Rethinking Fevers & Antibiotic Use: Holistic Pediatrics with Dr. Elisa Song

This is so important to understand and do alongside an antibiotic course or if your kids are taking medications that we know disrupt the microbiome. But also you can do this even if your kids had antibiotics years in the past. And so I really want to emphasize that point that we can help restore optimal gut health and microbiomes, no matter how long it's been. I mean, even if your kids have something, something a little persistent or chronic going on right now, we can always restore and reset your child's gut.

It isn't about being perfect. It's about being better. Hello, My name is Dr. Stephanie Stima and I host expert discussions with thought leaders in all facets of health, including nutrition, fitness, hormones, stress management, performance, recovery, longevity, healthspan, and energy production. On this show, we discuss complex science, but then we also alchemize it into actionable everyday living. The ultimate goal with the show is to assist you in making informed decisions about your health and to catapult you into being the hero in your own life. Hello, my Betties. Welcome back to better with Dr. Stephanie. It's me, your host, Dr. Stephanie Estima. And today I bring back my friend and colleague, Dr. Elisa Song. She is an integrative pediatrician. She's a Stanford trained, NYU trained, UCSF trained, integrative pediatrician, pediatric functional medicine expert, and of course, mom to two thriving children. Dr. Song is the chair of A4M's pediatric education and has been featured on Bloom TV, Forbes, Healthline, Mindbody Green, National Geographic, Popsugar, Parents, Motherly Parade, Very well Health, and the New York Post. Very well accoladed, very well spoken. I really respect Dr. Song's nuanced approach to healthcare and I had her back on the show because she has a new book, Healthy Kids, Happy Kids, and she talks about how and when there is a place for antibiotics, what we can do instead of running to get an antibiotic treatment, especially if there is a viral infection at play. We talk about fevers, some of the misconceptions around fevers, like they cause febrile seizures, if we don't reduce the fever, then that's a bad thing. So we talk a little bit about what antipyretics actually do. So acetaminophen, ibuprofen, their effects on the gut, and then of course, what to do in recovery. So if we've had to take medications, then what are some of the things that we can do to rebuild the gut and rebuild the general immune system so that we can improve our resilience? I thought this was a great episode to bring to you at the start of the school season and of course the looming cold and flu season that comes upon us every fall. So getting your immune system good now as school is starting is a great place to start. So please enjoy my conversation with Dr. Elisa Song Omega 3s are crucial for your heart health and your brain health, but it can be so hard to get them from food alone. Most women in perimenopause and menopause are not getting enough omega 3 from their diet, and taking a supplemental omega 3 is essential for you for closing that nutritional gap. Omega 3s help lower triglyceride levels and blood pressure, contributing to better heart health, and they improve cognitive function and memory. They can also help alleviate menstrual pain and help to maintain healthy, glowing skin and hair. Each serving of AG1 Omega 3 is sustainably sourced from wild caught small fish and a hint of natural lemon flavor in the formulation makes it easy to incorporate as part of your AG1 foundational nutrition plan without any fishy aftertaste. I personally take my AG1 Omega 3s first thing in the morning once I'm home from the gym. I grab my eggs from the fridge and the Omega 3s from the fridge door like clockwork and on repeat. If you haven't tried AG1 yet, they are bundling it with their Omega 3s for free, so it could not be a better time to start. It's something I've actually been able to stay consistent with and that's why I've been partnering with AG1 for so long. So subscribe today and get a one month supply of AG Omega 3s with your first AG1 order and you will also get their welcome kit with everything you need to get started on your AG1 journey. So make sure to check out drinkag1.com Stephanie to claim this special offer. That's drinkag1.com Stephanie all right, my dear friend, Dr. Lisa Song, welcome back to the Better Podcast.

Oh I'm so honored to be here. I love chatting with you.

And I love chatting with you. That's such a great way to get started. And we're gonna be talking about your book Healthy Kids, Happy Kids and very excited to get this episode out to our moms and primary caregivers as school is starting and we're kind of getting back into the swing of things. So I wanted to actually start off with in the book, which I've read, because as a mother I'm also always looking for ways that I can uplevel my children's health but you start off in the book talking about sex, some of the things you learned more about in medical school. And I thought we might just broadly talk about some of those topics. Then we can kind of get into the specifics of each one. So, for example, one of the first things that you say in this part where you said, I wish I learned more in medical school, and that antibiotic use during the first two years of life may increase the risk of mental health concerns later in childhood or adolescence by up to 50%, including sleep disorders, ADHD, mood and anxiety disorders, and other behavioral concerns.

Yeah, yeah. And I always preface this part with letting all the moms out there know that both of my kids did receive antibiotics when they were under five weeks of age. But when you look at the statistics, there's a really large study out of Finland that looked at mother infant pairs and found that those children who were exposed to antibiotics, even the ones in utero, like maybe you had a UTI or sinus infection while you were pregnant and you took antibiotics. So that exposure increased the risk for mental health concerns in your baby when they're older. And the more rounds of antibiotics, the higher the risk. Now, we also know this from adult literature. So this is not something that applies only to kids. It's just that for children in their really critical. Some people call it the first thousand days, but that first, from conception to about maybe two to three years of age, we have this golden opportunity to impact how their microbiome shapes and develops, which then has an impact on how their brain develops because of their gut brain connection. And we're gonna be diving into immune health, but also impacts how their gut immune system develops, because we know also, I also wish I had known that antibiotics or antacid medications given in the first six months of life could significantly increase your risk of your child developing any allergic disease like eczema, asthma, anaphylactic food allergies, hay fever. And think about what's skyrocketing in our kids and teens now. It's an explosion of allergic diseases, eczema. 1 in 5 kids has eczema. At least 1 in 10 is asthma. Anaphylactic food allergies are on the rise. I mean, we have EpiPen shortages, I mean, for a variety of reasons. And then look at our kids and our teenagers with our epidemic, our crisis of mental health and suicidal thinking and even suicidal attempts, even, especially in our teenage girls. So this is to just understand the potential underlying factors. And, you know, I always think to myself as a pediatrician, looking back, you Know, I have patients that I think back before I knew all this stuff, and I'm thinking, oh my gosh, I wish I'd done things differently. Right. And as a mom, you look back and you're like, oh, I wish I'd done this differently.

Like, if I could mom again, I would be the perfect.

Oh my gosh, you know, that's right. So, so many things. And we just have to pause, let that sink in, and then just move on. Right. We have to model that resilience for our kids and say, look, now we know, now we know better, and now we need to act on it because it's never too late to, to shift gears. But it's. But we have to know where we're starting from.

Totally. And it's our first time at life too. You know, it's our first time as moms even, you know, your first time as a mom of an infant, as a. First time as a mom with a toddler, first time as a mom with a teenager, first time as a mom with a 20 year old, et cetera, et cetera, et cetera.

That's right.

It's our first go at it as well, all through the arc of our, of our lives. So having some humility and some grace and some, you know, forgiveness, ability to forgive ourselves for our mistakes and what we didn't know, I think is important there too. Let's come back to the antibiotics just for a moment. You mentioned the gut brain axis. In the book. You talk about the gut brain axis and you talk about relationship with the immune system. Can we talk a little bit more mechanistically around what's happening there? So if we do have a child who, let's say in your case with your babies who had a course of antibiotics in the first five weeks, or, you know, you talk about the first thousand weeks in the book, you know, two and a half years, three years, let's say. What are some of the things that are happening in the gut with exposure to the antibiotics? Like what's happening and what's causing the distress in the gut that now is sending out distorted messages to the immune system and the brain?

Yeah. So one thing we know, when babies are born, it's a little controversial whether or not they have a completely clean slate, because there may be some passage of, you know, microbiome materials, you know, in organisms, even through the placenta, possibly through the cord blood. But we do know that when babies are born, the mode of delivery makes a huge impact on what microorganisms will choose to Call your baby's gut their home. So a vaginally birthed baby is going to have many more probiotic species in their gut that are, quote, beneficial, including the Lactobacillus species that naturally inhabit, hopefully, a woman's vaginal canal. A lot of gut microbes. In a baby who's born by cesarean section, we see a higher incidence of, of more pathogenic bacteria, bacteria that shouldn't be in your child's gut microbiome like skin flora, staph and strep species. And when that happens, the information that those gut microbes are sending to your child's developing brain or to your child's developing immune system, as you said, starts to become distorted. We know that. I mean, many listeners know that the vast majority of many of our, quote, brain chemicals or neurotransmitters are made by our gut microbes. So maybe up to 80% of all serotonin, but 50% of our dopamine is made by our gut microbiome. I believe that number is similar for the GABA and the acetylcholine that we use. And our gut microbiome makes over 400 times the melatonin than our brain. And so this communication now, it's not a simple just they make these, what are really called postbiotics, these byproducts that then they just go to the brain and do their thing. They have to communicate via the vagus nerve. But when we don't have the appropriate microbes to make our neurotransmitters, then you can see why it would be so challenging for a child's brain then to develop the appropriate pathways that then lead to appropriate sleep patterns, optimal stress management and HPA responses. Same thing with the immune system. At least 70 to 80% of our immune system is housed in our gut. And our microbiome has a direct line of communication. So I have parents and kids think about, you know, all kids have tonsils that are visible, some bigger than others. But our gut lining has tons of tonsil like patches that are our immune system in our gut, our gut associated lymphoid tissue. Now that when our microbiome communicates with our Galt, then that informs our blood's immune system. How are you going to respond to whatever you're exposed to, whether it's a food, whether it's a pathogen, whether it's an environmental toxin, Are you going to mop it up and clear it away and stay calm? Are you going to have a huge immune response and create a lot of inflammation or maybe you're going to create the wrong immune response and have chronic persistent inflammation or an autoimmune reaction. And we start seeing this tipping over of chronic inflammation and autoimmunity at very, very young ages. In fact, one of the factors that seems to be correlated with this increased rise of an abnormal immune response like this, atopia, eczema, asthma, food allergies, is the loss of species of bacteria called bifidobacteria. And bifidobacteria, for babies, should be the predominant dominant bacteria in their microbiome. When we look back over the centuries, our babies and us as adults, we were losing our bifidobacteria. And I think that's a really, really important part of understanding if we're going to impact our children's microbiomes. Where can we start? Well, as babies, let's start getting them optimal. Bifidobacteria.

Awesome. And then, so, coming back to the antibiotic use and the galt. So the gut associated lymphoid tissue, when we are exposed, let's say, to a course of antibiotics for whatever reason. And we're going to talk about what the. What some of the justifications are for taking antibiotics. It's not just all bad. Right. Like, there is a. There is a use for them. What I'm hearing you say is that now these tight junctions that should sort of filter out particles and debris and pieces of food and whatever can now cross the gut, which is technically one of the things that I found very interesting, is that the gut is technically still the outside of the body.

Yes, yes. We're long, hollow tube, right?

Yeah, we're long, hollow tube. So as it passes from inside the tube, inside the lumen, across the gut barrier, into the plasma, into the blood, this is the sort of origin, let's say, of the asthma and the food allergies and the eczema that you're discussing. Because if there's, let's say, a food particle that crosses and your developing immune system doesn't recognize it, I think that the. I am not an immunologist, so this is a very simplified, you know, feel free to correct me or redirect me here, but the immune system is gonna look at that as foreign and now start creating antibodies against that particle.

Yeah. And you know, we have things slip through that shouldn't. And yet our immune system should be designed to not overreact. It should tolerate certain exposures. And it's really this loss of tolerance to whatever we're being exposed to, even some of the foods that we really shouldn't be reacting to. We start losing our ability to tolerate these inflammatory hits. And so at some point, our kids and even our immune systems will tip over. But it's happening at younger and younger ages, which is what we need to be really concerned about. I mean, when I was in training and, you know, I've been at this for. And so when I was in med school, this was in the mid-1990s. I mean, it was so rare to have a child who had any anaphylactic food allergies. I mean, unheard of. Right. And even in residency at UCSF, I finished in 2000. So that's, you know, 20, 24 years. Right. In that time, it is the, this explosion of children with anaphylactic food allergies and the number of allergy centers that are popping up to try to assist with desensitization and the EpiPen shortages. And I mean, and when I go on field trips, I mean, now my kids are older, I miss those field trip days. But I was often asked to chaperone, and I have to think it was also because I'm a pediatrician and I would carry these bags of medicine like EpiPens and asthma inhalers and you name it. Which, you know, thinking back 20 years ago, if I had had kids 20 years ago, that that wouldn't be the case. And it's a relatively short span of time. I mean, 20 years might seem like a really long time. It's a, it's a little minuscule bit of time where our immune systems and our kids. Immune systems have drastically changed.

Yeah. I mean, if you put a peanut butter sandwich in a child's lunch, like, you might as well be sending a bomb to school. You know, like, there are kids that can't even be in the same room.

Yeah.

As, as, as, you know, peanut butter and jelly sandwich, let's say.

Yeah.

And, you know, to your point, I remember there was one girl in my, in my elementary school that had, she had like, everyone knew she was like, the only one in the school. Like, she had the really bad peanut allergy. And now it's like, you know, let's say out of 20 kids, like, 10 of them have some kind of allergy, something, something.

And it's. And these are true allergies. Not even, you know, the, the sensitivities that, that you and I help families or, you know, patients with, in terms of leaky gut and food sensitivities. But yeah, I mean, my daughter, who's 14 now, she's like, when we're trying to have. They don't call them play dates anymore, but when they get together, right? And I'm thinking about what food.

I've had to correct my language too because I'm a 13 year old, he's almost 14. And I'm like, you should get to get. And he just looked at me, he's like, you are so uncool. It's not a play date. I know, sorry.

I still think of it as play date. But you know, thinking about food, it's like, okay, so and so can't has a, has a, you know, milk allergy. So and so has an egg allergy. So and so has, you know, peanuts or cashews. And so really thinking carefully about what we're offering, even, even the quote, healthy foods. And you're like, okay, you gotta be allergen free. And here's the thing, I mean our kids immune systems have changed drastically. Their mental health has changed drastically. Their genes have, our genes evolutionarily haven't changed. So, so that tells us we have to look at, we can no longer blame it on our genes. We can look at all of the external factors that are making our kids and our genes not work for us. And when we recognize that it actually empowers us, right. It gives a little bit of the power back to us. Because if we can understand what factors are making our genes not work for us, then we can also understand the factors that we have in our control to shift it and then make our genes work for us again. Which is what I love. I mean, we can't just be all doom and gloom and okay, the world is toxic. We can't live here. It's like, well, okay, how do we live here and thrive in spite of our toxic world? Because unfortunately those toxins are here to stay no matter how much we try to minimize them.

Yeah. And we can talk about some of the sort of sneaky areas that we might be getting in our environment. Certain like personal care products and what we cook with and how we clean our home and all of that kind of thing. But before we get on there, I do want to talk a little bit about the justification for antibiotics because I think that, you know, and you are, you know, I, one of the things I respect most about you is your very balanced view and sort of taking in holistic practices, you know, vitalistic practices in your practice. And we'll talk about some of those today as well as sort of the traditional model, that allopathic model that includes medicines like antibiotics. So let's, let's so let's talk to our moms about. And maybe you can even bracket it in terms of age, if it would be helpful. But what are some conditions where antibiotics are justified? So you mentioned with your children five weeks of age, they had a course of antibiotics. Maybe it was appropriate, or maybe in hindsight, you were like, meh, maybe we could have waited it out. But what are some of the areas where it's like, yeah, we actually do need to do a course of drugs here.

Yeah, yeah. And this is such an important issue, not just from an individual child in front of me standpoint, but also from a public health standpoint. And I actually literally devoted an entire chapter to the antibiotic issue and called it what every parent and practitioner should know about Antibiotics. In some studies, we have seen that up to 70% of antibiotics written for children are inappropriately prescribed. So either they're prescribed for viral conditions like the common cold, for which antibiotics do zero, or perhaps they're just a bigger gun, like a way stronger antibiotic than what's needed for what's going on with your child. So we can see from an individual standpoint why that's so significant, because antibiotics are the single most significant and immediate acute disruptor of the gut microbiome. There's nothing that's gonna kind of wipe out a lot of the good stuff and kind of like raise the ground of your child's microbiome than antibiotics. Now, we do know that antibiotics are necessary sometimes, but even worldwide, we have this crisis of antibiotic resistance that is looming. And some experts are predicting that by 2050, which is right around the corner, antibiotic resistance is going to become a leading cause of death worldwide. And that's not okay. I mean, that's putting us back to, you know, when, you know, Sir Fleming discovered penicillium. Right. You know, way back. And we're gonna be back to the point where potentially a very minor, quote, minor skin infection or maybe ear infection could become something deadly because we've no antibiotics to treat it. So we have to be good antibiotic stewards. And as patients and as practitioners. And anyone listening to you is not the person who's, like, who goes into the doctor or the ER specifically for an antibiotic prescription, just in case. Just in case. Right? I mean, there are parents like that, and, you know, it takes time to educate and say, look, let's prescribe when absolutely necessary. And it's not such a fine. It's not such a clear line. Now, I list in the book six questions to ask your doctor before you take an antibiotic prescription, the number one question which is really important is to simply ask, hey, doc, is this antibiotic really necessary? Now, they may say yes anyway, because they may not know otherwise. Right? But sometimes in a busy, busy urgent care practice, and you're seeing one patient, you know, every five, 10 minutes, the easiest thing to do is to write the script. I'm not saying that's right or wrong, but also, in some studies, it's been found that doctors, doctors who think that you want that antibiotic prescription are twice as likely to write that prescription, even if they don't think it's appropriate. Right. And so just by asking that question in a, you know, in a partnership way, not in an adversarial way, but just like, hey, I'll do this if it's necessary for my child, but is it really necessary, then lets that doctor know, oh, you didn't come here just to get the prescription and walk out the door. You're a little bit more conscientious, mindful, you know, whatever it is about using antibiotics judiciously. So that really is the number one. Now, when would I consider an antibiotic really necessary? I do think looking at age groups is important. So, you know, babies under three months of age, even under six months of age, I have a very low threshold to start antibiotics if they look really sick or if I'm concerned that there might be something infectious going on. If there's an obvious, you know, older brother brought home a cold, and now they have a fever and a cold. All right, I'm gonna wait and watch. Now, under a month of age, nearly, you know, pretty much worldwide, that your baby would get antibiotics and a full workup, because under one month of age, their immune system is so underdeveloped that infections can become serious and spread very quickly.

I'm sorry to interrupt you. Is that true? Also, if the baby's being breastfed, does the baby have some sort of protection? Is there IGA or anything in the breast milk that's helping or no?

Yeah. In terms of bacterial infections, probably not. Now, in terms of, you know, getting a viral infection and sailing through it, yes. I mean, they're gonna. They're gonna typically do better than a baby who does not have access to breast milk. And I see this, you know, in. In families where, again, usually it's the older sibling, toddler, or whomever, like those germy little kids come home and they bring home whatever. Right. Whether it's a stomach flu or cold or, you know, whatever it is, and, you know, As a mom who's nursing and you're exhausted, a lot of times you get pretty sick too. Right. Your adrenals are worn out and you're just, you know, you're not sleeping. Hopefully you're taking care of yourself. But even that can be challenging. And so you might get really sick, but then the baby gets nothing or like hardly anything. Right.

Because of all your immune reaction won't necessarily transfer across the breast milk to protect the baby if you get sick.

No, no, it will. It will. So when you get sick, which is often, I kind of joke with parents and moms, I'm like, well, it's actually kind of good that you're sick because now you're making antibodies and you're protecting your newborn or you're protecting your baby at any age. Right.

I interrupted you. You were about to say one to two year olds with antibiotic use.

Oh, so under six months of age. I. I think, yeah, I probably would go ahead and just. And even if you have to start while you're waiting for, you know, blood cultures or whatever, cultures, when they're over six months of age, there's a little more wiggle room and need to look at how the baby is responding and what they've been exposed to. Now, there are certain infections where I do treat with antibiotics. I treat strep throat with antibiotics because nowadays with strep bacteria, we're seeing more commonly an autoimmune reaction in kids called PANDAs, or pediatric autoimmune neuropsychiatric disorders associated with strep, where kids, when they have a strep infection, which could be a strep throat, or it could be a skin strep infection, like impetigo. And they develop either a sudden or even a subacute onset of increasing anxiety, separation worries, ocd, eating restrictions, cognitive impairments. And so when we can treat that strep bacteria immediately, we can often prevent that pandas from occurring. So I do want to jump on strep infections with the caveat that if your child has a sore throat and even if they have white spots all over their tonsils, there's no way you can know that that's strep for sure without a culture. So I always ask for a culture. You can do a quick test in the office that can, you know, pretty immediately, within about 5 minutes or 15 minutes. Some tests tell you yes or no. They're kind of like the home COVID test, Right. But they're not 100%. So I always want to also send off a Culture as well. I've had some kids go to the ER or urgent care and have horrible looking throat. And you'll be told by the doctor, oh, I can tell it's strep. So here's the antibiotic. You cannot tell distinguish a strep throat from a viral pharyngitis or throat infection. And in fact, some of the worst looking throats I've seen have been from viruses. The monovirus can cause similar reactions. So I always ask for confirmation that it is strep throat before taking culture.

Is the gold standard. You can't smell a difference between, let's say, bacterial or viral throat infection.

No, you can't even, you know, even sinus infections, Right. That's another thing. I mean, often sinus infections, you know, may respond to antibiotics, but often with sinus infections, there's a combination. There may be some virus still lingering. There's often yeast or even mold I've cultured out right. You know, from sinuses. Of course, yeast mold don't respond to antibiotics. And then there may be some bacteria there. So that's where really using more of your natural medicine tools can get at. I mean, herbs have such a beautiful synergy in being able to be broadly antimicrobial and treat, you know, treating killing viruses, bacteria and yeast or mold at the same time. Which is often why I go to that first when it comes to ear infections or sinus infections, because again, you, you can't tell even by history or the smell or the color of the discharge whether it's bacterial. So strep infection, I would treat with antibiotics a urinary tract infection in a younger kiddo. What's my cutoff? Just depends on how sick they look. But I would, I would do a culture and start antibiotics if they're older, like if they're a teenager or maybe they're a middle schooler and you think, and it's an E. Coli uti, then yeah, go ahead and use a D Mannose first, you know, cranberry extract and get in all of that. But when they're younger, especially if kids have a harder time explaining and being in tune with their bodies to know that they're getting better or worse, then I would do the antibiotics. And whooping cough. Whooping cough is another case where I would do the antibiotics. Not necessarily for the person with whooping cough, because once you get to that cough, cough, cough stage antibiotics don't really do much. You just have to kind of go through it and use your homeopathy and, you know, all your other Tools, but it helps you be less contagious. It actually makes you not contagious once you start the antibiotics. And so in that way, then we can prevent spreading it to other people who may be more at risk, like our infants or our elderly or our.

Grandmothers who are watching the. Yeah, exactly.

Yeah.

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That's right. Yeah. So you know, and I don't recommend rushing to urgent care or the ER the moment your child's sick because I mean, for, for the most part, unless it's a clear. Okay, you know, Johnny's best friend had strep throat and now their throat's hurting, right? Then, yes, go ahead and get the culture. But most of the times, we're kind of like, what's going on? Are they starting to get sick even if they have a high fever initially? Well, most often urgent care or the doctor can say, you know what? Let's wait and see, right? Go home. Supportive care, which generally means Tylenol or Advil. If your kids feel crummy and have a fever, stay hydrated, take Benadryl or Sudafed, which haven't been found to work actually, in terms of reducing congestion when you're sick, and then wait it out. And if your kid still has a fever or symptoms after five days or seven days, then come back because it's probably bacterial, and here's the prescription. So that's gonna be the typical scenario. Now, when we take a more integrated pediatric approach, the paradigm's a little different, because I want you to start with supplements or herbs right away, right? Because if we can start immediately when that virus is first starting to try to colonize and be able to kick it out, we can often nip your child's illness in the bud within a matter of days, a day or two, as opposed to having it linger, linger, linger. This is also something, as I have kids heading off to college, I'm like, don't sit on it thinking it's just gonna pass. Do all the things that you've been doing at home. Call me, send me a message, call your mom, and we can walk through. What happens if you start getting that scratchy throat, stuffy head, you know, little chilly, and you're like, oh, I think I'm coming down with something. If you jump on it, I promise you, as a parent, as a young adult, I mean, for your children, you can really, really move them through that infection so much faster. And that the key is moving them through, like helping their immune system do what it's designed to do, not suppressing their symptoms so that now their immune system is not dealing with the infection appropriately. So what herbs might I try? Well, if you can swallow pills, I love olive leaf extract or oil of oregano. They're very potent if you can't swallow capsules. Now, my go to, though, as we're heading into cold and flu season, is this herb called Pelargonium sidoides, and it's a long word. It's actually an African bush herb that has been found to have amazing activity against virtually any virus your kid might encounter in the wintertime. Like, you know, common. The common cold coronaviruses. And adenoviruses, rhinoviruses, rsv, herpes viruses, Coxsackie, which is the hand, foot and mouth virus, and even some bacteria, some activity against maybe strep or staph. So that's my first go to whatever's going on, get your Pelargonium, which you can actually.

And how do you take that? What's the dosage? Do you take it consistently or is it just you up it in cold and flu season? Like how do you take it?

Yeah, I don't take it consistently. I'm kind of, you know, I want to take things when your body needs them. And so that's not one that I would take all winter long. But you can find it easily here in the States, in any pharmacy really, or online. And I'm sure in Canada too. It's a supplement called UMKA U M C K A. I've seen that. Yeah, it comes in a lot of different forms, but I get the cherry syrup that doesn't have alcohol in it because it also comes in a tincture that's alcohol based. There are some chewables, but I don't think the dosage is a little, for me, a little wonky with the chewables. So I get the liquid. It tastes really good. It's easy to give to most kids. And the bottle I believe says if under six, ask your doctor, which of course you go to your doctor and they'll be like, I don't know. Right. So I mean, I do, I have dosages in the book, but I'll let you guys know. So, you know, for one to, I'm trying to. I don't want to be inconsistent with the book, but this is typically what I'll do is, you know, if your kid's, you know, a toddler, I will do about half a teaspoon three times a day. If they're like an elementary school kid or a middle school kid, I'll do one to two teaspoons three times a day. And for an adult, or, you know, if you have a teenager who's adult size, then I'll do a tablespoon, which is basically three teaspoons three times a day. Now I have also for babies who are over six months of age, also given a little bit like a quarter of a teaspoon, you know, two to three times a day because there's nothing in it that has me worried that a six month old couldn't get it. What about an infant under 6 months of age? That's a little, I mean, that's where you know, I would want you anyway to be in touch with your doc and just say, okay, my baby's sick. And hopefully if you're nursing, they can get all of that through your breast milk as well. But that's, that's my first go to for pretty much anything over the winter. I mean, I call it the crud because we don't know oftentimes what it is. Right. We have no idea what virus is going around, but it's whatever crud's going around, that's what you go to. I also use homeopathic oscillococcinum, which if you go to Whole Foods. Yeah, it's like at the front. I mean, you'll see in the fall when you go back to school at Whole Foods or your natural health food store. I mean, literally it's gonna be at the front when you're checking out like one of those, like, oh, maybe I should grab that.

Right.

And so that one, if you start, that comes in little tiny vials with sprinkles in it and you just tip it back in your mouth, there are these tiny little sug pellets and you take one vial three times over a 24 hour period that actually had. There are some studies showing that it can compress the time to symptom free from any flu like illness. And so that too, that's viral based. Viral. Yeah. But you know, in the beginning you don't know whether it's viral or bacterial. So even I suspect that even if it's bacterial that it could help. But the key is to start in the pretty soon, like in the beginning. I mean, as soon as you start to feel rundown and sick, just start.

Yeah, it's kind of like echinacea, it sounds like where it sort of has its most potency. If you're taking it just as you're starting to feel symptomatic. Right?

Yeah. Okay. Well, because if you imagine, I mean, I think one of the main reasons behind it is for most viruses, let's say, let's take, you know, the common cold virus and you know, you inhale it up your nose and you know, you kind of breathe it in through your mouth and. And then it starts to multiply and try to colonize in your nasal and respiratory passages. Well, it takes a day, maybe two days for that colonization to really occur. So the first thing, if you, whether you use a neti pot or my favorite is Xclear saline, Xylitol nasal spray, if you can flush out daily, make that a habit, you Just at the end of the day, you're brushing your teeth, clear out your nose, have your kids, everyone has a little, you know, saline or excellent bottles lined up, and you just clear your nose. That's gonna flush out a lot of that virus before it can really take hold. Now, it takes a day or two for those organisms to multiply enough for your immune system to start to have a reaction. Right. Once your body is starting to react, how sick you feel is your immune response. It's not the virus. Right. Because that's why we see in the same household, like, for, you know, I might get really run down, super congested, lots of phlegm, you know, Kenzie might get a little headache, but otherwise, like, bouncing off the walls like nothing. And bode, it's his tummy and he gets a fever and he feels miserable, right? It's the same virus that we've all had. We've seen this. All right? But why are we acting differently? Because our immune systems are acting differently. And so if, you know, with that using the pelargonium and jumping on it right away, we're helping our body clear its viral load. And then we can add on supplements symptomatically to help recover faster from whatever specific way we're dealing with the infection, which is the beauty of homeopathy, because it really can be individualized. So your cold manifests as stuffy, congested nose, and your son's is more like faucet through the nose. Well, we have different homeopathic medicines for that.

Yeah. It's so funny as I'm thinking about my own family, like, one of my kids is like, it's all gut issues, like tummy ache and, you know. And the other one, it's upper respiratory stuff, headaches, you know, sort of general malaise. It's funny how the different symptoms can show up or even just in fevers. This is the other area that I want to talk to you about sometimes. And I think you put this in your book, too. And I was like, oh, my kids are like that too. I could have a child with a fever of 101. And it's just. He's just warm and he's like, he's just warm, but he's fine. And the other one, it's like, it's 101. And, you know, he has, like the. I have the cold compress. I've made him popsicles. And he's, you know, he's just. He's just dead. He's dead to the world.

Right?

So let's talk A little bit about fevers as an immune response first, maybe why fevers are actually a great thing that we don't want to kibosh them, we don't want to quash them. So what is a fever? You know, talking about immune response, what is a fever doing in the body?

Yeah, well, you know, fever is really one of the things that, as parents and as practitioners, there are a lot of misunderstandings, a lot of myths around, you know, what fever is and should we treat it or not? And that's something that the conventional medicine model has done to us as practitioners and parents. I mean, when I think back to my days in the er, when a kid came in with a fever and the triage nurse taking the temperature, taking some of the history, and then sending the kid out to the waiting room, before any doctor laid eyes on that kid, the nurse would give that kid a dose of Tylenol, right? That's just standard operating procedure. Right. And it still happens to this day, even though we should understand that fever is our body's natural immune and inflammatory response to helping fight whatever infection is going on. In this case, we actually want that inflammation, right? I mean, a lot of people think of inflammation as always bad. We don't want any inflammation. It's a fine balance. We need inflammation. Just like, you know, you have a. You know, your child skins their knee and it gets red and maybe a little pussy, that little yellow film on it. Well, that is inflammation bringing all of those white blood cells to the area to prevent infection and to help heal the skin. If that didn't happen, that your child's skin knee could quickly become an infection that took over very rapidly. And so we want inflammation, but we also want inflammation when it's done its job to go back down to normal levels, right? That's what doesn't happen for a lot of chronic diseases. We just keep inflammation up. Now, with fever, your body heating up is a way for you to slow down, right? Which is really important when you're sick. There literally is something called sickness behavior that we see in animals, right? We might see it a little more men than women, right? But we do have this, the man cold.

This is the man cold that you're talking about.

But there is something to that. When we are sick, everything slows down in an effort to preserve our energy to fight the infection. And we're not meant to eat normally or play normally or use our energy in a normal way. We're meant to slow down. So for parents who come and. And they say, well, you know, they're just. They're so tired. They're just laying on the couch making couch potatoes. I'm like, good, that's okay. Because some parents will come and say, well, you know, when I give them the Tylenol, they're acting normal. They're jumping on the trampoline, and it's great. I'm like, no, but now you're tricking your child's body and they're using even more energy. And then of course, the fever is going to come back because we haven't dealt with any of the underlying infection and trying to help their immune system work in the way it should. Fever and heat also slows down organisms. It slows down the viruses or the bacteria so that your immune cells can go and attack them more effectively. So there's a lot of benefits for fever. And in fact, what some of the studies have found is artificially reducing fever with a medicine like acetaminophen, which is Tylenol or ibuprofen, which is Advil or Motrin. Right. Artificially suppressing the fever can actually make you sicker for longer. They've seen this in kids with viral infections. In fact, they looked at chickenpox and found that the duration was longer. And some studies have even found that it increases the viral shedding from your nose, so it makes you sicker for longer and makes you more contagious, which is absolutely what we don't want, especially when it comes to our children. Right.

What is too high of a fever. So I feel blessed in a way that I was always taught, even through my schooling, that antipyretics, we should avoid them as much as we can. So the anti fever medications, and I've always been very comfortable navigating a fever up to 104Fahrenheit. And I remember saying this. I can't remember if it was a family member or friend. It was years ago when my children were younger and they're like, you know, I think that translates to like 38, maybe 39 centigrade.

Yeah.

And it was like, no, they're gonna get seizures. Like, they're gonna get seizures at that level. I'm like, no, they're not. They're just like 104 is a totally. That's sort of my upper limit. And I think the highest I've had. My kids have had 104 before, but it's like cold compresses, popsicles, as I mentioned, just like rest, soup, bone broth, you know, and it's.

Yeah, yeah. What's fascinating is you Know when, when I was doing research for the book, I was looking to see what are the guidelines in other countries, Right. And it varies so widely. And you know, when we think about what fever is too high and we're thinking about, you know, cannot really high fever cause brain damage? Can it cause febrile seizures? Well, we have to look and see. There are. You can have hyperthermia where your temperature goes up, up, up, up without a release and can cause damage. Now what's that number? It has to be at least over 107.6, which is.

Oh, Lord.

Right, yes. Now, if your child has a fever and they are not completely bundled up, right. So that they can't sweat and they're not drinking and they're dehydrated, well, potentially that could go. But in a normal immune response, your temperature's not gonna go that high. And so we really don't have to worry about that. Children tend to run a lot hotter. I mean, like my daughter, she'll run, you know, she doesn't. She hardly gets sick anymore. But when she was little, she would be 104.5 routinely, right. I even saw one time 105.5. And I'm kind of. That did make me hold my breath a little bit. Like, I do want you as a parent to call me and say, hey, this is what's going on. But then you always looked at your child and so, I mean, Kenzie would just be sitting there. Her cheeks were bright flushed red, which is how I knew she had a fever. But she'd be playing with her toys and like hanging out and like, you know, chatting with me and like, so it would be a total shock, right? Whereas, you know, Bode would have like 100.8. Right? And he's laying on the couch like it's the end of the world. Right? And so, but so fever, really, really in, you know, in a normal brain that is not over bundled, not in, you know, like a steaming hot sauna or an environment where you're not able to sweat it out, right. Fever will not get to the point where it causes brain damage. Now, seizures, that's a different story too. A lot of parents and practitioners are of the mindset that if the fever goes too high, it could cause a seizure. And my twin sister had febrile seizures when she was a baby. We treated things very differently back then. She was actually put on seizure medicines, which we don't do anymore. And my nephew had febrile seizures. So it can run in the family and they're so frightening when that happens. They're not uncommon. Right. So it does happen. But simple febrile seizures, where the fever goes up and your child has a seizure lasting less than 15 minutes, you know, whole body shaking does not go on to become a seizure disorder or epilepsy or cause brain damage. Now, when it's happening, it is really frightening. But here's the thing. I remember when I was first in training, we were instructed to tell patients, in order to prevent febrile seizures, you want to alternate Motrin and Tylenol around the clock. So every four hours for the Tylenol and then every eight hours for the Motrin and just around the clock to keep the fever from getting high enough that it's going to cause febrile seizures. There have been several, several meta analyses through the Cochrane database showing that this is not effective. If your child has had a febrile seizure, they may have another one. Right. But giving Tylenol Motrin around the clock does not help prevent a febrile seizure with the next fever. Unless. Okay, here's the big caveat. Unless they already had a febrile seizure in that fever episode. So the evidence now, and in this one Cochrane study, the latest one, the researchers who did this meta analysis note that there's really no place for using fever reducers simply to bring down the fever. That the goal is if our children are basically for comfort. Right. That is one of the goals. But bringing down the fever itself should not be the goal because it doesn't have the effect that we want it to and could have a negative impact also on your child's illness duration.

Yeah. And do you. So I'm thinking about. This is sort of not exactly the same, but it's a parallel when we would have concussed patients in the clinic and we were worried about the brain, like in, like chronic inflammation in the brain, one of the things would be either to do, you know, we were taught, you know, Tylenol, or to try and cool down the brain in some way. So that might be a cold plunge, you know, up to the neck. So, like the whole body is sort of, you're sort of cooling down the whole body. And then by, you know, by extension, all the, all the, you know, the vasculature that's going up into the brain will also be cooled because the blood is cool, is there? And as I'm saying this, I'm like, well, you're introducing the risk of water, but, you know, is cold plunging or something like that? Maybe cold compresses ice packs maybe, is that if we're starting to see the Fever in that 106, 107Fahrenheit is cooling the baby, cooling the child. Protocol? No studies, no evidence. What do we know about cooling?

Yeah, well, okay, so if they're 106 or 107, that's not a normal fever response. So I want you to go get seen. Right? But if your child's 104, maybe even 105 again, as a pediatrician, I still want you to call me, but you can do lukewarm baths. I wouldn't do cold because that can start shivering which can then increase your temperature. But if it's a lukewarm bath, that can be helpful. Putting lukewarm or cool cloth on the belly to cool your core can be more effective than or on the feet. There's, there's the wet sock method. The wet sock, wet sock method that actually can be very, very helpful. And this is where I don't want to leave parents hanging, right? Because then they're like, okay, my kid has a fever, they're miserable. Is there nothing I can do? And absolutely not. There's tons that we can do that won't suppress the fever but will help your kids get comfortable, can help lower their fever in a more natural way, help the body kind of literally, I kind of view it as compressing the time to wellness, right. So that pelargonium pseudoides that I mentioned, the oomca, that can help, right? So start that right away. If you're, you know, if, if you use some acupressure points. There's one acupressure point called large intestine 4 which is at the base of your thumb and index finger, that little web space, you can massage that and hold that firmly. Put a drop of lavender essential oil which has anti inflammatory properties in it and that can help bring the fever down. This point has actually been found in some studies to have antipyretic so fever lowering properties you can use. If they're over two, you can go ahead and use a little peppermint essential oil. You just wanna be mindful with the essential oils that you're using. The right dilutions if you're gonna be diffusing them. And so I give instructions on, you can look up dilutions, how to dilute, but you can look also in the appendix in the book, I have that resource for you. And then, you know, homeopathically do the oscillococcinum. Remember the homeopathy really does need to Be individualized. So just like we've given examples of our kids with very different fever responses. Right. So you know, for, let's say for a kiddo who has a sudden really high fever and you know, they're glassy eyed and they're kind of sweaty and they're red in the face. Well, that, that homeopathic medicine that would help them is homeopathic belladonna. If it's more like a low grade simmering, they're just kind of hovering around 101, you know, and nothing. Then you might do something called ferrum phosphoricum. If they're really achy, chilled, shivery and, you know, really restless and they have a high fever, that would be Rhus toxicodendron. So these are all weird sounding names if you're not used to homeopathy. But once you kind of get your, get your homeopathy toolkit under your belt, it becomes really easy to know, okay, this one, my child, when she gets a fever, she gets a fever that's more like belladonna as opposed to my son. I'm just going to keep the ferrum phosphoricum on hand because that's the one that helps him.

Yeah. And what. Explain the wet sock method. Just, I know we brushed over it, but do you, do you use the wet sock method recommended for your.

I mean, I don't use it that often, but I have pediatrician friends who do.

Right.

Where basically you're putting, you know, wet socks on the feet and then warm wool socks over and then just letting that cool naturally. But it tends to, I mean, it'll, it'll cool down your feet and somehow cool your body down. And I have pediatrician friends who swear by it. And so.

Yeah, and sometimes you can rub things on the feet too. Like you can rub the. Depending on the age of the patient, you can do the peppermint or the eucalyptus or something like that on the feet as well.

Absolutely. I mean, the feet has all of those acupressure points too. So it's kind of like a little microcosm of your body. So you can absolutely do that. I also, you know, I also recognize that there is a time and a place for fever reducers. Right. And so it's not like it's a never ever. But the times that I consider giving my kids, my patients or my kids a fever reducer is, I mean, two main reasons. If they're so uncomfortable that they don't want to drink anything because dehydration will exacerbate the fever. They need to be hydrated to heal. And so I'll give them a fever reducer just to help them be comfortable enough to drink or if they're so uncomfortable that they can't sleep, because we know how healing and restorative sleep is. So those are the times. But the goal isn't necessarily to bring the temperature down to kind of stone cold normal. It can be just to bring it down a hair just so that they're comfortable enough to sleep or to drink and stay hydrated and just be more comfortable. And then the question's always, okay, which one? Right. Because there's the Tylenol, then there's the ibuprofen. And I used to say I always prefer the ibuprofen because acetaminophen will deplete levels of our master antioxidant glutathione, which is really important also to help fight our infections and help us recover faster.

Right.

So if we're going to give Tylenol, then I usually also recommend doing Epsom salt baths to increase your glutathione levels, which your kids might really feel good anyway in a nice lukewarm bath. And also consider taking an extra glutathione supplement while you're taking the acetaminophen. But then as I was doing more research for the book and recognizing that ibuprofen, cause I would always say go to ibuprofen. Well, ibuprofen and some studies have been found to disrupt the microbiome as much as antibiotics. And so then I don't want then the downstream effects of microbiome disruption from ibuprofen. So if we're doing ibuprofen, then I also support the gut similar to how I would support a child on antibiotics so that their microbiome can recover after they're sick.

That's great. And I think we were talking before we got recording here that, that it's okay if you get sick. It doesn't. There's no comment on your health, your well being, if you fall sick. So we're talking about antibiotics, the justifications for them, antipyretics, and when you might use them. And if you do fall sick, and I'd love for you to maybe expand on this a little bit, it's really no comment on, you know, you didn't fail. You know, if your child gets sick, like, you're not failing as a mom or if you yourself get sick, you're. You're not failing at your health.

Yeah, yeah, absolutely. I mean, and you know, when we think about the true definition of resilience, it doesn't mean never taking a hit of any kind. Whether it's a psychological hit or, you know, a physical or physiologic or immune hit. The true definition of resilience is if you can take a hit and then stand right back up and bounce back and oftentimes stronger than before that hit. Right. There's this idea of hormesis where, you know, I mean, I kind of think of it as, you know, the saying, what doesn't kill you makes you stronger. It's kind of like, you know, these little small hits that your immune system or, you know, your brain or whatever it is can manage and then find a way to adapt and get stronger. Then you're going to be even stronger for whatever else comes next. And as you said, I mean, there, there was a time where, you know, if, if, I mean, this is a short. Whatever it is, four years ago, right. Can you believe, you know, we're four years after life changed? Right. It's now four and a half years. But in the beginning there, there, there was judgment when people got sick or got really sick that, well, it's because you're not, you're not living right. It's because you're doing something wrong. And now we know, look, we are all vulnerable to getting sick. And the definition of sick is not never getting sick because in fact, that can have the exact opposite effect. Where, I mean, think about, you know.

Well, we saw that, we saw that in the pandemic when you, when people started getting back together, people got deathly ill because their immune system had just gone to sleep because there was no stimulation. We were all isolated.

Well, and that happened with even, you know, very what, what should be very benign viruses for older kids and adults, the RSV virus. Right. In younger kids, if you're under one year of age, we know that's a risk factor for more serious RSV infection. But we were seeing 4 year olds and 7 year olds getting hospitalized with RSV, which was unheard of pre pandemic. It should have been, you know, at that point just, you know, a nasty cold, but nothing that was going to lead to more serious infection. And so, I mean, if you think about, you know, if you stop exercising, how quickly do your muscles atrophy and there's no way you're going to get that strength back without consistently working on it. And same thing with your immune system. We don't ever want to live in a bubble. We don't want to Live in a cesspool either. But we want to, you know, live in a way that we're, you know, we have these little exposures. Our kids have these little exposures. Their immune system learns what to do and then become stronger and stronger for the next time. And it's the same thing we see, you know, as a parent. Right. When your kids started daycare or preschool or school for the first time and they brought home all of those germs, what happened to us? We got sick every single time. We're like, oh, my gosh, I can't wait for, you know, the germ fest to end. But somewhere along the way, you know, whether maybe it's by the time they're second grade or third grade, they're not bringing home as much stuff. Maybe they are bringing stuff, but we're not getting sick as often, and we're not getting as sick because we've built up that immune training. And so it is something, too, that we want to let go of a lot of the fear that was kind of the judginess. Yes. And the judginess that occurred and really move forward now to recognizing that getting sick, skinning your knee, all of that, I mean, that's a part of. Of life and a part of becoming more and more resilient.

Yeah. Beautifully said. So how do we recover? So I wanted to talk a little bit about. In the book, you talk about prebiotics, probiotics, postbiotics. So if you have taken antibiotics, if you have been on some course of medication, how do we then knowing that the gut, let's say, is being wiped out. So even if it's a fever and we're taking the ibuprofen you mentioned, same effect potentially, that an antibiotic has on the population of the kingdom. You know, the kingdoms of the gut, the fungi, the bacteria, all the kingdoms that we have in there. What are some ways that we can begin to rebuild the gut? What are foods that we might consider, supplements that we might consider to help start to repopulate the gut in a favorable way.

Yeah. This is so important to understand and do alongside an antibiotic course or, you know, other medications, if your kids are taking medications that we know disrupt the microbiome, but also you can do this even if your kids had antibiotics years in the past. And so I really want to emphasize that point, that we can help restore optimal gut health and microbiomes, no matter how long it's been. I mean, even if your kids have something, something a little persistent or chronic going on right now. We can always restore and reset your child's gut. I had a mom email just this week saying that she was so distraught thinking about the antibiotics that her daughter had when she was a baby, and now her kid's older and having all of these health concerns. And when we have this knowledge, it can be that first, like, oh, my gosh, how did I let that happen? But we only know what we know at the time. And when your baby's an infant again, it can, could be absolutely necessary. But knowing that we can move forward is really important. And now, if you're listening, you know, okay, we can move forward, but what does that mean? Now, if your child is taking antibiotics at the moment, or you as an adult, you're taking antibiotics at the moment, the ideal time to start a gut restoration program, protocol, whatever you want to call it, is when you start doing antibiotics and actually let me back up, up. It's actually even before your kids take antibiotics because your gut microbiome wants to return to the state that it had at baseline. So if you and your family are living in a way that is optimizing your gut microbiomes even before you need the antibiotic or antacid medication or whatever else it is, it's much easier for your microbiomes to bounce right back. So laying those foundations. And that's why in the gut reset that I talk about R E S E T. The R E stands for returning to the five things that create microbiome magic every day. So we need those foundations, and we have to think about it's not just a matter of taking probiotics. Probiotic supplements do have a role, but I would say a much smaller role than I had thought, even as a functional medicine pediatrician, like five years ago. Right. Because even then, you know, if you had antibiotics, I would say, okay, let's get this. The, you know, highest number of colonies, like 100 billion colonies of as many different strains as possible, and let's just get it back in. Well, it doesn't work that way. And more isn't always better. Right. And so when we lay the foundations with, the key is making sure that we create an environment in your child's gut where a neighborhood where all of the friendly microorganisms want to come back. Because if your child's gut lining is leaky, there's inflammation, there's not such great neighbors in there. You know, let's say maybe there's some clostridia that's starting to overgrow or some strep or staph well, why would friendly Bifidobacteria or Lactobacillus want to come and call that their home? They're gonna find a different home. Right. So it's really about creating this ecosystem with how we're eating, how we're living our lives, and so that we can, you know, think about that foundation. And then the supplements. Right. Then during that time where we're resetting, there is a time for supplements. So you can consider taking an extra prebiotic supplement. What are prebiotics? Prebiotics are derived from plants. They are the fibers and the phytonutrients that feed our gut microbiome, that feed the probiotics and help them to grow and flourish. Right. And those are going to be from your colorful fruits and vegetables, your whole grains, your legumes. But during that time when we're repopulating, we may want to take an extra prebiotic to ensure that our probiotics have enough food to grow and then we can get the probiotics themselves. And you know, there are some strains, this is where strain can matter. There are some strains that have been found to recolonize your gut after antibiotics a little bit more efficiently. Not all of those are going to be readily available. So my strategy then is to just try to get a broad spectrum, you know, a lot of different strains in there. Because we have trillions of microorganisms in our gut. I think to date there have been 800 subspecies that have been identified and were strains and we're identifying more and more. So it doesn't make sense just to take one strain or two strains.

Right. You also talk about spore, is it spore? Is that in the probiotics category?

Yes, spore based probiotics, they're actually a new work category of probiotics. And, and you'll see those in the bacillus, you know, Bacillus coagulans, Bacillus subtilis, and those are, have been found to also be very beneficial in recolonizing the gut microbiome. And so you can also look to spore based probiotics. Now with the spores, those aren't gonna be killed by antibiotics. So when you're taking a probiotic supplement.

Oh, that's right.

Most your typical probiotics are bacteria, Lactobacillus, bifidobacteria species. And so you wanna take those at a different time of day than your antibiotic dose. If you're taking a spore based probiotic, you can take it at the same time. Even there's A beneficial yeast probiotic that some may be familiar with called Saccharomyces boulardii. Yes, really easy to find over the counter as floristor. That's actually been the one that's been widely studied. And so the Saccharomyces boulardii is a yeast probiotic that can prevent pathogenic yeast from overgrowing in your gut. I mean, a lot of women have the experience to take antibiotics and you know, they get a vaginal yeast infection or babies who get antibiotics and all of a sudden they have a really yeasty diaper rash or thrush on the tongue. Well, that saccharomycularity can help prevent that also can help prevent antibiotic induced diarrhea. So again, we're thinking about how do we get in a wide variety of different probiotic species to help our gut restore. Now with that though, if your child enjoys fermented foods, you definitely want to get that in, right? Fermented foods are, you know, are probiotics with a punch. I mean, we used to think the fermented foods, their main benefit were because of the probiotics. It's actually probably more due to the postbiotics, which we'll talk about in a second. But when they did a head to head study at Stanford University with students getting either a high fiber diet or a high fermented foods diet, they found that the group that got the high fermented foods diet had a greater improvement in microbiome diversity. So their microbiome improved more significantly than the group that had the high fiber diet. Now, the high fiber diet was really important for microbiome function. But if we're trying to recolonize and repopulate and regain our microbiome diversity, I'd say fermented foods are where that's gonna be at. And so really trying to get that in, even if it's just like a little spoonful of sauerkraut juice or you know, if your kids.

I drink that stuff, I love the sauerkraut juice. That's my favorite part. I mean, I like the sour cream. It's so delicious.

Yes, it's delicious. And here. And the reason, one of the reasons why it's so good for you is I mentioned the postbiotics. Well, when probiotics eat up prebiotics, they create products called postbiotics, right? This is, it's a fermentation byproduct. Well, those postbiotics are things like GABA, right? Those neurotransmitters that we mentioned, vitamins like vitamin B12, all sorts of nutrients that support our epigenetics. And they're chock full of, you know, they're kind of loaded into that kraut juice, right? Or kimchi juice or kombucha. And so can I ask you, is.

It in pickle juice as well?

Ah, so that's a great question.

I also really like the pickle juice.

As well, but it depends on the pickle. So pickling and fermentation are ancient practices. I mean, from way back in life, like ancient Mesopotamia, because they didn't have refrigerators, right. So they had to store the food, keep it from rotting. And so fermentation uses a brine of water and salt and ferments it in that way. Pickling preserves the food by adding vinegar.

Right.

So they taste very similar. But a pickled pickle, like, if you look at the ingredients and you see water and vinegar and your dill and whatever spices, that the vinegar is designed to kill everything, all the bacteria so it tastes good. But there's no probiotics in there and no postbiotics in there. There are companies like Bubbies.

That. I was gonna say the Bubbies.

The Bubbies, yeah. So drink the Bubbies juice. Right. Because Bubbies. And you can see it's a little more cloudy, right? You can actually see, you know, that. That there's some of that. That mother in there. And so a fermented pickle, absolutely. You're going to get the probiotic and the postbiotic benefits.

Okay, so Bubbies is our family favorite. So they're. Is it so they don't have vinegar, or is it because it's like the sugar and the salt?

Like, because they don't have the vinegar, it's okay. Yeah, they're fermented in a classic water, salt, brine. There are other. I mean, Bubbies are pretty easy to find. You know, I've seen even. I think I've even seen them in, like, Safeway here. But if you can't find bubbies and you just look at the ingredients, and if you see a pickle that says has vinegar in the ingredient list, it's still okay for you. I mean, I'm not talking Vlasic with the artificial colors that make it, you know that. That color. But, you know, you can find, like, Sonoma Brinery has pickles that are pickled in vinegar. But interestingly, they also have other pickles that are fermented. So you just have to look at the label, because sometimes you'll see the same brand and you're like, oh, yeah, we bought Sonoma Brinery, and it was fermented. But then you pick up the next. Next time you pick up a different batch, a different product from Sonoma Brinery, and it might be actually pickled.

Yeah. In the book, one of the things I thought was very useful was you sort of go through almost like a label reading exercise, right? Where it's like, which one has the sugars? Like, look at all the different names for the sugars. And which one of these ice creams would you choose? It's like, this ice cream has blah, blah, blah, has organic in it, but this one. So it's really, really well done. And I think, to your point, certainly, obviously a pediatrician, you're treating children, but this can apply to young adults. This can apply to women in 30s and 40s who are trying to balance their hormones thinking about their gut health. I think that this applies across the span of a lifetime, because to your point, gut health and gut issues really are the crux of many of the autoimmune and immune dysregulation that we're seeing in our. In our modern society. So there's beautiful things about living in a modern society, and there's also things that we have to. We have to mitigate those risks. So tell us where. You know, tell us where we can.

Find more of you, and I'll just give one one more tip. Heading into cold and flu season.

Oh, yes.

Because with. With the. With the. The lists and the exercises, read a label. There's so many actionable items that again, I mean, I've had adults say, oh, my gosh, this is. I. I'm revamping what we're doing. And also, you know, I had a. It was so amazing. I had this one functional medicine doctor read the book and say, wow. I actually. I thought I was doing, you know, an amazing job. And I took your sugar inventory, and I was shocked to see how much added sugar my kids were actually getting. And I give an example, you know, of our food when even as a holistic pediatrician, I thought we were doing a good job in keeping the added sugars down. Now, I am not gonna say, don't give your kids any sugar. I mean, that's not gonna work. Your kids are gonna rebel. What I am gonna say is, we have to be mindful of how much added sugar our kids are getting and teach our kids to be mindful of that, too. And so now my kids know, okay, they should have no more than six teaspoons of added sugar in a day on any of their packaged food foods. And they know how to read labels. And, you know, my daughter goes to Starbucks or Bode goes to Boba Tea with his friends, and he realizes, okay, that drink I really want, that has like eight teaspoons of added sugar. So I'm still gonna have it. I mean, of course I make that decision, right? And I'm gonna be really mindful of not having any more added sugar for the rest of the day and cushioning that with, you know, fiber and phytonutrients and all.

Or maybe I'll squash on my way home.

That's right.

I'll get those sugars in the muscles.

I'll lunge all the way home, right?

I'll lunge all the way home for my bubble tea dip.

So as we think about this sugar, it's just so, like, ubiquitous and insidious. So I encourage everyone, you know, just do a sugar inventory. What does that mean? Just take a normal old day, everything you're eating or your child's eating. Just take a look at how many grams of added sugar are in that serving and write it down and then just count it up. And if at the end of the day you're under 25 grams, awesome. If you're a little over, then, you know, oh, wow, that bread I'm buying has 4 grams or almost a teaspoon of added sugar in one slice. Let me find a different bread, right? It's just to know and make those swaps. Because nowadays the average teenager is not just having over six teaspoons of added sugar a day, they're having 34 teaspoons of added sugar a day. And same thing with adults because it comes in the form of those sugary drinks, right?

The Starbucks, the Boba, the Starbucks, Frappuccino. The kids go to Circle K or whatever, and they're getting there.

I had this one teenage athlete come in and fit, athletic, field hockey, all the things, but not performing as well as she wanted to. And we looked and she was having a Starbucks like maybe three, four times a week. Because that's what they did after practice, right? I was like, you know what? How about swapping that out? Maybe do it once a week, right? And immediately she noticed that the softness that was kind of over her, like, gone. And just, you know, more definition, stronger, just felt better. And so, you know, again, it's not saying never ever, but the reason why sugar is so important heading into the cold and flu season is that sugar can lower your white blood cells, ability to fight viruses. And bacteria by up to 50%. And that effect lasts, it starts within about 20 minutes of eating something with sugar and lasts for at least five hours. And so if you're kind of, you know, your kids are facing this onslaught of whatever germs that are going to be when they start school, then making sure that you're minimizing those added sugars is going to keep their immune system more alert and able to go on the defensive as soon as they need to.

Yeah. And it's such an impact. I love that your kids can read nutrition labels because I think that there is a certain, like, it's the cool thing to do, right? Like after a practice, like my boys are in soccer. So after practice it's like, here's some donuts or here's some, you know, all that kind of stuff. So it's so great for a child to be able to just rough calculation in their head how many extra teaspoons of sugar this is, because it really does add up, especially if you're having it multiple times a week to your point, with the athlete having the Starbucks a couple times a week. I think that, I think that it's a great exercise, like a great mental exercise for them. And then it also is a, is a opportunity for a conversation around marketing and a conversation around, you know, why are these, why do, when we go in the cereal aisle, why are all the Fruit Loops, why are they a little bit lower? It's like, because they're within grabbing hands of the little, the little people walking alongside, you know. So I think it's a good opportunity, opportunity to have a conversation about nutrition and the effect, of course, if you have a middle schooler or a teenager, the effect that it has on their sleep and their mood and their hormones and their skin, which all teenagers are concerned about, like not having acne and having great skin and their mood and their sleep and so forth. And I think it also is a great larger conversation around how we are marketed in North America at least, or western culture, you know, the marketing giants and geniuses and how we are potentially subject to those marketing messages and not understanding how we might be taking in some of these added sugars and compounds that we don't want.

Yeah. The more we can educate and empower our kids in a non judgy way, the more that they're gonna take this with them when they're out of the house. Because we want them to know how to do this as young adults on their own. So that's sugar. That's my sugar piece. And where to find me. So easiest place to find me is on my website, which is health. And I'm most active on Instagram, which is HealthyKidShappyKids. And my book Healthy Kids, Happy Kids is actually is available anywhere books are sold. I mean, most people buy on Amazon, but if you can support your local indie bookstore, please do.

Yes. Wonderful. Thank you. I just love any time that I get to spend with you. Thank you so much for coming back on the show. I know this is going to be so valuable for the moms with their young ones, teenagers, and then maybe for ourselves as well if we make it to our, if we even make our own to do list. You know, something to be thinking about in terms of remodeling our own gut health. So thank you so much for your time today.

Thanks for having me.

All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary health care provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.