This Is So Awkward S4E7 - Elisa Song on Healthy Kids, Happy Kids

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Welcome to this Is so Awkward the podcast. I'm Dr. Karen Adderson.

And I'm Vanessa Kroll Bennett. Everyone on Earth goes through puberty, so it shouldn't be cringy.

With science guidance and humor, we cover all of the physical, emotional and social changes that happen between the ages of 8 and 18.

We have tons more on lessawkward.com where members can get answers to all all of their questions all of the time. This stage of life is awkward for everyone involved, but it doesn't have to be.

Okay, buckle up and let's get into today's episode.

Vanessa, do you know when I met our guest, Alisa Song?

A long, long time ago.

She and.

I met the very first week of our internship at ucsf.

Babies.

We became babies and we became the best of friends. This was in the mid-90s in San Francisco, and we became the best of friends. There was a group of four of us who would have dinners together and we would cry and we would laugh. Elisa, this will not surprise you because you've talked to her and this is not going to surprise any of our listeners when they hear this episode. Elise was the first person to ever feed me quinoa. I have very, very fixed memory of that. And my other biggest memory of Elisa, and this goes to show how big her heart is, was the night that her cat was admitted to the ICU in the. I know, I know. We're a bunch of pediatricians and there's a lot of overlap there between pediatrics and veterinary medicine in terms of the love you have these beings that can't always communicate in your language. But you're going to hear it all with Elisa, who is the first integrative doctor I ever knew, the first functional medicine doctor I ever knew. She and I spent a month in our residency training doing alternative medicine, which is what it was called back in the 90s, studying acupuncture and acupressure and homeopathy and all sorts of things that I thought would be interesting to learn for a month. And guess what? Elisa did. She did it for a lifetime.

So not surprisingly, Elisa has an incredible resume. She's a Stanford, NYU and ucsf trained integrative pediatrician and pediatric functional medicine expert and a mom to two thriving children. God Bless. And as you will hear, she has dedicated her career to helping parents and practitioners bridge the gap between conventional and holistic pediatrics with evidence based pediatrician backed, parent approved approach. And some of what you're going to hear today is going to surprise you. You're going to learn some new stuff. You're going to open your mind. I certainly did. To some things. You might even feel a little parental guilt at the choices you made when your kids were younger. If so, join the club. It's a fascinating episode and Elisa has an incredible Instagram following and a new book entitled Healthy Kids, Happy Kids. So to celebrate all of her work, we have her on today.

Elisa Song I've been counting the minutes until you came onto this podcast. We are so thrilled to have you here. For listeners who don't know, and there's no reason any of our listeners would know this, but you and I met in 1997 when we became interns at UCSF in general pediatrics. We very quickly became the best of friends. There's a group of four of us who that was my family in residency. Elisa was the first person who ever cooked quinoa that I knew. I should have known that you were going to take on the functional medicine world because in 1997 you were making quinoa. And she and I actually created our own month long rotation when we were in our final year of training where we learned about alternative medicine and we were in San Francisco. We found a preceptor who didn't think we were off our rockers and we learned about acupressure and acupuncture and we learned about herbs and we learned about like every corner. We did a survey course in what was then called alternative medicine. And then we finished residency and I took a turn like everyone else with the, you know, all the other sheep. And I went to practice and I did the thing. And you, Elisa Song, broke barriers by becoming truly the first integrative pediatrician I knew that anyone had ever heard of. And it was rooted in a very traditional Western medicine education, but a deep love and appreciation for what is now known as functional medicine and all the alternative therapies. So with that very long prelude to who you are, can you tell us a little bit about how you landed there nearly a quarter of a century ago?

Oh my gosh, you're making me feel old.

I was just going to say that.

Quarter of a century.

But you don't look at it. And that's thanks to all of your functional medicine.

That's right. Well, first of all, Kara, I don't know that anyone would call you a sheep. Look at your path right now. Right? And. And it's just. It's been so fun getting to just watch your journey and to meet Vanessa and to here with you guys today, it's. I mean, comes full circle and, you know, like. Like k. You said. I mean, I don't think I would have gotten through pediatric residency if it weren't for you, Heather and Allison. I mean, there's just no way. Because, you know, even back then, I didn't really see a lot in the hospital setting or in the conventional pediatric clinic setting that I was like, oh, I really want to do that for the rest of my life. And so, I mean, which is why, you know, even in college, I actually was. I mean, I. I don't even even know if you know this, but applied to law school. I mean, I took the LSATs, and. And I was going to be a lawyer first because always, always grounded in wanting to help kids, but I was going to be a children's health advocate. And I even spent two summers in Washington, D.C. lobbying for. To raise the poverty level for, you know, Medicaid for kids and working with the Children's Defense Fund and the CDC Adolescent, Department of Adolescent and Student Health to try to implement policies to prevent teen pregnancy. So, you know, this advocacy is. And trying to find a different way to help kids on a broader level has always been my passion. And then in medical school, I mean, actually at Stanford undergrad here, this is now I'm going to date myself even more. But the late 1980s, right. I thought I was, you know, pursuing this path. I was a junior and heading towards law school. And I saw this flyer, you know, these pivotal moments where you're like, okay, that. That made me go this way, you know, when I was going this way. And so it was a flyer for the American Holistic Medical Association. And back then I was like, what the heck is that? Holistic medicine. And so I decided to take myself to the Santa Clara Convention center and listen. And I was like, oh, my gosh, this is mind blowing. You know, that the food actually makes a difference, that there's this other thing that we can do besides just pharmaceuticals that really could also be helpful. And so I heard folks like Andrew Weil and, you know, Deepak Chopra and Joan Borisenko who were really just starting to get known. And so that's where, I mean, I pivoted. I mean, all of my friends, senior year were coasting. And here I'm taking calculus that I and physics that I said I would never, ever, ever take again.

I hope people are watching on YouTube to see the expression on your face when you say those classes.

Oh, my gosh.

And I'm like, I've got my hands over my face. Because I'm like, that sounds like the worst senior year ever.

It really, it was tough. But this is, I mean, for. Mom is listening and dad's listening, right? Your kids, I mean, if they find something that they're passionate about and if they start pivoting, it can work out, you know, you know, it's. It's okay.

Know where your curiosity is going to take you, like fostering their curiosity. And now these days, Elise, it wouldn't be a flyer in the hallway of the, you know, academic building or the student union. It would probably be a TikTok or an Instagram post. But like, fostering, giving kids the space to move off the track a little bit and sort of like, be curious, I think is really important. That is an amazing origin story. Holy cow.

So anyhow, Cara, I was always kind of a little crunchy ish, you know, but I mean, you know me, I'm crunchy ish, but, you know, I like my Lululemons and I shop at Whole Foods. And you have one foot in crunchy.

And one foot in not. You have one foot in Western medicine and one foot in Eastern. It's like, it's just perfectly you.

Perfect.

This is my job as a layperson with two physicians or medical professionals is always to set definitions and create a foundation of understanding for our listeners before we go off into, like, very cool things like vagus nerves. Okay? And it's not Vegas, like Las Vegas. FYI, for those of you who are like, I got to search that up right now. Let's begin with what does it mean to be an integrative pediatrician? Like, what do those words mean? How is that different or unique from, you know, the run of the mill pediatricians in the car?

Well, there's nothing run of the mill, run of the mill about Cara. So even back in residency, so, you know, when I started my pediatric practice and. And I started my practice pretty fresh out of residency as an integrative functional medicine pediatric practice. So I've always practiced in this way. I had a two year stint where I went back to UCSF and I worked at the Mount Zion Clinic with some of my attendings and I loved it. But you know what was even better? I loved it. And it Showed me what I didn't want in a practice, because sometimes the things that you learn, it's actually more valuable to learn what you don't like about something, right?

That's right.

So I started the practice, and when I first started, I called myself a holistic pediatrician, which then I kind of stepped back. And you have to realize, too, that really all pediatricians are holistic, or at least they should be, right? I mean, they should really take this child, this teenager, in front of them as a whole person in the context of their family, their friends, their schools, their communities, their social environments, their digital environments, Right? So, you know, we really, we do take that holistic approach, which is why pediatrics is just a field where we can really have the opportunity to get to know kids and families on such a deeper level. That being said, you know, one of the things that really was dismaying and shocking and very sad to me was, you know, we just had our match. Residents will. Student, medical students will match on one day. It's not envelopes anymore, but I remember getting this envelope where every single medical student in my class, graduating class, were standing at the, in the hallways of NYU waiting to rip open the envelopes. And the TV cameras are there. And so we all at one time open up our envelopes and we look to see where we got placed for residency. We, you know, made our top 10 list, residencies make their top list, and you get matched, right? And so, I mean, some people, their hearts just sank, right? You can see the disappointment. I mean, what a terrible way to do things, right?

I know.

And then, you know, I got into ucsf, so I was so happy, right? But we just had this national match, and pediatrics was one of the residencies that had the most unfilled spots. And when you look at that satisfaction life this year, this year, this year in 2024. And another survey came out last year that pediatricians have some of the lowest satisfaction rates of any physician specialty. And that's heartbreaking. I mean, this is our future. And so, you know, Elisa, it's really.

Important for people to understand what this is going to mean, which is there aren't going to be as many physicians taking care of kids in the future. There may be other types of healthcare providers that fill in these holes, but physicians are not being trained in the numbers they used to. And pediatricians, more, more than any, they're not being trained because they're not opting in. And they are dissatisfied. And they're also, you know, it also tethers to pay these Kids have huge medical school debt and they can't necessarily pay it back on a pediatrician salary. Sorry, little rabbit hole.

But I think, well, no, I mean, that is so important because, I mean, it is actually, it is, you know, highly tied to pay as well because pediatricians are kind of the lowest of any specialty too. And so when we think about that, there should be such joy in pediatrics, right? I mean, we should see this baby in front of us and just imagine this beautiful life ahead of them. And I mean, a couple of things I really think have contributed to this, this loss of this joy. We kind of see the trajectory of children's and teens health now, right? With our crisis in mental health and kids and teenagers and we see, you know, the busy, busy, busy of the pediatric practice. And so one of the ways that, that I think, well, at least that I personally have, have really been able to maintain a lot of that joy. I'm not going to say it's always easy, right? But you know, you got to find joy in what you do. Otherwise you have to figure out how to bring joy back to what you're doing or pivot, right? And so with my practice as an integrative practice now, what I can really do is lean into the conventional training that I had because we're not throwing the baby out with the bathwater. There are absolutely times where medications are necessary. You know, antibiotics have been one of the greatest public health inventions of the 20th century, right. Except now we know and understand that something like antibiotics, it's a double edged sword, they've been way overused. We're heading into this time where by 2050, some experts speculate that antibiotic resistance could be a leading cause of death worldwide. Right? That's right around the corner. And we also know from a functional medicine perspective how much antibiotics disrupt your child, your teenagers, your own gut microbiome immediately, and all the downstream effects that that can have on your child's immune system and their brain health and their mental health. So we need to integrate, we need to understand how do we kind of mop that up, how do we restore resilience to our kids microbiomes and to them and use medications when they're necessary, but also have all of our other tools to help kids really thrive.

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And can we drill down on that last comment you just made? Because this is an important part of the definition that Vanessa is asking for. People often believe that functional medicine, holistic medicine, alternative medicine, integrative medicine, whatever you want to call it, is quote unquote, anti western medicine. Antibiotics are verboten. And you know what, can you please disabuse people of that notion? Maybe you could even spend a minute talking about some personal journeys that you've been on with your own kids, that you've written about where, you know, there's a place for all sorts of different strategies in healthcare. And sometimes those strategies are these traditional western medicines.

Yeah, absolutely. And you know, I will say that you may and you will be able to find practitioners who do sort of say, you know, nothing, nothing conventional, but that's not what I do. And that's not really the way to practice medicine. Just like you will find conventional docs who say nothing ever, ever, ever, quote alternative. I mean, that doesn't open your mind to scientific inquiry, doesn't help you to look at the evidence and, and make a truly personalized decision for yourself or for your family. And so I just, I think, you know, when we keep an open mind, that really is how we're going to serve our kids in the best way possible and also teaches them to, to keep an open mind and to ask questions. You know, we want, I mean, kids nowadays, you know, we want to empower them to go to the doctors and say, hey Doc, I'm just, can I ask, like, what is this medicine for? What are the side effects? Is there anything I should know, you know, about, about long term use? And that's not questioning the doctor's medical judgment. And that's where I think, you know, for a lot of physicians, we have to take our egos out of this. It's questioning the medicine and it's questioning the impact on themselves. And so, you know, I really want to.

Getting curious.

Yes, yeah, absolutely.

And learning the skill of being a critical consumer, which we want them to be in everything in their lives. Not just, you know, when they're in doctor's office, but also with media, with the food they choose, with all of those things. Elisa, I want us to drill down. There's going to be so many puns in the next 30 minutes, I just know it. So like we're just going to go there. At the heart of your work is the gut microbiome I should say, in the guts of your work is the gut microbiome. Sorry, I've been working with Cara for so long that I can't help but.

Pun every 15 vowels of my work. Right.

Yes, yes, yes, yes.

Oh, come sit by me.

So the gut microbiome has, like, gotten some play. And, like, you know, there is. It's in the ether. But can we start with a description of what it is and then move into why it is so important to people's health? But start with, like, a really good definition, because people have heard it all over the place, but I'm not sure anyone actually truly knows it, what it is.

Yeah, 100%. And you would be hard pressed nowadays to. I mean, people don't pick up newspapers anymore, but kind of picking up the proverbial newspaper, right? Scanning your newsfeed and just seeing. I mean, the microbiome is mentioned almost every day in some context or other. And I would imagine almost every listener has heard of probiotics and seen probiotic supplements on the shelves or know, okay, if I have yogurt, there's some probiotics in there. Right? And so when we really get into the science, though, and I am all about looking at the science that we have, not just in pediatrics journals, but in the gut journals, the nervous system journals, the immunology journals, the pathology journals, I mean, all of these, and trying to figure out how do we apply that to kids and to teens? Because, I mean, just like pediatricians, sadly, are kind of on the bottom of the barrel for life satisfaction. The same thing is actually true with pediatric research. I mean, pediatric peds is sort of this. It's not a moneymaker for researchers, Right. And for big pharma or for the nutraceutical industry. So the research is coming, but it's lagging way, way, way behind adult research. So definition, the microbiome is really the collection of the trillions of microscopic organisms in your gut and the environment that they live in and all the genes that they bring with them. So it's sort of this ecosystem in our gut, and this ecosystem, just like our kids are taught to, you know, reduce, reuse, recycle. Right? We're taking care of our world's ecosystem. We want to take care of our gut ecosystem. All of those microscopic organisms in our gut, they are technically called microbiota. Right? But a lot of people will use microbiome to really talk about all of the organisms in your gut. There are 10 times more microscopic organisms in and on us than human cells. And Way more like hundreds times more genes, bacterial genes, than human genes that actually influence how our health is expressed. And so when we think about who are we taking care of, who are we nourishing, you know, how am I going to keep my brain happy or my immune system strong or my skin clear? We're not just talking about us. We're talking about how do we get all of those microbes to actually work for us.

Do you want to give an example of one kind of process that happens on the level of the microbiome?

Yeah. So I will give an example. It's sort of an aha moment for a lot of teenagers, because a lot of teenagers and tweens have, you know, they have heard of these brain chemicals called neurotransmitters and have even learned about serotonin, which is our sort of feel good, stay happy and calm, manage stress, fall asleep more easily. Quote brain chemical. Well, when I tell teenagers and kids and parents that 90% of your body's serotonin is made by your gut microbiome, that's sort of like a. Like this aha moment. Oh, wow. Okay. I'm struggling with focus and attention. I am really anxious and I don't know how to manage it. I can't fall asleep because my brain just keeps going, going, going. Well. Okay. It's not just about taking, you know, this pill or this supplement. Right. It's not just about, you know, kind of trying to meditate your way out of it. That is part of it. Right. All of these may play a role, but bottom line, if we don't support your microbiome to make enough serotonin for your brain to stay happy and calm, it's going to be an uphill battle. So we always start with the gut when there's anything going on.

And I want to just give one sort of clinical corollary to that, which is people read and hear a lot about celiac disease, and celiac disease is a common example that's used exactly on this point. When a person has celiac disease and they are reacting to the gluten in their food, they have a lot of inflammation in their gut. And part of the. The downstream consequence of all that inflammation is they wipe out part of the microbiome. They wipe out a lot with the inflammation, but they wipe out part of the microbiome. When they wipe out part of the microbiome, they wipe out that serotonin production machine. And so there are a lot of parents out there who have kids who have celiac disease or who Themselves have it. Who will recognize this as, oh, that's the. Sometimes it's depression, sometimes it's manifest in other mental health ways. But that's what goes along. That's the mental health piece of celiac. And it starts in the gut with serotonin production. Right. So very good, sort of manageable example of how important. And now multiply it literally by billions because there are so many of these organisms and they all have unique make jobs, Right?

Absolutely. I mean, you know, some of our microorganisms make at least 50% of our dopamine, which is implicated in attention and focus, but also addiction. And so, you know, when we understand this intimate gut brain connection, and what's fascinating is our microbiome changes through the years. So, you know, when babies are born, they, they. I mean, is it completely sterile, you know, no organ organisms? That's kind of up for debate. But we know that when babies are born, their microbiome quickly takes shape depending on how they were born and what they're fed, if they received, you know, or mom received any medications during birth or pregnancy. And in that first zero to maybe three, three and a half years of age, there's this critical window of gut microbiome development where all of your gut bugs, you know, your probiotics and maybe not such good bacteria and microbes are colonizing your baby's gut and influencing their immune system. So their risk for eczema, asthma, allergies, influencing their brain formation. So risks for things like ADHD or anxiety, depression later on. So we have this explosion. I mean, toddlers have, you know, at least two, maybe three times more synapses or brain connections than adults. Right. So we don't get to keep them all. And it's the gut microbiome that drives the brain formation. What is fascinating is that we see this same change in our microbiomes that occur in the tween teen years that's also driving a lot of the br changes in teens. So I mean, we're kind of talking offline before about how you almost can think, oh my gosh, you know, I took antibiotics or my kids. I mean, personally, my own kids took antibiotics when they were under 2 months of age because it was necessary. My daughter had a uti, right, at three weeks. My son had strep coming from his ear at five weeks. And I'm not going to mess with that. I mean, they need antibiotics, but I could think, oh my gosh, is that why they have X, Y and Z right now?

Maybe.

And yet we also have this golden opportunity when they're older. And it's never too late to restore your microbiome.

So, Elisa, let's talk about that. Because if any of our listeners are like me, all they can think about is all the ways they screwed up. The best part of interviewing experts like you is to think about the many ways I have failed my children. And it's perfect because then I get off a recording and I'm like, hey, guys, here's something else really tangible that you can blame me for in all the ways that I have utterly messed up. But for those of you listening, thinking about what you fed your kid, like, one of my kids basically ate hot dogs and non organic strawberries for like an entire year of life. So they're done. Check. I've already ruined his microbiome. What is the time of puberty like in the context of the microbiome? And what are the opportunities for essentially resetting or repopulating a gut microbiome when things aren't going well or health is challenged?

So, you know, I just want to step back and acknowledge the guilt that we can all feel as moms, right? I mean, I literally, I still think about. This thought pops into my head and I still think about that tuna fish sandwich I had when I was like four months pregnant with Kenzie and just wondering, what did that do to her? I don't know.

I called my husband from a deli crying while I was pregnant because I was like, I have to eat the tuna sandwich.

Oh, I would have just totally eaten it. How about the two pounds? How about the two pounds of Snickers I ate when I was breastfeeding my kid, who was born on Halloween and my mom forgot to give out the Halloween candy. And so I literally just ate pounds of Snickers and he has a peanut allergy. And I'm like, like, you know, is it me? Elise is going to tell me. It's all, it's all.

You actually probably made.

I probably made it not as bad.

I mean, no, like, to Cara's point, you that actually might have. It might have been worse if you hadn't done that, right?

Oh, good. I feel good.

So, but, but here's the thing. For me as a pediatrician, is really important to understand some of the pivotal moments that maybe did affect your child's microbiome and could be contributing to what is happening right now for them. Whether it's, you know, really bad acne or really bad PMS or eczema, asthma, maybe they have anxiety or sleep problems. The sole point of that is just to tell their story and know where you're starting from.

I love that. I love that way of looking at it. I feel so much better already. Okay, keep talking.

Yeah, well, because we, I mean, we can't find solutions if we don't understand where things went off track. And it's not to shame or blame, it's just to say, you know what? We didn't know better at that time. Right. And now we do. And now we can know. These are the points that maybe were some tipping points. How do we move forward? Because there's always, there's always a path to move forward. And I will say, you know, the younger your kids are, the easier it is to restore their microbiome, to restore immune imbalance. I mean, whatever. Just like with adults with chronic health conditions, it's harder to get them back than it is for adults. It doesn't mean it's impossible. Right. So we just always start. And then we also tell our kids the goal is to build resilience in their microbiomes, their brains and immune system so that even if they have, you know, a boba tea with 52 grams of added sugar. Right. Or they, or they decide to get that unicorn rainbow, artificial colored Starbucks drink. Their microbiome. Yeah, their microbiome, their brains, their immune systems, their. They can bounce back.

One of the phrases you use, Elise, and I'm only interrupting just for people listening, because you use terminology in the book, that is such a relief. And then I want you to keep going, which is we should think of chronic disease or chronic disorders or conditions not as chronic, but as persistent, because persistent is not permanent. Persistent can be addressed. And I found that choice of language so powerful. Can you give us an example of a kid or a family you've worked with where they came in with a. A chronic condition of some sort or as we'll say now, a persistent condition. And you were able. And I want to frame it in our audiences, right? Like a tween or a teen where they came in and they've been grappling with something for a long time. And, and you talk about hearing their story and thinking about those pivotal moments. Talk us through one of those examples.

So I mean, just to get back to. Well, I don't know if you want an anxiety example or an immune example.

Anxiety is great.

Yeah. Just because so many of our kids are grappling with. Even if they don't have an anxiety disorder, we have an epidemic of anxiousness. Right. We, even as parents, we don't have the Tools, really, to manage our own anxiety and anxious feelings. So, I mean, how can we expect our kids to be able to. So I had this, this teenage girl, she was 13 at the time, and she'd been diagnosed with anxiety and adhd and who knows which drove what, right? They're so interconnected for years. And she had tried multiple different medications. You know, she played around with self harm and just you know, really was not in a great place. And so when we met, I mean, I have a conversation about kids, microbiomes in age appropriate language with every kid because I want them to understand why I'm making certain recommendations, right? Because like eating the rainbow, I mean, they're just gonna roll their eyes at you, right? But if you. I mean, I mean, parents are gonna roll their eyes at you too, right? Because they've heard it before. But yet we don't do it, right?

So unless it's the rainbow colored exploding gittles.

Oh, gosh, yeah. Four Skittles. Or yes, yes. Or Takis, the artificial blue ice flavor, whatever. I mean, it's. It's horrible.

Oh, God. So I haven't seen those yet.

Vanessa's like right now, Vanessa's like, oh, thank God I haven't seen those. That sounds very curious.

No, no, no.

But I did, Elisa. I did make Cara buy the Trader Joe's Takis for her house. And her kids walked in and opened the cabinet and they're like, who bought these? Like, they immediately knew they were not.

Of cars, stole my mother and were.

My mother and had someone who bought these snacks.

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And help us through the lens of kids in puberty? Right. So our language, conversation, communication with kids in an age appropriate way, starting on the front end of puberty, those 7, 8, 9, 10 year olds and how to communicate with them the first pass through and then moving into the older kids because we know we this communication morphs as they get older.

Yes.

So what that looks and sounds like, I mean your kids are right there, you're living it, you're learning a lot, I'm sure from your kids. But what does it sound like and what is effective for those kids?

Yeah. Well, so let me just finish up this story quickly about this 13 year old though, right? Because once she understood that connection between her gut and her brain, we looked at her gut, we realized that she had some abnormal organisms in her gut. Microbiome. We cleaned that up. One of the hardest things for her to do was to give up her Starbucks fix. I mean almost every day with, I mean so much added sugar. And I talked to her about how that was really affecting her brain. And slowly, slowly she was able to, you know, look at her diet, make some tweaks, have the occasional Starbucks. We clean up her gut and her mom sent me a letter. It was probably now maybe two, three months into it. It doesn't have to take that long, right? So two, three months into it and she wrote me a letter and Said, oh my gosh, you know, I have Rachel back. I mean, this is the first time, this first weekend where we actually all sat around and we enjoyed being together, right? And she was smiling and this was something that medications could never do, right? And so it can be profound, it can be relatively rapid and it doesn't have to be that complicated. So when I talk to preteens, right, the preteens tweens. Part of what, what inspired me to write the book was because I taught this six week, I created a six week curriculum for my kids. Third and fourth grade combined class, so they were eight to ten year olds. So fun. I mean, literally I mapped out every day of the curriculum and the first day we spoke about their microbiome and I called them, you know, their tiny little friends in the, in their gut and. Right, and what do they do? Right? I mean there's like most kids will have maybe about like 2 pounds of bacteria, microbiome, microbiota in their body, right? Adults can have like three to six pounds. I mean, that's a lot, right? And so I brought in like a two pound dumbbell and a two pound like pineapple. I just have them pass it around and say, this is how much, you know, your friends weigh and they're in your body and they're helping you, right? And you know, I just, I asked them questions, hey, who's ever had trouble sitting still in their seat and like wish that they didn't have to wiggle so much and get in trouble, right? Who's had trouble falling asleep because your mind was just full of thoughts and you know, good or bad, right? Or who wishes they could get along with their friends better or you know, have a, have an easier time with their worries. And you know, a lot of kids were like, raise their hands. And so I said, guess what? Right? All of that. If you are kind to your gut buddies, they're going to help you with all of that. We learned together how to read food labels because I think when kids can learn how to read food labels in a kind of a microbiome centric way as kids and teenagers and that's going to prepare them for a much healthier adulthood.

And what you mean by that is they are able to look at the ingredients on the food labels and what's going to wipe out their microbiome and what's going to feed their microbiome in a healthy way, right?

Absolutely. And what's going to, you know, nurture their brain? I mean, this is as we record, we're just at the end of, you know, St. Patty's Day. And you know, my kids, like most other kids, they want the lucky charms. So what I had bode do. I said, look, we can have the lucky charms, right? This is St. Patty's Day. This is part of, we can celebrate in that way. And we're just gonna look at the label together. And I had him write on our whiteboard all of the sussy ingredients that maybe, you know, hurt his microbiome.

Suspect.

Suspect. Yeah.

Right.

For those of you not versus my daughter.

My daughter talk.

Yeah. And my, my daughter Kenzie, she cringed and she crossed that out. I was like, come on guys. And so, so you're like, I'm trying here.

I'm trying.

Let me ruin it for you guys.

That's right. I'm like, what? We can't give our gut a glow up.

So we use that as a learning opportunity. And I didn't shame them. I didn't say, look, you can't have, oh my gosh, look how horrible this is. I said, look, I want you to be informed. Whatever you put in your mouth, just know what it is, right? Know how it could affect you. And so that for my 14 year old now, it gets her thinking more on that concrete, okay, how is this really impacting me? And then I can talk to older kids more about the actual science because I mean, they eat up like this. The gut brain, how does it communicate? What are neurotransmitters? Right?

So Elisa, let's talk about that because I learned a ton reading your book and the gut brain connection. You talked a little bit earlier about the chemicals, the hormones in our bodies that people assume actually all come from the brain, when in fact many of them, or the majority of some of them come from the gut. Talk to us about the gut brain connection and the vagus nerve and all of it and how that might look special during puberty with the beautiful sex hormones stew that our kids are bathing in and their brains are bathing in. Because this I think is really at the heart of a lot of how we better understand and are inspired to, to make change in our, in our own lives and our own families and better explain it to the kids in our lives.

So I love talking about the vagus nerve and I love that you said it's not Vegas like Las Vegas. It is Vegas. V A G U S But you know, there is Dr. Alessio Fasano who's at Harvard. He is really the world's leading researcher on celiac disease and he has said Your gut microbiome is not like Las Vegas. What happens in the gut microbiome does not stay in the gut microbiome. Right. Because of the gut. I love that so much.

It was like, who said, who thought scientists weren't funny? I was like, that's a great, That's a great.

I'm right here.

All right. Cara's the funniest person I know. She paid me to say that. Yeah. So it doesn't stay in Vegas. Right. What happens in the gut affects everything. So for people who don't know what the vagus nerve is, can you give them a little, a little background?

So the vagus nerve, it's the wandering nerve for those of you who know your Latin roots, because it wanders all around the body. It's the longest nerve in our body that goes from our brain all the way down into our central organ system, connects all of our organs. And it's a two way superhighway communication road between your brain and your gut microbiome. And what's fascinating to know, just like the majority of brain chemicals is made by our gut microbiome, most of this communication, so 80 to 90% of the communication between the gut and the brain actually occurs from the gut to your brain. So it's this. But we can't discount the brain to the gut pathway either. They're so intimately tied. And what's fascinating is a healthy gut microbiome has been shown to lead to a healthy vagus nerve, vice versa. A healthy vagus nerve also supports a healthy gut microbiome. Now, what does the vagus nerve do? So then we have to step back and understand something called the autonomic nervous system. So the autonomic nervous system has two main arms. One of them is our sympathetic nervous system, which many have heard of. It's that fight or flight response, that stress response when something is about to happen. Not necessarily a bad thing. Right? And this is where in our, in our modern world, we have to just step back and realize stress is just your body's physiological response to something that's about to happen. And it gets you ready. So if you think about it, I mean, think about your teens or you, if you never had any deadlines, would you ever get anything done?

No, I'd lie in bed all day reading books.

That's right. So we need that little bit of stress to propel us into motion, to get us in the zone. I mean, you know, athletes, musicians, performers. And who, if you've ever been in that kind of. You're excited or getting nervous about your performance. And then you're on and you're like, I'm in this flow state. Like I just, you know, I'm just on. That's what we want. We want a little bit of stress, that sympathetic nervous system responds response. And then we want the other part of our autonomic nervous system, the parasympathetic, which is controlled by the vagus nerve, to come in and say, hey, you've done your job, let's rest, let's heal, let's also digest, right? Let's kind of restore that calm. And so that vagus nerve, that restoration of calm, that nervous system regulation piece is something that, you know, we, and I'm gonna say from the moment you're born to the moment at the other end of your life, we have way too much practice being in this sympathetic state from like LA traffic or New York traffic or, you know, getting to school on time, make it to your soccer game, taking this test, friend drama. You know, you open up your, your phone and you look at someone tweeted something horrible about you, right? I mean, just all of that, right? We're just sympathetic, sympathetic, sympathetic. What we don't have enough time doing is in that parasympathetic, let's learn how to regulate our nervous system, be in that calm state so that we can manage our stress more appropriately. And so when we think about our gut microbiome is essential to help your brain be able to kick in and regulate. But we also need to exercise our vagus nerve because when we learn these tools for self regulation, for calming, for mindfulness, that also can help influence and improve your gut microbiome diversity. What I love about this, what's fascinating is that doing that vagus nerve work can improve your gut microbiome independent of diet. So the study in kids, right, even if your kids are not as receptive right now to changing their diet, if they can think about different ways to incorporate vagus nerve work, it's going to make a huge impact.

What do you say to parents who have super picky eaters who can't for a whole host of reasons change their diet and shift their microbiome that way, but who are resistant to doing some of this work? What's your best way in?

So just educating, talking, right? Not nagging, but just kind of, you know, letting kids know. And that's where, you know, when with the book, I mean, it's fascinating. I've had, you know, people reach out. Like I had this one mom who reached out and said the Biggest struggle was with her, her mom, grandma, right. Going over to grandparents house and just having all of this like horrible stuff that they're like, it's a treat. I'm, I'm a grandparent, you know. And so I had this one grandma actually read parts of the book and she went home, spoke with grandpa and said we need to rethink what treats are for our grandkids and completely overhauled their pantry. I mean, that's what you want. No nagging required.

Elisa, My father feeds my children cake for breakfast when he's in, so have.

Him read the book yet.

So does Henry Winkler.

They are similarly wonderful. Elisa, talk about the role that the hormones involved in puberty can play in this beautiful ecosystem.

This is where there's been more research in adults and you know, especially women. I mean, perimenopause is having its day, which is great, right. But a lot of research around, around how the microbiome affects our sex hormones and can affect sort of inflammatory responses that can affect how we go through perimenopause with all of its wonderful symptoms. Right. But we do know that the microbiome changes during this pre pubertal period and also changes during your teenage years. And there does seem to be a correlation because kids who have precocious puberty, so too early puberty, they seem to have these changes in their gut microbiome earlier. So there's a communication there. One important thing that our microbiome does, one of its roles is to metabolize estrogen. And so, you know, we have all of these processes that try to help, I mean, estrogen. There are some, you know, kinds of estrogen that aren't so good for us that may increase the risk for certain cancers, like breast cancers. There are some, you know, some forms of estrogen that are beneficial for us. And so our gut microbiome helps to, to when it's healthy, make sure that we have this healthy balance of estrogen.

And, and is this connected with the mood swings of early puberty, both the estrogen levels because of the metabolism happening at the level of the microbiome and also the downstream affects, all the neurotransmitters that the microbiome is producing or maybe not producing because of these shifts?

Yeah, I mean, absolutely. So I mean, when I talk to kids about going into puberty and you know, boys have estrogen too, girls have testosterone too. Right. I mean, it's not just that there's female sex hormones and male sex hormones, it's just the balance of it. But you know, when we have an overabundance of, let's say, these surges of estrogen. Then we might see more moodiness, more weepiness, you know, even before you get your period. Right. I mean, you can have these. These cyclical changes, you know, for years beforehand, and then, you know, when testosterone metabolism is off, then maybe we might see more of the acne and, you know, more of the anger and, you know, all. All the feelings that teenagers go through. And our microbiome plays a role in helping to. I don't want to use the word detoxify, but in a way it is, right? It's kind of detoxifying some of the hormones that we don't really want and, you know, creating a better balance for the hormones that we do want.

I mean, you're. You're filling out a storyboard where, who among us has not eaten junkie? And then our skin breaks out, right? So we draw a direct line, right? Maybe it's sugar, maybe it's this, maybe it's that. What you're doing is you're filling in all the steps in between. Okay? Maybe it is sugar, and maybe the sugar feeding the part of the microbiome that is not helpful to us that's increasing inflammation in the body that's then triggering all these things. So what you do and you do so beautifully in your book, I mean, this is truly a must read for anyone who has any interest in thinking outside of the narrow Western medicine box and looking at a more inclusive form of care for kids and for themselves. What you do is you tell the whole story and you encourage people to start getting curious in their own life and to start getting informed. And it's your gift. I mean, I think it's clear to our listeners that you are a gifted explainer, communicator, storyteller. I can't wait for the puberty version of this book.

All about the pressure.

Just plain, I'll make you quinoa and we can sit down, write a little.

Book proposal, storyboard it. Oh, my gosh, that would be so great.

But kidding aside, I mean, it's really the way you approach this information. It is no wonder, Elisa, that you have become the leading voice in integrative pediatrics to the extent that we spoke at an event in LA last fall. A woman, an acupuncturist, came up to us after the talk, and within a minute, it became clear she had brought you up as sort of the. The guru. And I said, elisa is my dear friend from residency. And Vanessa, did she start to cry? Was that what happened? Did she start? It was like a. It was a moment that was so massive for her that I knew you. So anyone who didn't know you before this podcast, we are so happy to be the one introducing you to this audience. The whole world is about to benefit from the information you put out.

Oh, thank you so much. You know, just to also educate tweens, teens in their choices and parents too. You know, sometimes you can go down a rabbit hole and feel like, oh, my gosh, there's so many that I have to do. And it's really just about starting one thing first, right? With anything you just, you can see. I mean, I always, you know, talk to, even to my own kids, but to parents and kids in my practice, you can, you can look at this mountain ahead and think, oh, my gosh, I have so far to climb. I have to do X, Y and Z. That's going to paralyze you, right? You just take it one step at a time. And periodically you have to stop and look back and realize, oh, my gosh, look how far I've come.

Even me.

I can think about, oh my gosh, all the things I have to do and change, but then I look back and realize, okay, I've done a lot already. I'm just gonna take it one step at a time.

And getting to know your body and how your body reacts and what choices you make. The Lucky Charms example, right? This is not a pristine, perfect journey that we're on. We're basically getting to know our bodies and our kids bodies and giving them the tools and the skills to understand all of that. And like, that's what this is all about. To be able to give them the knowledge and the skills to become healthy, independent, hopefully happy people. And this is part of that journey and it's just wonderful. I can't wait for people to read your book to get to know you and your work better because my eyes are totally opened. I mean, the Vegas NERP is now basically my best friend and. And Elisa, we're so grateful and we can't wait to have you back when you write your next book.

You're like, no. If you're like Kari, you're like, no.

Don'T even say it.

Thank you, thank you, thank you for everything you do and for inspiring us and informing us and opening our world up even wider. We're so grateful.

Oh, well, thank you guys for having me on. Maybe next time we will all do an in person interview.

Done.

Done.

Well, we have to decide. New York or California? So we can.

I don't care as long as there's kombucha. And quinoa.

And quinoa. I'll be sure to make my famous quinoa.

Thanks Elisa.

Thanks guys.

Thank you so much for listening. You can email us with questions, feedback or episode requests atpodcast less awkward.com if.

You want to learn more about what we do to make this whole stage of life less awkward for everyone involved. Our parent membership, our school health ed curriculum, our keynote talks and more are.

All@Lessawkward.Com and if you want products that make puberty so much more comfortable, visit myumla.com.

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