Ep. 360 Raising Resilient Kids: Insights from Holistic Pediatrician, Dr. Elisa Song

I am thrilled to have Dr. Elisa Song joining me today. 

Dr. Song is an integrative pediatrician and author of Healthy Kids Happy Kids. She trained at Stanford University, New York University (NYU), and the University of California, San Francisco (UCSF). 

In our conversation today, we dive into kids in crisis, exploring the butterfly effect of crisis impacting teens and young adults. We discuss the significance of the gut microbiome, dispelling myths surrounding antibiotics and addressing the resulting global health crisis. We touch on PANS, PANDAS, rheumatic fever, and strategies for restoring the gut microbiome of children, post-antibiotics. We also look at the significance of food labeling and constipation in children, explore the importance of the vagus nerve and heart rate variability, and examine the impact of sugar, glyphosate, and other forever chemicals. 

Stay tuned for today’s insightful and enlightening conversation with Dr. Elisa Song as we dive deeply into crucial aspects affecting pediatric health and wellness.

“There are kids who look fit, yet on the inside, they are metabolically unfit and unwell and heading toward a lifetime of virtually every chronic disease.”

– Dr. Elisa Song

IN THIS EPISODE YOU WILL LEARN

• Dr Song discusses the crisis surrounding the health of children and the shifts and trends she has seen in pediatric medicine over the last two decades
• Why do we need to address the root cause of illness instead of just treating the symptoms?
• How autoimmune disease rates in children are rising
• The importance of empowering teens through education and support to make healthy choices 
• How do antibiotics impact children’s health?
• Strategies for restoring the gut microbiome of children after antibiotics
• How the vagus nerve impacts the gut microbiome and brain
• How sugar affects children’s health
• The importance of gut health for brain function and detoxification
• How to improve children’s health through diet, exercise, and integrative treatments

Connect with Cynthia Thurlow

• Follow on Twitter
• Instagram
• LinkedIn
• Check out Cynthia’s website
• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Elisa Song

• On her website
• Find out more about Dr Song’s book here 

Transcript

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 

[00:00:29] Today, I had the honor of connecting with my friend and integrative pediatrician and pediatric functional medicine expert, Dr. Elisa Song. She is a Stanford, NYU, and UCSF-trained integrative pediatrician and she’s the author of the Healthy Kids Happy Kids book. Today, we dove into kids in crisis, the role of the butterfly effect, especially as it pertains to teens and young adults, the importance of the gut microbiome, why antibiotics are not benign, and the resultant global public health crisis, when to use antibiotics judiciously, myths around antibiotics, we touched on things like PANS and PANDAS as well as rheumatic fever, how to address our children’s gut microbiome after antibiotic therapy, the importance of the vagus nerve and heart rate variability, the impact of sugar, the importance of food labels, the role of glyphosate and other forever chemicals, and last but not least, addressing constipation in children. This is an invaluable conversation. I wish I’d had this book when my children were younger. It’ll be an invaluable book and resource for parents, grandparents and those that love children. 

[00:01:48] Welcome, my friends. So good to have you on the podcast. And as I’ve said before, I can’t think of a better pediatrician, colleague and friend to have on to share with my community. It’s such a pleasure to have you on today. 

Dr. Elisa Song: [00:01:59] Oh, I’m so honored and excited I get to see you, even if virtually. I have so much gratitude for you. [chuckles] 

Cynthia Thurlow: [00:02:06] Absolutely. And I think over the past 20 plus years, you and I have seen huge shifts in medicine, and certainly you working with a predominantly pediatric population. What are the things that have really shifted for you in terms of how healthy your patients are? What are the trends that you’ve been experiencing? Because you do such a beautiful job in your book, talking about how kids are in crisis. And I think it’s a perfect way to kind of segue into this conversation today. 

Dr. Elisa Song: [00:02:35] Yeah. Well, so I started my integrative pediatric practice in 2004, and prior to that, I was in med school in the late 90s and mid-90s, and my pediatric residency at UCSF. I finished in 2000. So that was a while ago. [chuckles] And I distinctly remember when I was in my developmental pediatric rotation at UCSF, I remember my attending telling me, “You know, what? We were observing and talking with a parent and child who had autism.” And my attending said, “Look, if you see a handful of kids with autism in your career, that’s going to be a lot.” This was in 1999, and there was no such thing as type 2 diabetes in the way it was called. It was called adult-onset diabetes. We didn’t see children with type 2 diabetes, and there wasn’t this thing called metabolic syndrome. And short kids had eczema, but their eczema was treated with maybe 1%, 2% hydrocortisone. Maybe you had to go a little stronger on the steroid scale to triamcinolone. But I remember being told, “Never, ever, ever put steroid creams in the diaper area and never ever put anything stronger than, like, a 0.5 or a 1% on the face.” 

[00:03:56] And fast forward now with one in five kids with eczema, I mean, oh, my goodness, we’re getting into stronger and stronger, not just steroids, but in some kids, these chemotherapy agents, these immunosuppressant agents. And we’re just getting to the point where we’re having to hit these things harder and harder. And so instead of saying, “Well, what’s the next drug I can develop?” We have to think, “Well, how did our kids get here in the first place? And is there something we can do so that if they’re on medications, maybe they’re not on them for life? Or if they’re on medications, how do we mitigate some of the side effects of the medications, or how do we prevent them from being on medications in the first place?” And so that’s where I’m at now. I am fortunate that my practice, as an integrated pediatric practice, it goes both ways. I see, well kids who, parents are already committed to uncovering the root causes of why kids are so sick and inflamed today? So, they tend to be more on the well side than, I think, most general practices. But then I see some of the sickest of the sick, which who’ve been searching for answers from their conventional specialists, and their kids aren’t getting better, they’re not thriving. So it is time to wake up now. 

Cynthia Thurlow: [00:05:12] Yeah. And I think on so many levels, and I’ve been very open on the podcast that my oldest son, Jack, who’s now 18, at four months old developed eczema. And I knew enough to know that it was beyond just a skin issue. And the traditionally trained allopathic pediatrician, who is a very good physician, just kept prescribing steroids, and I kept asking, “Could it be something else? You know, he’s exclusively breastfed. Is it something I’m eating? Could he have a food allergy?” And it was always kind of like, “Oh, Cynthia, kids just don’t have a lot of food allergies.”

Dr. Elisa Song: [00:05:45] Yeah.

Cynthia Thurlow: [00:05:45] Little did I know my son had anaphylactic reactions to peanuts and tree nuts and has not outgrown his allergies. And we’ve been able to navigate food choices and going to restaurants and eating out. But in many ways, I always credit Jack for opening up my eyes that there was more to health than kind of our traditional allopathic paradigm, which has its place. Let me be very clear. But I think for you, you have such a unique perspective because you’ve been in medicine for 25 plus years. What are some of the other things that you have been seeing with greater frequency? I know that it seems as if when I used to volunteer in the kids’ classrooms, I would say easily half the boys were on ADD, ADHD medications.

Dr. Elisa Song: [00:06:32] Yeah.

Cynthia Thurlow: [00:06:33] It seemed like every kid had an inhaler because they had some type of bronchospastic propensity. And then even with the mental health crisis that we’re seeing on so many levels, you as a clinician, having kind of a bird’s eye view into the shifts and changes that have occurred, I’m sure that it’s probably incredibly troubling, do you feel that a lot of the families that you’re working with, that they understand that there are these contributory factors that impact their children’s health, like the nutrition and the sleep, and the stress management. Do you feel like that has gotten easier to talk to them about, or do you still feel like there’s a bit of resistance?

Dr. Elisa Song: [00:07:11] I will say it’s perhaps not resistance so much as just the awareness and the firm belief in it, because we all know sleep can affect you, what you eat can affect you. But if we realize how much, and the reason I wrote the book is because I really want to open up not just parent’s eyes, but also practitioner’s eyes too. How significant our choices are on our microbiomes, our children’s microbiomes, and how that can have ripple effects to every other organ system in their body, like the skin, or the brain, or their hormones, their metabolic systems. And it is so important and with these numbers now the statistics from the CDC, and they are old, there are estimates that maybe around 40%, or at least one in two kids, has some sort of a chronic diagnosis.

[00:08:02] Now, when we say chronic diagnosis, what does that mean? We know maybe one in three to five kids has eczema, one in five kids will have ADHD, one in 10 kids will have asthma, as you said, as you noted, around one in 13 in some reports have autoimmunity. Many of your listeners have had brushes with autoimmunity or continue to. And there is a very nonspecific autoimmune marker in your blood called an ANA, an antinuclear antibody. And one of the most alarming studies that I found, there was a research group that looked at, through the years, ANA positivity rates by age group. And the age group with the fastest rise in ANA positivity were our 12- to 18-year-olds. These are our kids from the 80s to the 90s, they doubled in rates, and now they’ve tripled in rates again. And so, this is to me, it’s a red flag. It’s a huge canary in the coal mine saying, “Look, you could have ANA positive blood test. It doesn’t mean you have any autoimmune condition just yet.” So, they’re not going to be put into the 40% that has a chronic diagnosis. 

[00:09:10] However, that is a huge red flag that if we don’t intervene, then they may be headed towards any number of autoimmune illnesses. And what I tell parents, because it can be kind of frightening to see, “Oh, my gosh, my kid has a positive ANA, or they have X, Y and Z markers on their tests. And I tell them, “Look, this is actually a moment to celebrate, because now we know, before your kid has a diagnosis, just like the incredible epidemic and rise in kids with prediabetes, even athletes I’m seeing with high insulin, high fasting blood sugars, they’re heading towards diabetes.” And I let them know, “Look, this is the best news that we can get, because now we can kind of go back, figure out what led you to this place, figure out some of your triggers, and then identify how can we move forward so that you don’t develop diabetes, you don’t develop autoimmunity, you don’t develop X, Y, and Z.” And there’s so much nowadays, I think, fear out there. You see all the social media posts about, “Don’t put this in your mouth, don’t put this on your skin, this is toxic.”

[00:10:13] And yes, we need to know that, and we need to know what to do with that information. [laughs] Which is why I wrote the book, because I’m a mom. I don’t want to just sit here living in fear and feeling like I have to keep my kids in lonely little bubble. I want to know, how can we live in this modern world, understand the things that impact their health, minimize the “toxins” that we can. We’re not going to be 100% zero exposure. These forever chemicals, sorry, are everywhere. So how do we then help our kids thrive in this modern world and have the knowledge to move forward when they’re teenagers or college students or young adults on their own, or parents of their own? 

Cynthia Thurlow: [00:10:54] Yeah. And I think that reframe is so important because I think well-meaning people on social media or on podcasts end up scaring people, scaring parents. I have teenagers, and I feel like prior to them being teens, it was a whole lot easier to navigate food choices, nutritional choices. Now, oftentimes, they’re not always with my husband and I, and you have to kind of hope that all of the good lessons you have taught them that it’s sunk in, even if they’re not admitting it to you at the time. [Elisa laughs] So, I think that reframe of helping people understand that we do live in a fairly toxic world, but that doesn’t mean we can’t continue to make good choices that ultimately will push us into a direction where we’re going to be healthier than most others. 

Dr. Elisa Song: [00:11:39] Yeah.

Cynthia Thurlow: [00:11:40] And so you mention in the book, and I love the butterfly effect, and I’d love to identify what this is and how people can understand that we’re all interconnected. It’s not like each one of us, as a family is alone on an island that we are connected to one another quite significantly, and then kind of loop in the gut microbiome, which I know is a large focus of the book, and it’s obviously something I love discussing on the podcast. But helping parents understand the choices that we’re helping to make for them as they’re growing and becoming young adults has a large impact on how they will go on to live healthy lives. 

Dr. Elisa Song: [00:12:17] Yeah. So, I will tell you one gap in our health and wellness literature outreach is our teenagers, our preteens, and our teens and our young adults, sort of as moms, we have this, we’re reading all the books. [chuckles] The parenting books, the wellness books. But then all of a sudden, they hit this pre-puberty, puberty stage, and we’re like, “Okay, now what?” Right. [chuckles] 

Cynthia Thurlow: [00:12:37] Mm-hmm.

Dr. Elisa Song: [00:12:38] Because it’s not just about us anymore. It’s really and truly about them, which we want to take that opportunity to empower them. And I will tell you this book, I had one mom whose son, he’s either a junior or senior this year and he’s an athlete, he’s a football player. He read parts of the book with her and started making different choices. He started changing, what he chose? He went out with his friends, hung out after football practice and games, but he chose differently. Instead of getting the mocha chip, whatever, Frappuccino with the 52 g of added sugar, he thought about it and maybe he did choose that sometimes. But at least he knew what he was choosing and how he could make different choices around that. And so that’s what I want. [laughs] My high schoolers in the practice who are going off to college now and they’re asking me really astute questions when they’re looking at a supplement. Like, I have a kid who, I mean, gaming is, it’s a thing. And so, what’s fascinating is the gaming supplement industry is exploding.

[00:13:41] These nootropics for these gamers, how do you get your brain on? And so, thankfully this kid who’s 14,15 asked me about the supplement he saw obviously, targeted [chuckles] marketing. And it’s this neon green powdery, has sucralose, has acid sulfate, potassium, and yet the other ingredients, it has carnitine, it has phosphatidylcholine, it has CoQ10. It has a lot of the supplements that I would recommend for, nootropic support, neurologic support for a kid. So I said, “Look, I’m all for reaching your goals. Let’s take a look at these ingredients and understand what this acid sulfate, potassium and these sucralose, these artificial sweeteners do to your brain and to your microbiome. And let’s see if we can find some other solutions.” So, I love that. And I think when you frame for kids, little toddlers, all the way up to teenagers, even for adults, when you frame how our choices affect our microbiome and how important our microbiome is for our brains, immune systems, hormones, etc., even our epigenetic potentials, it makes it a little easier. It’s just like for moms, it’s so much easier for us to make those choices when we know it’s going to help our kids, if we know our choices are going to affect this whole ecosystem inside us that actually is helping to support us, it does frame it a little differently. I do think it helps. 

[00:14:57] So when we think about, you mentioned the butterfly effect. There was a, I believe, from MIT Dr. Lorenz, a meteorologist, who coined this butterfly effect. And actually, don’t know if he coined it or if it just kind of came afterwards, but he made this comment, he was doing all these statistical analyses about these tiny shifts that could happen in the atmosphere, in the environment, and is credited with saying, a comment, something to the effect of, “If a butterfly flaps its wings in Austin, Texas, could that set off a tornado in Taiwan?” And so, the calculations showed, “Yeah, it actually could.” This tiny little change. And that’s the same thing with our microbiome. A tiny little shift, for worse or for better, can set in motion this ripple effect for positive, lasting benefits on your HPA, your hypothalamic-pituitary-adrenal stress response, your hormones as you’re developing through puberty, and your thyroid, your developing immune system. And really, I think for us as parents, so importantly, our children’s developing brains in the toddler years and also in these preteen teen years, because there’s this explosion of change in our gut microbiota, the diversity and function, composition that occurs in our toddler years, that drives the changes in our toddlers’ brains, our baby’s brains. 

[00:16:14] But the same thing is happening in our preteen, teenage brains. So, we have that additional opportunity and so understanding that foundation and understanding– And a lot of people want to know the science. They want to know, maybe they’re on board, but partner isn’t on board or their kids aren’t. So, I gave a lot of the research on how the microbiome, truly for children and teenagers whose brains and immune systems are continuing to develop, how that shift can occur again, for better or for worse. And we get to choose, we get to choose a lot of it and what direction we want to take.

Cynthia Thurlow: [00:16:47] And I think it’s so interesting because certainly when we train, there was no discussion about the gut microbiome. And yet in the last 5 to 10 years, there’s been an explosion of research and focus on this. And it makes so much sense that things we put into our bodies have a huge net impact on the health of our gut microbiome and fully understanding that it has far reaching implications, far more than I think the average person understands. And I think I would be remiss if we didn’t discuss a very big topic which is antibiotics. You and I both know that sometimes they’re used judiciously, sometimes they are not. I think for many parents who, when you’re in the stage where you can’t leave your kids at home if they’re sick and you’re working, and how stressful that can be, I know that colleagues of mine that were pediatricians would sometimes say they felt pressured to prescribe when it was probably something viral. But let’s talk about how antibiotics impact the gut microbiome quite significantly. 

Dr. Elisa Song: [00:17:47] This is such an important issue on so many levels, on a global public health level, and also on that individual patient level, and so important that there’s actually an entire chapter. It’s chapter 10 [chuckles] in my book. It’s called, “What every parent and practitioners should know about antibiotics.” Because on a global public health level, we are at the point where antibiotic resistance could become a leading cause of death by 2050, that’s right around the corner. And that could be so frightening from really acknowledging that antibiotics are one of the greatest public health inventions of the 20th century. And now we’re in the 21st century, where we may not have antibiotics that could treat a simple ear infection or a strep throat. We should all be raising the alarm, not just practitioners and public health people, all of us. And then, as you said, in some studies, up to 70% of antibiotics prescribed for children are inappropriately prescribed for things like viral infections or maybe they’re a little broader spectrum, a little stronger than they need to be. And one thing that you said, that in some cases, it’s not necessarily the pediatrician just kind of writing the prescriptions. 

[00:19:08] Although I will say straight out of residency, I was moonlighting in an urgent care, and I was seeing literally one patient every 5 minutes, 8 minutes. It was crazy. I didn’t have time to pee because every time I went to the bathroom or even get a sip of water, I’d see 10 more charts stack up. So I’m like, “I just got to plow through.” And it’s all you could do to just kind of get your head above water. And in that situation, if a kid comes in with an earache and you really want to talk to them about, waiting and watching for 72 hours, and here are the signs. And if you have an integrated pediatrician, here are some options for using things like garlic oil that has as evidence to back it up. You don’t have time. And so, there’s that. And then get this in one study, they found that physicians are maybe up to twice as likely to prescribe an antibiotic prescription if they think the patient wants one. And so simply by you as a parent or a child, saying, “I want to discuss this.” I’m not the one that who wants just to walk out with the script, because there are some parents like that. I am the parent or the child who, “I want to know. I want to ask, are there options? What are the side effects? How do I mitigate the side effects?” And then as an individual, when we understand the impact of antibiotics on our microbiome, it does make it easier to feel confident asking those questions.

[00:20:27] Because just a couple of studies that I’m going to pause and just say, as a mom, if you go back and think, “Oh, my gosh, this was my child, this happened.” We can’t undo the past. And I know there’s plenty of mama guilt that will always be around, [laughs] no matter how old your kids are, it’s going to come back. But it’s really important to just know this. We need to know the story of how your child or teenager or young adult child got to where they are. But one study that looked at over almost 800,000 children and followed them from birth to about four years of age, found that antibiotics or even antacid medications, two major microbiome disrupting medications given in the first six months of life, could significantly increase the risk, maybe even double the risk of virtually every single allergic disease, including eczema, asthma, hay fever, hives, and anaphylactic food allergies, which when I was training in residency, hardly a patient who needed an EpiPen, and now there are shortages.

[00:21:30] This even includes, unfortunately, in utero exposure. So sometimes parents will say, “Well, they didn’t have antibiotics.” But you received antibiotics while you were pregnant for a UTI or a sinus infection or just like with my son Bodi, I was group B strep positive, so I received antibiotics around the delivery. So that does impact. And so, we need to know that and educate OB-GYNs and pediatricians and parents moving forward. Another study in Denmark, which keeps these amazing databases for research found that they looked at mother infant pairs and followed these children and found that antibiotics, even in utero, at any point in life, in this child’s life, could increase the risk of virtually any mental health concern by up to 50% when they were older kids or teenagers. We know that by the time in the US, kids are 18 one in two is going to have a mental health diagnosis. That’s like every other kid in your kid’s high school class. And the highest risk was when those antibiotics were received before six months of age, showing you the priming effect, that foundational effect. But the more rounds of antibiotics, the greater the risk as well. We see this in adult studies too. It’s in the literature. 

[00:22:52] So like you said before, “There is a time for medications.” We are firmly grounded in our conventional medicine training we need that. And yet now, from an integrative functional medicine standpoint, we need to understand, “Look, antibiotics are there for a reason.” Now, we know all of these unintended consequences on their microbiomes. How do we get the benefits from the antibiotics and know how to mop up and restore the microbiome disruption that will occur not just after antibiotics, but after a whole host of other medications. So that is where we can really have an integrative approach and not throw the baby out with the bathwater. Now, on the other hand, in part four of my book, I use homeopathy, essential oils. I have one right here to kind of perk me up, [chuckles] acupressure points, herbal medicines. So that instead of the waiting and watching supportive care approach that we have in conventional pediatrics, which basically means there’s not much you can do except to, of course, hug and cuddle your kid, give them fluids and just wait it out, there are so many natural remedies that can help your kids actually get better faster and potentially help you avoid the need for antibiotics or know that if antibiotics are needed, they really were needed. 

Cynthia Thurlow: [00:24:05] Yeah. I think it’s so helpful, first and foremost to acknowledge that we can’t change the past. So as an example for listeners, I had two breech kids. I had two C- sections. They give antibiotics before you deliver, even if you’re not laboring for a long period of time. And so, learning now that the antibiotics I received, which is kind of standard of care- 

Dr. Elisa Song: [00:24:27] Yeah.

Cynthia Thurlow: [00:24:28] -could potentially have impacted both of my kids before they were ever born. And then also understanding that there’s a time and a place for antibiotic therapy, there’s also adjunctive care that you do a beautiful job discussing in the book. Now, for the benefit of listeners who might be curious, what are some of the signs that an antibiotic is warranted? What are some of the most obvious things to you as a pediatrician that you’re like, these are no brainers. these are clearly circumstances where antibiotics are indicated. As someone who had spent a lot of time working in cardiology, I think a lot about strep,- 

Dr. Elisa Song: [00:25:04] Yes.

Cynthia Thurlow: [00:25:04] -but I’m sure there are other diagnoses that for you, there’s no question that someone warrants antibiotic to be used judiciously. 

Dr. Elisa Song: [00:25:12] Yeah, that’s such a great question. And I’ll tell you two indications that are not necessarily an indication. Number one is the height of the fever, because some viruses and some kids just run hot, hot, hot. [chuckles] I mean, my daughter, when she would get viral infections when she was younger, and even now, she’d be sitting there looking at me, I mean, chatting like she was fine, but her cheeks would be bright red, and she’d have maybe a little runny nose, and I would take her temperature and be like, “Oh, my gosh, you’re 104.5.” [laughs] And so, we cannot tell by the height of the fever, how sick your kids are, because kids tend to run hot, and also whether it’s viral or bacterial, there’s just no way the other, in terms of talking about strep, there is also no way that I can look in your throat, even if it’s the most horrible, red, swollen tonsils with pus covering your tonsils. I cannot tell just by looking whether it’s strep or mono sore throat or any number of other viral pharyngitis contributors. 

[00:26:22] So that is not necessarily an indication. You have to ask for a culture. You have to ask for a strep test to confirm. Because I’ve had some patients who on the weekends will go to urgent care and call me, page me, and say, “My kid was diagnosed with strep.” And I’ll say, “how?” And let’s say, “Well, the doc said, oh, he can just tell by looking.” There’s no way. [Cynthia laughs] I’m sorry, guys. The most awful throats that I’ve seen have been viral, whether it’s hand, foot, and mouth, which is so sad or mono or viruses. So, you can’t tell. Now, however, if it is strep, I do treat with antibiotics, and for a variety of different reasons. Strep throat can actually go away on its own, even without treatment. You don’t need antibiotics necessarily. Now, the reason we treat though, is because from a cardiology standpoint, as Cynthia was alluding to, there is a very rare condition called rheumatic fever that can affect your heart and be permanent and, well, lifelong is permanent, but be permanent and fairly devastating and so much more common in countries like Africa. We don’t see it that much in the states anymore. 

[00:27:35] However, we know that a 10-day course of antibiotics will prevent rheumatic fever from happening. Really important. It’s also, for me now, it’s so interesting how our immune systems have changed because we’ve gone from in the past. So, when I was starting out in medical school, there were more cases of rheumatic fever as that serious complication from strep. But we also saw quite a bit of autoimmune kidney disease, something called poststrep glomerulonephritis. [And so that was, we would see the elevated antistreptolysin O, the ASO, and then we need antibiotics and all the immune workup and the treatments. Now, we’re not even seeing poststrep kidney disease as an autoimmune phenomenon. What we are seeing is PANDAS, which for some of you listeners, you may know it’s either a sudden or sometimes it’s a little bit more subacute onset after strep of OCD, tics, separation anxiety, food aversions, handwriting, fine motor decline, cognitive fog. Very frightening if you’re going through this. That is now our autoimmune reaction that kids are having to strep, and PANDAS stands for pediatric acute-onset neuropsychiatric disorders associated with strep.

[00:28:51] We know that any number of toxins and other infections can cause this too, in which case it’s called PANS, pediatric acute-onset neuropsychiatric syndromes. So, whether it’s PANDAS or PANS, if it’s strep. I’ve seen too many kids with PANDAS. I do not want that on any kid if we can prevent it, and we can prevent it by immediately jumping on that with antibiotics. Now, other than that, an ear infection is not necessarily an indication for antibiotic. There are clinical clues though. So, if your child has a fever for more than about four or five days, I want to know about it, because it could still be viral. I’ve had some viruses last, had seven days of fever, but it’s a sign that, mm, most viruses, the fever resolves after about four or five days.

[00:29:33] If your child has a cold or some viral infection and they’re getting better, better, better fever is resolved, and then boom, another fever hits. Okay, that’s a sign that maybe bacteria has come and it’s a super infection. It’s nothing great about it, but it means that this bacteria has taken the opportunity to infect. And so that’s a typical story for pneumonia, where kids have a cough and a cold, and it’s a virus, a flu virus, and they have a fever for five days, they’re getting better, and then all of a sudden on day seven, they start coughing again and a fever comes back. That definitely makes me think, “Mm, this could be bacterial.” So, and I give a whole host of other indications to really think about and know when an antibiotic really might be appropriate, because as we’ve said, “There is absolutely a time and a place.” 

Cynthia Thurlow: [00:30:21] Yeah. And it’s so interesting because obviously, the advent of antibiotics had a profound impact on health and longevity. And there’s no judgment when I say this, but I think over, gosh, the last 25 years, I’ve just seen more and more and more antibiotic resistant organisms,-

Dr. Elisa Song: [00:30:40] Yeah.

Cynthia Thurlow: [00:30:41] -a lot of my clinical experience was working in hospitals, and we had MRSA, VRE. We had a whole constellation of drug-resistant organisms. And patients would have to be in isolation,-

Dr. Elisa Song: [00:30:55] Yeah.

Cynthia Thurlow: [00:30:53] -you would have to call in multiple consults with infectious disease to try to find this obscure, very expensive antibiotic that could treat their infection. So those concerns are warranted, but it’s very helpful that you we’re able to kind of identify key things that can clue parents into, like, this may now be a time when they need to see the pediatrician. I need touch base with the pediatrician. So, let’s say that someone appropriately is prescribed antibiotic therapy. What are some of the things that you work into your treatment protocols with your patients that are helpful for restoring that gut microbiome? Because I think everyone’s probably listening, like, “How many times has my kid been prescribed antibiotics? What are the things I need to do proactively?” So, what are some of the things that we need to be thinking about as parents? 

Dr. Elisa Song: [00:31:41] Well. I also want to just as we can’t really go back in time, I really want everyone to understand, from an integrated pediatric standpoint, even for my own children. When Kenzi was two to three weeks of age, she did get antibiotics for a urinary tract infection. We don’t mess with infections. When babies are under one month of age, even up to maybe under three months of age, there’s not a lot of wiggle room. I mean, infections can get serious pretty quickly. And my son between four and five weeks of age, there was strep going around this family wedding that we had been to, and of course, he didn’t get strep throat. It’s interesting little kids don’t tend to get strep throat. They get it elsewhere. But all of a sudden, he had this, it’s kind of gross, this green drainage from his ear. Like, “What the heck is going on?” At first, I thought, “Oh, it’s nothing.” But then my sister’s like, “It’s coming back.” [chuckles] So we took him to urgent care, and I asked my friend who was working there, I’m like, “Can you just send a culture?” Because I didn’t want to be my own baby’s pediatrician. And it grew out group A strep. I was. I’ve never seen it before. I’m like, “Okay, my kids are here to teach me.” 

[00:32:51] So both my kids had antibiotics, and so I did, at that point fortunately understand the impact of the gut microbiome and how this could influence their future health. But even if you didn’t, even if you’re listening now and your kids have had four or five different antibiotics. Or let’s say, they’re on other medications currently as a teenager that we know disrupt the gut microbiome sometimes, in some studies, as much as antibiotics, like, well, of course, many teens are on doxycycline for their acne, a low dose. Low dose doesn’t matter. It still disrupts the microbiome. They’re on a birth control pill, which also disrupts the gut microbiome because they have horrible period cramps and they have a lot of anxiety. So, they’re on an SSRI like Lexapro that also disrupts the gut microbiome. 

[00:33:36] So they’re on these medications that can maybe absolutely needed and helping them in the moment. But over time, what we see, what I see in my teenagers who are on these meds, they stop working as well. And so, the SSRI, it stopped working. And now what? Now we go on to the next medication and the birth control pill, which disrupts the microbiome and also depletes your B vitamins, can be contributing to the worsening anxiety and, of course, the antibiotic. And so, it’s about telling your child’s story. It’s about kind of unraveling the pieces to see, “Oh, wow. I didn’t realize all of that could be impacting what’s going on.” But when we know, we can say, “Look, these medications, she’s doing well on them, or he’s doing well on them, or he’s doing okay on them, but we’re not going to take them off right now.” How do we keep their microbiome resilient? Or if it’s been in the past, how do we restore it? And we can do that at any stage. So even if it’s been 10 years, since their antibiotic when you were pregnant or delivering, we can still, the longer it’s been, it does get a little bit harder to shift to things. It’s just like adults, as adults, if they’ve been working with you on some of their dysbiosis issues, we know it can take a while. Or if you have Candida, “Oh, yay, it’s gone for like two months, and then it comes back.” [chuckles] 

[00:34:51] And so, but the younger you start and your kids are like this open book we can absolutely– So, the foundations, it’s not just about throwing 100 gazillion colonies of probiotics into your gut. That is actually one of the biggest shifts that I have made over the past maybe five years in my thinking about probiotics and the research around restoring your microbiome, because we often think, of course, in America, more is better. And so, we get these mega doses, and it’s really not about the mega doses. In fact, sometimes mega doses might crowd out and prevent your native beneficial flora from coming back, and I tell kids, “Look, it is not like Jack’s magic beanstalk. You can’t just throw them on the ground, walk away [Cynthia laughs] and expect this amazing magic beanstalk to grow.” They need an ecosystem to call their home. They need a neighborhood that they want to say, “Hey, I’d like to move in there, and I want to bring all my good neighbors with me and stay.” It’s really about that. 

[00:35:56] And so how do we do that? I talk about the five things for creating microbiome magic, but that is one of the things, I’m going to say they’re all important. The two most important things I think that we can teach our kids is how do we think about nourishing our microbiome, to nourish ourselves and what kind of foods do we want to get in? One of the things that we want to be savvy about keeping out to the extent possible. And then the second thing is, how do we, on a daily basis, engage our vagus nerve to regulate our nervous system? Because that foundation of the gut brain connection via the vagus nerve will set your kids up and set their microbiomes up for success, no matter what life throws their way.

Cynthia Thurlow: [00:36:42] I think it’s so important because I’m sure many people listening have heard the nutrition piece. There’s clearly some foods that will disrupt the health of our gut microbiome. There are others that will beneficial. The vagus nerve may not be as familiarized with my community, and I’ll just share the story that when I first met you five years ago, so you were talking about heart math, and you were talking about heart rate variability, and you were talking about the vagus nerve, and it left a really indelible impression on me. So, for the benefit of listeners who may perhaps not be as familiarized with the role of the vagus nerve and why that’s so important, let’s spend a couple minutes talking about this, because this applies to adults as well. This is something that working in clinical cardiology, I can’t tell you how many people had a dysregulated vagus nerve or they had a vagotomy,-

Dr. Elisa Song: [00:37:35] Yeah.

Cynthia Thurlow: [00:37:35] -sometimes the nerve is cut, and the net impact on the body is quite significant and profound. But let’s talk a little bit about the vagus nerve and heart rate variability, because they’re both very, very important to understand. 

Dr. Elisa Song: [00:37:46] This is really and truly the microbiome and the vagus nerve are my two favorite topics to talk about because they’re so important. And the research as you said on the microbiome has really been exploding in the last five years. Even the research around the vagus nerve. Many in your audience listening right now, you’ve probably heard of the vagus nerve because it’s kind of having its day. [chuckles] But we have to understand it because it’s not just about wearing the devices and the gimmicks that will improve your heart rate variability. Those can help, I wear one just to help support me, because every day we have forces that are really impacting our vagus nerve’s ability to kind of kick in. But it is about the work that we can do to engage our vagus nerve every day. So just to back up, we have a part of our nervous system is called the autonomic nervous system that’s involuntary. It’s our part that controls our– there’s a sympathetic arm to our autonomic nervous system. So, the sympathetic nervous system, as many know, it’s responsible for our fight or flight, pupils dilated, we get a little sweaty where our muscles contract, we start breathing more shallowly, and we’re getting ready for something. 

[00:38:56] We’ve all heard of the proverbial saber-toothed tiger. Only now in our modern world, kids and adults, we have a saber-toothed tiger attacking us almost every moment of the day. We’re late for school, we have a soccer tournament. I have to give a speech in front of class. My friend just texted me something awful, and I just saw this horrible social media post. [chuckles] I mean, all these, like or we’re late for work, or I have to pack the kid’s lunch. I have to do this and then that. So every moment, we’re like, our sympathetic nervous systems, and many of us, it’s our sympathetic nervous system is just on all the time, and we don’t even realize it. If you round a corner and your kids suddenly pop in front of you and you’re like, “Ugh,” if you really jump and you’re not just like, “Oh, hey, Kenzi, you’re activated.” [laughs] And so our sympathetic nervous system gets a ton of exercise every day when in our normal healthy state, we want our sympathetic nervous system to kick in appropriately. Just like, as your listeners know, inflammation is not a blanket bad thing. It’s when it’s persistent and chronic that it is. Stress is not a blanket negative thing. We need stress to fight infections, to get motivated. But it’s just that it’s up here, chronic and persistent. 

[00:40:11] And normally, what happens when we have a stressor? I’m stuck in traffic, I’m late for work. Then you get to work, and you’re not late, your parasympathetic nervous system and your vagus nerve kick in and say, “You know what? You’re okay. Let’s get back to the rest, digest and heal, calm state.” Well, this parasympathetic vagus nerve response is just– it’s like, “Down here all the time. It’s not getting any exercise because we’re not engaging it purposefully, and we need to start doing that now. We can assess now your vagus nerve functioning in a variety of ways, and a lot of people may wear an Oura Ring, or your Apple watch can do the same thing. And heart rate variability is what it sounds like. So, I’ll have even kids or parents in the office, I’ll have them find their pulse on their neck. And just notice when I’m explaining what heart rate variability is you notice what the rate is. And now you take a, let’s say it’s kind of like this, and you take a slow breath in, and then you exhale slowly. Oh, wait, sorry let’s do that backwards. You take a slow breath in, and then you exhale slowly. So, your heart rate is variable depending on whether you’re breathing in or breathing out. It should speed up when you’re breathing in. It should slow down when you’re breathing out. That is normal, appropriate heart rate variability. When we’re stressed, it’s just boom, boom, boom, boom, fast and constant. 

[00:41:37] And what’s fascinating is there’s a cardiologist in Germany who I’ll send you the paper. I think you would love it, Cynthia. It just floored me, because we know our microbiomes have historically changed over the past century, from the time when we could measure our microbiome. [chuckles] But even since the 80s, this cardiologist in Germany has been monitoring kid’s heart rate variabilities, mostly because he has kids with ADHD. They come in for the EKG and so he’s been monitoring. And so, he has historical controls of kids without ADHD and with ADHD, and he’s found that over the decades, their heart rate variability is significantly lower, which I am going to guess is absolutely true for adults. And why heart rate variability? Heart rate variability is one of the best predictors of current and future health, the best predictors. And when it comes to our microbiome, why is engaging our vagus nerve and improving heart rate variability so important? Because there’s one study in children where, improving heart rate variability with things like gratitude or walking in nature, hugging, gargling, singing all the things that we can do that actually are free to engage your vagus nerve. Improving heart rate variability was found to improve their microbial, microbiome functioning and diversity, independent of diet. 

[00:43:01] And so if your kids are really selective or maybe they’re going out with their friends and you’re just kind of cringing at what they’re eating when they’re out with their friends, if we help them engage your vagus nerve every day, that’s helping their microbiome. It’s so key. And this intimate gut brain connection, this information superhighway that is from the microbiome to your brain, 80% to 90% of that communication occurs from your microbiome to your brain via this vagus nerve. So whichever way you’re going, you still need to engage the vagus nerve. And when you engage the vagus nerve, you’re going to help your microbiome and you’re going to help your brain. 

Cynthia Thurlow: [00:43:36] I think this is so important because as someone who has teenagers who are not always eating at home, helping them understand why it feels so good to connect with nature. Take the dogs for a walk. We have two dogs in the house and we talk about the role of oxytocin when they’re hugging their pets and how that can be helpful for lowering cortisol and addressing stress. So big takeaway for parents, maybe those of us who have older kids and are sometimes wondering what they’re eating when they’re outside the house, understanding that the health of our vagus nerve and heart rate variability can trump a lot of other choices that they make. So certainly, one of those things that I think is really helpful. Now, I would love touch on two more topics before we kind of wrap up today because there were a lot of questions that came in around sugar. We know that our children now are consuming way more sugar than they did 50, 60, 100 years ago. How do we navigate this? Because there is sugar that proliferates in condiments and so many products that are marketed to children. How do you proactively address this with your patients, your own children? Because it is such a huge issue and kid’s palates are so sensitized to sugar now. Sometimes it’s challenging to get them to drink things without sugar in them. 

Dr. Elisa Song: [00:44:58] Yeah. I want to look up the latest numbers for you because it is astounding how much sugar—It’s not just kids, it’s adults too. And the thing with the sugar is that, it has really infiltrated virtually everything that we’re eating. Virtually everything. When we look at, and this is why part– one of the most important things that I think in the book kids and teenagers and adults can take away from is how to read food labels like a gut hero. How do you be that gut hero food label detective that can really assess, “What am I actually putting into my body?” Because that is with all of these fancy code words for strawberry flavoring when you realize there’s probably 50 different chemicals that goes into that. We want to be savvy. Now, there was certainly candy and sugar when you and I were kids, we had soda pop. I mean, all that. But what we didn’t have was this daily, constant access to these sugar sweetened beverages. I think that is one of the biggest factors, biggest factors in why I’m seeing so many children. These children and teenagers with pre-diabetes markers in their blood work. Even if they’re slim, they look fit, they look fit on the outside, they’re exercising, working out every day. And then I checked their lab work, and their fasting insulin is maybe 17 or 18.

Cynthia Thurlow: [00:46:17] Wow.

Dr. Elisa Song: [00:46:18] They have hemoglobin– Right. Yes, wow. Just for the listeners and we would like it under five or under. But it is crazy. And maybe they have fasting blood sugars that are just butting up against 99, 100, or maybe over. This needs to be, we really need to sound the alarm bell, because these kids are not the picture of who we think of as having diabetes. These are kids who look fit and yet on the inside, they are metabolically unfit and unwell, and they are heading towards a lifetime of virtually every single chronic disease. Because we know that blood sugar and insulin dysregulation is one of the foundations for setting the stage for chronic inflammation. So, really important. Now, 100 years ago, the average American ate about two teaspoons of added sugar a day because you need some bread in your yeast to make the yeast rise. And of course, there were some treats, but two teaspoons. Fast forward now, adults have on average about 19 teaspoons of sugar a day, teenagers have 34 teaspoons of added sugar a day on average. That comes out to143 g, if you do the calculation, about 4.2 g per teaspoon. And so, when you think about 143 g that your kids are having, that’s about six times as much added sugar that the American Heart Association recommends for kids 2 to 18, they recommend no more than 25 g. 

[00:47:49] So I just present this to kids and families because they just have to understand where they’re starting from. And one of the most important things you can do is, without judgment, just do a sugar inventory. I have a daily sugar inventory that you can just look and see. Just look at your packages, actually look at the nutrition facts on the boba tea that you’re getting and just write down how much added sugar you’re getting. I give some tips and tricks on how to think about that, and then just see how much over. And then we think about, “How do we make those switches? How do we make those gut hero swaps so that, I can still go out with my friends and go to boba guys. But what am I going to choose? Or maybe I’m going to have the boba guys, whatever jasmine, strawberry thing, [chuckles] that has 42 g of sugar. But I’m going to make really different choices for the next couple of days to even it out.” And so, we don’t want to say never ever. That’s not the reality. But sugar sweetened beverages make up about half of the sugar calories for adults and kids and a lot of adults too. Before I thought about this, I went on my way to work going, “Oh, I’m going to get myself a vanilla latte or something blended.” Didn’t even think about it. 

[00:49:00] As I was on a typical day before, I really started reading every single food label and thinking about how to positively make these choices. Not in a depriving, shameful way, but I did this sugar inventory for a typical day for Kenzi and Bodi, and I was floored. And I share this with you because this was me even as a practicing holistic pediatrician, they were having 81 g of added sugar. 81 g and that was on a day that I thought they were eating really clean. And I thought, “Okay, so now we can have a little treat of a scoop of ice cream at the end of the day.”

[laughter]

[00:49:36] Like, “Oh, my gosh, they’ve had their, “treats” all day long.” And so, it’s kind of like, when you’re trying to lose weight or get to be more metabolically fit, you don’t necessarily want to step on the scale, but you have to. You got to know where you’re starting from. You got to know not just your weight, but your lean muscle mass and all the things. Because we know it’s not about weight. It’s about how metabolically fit we are on the inside. But you have to know where you’re starting from. And it’s the same thing with sugar. You have to know where you’re starting from. [chuckles] So, what I try to do in the book is just, obviously, I don’t want kids or families to feel ashamed at all because I’ve been there. Like, I’ve done that and you. But I want eyes wide open, I want informed choices, and I want parents and kids to feel empowered. 

Cynthia Thurlow: [00:50:22] And that’s really the most important message. And thank you for your transparency. I just about fell over last week. My kids, like most southern kids, love sweetened iced tea. And one of them brought home a bottle of sweetened iced tea. And I just looked at the label, and I didn’t want to make a big deal about it, but I just said, “I just want you to be aware, if you look at how much carbohydrate and sugars are in this.” It was like 40 g in this small bottle. And I just said, “Understand that when your body processes it, that if it’s fructose, it’s processed very differently than other types of sugars.” And so, we had this whole kind of interesting conversation. I just said, “There’s no judgment, but I just want you to build awareness.” Now last thing, I want to kind of touch on today to wrap things up, there were a lot of questions that came in around glyphosate. So obviously, this herbicide, pesticide, we know it’s been in the United States since the 1970s, this also is a patented antibiotic. 

Dr. Elisa Song: [00:51:19] Yep. 

Cynthia Thurlow: [00:51:19] And so in terms of, we’ve kind of addressed how antibiotics impact the gut microbiome, not just in children, but ourselves. But what have been some of the things that you yourself have observed when talking to your patients? What are the things that you can suggest for people to mitigate? Obviously, read the book, but mitigate exposure, because I don’t think there’s anyone listening that is not exposed. Again, it goes back-

Dr. Elisa Song: [00:51:45] Yeah.

Cynthia Thurlow: [00:51:46] – to that environment we all live in. But understanding that glyphosate is like another type of antibiotic that we can unknowingly be exposed to. 

Dr. Elisa Song: [00:51:53] Yeah. And so, I’m going to kind of lump in glyphosate with our endocrine disrupting environmental toxins because they’re one environmental toxins– you can actually find forever chemicals in food, but they’re kind of to me, they’re ubiquitous. And there’s so much literature showing how significantly they impact the gut microbiome. Virtually every single endocrine disrupting chemical, like parabens, bisphenol A, bisphenol F, you name it, phthalates. And now these PFAS, these forever chemicals, which have been in the news, in our drinking water, in our soil, in our Lululemon yoga pants. [chuckles] I mean, they’re everywhere. So these forever chemicals and glyphosate. Now, they disrupt the gut microbiome, as significantly as antibiotics. And sadly, as you said, “It’s virtually impossible to have zero exposure.” And I will say, “I think it’s really impossible if we’re going to live anywhere in this world.” Sadly, even in some of the far remote reaches that, even the way the jet streams are, I mean, the pollution can be even higher in some remote places. 

[00:53:02] And so, the key is to build that foundation of microbiome resilience so that no matter what you’re faced with, they still have the microbial composition that can help detoxify those forever chemicals and parabens. They have the resilience to bounce back after they eat a food that’s nonorganic or that Unicorn secret Frappuccino drink on the Starbucks secret menu, [chuckles] whatever it is. So, glyphosate is really interesting because glyphosate, as you said, was initially patented as antibiotic by Monsanto. And it actually can preferentially kill your beneficial lactobacilli and bifidobacteria and preserve these abnormal bacteria, including bacteria that have been associated with increased risk for autoimmune reactivity and clostridia. I mean, C. diff is rampant, resistant, and recurrent C. diff. We are actually at the point where C. diff is getting almost impossible to treat unless you have a fecal transplant. And what’s interesting is glyphosate can interfere with something called the shikimate pathway in our microbiota that is involved in production of neurotransmitters like serotonin or dopamine. And some people have said, “Well, why? Who cares? Why is that important?” Because it’s not us. I mean, that’s not going to impact us. Well, guess what? 90% of our serotonin is actually made by the microbiota in our gut. Somewhere up to 50% of our dopamine is made in our gut. 

[00:54:37] Our microbiota make 400 times more melatonin than we do, our human cells do. And so, if we disrupt this shikimate pathway in our microbiome, guess what? We don’t have the neurotransmitters to keep our brains calm and focused, less addicted. I mean, all the things, fall asleep, and then these forever chemicals too. What’s really interesting? Okay, how do we mitigate these? First of all, of course, you want to try at least if you’re eating any foods off the environmental working group’s Dirty Dozen list, try to have those organic when possible. Reduce where you can your exposure to endocrine disruptors. Don’t microwave any food in plastic, store in glass, Tupperware, be mindful of your baby’s toys that are plastic. There are ways to reduce our exposures to these forever chemicals. We can’t reduce them forever, I mean, completely. So, in the research for both glyphosate and forever chemicals, what’s been shown to actually help reduce our body burden? Fermented foods and fiber. Guess what fiber and fermented foods do? They’re great for our gut microbiome. We need that. 

[00:55:51] And our microbiota have– they actually have their own– our livers have a detoxification pathway called the cytochrome P450 pathway. Our gut microbiota have their own cytochrome P450 enzyme process, just like our liver, that helps us process all of these toxins and clear them out. So, you bet we want the right bugs in our gut. The other thing too, is, you know, even if you can’t always buy organic now, I’m a huge proponent for frozen organic foods, fruits and vegetables, especially if you are living in areas where maybe you don’t have fresh farmers markets available to you all the time. But frozen foods can be an affordable way to get an organic food. And oftentimes, frozen foods have more nutritional value because they’re picked at the height of ripeness and flash frozen, as opposed to maybe some organic strawberries are being shipped over from Mexico, and it’s taken a little while to get to you, and they’re not in season. So, because I’ve had a question from parents, “Well, if I can’t eat it organic, should I not eat it at all?” I’m like, “No, you should.” Because fruits and vegetables have also been found to help us detoxify and lower our body burdens of all of these environmental chemicals. These are all the ways that I talk about nourishing your microbiome. Guess what? By nourishing your microbiome, you are going to help support healthy detoxification from any of these environmental toxicants that we’re exposed to. 

Cynthia Thurlow: [00:57:18] So many good tips. And one last thing that just kind of dropped into my head when we were talking about detoxifying and processing, how many kids are constipated? And we know that just being able to defecate every day is a really important component of the elimination process in the body. Just really briefly, I know that MiraLAX is doled out not just to pediatric patients, but adult patients. Like, it’s like water, and it’s not designed to be used long term. What are some of your common ways that you address constipation, just really briefly, because I know inevitably this will be a question that will come in after hearing your conversation about endocrine disruptive chemicals. 

Dr. Elisa Song: [00:58:03] So, yes. One thing that I want parents to understand, if your child is on MiraLAX, it is what it is. That’s a tool that in conventional pediatrics we have, there are neurologic concerns. The FDA has stalled in its request for more studies on the neuropsychiatric concerns that many parents have reported with MiraLAX. MiraLAX is polyethylene glycol, which is essentially antifreeze. And it’s, like you said, for kids and for adults. And one thing that we know is that, with MiraLAX, actually, it’s never been studied for use in children. I mean, that is astounding to me. And it’s never been studied– I mean, even when you look on the bottle as an adult using MiraLAX, it says, “Not for use for more than two weeks.” And so we have these kids and adults who are just taking it every day for months or years because that’s the only way they can poop. And as you said, our poop is, that’s the waste products of our body. And I tell kids, “Look, if you’re not pooping every day, at least every other day, and it’s like a nice big log getting everything out, think about if you didn’t, if you just let the trash build up under your kitchen sink, you never took it out, what would happen?” I mean, that same phenomena is happening in your gut. And not just is the waste kind of accumulating and you just don’t feel very good. You’re actually reabsorbing some of that waste, sadly.

[00:59:36] We can reabsorb some of the toxins that our liver has done a lot of hard work, and our microbiome has done a lot of hard work to convert into compounds that we can excrete. And what’s interesting is, as we’re talking about fiber, there was one study that looked at, kind of modeled the economic impact if people just ate an apple a day, literally. Three and a half to four more grams of fiber, not a lot of fiber. I mean, it is a lot of fiber, but with the skin on. The economic impact, we would be saving for functional constipation $8 billion annually. I mean, that’s huge. Really, like an apple a day, it’s kind of cliche, but it’s true. So, what can we do. The first thing is, of course. I mean, it sounds, I don’t want to be simplistic, but it really is, hydration. Most of us are chronically dehydrated. 50% of kids on any given day don’t get enough hydration. And it’s not the fancy electrolyte drinks, it can be plain old water. [chuckles] So really hydration, because adequate water drinkers, in one study, people who drink “enough water” or good water drinkers were also found to better fruit and vegetable eaters and also found to have different microbiomes than people who didn’t drink enough water. 

[01:00:58] There are some adults who go throughout the day and don’t drink any water so. And water will support a healthy gut microbiome so that’s one thing. Exercise, lot of kids are not moving enough and through the pandemic with Zoom schooling, we just became a sedentary population, a lot of kids. So, movement is really important. You got to get your leg muscles moving, your intestine moving, really important. Jump on the trampoline for fun. Kids should be getting at least 1 hour of exertional exercise every single day. It doesn’t have to be in one sitting. It could be briskly walking to school. It could be trampoline. It could be soccer practice combined. And exercise has also been found to improve your gut microbiome, independent of diet. I love that. I love that. And then from a food standpoint, the biggest culprit is dairy. Many of you guys know this. Many of you guys have experimented to know when you have a bowl full of ice cream and you had the cheese appetizer and the fondue with dinner, [laughs] you get backed up. But it is true. I’ve had some kids where, every single little bit of dairy had to be removed before they started stooling regularly. And then they could incorporate it back in once their whole microbiome has kind of resettled. 

[01:02:11] And then I list in the book, part 4 is all about, all the different integrative treatments I use for the top 25 conditions in kids. And of course, constipation is way up there. And so, I’ll just give you two tips, magnesium just like for adults, one of the most common nutrient insufficiencies or deficiencies in kids, you got to bring your magnesium way up to what’s called bowel tolerance until you have really soft, mushy, poops for a little bit and then you slowly back down. And then I do acupuncture in the office. Kids respond beautifully well, but you can do acupressure at home. There’s a point called large intestine 4 that every day your kids can, while they’re on the toilet, they can massage, or you can massage a few times a day. And that can also help. 

Cynthia Thurlow: [01:02:52] No. And it’s so interesting. Now, I wish I’d had this book when my kids were infants and toddlers. It’s such an all-encompassing guide. Please let listeners know how to connect with you, how to purchase your new book, how to follow you on social media. You are always a wealth of information. 

Dr. Elisa Song: [01:03:08] So the best way to find me is either my website, it’s www.healthykidshappykids.com. You can find my book. You can find more information about my book on healthykidshappykids.com/book. It’s available at any major retailer. Amazon, Barnes & Noble, Books-A-Million, support your indie bookstores and local bookstores. I’ve had families tell me that in their tiny little town in Michigan, they’ve been able to order the book. So, wherever you can get books, you can find my book. 

Cynthia Thurlow: [01:03:39] Well, thank you again, my friend. Such a pleasure to connect with you today. 

Dr. Elisa Song: [01:03:42] Oh, thanks for having me. 

Cynthia Thurlow: [01:03:45] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.