Episode 142: An integrative approach to anxiety and mental health in children and teens with Dr. Elisa Song [Part 1]

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Welcome to the Natural Super Kids Podcast where you will discover practical strategies to inspire you to boost the health and nutrition of your kids. I'm Jessica Donovan, a qualified naturopath specialising in kids health and I want to make it as easy as possible for you to raise healthy and happy kids. Let's get into it.

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Hello everybody. Welcome back to the Natural Super Kids Podcast. Jessica Donovan here. I am absolutely thrilled and honored to be joined in today's episode and next week's episode by the amazing and incredible Dr. Alyssa song. I've been a huge fan of Dr. Alyssa song for many years. I've you know she does a lot of practitioner training. I've heard her talk on a lot of podcasts. She is a wealth of knowledge when it comes to children's health and wellness and today we are going to be talking about kids mental health, particularly diving into anxiety and a huge focus on the role of the gut microbiome when it comes to our kids mental health. It's a really inspiring, fascinating chat. I always learn a lot when I listen to Alyssa and I know you will learn a lot by listening to today's episode episode as well. So Alyssa and I had a Long chat. And I've decided to break it up into two podcast episodes. This one and next week. So in today's episode we talk a lot about the stats of mental health. We talk about the conventional treatment for anxiety and depression and why it's not working for our kids and our adults for that matter. We talk about a root cause functional medicine approach to child and teen anxiety and some of the factors that are disrupting the all important gut microbiome and how that is impacting our kids mental health as well. We talk a lot about medications and Dr. Alyssa Song is.

Is really well versed in this. So let me tell you a little bit more about Dr. Alyssa. She's a Stanford trained integrative pediatrician, pediatric functional medicine expert, and she's a mum to two thriving children. In her integrative pediatric practice, Whole Family Wellness, she's helped thousands of kids get to the root cause of their health concerns as well as empowered parents to help their children thrive in their body, their mind, their spirit by integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine and essential oils. Dr. Song has also created an amazing resource at Healthy Kids Happy Kids, which is an online holistic pediatric resource to help practitioners and parents bridge the gap between conventional and integrative pediatrics with an evidence based, pediatrician backed, mum approved approach. What an amazing lady. Let's meet Alyssa for this amazing first episode.

So great to have you here on the podcast, Alyssa.

Oh, I'm so excited to be here. I'm really honored to share whatever information I can.

Okay, let's dive in. So we know that the state of childhood mental health is not in a good way, especially for our teenage girls, really, when it comes to anxiety specifically. So can you share some more about the current statistics?

Yeah, and you know, this is during the pandemic. You know, as we're coming out of COVID there really have been, there has been a much, much greater awareness of the state of mental health emergency that our children and our teens have been. And you know, the American Academy of Pediatrics really called for this state of emergency in children's mental health. But I just want to remind our listeners that we have been in a state of mental health emergency for our kids and teens, I mean, long before the pandemic. So I'm really grateful that there is more.

Awareness now. I hope that translates into more public health action and more awareness on the part of practitioners and parents to really understand, try to understand what's going on with kids and teenagers. But through the pandemic there were an increase reports of emergency room visits for suicidality, suicidal ideation, suicide attempts, and, you know, a higher proportion of adolescent girls, but certainly boys were not excluded. And I mean, really, I just saw this article, it was heartbreaking. Even kids as young as 8 years of age, there was an increasing number of young children who were being seen in the hospital with suicide attempts. So it's really something that covers, you know, many, many ages, not just our older teens and our young adults. But we know now, you know, from some of the recent statistics, at least one in three teenage girls has anxiety. When kids are younger. It's, it's on the order of anywhere from 1 to 5 to 1 in 10 kids will have anxiety. And by the time kids are 18, it's estimated that one in two will have some sort of a mental health diagnosis, something that's going on. And some of the more recent statistics have found that one in five teenage girls has seriously considered suicide. And, well, let me back that up. One in three has seriously considered suicide, one in five has made a plan, and one in ten has actually tried. I mean, that is just devastating. And, you know, when we think about where our public health priorities lie, and you know, the, of course we're coming out of this pandemic where the fear was so intense as we were talking offline before, and the uncertainty of how kids would fare and how teenagers would fare, and now we know that age is really and truly one of the most significant risk factors for doing poorly with COVID And by far and away, our children are doing well even if they get Covid. And the numbers, when we look at the numbers in 2020, of the top leading causes of death for our Youth in our 15 to 24 year age range, suicide was the third leading cause of death. Something like over 6,000 children died by suicide. Number two was homicide. So that's another, you know, over 6,000 kids. Number one was accidental injury. So these top three go hand in hand with risk taking behaviors, you know, violence, with mental health concerns. So 6,000 died by suicide, 6,000 by homicide. In that same year, there were 501 deaths from COVID 19. Now, I'm not minimizing any death at all by any means, but when we look at the risk factors, our youth during the pandemic were on the order of 10 to 55 times more likely to die by suicide and violence combined than they were of COVID And then when we look at our even younger kids, 10 to 14 years of age, suicide is the second leading cause of death, second leading cause, far above, you know, COVID 19 and influenza. And then even for 5 to 9 year olds, we're looking at suicide as the 10th leading cause of death. So we need to really wake up and understand that our kids are in crisis. And you know, it's not necessarily just a phase they're going through. It's not necessarily just being an angry teenager. There really may be truly be something going on with our kids that we need to dive in, dig in, find out what's going on for our kids and also look to see from a functional medicine, nutritional standpoint, lifestyle standpoint, what are the factors that are really working against our kids mental health that we actually have the power to influence and do something about.

Yes, so true. And as a mum myself of two teenagers, like those statistics are just absolutely heartbreaking, aren't they?

Yeah, yeah.

So the conventional treatment of anxiety and depression isn't working for our kids or really our adults, you know, for that matter. So what's going on?

Well, you know, the conventional treatment, and I will say, you know, as a pediatrician, I understand that there is a time and a place for medications, but we have to understand that these SSRI medications, these selective serotonin reuptake inhibitors, which are the primary medication that is used for anxiety and depression in children and teenagers. Well, first of all, they have a black box warning on them that for teenagers and youth they may actually increase suicidality when started. So, you know, sort of, you know, countering the very thing, reinforcing the very thing that we're trying to avoid. And we know that. Yeah, and we know that there are many, many treatment failures. So SSRIs don't work much of the time or if they do work initially, they eventually, for the majority of adults and children, stop working. And I have some ideas on why that may be and I do think it lies in the gut microbiome and their serotonin production. But we have to think what else can we do besides just medications? Because medications are not this panacea for our children when they have anxiety or depression. And for many of our kids, they don't have just one mental health concern. They may have anxiety and they may have ADHD and they may have.

You know, insomnia. So then they're placed on many different medications around this polypharmacy of psychiatric medicines that we have no idea, you know, about the synergistic effects and the long term effects for children who are placed on these psychiatric medications when they're young and without really any end in Sight, if you have an 8 year old who is diagnosed with bipolar and placed on medications, when does it stop? And so then you're relegating this child to this basically a lifetime of medications. Unless we can step back and think what are some of these areas? What are some of the underlying factors that are not being addressed by medications?

Yes, and that's exactly what I want to dive into next is like that root cause, functional medicine approach to child and teen anxiety. What are the things you want parents to know about that?

Yeah, well, and I don't want to be too simplistic, but almost all of it, as you know and many of your listeners know, really lies in the factors that are disrupting our children's and our teenagers gut microbiomes these days. Because we know that the gut and the brain are intimately connected. And some people will call the gut our second brain, but the gut is probably our primary brain. What most people don't really know, in fact, and this was something that was new for me as I was diving into research and for my book that's coming out and I realized what. Wow. So our, our gut has a nervous system called the enteric nervous system that has these, these glial cells, these, these nerve cells that look very similar to brain cells. And what's fascinating is that our enteric nervous system, so our guts and nervous system can actually live without our brain, but our brain cannot live without our enteric nervous system. Wow. Isn't that fascinating?

Yes, I did not know that.

I mean some of these things you're like, whoa, you know, that's, it's crazy. And then, you know, of course most of your listeners have heard of the vagus nerve and that two bidirectional, two way information superhighway between the gut and the brain. But what some people don't realize is that 80 to 90% of the communication is happening from, from the gut to the brain. So the vast majority of the communication, the direction, the information is being relayed by the gut microbiome and informing your child's brain how to think, how to behave, what their mood is going to be. And especially for our children, where their brains have so much plasticity. And even for our teenagers, the teenage brain is just exciting, exploding with synapses and new connections in a very similar way as your toddler's brain, you know, your infant's brain. It's literally, you know, every day a new synaptic, well, not just a new, many, many new synaptic connections and synapses or the connections between Your brain cells are exploding. And for teenage boys, that continues even until your late 20s. And so we have these moments in time, these infant toddler years and our adolescent years where brain growth is exploding. You know, our synapses are exploding. We don't get to keep all of those synapses. In fact, a child at 3 years of age has something like 50% more synapses than an adult's brain. And so at some point, those synapses need to get pruned, just like a rose bush going crazy. You know, I do not have a green thumb, but I've been told you prune your rosebush stem, no matter how much that hurts to begin with, because you know that you are then going to nourish and nurture the remaining buds to create the most beautiful roses. Same thing with, you know, fruit trees. And so this pruning takes place so our kids and we don't keep all of our synapses that we form. Now the goal is hopefully that the healthiest, most appropriate synapses get formed and the healthiest ones stay. And so we do have the power to influence that and inform our kids. You know, how do we keep the ones that we. How do we make the ones that we want to keep, and how do we keep the ones that we would like to stay with us? Now, the gut microbiome has the same explosion in microbial composition, you know, diversity and function in our infection infant years, from about 0 to 2 or 3 years of age, but then also again in our adolescent years, sort of our preteen adolescent years. That same shift happens in our, in our elderly years, in our senescent years. And so this, the. Now we know that this explosion and the change in our gut microbiome is really what is driving the changes in our children's developing brains and our teenagers developing brains. So the more we can protect and support a healthy gut microbiome. Microbiome, the more we are going to protect and support a healthy brain. And part of that is, as we're talking about specifically teen and child anxiety today, it's really understanding that the majority of our brain chemicals are really gut chemicals, these neurotransmitters. So 80 to 90% of our serotonin, which is our feel good, relaxed, manage stress, help with sleep. Neurotransmitter is made by our gut microbiome. About 50% of our dopamine, which is our attention, reward, focus, you know, potential addiction capacity if we don't have enough of it, dope. About 50% of dopamine is made by our gut microbiome. And the majority of melatonin is made in our gut, which is our sleep hormone. We have a lot of other neurotransmitters like acetylcholine and GABA that are produced by our gut microbes. So if we don't have a healthy balance of gut microbes, we're not going to have a healthy gut, healthy gut brain access, we're not going to have a healthy brain. So understanding.

This connection and what we can do about it is a major factor of importance for kids when they're dealing with anxiety.

Yes, I think you've just explained that so well. I love that analogy of the pruning. I've been reading a lot about the teenage brain trying to understand for, for my parenting really he's forgetful teenagers. I mean my son left this morning and he's got work straight after school and last week he, he messages me and says I forgot my work T shirt. Can you bring it? I'm like, no mate, I'm, I'm working, I've got no time to bring it. And today he got halfway to the bus stop and nearly forgot it.

But learn.

Yeah, yes, yes, that's right. But I think, you know, I'm just experiencing firsthand like how that that teenage brain is really changing and, and I love that sort of comparison to the, to the toddler brain. I think we do need to give our teenagers a bit of, you know, relax a bit on, on being on their back because they, there is a lot going on in their brain at this age, isn't there?

So much, there's so much. I mean just every day something, it's just like, you know, when you're, when your kids were babies and you could see the wheels turning in their brain and you know, the next day they learned a new word or they were doing a, you know, doing a different developmental milestone. And so I mean the same thing is happening in our kids brains and you know that. And you know, it's interesting. Brains mature from the back to the front. And so the front part of our brain, the prefrontal cortex, which is your decision making, cause and effect, you know, rational part, impulse control. Part of your brain is the last to mature. So we need to remember that at the same time all the rest of their brain is, is just exploding like crazy, including their emotional part of the brain, the amygdala that just, that acts and feels. And so you know, at. Eventually the prefrontal cortex catches up, but they really are, you know, I mean not necessarily just driven by emotion, but emotions and that feeling and you know, all of that is such a huge part of, of adolescence and it makes sense from a neuroplasticity standpoint. Yeah, yeah, definitely.

And yeah, the other thing that I just wanted to go back to is that, you know, that, that gut brain communication and that you said 80 to 90% of it is like gut to brain, which is super interesting and makes so much sense. So, you know, and I've talked about that on the podcast before, like how important the gut is to brain health in general and that neurotransmitter production which is so important in our kids mood, behavior, mental health. So let's dive into some of the, I guess the factors, the modern day factors that are affecting our kids gut microbiome.

Yeah, you know, there are, I look at, I categorize them in my mind mentally. I mean, there's nothing ever falls into three neat categories, but I kind of have three, you know, factors that really affect our children's microbiomes and in turn then affect that gut brain connection. So, and these are what I call microbiome mischief makers. I mean, they don't, they don't necessarily permanently, you know, cause harm to the gut microbiome, but they cause a lot of mischief. And if we're not aware, they can cause long term and sometimes very difficult to reverse mischief because, you know, it's just like anything, you know, if you have a leak in the roof, if you patch it up immediately, then it's done, not a problem at all. But if you wait and you think, oh, get to it later, then the rainy season comes and you think, oh, well, you know, now what am I going to do? And that hole just gets bigger and bigger and bigger. It takes a lot longer to patch that up. So same thing with healing. The longer you wait to start the healing process, the longer it takes to get back to the place where you want to be. So you know, when you notice signs that, well, I would say even, even hopefully long before your kids develop anxiety, if you know that there are factors that are contributing to disruption of their gut microbiomes, then have a chat with your kids. Hey, let's talk about why your gut and gut is so important. You know, all those, all those good, you know, the buddies in your belly, the good microbes in your tummy, how are they affecting your brain or your immune system and all the things that you want to do. And so we can relate it back and we want to make it very relatable to children. You Know when I was, when I had the opportunity to teach a six week, it was a, it was essentially a gut health course for my, my kids. Third and fourth grade classes, they were eight and nine years of age, but we called it, you know, happy. What do we call a healthy belly happy You. And in the first session, I mean, all these kids are sitting around in a circle and I just asked around the room, I said, you can raise your hands or not, but just think about, you know, think about these questions. Who here has ever had trouble falling asleep? Who here has ever had a tummy ache? Who here has ever felt like they had their worries were so big that they couldn't manage or who's ever felt like it was really hard to sit still in your seat and you just wish you didn't get in trouble so much, you know, from the teacher. And so, you know, one by or, or who here, you know, gets sick and misses school more than they or parties more than they want to. And so, you know, one by one the hands would go up and, and all of those things we can relate back to. Hey, guess what? Did you know that all of those tiny little microscopic organisms in your belly, those probiotics, they help you to feel better, you know, be stronger, get sick less often. So we want to relate it back to what's important to them. And same thing with our teenagers. So for our teenagers, you know, being healthy isn't, I mean, that's just not going to cut it, you know, but if, if for them, for a lot of teenagers, it's their skin. Yes, right, Their skin or their hair. And guaranteed you, you help support their gut microbiome and their skin will get clearer at 100%. Right? Or for some kids, it may be, you know, be having a more accurate basketball shot or being faster on the soccer field or.

You know, rehearsing their lines better for the school play. So whatever it is, absolutely, if it's affecting their brain or affecting their immune system or affecting their skin, it comes down to what is the health of your gut microbiome. And, and so, you know, just making it relatable and relevant to our children is going to help them shift any of the factors that are in their control that are really making mischief on their microbiomes. So the one of the first things is really, you know, medications that they may be on and they may not have, have control over these but, you know, antibiotics, because they are not discriminating in what they kill, you know, they'll kill the good stuff, right? A good bacteria, right. Along with the bad bacteria. So antibiotics are really the single biggest acute immediate disruptor to the gut microbiome. And some studies have found that even just one round of antibiotics as a toddler could increase the risk of any mental health concern by the time these kids are older. And the more rounds of antibiotics, the higher the risk. And the, the, the risk seems to be the greatest if that first round of antibiotics was given under 6 months of age. So if our kids are on antibiotics, well, we need to know that is going to disrupt their gut microbiome. How do we, if those antibiotics are necessary, how do we support that child's gut microbiome to restore to a healthier state once those antibiotics are completed? Now, I will say that there are some studies showing that up to 70% of antibiotics prescribed for children are inappropriately prescribed. So that's why I said if those antibiotics are necessary. So we also want to practice really, really good antibiotic stewardship, knowing that by the year 2050, some health experts are concerned that antibiotic resistance is going to be a leading cause of death worldwide. So that's a public health issue. But from an individual health issue, we know the havoc that antibiotics wreak on the gut microbiome. So if they're not appropriately prescribed, then we are needlessly disrupting our kids microbiomes. So asking your pediatrician or your gp, you know, when you get an antibiotic prescription, asking the question, hey, doctor, is this really necessary? Now, it's not questioning your doctor's judgment, it's just asking, is this necessary? Because some studies have shown that doctors are much more likely to prescribe an antibiotic when they think that the patient wants a prescription, even if the doctor doesn't believe that the antibiotic is completely necessary. Right. So just voicing that question alone will let that doctor know? No. Okay. I don't have a mom in front of me who wants an antibiotic for every sniffle or cough. Right. Because there are some mothers, some, I'm not going to say just mothers, but there are some parents who, you know, grew up like I did, you know, where an antibiotic was given, left and right for every single viral infection. And so if the doctor knows that you're not one of those parents, that you want to use antibiotics judiciously and only when necessary. Necessary, then they may say, you know what? Yeah, we have some time to wait and see.

Yes, I love that that's such a simple approach. And it's not like you said, you're not, you know, questioning their judgment or, you know, getting into an argument or anything. It's just asking that question because I think a lot of gps, and this is a societal thing, people go to the doctor, they want a solution, they want to, they want to walk out with a prescription. A lot of people. So if we just, you know, bring that conversation up. Yeah, I just love that.

Yeah. And then, you know, also knowing that there are other medications that can also disrupt the gut microbiome now, specifically for our teenagers, what I worry about, because we have this crisis right now. So how many of our teenagers are on low dose antibiotics for their acne? Right. On a daily basis they're on doxycycline or minocycline. So they're continuing on these, on these antibiotics. And it doesn't matter whether it's low dose or high dose, it's still going to disrupt the gut microbiome. And then how many of our teenage girls take ibuprofen for menstrual cramps or naproxen or something similar? And our N set are non steroidal anti inflammatory drugs. That class of medications have been found to, some studies disrupt the gut microbiome possibly even more than antibiotics. So we need to be aware of that. And then we have birth control pills which many of our teenage girls are on because of their skin or because of their cramps. And again, if we can get to the heart of the gut microbiome, we can support that. And even our SSRIs, our antidepressant medications, those too disrupt the gut microbiome. If your kids have asthma or eczema and they're putting steroid creams on or taking an inhaled steroid for asthma, that also disrupts the gut microbiome. So I'm not saying stop these medications. What I am saying is if they've been prescribed, know that the unintended consequence is gonna be a further disruption to your child and your teenager's gut microbiome and support their gut microbiome when they're on these medications. You know, learn how to really. And we can, we'll, we'll go into what that means. But that is something. Just taking a look at what medications are my kids on, antacid medications, they are a huge disruptor to the gut microbiome. And while we're talking about the gut brain connection, I know you've spoken about the gut immune system connection, but we also know that antibiotics or antacid medications given in those first six months of life can significantly nearly double the risk of every single alone allergic disease like eczema. Asthma, allergies, hay fever, anaphylaxis by the time Those kids are 4 years of age because of how important the gut microbiome is in shaping our children's developing immune systems. So, you know, we have to really, you know, think about all of that. I just, in fact, spoke with a mom this morning. I was giving a lecture to one of the nursing schools in Los Angeles and one of the nursing nurse practitioner students was pregnant. And you know, after hearing me say this, she, she said, oh my gosh, but I'm on an antacid medication because I have really severe heartburn and, and hyperemesis gravidum. And, and I said, you know what, it's okay. You know, you take these, but, but then eat fermented foods, take your probiotics, right? Support your gut microbiome.

It's just a matter of having the knowledge of like, you know, making up for those medications that you might need to be on and the antacids. I mean, you know, so many babies are put on anti reflux medication, aren't they? Like, it's a really common, like one of, I think maybe one of the most commonly prescribed medications for babies.

Yeah, it's true. It's so common. I remember when, so after we, my husband and I came to Australia for a honeymoon, we decided to do an around the world trip. I mean, we just got that, that travel bug in us. And so I remember I was in, in a practice, pediatric practice at UCSF and my husband and I quit our jobs to travel. And then when I came back, I took a temporary job because my goal was to open up my holistic pediatric practice as soon as we came back. So I took a temporary job to just kind of get set up and do the planning. And in that one year of travel, when I came back all of a sudden and every single baby was on Zantac, Ranitidine and antacid medication because all because it was suddenly approved for infant reflux. And so then I'm just looking at these babies who, you know, babies often go through a fussy phase that has GI symptoms associated with it arching the back. And all babies have reflux, but they don't all have reflux disease. And so all of a sudden we went from really looking at these colicky babies and I think really diagnosing them, many of them incorrectly with reflux and putting them on antacid medications. There are certainly some babies who really do have reflux disease, but the vast majority, they don't have reflux disease. They have Reflux, they are spitting up and they, they're going through a fussy phase simultaneously. And if we can support mama, if we can support baby through that phase, then many times we can avoid those antacid medications and have healthier babies in the long term. Because I mean some of the treatments for that fussy colicky phase is they are infant probiotics and there are some well studied ones to help support that. And there are herbs that moms can take and herbs that you can even give to the baby to some support that.

Yeah, definitely. And it comes back to that. You know, everyone's so busy, they just want that quick fix. But when we look at those stats of like allergic disease doubling in, that's what you said, isn't it? In it, in babies that take these, these medications before six months then like I don't think that information is being communicated to parents when these, these medications are prescribed, is it?

No, it certainly isn't. And I actually, I think that, I really think that, you know, from, from an ethical standpoint, any practitioner who is prescribing these medications need to really provide that information and to say I really truly believe this antibiotic is necessary. So please, you know, here's this prescription for your child's pneumonia or whatever it is. And we also know the long term effects of disrupting the gut microbiome. So here's what you do to restore your child's gut microbiome. I feel that it really is our obligation because now our children there are dying far less from infectious diseases and more from this slow insidious progression of these chronic diseases that really are, you know, in previous generations were diseases of adults, not children. So it really is our responsibility as practitioners as, and certainly as the prescribing practitioner. So we have a ways to go. Yes, but, but slowly, slowly we are getting there.

Well, yeah, and that's why we're both so passionate about, you know, getting this information out there. Right.

Dr. Alyssa Song has so much more amazing information to share with us. But we are going to leave the rest of this episode, part two of this episode we for next week where Dr. Alyssa Song and I dive into some other, the other two categories that are affecting our kids gut microbiome. We're also going to be talking about a lot about the vagus nerve and how we can improve vagus nerve function in children and why this is important when it comes to their mental health. And Dr. Elissa also talks about some other factors that are really important when it comes to our kids mental health and some supplements and holistic pediatric treatments that we might want to consider for our kids and teens with anxiety. So tune in to next week's episode to find out all of that great information. We'll see you then.

Thank you so much for joining me on the podcast today. Head on over to our website, naturalsuperkids.com for the show notes for this episode, as well as a whole heap of inspiration to help you raise healthy and happy kids. I'll see you next week.