Healthy Kids, Happy Kids: The Immune System, The Vagus Nerve, and Microbiome Magic with Holistic Pediatrician Elisa Song

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How do we get kids to be able to manage their chronic psychological stress? Because chronic psychological stress is a major disruptor to our microbiome. It's a major disruptor to our immune system. So helping kids to really connect with their gut brain connection and connect and optimize their vagus nerve functioning. Even if you don't change their diet just yet, even if they're the pickiest eaters in the world and you're like, I don't know, I'm going to get them to eat just even one, one little bite of carrots. That's okay. If you work on their vagus nerve, it will improve their microbiome. It will their immune system and their brain functioning.

Hi everyone. Before we dive into today's episode, I want to share some exciting news. I have spent the last year working on creating a brand new supplement designed especially for women over 35 who want to support their metabolism and their muscle mass in the easiest, most convenient way possible. It is an essential amino acid supplement, which you might have heard of lately, but it is not just that. It is crafted with several key additional ingredients that make it that much better for women than anything else out there. It's called Aminos plus and I am so proud of this supplement. It's a year in the making, but it's actually a decade in the making. This isn't just a product I'm putting my name behind. This is, at long last, my brand. I call the shots. My brand umbrella is called Ideal Age and the supplement is called Aminos Plus. Now you might wonder why Ideal Age? It's because we have the power to make any age our ideal age. And based upon the response I've gotten so far, I fully expect the first run to sell out. I already have a larger waiting list than I have first run supplies, but that's okay, we can get more. So don't hesitate. Get updates by going to idealage.com and again, don't wait because I have an amazing launch exclusive discount for you, my incredible people, my listeners who have opted in for those updates. Your support is huge for me as I am competing against some very well financed companies in this category, one of whom I actually turned down for podcast sponsorship because I was working on this very product. Now I know you have a choice in your essential aminos and I also know you will be thrilled if you choose mine. Back to the show. The information in this podcast should not be considered personal, individual or medical advice. My guest today is Dr. Elisa Song. And folks, this was such a moment for me. Dr. Song has had such an impact on me personally and on my parenting. And if you don't already know who she is, which of course you do, I am so stinking excited to introduce her to you today. She's the author of the new book Healthy Kids, Happy Kids, An Integrative Pediatrician's Guide to Whole Child Resilience, which is an unbelievably dense book that will guide you through raising kids in this insane modern world. We didn't even scratch the surface of her book today. Her book takes you through the gut, the microbiome, the vagus nerve, what to do when your child is sick, why your child is sick, why your child is sick a lot, chronic illness, acute illness, and also most importantly, I think empowering Integrative ways from functional medicine to so called alternative and even conventional medicine to, to help just lay a really great foundation for your kids wellness. Dr. Song is a Stanford, NYU and UCSF trained pediatrician and she's one of the pioneers of pediatric, integrative and functional medicine. And I know you will love this interview and her book again, Healthy Kids, Happy Kids, An Integrative Pediatrician's Guide to Whole Child Resilience. It is out tomorrow, so go straight to your Amazon app and order it. You will be glad you did. Onto the interview. Dr. Song, welcome to the show.

Oh, thanks so much. I'm so excited to be here.

Oh my gosh, this is so, this is so perfect today because I'm actually just now learning a little bit about the vagus nerve. So I want to talk to you about that for sure during the course of this show. But on a personal level, you have done so much for myself and my family, I could get choked up even talking about it. I've purchased all of your products. I've gotten that starter kit with the homeopathy and all of that.

And oh my gosh, I've gone way back. Oh yeah.

Yes. I have been with you for a long time and it's just amazing how everything that you say, the way you couch it is so open and affirming and welcoming to people that are coming from maybe a more conventional perspective, maybe they're coming from a more holistic perspective. And you're so able to speak to people just across the spectrum of the medical spectrum.

And I think that's amazing.

And I think that's, that's a key reason why integrative medicine and integrative pediatrics is having its moment, that people are actually starting to consider it, to utilize it, and to be more curious about it. And I think that is largely because of you. So thank you so, so much for your help.

Thank you so much. That means everything to me. That's what I want. I want to just help parents like me just feel more confident in what they're doing.

Yes, absolutely. Well, and you've written a book which is. We're going to talk about that too. Healthy kids, happy kids. But let's start at the beginning. I would like to hear a little bit about your pivot from law and advocacy to medicine and why you ended up in integrative pediatrics.

So, you know, I actually, as you said, I mean, I was really kind of focused on doing law. Not so much doing trial law because that's not in me, but really.

But it was more type of person for that.

Yeah, exactly. So, you know, I really, from the moment I was young, I just always knew I wanted to work with children. And so that was part of my mission in life, to just serve kids. And so when I went to college, you know, as an undergrad here at Stanford, I'm like, what do I do?

You know?

And my mom was a doc. And everything I saw as a busy obgyn, her office was attached to our house. And, I mean, she was up all night, like, delivering babies and just seeing patients. And I just thought, I don't want that for my life. So busy. And she did her best. To her credit, we had almost every dinner together. She would carve out time in her schedule to kind of pop into the living room where her door was connected and then, you know, have dinner with us. And so that was, I think, a part of why I think that family time, family meals are so important. Anyhow, so here I was. I'm like, okay, I don't think I want to be a pediatrician, but maybe I'll be a lawyer. Maybe I'll be a civil rights lawyer, children's advocate. And for two summers, I went to the Children's Defense fund in Washington, D.C. and I lobbied on Capitol Hill. I mean, what a world, right? I mean, I lobbied to raise the poverty level so that more and more children could qualify for Medicare benefits and tried to work on policies to reduce teen pregnancy, especially in our vulnerable populations. And it was great. And yet it's a slow process, and you don't really work with kids. So I had that kind of aha moment, like, hmm, what can I do? And it was exactly at that point, after I'd taken the LSATs and I was getting my law school applications ready, I stumbled across a flyer at Stanford on this on the telephone pole. And it was a conference for the American Holistic Medical association, which doesn't exist anymore. It's kind of morphed into different things. And I thought, well, what is that? Because this was. This was in the late 80s, early 90s, where it wasn't even called. I mean, it was called holistic, but it was called alternative medicine. Right? I mean, it was just sort of this, like, oh, it's kind of this other thing. So I thought, well, let me check this out. And my mind was blown. I'm like, oh, my gosh. I heard people who were really starting to get known, like Andrew Weil and Deepak Chopra, and I remember calling my mom and like, hey, mom, you know, I think. I think I might want to be a naturopathic. Doctor. And she's like, what's that? You know, that was the common refrain back that. Rephrase back then. What is that? Right? And I thought, hmm, well, you know, nobody, she would have supported anything, anything I wanted to do. But she's like, well, you know, maybe you want to, if you're interested in medicine, maybe you do medical school first, regular medicine first. And so that's a path I pursued. But it was really always, always, even in medical school, even in residency. I knew there was going to be a different way for me to practice medicine. So I mean, here I am. I mean, it's not, it's not because you, many, many people in the functional integrative medicine world, they come to this because, I mean, knock on wood, this isn't my story, but sadly, because the conventional system has failed them or you know, failed their family members and they're looking for answers sort of outside the box. You know, I was fortunate to just always practice this way. And yeah, I wouldn't do it any other way.

I feel like I've seen, even in the short amount of time that I've been in this community, I've seen the terminology go from alternative to holistic to integrative. And it's been an interesting, an interesting evolution. And now a lot of these universities have integrative medicine clinics and such. So it really is sort of weaving its way into the more conventional paradigm, which I think is very, very interesting.

And I think it's terrific. Right, because integrative doesn't mean either or it means you can really take the best of all the worlds that fit in with your family's needs and your child or you or your family members unique health history, which I love.

Yes. So what would be an example of that in your practice where you would blend the conventional with the holistic?

Let's take for instance as we record right now, we are kind of starting in the middle of allergy season, right. And a lot of people, including my daughter who has decided at 14 that she, she is a ref for our club soccer team. Oh my go.

So everybody be nice to the young refs, please. Parents be nice. They work so hard.

That's we, we have.

Yes. I always make sure.

And sometimes they miss the offsides. Yeah.

Yes, exactly.

So, but she, so she's doing it and she loves it. And she's on grass fields and tree lined fields all weekend long. And so she, she's just sneezing, eyes itchy, snuffling. And so this is how I approach things. There is A time and a place for medications like over the counter antihistamines. So we have our bottle of Zyrtec at home. I don't say never. Right. But I also recognize some of these over the counter antihistamines. If we take them for prolonged periods, especially over time. And in the elderly, there are a class of medicines called anticholinergic medicines that may increase the risk later on of cognitive decline of dementia, and so can understand that. And I also understand my daughter's need for some immediate relief. Right. So she gets a Zyrtec. However, it has an overlap. So then I incorporate an herb called quercetin, which is a natural antihistamine. Amazing antioxidant. Amazing. For your gut lining and for your immune system. I incorporate just simple lifestyle techniques like clearing out her nose every day with a saline spray, wiping the pollen off her face and her hair after she comes in from outside. And I'll incorporate some homeopathy also for symptom relief. And we overlap those so that eventually with the quercetin especially, she feels better and better. I'm also giving her zinc and vitamin C for histamine relief. And she can then move from using Zyrtec every day to as needed. Right. Okay. On the days where it's super high pollen count days. Okay, let's, let's use that. So that, that would be kind of a simple example for right now. Another example would be antibiotics. I don't say never ever to antibiotics, but I also understand the repercussions of antibiotics in killing not just the bugs that you might want to kill like these, you know, let's say it's an ear infection or strep throat, which I always treat with antibiotics. And yet they can wipe out completely all the bugs that we actually want to keep, like our probiotics in our microbiome. And that for children especially can have preferred profound effects on their future immune health and, and brain health and metabolic health. And so I don't say never. I use antibiotics when absolutely necessary and I work with families to restore their microbiome so that kids can have a healthier trajectory in life.

Liz here, interrupting with another winter health tip. Soon it is going to be too cold in many parts of the world to get outside and do my favorite health activ activity walk. Walking more has transformed my body and my life and there is no way I'm going to let that habit go. During the winter, I use my walking pad almost every single day all year round. It is my secret weapon because I can stack work plus walking Folding laundry plus walking or listening to a podcast while walking and get those steps in. I actually have two walking pads, both from Walking Pad the company. These aren't just any walking pads, they are the walking pads and both of them fold up up for easy roll away storage. One folds flat and the other folds vertically. And I love them so much. You can get the best deal possible on your walking pad by going to walkingpad.com realfoodliz. I want to talk about earaches. Actually, I feel like I've had a lot of friends lately who are like kushi Earth. There's a bunch of different things that their practitioners have said to them. Like even as far as, like, don't use antibiotics, just let the eardrum burst and then the pressure will be relieved. I mean there's a lot of sort of antibiotic avoidance reasons and lines of reasoning that different practitioners are using. And I don't want to talk trash on anything because I don't know, I'm not a medical practitioner but, but I'm curious as to with something like an earache or something that's kind of like, do we go the antibiotic route or don't we? What do you look for in making that decision?

So it's really interesting, I mean, for I think, good reason. Even more pediatricians are trying to be good antibiotic stewards, right? Be really judicious in their use of antibiotics because we are heading into a world crisis of antibiotic resistance. In fact, by 2050, some experts have projected that antibiotic resistance will become a leading cause of death in the world, which is frightening. You know, that, that a simple infection, let's say a skin infection that could be treated by cephalexin would all of a sudden not respond. And then we're left with these superbugs that, I mean, what do you do? And the answer isn't necessary to create more and more antibiotics, but to figure out how do we get here in the first place. And part of that is we just really want to be mindful of the overuse of inappropriate antibiotics. Some studies have found that in children, up to 70% of antibiotics prescribed are inappropriately prescribed, whether it's for viral infections like a cold that antibiotics aren't going to do anything about, or perhaps just a strong, much stronger, broader spectrum antibiotic than is necessary. But in the case of ear infections specifically back in, I mean, this is in the early 2000s, the American Academy of Pediatrics actually recognized that many, many ear infections were being over prescribed antibiotics and that many ear infections would actually resolve on their own. If we take a kind of a watchful waiting approach, is what they call it even. I mean, even bacterial ear infections can resolve on their own. So recognizing that a good number of ear infections are viral, many, many are mixed. So they have sort of a viral and a bacterial picture in the middle of the eardrum and not just straight bacteria. And so for most healthy kids, the American Academy of pediatrics recommends waiting 48 hours. Just kind of, let's just wait and see. Is your infection going to get better? Is the fever going to resolve? Is the pain going to improve? Or if your kid continues to get worse and worse and worse, then follow up in 48 hours and you get the antibiotics. The problem with that approach is as a parent, your kid is screaming in pain, Right. And you're like, what do you do? And Sudafed, Benadryl have not been shown to help with ear infections. And so that's where. Right. And so we try. I mean, I've certainly tried at certain points, but it doesn't. It really isn't going to move the needle in terms of supporting your child with their pain. Tylenol Ibuprofen temporarily might relieve the pain, but it's not going to help fix what's going on underneath behind their eardrum. And so that's where things like garlic ear drops. Well, why garlic? Why does that work so well? Well, garlic is an amazing general antimicrobial. So it will kill bacteria, it will kill yeast, it can even kill yeast. And sometimes, yes, there's fungus that, that can grow behind the ear. And so when you use the garlic ear drops into your child's eardrum, when they have an ear infection, some of that garlic will kind of diffuse through the eardrum and start killing whatever abnormal microorganisms are in there. So it can work really well. And a topical drop of garlic and a few other herbs was found to work better than a topical sort of anesthetic ear drop to manage the pain. So you get both pain relief and antimicrobial support. So there are a lot of other things that we can do for ear infections, but sometimes antibiotics are necessary. The vast majority of the times I would say no, especially when you use some of your integrative tools. And really, since I've been doing this with ear infections, ear infections are the number one reason, or earaches, I should say. Ear aches are the number one reason for visit to the doctor's office. The pediatrician's office. Right. Super common. And I remember before I started working, before I opened my practice, I would moonlight in some urgent care clinics and literally, I mean, for hours, like the night shift, let's say from like 5 to 10 o' clock at night. I mean, I would be writing prescription after prescription after prescription for ear infections, because first of all, when you have a five minute sick visit, but what can you really do? And there weren't any other tools. Right. And so now, since incorporating all of these integrated modalities, I mean, literally in the past 10 years, I probably can count on the fingers of both hands how many times I've had to prescribe antibiotics. And when I do, I know they're really necessary. So I can say with conviction to this parent in front of me who may be hesitant about starting antibiotics, look, this is the time for antibiotics. We can do the mop up later for your child's microbiome, but this is absolutely necessary.

All right, I've got a couple things that I want to ask you and then I want to talk about the microbiome mop up that you just talked about, because I love that. But speaking quickly of say, fever, of Tylenol, of ibuprofen, can you offer some reassurance to parents who absolutely freak out when a kid's fever, for example, goes above 101, 102? My kids tend toward really high fevers and I've also generally done pretty well with that in treating the child and not the fever. But overall, what kind of reassurance can you offer parents about fever?

There's so much data to show that we really should not be afraid of fever. And this is something that I think conventional pediatrics, when I was in training, there's this underlying, you know, fever phobia that we have as practitioners that we then impart to parents, unfortunately, and grandparents. Right. Because sometimes it's not necessarily parents who are freaking out, but it's grandparents who are freaking out. Right. And so, you know, for me, I have one kiddo, my son, who he'll get to maybe 100.9101, which is considered a low grade fever in children. And Kenzie, when she was younger, she would go to 104.5, right. But she'd be looking at me, her cheeks are flaming hot, but she's chatting away, sipping water and seeming okay. Right. As opposed to my son who's at 101, he's like laying on the couch, demonia and groaning like it's the end of the world. Right. So just different kids. Right. But we have studies have shown that fever. Well, first of all from an evolutionary standpoint. Let's just think back. Our body has a wisdom. There's a reason our body has reactions to whatever it's having reactions to. And we would actually do. Do well to listen to our body more. And so. And we' kind of lost touch with the fact that our body, in its wisdom, will show us these signs. When we are infected with a virus or a bacteria, our body creates an inflammatory response. And in this case, inflammation is not a bad thing. Our immune system is recruiting immune cells to wherever our sinuses or our lungs. Or if you imagine a cut and it gets red and pusy, that's our immune cell thing. Ooh, let's heal it up. And that inflammatory response is what causes the fever in infections. And so the fever is our body's natural response to trying to fight whatever's going on. And some of the studies have shown that if we artificially suppress the fever with acetaminophen, Tylenol or ibuprofen, which is Motrin or Advil, we can actually prolong the duration of that illness. So think about it from a logical standpoint. Why would that be? Well, if we're blocking our immune system's ability to do what it's trying to do to fight the infection by temporarily bringing the fever down, temporarily reducing that immune response, temporarily making your kids feel better, but keeping the infection around longer, because our immune system hasn't had a chance to really do its thing and knock the infection out. Which is why I think a lot of times parents have this experience where, and certainly with Kenzie, I did, she would get this high fever. She'd be done in a day or two, as opposed to that kind of lingering fever with Bode, and you're like, oh, my gosh, it's day six and he's still not. And so fever helps our body to get over viral infections faster. And one, there one or two studies showed that reducing fevers could actually increase viral shedding from that person's nose. So what does that mean? It might make you more contagious. So the last thing you want is to have your kiddo be sicker for longer. And not only that, be more contagious to your family members and to their friends when they go back to school. And so that's one thing. Now, I often hear parents say, well, what about febrile seizures? Okay, they're worried, and they have, especially if your child has already had one, which is one of the most frightening things you could ever go through. But now we know that simple Febrile seizures, they do not lead later to a seizure disorder or to any kind of brain damage. So in these large reviews of studies, there's a database called the Cochrane Database, where researchers will come and look at all the studies that have been done in the past and come up with these kind of sweeping reviews. And so there have been a couple of reviews of the studies around febrile seizures, seizures induced by fever, and. But across the board, the studies have shown that giving Tylenol or ibuprofen around the clock to try to lower keep the fever down does not prevent febrile seizures from occurring, with the caveat that it may if your child has already had a febrile seizure in that particular illness episode. And one of the latest reviews, the author's note, the goal of using a fever reducer, acetaminophen or ibuprofen. The only goal should be for the comfort of the child, not to bring the fever down to normal. So it's not to reduce the fever, it is to help your child feel more comfortable. And I'm going to put an and to that because we don't want our kids acting completely normal when they're sick either. So the goal is not to bring the fever down and have your kids be able to run outside and jump on the trampoline like normal. There is a reason why when we are sick, we act sick. There's something called sickness behavior, which we find in humans and animals, which is our body's way of hunkering down. We want to be left alone, we want to sleep all day. We don't want to eat that much. We might be grumpy, but it's our body's way of saying slow it down so that your immune system can fight the infection better. So. So when my kids are sick or my patients, when they're sick, I want them to be couch potatoes. There's nothing wrong with that. There's nothing wrong with acting sick when you are sick because your body is actually saying, slow it down. Listen to your body's wisdom. If you can slow it down, not go, go, go. I mean, this is for moms too. You know, listening when you're under the weather and you're like, I gotta push through, you know, I gotta, I gotta do X, Y and Z. It's not helping you get better faster. So listen and slow down.

Has there been any research done on the man cold?

Yes, there has been. The man flu, the man cold. Well, first of all, not to discredit what dads do in households because my husband, Peter, he's just. He's kind of taken up the reins on so much of the household stuff, especially as I've been so busy with the book and the practice and all of that. And so he's. I mean, we jokingly call him Doober because he's like the driver everywhere. But yet, right? Dads, when they get sick, what do they do? They go into their bedrooms and just sleep all day and all night. Right? And as a mom, you're like, I can't do that when I'm sick. Right? Because what's gonna happen to the kids? Are they gonna, you know, go wild in the house? But there is actually, it's interesting. There was an animal study. They looked at male and female. I think they were rats, and basically made them sick and found that men did seem to mount a stronger inflammatory response, like a higher cytokine response, so that maybe. Maybe they actually do feel sicker even with the same. When it comes. So I actually. I told my husband. I was like, you know, maybe there is a reason, but. But anyhow, we know, right? The man cold. It's just. It's funny. But there must be a reason across the board that it's not an uncommon story.

Yes, exactly. Okay, so then would it be accurate for me to say that Tylenol ibuprofen artificially bringing down a fever that does not treat the illness? So Tylenol Ibuprofen is not treating the underlying illness, it's just maybe making the child more comfortable, maybe making the parent more comfortable and a little bit less frightened. Is that accurate?

100%. Right. It's not treating anything except bringing the fever down. I mean, that's really all it's doing. And sometimes we do need our kids to be a little more comfortable, because if they're so uncomfortable and they're moaning and groaning and they're not drinking, so they're getting dehydrated or they're not able to sleep well, I mean, those are two reasons. When I say, look, let's bring the fever down, it doesn't have to be, quote, a normal temperature, but enough that your child can be comfortable in their sleep because sleep is healing, and enough that they want to drink because dehydration makes everything worse. But it doesn't do anything for the infection, which is why it might prolong your illness. And I have some parents who will seem a bit surprised when they give the Tylenol and their kids are totally normal, quote, normal, bouncing off the walls. And then the fever wears off and oh, my gosh, they're acting sick again. Well, because there was nothing that. In that Tylenol that is supporting your child's immune system to recover more quickly. So we just need to know that there's a time for comfort, there's a time for using them, but it's not helping the infection in any way. And so that's where we want to try to look to other tools for that.

So you're very passionate about gut health. I mean, your book is like a masterful education on how we can. Can support that as parents. Is there a way to, in keeping gut health in mind, keep our kids from getting sick so often? Speaking of illness, it's like, I feel like in the wintertime, it's like illness after illness after illness. If we feel like that's going on in our house, where do we look first? Do we look at the gut?

Yeah. So, I mean, there can be so, so many different areas that we might look at. I mean, you might have been told, oh, well, getting daily exercise can boost your immune system and, oh, what, getting more sleep and reducing your stress levels. Yes, yes. And all of that, really, I truly believe, is tied to how our diet and lifestyle factors impact the health of our microbiome. So our gut microbiome is composed of trillions of microscopic organisms. It's not just bacteria. There are viruses in there that were just really on the tip of the iceberg, I think, of learning about how beneficial these viruses can be for us. There can be parasites, there can be good and bad bacteria, There can be fungi in there. And so all of that creates our gut ecosystem. And our microbiome houses 70% or 80% of our immune system and is really our first interface. If you think about it, we're one long hollow tube from our mouth all the way down to where the poop comes out. And our inner inside is actually wide open to the outside and is our largest interface with invading viruses and bacteria, with the food that we eat, with any environmental toxin that we might be exposed to and inhale or ingest. And so our gut microbiome has a critical role in communicating with our internal immune system and telling it how to react. And so when we're getting sick after sick or not recovering as quickly as we should, we always want to look to see how is our microbiome communicating with our immune system? What's going on there? Are there points of abnormal bacteria or abnormal microorganisms in there? Is there maybe too much inflammation? Is there something maybe called a, quote, leaky gut but apart from diving into that, if we can support a healthy gut microbiome, then our microbiome can talk to our immune system and say, hey, hey, let's have a healthy response. If we get exposed to something, we don't necessarily have to get sick. We can kind of squash it right before it does anything. Or if we do get sick from it, we can mount a more robust immune response and get better faster. So we always look to that. And how we live and eat and think all affect the health of our microbiome. So we can choose different ways to support our gut microbiome. It all makes a difference. But if we have that in mind, that our gut microbiome is the cornerstone for our immune health, especially our children's immune health, then we can reframe what we're doing and how we're living in a way that's more microbiome centric. And we can also take things like probiotics. In fact, there are a couple of different. Several different specific probiotic strains at this point that have been identified when taken during the cold and flu season, can reduce the number of infections and fevers and missed days of. Of school. So, yeah, I mean, I take those and give those to my patients and kids over the winter, too.

I want to ask you about the gut reset in the book, but first maybe I want to maybe get a bit of perspective on what children's immune systems need as far as external inputs like exposures. And I guess the way. I guess I'll tell a story to sort of couch my question. During the pandemic, we were not exposed to much. I sent my daughter to an outdoor school. So she was outside literally eight hours a day, five days a week. And I was like, her immune system is going to be top notch from this. I mean, I never went inside. And then immediately we get back into, you know, normal life and it's like illness after illness. So I guess my question is, I know being outside is very important, but in dealing with our reality, which is illnesses, communicable disease, large groups and crowds of people, is it necessary for children to be exposed to those larger groups, to just kind of throw them, throw them into the germ tank and intentionally, not intentionally, but be open and willing to have your children exposed to lots of people, lots of different places, lots of dirty floors, lots of, you know, bathrooms and whatnot in order for them to have an immune system that interfaces properly with the real world? Is that. Am I making sense?

You are totally making sense. Our immune system from birth is A naive immune system. And all of the exposures that that baby's gut microbiome and immune system have early in life and throughout life really informs how their immune system will develop and how they're going to respond to future immune insults. And the reality is, unless you live in a tiny little lonely bubble, which is not good for anything in any way, you can't avoid different infections. And the pandemic was this experiment in the hygiene hypothesis amplified like. Like to the umph degree. I mean, I don't want to really kind of belittle all that. The fear that we had. I mean, we were in the thick of it. And when things first started, I don't think anyone really experienced, at least in our generation, that level of fear, what is going on in the world and the unknown of what's gonna happen to our children especially. Right. And yet as the pandemic wore on, I mean, we just, we started to learn more and know better. And at the same time, there still was this underlying fear and negativity about any germ exposure, right? And so with that, so many kids, even kids who went to outdoor schools, which is awesome, we still were not standing that close to each other. There still was a certain element of we're not gonna hug and touch and kiss and share food, right? Food was packaged, individual serving sizes, or you brought your own. There was nothing communal. And so we weren't getting exposed to even each other's healthy germs, which makes a difference too. And so our kids immune systems, they just, they. They lost their training. I mean, think about. If you don't work out for even two weeks, you feel deconditioned, and it, I mean, sadly, it takes a lot longer to recondition than it did to lose that conditioning. And so kind of like, we all know that, right? So same thing with your immune system. Our kids immune systems. Our immune systems just lost, literally lost almost all of its muscles. And we saw that. We saw that especially with our young, young children who maybe were born just before the pandemic or born during the pandemic, where they didn't have all of their family members kissing and touching and going to the neighbor's house and letting the neighbor's dog lick them. And playgrounds were shut down for a while. And so those babies and infants growing up during that time, especially their immune systems, were exposed to almost nothing except for maybe their families, their immediate family's microbiomes. And when life started to open up two winters ago, that really and truly, I think, is one of the Reasons why so many young children and older children, so let's say like four years of age, who shouldn't really have severe RSV infections. We're getting severe RSV infections and getting hospitalized because think about that, four years old, they were babies when the pandemic started, so no exposures. So these infections where before the pandemic, some studies show that almost 100% of all children have had RSV by the time they're two. And so but when you're older, two, if you get it again, it should just be this annoying cold, right? So their immune systems just weren't exposed. And even if we go way back in time, some parents might remember the really unusual cases worldwide of hepatitis that were affecting infants and causing infants to be hospitalized, even some requiring liver transplants. And I know I was watching really carefully to see is this how Covid is manifesting? Is this the next epidemic that we're going to have to worry about? And thankfully it didn't become that. However, now through really trying to dig deep and figure out why is this happening with these infants. A lot of researchers agree that there was this combination of this very common adenovirus, so a cold causing virus, a very common human herpes respiratory virus, and another virus that kids should have been exposed to, built some immune tolerance to, but never did. And so now these, these kids were coming out in the world exposed all at once to these common viruses and their immune systems couldn't handle it. And so we need this training. I don't necessarily want kids to get exposed to 50 germs all at once, which is kind of what happened two winters ago. But we don't want to be afraid of exposures. We don't want to sanitize our kids hands with, you know, hand sanitizer after touching the doorknob or when they come home from school, immediately, scrub, scrub, scrub. I mean, yes, we wash our hands, but you don't have to sanitize like that. And so I think just getting some perspective and realizing, okay, these just like fever serves a purpose, these exposures serve a purpose. And if we are prepared, if we prepare our child's body with the healthiest, strongest immune system possible, then they have a much better chance of weathering whatever exposure that they'll have.

So let's talk then about being proactive, because everything I've been asking you so far is kind of the reactive stuff. How do we deal with things after they're already happening, after the ball is already rolling. But the proactive stuff that you talk about in Your book and that you've always talked about. Can you walk me through what those most important steps are that parents can do to set a real, really good proactive foundation for their kids?

So when I was writing the book, I thought, what's going to be the easiest way to frame things, right? The easiest way for parents to explain things to children. And I encourage you guys, when you read the book, read it with your kids. There are parts just, you know, tell them stories and have them understand how important their microbiomes are. And so when we realize help kids connect the dots between I'm getting sick so often or why am I missing so many birthday parties because I'm so sick all the time or I can't sit still in my seat or I'm getting in trouble all the time or I have so many worries I'm having trouble falling asleep or it's hard to get along with my friends. The gut brain connection connecting the dots for kids on how important the microbiome is for supporting a healthy gut brain connection. Up to 90% of our serotonin, which helps us keep calm and relax and help asleep, is made by our gut microbiome. And when kids understand that, they can be their best advocates. Hey, this food is. Maybe this package doesn't seem like it's going to be good for my microbiome. It sounds far fetched, but I promise you it can happen. Right? It can happen. And so there's two main foundations that I would love families to focus on. Of course there's the food. And so we think about, you know, what we should be getting in all of our microbiome champions. I mean, we've been told forever to eat the rainbow. But if we know how much these foods, these plant based foods are the fuel for our probiotics. They feed our good bacteria so that they can create vitamins for us and neurotransmitters for us and antibiotic chemicals and anti cancer chemicals for us, then we know, oh, I actually I'm not just eating for me, I'm eating to feed these microbes that are serving me, that are my allies. But one thing that I really try to also focus on are the things that we want to mindfully keep away from our microbiome and teach our kids how to do the same, how to read labels so they understand what are the ingredients in this packaged food that are creating mischief in our microbiome. And maybe it's not a never ever, ever, but it's a little, let's stop and think, are these artificial Dyes or these food additives, are they something that's going to help me and my microbiome be happy? And so when you teach your kids how to read labels and be savvy about choosing those, you guys, it's amazing. My kids now, they're on their own a lot of times, going downtown with their friends, buying packaged foods, and they can look at packages and still have chips with their friends, but choose one that are gonna be a little bit friendlier for their brains and their microbiome. So I teach kids how to read food labels like a gut hero. And it's a fun exercise. And the younger you are, I mean, the more fun they have with it, actually. It's like, mom, look at this on the shelf. So that's one of the things that can really move the needle for our kids health now and especially in the future, as they're making food decisions on their own. And then the second thing that you touched upon earlier is how do we get kids to be able to manage their chronic psychological stress? Because chronic psychological stress is a major disruptor to our microbiome. It's a major disruptor to our immune system. So helping kids to really connect with their gut brain connection and connect and optimize their vagus nerve functioning. Even if you don't change their diet just yet, even if they're the pickiest eaters in the world and you're like, I don't know how I'm going to get them to eat just even one little bite of carrots. That's okay. If you work on their vagus nerve, it will improve their microbiome, it will improve their immune system and their brain functioning.

I want to talk, let's talk about the vagus nerve because I am fascinated about this. You have a whole chapter on it, so obviously folks buy the book, but can you talk to me about why the vagus nerve is so important to the microbiome? Is it the stress response?

So it's, it's part of it, the vagus nerve. For folks who aren't as familiar with it, we'll step back and talk about the autonomic nervous system. So the autonomic nervous system is a part of our body, right? Our nervous system with two main arms. There's a sympathetic nervous system which is responsible for our fight or flight response. And it's balanced. You know, let's say we have a deadline due. And we're like, heart's racing people's eyes. We're like, okay, I gotta get this done. And our sympathetic Nervous system kind of kicks in, right? As it should, right? This stress response, it's a normal, adaptive response to something that is about to happen. Before a soccer game, your kid's heart starts racing. Okay. I end up getting a little nervous for the game. How's the other team gonna be? That's normal. It gets us prepared mentally, physically, for whatever's about to happen. So that's a sympathetic nervous response. And then that's balanced by. Once that acute stressor is over, our parasympathetic nervous system with our vagus nerve kicks in and says, hey, you've done your job. Let's settle down and let's get into that vagus nerve rest, digest, and heal state. Now, the problem in our modern world is we have these big stressors. Getting a school on time, making it to your soccer game, doing your homework, friend drama, all of these. Like sympathetic, sympathetic, sympathetic, sympathetic fight or flight all day long. Our sympathetic nervous system gets way too much exercise in our modern world. Right. What doesn't get enough exercise is our vagus nerve that can then kick in and say, okay, let's breathe, let's regulate. This is not as huge a deal as your brain is making you feel like it is. Let's settle things down. And so our vagus nerve needs that exercise every single day, just like our sympathetic nervous system does without us even thinking. And why is that so important? Well, our vagus nerve is our main super highway of communication between our gut and our brain. And so when we're thinking about our brain signals to our gut microbiome, when we're in this acute state of stress, your brain sends signals down back to your gut and can literally change your microbiome within an hour. What? Yes. One hour. There's been studies that have looked at, there's something called zonulin and that can be triggered and induced, something called leaky gut. And so zonulin is released within one hour of an acute psychological stressor.

Wow.

So we can see how impactful it is. Your brain state, your mental health state, is to your gut microbiome. Well, your gut microbiome, though, is responsible for 80 to 90% of that communication back to your brain. So what does your gut microbiome do? It makes 90% of our serotonin, which helps us feel calm and relaxed. It makes 50% of our dopamine, which helps us stay focused and pay attention. It makes 400 times more melatonin than our brain. So our gut microbiome in a healthy state can say, hey, brain, you are tricking me into thinking that I'm super stressed, I'm going to send up more serotonin or more dopamine or melatonin so I can sleep more calmly, I can think more calmly, I can be more focused. So having a healthy gut microbiome is the foundation to really having that healthy and happier brain. And so it is a two way street. But your microbiome does a lot more, you know, has a lot more influence here in this gut brain connection than our brain. So we want to work on both a healthy gut microbiome and also so sending engaging our vagus nerve so that communication can happen in a really efficient, healthy, proactive way.

All right, well, not that I want to give away anything in the book, but is there any concrete takeaway or concrete tip that we can use, even right now that I could use right now that would sort of calm me down and get me in that sweet vagus nerve spot?

Yes, 100%. And if we're not quite sure what that means to be in that of parasympathetic state, just think back to. We've all as adults had moments where we're in the flow, we're in the zone. You're like time is just going by like it's nothing and you are on, you're writing that book without even thinking about or you're just in that flow, that creative zone. And so that's a parasympathetic state. That's when you've engaged your heart and your brain and something called heart rate variability is optimized. We've all had that. And so that's the state that we want to be able to get back into. Do we want to be in that all the time? No, because that's not life. And we need stress to kind of get us going. Just think about it. If you had zero deadlines, would you ever get anything done? Most people would be like, I'll get to it later. But that deadline kicks us into gear, gets our sympathetic going, and then our parasympathetic gets us into the zone so we can actually accomplish what we're supposed to accomplish. So we need both. That is why one of the things I write in the book is that stress is not a four letter word. We need to get that out of our vocabulary. We need to change our mindset around stress. Stress is not something to be avoided. Stress is something that is there. And what we need to do is figure out ways to engage our parasympathetic to manage our stress more efficiently. And so one thing that I want kids and parents to be able to learn how to do. Every single day is focusing on how we're breathing. And it can be that simple. This phrase keeps going on in my mind. I mean, for the past couple weeks, I forget who was saying how. Someone was telling me how complicated things are in her life. And I'm like, look, life is complicated, but solutions do not have to be. And sometimes the simplest solutions are the most profound because we can actually do them. And so when we think about how we're breathing, there's a way of breathing that many of you guys have heard of. It's called diaphragmatic breathing or belly breathing. Now, when we belly breathe, we're not sucking in our gut like we've been, you know, taught to do over the years. We're not breathing with our shoulders tense up to our ears, our shoulders are down, and we imagine the. That there's a balloon in our belly. We can put a hand on our chest if we want to, just to keep our chest still. And we just. When we inhale slowly, we imagine the balloon in our belly expanding and inflating. And when we exhale, that balloon is deflating, all while our chest is staying still. And if we're sitting there and we can take these slow belly breaths, fully inflating the balloon, fully deflating the balloon with every exhale that has been shown to engage our vagus nerve, improve vagus nerve function, all while improving feelings of calm, happiness and contentedness. And so, kind of it's not just to feel good, which is great, we want to do that, but it literally is to engage our vagus nerve. And so if we do that, you have to breathe anyway. You might as well breathe in a way that engages our vagus nerve so that your vagus nerve gets that exercise every single day. And it's something that, I mean, I'll teach kids how to tap, right? Or teach kids different visualization exercises, which they can do. But a lot of times, kids don't necessarily want to sit there in class and tap away because they don't want to look different. They can breathe anytime. They can belly breathe anytime they want to. And so in that moment, we want to teach our kids, or even ourselves, when we're stuck in traffic and we're going to be late to work, what do you do? Okay, you're still going to be stuck in traffic. But if we just sit there, relax your shoulders, and we can take those 10 slow breaths, we can manage that traffic a little bit more easily. Get to work. And Be able to then immediately jump in wherever we need to without that fight or flight affecting us. Same thing with our kids when they're in class and they have an exam that they're about to take, or let's say a friend has said something kind of unkind to them and they're just really rattled instead of reacting right away. Stop, pause, take those breaths, Engage your vagus nerve. They will have a much clearer mind about what they want to say or do next. Which, if we could all do that, we just have better relationships. Right. But it's truly this ability to connect, kind of stop and regulate, engage your breath that's going to help so much for your child to not only manage the stress that they have in elementary or middle school, but high school, college, with their partners in life, with their own children, as their children are kind of annoying them as they're doing X, Y and Z. It will serve you so much. And again, simple. Yes. Profound. Yes. Because. Because simple shifts make a huge difference. It's just something that we have to do because honestly, a lot of families and in our kind of biohacking generation, people want. They want to take the latest and greatest supplement or use the latest and greatest device, and it's like, yeah, but if you don't get back to the basics, it doesn't matter how much you try to biohack, it's not gonna make as much of a difference. And it's the things that you can do every day by yourself that you can take with you forever and ever and really are gonna create lifelong health.

Yeah. Well, I want to drop a couple of crumbs. For parents of teens. My paradigm is little kids, but I was hoping before we wrap up, you could maybe give people some knowledge around the approach to help. We were talking about, you know, mental stress and your mental state techniques for helping kids and teens who experience anxiety.

Yeah. Well, one of the things that we have to figure out is what are some of the root causes? I always look at the gut microbiome because when you have kind of unmanageable anxiety, it's kind of like a chicken and egg thing. We know that the anxiety can disrupt the microbiome, but also the microbiome can make it harder to manage stress. So we know there's going to be an element of gut microbiome disruption that we want to work on, but we also want to step back. I think. I think from a functional medicine perspective, sometimes, even though it's such a truly kind of holistic, personalized approach, we forget to step back and say, well, what else is going on in this teen's life? I mean, could it really be that the friend drama is getting too much or you know, how much social media is going on? How much is that impacting them? What's going on in their family life? Whatever it is, is it more that they're stressed about their appearance because they have acne and that's the source. And so we want to really work with kids, develop that trust, trusting relationships so that hopefully they can open up about what, what are some of the drivers of that anxiety, of that worry. Even our preteens. This is a time where as parents we just have so much less influence in their lives than their peers. So understanding what's going on in their kids lives, I mean my kids right now through the pandemic, we did get them phones earlier than I had anticipated, right, Because I was going to wait until they were in eighth grade, but they were starting to go out on their own with their friends and I thought, well, just for safety, to be honest guys, as a parent I would have done things differently. I would have gotten one of those smartphones, what are they called, like Pinwheel.

Or Gab or the kids version where.

You can actually get a smartphone. But I would grade the introduction to texting and emails and things like that. My kids don't have social media. I have no intention of having them have social media until they're much older. Because studies have shown that the most vulnerable times for kids brains and mental health around social media is in the tween ages, like maybe 11 and 12. And then interestingly, the next really vulnerable time for boys and Girls is around 19 years of age, which makes sense as they're kind of heading out of high school and everyone else might be doing something that they're not and they have different expectations for their lives. But in these vulnerable windows I would say have some caution there. But then I look at food and I look at lifestyle, okay? Because root cause number one for kids who are experiencing mood issues often is their ultra processed diet. We know that ultra processed foods, those artificial dyes, too much added sugar in their diets, all of these food emulsifiers, food additives that disrupt the gut, Microsoft microbiome. They become a ubiquitous, almost daily source of microbiome disruption. So again, teaching your kiddos how to read food labels. I had one mom who's reading the book early and kind of giving me some feedback and she actually has a high schooler who's a student athlete. And being athletic is really important to Him. So they were reading this together, and he's like, oh, I'm gonna buy a different package of. In a different hydration drink, get rid of the prime, do different ones because he connected the dots through the book on his gut microbiome and his sports performance, which absolutely makes a difference. And so helping kids connect the dots so they can make better choices. Some of our kids, they're getting a boba tea or like a Frappuccino every single day after school with their friends. And just to put that into perspective, no judgment here, but some parents are too. And so we just have to understand for our kiddos, we want them to have no more than 25 grams of added sugar in a day. And that's not a they should have 25 grams. It's a they should have no more than that. That's about six teaspoons of added sugar. One boba or one, you know, frappuccino drink could have anywhere from 35 grams to. I've seen ones that are like 56 grams of added sugar in a day. So the sugar is a direct highway to your brain to affect their neurotransmitter levels, affect the way they feel, reward and motivation, which is compounded by that same effect of social media on their brain's reward system. And if they're playing video games, again compounded, all of that is affecting how they're perceiving the world, which we really need to understand as parents. And then. So that's one area. And then our kids, many of them are going to be on medications that further disrupt their microbiomes. So we just have to think about this too. And I'm not saying go off of medications if your child's doctor or your teen is on them right now. But the medications that we know that can disrupt our gut microbiome are, number one, antibiotics. How many of our teenagers are on low dose doxycycline for their acne. Birth control pills can disrupt the gut microbiome. Steroids of any kind. So if they're having inhaled steroids or oral steroids for their asthma or allergies. Ibuprofen. Ibuprofen has been found to disrupt the gut microbiome as much as some antibiotics. And so some of our student athletes or kids, they go play, they're playing a game of flag football, they come home, they're achy and they're sore. All right, I'm going to pop some Advil. So all of that is. We just have to approach that with knowledge because. Oh, and even SSRI medications, antidepressant medications disrupt the gut microbiome. So if your kids are on all these different medications, some of them to actually help their mood and it's not helping, don't necessarily go off of them. But know okay, we need to do a lot of work on supporting your child's gut microbiome so that they can make the neurotransmitters to help that SSRI medication work even better or to provide the chemicals that your brain needs to actually be able to manage stress more effectively and be happy and calm.

Yeah, this is why I love your approach so much is because it's never you need to stop doing that. That's toxic. That's terrible for you. It's how can we meld these two approaches so that the individual gets what they need and is are also able to treat address anything that pops up along the way. So I appreciate that so much about you. We didn't even scratch the surface today. There is so much in your book. I mean from like guides and resources to supplements to acupressure functional testing, which is another big one. And I just cannot recommend your work enough. So I hope folks all go out and buy the book Healthy Kids, Happy Kids, An Integrative Pediatrician's Guide to Whole Child Resilience. And when this episode airs it will be out tomorrow so you can order it now and you do not have to wait. You will be able to get it almost right away.

It's right here and when you order it, yeah you, you hopefully will be in time to get in on some pre order goodies. But I promise you no matter what, you will get lots of goodies. There's lots of of bonuses in the book too so can't, can't wait to help support you guys.

Love it. So happy you're doing this. Thank you so much for coming on.

Oh thank you Liz. I'm so I'm really excited to be on and and to talk with all of you mamas and papas out there.

Before you shut down your podcast app, please take a moment to subscribe and leave a review. It's a small thing you can do that I appreciate more than you can imagine. See you next week. If you've made it this far, you have got to listen to the latest from Liz. Hi, that's me on the Ideal Age podcast. We are Talking everything women 40 plus are thinking about from perimenopause to parenting, hello K kids, sports to fitness, finances and even early facelifts. It is unfiltered, mostly uncensored and you will love it. Search your podcast app for the Ideal Age Podcast.