Episode #204: Healthy Kids, Happy Kids with Dr. Elisa Song, MD

Welcome to Better Health Guy Blogcasts Empowering your Better health and now here's Scott, your Better Health Guy. The content of this show is for informational purposes only and is not intended to diagnose, treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or or his information to facilitate self treatment. As always, please discuss any potential health related decisions with your own personal medical authority.

Hello everyone and welcome to episode 204 of the Better Health Guy Blogcast series. Today's guest is Dr. Elisa Song and the topic of the show is Healthy kids, happy kids. Dr. Elisa Song is a Stanford NYU UCSF trained integrative pediatrician, the pediatric functional medicine expert and mom to two thriving children and she's on a mission to revolutionize the future of Children's Health. Dr. Song is the best selling author of Healthy Kids Happy An Integrative Pediatrician's Guide to whole child resilience. Dr. Song created healthy Kids Happy Kids as an online holistic pediatric resource to help practitioners and parents bridge the gap between conventional and integrative pediatrics with an evidence based pediatrician backed mom approved approach. In her integrative pediatric practice, she's helped thousands of kids to get to the root causes of their health concerns and empowered parents to help their children thrive by integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine and essential oils. Dr. Song is chair of A4M's pediatric education and has lectured around the world at leading integrative and functional medicine conferences and premier parenting events. She's also been featured in hundreds of top podcasts, print and online media outlets including the Wellness Mama Podcast, Bloom TV, Forbes, Healthline, Mind, BodyGreen, National Geographic, POPSUGAR, Parents, Motherly Parade, Verywell Health and New York Post. And now my interview with Dr. Alisa Song.

I am excited today to have Dr. Elisa Song with us to talk about her new book, Healthy Kids, Happy Kids An Integrative Pediatrician's Guide to Whole Child Resilience and to share how she approaches children's health from an integrative lens. Thanks so much for being here today Dr. Song.

Oh thanks Scott. What an honor to be here.

You trained at Stanford, nyu, the University of California, San Francisco, but these schools did not really give you most of the knowledge that you use today when working with children with more chronic or as you like to term it, more persistent conditions. So what do you wish that you had learned in medical school that you instead had to learn on your own?

You know so much you know, we can always go back and think about, you know, what I wish I had known, what I wish I had done differently. And I guess, you know, for, for anyone listening, especially if you're a parent or even as a practitioner, you know, you don't want to sit with all that regret because even as a practitioner, I think, oh my gosh, if I'd known this with X, Y and Z patients, you know, 20 years ago, 15 years ago, but now, you know, and we keep learning and we keep moving forward and keep our minds open. But I wish I had known so much more about how foundational a child's, an infant's developing gut microbiome is to the rest of their life. I mean, to their metabolic health, their hormone health, their immune health, their mental health, all of the things that now, as adults, many of us are living with, and especially with the immune regulation piece, which I think is, is so key for so many of the listeners, that immune regulation, immune tolerance, appropriate immune response is laid really when you're born in how your microbiome develops in those first, you know, thousand days of life in early toddlerhood. It's not that it can't change, but when we look at the data, and especially the first six months of life, if there's been a disturbance of the gut microbiome, for instance, I mean, I point to two, two large studies that to me are really eye opening and should really help parents and practitioners understand, okay, this is where we need to start and this is where we always need to look for kids. So one really large study, nearly 800,000 children, found that infants who were, who received antibiotics or antacid medications in the first six months of life had a significantly increased risk, sometimes double the risk of virtually every sing allergic disease by the time they were four years of age. Another study, and this, this includes eczema, asthma, atopi, anaphylactic food allergies, hives. And another study out of Finland looked at, I believe it was a little over a million live births and tracked babies who were exposed to antibiotics in the first two years of life. And by exposure, I also mean in utero, when moms received antibiotics for maybe a sinus infection or UTI or maybe during delivery for group B strep. And any exposure to antibiotics, especially in the first six months of life, significantly increase the risk of, I mean, virtually any mental health concern by the time they were older kids or teenagers, like anxiety, depression, adhd. The more rounds of antibiotics, the higher the risk. We know this from adult studies, too, with antibiotics and Subsequent increased risk in adults with, with of depression, anxiety, mental health concerns. So we need to understand that. And yet when we think about antibiotics, you know, we also, I'm sure we'll discuss this in a little bit, but they can be life saving. But if we don't understand the disruptive microbiome effects then, then we are not doing as, as much of a service as we can to our kids and to our adults. I also wish I knew more about fever. You know, fever phobia is the best, biggest, one of the biggest myths that still persists in parents and grandparents and practitioners and really understanding that when we reduce fevers artificially with things like Tylenol or Motrin, we actually can be keeping our kids sicker for longer and making them more contagious. And so, you know, the, the, the fact that even still today in most emergency rooms or urgent care clinics, if you bring your child in with a fever and the triage nurse is assessing them and then telling them to wait in the waiting room before the doctor comes and sees them, even before the doctor lays eyes on kids, no matter what your child looks like, very often the first thing is here's some Tylenol, now go wait in the waiting room. So we need to rethink how we're doing and really we want to do this in an evidence based way, not in a, in a fear based way and to really spread, spread the knowledge that, that with this information we can do better for our kids. We can, we can have a future where, you know, one in two kids doesn't have a chronic health concern.

You say that the new normal is not normal, that so many children today are not healthy. So what's changed? What are the factors that are driving the reality that the new normal is a sick child? And how much of a role do things like environmental toxicants play in pediatric health? How much is the, or quality of our food supply a factor in the new normal or maybe other factors? What do you see as the key contributors to why things today are so different?

You know, it's, it's really, it's all of the above. I will, you know, point to one study with, about autoimmunity and we know that autoimmunity is on the rise in, in adults as well as children. And some listeners may be familiar with a blood marker called an ana, an antinuclear antibody, very, very non specific autoimmune marker. It does not tell you that you have an autoimmune disease and it doesn't tell you what autoimmune disease, you know, may develop. It just tells you that it's sort of the canary in a coal mine. If you have a positive A and A, it lets me know, okay, this child or this teenager's immune system is tipping over into an autoimmune immune system. And now we need to really dig deeper. So this particular research article, they looked at different age ranges through the decades and followed their ANA positivity rates. Well, what they found was in every single age group since the, you know, late 1900s, A&A levels, positivity rates have been increasing. The group with the fastest rise in positive ANA rates was our teenagers, our 12 to 18 year olds. And you know, in the 80s, the positive AA rate, something, something like doubled. And then in the early 2000s, they tripled again. And so our kids now are showing signs that they are developing autoimmune reactivity. Now many of these, these kids don't have an, A diagnosed autoimmune disease just yet, but we don't want to wait until they're 30 or, or in their late 20s, you know, all of a sudden in college, boom, they have an autoimmune disease or in the 30s or 40s. And the research, you know, this is a short span of time that they were looking at these numbers. Maybe 40 years. Genes don't change in 40 years. Right. Genes don't even change really in the past century. And yet this, this, this phenomenal and, you know, unacceptable surge in autoimmunity and chronic disease. So what's going on? It's, it's our environment. It's the environment. And so what about the environment in our kids? Well, their microbiomes have changed largely as a result of the foods that we're eating. Our lifestyles are contrib, Environmental toxicants play a huge role. We cannot escape these forever chemicals. These forever chemicals are here to stay, no matter how clean and green you're living. We have them in us. Our children have them in us. Microplastics, all of us. And so understanding that, you know, these, these forces, you know, environmental toxicants, they, they are also, you know, in addition to being endocrine disrupting chemicals, they're also now really known to be microbiome disrupting chemicals. And so when we understand that, we have to realize if we are going to be exposed to these on a daily basis, what can we do on a daily basis to keep our kids and our own microbiomes healthy?

So let's build a little bit on the autoimmune conversation and talk about diagnoses like ulcerative colitis or Crohn's. Are those conditions that we can effectively treat? And is the problem more autoimmunity or immune dysregulation? Is it more inflammatory? Are there patterns of infections that you commonly find when people are dealing with ulcerative colitis or Crohn's? What are the kind of underlying drivers and can those conditions be fully resolved or do they require lifelong management like many would suggest?

So they can be resolved. I've had, in fact, in the book, I give a case story of two siblings whose IBD inflammatory bowel disease resolved, Crohn's disease and juvenile arthritis. So let's, you know, there's a broad range of autoimmune conditions and I've seen them resolve. I've seen their markers resolve. I've seen them go not just into remission, but stay in remission. Because that's the key as patients and as practitioners. It's not enough to say that you're in remission. The key is, are you going to stay there? Because I've had kids where we get them, we get them well and. But then they start sliding back because we haven't really addressed all of the root factors that are going on. So it absolutely is a phenomenon, of course, of autoimmunity. But it starts with immune dysregulation. You know, autoimmune diseases. We have to remember even before you get the diagnosis, it's probably in a, in a child's case, years of immune dysregulation that leads to that autoimmune point. For some adults, it's decades. So it's not, not just, you know, all of a sudden they shift over and develop an autoimmune disease. It's these, these, you know, years and years and years of factors that are working to dysregulate their immune system. Really, I would say starting with the gut microbiome, because we know that many gut microbes can tip kids and adults over into autoimmune reactivity. So for, in the case of, you know, of ibd, I look for these gram negative bacteria which are linked with increased autoimmune risk, like Klebsiella citrobacter proteus. And you know, many, many of you listening are familiar with those. And then, you know, there are also other, you know, there may be some viruses that are implicated, there may be, there may be other microorganisms that are implicated, but there are a wide variety. These gram negative bacteria in particular are the ones that I look for and you know, why, why is that? There's. There may be some molecular mimicry. You know, there are some organisms that have a part, a part of them that look very similar to a part of our human, our human bodies. And so in attacking those organisms, our immune system, if, if dysregulated, not functioning appropriately, starts attacking our cells by accident. Some of them just, I think, you know, it may be that some of them just really are more LPS endotoxin producers. And in the face of a leaky gut, those endotoxins get absorbed and wreak all sorts of autoimmune and inflammatory havoc.

It's interesting. With Klebsiella, I'm hearing more practitioners finding it in the sinuses now, since the start of the pandemic, possibly correlated to wearing masks and breathing in a lot of things that we didn't have in our sinuses before. Dr. Alessio Fasano says that the gut is not like Las Vegas, that what happens in the gut does not stay in the gut. Essentially, every body system is impacted by our gut. We know that 70 to 80% of our immune system comes from the gut. So what are the common patterns of GI dysbiosis that you see in your patients? Is this more of an imbalance of beneficial flora or missing beneficial flora? Are these pathogenic bacteria, fungi, parasites, or maybe even viruses? What do you commonly see and why have these issues become so prevalent? Is it more antibiotics again coming back to food? Is it more cesarean births? Is it less breastfeeding? What's driving our poor gut health today day?

Yeah, well, one of the things that, that I really want listeners to understand is that infants and young child microbiomes are very different than adult microbiomes. This is really, really key. And up until very recently, we've really only been able to rely on microbiome testing labs that offer adult reference ranges. And when I say adult, you know, babies, their microbiomes go through many different phases of development. So the first zero to six months of life where babies are exclusively either breastfed or formula fed or maybe a combination, their microbiomes are meant to digest the, you know, breast milk or formula, but not really any other solids. Then there's a shift when solids are introduced and, you know, between six to nine months and certainly by 12 months, there's a maturation of the gut microbiome that takes place. And then through the toddler years and even, even further maturation. And so the, the child microbiome reaches a more adult like state by the time they're about maybe three to four years of age. So when you're doing a test like you know, doctor's data or, or GI MAP or you know, Genova GI effects, any of the really commonly used ones, we have to, if we are going to use those tests for a child under four, we really have to understand what we're looking at now. You know, full disclosure, I am actually now because I love this test so much, I was asked to be on the advisory board for Tiny Health and I'm now their chief medical officer and so excited. So I do think especially for children, it is really hands down the only test we should be using for kids under four. It's also relative to there's a difference in the way the microbiome analysis is done and there are only a few labs that are doing this right now. There's, you know, Microbiome labs has their tests and also Tiny Health you shotgun metagenomics for their testing which gives you a look at every single organism that's, that's been, whose, whose DNA has been analyzed in your microbiome without amplification. So we can see the actual relative amounts of each of these microbes down to the strain, the subspecies level with QPCR testing. And of course we're all familiar with PCR testing now from COVID but what does PCR testing do? And PCR is what most other lab companies use like Genova GIFx, doctor's data. I think they're fantastic tests. But you know, really we need to be shifting. With QPCR we are amplifying the genetic material of the microorganisms and looking for specific organisms in that analysis. And so sometimes we might actually see, you know, that an organism looks like there's, there's a lot more than there actually may be. So and then Tiny Health also has these specific age ranges now for reference ranges for what the microbiome should look like at 0 to 6, you know, then the, the 6 to 12 and then the toddler years. Now what is the main difference? Infants should have very low diversity. As an adult we should have a lot of microbiome diversity. We should have a lot of different beneficial microbes in our gut. For babies it should be almost exclusively up to 80% or even more. Bifidobacteria species, no Achkermansia and no Faecali bacterium is very normal for babies. Right. And that's very different than adults. So just understanding that is really important now. So back to your question. Long winded way of saying when we're Looking at the patterns of dysbiosis, we need to know what age we're talking about, but primarily what I see for many, many kids and one of the most important things to correct is the inadequacy of the beneficial flora. That is, you know, we are all trained now in functional medicine to look at the bad guys and how do we kill them, you know, how do we get rid of them? And we really, I think, need to shift our focus and you know, what, how do we get the beneficial guys in? How do we make sure there's enough bifidobacteria in, in our babies or enough, you know, keystone, you know, Akkermansia or faecalibacterium or Rosa Bureau in our adult microbiomes, in our older kids microbiomes and adult microbiomes. Because when we do that, guess what? Laying down that foundation and having a healthy, healthy flora will crowd out the disruptive flora so that we don't have to do as much killing, you know, in the long run. Now there are, of course, if I see in a child with a really, you know, high family history, strong family history of autoimmunity, or I see a child with pandas and they have strep colonizing their gut, I do want to get rid of that, you know, so I do work on eliminating that dysbiosis. But, but if we're not working in tandem with, with supporting their benefic of flora, we're not going to really have long term results. And a lot of people have seen this. You know, they do their GI test and they're just not getting in enough of the good guys and maybe the bad guys. You know, maybe you had some Klebsiella, maybe you had some Candida, maybe you had some parasites that, that. Yay. The next test shows that it's not there. Six months later, you repeat and they're back again, right? So because your gut microbiome wants to return to the state it was in before you do any of the killing, right, Even with, you know, let's say antibiotics for, you know, an ear infection, your microbiome is going to bounce back to the state that it was in before unless we know how to really, you know, restore and optimize that healthy microbiome. And by microbiome, I don't just mean the microbiota. I don't just mean looking at, you know, the beneficial, you know, bifido or lactose species. What I really mean is the ecology, the ecosystem in your gut that is your microbiome, your microbiome is that ecosystem, the microbiota, the organisms and their genes and the environment in which they live. So the goal then is to make your child's gut, or our gut, the friendliest neighborhood possible so that these beneficial microbes want to call your gut their home. And when they do and they move in and they have their plot of land and they're growing, they call in all of their beneficial friends to come in also.

So just wrapping up on that question then, since a lot of these infants probably aren't eating a lot of foods that we're eating as adults, what do you think are the primary contributors to dysbiosis in the microbiome that we see in younger people?

So, I mean, when we're talking about infants in particular, we know the factors that really can start babies off with a more disruptive pattern of microbes. So cesarean birth, antibiotic exposure, you know, for things like group B strep positivity in moms, you know, vaginal group B strep positive around birth, antibiotics or antacids that are given to infants early on in life. Formula, also formula fed babies also tend to have microbiome patterns that are more similar to cesarean birth babies. And that pattern does increase the risk for atopy, things like eczema, asthma, allergies, that atopic march that can happen and maybe even to autoimmunity later on. Now, the other thing too, though, is having a vaginal birth, unmedicated, 100% breastfeeding, that is amazing, but it doesn't necessarily, unfortunately guarantee that your babies are going to be born with the best chance to have an optimal microbiome colonization. So then what are the other factors? We need to make sure moms have healthy gut microbiomes. We need to make sure moms have healthy vaginal microbiomes. And when we over the years, as you can imagine, over the decades, maternal microbiomes have changed and become less and less healthy. Maternal vaginal microbiomes have changed. Maternal breast milk glands or mammary microbiomes have subsequently changed because that relies on a healthy gut microbiome. So if we can start with moms, even preconception and, you know, and the dads don't get, you know, a free pass, it's the dad's microbiomes also matter. We're going to start the babies off with the best microbiome in life now. And, you know, there's one study that looked at microbiome patterns a hundred years ago, is a pathologist in Scotland, and, and he was culturing baby Poop even back then, right? I mean, it's amazing that, that he did that. And so, and even back then there was formula because there were some mothers who just, you know, couldn't breastfeed for whatever reason. And so he actually looked at the microbiomes of breastfed babies and formula fed babies in Scotland 100 years ago and found that breastfed babies had nearly 100% bifidobacteria and formula fed babies had different microbiomes. Now, fast forward 100 years, our breastfed babies microbiomes looked much more similar to the formula fed microbiomes of a hundred babies of 100 years ago. And so even then, you know, even if, you know, all the things are, quote, right, we still want to be mindful that there, that there are things that we can do to improve our baby's microbiomes and their chance for lifelong health.

Less, as I understand, even a lot of the environmental toxicants that we have today, some of those can be found in breast milk as well. Thus the whole preconception planning and the need to really detoxify before getting pregnant and all of that. When we look at some of these microbiome tests, can we look at the patterns in a healthy child compared to an allergic child, compared to a pans or pandas child compared to an autism child, and essentially look at the fingerprint of the microbiome and use that to paint or kind of confirm the diagnosis or at least to give you clues in the direction of what symptom presentation might be happening in that child.

I love this question. I think that is going to be the future where we can look at an infant's microbiome or a young child's microbiome pattern and see that signature that, okay, unless we intervene, this child is very likely, this baby is very likely going to develop food allergies or is a higher risk for developing ADHD or autism. And those signatures are being looked at right now. Those signatures really are probably more relevant for the younger, younger ages. But we may find some, some signatures for older kids. But there are some, you know, in the tiny health report they've seen because they've, they've now, you know, been able to analyze, you know, tens of thousands of infant and toddler stool analyses have found certain signatures that, you know, in the literature and correlating with their stool analysis seem to indicate in certain babies a higher signature risk for food allergies. Or right now they're reporting on the atopian food allergies. But they, but they are looking at the signature risk for autism, adhd, autoimmunity in the future. So we'll have that. And these signatures, they're not. They're not diagnostic. They can never be diagnostic because there's so many other factors, you know, than just then the microbiome too, that we have to look at, especially as our kids get older. But they are like, again, like that, Ana. They are that canary in the coal mine. Something's going on. We need to look at this now. You know, what might we see? I mean, we know for kids with autism, we may see higher levels of clostridia that need to be treated, right? Because Clostridia. Why Clostridia? Clostridia is more likely to overproduce and have children have an overabundance of propionic acid, which in rat studies at UC Davis, propionic acid was shown to induce autistic behaviors in rats. And when you took away the propionic acid, those behaviors normalized. You know, is with, with streptococcus in the gut, I don't want any factor in a child with pandas to really continue to trigger and perpetuate and that autoimmune and neuroinflammatory reaction. And, you know, we do see for kids with pandas, somet sometimes it's not the strep throat that is the problem. Sometimes it's the perianal strep infection that is, that is the thing that keeps coming back. Right? And so, yeah, we're not there yet. I think that is the wave of the future to be able to look at a microbiome. And now I can, you know, look at a microbiome and see, oh, okay, so low bifido, you know, probably going to have sleep problems or low Akkermansia, you know, probably going to have some metabolic, you know, imbalances. But again, those are. Those are clues and, you know, signatures, but not diagnostic.

So while we're talking about the gut, we know that a lot of our neurotransmitters also are produced in the gut. It often seems that people jump from I have anxiety or I have depression kind of right into let's test and address neurotransmitters without really exploring the root causes of why we might have those imbalances in the first, first place. There's also some debate about whether or not looking at neurotransmitters in urine or blood even represents what's happening in the brain. So what are your thoughts on neurotransmitter testing? When does that make sense in the timeline of your patient care and what are some of the root causes that we might want to explore and address before getting into neurotransmitter optimization?

Yeah, you know, I don't do neurotransmitter testing anymore. I mean, years, years ago I used to do some urine neurotransmitter testing, but I don't, I never. Not that it, it may be useful, but again, as you said, it may not necessarily reflect what's going on. I will say it's, it's fascinating. I mean I have kids with, and even blood markers, I do check a blood serotonin because sometimes with kids who already on an antidepressant, you know, maybe they're on anti anxiety med, maybe they're on Lexapro already and it's not helping. And so then I want to know what things can help move the needle with this child in front of me who's coming because they're on medications and they're not improving. And so if they have a blood serotonin level that is like nil, then you have to presume, even if, you know, a psychiatrist will say, well, we don't know what that means for levels in the brain. Well, if your blood has none, how can your brain have adequate levels? Right? I mean, it just, it makes sense. And then, I mean, most psychiatrists will not be willing to have a child take something like 5 HTP to, you know, boost serotonin levels if they're also on an SSRI medication. So then what do we do? Well, we have to look at the root cause. We know that's, you know, 80, maybe 90% of serotonin is made by our gut microbes. You know, 50% of dopamine by our gut microbes, acetylcholine, GABA made by our gut microbes, microbes, Melatonin. And however, we need healthy gut microbes, we need those species, those strains of lactobacillus and bifidobacteria that actually produce these neurotransmitters that are actually postbiotics, right? These, these neurotransmitters especially, you know, let's say, you know, gaba. I mean, you can find GABA in kombucha because it's a postbiotic, it's a post fermentation product. But we need to have that healthy gut microbio. So when, so then I always start with a stool analysis for kids who have any, you know, neurodevelopmental concern. I also want to make sure that from a nutrient standpoint, that they have the substrates to produce those neurotransmitters. So you know, they're getting enough protein in. They have the amino acids that are the building blocks. They have their B vitamins, which interestingly most, most B vitamins are. Many B vitamins are going to be made by our microbes. So we need healthy microbes that have high vitamin producing capacity. And when I look at some stool analyses and you know, a child comes in with anxiety or depression and has low vitamin B9 or folate producing capacity in their microbiome, low B12 producing capacity in their microbiome, well then I definitely wanna look at levels if I can. Blood tests are sometimes, you know, a little tricky to get in children. So then you can use, look at your urine organic acid test. Look at the fig L aminoglutamic acid for folate need. Look at methylmalonic acid for B12 need. Because then, you know, if they don't have those substrates, we're not gonna have healthy neurotransmitter levels either. So there's so many factors that go in, but you know, anxiety, depression. We have to also not just look at the, at the lab data, but we need to step back and look more holistically at what's going on. And you know, that is really, you know, as, as a clinician, as a practitioner, what, what's the right way to say this? I think in functional medicine, I love functional medicine. I'm a functional medicine pediatrician. I've been doing this for 20 years now. I will say one of the things that as that functional medicine has not done the best job with is really stepping back and saying, look, your patient in front of you is not the sum of their lab tests. We are relying so much on individual lab markers and we get this urine organic acid test or this microbiome analysis and we give it a vitamin for this imbalance, a probiotic for that imbalance, and all of a sudden we're left with, you know, 50 million supplements and, and not then stepping back and looking at, well, what are the, some of the most important factors for anxiety and depression? Yes, it's the microbiome, but it's also, are they lonely? You know, are they connected with other people? Are they sleeping, you know, what ultra processed foods are in their diet that are also wreaking havoc on their, on their microbiomes. So you know, for, and for teenagers and children, we, we must look at the impact of social media and screen time on their mental health. So you know, it is a global holistic picture. But Then we can see what's going to move the needle. You know, I had one child who, you know, once we were able to really get a handle on their social media use and understand that that was one of the big factors, their, their anxiety all of a sudden. Not that they weren't an anxious person, you know, baseline to begin with, but they no longer had clinical anxiety. So, I mean, there, there are just so many other factors.

Another thing that I commonly hear is, I have this SNP or I have that snp, I'm broken. I won't get. Well, adults certainly have that focus. Sometimes parents look so much at the genetics. So how often do SNPs or single nucleotide polymorphisms determine outcomes? How much of a focus in your practice and clinical care do you put on SNPs, and what portion of our genetics represents potential versus being truly deterministic?

You know, when we think about our, you know, genes, our SNPs are a teeny, tiny little, you know, sections of our genes. And I'm going to be honest, I don't really do a lot of SNP testing in my office. I used to do more. Now I am a little bit more cautious with SNP testing because I want to really assess how a parent or a child is going to receive that. And I do a lot of education beforehand. Because your SNPs do not set your health history in stone. They do not set your genetic history in stone. We know so much more now about epigenetics, and if we use these SNPs to empower us to know. All right, these are some of my risk factors. I may need more methylation support as I get older, but it's not gonna set in stone that I'm going to get, you know, heart disease or anxiety or diabetes or whatever other things, quote, run in the family. That's the other thing too, is, you know, I tell kids, it's so important for kids to understand that just because, you know, 10 past family members, everyone on dad's side has, you know, type 2 diabetes, it is not set in stone that you will get diabetes. In that case, understanding your SNPs and saying, oh, this is where we can intervene for. To really empower ourselves and make our genes work for us instead of against us can be really great knowledge. But yet, yes, I do see a lot of, you know, families coming in and saying, well, you know, I have MTHFR and blame that on every single ailment in the world. And I let people know, Look, I have two MTHFR SNPs. Right. I don't have any particular health concerns as far as I know. And yet I know I need to make sure that I'm, I'm living and eating in a way that supports healthy methylation.

Right.

But we have, so we have so many redundant systems in our bodies for methylation that just because you have the double C6770, the bad one doesn't mean, I mean I've, I've had kids come in and adult parents where we've checked and they do have, they have the bad MTHFR SNP's. And yet when we check their methylation, the malonic acid, when we check their fig lube, they're perfect, right? Because they, they are able to, you know, use other systems. So again, it's not. If we can use SNPs to understand that this is, this shows a relative risk, it also shows what we can do proactively to reduce that relative risk, then that's amazing. But if we are going to sit there and have worries that this is, this means that I'm destined or my child is destined to have a poor health outcome, then, then I wouldn't do it because then that worry can, can actually be more inflammatory than, than not having that knowledge at all.

And I think sometimes the way we internalize that brokenness probably has more epigenetic influence over the expression of our genes than that SNP would have anyway.

Oh, I, I love that. Scott, I'm so glad you bring that up because I mean, let's, let's look at pregnancy and epigenetics during pregnancy. We know how much, you know while a woman is pregnant, what happens while during pregnancy and in utero sets that epigenetic stage for your child for later risk for things like, you know, diabetes or anxiety or whatever it is. It's not to discount some of the incredible stressors that we undergo. You know, for me as a parent and as a, as a pediatrician, I do not feel that I am serving kids and families by just, you know, sharing all of the statistics and the research and painting a picture of doom and gloom. We have to have proactive solutions. And you know, I want families to move forward with hope. Not that it's. Everything's going to be a quick fix. It's a long journey for many, many kids and adults. Right. And there are many ups and downs. So it's not going to be a straight path to healing. There's going to be a lot of twists and turns. But we have to know that healing is possible. We have to have this vision that we can be healthy if we're going to reach that state is so important. And, you know, you know, mindset, the. The power of mindset, you know, not to be Pollyanna, but, you know, there's a big study, it's called Project Ice Storm. And in Canada, there was this. It was considered one of the worst natural disasters in Canadian history of families. People were starving. I mean, it was just so. There was no access to food. And the conditions were really bleak. And these researchers interviewed and looked at women who are pregnant during Project Ice Storm, and it was a hardship for so many. Right. What they found was despite the objective hardship, so you could have two women had the same objective hardship when women had a more positive mindset, could see some silver linings, let's say, right. Their babies did not have then the epigenetic imprinting for increased risk, risk for an abnormal, you know, HPA stress response and, you know, anxiety compared to the woman who, you know, viewed subjectively that the event was also horrible. And we saw that in the pandemic too, that, you know, that the worry about things, you know, really, really did contribute to some worse outcomes. Not that, you know, not that you could wish your way out of. Of poor outcomes, but. But it does matter, you know, how we think and how we view what healing can mean.

You say that increased intestinal permeability or leaky gut is involved in many persistent childhood conditions, including eczema, Crohn's, celiac food and pollen allergies, migraines, IBS, juvenile arthritis, autism, type 1 diabetes, ADHD, Hashimoto's, obesity, and now multisystem inflammatory syndrome in children. MIS C resulting from COVID That's a long list. Some of my favorite tools in the intestinal hyperpermeability support realm are things like butyrate or tributerin x megaspore, BPC157, the ion biome, Ion gut product. What are some of the things that you use in kids to help address and support their intestinal permeability?

Yeah, you know, the trickier thing with kids is, you know, until kids can learn how to swallow, it can be really challenging to get in supplements. You know, it's not impossible, but when you're opening up capsules, trying to mix it into a smoothie, you know, give it in different ways. I mean, butyrate just tastes terrible. There's really, you know, I've. I've asked, you know, as I really, you know, look to find kids microbiome products that that I love. I'm gonna say honestly, over the years I haven't found any that I really, really love. So I've been talking with different supplement contract manufacture. See, hey, can you make this for me? You know my, my wish list and I've asked can we put butyrate in because it's such an important postbiotic and, and gut protector and, and brain and immune protector and I mean across the board they're like, there's no way to make it taste good. There's just, it's, it's horrible, right? And so it's, unless you can swallow, I would say it's, it's going to be a little tricky. I've had kids who don't mind the taste of whatever, you know, parents make. And I would say if you, you know, try to mask a more kind of bitter, pungent supplement in a smoothie or something sweet is probably going to less work less well than maybe putting in some mashed potatoes or something a little savory, right? So with increased intestinal permeability, I would say the things that have moved the needle the most for my kids are two things. So sbi, serum derived bovine immunoglobulin. Many, many kids do really well on that. Now why is that? You know, if they, and even if they don't have necessarily these gram negative bacteria like Klebsiella or Citrobacter that produce more endotoxins, we know that, you know, Candida and even Strep can have endotoxin like compounds that they're secreting. And so SBI will bind to those endotoxins before they can enter the leaky gut. They bind before they can, you know, really degrade that mucus layer on your intestinal lining and further exacerbate leaky gut. Prebiotics as well are really, really helpful. Now when we're thinking about the leaky gut and supporting the mucus layer, you know, that's where something like Akkermansia muciniphila comes into play. But, and there are many Akkermansia products on the market now. But it can be, I will say, you know, that I don't know how well those supplements alone will colonize the gut. And so I do think if you use a prebiotic that supports Akkermansia. Now Akkermansia really loves to feed on pomegranate. So taking a prebiotic with pomegranate extract can be really helpful. Now we can see a lot of, even in adults, many, many health concerns and gut dysbiosis related to a loss or decrease of Bifidobacteria species. So that's what I focus on more now is really making sure bifidobacteria is at healthy levels. And, and because when you have healthy levels of bifidobacteria, that's going to support Akkermansia and Faecalibacterium. So Facalibacterium prasnitzi and Rosiburia, those are two primary butyrate producing species in our gut. And so we don't have Faecalibacterium and Rosa buria probiotic supplements readily available. So what can we do? Well, we incredibly increase Bifido because they'll call in Faecalibacterium and they'll call in Rosa Buria to say, hey, come live with me. And so with bifido it's not just a matter of throwing in bifido. Bifido need particular prebiotics. So yes, you need the prebiotics, the fiber and phytonutrients, but they're going to thrive on HMOs. So human milk oligosaccharides, these HMOs are, you know, are the breast milk is chock full of HMOs that specifically feed Bifidobacter. And now we actually have manufactured HMOs that are analogs to, you might see 2 FL, 2 ficosa lactose, which is the primary HMO in colostrum. And I'll have to, you know, there's 3 FL, there's LNNT. So you can get these as supplements now and then. And there's some research now on using these HMOs not just for babies but for adults with IBD and you know, older kids and adults for mental health concerns with, with great benefit. So what's the product? I mean people want to know what product I'm looking at. So Layer Origin has an HMO product. They have one that's called pure HMO, that's just two FL, but they also have a five HMO blend because there are many, many different HMOs in breast milk. So they have a, it's called a super HMO for kids and a powder for infants. Begin Health has a powder that has two Fl and oligofructose. So an inulin prebiotic from that can be used for the whole family. I actually, I've had kids do very, very well on metagenics has a powder, a protein replace a powder called Ultra GI Replenish that has two ficosa lactose in it and it has a particular form of glutamine that is may perhaps, you know, serve the small intestinal lining better than straight L glutamine. As far as probiotics go, you know, that's a tough one. You know, there's, you want to use strains that are really beneficial and also clinically shown to restore the gut microbiome after things like antibiotics or disruption. And there's pediatric studies lag way behind adult studies. Now there are some strains that have been found to be helpful and you might find those in, I think probiomed from Designs for Health has some of those strains. Orthobiotic has some of those strains. So, you know, I have, I try to rotate those around. The spores, I think are really not a lot of pediatric studies. I think Megaspore is a great product. But, you know, the Megaspore kids. Yeah, there's some data now there's more in vitro, you know, on helping the gut lining. Nothing in pediatrics specifically. So I kind of am waiting to see. Because the thing with probiotics is now I will say what's shifted the most in my, in the past 20 years of doing this is I used to say that everyone should take a probiotic every single day. Well, I've shifted that now because we can see in some of the stool analyses that when you give certain pro, you know, probiotics too much for too long, sometimes you'll get colonization of just those species. But what about all the other thousands and thousands of species that we want so they can overtake and sometimes that's, that can be too much and not.

Really serving removal of offending sensitive or maybe allergenic foods can also be another way to address and support leaky gut. But my observation has been that if you run four different food allergy tests on the same person, the results don't usually seem to align. So how do you assess the potential for food triggers in children? And are there some non negotiables that you always suggest avoiding like maybe gluten or a one cow dairy?

Yeah, you know, I will say I, I don't think I have any absolutes, but I do really, really want kids while we're trying to heal their leaky gut to do a trial of gluten and dairy elimination. And why is that? I mean, many know that the gluten proteins, they can directly trigger zonulin release, meaning they can directly trigger leaky gut. And this is even in a, in non celiac patients. And you know, Dr. Alessio Fasano that you mentioned, you Know, is, has done a lot of work on this. And so I think really while we're healing, removing the gluten and casein, because casein can have similar effects, is really important. We don't want to try to heal the leaky gut while we're on the other side giving factors that perpetuate the leaky gut and then other foods. That's a tough one because as you said, the tests are so varied and then all of a sudden, you know, you'll have kids or adults who are eating five foods, foods and you know, just narrow, narrow, narrow and so stressed about what they're going to eat. And I'll tell you, for children, that's even more stressful, right? For the kids and for the parents. And then you have to think, are they now then getting the nutrients and the polyphenols from their foods that they need to heal the leaky gut. So I am not for restrictive, you know, super elimination diets. However, there are some tip offs. If a kid is craving a food, that's a sign that they are having and you know, an immune response to them. So, you know, whatever you crave, they can be really hard to get rid of. But I really want to try to remove that. I, I think that the more important key is to rotate, you know, rotate those foods that, that and try to have as much variety as possible because in, in doing so, you know, if you're, if you're, I see eggs is really, you know, eggs are, can be a big thing too. That's inflammatory. If you're used to having eggs five days a week for breakfast. Okay, well how about we, we do two days a week and on those other days we look to see can we have maybe some, you know, cauliflower waffles or can we have, you know, some, some oatmeal with, you know, chock full of nuts and seeds and dried fruits and really trying to vary it up because then whatever antigens may be exposed in those foods to your gut, even if they slip through that leaky gut, it's not like it's a daily onslaught that.

One of my takeaways from reading your book is that I would love to come eat regularly at your house because you have all kinds of cool things and recipes and whatnot in there. It sounds like a fun, fun place to eat.

Well, and it's fun that my kids are starting to cook now too.

So you talk about some cases in the book that were driven by klebsiella. I know some practitioners use immune modulation tools like the PK mix from the low dose allergen or LDA realm, or the UTI mix mix in the LDI or low dose immunotherapy realm. So just generally, how do we balance the immune modulation versus killing and what are some of the tools that you might use to modulate the immune response that really often is kind of at the core of the symptoms we experience?

Yeah, so you know, the klebsiella that, you know, that is when I was referring to the two siblings who, you know, one had crohn's, the other had crohn's and juvenile arthritis. When we treated the klebsiella in their gut, when we were able to eradicate the klebsiella, that's actually what drove their remission.

Right.

That's what drove their healing. So it can be really powerful. But before the, before the killing, I really want to work on immune modulation and again work on the beneficial flora because if you start with the killing, oftentimes you're going to cause people to just feel so much worse. And if you don't have that foundation, their immune system is going to go right back. And so I don't, I don't use LDA or LDI in my office. I know kids who do phenomenally well with it, but I'm not an LDA LDI practitioner. What I use are different, different nutrients and supplements that can help with the immune modulation. So I'm a huge, huge fan of specialized pro resolving mediators. So these SPMs, I just, you know, I love, love, love SPMs and I think that most people can use SPMs because really living in our modern world is causing immune dysfunction every day. But SPMs are those, you know, those small molecules derived from the omega 3s found in fish oils. So even if you're taking a fish oil, you're probably not going to get enough SPMs in that fish oil to be therapeutic if you have a health concern. So also taking an additional SPM supplement and you can go quite high. So for instance with my, my like an 8 year old with pandas and I might be giving them four capsules twice a day or more. And so you can go quite high. Low dose naltrexone can be very helpful in modulating the immune response and having a healthier immune response. I love Chinese skullcap that's in a orthomolecular product called Inflammablox that I'll have, you know, many kids on. And kids will report that they feel better on that working on the vagus nerve. Really, really important because the vagus nerve is really implicated in that healthier immune response. And we know that, you know, patients who are, are, are ill and you know, heading towards sepsis, when you can modulate and, and improve their vagal nerve response, that's going to improve their immune response. So. And there are a variety of things that, that kids can, I mean, it's harder for, for kids. These vagus nerve stimulators, many of them are not authorized for children. And so I've used different ear, you know, auricular clips to stimulate. But again, that's not something I can recommend for all people because it's not, you know, I'd want you to, to work with a practitioner. But heart math can be helpful. I wear my Apollo all the time and I do think that can be very helpful for I'm wearing it now. I think that can be very helpful for children as a passive way to help engage their vagus nerve.

Let's talk a little bit more about endotoxins or lipopolysaccharides. Do we have a way yet to test for them? We know that things like working on leaky gut can red the amount of LPS that moves from the gut into the bloodstream. But how do we minimize the creation of these bacterial endotoxins? I've heard that some fats, like maybe coconut oil and others could actually increase the impact of LPS or LPS getting into the bloodstream. So what increases or decreases endotoxins in the body and what tools do you use to reduce lipopolysaccharides?

Yeah, so lps, lipopolysaccharides, when they're absorbed through the leaky gut, they're gonna get bound to lipopolysaccharide binding protein. And it's really these LPs, LBP, you know, compounds that are circulating that can then kind of wind up in various parts of your brain or your body and, and cause problems. So LPS is secreted mostly by gram negative bacteria that we've already spoken about. Those Enterobacteraceae family, so E. Coli, Salmonella, Proteus, Klebsiella, Citrobacter. Also some LPS like compounds can be secreted by Candida and Strep species. So I mentioned the serum derived bovine immunoglobulin that sbi as really the only thing that I know of that will bind LPS in the gut lumen before it can get absorbed. And so that in that way we're Reducing the load of LPS in your blood. You can measure LPS in your blood? I don't know how to do it commercially though. I mean, I think it's really more still for investigational purpose. In the stool. Some companies can look for hexa LPS index or LPS producing capacity. So if that's really high, then you know, wow, I have a lot of organisms that have the capacity to produce a lot of lps. It doesn't mean that they are producing, you know, all that lps, but if they're, if it's there and you're having health concerns and signs of a leaky gut, you bet. I'm going to want to work on reducing those micro probes that you know are LPS producers and then, you know, add in a binder. So really important.

And when you say sbi is that the SBI protect from orthomolecular that you're usually using?

Yeah, yeah. The serum derived bovine immunoglobulin. Microbiome Labs has a product too.

Mega igg.

Yep. They were orthomolecular was first on the market. So that's still. That's still. And it comes in a powder. So as well.

You talk about five simple things we can do to increase gut resilience and create microbiome magic. You say we need to nourish bre, breathe, move, drink and sleep to create more gut resilience. And in the book you talk about good decisions and bad decisions in each of those categories. You talk about fiber, phytonutrients and fermented foods as microbiome champions. I want to talk a little bit about polyphenols and using polyphenols to support our microbiomes. We could think about things like bilberry, cranberry, beetroot, pomegranate. You mentioned acai, maybe even, even quercetin. Is it true that we can potentially get too many polyphenols and that that in and of itself can be detrimental to the gut? And how then do you determine which polyphenols might support that patient in front of you? What are some of your favorites?

Yeah, well, so this is fascinating. And you know, when I talk about the five things for microbiome magic, what I'm trying to help empower kids and families to do is be able to make choices that nourish their microbiome. So really framing, how can I, you know, eat in a way or avoid certain things that will continue to nourish my microbiome? So, you know, there's, there's rarely a thing that's, you know, 100% good or bad. So I don't, it's really to move things in a proactive way. But the, the microbiome champions your fiber phytonutrients and fermented foods. Those phytonutrients, the polyphenols and food that give your food all the color are so important. They can act, act as prebiotics to your microbes and your micro, your microbes, beneficial microbes also use those and interact with those polyphenols to then create different substances that really help support our epigenetics. We don't really, you know, a lot of those polyphenols don't get absorbed. We as humans don't really use those polyphenols. It's our microbiome that needs those polyphenols. And so, you know, when we're thinking about supplements, you know, I'm not going to be that helpful with giving supplements because I don't use a lot of phytonutrient supplements. There's one called Phytopri that is I think a pretty good one. But you know, quercetin is an amazing phytonutrient. You know, polyphenol from foods that helps support the gut lining, can help kick out the bad guys, reduces mast cell activation and can and support healthy histamine levels. And yet, you ask, can too much be not so good? Maybe too much quercetin can impact your thyroid function. So, you know, while I do give quercetin as a supplement for kids who are having allergies or asthma or other signs of histamine, histamine reactions, it's not necessarily to do every single day. There are other, you know, polyphenols from, I mentioned polyphenols from pomegranate can support Akkermansia. The polyphenols from kiwi fruit, specifically the gold kiwi fruit, can support phecalibacterium. That's so important for, for butyrate production. And then beetroot, I mean, beetroot is having its day right now, but beets can support the microbes that support urolithin a production and our, in our mitochondria. So again, if we can get that, these from food. Because the other thing too is when we're, when we're purifying out these polyphenols, we're also missing all of the other benefits. There's so many other, you know, fighting nutrients and nutrients from the actual food that I, you know, really like to get it from food, if possible, and then use targeted supplements.

So coming back to the histamine, the mast cell activation conversation, is that something that you commonly see in your patient population and in those people that do have histamine issues, how do we then start to incorporate fermented foods? And then maybe just building on that and I'll let you then run with it. In the book, you talk about creating your own kombucha at home, wondering if maybe somebody has high levels of mold in their home. Do we need to be concerned that they could be fermenting or growing things that are health negating? And with the histamine and fungal potential of, of kombucha, personally, I've generally avoided it, but it sounds like you find it more of a health food, so I'd love to hear your thoughts on that as well.

Yeah. So I mean, fermented foods, you know, just like anything else. I think even with the oxalate issue. Right. You know, it's not that if, if you have an oxalate issue or if you have a histamine issue, it's not that you can't tolerate any oxalates or any fermented foods. You have to think about the load. And this really depends on the person. So, you know, for, for a, a patient who has, has, you know, mast cell activation syndrome, has histamine issues, which I do commonly see in kids, we have to remember that, you know, with, with MCAs, the, the histamine symptoms are gonna often go way beyond the classic allergy symptoms of runny nose, itchy eyes, you know, scratchy throats. And some kids don't have any of those issues. And yet we can see high histamine problems with dermatographism on their skin reflux, which is a histamine type 2 receptor issue. And, you know, maybe, maybe, maybe diarrhea or gut symptoms or autoimmune symptoms. Very often there's a histamine component. So I do find fermented foods. You know, I've even had questions about what about bone broth. You know, is bone broth not good? And bone broth is so healing. So again, it's just going slow and really figuring out what total load can you, can you handle? Because the fermented foods, they're actually, the benefit for fermented foods is really not so much the probiotic content content. That's some of it. Most of it is their postbiotic content that we've been talking about, the butyrate, the gaba, the vitamin production. And then if there Are histamine issues though that really. And parents or kids say, I just can't tolerate. They feel much worse flushing or whatever after the fermented food. Okay, well then not yet. Let's just wait. But then we look to the gut again and there are histamine producing species in your gut that can be elevated. So we want to remove those. There are some like, you know, tiny. Health will look at, you know, your load of histamine production capacity, you know, your species. And if that's really high, okay, then maybe we want to switch over and use a low histamine producing probiotic like Seeking Health's probiotic. Histamine X or custom probiotics has their, you know, their D lactate, you know, probiotic powder and capsules. So using, using that as your probiotic. I do, a lot of my kids do well on Dao enzyme supplements. So there's Zymogen, has their Histao designs for health, has Histogest, Seeking Health has their histamine digest. So yeah, there are. So it's basically the Dao enzyme right? Now when you're talking about Scoby's though, making kombucha, I mean, if you've never made kombucha, it's super, super fun. But if your house is moldy, I agree there could be some concerns. Right? But you know, there's, it is fascinating to get your scoby and then watch these babies growing. I mean there's, it's just, it's the coolest thing. And you know, I made kombucha in my daughter's third and fourth grade class and they were all like, what is that? And we're fermenting the kombucha, the first brew, and then we did the second brew and added, you know, different organic, you know, fruits and vegetables to it. But yes, I mean, Scoby, Scoby is a symbiotic community of bacteria and yeast. So if you are very sensitive to yeast, yeast, you know, and, and you know, have a lot of mold issues, you may not do well with kombucha, right? Not yet. You may need to use other fermented foods that don't have that yeast component in it. So, and again, it's just, it's just to try and see, I would. If you have an area in your home that, you know either, you know, has more mold or you suspect that's a moldy area, don't brew your kombucha there. Store it maybe in the garage, you know, with, with a cover on it and you can tell if it's getting moldy. I had one, one kombucha that lasted for a very long time. And then so sadly it started to grow some old because I wasn't taking care of it. So then you just use a new one.

You have so many great ideas for varying our diets and supporting our microbiomes with food that's healthy, fuels our microbiome and is really enjoyable. I think you make the book really fun. You talk about the whole gut rainbow smoothie. I personally have my morning power shake, which really has been very key in my own recovery. So talk to us a bit about the whole gut rainbow and talk to us about how we can use smoothies to support our health, to support our microbiomes. Are there ingredients that top the list for you as being health supporting and then maybe some that we might think are health supporting but could potentially be problematic?

Yeah. So, you know, smoothies. So first for kids, I just. And adults in general, I think a smoothie as you're doing at. In the morning should be an adjunct. I don't want kids to get most of their food as smoking smoothies and. But it is a segue for kids who are, you know, maybe not liking a ton of variety of fruits and vegetables just yet to make a really yummy smoothie. As a foray to. To get in more of those phytonutrients and get in more fiber, um, there is, you know, when you use some of those powerful blenders, they do break down the fiber quite a bit. So, you know, I would encourage you if, Unless, you know, if you can keep some of the chunkiness, that's going to have some more of the fiber in it. It also doesn't help your kids learn the flavor of unique. Of the these, each unique vegetable or fruit or nut or seed that you put in it. So. So, you know, I do want kids to be involved in making the smoothie to see what's in it. But smoothies for a lot of people mean just a lot of fruit, you know, and some. And some frozen yogurt and then that's it. Right.

Which is ice cream.

Yeah, that's. That's dessert. That is not a health smoothie. When we're talking about whole go rainbow smoothie, we want to think beyond just fruits. We want to. And, and really frankly beyond just fruits and vegetables. We want to get enough nuts and seeds in there, such a great source of fiber and healthy fats. We want to think about getting like avocado in there to get more cream in again, if histamine is an issue, you may need to lower that. Frozen cauliflower. Frozen beets are so great in smoothies. And then we need a source of healthy fats and healthy proteins. I love adding legumes. If you can tolerate legumes, they are the highest source of fiber. Most foods are. Garbanzo beans are easily going to smooth it. These add a little cream to it without, you know, adding a significant amount of flavor. And when we think about oxalates, you know, what is the most common vegetable that's put into smoothies? For most people, it's spinach. Right? Spinach. Handfuls of spinach, which if you have oxalate issues, maybe not so good. Now I do want people to think about the fact that, you know, when you, when you eat calcium rich foods with an oxalate containing food, you can lower the absorption of those oxalates. And so a lot of the. So then focus on, you know, get your nuts and, and seeds in, get your legumes in. I mean, those are going to be more calcium rich. That can lower the impact of oxalates on your diet right in your system. So with the whole gut rainbow, we're looking at not just fruits, not just vegetables, but thinking beyond about how do we get all of our microbiome champions in. And I love spice. We have to remember the spices. Okay, Those, those spices. Chocolate, phytonutrients and like cinnamon, one of my favorite because it helps lower and regulate blood sugar. You know, many, many people with chronic illnesses, even children, have blood sugar regulation problems and insulin resistance. Even if you are slim and fit and look, you know, like an active, you know, teenager, let's say. And, and cinnamon. And many of these spices have antimicrobial properties. In fact, cinnamon, you know, can, you know, has action against klebsiella and citrobacter and streptococcus. And so just getting those in can be really beneficial for multiple reasons.

When I have my Mark Hyman Himalayan Tartary buckwheat pancakes, I kind of justify it by saying, well, it has clove in there, so that's good for balancing my microbiome.

Yeah, absolutely. Clove is amazing.

Plus it's delicious. So let's extend a little bit on the nut and seed conversation and talk about seed oils. I'm seeing more and more people these days really vilifying seed oils, saying that all seed oils are bad. Add I personally disagree and I do add some seed oils to my power shake every day. I also love things like black seed oil. So from my perspective, There are unhealthy omega 6 fatty acids. There's healthy omega 6 fatty acids. I think it depends on whether we're cooking with them, which is not good, or whether we're using correctly processed things for their health properties. So wondering from your opinion, are there seed oils that we maybe should say yes to and might it matter how that oil was prepared and then what we're using it for?

Yeah, you know, I am rarely about absolutes and you are right. There's some seed oils that have significant health benefit. It's really more in how they're processed. And so if we can find, you know, expeller pressed, organic, you know, cold pressed seed oils, then, then that is a better option. Right? For sure. But you know, when we think about, you know, omega 3 and omega 6 balance, the issue here is that most in the, if you're eating a standard American diet, most of us get too much Omega 6 and get the inflammatory Omega 6s. Now there are some very, very beneficial Omega 6s, especially if you have, as a woman, hormonal imbalances, especially if as a child or an adult you have eczema, asthma, you know, atopi, allergies, autoimmunity. So the main omega 6 that is really beneficial and lacking in many is GLA, gamma linolenic acid and gamma L linic acid. You're going to find in black currant seed oil, borage seed oil, even primrose seed oil. It's from the seeds. It's, it can be tricky to find, you know, a seed oil that is not extracted with hexane. I mean, that's one of the issues. Right, but, but then, you know, over the years, as I've treated kids with eczema and asthma and really loaded them up with the gla, that is when, you know, and the studies are with really high doses of gla, you know, for eczema and for autoimmunity, that's when we can start seeing some of the needle move with their immune regulation. So I, you know, I, I do think that seed oils can be an important role in healing for a lot of kids. But you just have to be mindful of how it's prepared.

It shocks me that we still use fdmc, artificial food dyes and colorings. Given all the problems they can create for our health, in some people they can trigger hyperactivity, they can create dysbiosis in our gut. They may even have antimicrobial effects against our good bacteria, but not the harmful bacteria. So from your perspective, Are we moving in the right direction with these health negating additives being removed from our food supply? And why does it seem that the United States is so far behind Europe in addressing the coloring issue issue?

You know, I, I imagine the listeners have a lot of thoughts on this too. Right. But you know, we are so far behind and you know, there are some states, like California, you know, is banned red 40, but so far behind, it's really, it's the food industry. What's fascinating is in 2000, I want to say 2014, you know, Kellogg, Nestle, a bunch of these big, big food companies declared that they were going to remove these artificial dyes from their cereals like Lucky Charms or these like Skittles. And I thought, oh my gosh, wow, that's awesome that they were going to use. The dyes are actually currently used in Europe. Right. That never happened. And of course they made it clear to the public that they weren't removing these because there are any health concerns. But it was more because, you know, the public, public was wanting it. And then they kind of backtracked and said that they weren't doing it because Americans prefer brighter colors. Now if Americans knew how harmful those colors were to their brain, if they realized how, you know, damaging they were to children's brains and how much that could be contributing to your child's sensory, behavioral, you know, attention and focus issues, then we would want different. No parent knowing that would say, well, I want my kids to have those colors. So, and many of them have been shown to be linked with increased, you know, disruptive gut microbiomes and leaky gut. So it is a piece of what we need to understand in choosing packaged foods for our kids.

You talk about microbiome mischief makers in the book, such as food additives, colors, added sugar, sugar substitutes and even glyphosate. I want to talk first about artificial sweeteners like erythritol. Some suggest it has benefits in that it may help the microbiota to create more short chain fatty acids. Others suggest that it may disrupt the gut. So what are your thoughts on erythritol and then what sweeteners are supporting the microbiome and which ones are potentially harming it?

Yeah. So, you know, there, there are a bunch of artificial non nutritive sweeteners and you know, natural kind of plant based non nutritive sweeteners that are on the market in an effort to reduce added sugars. Now there's there really. I have not yet been able to find a paper that shows that using these artificial sugar substitutes, these zero calorie substitutes like sucralose or saccharin or acesulfine potassium actually have the benefit that they intended to reduce the rates of diabetes and metabolic syndrome and reduce our sugar cravings. In fact, some studies show the exact opposite. So you know, many of these lower, like zero sugar energy drinks that kids are drinking or you know, the foods are eating, not really. I mean I, I tell kids I'd rather you actually had some real sugar but just less of it, you know. Now what about, you know, the, the non artificial ones like erythritol, xylitol, these, these sugar alcohols, some of them can cause just GI discomfort. I mean that's probably the biggest, biggest side effect if you have too much. There are some papers, you know, recently showing, you know, looking at erythritol and xylitol, there were same researchers finding that they, you know, were really for adults, you know, maybe more inflammatory. They were poorly designed studies. And I think that we're going to have to really, really look more closely at the data because some of these, like xylitol can act as a prebiotic and can have, you know, have some benefits on the gut. There is, you know, monk fruit may have some benefits on the gut. Lo Juan go. That you'll see. Now sometimes the, the monk fruit will be mixed with erythritol. So you just want to look, you know, if you don't want the erythritol then get the 100% monk fruit. But in my mind, you know, monk fruit is going to be one of the sweeteners. It's know doesn't have the bitter aftertaste that I find with stevia. So and monk fruit really, at least preliminarily does seem like it can help support the microbiome and then just like anything else, everything in moderation. Right. The key is to reduce our sweet craving intensity. You know, the, the, the need for more and more sweets and that. I think the more we move away from ultra processed foods, the more our taste buds will adjust to just wanting a little less sugar, a little less fat, a little less salt.

What's the impact of glyphosate on our health? Can it negatively impact our microbiome? Can it be a contributor to intestinal hyperpermeability or leaky gut? And once we then shift to more organic foods, not that there's not some potential for glyphosate, but there is less potential. So we're shifting to organic foods to try and minimize Exposure, how do we then support the body in detoxifying any remaining glyphosate? Or is that not really critical since it's a water soluble compound? And then maybe talk to us about where do sauerkraut and apple cider vinegar come into the glyphosate conversation?

Yeah, well, the, the great thing about glyphosate, as you mentioned, it's water soluble. We excrete most of it in our kidneys. So if we reduce our exposures, we can actually lower our burden very, very quickly. It's unlike pfas, right, the forever chemicals. There's not a lot of excretion that happens in the urine. And so with glyphosate, many people know that glyphosate was originally patented by Monsanto as an antibiotic. So, well, and I should say more broadly an antimicrobial. So it can kill beneficial flora and in fact there's, it insidiously actually kills your good flora preferentially while preserving things like clostridia and some of the not such good, you know, disruptive flora. So, so that, I mean, we get kind of a double whammy there. And it can also trigger leaky gut. So once we make the shift to mostly organic foods, I know some families, you know, will tell me that they're 100% organic. But once you start eating out or doing any, you know, not necessarily reality for, for many. So choosing from the environmental working group, you know, your, your dirty dozen list, choosing those organic. But then, yeah, many of us are still going to get exposed to some glyphosate throughout the day. So lower your body burden, stay super hydrated. So you're peeing as often as possible, right. You know, you're, you're have the ability to excrete and then probiotics, right? There's certain probiotics, you know, sauerkraut, apple cider vinegar. There is a role because certain probiotics have been found to support the elimination of glyphosate. So I think that's fantastic as far as getting the glyphosate residue off. I mean you can, you can use some vinegar, vinegar just even washing. They found washing under running water, you know, for two minutes can remove much of the glyphosate residue that's on the surface. It's obviously it's not going to do anything if the glyphosate is embedded into, into the plant.

You talk about the importance of drinking enough water in the book, including for supporting bowel movements. My observation is that Many of us drink a lot, but we also pee it out that we really are still cellularly dehydrated. That's also part of the shoemaker biotoxin pathway where we have low antidiuretic hormones hormone. So what are some of your favorite tools for optimizing hydration? That hydration potential of the water we are drinking? Do you like to add anything specific to facilitate cellular hydration? And do you think there's benefits in structuring the water?

Yeah, you know, I don't use a lot of structured water so I don't have any experience with that. I'm really curious to try. But I think, you know, it is interesting though because some of the studies have found that you know, water versus electrolyte water, water were kind of equally hydrating. I think though most of us are lacking electrolytes. So you know, putting in some electrolytes, just getting some trace mineral drops and putting those in many, many electrolyte powders though, which are, you know, really kind of all the rage right now. So much sodium in them and some of them are just, you know, have, have you know, non nutritive sweeteners. And I mean electrolytes are kind of salty, right? They're going to make your, you know, so, so to try to mask them as sweet. A lot of times there are other ingredients that we don't want. So I kind of look more closely at that. But you know, I like to just get some trace mineral drops and put a little in into each water bottle. You know, every cup that you're drinking.

You talk about the benefits of exercise and sleep on the microbiome. I'm curious, how important is it to mitigate or reduce electromagnetic fields in the sleep location to optimize the sleep for a child? Child. Are there specific things that you suggest from an EMF hygiene perspective in the sleep location?

Yeah, you know, for sure. And some people are much more sensitive to EMFs than others, just like some people are much more sensitive to mold exposures than others. But you know, it's, I would say, I mean EMFs go hand in hand with screens, right? So there's that double. It's the emfs and the screens and you know, the bright light from the phones that are really reducing your, your own melatonin production. And so ideally kids would be off their screens for one to two hours before going to bed. For our high schoolers who have homework till the wee hours of the night, it's often not a reality. It's very, you know, very sadly they're on their computers and then they're on their phones. So but even then, really, you know, helping them to reduce their. They're non. You know, they're kind of. What would be the right word? The non necessary. You know, screen time. Use is really important. So you know, use, you can use things like this, you know, the nightlight mode on your computer, on your phone, keeping it out of the room. Really, really important. I just, I don't want kids to have devices in their rooms at all. So that is part of, just as a family. You keep your devices and charge them all in the living room or the, the kitchen, wherever you guys have your charging station, but not in the room. And so, and you know, I've had some kids who were really sensitive, very sensitive. And so then we're looking around to see where the outlets in the room, you know, can we maybe move the bed, you know, to the other side of the room? So it just depends. I mean that may be a part of the sleep hygiene that we look at if kids have sleep disturbance. But emfs for sure a big, A big deal. I don't, I love that you are wired. I don't use. These are wired, you know, headsets too. When I exercise, I have wired headsets. My kids want air pods or whatever and I let them know that that is the one thing that, that they will never get from me because I, I mean it is, I feel so strongly that they should not have any EMF exposure that close to their brains.

Totally agree. Do you ever recommend people put their WI fi router on a timer so that it's turned off at sleep time?

Yeah, yeah, yeah. I mean, in that as if you have kids. It's, it's for the emfs, it is also so that they're not getting on their phones in the mid night and able to do, you know, do whatever they want.

When I was a child, I had so many ear infections and the antibiotics tasted like candy. So as bad as the ear infections were, the upside was getting the candy. And I remember that yellow stuff under the sink. It was always like, oh, at least I get the antibiotics. So now we know how bad antibiotics are for our microbiomes. In the book you talk about peargonium as a tool for many bacteria and viruses. So is that something that's usually administered as an herb? Is it a homeopathic? And how might it be an alternative for things like ear infections without the potential downsides?

Yeah. So Pelargonium cydoides is an African bush herb. I love it. It's my first go to at the start of any, any illness and you know at the start of like a sore throat, a little fever, a scratchy, you know, itchy nose. You don't necessarily know if it's a virus or bacteria. It's probably virus viral to start but you don't know. But Pelargonium pseudoides has been found to have in vitro activity against a wide variety of viruses including the common cold, adenoviruses, rhinoviruses, certain coronaviruses, certain bacteria like Haemophilus, streptococcus influenza virus, Coxsackie virus, mouth virus, herpes viruses. So much activity. I love it. And herb homeopathic both. It's given in a 1x dilution which there is some active component in it' just a homeopathic dilution that's ultra diluted so but it's found in, you can find it over the counter nature's way. They're U M C K A and it comes in tablets or syrup. I use the cherry flavored non alcohol syrup because it's so easy to give to kids. But that, that is my go to and can be great for any of the causative. For most of the causative organisms that can cause ear infections. For things like strep throat, I do use antibiotics but but for the vast majority of common pediatric infections, Pelargonium is amazing.

How often do chronic viruses impact kids? If we're thinking about herpes simplex, cytomegalovirus, Epstein Barr, varicella, Coxsackie in adults with chronic illness, my observation over the years has been that those reactivated chronic viruses do play a fairly significant role for some people but is that less common until they kind of get into their teenage and adult years? What do you think about chronic viruses as a contributor to these persistent conditions?

Yeah, I think it can definitely play a role for my pans Pandas kids, you know herpes 6 Epstein Barr can be common. I don't, I mean varicella activation not going to be that common in kids because most kids have, I mean the vast majority of kids in the US have had the varicella vaccine so. So that's not going to reactivate activate CMB is very common. I see some pans kids with elevated CMB levels but I don't know that that is really the causative factor. But for sure, you know herpes 6 Epstein Barr, Coxsackie can play a role. I'm going to say from my experience it probably plays a lesser role than for the adult populations and you know for instance, for many kids they have not yet been exposed to Epstein Barr, sometimes in utero, you know, or from they may have been exposed but other otherwise, you know, we're kind of not seeing that a lot. Just herpes 6 though roseola, super. It's one of the most common childhood illnesses so you bet many kids are carrying herpes 6 and so that's why that is one of the ones that I always check when, at first, when I'm looking at pans.

We've talked a little bit about prebiotics, probiotics, postbiotics with prebiotics. Do you find that someone that has significant dysbiosis, maybe even Sibo, may not tolerate the prebiotics early on on, that there may need to be some other work that's done first so that they can tolerate those prebiotics and then how do you know when the time is right for the prebiotics, when they're more likely to be better tolerated? And are we at times feeding the bad guys with prebiotics as much as we might be feeding the good guys?

That is such an amazing question and I wish I had a great answer for that because I have, I have combed the literature to find evidence that inulin physical feeds Klebsiella citrobacter, these gram negative bacteria because that is what as I was starting out of functional medicine was told. So I, I look for an inulin free probiotic when patients have these gram negative bacteria because they can inadvertently feed those gram negative bacteria that produce those endotoxins. You know the one of the studies I found looked showed that inulin actually may decrease Klebsiella levels regardless inulin, I mean inulin can cause some GI distress. So I usually start with a prebiotic like now like the HMOs, right? The two Ficosa, lactose and you know, some phytonutrients that are going to be in some of the prebiotic blends as and act as prebiotics. So prebiotics are going to be great to start with because they're going to start feeding the good guys and then I'll move to some of the, some of the killers.

So building on the bifido conversation, Sabine Hazen talks about the importance of bifido. She did some research showing a correlation between higher bifido levels and better outcomes with COVID She also showed that people that were taking ivermectin may have had higher bifido levels as well. My personal experience has been that my bifido levels are very Low. And I've done many, many, many, many, many things to work on that. I also recently heard a podcast from someone who runs a lab that does microbiome testing. Testing that said about 90% of the population that they test now have low bifido and low achromancia. You talked about the two Fl wondering what other thoughts you might have about how can we really support bifido, but also in a way that leads to some longer term colonization and not something that as soon as we stop we're kind of back to where we started. What are some of your favorite hacks for increasing difficulties? Bifido in a manner that will persist?

Yeah, well, I think up until recently, you know, these, these HMOs really weren't available commercially to be used with bifido. And I do see that once, you know, Bifido and HMOs are used to pair together that that colonization improves. So I think that's going to be the most important thing if you're taking a, if you need to boost your bifido, which. Yes. I mean so many adults have like nil. And you know, adults should have less than, than babies. Obviously adults we don'. Bifido, but we need bifido. You know, as, as you said, Dr. Hazan found that, you know, lower bifido levels correlated with worse Covid outcomes for, for infants and children. We know lower bifido can correlate with increased loss of immune tolerance. So they have more food allergies, they have more, you know, eczema, more allergy type symptoms. So that really is going to be my best hack. Just find, get an HMO supplement and take it with your bifidone. See if it, see if that can create and then bifida once it's there helps support a healthier gut lining that then will allow your other like Akkermansia, your other keystone species to come in.

There have been some practitioners that I've spoken with that have suggested that taking too many probiotics could also potentially be a contributor to dysbiosis or to sibo. You mentioned a little bit about the potential to dysbiosis with constantly consuming the same probiotic that we may maybe aren't getting the full diversity. But wondering if you've seen or think that taking too many probiotics might contribute to SIBO in some people as well.

Yeah, for sure. Again, I, you know, I think that, that we need to move away from using probiotics every single day because sometimes you get too much of a good thing and Then, then we get, and then it becomes not so good. Right. So, so really targeting your probiotics maybe for two to three months, months, you know, after, after antibiotic treatment for, I mean, for patients listening who are on antimicrobials. Months. For months, Months, months, months, months. It may be then rotating and just, you know, getting a smaller amount. We don't need hundreds of billions of colonies and you know, more is not always better. But I definitely see sometimes then these quote, beneficial species overtaking your gut flora and then becoming dysbiotic. Right. I mean it's, it's all about the relative balance. We know in babies they should have, have higher Klebsiella and Citrobacter and Proteus to train your immune system. So it's not so much that anything is patently bad or good, it's a relative amount.

And it's interesting because more and more you see research suggesting that even H. Pylori may train the immune system and that these triple antibiotic protocols that are kind of potentially creating more disruption may not always be the right response to something like H. Pylori. I know there's a lot of debate around, around that you say in the book that the top five deficiencies in kids are vitamin D, zinc, magnesium, iron and Omega 3. The only one that maybe surprised me a little was the iron. And I think maybe it's going to be different in kids than adults. I think that in some cases we know iron can be a food for microbes. We know iron toxicity occurs in some people. So how do we assess the potential need for iron in children and how often do they need additional iron and when they do need iron, do you prefer to use foods that are high in iron or exogenous iron supplementation?

Iron levels or hemoglobin levels are checked routinely, routinely checked in infants at the nine month mark because that is when their, their stores or ferritin and iron stores really dip. And it's one of the reasons, I mean, iron and zinc also, you know, tend to dip. It's one of the reasons why animal proteins are now suggesting as some of the first foods for babies, recognizing how low many babies can get in their iron and zinc levels. And so for babies developing brains, iron is critically important. So that's, that's why. And then even for younger kids or teenagers, we can see that low ferritin levels, you know, under 40 can really contribute to poor sleep, low mood, poor attention and focus. So I do think it's different than adults. It's very interesting because as I I mean, I do a lot of blood testing on my patients. So as become older teenagers, I start to see the shifts then where iron can then sometimes get elevated. Not so much the ferritin, but we see iron elevating and then we know, oh, okay now. So there, you know, I don't know exactly what the process is, but it seems that there's a different way that, that children and older teens and adults are utilizing their iron. And so I don't really worry about iron overload in younger kids now. I do like to check their levels though, because iron, you know, can be toxic at high levels. And, and before I give a lot of iron supplementation, I will check their ferritin and iron levels. I do, you know, if I'm going to use a supplement, it's the ferrous bis glycinate form, the quote gentle iron form that's a little more easily absorbed. There's Florida, which can also be very helpful, the iron and herbs, because you need vitamin C to enhance iron absorption. And then I would love for kids to boost their irons through foods, but they sometimes that's challenging to do. So then we'll do a supplement.

Your gut reset program has four phases which are return to the things for the microbiome magic, namely nourish, breathe, move, hydrate and sleep that we talked about. Then seal and heal leaky gut, then eliminate GI dysbiosis and finally transform the gut microbiome. I want to talk a little bit about the glutamine delay dilemma where we may be using glutamine to support leaky gut and at the same time, for some people, that glutamine can lead to higher levels of glutamate, which can itself be excitotoxic. So is that a common concern with glutamine, that it could potentially create more problems in kids than it might be helping? And how often do you see this glutamate excess picture driving their clinical presentation?

I think the glutamate excess, even aspartate excess, if we're checking, you know, the urine organic acid test and we see they're elevated, it can, you know, for, for kids be one of the factors in their anxiety or their ADHD or their autism symptoms. On the other hand, using glutamine as a supplement to restore the leaky gut lining. I will say in my 20 years of, you know, clinical practice, I've had one child that maybe had an adverse reaction to glutamine. Right. It is a theoretical concern, but I just don't see it in practice. And I know I had a conversation with Dr. Nancy O' Hara who is an autism pants panic pandas expert and her population would be the population that we would be the most concerned about this happening. And she also really doesn't see it. So I think it's a theoretical concern. Same thing with strep thermophilus in probiotics. She and I both really have not seen that be a problem for our pans kids. Pandas kids. It's a theoretical concern but again we're not seeing it in clinical practice.

You talked a little bit about some of the microbiome testing that you use. I want to extend maybe into the parasite conversation. We know that for the, the most part parasites are pretty much ignored by the medical profession. Testing is notoriously poor. Wondering how you evaluate and treat parasites in your kids. Are there any tests that you're finding helpful in the parasite realm? And then there's always the kind of add on to that conversation which is are all parasites bad or might some also be beneficial? We know certain parasites particularly, particularly Dr. Nancy O' Hara that you just mentioned uses some parasites to help with immune modulation. So what are your thoughts on identifying, treating parasites?

That's right. You know it's fascinating, you know, thinking about using helminths for alopecia, you know, and autoimmune conditions. So it's the same conversation, right? It's is, is anything ever always bad? I mean just because we see it doesn't necessarily mean it has to be treated. So I always, you always want to look at the child in front of you and go, go with symptoms. Now what are, and so there are symptoms. I mean people will notice the cyclical pattern. So it may not necessarily be on the full moon. Sometimes it's on the new moon that parents, I'll have parents track, I mean they think I'm crazy. But have them track, you know, their kids mood or symptoms or whatever it is their eye blinking ticks or you know, whatever other symptoms. So I go on symptoms. Same thing with yeast. Yeast can be really hard to detect. And, and some, some yeast is beneficial, beneficial in our, in our, and very normal in our microbiome. But if there are symptoms like the teeth grinding, the itchy body, you know, the, the behavioral changes around the time the ticks I often see as a parasite symptom, then I may do a trial, like a three month trial of a parasite protocol. Testing wise we all know parasites are really, really difficult to detect. I think you know Genova with their PCR testing I think does maybe a better job than some of the other tests maybe gi, GI maps sometimes can show, but otherwise I will, I do typically use a combination around the full moon. I'll do a three day course of alinea and then like a week of biocytin and then repeat that for three months and then see what happens. I've had kids, you know, I have one kid who had, you know, just ticks, eye blinking, head jerking, and they were really, you know, much more significant. He had diant amoeba fragilis on, on his stool test, which is sometimes considered commensal, not a problem. But we treated it with Flagyl actually and his ticks immediately went away.

So let's talk a little bit about some of the microbial support tools. You talked about the fact that generally speaking we're trying to balance and replace the good guys, but that there are times when maybe we have to address pathogenic organisms in the gut as well. Why is MCT oil one of your top favorites? And what are some other top herbs or homeopathics that you might use in kids to bring more balance to their pathogenic organisms in their microbiome?

Yeah, so yes, you're right. There's, there's gonna be a time for killers, but you know, sometimes it's a little bit later than, than, than many people will start. So MCT oil, medium chain triglyceride oil that's actually found in breast milk. It's a natural component of breast milk. And so, you know, for the most part, very, very safe and easily tolerated when we're using it as an antimicrobial. When you're older, you just have to start low because it can be, I mean, if you've ever taken like a huge tablesp months and had, you know, some GI symptoms, it may be all those organisms being killed off. But it has broad antimicrobial benefits properties, which is great. I mean, it has activity against, you know, bacteria, against, you know, yeast, against viruses, maybe some activity against parasites. So as a broad antimicrobial, it can be very beneficial. But then, you know, there are times, for instance, I mentioned with parasites, I'll often go with the prescription for Pandas. And if there's strep in the gut, I will go with an antibiotic prescription. If, you know, for kids who have autoimmune issues and they have Klebsiella or Citrobacter, I often will use an antibiotic prescription. Not for long term, but maybe for 10 to 14 day course and then follow it up with herbals Follow it up with MCT Biocidin. I mean the reason why I say biocidin is because it's just so easy to give to kids. I mean the drop proper form.

You have a section in the book where you review common conditions that you see in children and provide approaches for each condition. It's kind of an encyclopedia. Things like diet, lifestyle, herbs, homeopathy, acupressure points, even essential oils for those various conditions. One of them that you talk about is strep and the potential for the development of pandas. Strep can also be involved in some kids with pans which is just a broader definition of pandas. Other triggers or contributors what are some of your favorite go tos for supporting your kids dealing with pandas and pans?

I mean so many different facets, right? Because we have to take a multi pronged approach to pans panness. The first is to identify the causative factor when we need to know or factors. Is it mold? That's you know, the inflammatory factor, what are the infections? And then you know, really thinking then about okay there's the killers but there's the immune modulation really important for our panspanous kids. When I talk with my panspanous kids, the two things that I mentioned before that, that they will tell me where the biggest needle mover are the SPMS and the ldn. So the specialized pro resolving mediators and low dose naltrexone. And then we're also going to give our anti inflammatory, if we can have an anti inflammatory diet. You know, so important to remove the artificial dyes from their diet, the artificial sweeteners, really trying to move away from an ultra processed diet and a more whole foods diet and helping them to make those swaps. So if they're really used to eating, eating, you know, I don't know, Gatorade after every sports game. Well give them different swaps to use, you know, with I mean just plain old coconut water, right. And then you know, trying to really get in for a lot of kids with pans they'll have the eating restriction, right that that is a hallmark, a key factor. So it may be that we're just, we're loading up a smoothie and just having them get whatever they can in their smoothie. You're throwing in some coconut oil, you're throwing lots of nut or seed butters to get in the healthy fats. You're getting in your proteins to really support healing. Mitochondrial support's really important for panspanous kids. Mast cell support is often needed and of course the microbiome support.

I want to talk just a little bit about mold and Lyme. So how often do you find mold in the home or school playing a role in your persistently ill children? Another piece of that I know Dr. Neil Nathan talks about that. His observation has been that a focus on the gut does not work well until you get the person out of the mold and address the mold and mycotoxins that are also impacting the gut. So interested in your thoughts on how often the external environment factors into your work and has to be addressed to really optimize the healing focus for these kids and then extending on that since these often come together. What about infections like Borrelia in Lyme or co infections like Bartonella or Babesia that may be transmitted congenitally? How often are those playing a role in your practice?

So, okay, let's talk about the mold. I do see mycotoxin concerns in kids. I mean many kids will, in a family will often find, you know, maybe it's the mom and one child. So it's not the whole, you know, not all family members are going to be affected by mycotoxin illness. Even if there's mold present in the house, mold in the schools, I have seen that be a factor. Some of those rooms are really old and have had water damage, you know, many, many times over. And so that's kind of, you know, if your kids are really, really sick, they, they may anyway be homeschooling but getting out. I've had a family move to Arizona where it's really dry to try to get out of the molds because they were living right on the water, water here and joint pains, GI symptoms, you know, mood, irritability, all improved once they move there. And it was challenging to really move the needle when they were here. I do think that you can support the gut in a way that can move towards restoration even, even while living or being exposed to that moldy environment. Again, I think it's really, you know, I do think that using more prebiotics in a targeted way can be one of the most beneficial things in, in supporting the restoration of the gut microbiome, even if you're living in an inflammatory environment. Congenital Lyme, fortunately, even for my moms who have been really sick with Lyme or being treated for Lyme during pregnancy, I am not seeing most kids have lime after, after the born, which is really great.

So before we get to our last two quick wrap up questions, there is some debate today about whether or not Covid may persist in the gut. There's some recent research suggesting that Covid may actually become part of our microbiome, meaning infecting the beneficial bacteria and that then our own microbiome leads to some persistent symptoms. Symptoms in persistent or long Covid. So wondering what your thoughts are on how Covid has changed the pediatric persistent illness landscape?

You know, I'm not seeing that as a major factor. I mean the vast majority of kids do well and, and I will say my population is probably more skewed because I have them on SPMs when, you know, when they get Covid and you know, I have glutathione and all the things that help to support a healthier immune response. So I'm not seeing just yet, but we'll have to see because you know, chronic illness is the, the road to chronic il this. Even if, let's say Covid was one of the triggers, it can be years later. I, I am going to be watching that closely.

So tell our listeners more about how they can learn about your book and also become part of the Healthy Kids Happy Kids community and really continue to follow your amazing work.

Yeah, so the book is available anywhere books are sold. So of course Amazon, but Barnes and Noble, Target, Walmart, even your local indie bookstores. So I love supporting small books stores. So yeah, pretty much anywhere you can, you can find books. And the best place to stay in touch with me is@healthykidshappykids.com and just follow me on Instagram. That's where I'm most active. That's HealthyKids Happy Kids.

My last question is the same for every guest and that is what are some of the key things that you do on a daily basis in support of your own health?

I would say the two things, I mean, I guess it's vary through the years but the two things that I'm doing right now really consistently number one is I'm really doing, making my best effort to be in bed by 9:30 because I wake up early. And so sleep is if you can master your sleep or your kids, so many other things will fall into place. And then also when I wake up in the morning I just, I have a five minute, you know, breathing meditation to just kind of set the tone for the day. So those I think, you know, the way you end your night and the way you start your day today are so important.

Amazing. Such a great conversation, so many pearls. This book is amazing. I really encourage people to get the book Healthy Kids Happy Kids and I just want to honor you not for spending time with us today, which I'm very grateful for, but really for putting your life's work and your passion into making kids healthier and happier. You do such incredible work and I'm just so honored honored to know you and just really appreciate and honor the work that you do. So thank you so much. Dr. Song, you're incredible.

Oh, thank you for having me.

To learn more about Today's guests, visit HealthyKids Happy Kids.com that's HealthyKidsHappyKids.com HealthyKids Happy Kids.com thanks so much for listening to today's episode. If you're enjoying the podcast, please leave a positive rating or review as do Doing so will help the show reach a broader audience. To support the show, visit betterhealthguy.com donate to get my newsletter, visit betterhealthguy.com newsletters to follow me on Facebook, Instagram X or TikTok.

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