Episode 21: Empowering the Mom Doctor with Naturopathic Medicine with Dr Elana Roumell

Evelyne: Happy you’re here. Today, we’ll be talking broadly about children’s health with a special focus on GI and immune health. Elana and I have known each other for many years since she started in practice in San Diego 10 years ago, and we share birthdays, so we have that special Leo connection. Dr. Elana Roumell is a pediatric naturopathic doctor and mom of three with a mission to teach moms how to safely be a Doctor Mom. She loves to teach moms how to transform their fear, panic, and overwhelm when their child gets sick into feeling calm, competent, confident, and well-equipped with the right tools to prevent illness and treat it wisely. Her Doctor Mom Membership with over a thousand members helps moms feel calm, competent, and confident when their child gets sick and ultimately helps parents feel empowered with their family’s healthcare decisions. She’s also the co-host of the popular podcast, the Doctor Mom, with almost 2 million downloads. She loves to help support and inspire moms around the world. It is so great to have you here. And first of all, how did you get into naturopathic medicine and then come to specialize in pediatric health?

Elana Roumell: Okay, great, Evelyne. I love this question. It also helps me honor my brother who unfortunately passed away when he was young. He had very severe eczema, anaphylactic shock to many foods, it developed into very severe asthma, and so he passed away suddenly at age seven. This is very rare, so if a listener is listening and has a child with eczema or asthma, please do not think that this is necessarily going to happen to your child. My brother was very sick. And so as a young child, I was only nine years old. I looked at it and I said, “How did conventional medicine not help him? He was on all the nebulizers, all the steroids, all of the pills, anything that we could give him. Yet he still passed away.” And so as I got older, I got very interested in health and wellness because I honestly wanted to protect my own health and I didn’t want to see my parents suffer and lose another child. I really wanted to be as healthy as possible. I came across naturopathic medicine. And what I loved about it is that I would be trained in both the conventional model but also natural therapies. And I would be able to educate parents to know that there’s options and that we can integrate when there’s a time and a place, or we could just do natural medicines, what their chosen path is. I’ve never regret it. I’ve never looked back. I think it’s such an incredible career. But what I did find is that seeing parents come into my office with sick and sick kiddos, I realized that there was not a lot of education around how to help their children when sick at home and when a mom or a parent needs to know when to go visit the doctor or when they can stay at home, and that’s when I just decided I want to share all my protocols. I want to share all of the things and all of my knowledge so that parents can just stay calm and feel confident and really know how to help their kids the best that they can. I love that, and that’s where the Doctor Mom Membership has come alive, and that’s where my podcast and all of this great stuff, and it’s truly my pleasure to educate. I love it.

Evelyne: Thank you so much, and thank you for sharing that story, Elana. And whenever someone asks me about something related to children’s health, I just say, “Go to Elana’s Instagram page.”

Elana Roumell: Oh, thanks.

Evelyne: “I’m sure the answer is on there.” Yeah. When you were in practice, and even now as I’m sure you’re getting messages from people all the time, what are some of the most common concerns that you’re seeing and the most common questions that you get?

Elana Roumell: Okay. So one of the most common anxiety-provoking topics that I talk a lot about with patients is around vaccines. And because this is just something that all parents are faced with as early as the first day a child is born to get their shots, and so we talk about it during pregnancy and then we’ll talk about it after the child is born. And this is something that we talk about extensively, I believe in informed consent so they know and feel empowered with a plan. So that is something that comes up a lot in practice and with concerned parents. And rightfully so, I think that there’s a lack of education and I’d love to help bridge that gap. But as far as conditions go, there’s probably two that come up very often starting in young is eczema. It could be very mild, just little rashes that more so the parents are actually more concerned about. The kid is not as concerned unless it becomes very severe. Constipation is something that I see quite frequently. And then just like the general illness. Who comes to me would just say, “My kids are just getting sick frequently. Why is it that every month, there’s another cold or another cough?” And so those are just maybe some quick examples of what I’ll see in clinical practice that are pretty common. And there’s of course other things that you’ll see, but those are probably the most high topics that we talk about.

Evelyne: I’d love to dive deeper into some of those because, of course, when it comes to illnesses, especially during cold and flu season, I think, well, the joke though it’s not funny at all, is that with daycare and school, kids are coming home with a different bug every single week. Parents get sick. It’s just not fun for anybody. And so what is normal when it comes to the amount of infections to get maybe over the course of the year or during cold and flu season? And along with that, what are some things that can be done both early on in life to help with that, like say with a new baby? And then also, I know this question is getting long, but then what are you recommending to treat things like that?

Elana Roumell: Great. Okay. Yes. Many, many questions within the question. So let’s first start with, what’s normal. I think that’s a really great place to start because I think a lot of parents get very anxious and think, “Gosh, why is my kid getting sick so often while the normal average is actually they’re right in there.” Let’s break it down to a preschooler, so someone before they hit elementary school, but maybe they’re in daycare or preschool. They’re getting anywhere from 8 to 12 colds or illnesses every year. That’s almost once a month. Okay, Evelyne, right?

Evelyne: Yeah.

Elana Roumell: If you break it down to 12. Then when they get to kindergarten and elementary school, it kind of goes down to 6 to 8 illnesses a year, but that’s still every other month. And then when you get a little bit older into your teens and then adulthood, you’re looking at maybe anywhere from 1 to 3 a year. Okay. So why is this happening? What’s happening? I think it’s actually a beautiful thing in the sense that your child’s immune system is very immature and it’s learning about the world and it’s training what’s foreign, what’s not foreign, how to create antibodies, so you’re going to see a child get sick more than a teenager or an adult because they’re so fresh into the world. Having a child be sick is not a bad thing. It creates resiliency and it creates an environment where their bugs and their microbiome are figuring it out and trying to get them into a really resilient state. So as they get older, they can offset a lot of these illnesses. So I think that we need to take a step back and see what’s normal and what’s okay. Now, in my experience, what I’m looking to do, and my goals are with the parents that I work with, is to not necessarily decrease the frequency because we know it’s going to probably happen. What I want to do is I want to decrease the intensity of the symptoms, decrease the duration. So when I have a patient come in and they’re sick every month, but their cold lingers for three to four weeks, there is no break in between the illness. So it feels like their child is just sick all year long. And I see this quite a bit. When moms and parents can learn natural medicines and great therapies and also lay that foundation, which I’m going to get to, we will see illnesses could be as short as 1, 2, 3 days, and now, there’s a whole month or two that go by until the next cold hits. The intensity, so maybe a kid has the runny nose, but they’re running around and they’re playing and they’re happy. It’s not taking them away from the things that they love. So these are the things that we’re really honing in on when it comes to natural medicines and also laying a foundation. Let’s go now into that stage because that was a great question, is that, there are different levels of intervention that we could do for kiddos in order to build their resilience, and what I call is help minimize their susceptibility to illness. Okay. There’s different levels of what to do. So first, let me talk about what susceptibility is. Let’s take a room of a hundred people. The flu virus is now throughout this room. Not all 100 people are going to get the flu. 70 of those people may get the flu, but 30 people leave the room and they don’t get the flu virus. They don’t mount symptoms. This is talking about susceptibility. 70 people, susceptibility is high. They’re going to get the flu, but 30 of those people have low susceptibility. What the foundations do is work on susceptibility. It helps lower the susceptibility of an individual to contracting an infection. They may be exposed, but because their susceptibility is lower and their resiliency is higher, they have a robust immune system, they’re not going to catch it even if exposed. So that’s what we also like to highlight. So Evelyne, are you following me because before I go into what the foundation looks like, does that all make sense?

Evelyne: Yes, this is perfect. Yes.

Elana Roumell: Perfect. Okay, great. So now, let’s talk about foundation. I like to take these complex ideas and try to make them as simple as possible, so I’m glad I’m doing an okay job. So the foundation of an individual specifically for kids is going to be three different things that I just think they all should be taking daily to help with that susceptibility. Vitamin D, probiotics, and a fish oil. The reason is that these three are all targeting the immune system. And you think probiotics, why does that target the immune system, is because 70% of our immune system lives in our gut, so probiotics are incredibly important. Vitamin D, we already know does a myriad of things from neurological to immune to bone health. I mean the list goes on. It’s more of a hormone than a vitamin, and we see so many deficient kiddos and pregnant moms, so vitamin D is very important. And as far as fish oil goes, it has so much to do with the inflammatory response. The Th1 and Th2 which are inflammatory and molecules that we need to balance. And so if we have fish oil, it’s not only great for this balance of inflammation, it’s also incredibly important for brain health in these developing children. So just those three are something that I think lays a good foundation from the time that they’re infants. And we could talk ages about that, but from the time they’re infants. These are supplements, but in addition, of course, a healthy diet and environment, and we’ll get into that later. But as far as supplements go, that’s the foundation.

Evelyne: Can I ask you some follow-up questions for that one?

Elana Roumell: Go ahead.

Evelyne: Yeah. So with vitamin D, based on a child’s age, what are the levels you like to see?

Elana Roumell: Great. The APA, which is the American Pediatric Association, they will say that a child from newborn to one year of age needs 400 to 800 IUs a day. Okay. So that’s a good range, the 400 to 800. As a child goes up to 12 months or older, 1,000 IUs is probably the minimum that you would want your child on. It can go up from there, but that’s where it gets a little tricky because vitamin D could be toxic in too large amounts, and this is where testing is nice. Unfortunately, with kiddos, it’s not easy to test. They don’t want to do blood draws. It’s a traumatic experience. So I would just say doing at least that minimum amount would be very beneficial for these kids. Now, the cool thing about it is that if you’re a breastfeeding mother, you can take enough vitamin D for your own needs and for your infant’s needs who’s breastfeeding. If you take that route, mothers need to take at least 6,400 IUs to get their needs met and to get the infant’s needs met. And if you think about it, a baby will get what they need before the mother will get what she needs. So essentially with nursing mothers, I happen to be a nursing mother right now. I will give all of the nutrients that baby needs and I will be left with whatever is left over, which if you’re not on really good products as a nursing mom, you’ll be left depleted and you’ll need more nutrients to help restore. Baby gets it first, which is really the best thing in my opinion, so we have to nurse ourselves and the baby. So that’s usually what I recommend to do. Go through the mom versus the infant directly if you’re breastfeeding. Otherwise, you can just give it right to the infant.

Evelyne: Okay. And then when it comes to fish oil amounts of EPA and DHA, can you review that as well?

Elana Roumell: Great. Okay. So it depends on if a child is symptomatic. If there are no symptoms, and this is for general wellness and it’s just for that laying that foundation. For children, you want to look at least 200 or so for DHA. DHA is the molecule in fish oil that’s very, very important for brain development. Then there’s a molecule called EPA. And EPA is that molecule that’s really good for bringing down the inflammation and working on that immune system. For general wellness, I would say maybe for EPA, anywhere between 200 to 500 milligrams a day. Again, it kind of depends on the age of the child, so this is a general broad range. But if symptoms arise, let’s say there’s that eczema or recurrent infections or chronic ear infections or asthma or breathing difficulties, we are going up much, much higher. And that’s why I actually love some products, but one of my favorite fish oil is from Designs for Health because they’re so packed with high-dose EPA and DHA so that we can really target those sick kiddos so well, and they taste so good.

Evelyne: Thank you. And this is so helpful for practitioners who maybe don’t always work with kids, or like me, I don’t have kids, so I’m always looking it up and looking to your account-

Elana Roumell: Oh, yeah.

Evelyne: … and your information, so thank you. And then when it comes to the probiotics, are there specific strains that we should be looking for?

Elana Roumell: Yes, very much so. A child’s microbiome looks very different than an adult microbiome. A child that’s from newborn to the age of two or three is much more plentiful with bifidobacteria, and their diversity is much lower. Then you take an adult or even a child over five. They say by the time a kid hits five, their microbiome looks a lot more like a adult. But between that age of 3 to 5, there’s still less diversity. But let’s say take a kid over five, diversity is just through the roof. There’s just so much now going on. They’re exposed to more. There’s so much going… That’s beautiful. That’s how it should be. So when you’re choosing probiotics, you can’t introduce a diverse group of probiotics to an immature gut because that’s not how nature intended. We need to be very conscientious of what type of probiotics are in those first 2 to 3 years of life. And so what we want is something very rich with bifidobacteria. There are some lactobacillus species, but still less. But Bifidobacterium specifically infantis is very important. So you really want to focus on products that are specific to either babies or infants for a reason, up until the age of two. Now the other part of that is, there are some guts because I see a lot of gut tests, that even if bifidobacteria is supplemented, they’re not populating well because they may not be getting a prebiotic called Human Milk Oligosaccharides. It’s called HMOs. So HMOs are naturally occurring in breast milk for most parents, for most moms. Some moms though, unfortunately, do produce less. That could be a genetic mutation. It’s called FUT2. They have a genetic mutation FUT2. I personally have that so I know a lot about it. I actually don’t produce as many HMOs as somebody else. So it’s also good to know your genes. So I’m always supplementing with more HMOs in order for my kid’s gut to populate their own bifido. You need the food for bifido to feed in order to populate more. With formula-fed babies, we should always make sure that there’s HMO in either formula which more formulas are starting to come out with that but not all, or we’re supplementing in order for the body to have what it needs in order to populate that bifido. I mean, nature’s so beautiful. It’s amazing. If you’re a lactating mom and you’re nursing, you should have plenty of HMOs in your breast milk unless you want to test for this genetic mutation, FUT2. Other than that, you can always supplement with it. So I just think sometimes the combination of HMOs and bifido, can also really help a baby’s gut or a toddler’s gut really set themselves up for great health over time.

Evelyne: Awesome, thank you. It’s so interesting about the FUT2. I did not know about that. I’m taking so many notes right now.

Elana Roumell: Yeah, I know you have practitioners listening, so I think that that’s a nice little clinical pearl to show.

Evelyne: It is. Absolutely. So we’ve talked about gut health in the context of the immune system. So over your years as a naturopath, seeing a lot of gut tests, and I want to ask about gut testing in kids, but do you find, or do you think even just in the last 10 years that gut health has gotten worse in children?

Elana Roumell: It’s a fantastic question. And I would say, the answer to that is yes, but we’re still… I have some theories on why that may be.

Evelyne: Yes, please share.

Elana Roumell: I don’t know exactly why, but I will say though, I’ve not only seen gut tests worse, but I think I’m seeing just more toxins in the environment contributing to what I think is then difficulty than in the gut, imbalance in the gut. One thing that I never saw as much of, early on in my practice was mold toxicity. Mold toxicity wasn’t even talked to me in school when I was back in school in 2007. I mean, it just wasn’t the big height that it is now. And I’m so glad it is because we’re seeing a lot, especially here in California, mold-toxic patients because of either where they’re living or living environments or being close to the ocean or whatnot. There’s just so many different reasons. And when there’s a toxic in the environment that an individual is exposed to a lot, the immune system is working very hard to detoxify, to fight it, to kill it, to clear it, and that puts a burden on a child, especially a very young child, a very small child’s body. And so when that happens, we’re going to see an increase in illnesses because it’s having so much time fighting this chronic toxicity and so what I would call still an illness, and then it’s not having as much time to fight these acute illnesses and then it’s not repairing the gut because the gut is working so hard to try to clear these toxins. So I think that could be one of the theories of why this may be happening. Another one is just our food. It is near impossible for a mother, a parent, to reduce all sugar, to reduce all processed foods, to avoid, or to only feed their child organic foods. In today’s society, it is everywhere. It is everywhere. And it’s a fight that I wish we didn’t have as parents. I think it’s made parenting much more complex and challenging. In addition to screen times and so many other environmental factors going on, we could go into that soon, but my hope though is we’re not stressing too much about avoiding it a hundred percent, that we’re just doing our best to reduce it. It’s in our environment. It’s happening. But then, what are the things that we can control to add to the diet or to the lifestyle that can be beneficial? So that’s a lot more fermented foods. It’s a lot more just whole foods in general and cooking at home a lot more and good oils and all of that stuff that I know you know, Evelyne, and a lot of practitioners also know. But I will say that I do think that there is more of a battle these days because schools and because communities are just… It’s just everywhere. And they’re convenient foods and with parents having to work so much more to keep up with paying bills and staying on top of things, I just feel like they’re not able to control this as easily as I think it used to be with more homemade meals and just preparing, meal prepping as often as they could. I hope that that all makes sense.

Evelyne: Yeah, absolutely. And it is sad and frustrating. I feel like it’s so much harder for parents and for children just in general, to live in this world these days.

Elana Roumell: There’s no question. And even stress, you know?

Evelyne: Yeah.

Elana Roumell: Stress impacts gut. So there’s just so many factors that are coming at us these days.

Evelyne: Yeah. With the gut testing, how often are you recommending that a practitioner run a gut test on a kid if they see something amiss? And you mentioned constipation that you see a lot, would you run a gut test for that or is it more for other issues?

Elana Roumell: It all depends on the child’s severity of symptoms and also the parent’s desire to even spend the money on tests. It always comes down to priorities, expenses, and also compliance, because blood tests are very hard for kids, but a stool test is not as big of a deal or a urine test for the kiddos. If I see any type of diarrhea or chronic diarrhea, a hundred percent, every kid is going to get a stool test because I want to rule out parasites or dysbiosis or opportunistic pathogens, things like that. I convince them. It has to happen, and they understand why. When it comes to constipation, I don’t always go right to testing. Yes, you can have a parasite and it can show constipation, but it’s much more rare. You usually see more diarrhea as classic symptoms. It’s not to say it can’t be that. So what I usually like to do with something like constipation is I will start therapies and see if we can get some improvement. If there’s no improvement after some treatment, then yes, we need to start digging deeper because if the main staples aren’t working, then yes, we need to kind of see what we’re treating. Does that kind of help?

Evelyne: Yeah.

Elana Roumell: Because it really is a very individualized decision if we’re going to do that or not.

Evelyne: Yeah, definitely. I also received this question from someone just out of curiosity, do you ever recommend fecal microbiota transplantation in children?

Elana Roumell: Oh my God. This is a great question. I’m going to be transparent. I’m not up to date with the research to know this for pediatrics. And so it is definitely not my first-line therapy. I would never just go right to that. I would say that maybe with irritable bowel disease, which is rare in kids, but Crohn’s disease, ulcerative colitis, things that are very severe, it’s an autoimmune disease that is complicating gut health, then I would start thinking about things like this. But I would never consider it just for the first-line therapy because we have so many tools. We have so many great tools in our toolkit. We get to start with… What I like to do is in different tiers. We start with some general stuff, and if that’s not working, we kind of move to a middle one, and then we get the big guns out. If that’s not working, then we can just consider that. There’s just so many tools. We got to do one step at a time.

Evelyne: With a “gut protocol”, do you kind of follow the same path that you would take an adult through like the 5R protocol? And do you tend to start with strengthening the gut maybe by fixing intestinal permeability or do you like to start with, if warranted of course, like antimicrobials? What are your thoughts on that?

Elana Roumell: Great. So 5R still can apply to kiddos. It just looks a little different. The first thing that I like to just talk to parents about is more so diet, and avoiding foods that will irritate. So for example, dairy is something that just comes up so frequently in clinical practice. Honestly, I wish it wasn’t the care. I think there are many benefits to dairy but there are so many kids that suffer from either recurring ear infections, eczema, recurring illnesses, congestion, enlarged adenoids or tonsils that when we avoid dairy 100%, we just see symptomatic improvement in about 50% of my patients just with that alone.

Evelyne: That’s amazing.

Elana Roumell: You have to avoid it a hundred percent for 4 to 6 weeks because it does take some time. It needs to be something that the parents are compliant with. And with just that alone, that gives me so much information. Because yes, I give them all this gut strengthening or digestive enzymes or probiotics, but if you’re still eating foods or exposed to toxins let’s say that are continuing to aggravate the body, you’re not going to really get that far with supplements. So we really always need to learn avoidance before we can go and do some healing. That’s the first place that I always start. And then food sensitivity test is also really nice because it could be more than just dairy. It could be almonds, and kids eat almond milk every day. It could be gluten. We just don’t know, so I think I like IgG food tests. It’s just a good general idea. It’s not always a hundred percent reliable, but it gives us some information. So that’s always where I start. And then again, you always have to make, especially with kids, things that are very easy and compliant. Is it powder that’s going to help them best? Is it going to be liquid? You just always have to get in their world to really understand, “Okay, will they take this? Okay, great. Now, I can make a protocol specific for you so that we can really help heal.”

Evelyne: Are you going to be using antimicrobials with kids as well?

Elana Roumell: I only will use antimicrobials if I do a stool test and I see opportunistic pathogens. I don’t believe in overusing antimicrobials because I think that that can actually really disrupt good bacteria as well. Our herbs are very powerful. They’re not as I think detrimental as some of the antibiotics, but I do think that you still need to be wise and careful. And I also really like to retest. Because in order for me to know how long this protocol needs to be with antimicrobials, I need to know if we’re doing a good job and if it’s cleared or not.

Evelyne: Yeah. Thank you. Since you just mentioned antibiotics, I have a question about that. Antibiotics are very commonly given to children, right?

Elana Roumell: Yes.

Evelyne: A lot of times when not warranted. Do you recommend probiotics are given simultaneously during treatment? After? How long should they be on it? What are your thoughts on that?

Elana Roumell: I’ll go ahead into that. But before I do, I just want to preface. I do think that they are overprescribed, and I also think a lot of it is because conventional and medical doctors, they don’t have other tools. This is their tool. A parent comes with feeling anxious and stressed and want to just appease their children. And sometimes parents also push to prescribe it because they just want a solution. They want to help their kids. Just to be fair, doctors are just trying to do what they can with the tools that they have. Parents are also at the whim of what their doctor tells them. This is why I feel so passionate about education because there are so many other tools out there. It’s either prevent antibiotics from starting. Or if there is truly a need for antibiotics, are there something that are strong antimicrobials that we could do to substitute while managing and being very observant of any complications when to know to give it. So there’s a fine line there, but we’ve got good tools. If a child does need antibiotics, and there is a time and a place, I always recommend a… It’s more of a yeast. It’s Saccharomyces boulardii. We’ve seen great research to show that it decrease complications of antibiotic use like potentially Clostridium. This is a opportunistic bacteria that can multiply during times of antibiotic use. So if we want to try to minimize that or avoid that from happening, causing diarrhea during or after antibiotics, Saccharomyces boulardii is great. It also just helps to keep the microflora much better balanced. Any product, I love, I want them to add Saccharomyces boulardii either to their maintenance of the probiotic that they’re taking daily, again, for those foundations, or they can stop their daily probiotic that’s giving them the foundations, and then add during and after a good probiotic with Saccharomyces boulardii. Now, I like to do during antibiotic use at least two hours away from the dose. I don’t care if it’s five hours, 10 hours, it just can’t be less than two hours. You don’t want to take the antibiotic and that Saccharomyces at the same time. Just two hours before or after or more. The other thing that I like to do is continue it up to two to three weeks after the antibiotic round has been done. Okay? So you still want to continue after. So that’s just a protocol that I like. And of course, during antibiotics, you can always do extra bone broth, fermented veggies, things like that, or even like a leaky gut type of nice combination of things like glutamine-rich stuff. But to me, Saccharomyces boulardii has to be on board. That’s my protocol.

Evelyne: That’s great and great for adults too taking antibiotics.

Elana Roumell: Absolutely. Yes.

Evelyne: Yeah. I want to go back to the food since you mentioned that. And your kids eat relatively healthy. I see that on Instagram, of course, being the children of a naturopathic mom. What about picky eaters? What are some tips that you give to the parents that you work with to get their kids to eat healthier foods?

Elana Roumell: Great. And I think this is a great question, Evelyne, and want to be completely transparent. I absolutely serve healthy food to my kids and my six and a half year old soon to be seven definitely has changed a lot of her preferences and will say no to more things, where when she was three, she was very happy to eat them. I just want to also give a sense of grace to parents or even practitioners listening just to as far as what could be normal, is that kids go in phases and that’s okay. And it’s not to say that they won’t come back to that phase. Because there’s days where my six-and-a-half-year-old will say, “I don’t like vegetables,” and then really eat all of her broccoli and green beans from her plate. So just don’t take it so seriously is what I would like to say about picky eating. Because every day is a different day and their mood shift, and I just think that that needs to just take on meeting out of that. But what I do like to do, especially with the young kids, especially with the babies, is you start introducing these tastes early. I think many parents are so surprised that my kids love sauerkraut, kimchi, and fermented foods. They’re like, “There’s no way. My kid would not like it.” And I’m like, “Have you tried it?” And they’re like, “No, they wouldn’t like it.” And I’m like, “But who’s to assume that that’s the case?” I’m shocked. I mean I go through so much sauerkraut and kimchi because even my infant who’s only 14 months just devours it. And you’re like, “Great.” I mean this is amazing. My point in that is, always introduce early. So the foods that I like to introduce early are the fermented foods or fishes. Because fishes is a very distinct taste, and if they can create a good taste for it young, it’s more likely that they’ll like it when they’re older. And the other food is something like liver, like liverwurst because it’s just so nutrient-dense. The idea is that these kiddos, they’re not eating a lot. Now, as they get older, they eat a lot more. But infants only really need a tablespoon of food at one… It’s not a lot of food. So if you’re only giving such small amounts, you might as well make it as nutrient-rich as possible. This is why I love fermented foods, Omega-rich foods, and then nutrient-dense foods which is often times organ meat. Now, I don’t like to cook organ meat, so I either will take organ meat in a pill form that’s desiccated and just mix it in stuff, or just buy something like liverwurst and just serve it. With that said, I say some infants don’t eat a lot. There are some infants that will eat a lot. So there’s no measure in that. Don’t make meaning out of it. Just serve food and let them innately just go for it. That is probably my biggest tip for picky eating is that I think we become too involved. We make meaning out of it, and it becomes a power struggle. So my biggest advice is you serve the food. You put the food there. It doesn’t matter if they say they don’t want it. They don’t like vegetables. It doesn’t matter. This is what’s for dinner. Put it on their plate. My rule in my house is you take one bite. If you don’t like it, I’m not going to force you to eat. Take one bite. And 70% of that time, they take a bite and they’re like, “Oh. Oh yeah, I’ll eat these green beans. Oh, I’ll eat this burger. I’ll eat this.” So it’s okay. Just let them do their thing. Don’t force them to eat. There’s going to be some days these kids are going to eat so much when they’re going through a growth spur. And then there’s going to be a day that they’re like, “I don’t want to eat this.” And you’re like, “Okay, don’t eat it.” And then leave it at that. I hope that that helps. There’s so many tips I have in my membership and I go on and on about picky eating tips. But at least, you can kind of understand the basis behind there.

Evelyne: Yes, very, very helpful. Thank you. I want to go back to one of the other top issues that you see, eczema. Very common, it seems to be more common and we see eczema a lot with allergies and asthma, the atopic triad. So what is going on there and what are all the different factors that you are considering when assessing that?

Elana Roumell: When I see a kid with eczema, I look at it like I’m so grateful that I have this information. Now, I know that this is not how parents look at it. But what it does for me is it tells me information about what’s going on in this child’s body. If there is a rash or an eczema rash, and I see that. I know this child needs more support in their inflammatory markers. We need to really, really increase that fish oil because we’re not giving enough of it. We need to really make sure we’re being diligent about their probiotic. There’s some parents who get busy and so it’s like, “Sure, I’ve got my vitamin D, my probiotic, and fish oil, but I give it twice a week.” Is that enough? Well, for a generally well child, if that’s what works for your family and that’s what gives you peace of mind, you do that. But if your child has symptoms like eczema. Nope, you’re doing this every day now. It gives us information to know that we need to be more aggressive. We need to be more diligent. We need to just be more consistent. Again, vitamin D, fish oil, probiotics, that in a child with eczema, we are being consistent and diligent, and we may even need to go up in amounts for this child. Then we’re starting to look for improvements. If just going up in amounts is improving it, beautiful. The body is just telling us that it needed more support. If the body’s not responding to that, then now we need to dig a little bit deeper to understand what is going on. Again, are there opportunistic bacteria? Are there food sensitivities? Are there other lingering allergies that’s happening where we need to focus on immune modulation? There’s just so many different things that we can catch early because like you said, there’s a triad. If left untreated, eczema, we are going to start seeing ear infections. If left untreated, eczema and ear infections, we are going to now start moving into asthma. So the beautiful thing about this is that when eczema arises in a child, we have information, and that information is going to dictate how we’re going to be extra observant of our child. We’re going to be extra conscientious of what therapies to give. And as long as we see improvement, we know we are preventing chronic disease from happening. What a beautiful thing that the body gave us information about.

Evelyne: I love that perspective. Thank you. And I don’t know the latest numbers you probably do, but chronic diseases are very much prevalent in children, and it’s just crazy. So we as practitioners really can play a role starting with all of these basic things like the lifestyle foundations that you mentioned and some basic supplementation to help prevent that from progressing.

Elana Roumell: If anyone’s listening or a practitioner, and you know that people who are attracted to our kind of medicine are very proactive parents. And so when you’re proactive, you’re going to see a lot less chronic illness because I believe a lot of chronic disease comes from untreated root cause things that could have been caught and treated early on. That’s also to say, if you find that your child is again susceptible to this type of path, that’s where we have to be even extra conscientious of environmental toxins or extra conscientious of the food that they eat or extra conscientious of things that we can actually control. Whereas then there’s some kids who just don’t have symptoms that they have a little bit more leeway and like, “You know what? You want that sugary doughnut. Okay, you could probably get away with it and not get sick tomorrow.” Whereas there’s other kids who are less resilient, who have more susceptibility that you know if they’re going to have that sugary doughnut, they’re probably going to end up sick the next day. You got to really observe your child. You got to treat them individually, and just be really observant. And this is what I teach my Doctor Moms, that I call Doctor Moms is, “How can you be the best observer of your child so you can be their best advocate and set them up for long-term great health.” And a mom, specifically has so much connection and intuition when it comes to their child that they’re the best ones. It’s not their doctor always. They’re the best ones because as a mom and a parent, you are the historian telling the doctor what’s going on with your child. The child’s not the one doing that. It’s the parent. So you’ve got to be that observe, that very focused, be with that child, know their patterns, in order for us doctors to really help that child optimally.

Evelyne: Yeah, definitely. And you mentioned the environmental factors again. I had a question since you brought up the mold toxicity, which I feel like is so much more talked about now than like you said when you were in school, even since I started in this field. Do you think that now we’re looking more at genetic susceptibility? Because it does seem like some people do horribly when they’re exposed to mold and other people, it just doesn’t bother them at all.

Elana Roumell: Great question. Yeah. So 40% of the population have more of a sensitivity to mold. So we do know that. That’s why if there’s mold in a house, the entire household, each member will have a different type of response. Some will have no response. Some will have different types of symptoms, some neurological, some gut, some… It really just shows up so differently in so many different individuals. But again, this is why medicine could be so individualized. It’s not a one size fits all. With that said, we know mold is a toxin, so it should not be in the environment. Even if an individual doesn’t have symptoms, over time, if enough mold is there for long enough, they’re going to start developing something. The hard thing with mold is that mold spores don’t go away without true remediation. Very different than VOCs, formaldehyde, things like let’s say you buy new furniture, that will off-gas over time. It’s still not a great chemical to have around, but at least, after five years of off-gassing, that couch is fine. But if mold spores are in that sofa, unfortunately, even five years later, they can still be there. So it is something that is very challenging. It could be a huge lifestyle change for parents if mold is something that is present. But I would say the first thing to do is just get a mycotoxin test, which is a urine test, very easy to get in a family member if you’re suspicious. Because if it’s circulating in the body, you know it’s somewhere in the environment and we need to start getting it out, and we’ve got very safe protocols for pediatrics specifically inside my membership and all of that. So you could still heal. You could heal from all of this. It just takes some time, some patience, and some commitment to some of these supplements and products.

Evelyne: And you mentioned neurological things. What are some of the things or some of the specific symptoms that make you think, “Okay, I want to test for mycotoxins in children?”

Elana Roumell: Oh, yeah. I mean, well, especially with kids. I mean, I think behavioral issues like meltdowns that just like, yes, meltdowns and tantrums are very normal, but it’s easy to see when it just gets abnormal and they just don’t come around with that. For many adults, I think a lot of it is brain fog, but you’re not going to really understand that or see that in kids. You could definitely say… I think more in kids, it’s mostly chronic illness. So it’s like they’re always sick or because mold likes to live in the nasal passages, it’s just constant runny noses. It just never ends. And likely enlarged tonsils or adenoids where it’s like, again, they’re doing everything but there’s just inflammation. It’s inflammation in the body. But again, every individual, it looks a little different.

Evelyne: Yeah, thank you. And another question that I frequently receive is just around hyperactivity, mood in general, lack of focus especially in say elementary school, but also teenagers, right?

Elana Roumell: Yeah.

Evelyne: And I think this is where herbal medicine and naturopathic medicine really shine. So I’m curious, what are some of your favorite, say herbs to you-

Elana Roumell: Great.

Evelyne: … that parents can trial, that doctors can recommend specifically for that?

Elana Roumell: Yeah. I love this question, and I would actually say ADHD or any type of diagnosis in this realm really, really does need thorough testing. And the reason why I say this is that I’ve seen behavior, I mean so many anger and frustration just because Candida is elevated in this child. I’ve seen behavioral because Clostridium is elevated, so I need to know what may be causing that in order to have a targeted approach. Lack of focus could even be because there’s toxins and the detox pathways aren’t open. It could be because of low amounts of zinc. Zinc is very correlated with ADHD symptoms. So it just kind of all depends. But I do love Nervines for ADHD. I think even if we’re also addressing the root cause, a lot of Nervines to really support the nervous system, even like lemon balm as an example, a Schisandra, things like this that just are really nourishing to the neurological symptom can always be part of the protocol when you’re also treating what the underlying cause is. Does that make sense, Evelyne?

Evelyne: Absolutely. Yeah. And I’m a huge fan of those as well being an herbalist. And I think they can be so gentle like the chamomile, lemon balm. Even I know, Bacopa. I don’t know how much you used that for focus. Yeah.

Elana Roumell: Bacopa is great for focus. Yes. And it actually has other effects where we are finding that Bacopa specifically can help. It’s part of our vaccine and immune protocol that if a parent chooses to get their child vaccinated, we support whether they vaccinate or not in our programs. Bacopa is actually one of the remedies that we are finding can help bind to aluminum in the aluminum-containing vaccines.

Evelyne: Interesting.

Elana Roumell: That and magnesium malate. And it can also help with that detox. So I don’t know if maybe or without vaccines, Bacopa could be working not just from the nervine perspective, but also from a detox perspective. We have to look at it like that too. It’s neat.

Evelyne: Interesting. Thank you for sharing that. I want to talk. I know I keep switching gears kind of going all over the place.

Elana Roumell: It’s okay. This is great.

Evelyne: There’s so many-

Elana Roumell: We’re getting through the questions. I love it.

Evelyne: … interesting things. So a question just on screen time and then social media though I think that’s more like older kids and I know your kids are still under eight years old, right?

Elana Roumell: Yeah.

Evelyne: But how do you limit screen time in children?

Elana Roumell: Evelyne, this is such a challenging question. In fact, my husband and I were just seeing our therapist the other day and we had a whole hour talking about this. So I want to just preface to say that it is a very challenging experience, I think being a parent now, with all the devices, with the iPads, with games, with Netflix and Disney+ and there’s so much stimulation coming at these kids, and it becomes very addicting. It’s also I think something for us parents to get very clear on and be open to this idea that the discussion around screen time in a family doesn’t just stop at the kids. It also has to do with the parents. Because as we model being on our phones constantly checking emails, checking messages, getting back to things, our kids see that as normal, healthy and something that they want to model after too because we get as addicted to our phones or our iPads or whatever technology people are using, just as much as the kids will just get sucked into these screens. Now with screen time, studies show it’s inevitable. I see it in my own kids. I hear it from my patients. But it is very easy to get addicted because we have dopamine release from it. We also have… We see studies that show that the more screen time, the more specifically social media in these older kids is more increase of anxiety, depression, ADHD, behavioral issues, so we don’t see a lot of benefit from screen time. We see a lot more risks from screen time. It’s not to say that a little bit is not a problem. But a little bit still gets that mind addicted to it. So where’s that balance? And I think every child has a different tolerance for it. When you ask your child to turn off the TV or stop their iPad and they willingly are able to, that’s a healthy response. Or maybe give them a two-minute warning. Maybe don’t stop it right away, but like, “Hey, in five minutes, no more iPad,” and they’re able to transition and then go play. That would be, I would say a healthy response. And there are plenty of children who say five minutes and they’re like, “Okay.” And then they can’t do it. They get the tantrums. There’s the behavior. There’s anger. That’s when I think you have to just assess, it’s doing more harm than good and then reset. I’ve heard many families do a technology reset, almost like a detox for someone. Eating too much sugar, having do a reset. This is part of day-to-day in our society. And I think that we just have to, again, as parents be the best observers of our kids. What may work for one kid won’t work for another. Different ages, different neurology, different type of addicted personalities, we just have to take it one day at a time. Continue to be as transparent as you can with your partner so you’re on the same page and be an example yourself and try your best to also model how you put these away, how you’re not addicted to your technology, and it is a true process and a journey for all of us.

Evelyne: Yeah, I love that you shared that, especially both as a doctor and as a mom of three kids. So thank you.

Elana Roumell: Yes.

Evelyne: Elana, I have a question. Since we are speaking to practitioners, you’ve transitioned away from private practice to serving online, which is just amazing, and I know that many practitioners want to do that. You have your podcast, your Instagram, your Doctor Mom Membership, and I’m curious what that transition looked like for you. Is it something that you prepared for a long time? Did you do both for a while? How did that process happen for you?

Elana Roumell: Great. I love this question, Evelyne. Thanks for asking. I haven’t shared this much on a podcast, so this will be great. So first of all, I want to say, when I was in my medical school training, I went to SCNM. I knew I was going to do something different and out of the box. I even remember telling my study partners, Adria and Stuart. We were very close friends and study partners. I just said to her, I’m like, “I’m going to do something out of the box. I don’t see myself being a clinician forever.” And I remember her response was like, “So why are you here? You don’t want to be the general doctor?” And I was like, “No, I don’t. I think I will do it for years to build a…” I mean, I wanted to do it at least for a decade so I had my residency and practice and I really understood it, but I just knew I was going to do something outside of the box. I didn’t know what that looked like. And then when I went into general practice, I started realizing that there is a huge need for education. And that when parents were coming to me, very anxious and very scared, that half the time, they were coming to me and they didn’t need to be there. They could do this at home with their kids safely and effectively, but they didn’t have the skill set that I had, that I learned in medical school, and that I learned through clinical practice. So could I teach these moms to be Doctor Moms? “Doctor Moms” to know when they can safely treat their kid from home and when to decide that the signs and symptoms are recurring that they’re like, “Yep, this is the time to go see the doctor.” And so as I was kind of playing around with that idea, I knew that needed to be out there in the world, and I knew that I needed to share my stuff with the world. And so I took a big chance and I created courses and programs, and I had no idea what to expect. I just wanted to launch it and I wanted to give it to the world. And if I made no money from it, it was still a project that I just knew needs to be out there. If I made money from it, great. If I made a lot of money from it, we’ll figure it out from there. I ended up making a lot of money from it. I did not expect that my initial launch would be so successful. I think it was just the perfect timing, the way that I marketed it, the way that I taught, I don’t know what it was, but it was the perfect recipe for success, and it was enough of a success for me to say to myself, “I need to put more of my heart and my soul into this. I need to build a team to help me because now, I had more sales than I could manage.” I mean it was a great problem, yet still a problem. I knew what that was like building my clinical practice where if I had too many patients coming in and I didn’t have my foundations laid out really strong in my business, I burned out. I knew what that felt like, and so I knew that I didn’t want to burn out in my online business. So I made a very big decision after my second child. I realized I could not do all of this. I could not run a business and own a medical center. I could not see patients and really give it my all to my patients and build my online business. It was just… Be a mom, okay, and be a wife, and my value for myself being healthy and well. I had to just make a choice. And after my second child was born, the choice was clear to me that I want to put my all into the online business and I can always go back to patient care. And from that day, I don’t regret it. One day, my life is like a dream. My career, I helped thousands and thousands of people. I’ve now 1,400 members, over 1,400 members of my membership. It is a dream. It grows every month. I get to reach… Now, I have over a hundred thousand followers on my Instagram account. I get to give free information to really empower parents. I’m living a dream and I’m so happy I took the plunge and I did it. With that said, a lot of naturopathic doctors ask me for coaching and tools, and I also know how hard it is to build an online business while seeing patients. So there’s got to be this balance of, is the finances there for you to then take the plunge 100%? And more times than not, it’s not. So you still have to see some. But it’s that level of what is workable in your life in order to pay the bills, but also make sure that you’re not burning out because I see way too much burnout in this profession. It’s something that I think maybe one day I may do business coaching or something because the burnout is so real and I feel it from this profession. And I just want everyone to be able to have the dream balance where they’re still making a significant difference, getting paid what they deserve, and having the life and the personal life that is really enriching for them. That to me, is very important. That we make choices based on our values in order to get to these goals. And I’m very aligned with that. I’m very clear about my values, and so I make choices based on that. I am a yes or I’m a no. And that’s why I think my life is working out so well in that regard. So that’s my little two cents in my background.

Evelyne: I love this, Elana. I’m so proud of you, especially because-

Elana Roumell: Thank you.

Evelyne: … I’ve now known you for 10 years and the things that I’ve seen you do is really consistency, I think with your Instagram just consistently providing value every single day.

Elana Roumell: Thank you.

Evelyne: And I think you’re also very clear about boundaries and just so clear on your vision.

Elana Roumell: Thank you.

Evelyne: It’s really amazing. Yeah.

Elana Roumell: Yeah. And I think a lot of people think, “Oh, it’s all passive income.” It’s like, “No, this is a full-on career, is to go online.” I have a team now of… There’s seven people on my team that are regular workers with me. So it is a team approach and it’s just a different design of a business. It takes certain personality traits, different organizational traits, but I have a true passion for this, and I absolutely love my clear niche, my clear vision, and I don’t stray from that, so it is a very consistent message. And yes, there’s a lot of content that gets put out in order to stay up-to-date and stay engaged and all of that. And I’m very committed to it, so I love it. Thank you for the acknowledgment, Evelyne.

Evelyne: Yeah, and thank you for being so transparent about this. It’s actually something we haven’t really talked about on the podcast, but obviously, it comes up when I talk to practitioners all the time, so thank you.

Elana Roumell: Oh, yeah. Oh, absolutely.

Evelyne: Before we wrap up, we have some questions that I like to ask everybody on this podcast. What is something that you’ve changed your mind about through your years in practice?

Elana Roumell: I think there’s a number of things that I’ve obviously changed my mind about. I think, to be completely honest, I feel like we do so much sometimes that I think that sometimes doing less is more. And I want to say this in all contexts because I think different disease states warrants more than less. But at least for me in the pediatric space, I think that what I’ve come to realize is it is very hard to be a parent as is. There’s a lot of demands. There’s a lot of things coming at you. And for a pediatric naturopathic doctor to just give the blanket of all of these things to parents, actually I think could do more harm than good in the context of anxiety, stress, overwhelm, and really at the end of the day, I don’t think every child needs so much. I think that what shifted for me was that even though I knew all these beautiful tools and that my medicine kit was so broad and I was able to tackle it from so many angles, what’s changed dramatically is just giving parents more permission to doing less than more. And that you don’t always need to just grab supplements to have great healing. For example, I talk a lot about cold wet socks. Cold wet socks is a hydrotherapy technique that takes very little money. You have the cotton socks and the wool socks and cold ice water, and you could see rapid improvement, especially with kids without needing your herbs, your homeopathics, your health food supplements necessarily for a fever. I mean, I think that I’ve kind of really shifted to trying to find what’s so much more easy, what’s more empowering for parents than having to spend a lot of money or always keep their medicine kit stocked, although there’s always that that needs to be stocked. But I think that that’s probably one of my biggest shifts in my mindset over the years.

Evelyne: Yeah, very helpful. And what are your three favorite supplements for yourself? For your health?

Elana Roumell: Oh, for me?

Evelyne: Yeah.

Elana Roumell: Okay. Well, I’m a nursing mama, so I’m taking the best prenatal on the market that I can, that is rich in nutrients because as we all know that baby gets what they need first and leaves mom with what’s left. So I don’t want to be a depleted mom. So a very high-quality prenatal is essential for me personally. Pre and probiotic, so not just a probiotic, but a pre and probiotic. Even though I eat tons of fermented foods and whatnot, I still just always want to make sure my gut microbiome is the best specifically for my family. And because I have that FUT2 genetic mutation, I do take the HMO for then my baby’s needs. So that’s seasonal. It’s not like that’s forever long. But those are just three that I really make sure to take daily. If I may add, I also think adaptogens right now are so important, especially because I’m in a stressful time of my season. I’m actually moving to a different state very soon. In fact, Evelyne, I was going to tell you, it’s next week that we’re moving. It ended up becoming a lot sooner. So I’m so happy though, to still sit here on the podcast, but there’s so much to do personally. And during times like this, it’s very important that I am just taking adaptogens because life as a mom of three and a business owner is no small feat. And I think that just nourishing myself and keeping myself as healthy as possible only lends itself for me to help more and more people in the world. That’s what I do in addition to obviously exercise and eat healthy and such sleep.

Evelyne: I have a follow-up question on that. Since you mentioned adaptogens and you are a nursing mom. What adaptogens are you comfortable taking while nursing?

Elana Roumell: Great. Okay. This is a great question because you do need to be a little bit more mindful of lactating moms. But these herbs I think are even safe during pregnancy and even after pregnancy. Shatavari is one that’s very gentle and great. Holy Basil, Milky Oat Straw, so nutritive. Rhodiola, Schisandra, these are some of my favorites that I still think are incredibly safe, effective, and again, something that you can really feel like you can rely on before, during, or even after pregnancy.

Evelyne: Awesome. Thank you. And what are your favorite health practices that keep you healthy, resilient, and balanced?

Elana Roumell: Great. The first one that comes to mind is walking. It’s like when I just start feeling either overwhelmed or stressed, it’s just so easy for me. I don’t have to think about it. It’s free. It’s there. You just get out and you go walking. You get outside and you go walking. Even if it’s like taking a business call while you’re walking or if it’s taking the kids out for a walk. I find it to be such a gentle, but so powerful therapy for my mind, for my body, for just everything just to get moving. So sunshine, all of that stuff. It is just my favorite thing that I can do for health and wellness is just get moving and go walking.

Evelyne: I love it. I love a good long walk.

Elana Roumell: Yes.

Evelyne: Amazing.

Elana Roumell: And look it. As parents, it’s a lot. I miss Pilates. I miss this. But the idea of driving to a place and then going and then coming back and then showering and all of this stuff, this is all stuff that is real. And when you have three kids in a business, you have to be very efficient with your time. And so sometimes there’s seasons where you’re like, “Those hard workouts or…” I don’t have that time or that energy. And sometimes also when you’re not getting a lot of sleep as a new mom, or not a new mom, but just a mom to a young infant where I’m still nursing throughout the night, you have to really just step back and say, “What is something gentle that you could still do that’s consistent, but also that you’re just moving?” And so to me, walking is just one of the best therapies for me.

Evelyne: Gotcha.

Elana Roumell: I actually have a date with a friend later today to go walk, because you could do that with someone and also catch up. So it’s very efficient.

Evelyne: Awesome. Well, Elana, thank you so very much. This has been really incredible. I took so many notes. I learned so much from you. And I so appreciate you being here today.

Elana Roumell: It’s my pleasure. And I hope that the listeners, whether you’re a practitioner or a parent yourself, that you know that there are resources out there. If you’re not really all that up to date with pediatric protocols, I share all of that inside my membership. It’s a very affordable membership where I share all my recommended amounts, and what’s safe for different weights or ages. I love sharing this stuff. It’s here for you. If you ever need it, you can go to doctormommembership.com. I also have a vaccine program. Dr. Ari Calhoun And I, we partnered together and we just give a ton of informed consent. That’s the Vaccine Empowerment program. That’s something that we don’t all have the time to educate inside of our clinic, and so that’s a great program. And my Instagram page is free. It’s drelanaroumell. That’s my handle. And there’s so much information there. So I hope you follow me. I love sharing this information with you, guys.

Evelyne: Yes, thank you so much. And thank you for sharing those links. And thank you for tuning into Conversations for Health today. Check out the show notes for resources from our conversation. Please share this podcast with your colleagues, follow, rate, leave review wherever you listen, and thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts exploring evidence-based cutting-edge research and practical tips.