch on today, to wrap things up, there were a lot of questions that came in around glyphosate. So obviously, this herbicide, pesticide, we know it's been in the United states since the 1970s. This also is a patented antibiotic. And so in terms of. We've kind of addressed how antibiotics impact the gut microbiome, not just in children, but ourselves. But what have been some of the things that you yourself have observed when talking to your patients? You know, what are the things that you can suggest for people to mitigate, obviously. Read the book, book, but mitigate exposure because I don't think there's anyone listening that is not exposed. I think again, it goes back to that environment we all live in. But understanding that glyphosate's like another type of antibiotic that we can unknowingly be exposed to.

Yeah. And you know, so I'm going to kind of lump in glyphosate with our endocrine disrupting environmental toxins because they're, you know, one environmental toxins. You can actually find forever chemicals in food, but they're kind of, to me, they're ubiquitous and there's so much literature showing how significantly they impact the gut microbiome. Virtually every single endocrine disrupting chemical like parabens, bisphenol A, bisphenol F, you know, you name it, phthalates, and now these pfas, these forever chemicals which, you know, has, have been in the news in our drinking water, in our soil, in our lululemon yoga pants. I mean, they're everywhere. I know, right, so, so these forever chemicals and glyphosate now, they disrupt the gut microbiome as significantly as antibiotics. And sadly, as you said, it's virtually impossible to have zero exposure. And I will say I think it's really impossible if we're going to live anywhere in this world. Right. Sadly, even in some of the far remote reaches, even the way the jet streams are, I mean the pollution can be even higher in some remote remote places. And so the key is to build that foundation of microbiome resilience so that no matter what you're faced with, they still have the microbial composition that can help detoxify, you know, those forever chemicals and parabens, they have the resilience to bounce back after they eat a food that's non organic, so. Or that, you know, that unicorn secret frappuccino drink on the side, Starbucks secret menu, whatever it is. So glyphosate is really interesting because glyphosate, as you said, was initially patented as an antibiotic by Monsanto and it actually can preferentially kill your beneficial lactobacilli and bifidobacteria and preserve these abnormal bacteria, including bacteria that have been associated with increased risk for autoimmune reactivity and clostridium. I mean, C. Diff is rampant resistant and recurrent C. Diff. We are actually at the point where C. Diff is getting almost impossible to treat unless you have a fecal transplant. So and what's interesting is glyphosate can interfere with something called the shikimate pathway in our microbiota that is involved in production of neurotransmitters like serotonin or dopamine. And so some people have said, well, why? Who cares? Why is that important, right? Because it's not us. I mean, you know, that's not gonna impact us. Well, guess what? 90% of our serotonin is actually made by the microbiota in our gut. Somewhere up to 50% of our dopamine is made in our gut. Our microbiota make 400 times more melatonin than we do our human cells do. And so if we disrupt this shikimate pathway in our microbiome, guess what? We don't have the neurotransmitters to keep our brains calm and focused, less addicted. I mean, all the things, right, Fall asleep and then these forever chemicals, too. What's really interesting, okay, how do we mitigate these, first of all, of course, I mean, you want to try at least, you know, at least if you're eating any foods off the Environmental Working Group's dirty dozen list, try to have those organic when possible, right? Reduce where you can your exposure to endocrine disruptors. Don't microwave any food. And plastic. Store in glass Tupperware. You know, be mindful of your baby's toys that are plastic. You know, there are ways to reduce our exposures to these forever chemicals. We can't produce them forever. I mean, completely. So in the research for both glyphosate and for forever chemicals, what's been shown to actually help reduce our body burden? Fermented foods. Fermented foods and fiber. Guess what fiber fermented foods do. They're great for our gut microbiome, right? We need that. And our microbiota have. They actually have their own. You know, our livers have a detoxification pathway called the cytochrome P450 pathway. Our gut microbiota have their own cytochrome P450 enzyme process, just like our liver. That helps us process all of these toxins and clear them out. So, you bet we want the right bugs in our gut. The other thing, too is, you know, even if you can't always buy organic, now I'm a huge proponent for frozen organic foods, fruits and vegetables, especially if you are living in areas where maybe you don't have fresh farmer's markets available to you all the time. But frozen foods can be, you know, an affordable way to get in. Organic foods and Oftentimes, frozen foods have more nutritional value because they're picked at the height of ripeness and flash frozen, as opposed to maybe some organic strawberries are being shipped over from Mexico and it's taken a little while to get to. And they're not in season. But so, because I've had a question from parents, well, if I can't eat it organic, should I not eat it at all? I'm like, no, you should. Because fruits and vegetables have also been found to help us detoxify and lower our body burdens of, you know, all of these environmental chemicals. So, you know, these are all the ways that Itox talk about nourishing your microbiome. Guess what? By nourishing your microbiome, you are going to help support healthy detoxification from any of these environmental toxicants that we're exposed to.

No? So many good tips. And one last thing that just kind of dropped into my head when we were talking about detoxifying and processing. How many kids are constipated? And we know that just being able to defecate every day is a really, really important component of the elimination process in the body. Just really briefly, I know that, you know, Miralax is, you know, doled out not just to pediatric patients, but adult patients. Like, it's like water and it's not designed to be used long term. What are some of your common ways that you address constipation? Just really briefly, because I know inevitably this will be a question that will come in after hearing your conversation about endocrine disruptive chemicals.

So, yes, one thing that I want parents to understand, you know, if your child is on Miralax, you know, just, it is what it is. That's a tool that in conventional pediatrics we have, there are neurologic concerns. I mean, there are, you know, the FDA has kind of stalled in its request for more studies on the neuropsychiatric concerns that many parents have reported with Miralax. So Miralax is polyethylene glycol, which is, I mean, essentially antifungal freeze. And it's like you said, for kids and for adults. Right. And one thing that we know is that, you know, with Miralax, actually, it's never been studied for use in children. I mean, that is astounding to me. And it's never been studied. You know, I mean, even when you look on the bottle as an adult using Miralax, it says not for use for more than two weeks. And so we have these kids and adults who are, are Just taking it every day for months or years because that's the only way they can poop. And as you said, our poop is. I mean, that's the waste products of our body. And I tell kids, look, if you're not pooping every day, at least every other day, and it's like a nice big log, you know, getting everything out, think about if you didn't, if you just let the trash build up under your kitchen sink, you never took it out, what would happen? I mean, that same phenomena is happening in your gut and not just is the waste kind of accumulating and you just don't feel very good. You're actually reabsorbing some of that waste, sadly. Right. We can reabsorb some of the toxins that our liver has done a lot of hard work and our microbiome has done a lot of hard work to convert into compounds that we can excrete. And what's interesting is, you know, as we're talking about fiber, there was one study that looked at, kind of modeled the economic impact if people just ate an apple a day. Literally, right. Three and a half to four more grams of fiber. Not a lot of fiber. I mean, it is a lot of fiber, but, you know, with the skin on, the economic impact, we would be saving for functional constipation $8 billion annually. I mean, that's huge. That's. I mean, really like an apple a day. Right. It's kind of cliche, but it's true. So, you know, what can we do? I mean, the first thing is, of course, I mean, it sounds. I don't wanna be simplistic, but it really is, you know, hydration. I mean, most of us are chronically dehydrated. 50% of kids on any given day don't get enough hydration. And it's not, you know, the fancy electrolyte drinks. It can be plain old water, right? So really hydration. Because water drinkers, you know, adequate water drinkers. In one study, people who drank and quote, enough water or good, were good water drinkers who were also found to be better fruit and vegetable eaters and also found to have different microbiomes than people who didn't drink enough water. There are some adults who go throughout the day and don't drink any water, you know, so. And water, you know, will support a healthy gut microbiome. So that's one thing. Exercise. Lot of kids are not moving enough. And through the pandemic, you know, with zoom schooling, we just became a sedentary, you know, Population a lot of kids, so, so movement is really important. You gotta get your, you know, your leg muscles moving, your intestines moving. Really important. Jump on the trampoline for fun. Kids should be getting at least one hour of exertional exercise every single day. It doesn't have to be in one sitting. It could be briskly walking to school, it could be trampoline, it could be soccer practice combined. And exercise has also been found to improve your gut microbiome independent of diet. I love that. Right? I love that. And then, then from a food standpoint, the biggest culprit is dairy. Many of you guys know this, right? Many of you guys have experimented, know, you know, when you have a bowl full of, you know, ice cream and you had the cheese appetizer and you know, the fondue with dinner, I mean, you get backed up. But it is true, I've had some kids where, I mean, every single single little bit of dairy had to be removed before they started stooling regularly. And then they could incorporate it back back in once their whole microbiome was kind of resettled. And then, you know, I list in the book, you know, part four is all about, you know, all the different integrative treatments I use for the top 25 conditions in kids. And of course constipation is way up there. And so I'll just give you two tips. Magnesium. Just like for adults, one of the most common nutrient insufficiencies or deficiencies in kids, you got to bring your magnesium way up to what, what's called bowel tolerance. And so you have really soft and mushy poops for a little bit and then you slowly back down. And then I do acupuncture in the office. It's kids respond beautifully well, but you can do acupressure at home. There's a point called large intestine 4 that every day your kids can, you know, while they're on the toilet, they can massage or you can massage a few times a day. And that can also help.

No. And it's so interesting now. I wish I had had this book when my kids were infants and toddlers. It's such an all encompassing guide. Please let listeners know how to connect with you, how to purchase your new book, how to follow you on social media. You're always a wealth of information.

So the best way to find me is either my website, it's www.healthykidshappykids.com. you can find my book, you can find more information about my book on HealthyKidShappyKids.com book. It's available at any major retailer. You know, Amazon, Barnes and Noble books, a million support your indie bookstores and local bookstores. I've had, you know, families tell me that in their, you know, tiny little books and little town in Michigan, they've been able to order the book. So wherever you can get books, you can find my book.

Well, thank you again, my friend. Such a pleasure to connect with you today.

Oh, thanks for having me.

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