Episode 70: The Power of Integrative Pediatric Care with Dr. Elisa Song

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Welcome to no One Told Us the podcast that tells the truth about parenting and talks about all the stuff you wish you knew before having kids. I'm your host Rachel and today I'm speaking with Dr. Elisa Song, who is a Stanford, NYU and UCSF trained integrative pediatrician, pediatric functional medicine expert, and mom to two to thriving teenagers. She's also the author of the national bestseller Healthy Kids, Happy Kids An Integrative Pediatrician's Guide to Whole Child Resilience. In her integrative pediatric practice, she's helped thousands of kids get to the root cause of their health concerns and she empowers parents to help their children thrive by integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine and more. And I'm so excited to chat today. I have been loving your book and this is something that I talk about with parents all the time, but I really try to stay in my own lane so I try to like refer out to amazing practitioners like you. But parents have a lot of questions about their kids health and the functional side of things. So I'm hoping that this conversation will shed some light on some things that lots of parents are dealing with today. So thank you so much for joining.

Oh you're so welcome. And I'm so honored to be here because it is true. I mean even for me as a pediatrician, I mean as a pediatrician, having my kids as pediatricians and I was already practicing in this integrative, holistic way. There are so many things that I still wish I had been told. Right. And so you know, getting this information out is so important. So thank you for your work.

Yeah, of course. So I would first kind of just love to hear what drew you to more of an integrative lens and more of an integrative practice. And did you find that a difficult path to go down since you were trained at places like Stanford and NYU and ucsf? Did you feel like that was kind of like a different path than what your colleagues were doing?

Very different. Especially because back then, I mean, I You know, I finished my pediatric residency at UCSF in 2000. I mean, that was kind of a long time ago, 24 years ago. And you know, back then it wasn't even called integrative medicine or holistic medicine. It was called alternative medicine. Right. So we've kind of, we've come a long way. And what drew me to really a more integrative approach, I've always wanted to practice in this way. I didn't always want to be a doctor. I actually thought like I was going to be a teacher, I wanted to work with kids. I actually decided at Stanford I was going to be a civil rights lawyer and work in Washington, D.C. advocating for children's rights. And I went down that path. I mean, I took the LSATs and everything. And then I stumbled upon as a young. Gosh, how old was I? Maybe 19 years old, 20 years old, this flyer for the conference of the American Holistic Medical Association. And I thought, what is that? I'd always been interested in spirituality and mind body medicine. And so when I went, my mind was just blown. I heard from people who were just starting to get known, like Andrew Weil and Deepak Chopra and Joan Borisenko, and I thought, okay, this might be a, a path in medicine that might be appealing because I had come from a very conventional medicine background. I mean, my mom was an obgyn, and I mean, nothing I really saw in medicine was that appealing to me. But I thought, you know, if I could do something like this, then it might be really worthwhile and I could work with children. So that's always informed my path. It wasn't always. I've been blessed to have amazing friends, friends in my pediatric circle who, I mean, they definitely thought I was a little out there and they knew, okay, patients and parents who were wanting a more holistic approach. They knew to send those families to me, but they never judged. And even now, being so much more out there in the world and being more, I guess, open to, more vulnerable, right? I mean, they're just still so supportive. And my family's been so supportive. So I have been really lucky on this path.

That's so great. So do you notice in your own practice that there is a big need for this type of medicine and like a big push for pediatricians to be a little bit more holistic. Because I feel like sometimes it's like by certain groups of people, this type of medicine is kind of like looked at like it's woo woo or not real or all of those types of things. So I'm curious about the types of families that are coming into your office.

You know, it's interesting, I think, because I trained here. I did my undergrad at Stanford. I trained at ucsf. So I know a lot of folks here. You know, I know a lot of pediatric specialists and primary care pediatricians. So they know me. I mean, they've known me from the beginning. They know I'm not totally out there. They know I'm really grounded in the evidence, and I don't do anything that's. I mean, I don't want to judge anything. But, you know, it's more, I think, because of that I've been able to practice in this way and attract families who they. I guess the way to put it would really be the best of both worlds because I do practice conventional pediatrics. I write prescriptions when they're absolutely needed. But I also recognize, and many families recognize, that some of those prescriptions don't come without unintended side effects and adverse effects, especially antibiotics or other medications, even ADHD medications. So they're wanting to know if my child needs medications, how can I help to support my child? Or if is there a way to maybe kind of bolster, build up resilience in my kids? So perhaps they don't even need those medications. So it's really kind of trying to not throw the baby out with the bathwater, because I think when we really take a holistic approach, it can become that way where we kind of shun everything conventional. And there have been so many benefits with our conventional pediatric world. It's just now we have to recognize, look, you know, we're in a place where we, we know better and we need to do better by our kids as, as pediatricians and, and, and as parents, too, we need to understand, you know, some of those unintended consequences of, of the conventional pediatric model.

I love that so much because, yeah, there does seem to be kind of this divide, right, where it's like one, I guess, side is vilifying the other. It's like conventional medicine versus more holistic and natural stuff. And there are so many great benefits to both. So I love that. And I love that. You also mentioned that you don't always go straight to medications. Because I know as a parent, like, I, you know, I just go to Kaiser here in San Francisco, and we love our pediatricians. They're, they're great. We've gone to some other, like, smaller practices as well. But it does frustrate me as a parent when I bring in my child for a concern and they're barely looked at before a prescription is kind of thrown our way. And when I question and say, is this really necessary? Do we have to go right to this right away? Is there any other option? I feel like there's like this annoyance from the doctor sometimes where it's like, oh, just do what I'm telling you, please. Or like, oh, just take it, it's fine, it's safe. I don't know, I guess I just wish that there was a little bit more of a dialogue and a back and forth understanding of like, I'm not against medicine, I'm not against conventional medicine, I am not against medic, I'm not against vaccines. Like, I think that there's a place for all of those things. But I just want to feel informed as a parent too.

And I think what parents want now, it's a very different time than when I grew up. And I remember my pediatrician, I mean, super nice man and he was great. We saw him from the time we were babies all the way. I mean, I remember going back, coming back from college and having my checkups with him until he finally booted me out the door. But, you know, it's different. We didn't question, you know, anything that the doctor told us. And it was much more of an, kind of an authoritarian sort of a relationship. And I will say, you know, even a paternalistic kind of a relationship, it really wasn't a collaborative team approach to healthcare. And now I think as parents, that's what we are seeking and that's what we should seek. We should seek a partner in health for our children. Not someone who is just going to say, well, you know, just do this because I told you so and I'm the doctor and I think most doctors are not that way nowadays. But the problem with the current system is time is really against that collaborative approach. I mean, when you've been to. I remember being in urgent care moonlighting, you know, as a resident or even shortly after residency. And I mean literally. And I think this was actually at Kaiser, I had like a six hour shift from like, you know, 4:00 clock till 10:00 clock at night. I literally didn't get up once to pee or have a bite to eat or even drink a sip of water. Because I was, I mean, I would see the charts piling up on my desk and I would have maybe five minutes to see a patient. I mean, in five minutes, even if you want to have that collaborative discussion of, you know, well, maybe we can wait and watch for this Antibiotic. Here are the things to look for. Here's when you should start. Oh, and you know, if you do take the antibiotics, we know what that does to your child's microbiome, biome. Here are the things to support. You can't do that in five minutes. So I mean, there are, I think it's really a lot to do with the system and that does have to change, unfortunately, before we can have a truly collaborative, personalized approach to our children's health, which is what we as parents should be asking for and which is, you know, really what we should be demanding of our healthcare system.

Yeah, absolutely agree. We're going to take one quick break here and when we come back, I'd love to speak with you about something that I see all the time in my sleep and lactation practice, which is nutritional deficiencies and vitamin deficiencies. We'll be right back.

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So one thing as a sleep specialist and you know, we see parents all the time who are having really acute sleep problems, sometimes feeding problems. Going along with those, you know, we always refer out and have them get work that's necessary to be done. But one thing that we do notice all the time is that lots of these babies who are and toddlers who are struggling with things like sleep or, you know, behavior or all kinds of things. One thing that it often comes down to is a deficiency of some sort. So I would love for you to give us your perspective on some of the most common deficiencies that we see in little kids and babies like iron or vitamin D and how those can actually affect sleep.

Yeah, well, what's interesting is, you know, when we're thinking about a baby and you're seeing, of course, newborns and you know, with for nursing support. And also of course, along with that oftentimes comes sleep support. And so what's fascinating now is we know so much about how and infants developing gut microbiome can impact their sleep, their temperament, their moods and their behaviors. And that starts from the moment they're born and really kind of lays the foundation for what may happen in your toddler years or when your kids are school age or teenagers. And one thing that correlates with that really quote, fussy phase or the colicky phase is an abnormal balance of bacteria or microbes in your child's gut microbio. And that can also go along with, we can see certain signatures of microbiome patterns in your baby that can predict, oh, maybe this baby's microbiome pattern is not the most conducive to restorative sleep. And so one of the things that I will look at for babies who really are having trouble sleeping in those early stages or even in the later stages in life, but in those early stages is really how much of the beneficial bacteria do they have in their gut microbiome. This is really important. There is a classic kind of a general species of bacteria, beneficial bacteria called bifidobacteria, which many people are familiar with, and that's so important to lay the foundation for healthy sleep, healthy immune development, healthy brain development. And we know that over the past century or so, our babies, even our breastfed babies, are slowly losing their percentage of bifidobacteria in their gut microbiomes. And babies in reality should have maybe 80% of their microbiome made up of Bifidobacteria species. Now, breast milk is uniquely designed to feed the bifidobacteria. There's all these amazing prebiotic substances called human milk oligosaccharides. And so that feeds specifically that bifidobacteria. And we have that healthy bifidobacteria. It trains your baby's immune system to build tolerance, have lower risk for food allergies and eczema and asthma and even hay fever later on in life. So that's one of the first things I look at. So now is that a nutritional deficiency? Not necessarily, but it is a deficiency, this loss of bifidobacteria. And so if we can really optimize that now, of course, breast milk, again, those HMOs that are really chock full in breast milk, that's One of the best ways to support that bifidobacteria. For moms who are only able to maybe partially nurse or for whatever reason unable to fully establish breastfeeding, there are human milk oligosaccharide products. Like there's a 2FL product on the market now that can be a helpful addition even for breastfeed babies. Sometimes it is. And of course, there are infant probiotics that have the bifidobacteria. So I'd say if you have a fussy baby, a baby who's really not sleeping through the night, who seems to have the tummy issues or curling, scrunched up when they're trying to poop, or they're screaming and arching their backs and maybe having a little spit up or a lot of spit up, looking at their microbiome and supporting, that can be very, very helpful. Now, when we think about, though, the sleep, I mean, let's think about sleep because that's our number one. We want our kids and our babies to sleep, especially as kids get older. What I look at is, is what are some of the nutrients that can impact sleep? And one of the most important is magnesium. We know that magnesium is a very, very common nutrient deficiency in both children and adults. And for my kiddos in the practice, oftentimes when I have the opportunity, I will check lab work. And this is mostly blood work. But not every family has a pediatrician who's able to, who may be willing to order lab work. And then again, you know, thinking about doing blood work in kids, it's not a small deal.

No, it's not fun.

Yeah, no, I mean, we have to be prepared for that. And we can make it very smooth. And I encourage you to think about how to, you know, we can talk about that as well. But magnesium, what are some of the signs that your baby, your child, your teenager might need more magnesium while having trouble sleeping? Right. Falling asleep or staying asleep, that is a very, very common symptom. Having constipation. So hard stools, I mean, that's definitely to me screaming out, okay, this baby probably or child needs more magnesium. Headaches also can be a feature for magnesium deficiencies. Magnesium is responsible for relaxing our muscles. So any, you know, any muscle cramps, you know, your teenage athletes who really cramp up while they're playing sp or after sports, if you wake up with muscle cramps, I mean, we know for a lot of moms while you're pregnant, you'll have those cramps. I mean, think about magnesium and potassium, right? But magnesium Also, you know, anxiety, right. Magnesium is a very calming, calming mineral. So anyone who's having trouble with managing stress, you know, quieting their mind for bed, quieting their mind before heading to school, you know, we're now, as we're interviewing right now, it's back to school time. And a lot of kids have back to school jitters and worries, you know, no matter what age they are and how long they've been in school. And so sometimes just giving a little extra magnesium during this time can be really, really supportive. Another time that I think of magnesium and, you know, really helping our kids out is if they have any problems with, with wheezing, you know, if they tend to wheeze or have lung muscle spasms. Remember, magnesium relaxes muscles. So the muscles around your lungs, your small lung spaces, the bronchioles that spasm when you have a cold and cause wheezing or when you have allergies, that can be really, really reduced by having enough magnesium on board. When we think about our older kids, our teenagers, anyone with period cramps, magnesium can be really helpful. Or as a mom, once you get your period back after your baby's born, you're like, oh my gosh, I forgot about those cramps. Then magnesium can be really helpful. And you don't have to write furiously down, guys, in the book, in one of the last chapters, I put down a list of these clinical clues, these symptoms that can appear if your child may need more of these particular nutrients. So as you go through the list of magnesium, if you're like, check, check, check, oh my gosh, you know, my child is all of these. These are, I have all of these, then that's a sign. Hey, let's either focus on hopefully getting in more magnesium rich foods and if needed, maybe try a supplement.

And one thing that has been going really viral on TikTok recently, and maybe it's just my algorithm is showing me this stuff, but to me, it feels like every other video I see is about this magnesium lotion or magnesium magnesium sprays. And I get clients asking me about this stuff all the time. And I'm not really sure what to say because I am not a doctor and I am always very hesitant to recommend supplements because it's just outside of my scope. But I would love to hear what you think about things like topical magnesium, particularly for really little ones like babies and toddlers. Is there a risk? Is there a benefit?

Yeah, you know, I think, I mean, of course, your skin as one of our largest and most absorptive organs, anything you put on your skin will get absorbed through your skin. So we want to always be mindful of what we're putting on our skin, especially our baby skin, and using clean products that don't have, you know, parabens and that, you know, ideally aren't going to be loaded with, you know, artificial scents and all of those endocrine, you know, hormone disruptors that are ever present, unfortunately, in America and sold skincare and cosmetic products. So you want to look for more clean products. But then, you know, magnesium spray, magnesium oil, those can be helpful. You know, I actually, I have to say I haven't measured magnesium levels in the blood before and after to see is that enough? And even, you know, there are vitamin patches. I have to say, you know, that I'm not sure how effective those are in terms of raising your blood magnesium levels, but I think they can be helpful. I haven't seen any wows with them. I don't know. With babies, I always start really low, small amounts and go up slowly. And when we think about the sprays and the magnesium oils, they're not like massage oils that we're thinking of. They don't go on smoothly on the skin. They typically use magnesium chloride, which is a magnesium salt, and they're kind of sticky. So I've had kids use magnesium spray or put magnesium oil on at nighttime, especially if they're not. If they are a little bit more on the picky side and don't necessarily like taking the magnesium supplement. We've used some of the magnesium topicals, but they're not something that, as you lay down and snuggle with your kid, you can massage on their back and just rub their back to sleep. It's just to apply a little bit and kind of leave on at least the ones that I've tried. Another way to really boost your magnesium levels, though, is with an Epsom salt bath.

I was just gonna ask about that. Yeah, I do that with my kids all the time.

Yeah. Yeah. I love Epsom Sal. And Epsom salts are magnesium sulfate. So they actually have multiple benefits for our kids. The magnesium is going to get absorbed. I've had kids who take a nice, warm Epsom salt bath and have histories of constipation, and they're able to poop right after. Now that's also. You're relaxed. Everything just kind of calms down in the bath. But the magnesium also really helps, too. And then the sulfate in the magnesium sulfate salt will enhance the production of something called glutathione in our bodies. And glutathione is what's considered our master antioxidant. Helps with supporting detoxification and immune support, getting over viral respiratory infections. And so there's a lot of benefit for magnesium. When kids are wheezing, one thing I'll do is have parents just immediately draw an Epsom salt bath, put them in, because the magnesium and the glutathione just helps calm the lungs and can help really reduce that wheezing episode.

That's really interesting. And so when you say wheezing, does that mean, like, kids who are asthmatic or if they're sick or just if they're wheezing because of an unknown reason or.

All above, all of the. Above all of the above, because the mechanism for wheezing is that spasm in your lung muscles. So whether it's triggered by hay fever, like an allergy to dust mites or pollen, or if it's triggered by exercise or a cold, or maybe they've been diagnosed with asthma, and, you know that a cold always triggers it. So they're starting to get a sniffle, and you'd hopefully like to prevent them from going down a big path of, you know, needing a ton of inhalers and medical treatments during that cold. You can start Epsom salt baths right away, you know, even at the beginning of the cold. Now, I would still use their rescue inhaler, you know, as directed, if they need it. It's not a replacement, but it can help to reduce the severity or just in that moment, if they're really wheezy and you're, you know, you're getting. Setting up your nebulizer machine, well, go ahead and draw the bath and then do the nebulizer, you know, while they're in the bath and just kind of letting everything help. Help calm their muscles down in their lungs.

Okay, that's really interesting. What about iron? Because this is another one that we see a lot of, particularly with babies and toddlers, specifically ferritin. So what can you tell us about iron and. And the impact of iron and ferritin on everything, but particularly sleep, too?

Yeah, well, you know, iron is so important for baby's brain development, and it is one of the more widely recognized nutrient deficiencies in children, especially, you know, right around nine months of age. You know, many babies will have, if you go to your pediatrician's office, may have their little prick, a little finger prick, or a little toe prick to check hemoglobin. Hemoglobin is a measure of, you know, anemia. And there are. There are Various reasons, but the most common is going to be iron deficiency anemia. You can also have anemia from B12 deficiency, but in infants, when we look at low hemoglobins, it's usually because they're not getting enough iron. And what happens at that point? Iron stores start to become more and more depleted, and babies reach a low point of their iron stores and also zinc stores right around nine months of age. And so then we want to make sure that they're getting in enough food sources of iron and sometimes even need an iron supplement. That's actually why now it's very different from when I was first in training in pediatrics. The recommendations for first foods includes animal proteins because they are richer in iron and zinc. So we don't wait to start those until nine or 10 months, which is what I learned in training. We can start those right away. Some of the first foods. And so when we look at iron in our body and how sufficient your child is, we look at hemoglobin, but also ferritin. And ferritin is a marker for your stores of iron. So what is your iron reserve? And you can have a situation where you have low iron stores but. But have totally normal hemoglobin, so you're not technically anemic.

And we see this a lot. This is why a lot of times clients will come back to us and say, oh, my doctor said that the iron's fine because their hemoglobin was normal.

That's right.

And they're not doing the full panel.

Yeah, yeah. And that can be the case for moms. Right? It's often the case for teenagers, especially teenage girls, where I see they're not. Not technically anemic, but their ferritin is either at the bottom of the normal range or they're just outright low. Right now, when we think about ferritin and iron, what do we need that for? So again, I mentioned brain development. So if your kiddos are having any issues with having trouble staying focused or paying attention or even dealing with their moods or having trouble. Trouble with sleep, when you have low ferritin, that absolutely can affect your sleep. Sometimes. It's also poor endurance. It may be outright low energy, but a lot of parents will say, well, my kids have a lot of energy, but when you really kind of dive into that and explore that a little further, yes, they have a lot of energy to run around for maybe half an hour at the park, but then they have to come home and they crash a little bit, and they need to regroup, and then you know, they can go out and run around. So there's these energies, like ups and downs really, you know, these, these peaks and these valleys as opposed to a sustained, you know, sustained level of energy. Sometimes you will, you will notice your kids, the whites of their eyes look a little bit whiter, you know, a little more pale. Inside of the cheek might look a little bit more pale. Not kind of a nice rosy pink that we would expect to see sometimes. Skin is outright pale. You know, my niece, one time, I looked at her, I was like, oh, I mean, she had fair skin anyway, but she just looked so fair. And you could see she didn't really have dark circles under her eyes, but they were so pronounced because of the difference between her skin and she wasn't anemic, but she had low ferritin levels. Now there is, you know, when we think about blood levels, we also want to think about not just is it in the normal range, but is it in the optimal range? And this is what we think about from an integrated pediatric standpoint, from a functional medicine standpoint point, because we know there are, there's a wide range for normal. I don't know if I just want to be, quote, normal.

Right.

I want to be optimal. I want my kids to be thriving at like the highest end. Right. Not just kind of barely skirting by. Right, exactly. And so typically, you know, when we look at ferritin levels, I'm going to, it does vary by age and it can vary by gender, but we think about the typical range for kids, let's say at Quest labs, if you go to Quest labs, will be maybe between a 20 and an 80 for optimal brain functioning, sleep, energy and endurance, mood. I like to have the ferritin at least at 40. So 40 to 60 is more the optimal range. So looking at that, if your kids are at a 21, that's not going to be optimal for where we want them to be. And so then, you know, focusing on those iron rich foods, iron in foods, it's interesting. You know, I get questions about, well, can you be a vegetarian and still get enough iron? And yes, but you have to be more mindful about it. You have to be more thoughtful about it. The iron, the heme iron found in animal proteins is more easily absorbed by our intestines. Now what's fascinating is the lower our iron stores go, the more easily the non heme iron from vegetarian sources actually is absorbed. So it's kind of, you know, we get a little bit more that way. Iron is going to be much more Easily absorbed also when it's taken concurrently with vitamin C. So if you're having a hamburger, you know, for the iron in the beef, well, you know, make sure you load that hamburger up with tomatoes and maybe some kale or spinach, or you have a side of broccoli so that you have the vitamin C paired with the iron. So there are some ways that we can get booster iron levels even without supplementation. And another trick is if you're using cast iron skillets or pans and cooking in that will help to infuse whatever you're cooking with a little bit more iron from the cast iron cast iron skillet, which is also another, you know, it's definitely a healthier kind of a cookware pan to use than the nonstick pans, which we want to not use because of all the PFAs and the forever chemicals in there.

Yeah, exactly. And is it true also, I think I heard that calcium can inhibit the absorption of iron. Is that true?

So, like, yeah. So there are certain, I mean, some minerals you don't want to take together necessarily. It's mostly iron and zinc are the ones that are really good, going to kind of compete. And then calcium, typically, calcium is, you know, it's harder to absorb anyway, and it's a big, big mineral. And so, you know, typically, you know, I'll take calcium on its own, or you can take calcium with magnesium.

Okay. We're having some concerns with my toddler, and we ended up getting her blood done and her, her ferritin came back at a 23. So we were told, oh, yeah, everything looks good. It's normal. And I was like, I don't know, I would really love to supplement her. And luckily they were like, okay. They weren't going to fight me. So they said, you know, it's fine to do supplements. And I was kind of sharing about this on Instagram, and I have a lot of international followers and some came back and said, oh, that's just normal here. We just supplement with iron for all babies. So can you talk a little bit more about how. Because I know, like, here it's recommended that all babies get vitamin D, for example, but that's kind of it. Can you tell us a little bit about why we're giving certain ones and not others or how that's decided?

You know, it's interesting. I think it's really just different guidelines and, you know, here in the States, expecting that there's going to be more, like, better nutrition than in some developing countries where there may be. It may be very common just to give iron drops and vitamin D drops or other mineral drops and vitamin drops. Iron is one though. It is, you know, it can most of the other vitamins and minerals like your, let's say if you're supplementing with vitamin B12, it's a water soluble vitamin so you kind of pee out all the extra. So there's very, very low risk of getting to a toxic level. Iron can have some toxicity associated with it, which is why, you know, I remember as a kid, you know, those iron pills used to, to be super yummy. Right. And there weren't childproof supplements, you know, prescription bottles. Right. You can easily open. And so, you know, in the, in the ers we would sometimes see kids who kind of, you know, dump the whole container of yummy iron or like the Bayer, you know, the Bayer's Johnson Baby aspirin just dumping. I remember, I remember, you know, thinking those were candy because they were so sweet. Right. And so now we know just to be a little bit more cautious. But you know, I think a little bit of iron supplementation, especially if your kids have any symptoms of iron deficiency is going. And I've had babies do this and measure their levels and you know, it would be challenging to get to toxic levels if you follow the dosage instructions for the average infant or the child. Now also you just want to know that some of the over the counter iron drops, especially the ones that may be maybe recommended by conventional pediatricians, unfortunately some of those have artificial flavors and artificial sweeteners in them or preservatives that really aren't gonna be beneficial for your child's developing microbiomes and their immune systems and even their nervous system. So getting a clean iron supplement that doesn't have saccharin or sucralose or polysorbate 80, some of them I've even seen have some like propyl parabens in them as preservatives. So just read the labels. I mean that bottom line, whatever you put in or on your baby.

Right, right.

Read the label. Right, yeah.

And always, always best to start with foods first if you can. Right. That's why I love your book. You give so many great recommendations for foods for all of these different types of things too, which I love. We're going to take one more quick break and when we come back, we are going to talk a little bit more about the gut microbiome. Be right back.

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We have been talking all about nutrients and deficiencies and things like that. And at the beginning of the episode, you also mentioned the good gut microbiome and how certain things like antibiotics, you know, can kind of harm our microbiome, especially when we're so young. What are some things that parents can do to either prepare for a round of antibiotics or recover from a round of antibiotics? And what are some things to keep in mind for just nourishing our child's gut microbiome?

Yeah, so this is a really important issue. In fact, it's. I have a whole chapter in the book devoted to what every parent and practitioner should know about antibiotics. And, you know, the concern, concerns really are on multiple levels from a public health concern. We know that the overuse of antibiotics is really creating a massive rise in antibiotic resistant bacteria. And by 2050, the World Health Organization and several experts are concerned that antibiotic resistance will become a leading cause of death worldwide. So that is really frightening. I mean, we need to take antibiotic stewardship and, you know, really the appropriate use of antibiotics very, very seriously. From a global standpoint, this is, you know, antibiotics were one of the most important discoveries of the 20th century. So we can't let ourselves go back to a time where, you know, even simple infections, there was nothing that we could do and could become deadly. So that's one issue. And then on an individual level, we know antibiotics are not, they're not picky in who they kill. Right. And so we know that there are pathogenic bacteria that may be causing infections like, let's say, bacterial pneumonia. And so we want the antibiotics to kill those bad bacteria, but at the same time, they can kill along with it all of the beneficial bacteria that make up our microbiomes. And I say microbiomes because we have microbiomes. These ecosystems of trillions of tiny microscopic organisms all over us, in and on us. Our skin has its own microbiome. As women, our vaginas have our own microbiome. Our breast milk glands have our own microbiome. And the most well studied microbiome is our gut microbiome. So most of the times when you're looking at studies or seeing articles in on your newsfeed, you'll see discussion about the microbiome is referring to your gut microbiome. Now, for babies, I mean, there's all sorts of factors that go into how your baby's microbiome shapes in those early days, including were they vaginally birthed or born by C section? Did you, as mama, receive antibiotics either during pregnancy, maybe for a UTI or a sinus infection, or did you have group B strep positivity during this particular birth and received antibiotics? What is the health of your vaginal and gut microbiome during the delivery and even during pregnancy? And how is the baby fed initially, breast formula or both? And all of those can shape how your baby's microbiome develops. And we know that that influence of how your baby's microbiome develops can then shape how their immune system develops. Do they have risks later on for increasingly common eczema and asthma or hay fever, even anaphylactic food allergies on the rise now, way more common than when I was in training, can really also be linked to how healthy is your baby's gut microbiome from the start and the gut brain connection. We know how healthy your child's microbiome is in those early stages can influence later on their potential risks for ADHD or anxiety or we mentioned sleep problems. Now with antibiotics, it's a particular, I guess we would call concern for infants. There are some large studies, and I'm gonna take a moment because this is where a lot of moms will look back and think, oh, my gosh, but I didn't know, right? Just like your podcast, like no one told us. And we can't go back in time and change what's happened in the past, but what we can do is now know, okay, Maybe that is what laid the foundations for, you know, my toddler who is now having tons of sensory and behavioral concerns, or my teenager, who's really struggling with anxiety, or, you know, my middle child, who has really bad eczema and asthma. So some really, you know, this One study, nearly 800,000 children found that antibiotics or antacid medications, because antacid medications also disrupt the gut microbiome.

Oh, so like reflux meds.

Reflux meds.

Oh, okay.

Like, you know, Zantac is no longer given, but any of the reflux meds that are given now to infants. So antacids, antibiotics given in the first six months of life could significantly increase the risk of your baby developing virtually any allergic disorder by the time they're four years of age. You know, sometimes double the risk.

Wow.

Right. Another study, this is out of Denmark, looked at, I mean, it was a huge study of mother infant pairs and also found the antibiotics to the baby at any stage, but especially if there was antibiotic exposure before 6 months of age, including in utero, like when you were pregnant with your baby, could significantly increase the risk for several, many mental health concerns by the time they were older kids or teenagers. Now, both of my kiddos had antibiotics when they're less than five weeks of age. Now, I did have the. I was lucky enough at that time to understand the disruption to their gut microbiome. What are some of the consequences that could, could occur. I didn't know all of it, though. I didn't know what I know now. Right. There are a lot of things even I go back and wish I had known. But even if that is your child and they're struggling with issues now, at least now you know, okay, let's look at the gut microbiome. Right? Because if your child has eczema or asthma or struggling with anxiety, social anxieties or separation anxieties, chances are, in a conventional pediatric visit, your doctor is probably not going to mention, oh, we should look at their gut microbiome and see how to restore their microbiome to kind of right the path. But now you know. Now you know, okay, let's look at the gut microbiome. Let's see. How can I, even if I don't have a functional doc to do all of this testing and guide me through, what are the things I can do to help really nourish and restore my child's gut microbiome, even from now? Because absolutely, we can restore your baby or your child's or your teenager's microbiome no matter what stage they're at. It might take a little longer, but we can do it. And the knowing to look there is the first part.

Yeah. So it's not too late. I love, I love that because yeah, we all have that mom guilt of like, oh, I had group B strep and I couldn't help it. And yeah, yeah, it's so tough. Yeah. I love how you weave that throughout the book is how important the microbiome is in our kids guts. I would love for everyone to grab your book and I'm sure everyone listening is like, I wish she was my pediatrician. So I will link all of that in the show notes. But my last question for you is actually not as a doctor, it's as a mom. And I'd love to know because you have teenagers so you're a few steps ahead of many of us. What's something that no one told you that you wish you knew before becoming a parent?

I think the biggest thing, the most important thing that I wish I had learned and I actually was just talking to my kids about this this weekend. It's funny, I actually, I was blessed to have the most amazing pediatric attending at UCSF who became my daughter's first pediatrician, you know, and then we moved down to the, the peninsula and she, her what we call anticipatory guidance, like helping parents anticipate the next stages was so beautiful. I mean she was so gifted in that way. And so I guess there are two things that I wish someone had reminded me because I knew those, but they were, they haven't been as present as I would have hoped. Now the first would be as we were first about to have Kenzie. Right. Kind of deliver into this world. I wish that I had remembered to take a moment a day or an afternoon with my husband to write out all the things that we were going to miss about not having a baby in our lives. Right. And that's nothing to do with not wanting the baby or saying that you have regrets or oh, I wish I had that life again. It's just saying, look, I know we are going to miss not being able to just on a whim, you know, take off for the weekend because we used to do that a lot, right. Or you know, I know I'm going to miss, you know, whatever it is, you know, being able to eat dinner, like go out to the fanciest restaurant we want to whenever we want to.

Right.

So you just write that and you just say, okay, I'm to going, going to. Yes, we will get back to that at some point. But these are things, I acknowledge that there are things that are not going to be part of our lives for a while, and we are going to embrace all the new things, but they're going to be different. So that's one thing. Now, the second thing that I'm constantly reminding myself, and I wish I had remembered as they were younger, is to think about reverse engineering the adult that you want your child to become. Right? It's not just modeling that, because we all know and we want to show them the good, the bad, the ugly, right? We have to show them that we are real and that we overcome some of the challenges that we go through. But thinking about, okay, if you want your child to be independent thinkers and respectful and kind and also respecting themselves, what are the things that really they need to start learning even as toddlers? And how do we impart that? How do we reverse engineer that? And it's not about helping them all the time and fixing everything. Right. It's not about always making sure that they're happy. And so I wish I had had those more frequent reminders along the way as we have teenagers. And I think back, oh, should I not have done that for them when they were little? But yeah.

Oh, that's such good advice. Thank you so much. Where can everybody connect with you and find your book and all of that stuff?

Yeah, so the best place to find me and just, you know, get more information. And, you know, I love to post educational content. You know, I'm a busy mom, like all of you listeners, so I never post fluff. I don't actually send out too many newsletters or write, you know, Instagram posts that often. But when I do, I really try to pack it in with information so that it is worth. Like you are giving me the honor of spending 5, 10 minutes with my content. I want to make it worth your time. And so that's on Instagram is where I'm most active. So that's HealthyKidsHappyKids. My website where you can get my newsletter is HealthyKidHappyKids.com and my book, you can go to my book website, but it's available anywhere, pretty much anywhere books are sold. So Amazon, Barnes and Noble, Walmart, Target, a lot of. I've been popping into kind of small, local indie bookstores when I'm traveling. And a lot of them have at least one copy, maybe two. So supporting your small bookstores. In fact, in San Francisco, gosh, is it right near Dolores park, there's a bookstore that one of my families was walking through and then said, hey, look, here's your book, so I love that. Yeah, I love it.

It's a great book. It's definitely something that I'll put parents should have on hand, so I highly recommend it. And I'll put all of that in the show notes as well so people can easily find it. Thank you so, so much, Elisa. It was so fun to chat with you, and you're just such a wealth of knowledge and it's so refreshing to hear all of the stuff that you share for families. I really appreciate you.

Yeah. Well, thank you for having me on.