Season 3, Episode 5: Focusing on the Pediatric Gut Microbiome with Dr. Elisa Song

Evelyne: I am so excited, too. We’ll be talking about children’s health with a focus on the gut microbiome today. In 2005, the New England Journal of Medicine predicted that, for the first time in history, our kids are expected to have a shorter lifespan than us, their parents. I don’t have kids, but I’m reading generally. 20 years later, when nearly one in two kids has a chronic condition, the time to revolutionize the future of children’s health with a pediatric integrative and functional medicine approach is now.

Dr. Elisa Song MD is a Stanford, NYU, UCSF-trained integrative pediatrician, pediatric functional medicine expert, and most importantly, a mom to two thriving children. She’s the bestselling author of Healthy Kids, Happy Kids: An Integrative Pediatrician’s Guide to Whole Child Resilience. In her integrative pediatric practice, Whole Family Wellness in the Bay Area, she’s helped thousands of kids get to the root causes of their health concerns and helped their parents understand how to help their children thrive by integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine, and essential oils. She’s the chair of A4M’s pediatric education, and she created Healthy Kids, Happy Kids as an online resource to help practitioners and parents bridge the gap between conventional and integrative pediatrics with an evidence-based approach. It’s so great to have you here. First of all, how did you first start incorporating these modalities as a conventional pediatrician?

Elisa Song: So I actually started my pediatric journey wanting to go into a more integrative… Back then, it was called alternative medicine, but it was always an interest of mine. And so when I graduated from NYU Medical School, well, I was really interested. There was one elective in West Virginia. I’m going to date myself. I was in med school in ’93. And so in the early ’90s, there really wasn’t a lot of support for me as a medical student to go down to West Virginia and do this alternative medicine elective designed for medical students. But it was always there. That passion was always there. And then, when I was at UCSF in San Francisco, I was able to design my own senior elective, my senior resident elective, on an integrative… I mean, back then again, it was called alternative medicine approach. It’s not alternative. It’s integrative, but an alternative medicine approach to juvenile arthritis.

Evelyne: Wow.

Elisa Song: So I had the opportunity to go to acupuncture offices and chiropractors offices and osteopaths, and energy workers and just see what they do and talk with them, and dive into the research. There wasn’t a lot of research back then, but some of the research, and as I think back on it, it really was taking that functional medicine approach. Let’s see what the pathophysiology is. Let’s see what the journals say. Not just the pediatric journals, but all the other immune, GI, nervous system journals have to say with where we could possibly intervene, whether it’s with diet and lifestyle or supplements, or even medication.

So it’s been a journey. It’s been a journey, but I’m fortunate. I started my practice in 2004 as an integrative and functional medicine pediatric practice. From the time that I started my practice, this is how I’ve practiced, and I love it. I wouldn’t do it any other way. I joke with my husband and kids. I’m like, “If something happened and I weren’t able to practice medicine anymore in this way, I would open a restaurant or do something totally different.”

Evelyne: Though a restaurant might not be that different, right?

Elisa Song: Yeah, that’s true. Yeah, that is true.

Evelyne: Because you talk so much about food. We know that we would all come eat there because it would be very healthy.

Elisa Song: And delicious. And delicious.

Evelyne: And delicious. Yes. That’s key. So let’s set the stage a little bit. When it comes to our children’s microbiomes, what are the known areas that it impacts?

Elisa Song: The listeners now, I mean, you guys are all super savvy on gut health and implications for virtually every chronic disease. When I think about pediatrics though, it’s this… We have such a unique opportunity to truly impact future epigenetics, and immune, hormone, metabolic, brain health. And we have to step back, and many listeners will know this, but it really has to hit home. There’s some research papers that I feel like every pediatrician, every medical student, every resident should understand.

There’s a really large study. It was a military study, nearly 800,000 children. And they looked at children who received antibiotics or antacid medications in the first six months of life compared with children who didn’t and found that in the group that received these antibiotics or antacid medications, they had an increased risk of every single allergic disease, like anaphylactic food allergies, asthma, eczema, hay fever, hives. Up to double the risk. And we also know about the gut-brain connection. And we’ll dive into that later as well. But one of the things we know… This is a large Danish study where they can keep track of these mother-infant dyads, these cohorts, and found that antibiotic use, even prenatal, through the toddler years, significantly increased by 50% virtually all of the mental health conditions studied.

In our day and age of mental health emergency in our children, we have to understand where can we impact. And the microbiome is one of the areas where if we can impact our children’s microbiome for the better, our infant’s microbiomes or teenager’s microbiomes for the better, we will have trickle effects on virtually every single organ system, whether it’s for a teenager, their skin that they’re worried about, or we’re worried about toddlers behaviors or metabolic health. The imprinting that happens early on in those first 1,000 days of shaping your child’s gut microbiome from conception all the way to about two and a half years of age sets the stage and informs their immune system how to behave, not just now but later in life, how their brain should behave, think, even IQ, how their epigenetics will be modified to increase or not increase the risk of metabolic syndrome, type 2 diabetes, and all the things that our kids are really dying from.

In 2005, you mentioned the New England Journal of Medicine study that study the shocking fact that now, almost 20 years later, we’re not in any better condition.

Evelyne: The worse.

Elisa Song: We’re worse. We’re at the state where nearly one in two kids has a chronic condition. During the pandemic, the World Health Organization noted that eight in 10 people worldwide die of non-communicable diseases. They’re not dying of infections. They’re dying of heart disease, obesity, cancer, all of the diseases that are diet- and lifestyle-related. And it’s starting younger and younger in our kids. So we really need to act now.

Evelyne: Yeah. It’s scary, and you gave me chills. I mean, I’ve heard this before, but it’s just very unfortunate. But, fortunately, as functional medicine practitioners, we can definitely make changes. And I love that your book is written to parents but also to practitioners. It’s such a great resource, and we’ll talk about that more as well. So you mentioned the first 1,000 days. After 1,000 days, is that when the immune system is developed? Can you talk a little bit more specifically about how the microbiome actually forms the immune system?

Elisa Song: Yeah. Well, it’s so interesting. And the first 1,000 days is kind of fluid, but it really does start at conception because mom’s microbiome, her vaginal and her gut microbiome impacts the baby’s microbiome, also how the baby’s birth and fed. But we have this window where the… as an infant’s gut microbiome is taking shape. And what’s really interesting is, in the adult world, we think that microbiome diversity is good. For babies, we want less diversity. The movement toward a more diverse microbiome actually signals a less healthy microbiome in infants. So once babies are two and a half, three years of age, their microbiome appears much more adult-like. There’s still some fluidity, but still adult-like, with a high diversity of different bacterial species and strains.

In the infant, we want primarily bifidobacteria. That is really the key. Bifidobacteria will feed… Evolutionarily designed to feed on human milk oligosaccharides. These are the prebiotics specifically found in breast milk that has so many nurturing qualities, but specifically they feed these bifidobacteria. Bifidobacteria are our friends. Bifidobacteria will promote the growth of some of our keystone species, like F. prau, Faecalibacterium prausnitzii. I hope I’m pronouncing that right. But those are our butyrate-producing friends. And butyrate… We now know there’s been an abundance of research on butyrate. But butyrate is one of our master regulators of overall health as a postbiotic.

And so as we think about how to impact our children’s health, if we start in the beginning, we want to support bifidobacteria species. And how does that affect their developing immune system? Well, I mean, people have heard that 70% of the immune system is in the gut. As infants and we know that bifidobacteria and the loss of bifidobacteria, so conversely, right? It’s kind of a flip side. Bifidobacteria is protective and can help babies develop immune tolerance to different food antigens. The loss of bifidobacteria, on the other hand, increases the risk of food allergies and loss of immune tolerance, could increase then later on the risk of autoimmunity, that loss of immune tolerance.

And with the amazing… I mean, not amazing in a good way, but shocking increase in number of children with anaphylactic food allergies requiring EpiPens, requiring sublingual immunotherapy just so that they can be safe in their schools and on an airplane is really alarming. I mean, when I was in residency, that was hardly a thing. I mean, hardly did I prescribe EpiPens. And now, when I am at my kid’s school and one of the parent chaperones, as a physician, I’m often asked, “Hey, can you carry all the medications that the group is on?” and there’ll be bags-

Evelyne: Oh my gosh.

Elisa Song: … of EpiPens, inhalers, seizure medicines. I mean, you name it. I’m like, “Oh my gosh, what is going on here?” And so this bifidobacteria is really interesting. I mean, this is one of my pet projects. I’m diving into this loss of bifidobacteria because I think this plays such a significant underpinning role in why we’re so unhealthy these days.

One research paper found, this pathologist, in looking at the microbiome of infants 100 years ago, breastfed infants of 100 years ago had almost exclusively bifidobacteria in their gut microbiomes, and their microbiomes were different than formula-fed infants of that time. So even then, there’s a recognition. The modern-day infant, even the exclusively breastfed baby, the exclusively breastfed baby of today, their microbiome looks much more like the microbiome of a formula-fed infant 100 years ago. And then we have the further divergence of our formula-fed babies today. So it’s like, “Whoa.” I mean, even breastfed babies. I feel like we all need this support. We all need this education on how to help babies get the best microbiome footing from birth.

Evelyne: Yeah. So you brought up something that I wanted to ask about, and I definitely want to get into. What are the reasons why this has changed so much? And so I was thinking, okay, if they’re exclusively breastfed, then it would make sense till the two and a half years that there would be more bifidobacteria. But don’t we start giving kids food at six months of age? And I mean, should we not be doing that? Or is it more like the type of foods that we’re getting, the things that we’re exposed to, even if we eat organic and we try to give our children all the best foods? Can you talk more about that?

Elisa Song: So yes, most of the time we’re recommending now starting solids around six months of age, sometimes a little earlier. What’s interesting is that this shift towards a more mature microbiome occurs as soon as non-breast milk is introduced. So if you introduce solids, that is going to shift the baby’s gut microbiome towards a more mature pattern, as it should. But I do then have concerns about introducing solids maybe a little too early, even though that’s been shown to help reduce the risk of food allergies in families where that is a problem.

So another thing that I look at. I think this is such a modern problem that’s really occurred since… In the book, I talk about what I think. My conjecture is that it really happened when the TV dinner was invented in the 1950s, when Swanson developed the first homemade TV dinner. I mean, homemade, right? This is when moms were supposed… Where the idea of the super mom, you could work and come home and… What’s that commercial? Fry up the bacon and whatever it is. So these targeted towards moms, busy moms stressed about getting food on the table, nourishing their kids, and, “Oh, look, you could have a TV dinner that’s just like homemade.” Of course, it was on an aluminum tray, just like homemade, baked in the oven, ready in 15 minutes.

But that’s what we want now, too. I mean, we’re also busy, and we want to know, “Okay, I want to feed my kids the best, but sometimes we’re busy. So how do I buy these packaged foods?” And so this progression from these TV dinners to packaged foods to these ultra-processed food, with all the food scientists now coming in and making food salty or sweeter, more addictive, mouthfeel. It’s like this crazy thing and the psychology around packaging. But if we look back at this progression of how we eat… That first Swanson TV dinner tray actually has a place in the Smithsonian Institute of History. It has an award. It has an award for forever changing the way Americans think about food. And I don’t think that’s such a good thing.

But I also see more and more autoimmunity in kids. And if we look at the rates of ANA, anti-nuclear antibodies… This one research paper looked at different decades or different time periods, from the ’80s to the early 2000s and then the early 2000s to now, and followed different age cohorts and found that in every single age group, ANA positivity rates significantly increased over time. The age group with the most significant drastic increase were our teenagers, our 12- to 19-year-olds.

Evelyne: Wow.

Elisa Song: And in the early ’80s to early 2000s, their ANA positivity rates doubled. And then, from the early 2000s to now, tripled. And the researchers know, okay, our genes haven’t changed. This is like 40 years. Genes have not changed. What has changed is our environment, the way kids are eating, the way that they’re thinking, and that’s completely changed our epigenetic profiling.

But to your point, there are some families who… I mean, in my practice, amazing families who they are eating clean, they’re living clean, they’re buying the green products, and yet their kids still have the eczema or their kids still have the ADHD. And what’s going on? Well, of all the things that disrupt our gut microbiomes, yes, it’s ultra-processed foods, way up there. Antibiotic use, misuse, and appropriate use, way up there. But the third thing that is way up there that we need to recognize is psychological stress. There’s no pill for that. I mean, that’s something that takes work. There’s no supplement plan that’s going to help you manage your stress. Well, that’s not true. I mean, magnesium, all those things can help with stress management, but you have to do the work too in terms of engaging your vagus nerve and regulating your nervous system.

And I feel like that is probably the single biggest insidious factor in disrupting our kids’ microbiomes. Even if they’re doing everything else, quote, “right,” if we don’t manage that piece, their gut microbiomes, our gut microbiomes are going to continue to become dysbiotic and leaky. This one fact I looked, I was like, “Oh my gosh, psychological stress can trigger zonulin release within one hour, one hour.” And it doesn’t mean that we should have no stress because no stress is actually more stressful than manageable stress. But it means that we have the stress and we need to 100% have the tools to manage that so that we can go back to a state of optimal mental health, optimal gut health.

Evelyne: Yeah. I so wish that I had been taught this when I was little. I feel like I still don’t breathe properly. And now it’s in our vernacular. Just everybody knows a little bit about the vagus nerve, even people who aren’t in our field. So I’m curious about that. You actually devote an entire chapter to the vagus nerve in your book. And can you tell us a little bit more about some of the practices that you do with children to work on this? How can practitioners incorporate this with kids in their practices?

Elisa Song: Yeah. So the key to… I think, for kids and for teenagers, if we’re trying to convince them to do something, we don’t want to make it seem like something extra. That’s why all the things in my book, I wrote it with practitioners in mind so that your job can be easier as you’re trying to explain why we’re maybe pursuing a particular diet or why mindfulness is so important. There’s only so much time in an office visit, even a longer functional medicine office visit. So when kids and parents understand the why of it, why engaging your vagus nerve is so important for your gut microbiome, and why nurturing your gut microbiome is so important for whatever concern they came in for, even if it has nothing, quote, “to do” with GI symptoms, it’s everything.

And so I try to help kids and parents understand these are things that you’re doing every day. We just want to do things in a way that more purposefully nurtures the gut microbiome. And so, one of the things is just learning how to, as you said, breathe in the right way because we breathe every single moment. We have to breathe. And so, if you have kids, focus on their breathing and understand what are the mechanics of breathing. When you breathe, there’s this big, umbrella-like muscle right underneath your rib cage. And as you breathe, it pushes down to expand your lungs. And then, as you exhale, it goes up to push out all the air. Well, that doesn’t happen by moving our shoulders up and down. It happens by keeping our shoulders nice and relaxed, having them put their hand on their chest, feel that their chest is really not moving when they’re breathing, another hand on their belly, and as they breathe, that balloon literally will inflate under their hand on their belly slowly. And then, as they exhale, that balloon deflates.

And over years, as we’ve been taught to suck it in and stick in our guts, and we don’t want our guts hanging out, well, that’s not conducive to this diaphragmatic breathing. Because diaphragmatic breathing in this way has been shown to regulate the nervous system, calm, improve positive emotions. And most importantly, I want research-backed ways to improve heart rate variability and vagus nerve function, and diaphragmatic breathing absolutely can improve heart rate variability. The reason why that’s so important to your gut microbiome is that improving heart rate variability can improve, in children, the study, can improve microbial diversity and microbiome health, independent of diet. So even if food is one of the hardest things to change, just working on breathing the, quote, “right way.”

And this is something for kids. If they’re sitting in class getting worked up over a presentation they’re about to give, or maybe they’re older, like a teenager, and they just got a really mean text from their friend, or they’re seeing something on social media that’s just making them feel crazy, right? If kids learn how to regulate their nervous system, I think that is going to be one of the paths to future health. And one of the best ways… I mean, there are other ways. One of the best ways that nobody has to know what you’re doing is just sitting there, bringing your mind to your breath, really doing that diaphragmatic breathing, slowing your breath, belly out as you’re inhaling, belly in as you’re exhaling. Just that, even five breaths in that moment, because then they can stop that fight or flight response, regulate, and look and see what the next step is going to be. And their gut microbiome is going to end up staying healthier for it, as opposed to this constant onslaught of sympathetic overdrive that is triggering that leaky gut and dysbiosis.

Evelyne: Yeah. Amazing. And I love how you described it in such a simple way to teach kids. I see my best friend’s daughter; she does yoga. My nieces have been taught how to breathe. They have a dragon breath and a fire breath.

Elisa Song: Yeah, love it. Yep.

Evelyne: It’s amazing to see their reactions when they get stressed out. They just know immediately, “Oh, I got to do this type of breath.” And fascinating to hear that that actually increases microbial diversity. That’s amazing.

Elisa Song: Yeah.

Evelyne: I want to talk about something else that disrupts the gut microbiome. Can we talk about glyphosate for a few minutes?

Elisa Song: Absolutely.

Evelyne: Yeah. So, in your book, you do share the EPA report from 2020 that said there’s no risk to human health, it’s not an endocrine disruptor, there’s no indication that children are more sensitive to it due to in utero or postnatal exposure. So what’s the deal?

Elisa Song: Well, I mean, we know how great the EPA and the FDA has been in safeguarding our health and our children’s health. I mean, it is criminal, right? And it is something that I think we, as practitioners and as parents, and as educators, we can absolutely make that difference for that child or that family in front of us. But I do think that, to the extent possible, we have a responsibility to try to do things on a broader level, whether it’s teaching at your kids’ schools or calling your state legislator to ban Red 40. It can be simple. Or if you have the gumption, then you go to Capitol Hill or go to Sacramento and lobby in person. It all makes a difference. And I tell you, as healthcare practitioners, there’s a level of respect that legislators will listen to if we all help support that. Of course, voting with our dollars is going to make a difference.

But when we think about glyphosate, glyphosate as an herbicide, what many parents don’t know, I think many practitioners do recognize, is that it was initially patented by Monsanto as an antibiotic. And this has huge ramifications for our soil microbiome and for our microbiome. I mean, it’s not just about us. It’s about our environment and our ecosystem. So, as plants grow and the roots are in the dirt, these plants rely on bacteria and yeast and different organisms to support and nurture the roots with different nutrients. As an antibiotic, antimicrobial, glyphosate, when it’s sprayed on the ground, it will kill all of those in the ground as well. And so what happens is our soil becomes nutrient depleted and our food becomes nutrient depleted. So we have a less nutrient-dense food product that ends up on our plate.

And then not only is the food less nutrient-dense. When it’s coated with glyphosate and we ingest that, glyphosate has this really insidious way of preferentially killing our beneficial microbes or lactobacilli and bifidobacteria, and preserving our pathogenic bacteria, like clostridia. And so we get another double whammy, where now this glyphosate is directly triggering gut dysbiosis, and we have fewer of the nutrients from that food to help protect us. Fewer phytonutrients and macronutrients. And not only that, glyphosate has been shown to trigger zonulin release. So there’s just all sorts of ways that we can imagine. As food has become more and more ultra-processed, as farming has become less sustainable and regenerative, and less organic, the food that we’re eating is really not doing what it’s supposed to and is harming us, even without our knowing it.

Now, when I talk about gut microbiome resilience, what I talk to parents about and kids about is that it’s not about being 100% perfect with your diet because we know there are so many other things that impact our gut microbiome. The key really is to build that foundation of microbiome resilience and reduce, where you can, the number of factors that disrupt our gut microbiome so that when you do encounter a gut microbiome disruptor, your microbiome has the ability to bounce right back. I mean, the same thing with our immune system. Through the pandemic, it was not about shielding yourself from every single infectious exposure. That’s not the way to build a resilient immune system either. What it really was about was building that foundation of immune resilience so that you could get sick as a child with, whether it’s RSV or influenza, or COVID, and be able to manage, bounce right back, and have a healthy, even healthier, immune system afterward.

Evelyne: I want to go back to the glyphosate for a second. I haven’t looked at the research personally in a while. What do some of the studies show, whether it’s in animals or humans, in relation to the gut microbiome?

Elisa Song: So glyphosate will definitely disrupt our gut microbiome. We know that. It also disrupts… In fact, in terms of the bacteria that are in our gut, glyphosate will interfere with some of the pathways, like the shikimate pathway, that’s responsible for neurotransmitter production. So then, inadvertently, we know that the vast majority of many of our neurotransmitters are made by our gut microbiome. Like serotonin, 90% made by our gut microbiome. 50% of dopamine. Over 400 times more melatonin is made by our gut microbiome than by our brain. And so, if we are interfering with… Even if we have beneficial bacteria, probiotics or psychobiotics that are making these neurotransmitters for us, glyphosate can directly impede that action, and then that leads to a depletion of these neurotransmitters that are going to help support our neurologic function, our cognitive function, and our mental health.

Evelyne: It’s really crazy. Let’s talk about antibiotics a little bit more. So we know that sometimes antibiotics are unavoidable. Sometimes they’re given to babies in the hospital, and it’s necessary. And I know that in functional medicine, that’s one of the questions that are asked, right? From the timeline, did you take a lot of antibiotics as a child? So I’d love to talk more about your use of them. When do you determine whether it’s absolutely necessary? And then some of the ways that we can mitigate having taken antibiotics.

Elisa Song: Yeah, I love the way you frame that. How do we know when they’re absolutely necessary? Because they are necessary sometimes. And I always tell parents, because when they hear the statistics around the impact of antibiotics given as an infant and future immune health and future mental health, it can be… It’s an aha moment but also like a “Oh crap” moment, right?

Evelyne: Mm-hmm.

Elisa Song: I did that to my kid. And so I have to step back and let parents know. And even practitioners, because I’ve had practitioners, who are parents, who are moms, hear me talk about these studies and have that moment of, “Oh my God, I didn’t know that.” And so I let parents and practitioners know, I mean, both of my children, they both had antibiotics when they were under six months of age. So my daughter had a urinary tract infection at two weeks of age. And my son… There was strep exposure. We were at a family wedding, and there was strep. And my son, at five weeks, developed this green, icky discharge from his ear. And when we cultured it, it grew out strep.

Evelyne: Gosh.

Elisa Song: So I’m not going to not treat them with antibiotics because I know how fragile their developing immune systems could be if we didn’t. Now, did I want to avoid them? Absolutely. But in that case, I knew they were really necessary. And I was fortunate enough to know how to mop up and restore their gut microbiomes. But even if parents didn’t know about the disruption to their children’s microbiomes at that point, even if it’s 10 years from that time, we can still restore their gut microbiome. I mean, that’s exactly what we do as functional medicine practitioners. We wouldn’t be doing this work if we couldn’t. You know?

Evelyne: Right.

Elisa Song: But as we all know, the older we get and the more entrenched these immune imbalances or neurologic or cognitive, or mental health imbalances, metabolic imbalances become, it gets harder. It gets harder to restore the microbiome and have it stick. I mean, we’ve all had experiences as practitioners where you’re like, “Yay, their guts better. Their symptoms are better. They’re gone.” And then a few months later, symptoms start to creep back a little bit. You look at the tests. “Oh boy, things are starting to get a little unraveled.” The key is we need to make it stick. So that’s, you know, ideas about that.

But as far as antibiotics go, the first really important step is understanding if they’re necessary. And as a parent, and even as a practitioner, it can be hard to determine, but there often is a lot of wiggle room. In one study, up to 70% of antibiotics prescribed to children were inappropriately prescribed.

Evelyne: Wow.

Elisa Song: 70%. Either for a viral infection, which we know antibiotics are going to do nothing for, or just a broader spectrum, so we’re killing more. Kind of scorched earth policy, right? Killing more than we want to. And what’s the problem with that? So yes, we have our individual child in front of us and their gut microbiome, but it’s a public health emergency right now too. Some experts are estimating… They’re predicting that by 2050, which is right around the corner, antibiotic resistance will become a leading cause of death worldwide. Now, that is frightening. And the FDA has called for the production, creation, patenting, manufacturing of new antibiotics. I’m like, “Well, maybe that’s what got us here in the first place.” But we need to be very judicious.

And in the book, I have six questions that I have patients go through with the prescribing doctor because it might not be your primary. It might be in urgent care or the emergency room. But six questions to ask. The most important question, is this antibiotic really necessary? I mean, really and truly, that is the most important question because one study found that practitioners, even if they thought the antibiotic wouldn’t help, they know in the back of their mind that it’s probably a cold, not a bacterial infection, but they were up to two times as likely to prescribe an antibiotic knowing this when they thought that the patient or parent wanted antibiotics.

Evelyne: Wow.

Elisa Song: So just by asking that question, not in an adversarial way, but “Hey, doc, is this really necessary?” helps you question the antibiotic, not the doctor, and lets them know that you’re not one of the parents who are coming in specifically looking for a prescription. Because there are parents who do just want the prescription and get out the door, right? But it lets them know, “Hey, I’m not one of those parents. I’m a parent who just really wants to be thoughtful about antibiotic use. I’m not saying no, but I am saying, ‘Hmm. Can we think about this a little bit more?’”

Evelyne: So if somebody does have to get on antibiotics, what are the best things to do during that time period and after?

Elisa Song: So I’ve had a lot of parents being told different… I’m going to say misperceptions about taking probiotics while you’re on antibiotics. One of the most common things I hear… Fortunately, not as much anymore. But literally just last week, I had a patient who, over the weekend, had to go to urgent care, had strep throat. I do treat strep throat with antibiotics because I do worry about PANDAS developing in kids. And so, she asked about, “Hey, what can I do to help my kid’s microbiome? Can he take probiotics right now?” And the doctor had told them, “Don’t take probiotics while you’re taking antibiotics because it will make the antibiotic less effective.” I’m like, “What? Not really.”

In fact, what’s fascinating is that one of the studies that I saw found that taking antibiotics could actually make your antibiotic more effective. Great. We don’t want antibiotic resistance. And another study in children found that giving probiotics even before a round of amoxicillin, which is the most common antibiotic given, preserved the microbiome more effectively and reduced the antibiotic-induced disruption.

Evelyne: Interesting.

Elisa Song: So that’s really powerful to me.

Evelyne: Yeah.

Elisa Song: And so, while kids are taking antibiotics, I do recommend parents take antibiotics alongside their antibiotics. So at least an hour or two away from one of their antibiotic doses. Some antibiotics are going to be given two or maybe three times a day. And it just gets too hard to take, from a timing standpoint, probiotics after each dose. So at least one of them. And I sit there and I map out the timing.

So, if I have a kiddo who is taking amoxicillin at breakfast and then coming home and having it at dinner, then I have them think about, “Well, what would make more sense for you guys? Would it be to take the probiotic supplement right after school when they come home, maybe a couple of hours before dinner? Or would it make sense at bedtime?” I often find bedtime is one of the best times because they can put it, having a little drink, little yogurt, whatever, little tiny snack right before bed with the probiotic, brush your teeth, and go to bed. And then you have the probiotic sitting in there, hopefully making it down to the colon and able to at least repopulate a bit before the next round of amoxicillin.

But the other thing that I like to do during antibiotic courses, and for at least a month or two afterwards, because it can take a couple of months for the microbiome to restore to a pre-antibiotic state. And some species take years, like four or five years, to actually come back. So, I do recommend probiotics for probably at least a couple of months during and then after the antibiotic course. And while you’re on the antibiotic course, some antibiotics have been shown to trigger leaky gut as well, to trigger increased intestinal permeability and zonulin release. So I like to have some additional supports for the small intestinal lining so that we don’t end up with an even leakier gut at the end of the antibiotic course. So things like glutamine and zinc and quercetin, omega-3s. I mean, all of those are going to be great.

And then the other thing I talk to parents about is really, again, this is about building that resilience. You have to have the foundations. We have to go back to the foundations. That sounds simple, but they’re the ones that are going to make the biggest difference in restoring your microbiome and having it stay restored. And so we have to… Everyone listening knows the saying, “You can’t out supplement a bad diet and lifestyle.” Well, you can’t fix your gut microbiome with just supplements either. I mean, that’s not going to happen. You need to look at food as medicine and lifestyle as medicine, especially as it relates to how can we nourish our gut microbiome. And that’s going to be the key to really lasting healing, whether it’s after antibiotics or if you’re working with a child with rheumatoid arthritis or Crohn’s or ADHD, or whatever else.

Evelyne: Yeah. I will go back to the food, but I have more questions on the supplements. So in terms of dosing, I first want to talk about the ones you mentioned. So zinc, omega-3s. What else did you say?

Elisa Song: Glutamine.

Evelyne: Yes, glutamine. And you mentioned one more.

Elisa Song: Quercetin. Quercetin.

Evelyne: Quercetin, right. Okay. Are you able to share what doses you use? And I think you have some in the book too, and I guess it depends by age, but generally. Okay.

Elisa Song: Yeah, in the book, actually in the back, because that’s the number one question. What dose do I give? Or as a parent, and even as practitioners, because there’s not… Unfortunately, there’s still not a ton of pediatric-specific functional medicine training. IFM this year has pediatric track, which is awesome. And now, as chair for A4M’s pediatric education, it’s so exciting because our annual pediatric conference, it’s a dedicated three days-

Evelyne: Amazing.

Elisa Song: … to pediatric functional medicine training. I mean, it really is about time. So I do give the dosages.

So let’s start with zinc. Zinc is one of those, and I’m going to give a pearl for practitioners. Zinc is implicated in, or I should say zinc deficiency, implicated in sound sensitivity. So it can amplify certain sounds. So your kids who cover their ears in a public toilet or won’t let you vacuum the house or use a blender when they’re in the house. Zinc also changes how you taste. So our picky eaters or our poor eaters with low appetite, if you supplement with zinc… I mean, you can measure zinc, of course, but if you just start supplementing… So many of the times I’ll have parents say, “Wow, they’re not as sensitive. They’re okay with sounds now. The tags on their shirts, it doesn’t bother them anymore. Their palate is expanding a little bit.” So when you have a sensory kid, a picky kid, a low-appetite kid, think about zinc. Really important.

Evelyne: Amazing tip. Thank you.

Elisa Song: Yeah. So now for dosage of zinc. I mean, ideally, I would test the red blood cell zinc because it can be astonishing how low they are and how much supplementation they need. But in general, if you have a kiddo, maybe in their toddler years, I might do five milligrams to start with. With an elementary school-age kid, I might do 10 to 15 milligrams. In adolescent, I do 25 to 30 milligrams. Again, sometimes I’m going way higher. Zinc, as listeners know if you’ve treated your patients with zinc, it is notorious for causing tummy upset, just nausea, sometimes outright vomiting, and I don’t get that a ton. But if you give it with food, away from your iron and calcium, because they will compete for absorption. But give it with food, or maybe give it at bedtime, so that even if their tummy’s a little upset, they’re still sleeping throughout. So that’s zinc.

Glutamine. We know glutamine is really well tolerated at very high dosages, and very high dosages are often needed, but it can be hard to get in that much powder into a kid. So anyhow. So for a toddler, I might do 500 milligrams. For an elementary, middle school-age kid, 1,000 milligrams to maybe 2,000. And then for your teenager, two to 5,000 milligrams. Again, it can be a lot of powder. So we just want to be mindful of that.

Omegas are all over the place. Because honestly, depends on what’s going on, if your kids have eczema, if your kids have attention and focus issues or sleep concerns, or immune, they’re getting sick all the time, I might dose omegas really high. And depending on… You may, for some conditions, want a higher DHA versus a higher EPA, right? For eczema, asthma, allergies, atopic illnesses. We want to also combine the beneficial omega-6 GLA. So you may need a separate gamma-linolenic acid as borage oil, evening primrose oil, black currant oil, or a combination, 3, 6, 9 omega. And so there are lots of different concerns there.

But as a general rule, I guess if we’re looking at… Let’s say we’re looking at cod liver oil. If you look at cod liver oil in general, I would say maybe half a teaspoon of cod liver oil per 25 pounds of body weight. But that still is very low to me. That’s where I start. So I would say fish oil, I don’t worry about going higher up. I have a couple of kids, interestingly, they get nose bleeds with the slightest fish oil, even SPM, which is, I love, love, love SPM, but I haven’t… I mean, I’m not quite sure why. One kiddo actually was improved when we just added K2 to her supplement regimen. But another kiddo, he just always gets the bloody noses.

Quercetin. Quercetin is another one of my favorite supplements. It’s a great nutrient found in the skin of red apples, red onions, grapes, green tea, spinach. It’s a natural mast cell stabilizer, so it can reduce histamine release. So, of course, it’s really… I use it for any kiddo who has histamine issues, whether it’s outright allergies, eczema, asthma, or if they’re having reflux symptoms. Remember, H2-receptors, or histamine-two receptors, are in our stomach that increase acid production and any chronic condition we know. I mean, mast cell activation now is… That’s another thing that is really coming to the forefront over the past several years.

And quercetin can act as a prebiotic. It really helps support the growth of beneficial bacteria. Quercetin can also help restore and heal the leaky gut lining. So it’s one of my favorite. It’s a little harder to dissolve in water. So it’s just one of those ones that, unfortunately, I wish were easier to make a form that could be easily dissolved. But until kids can swallow, it’s just mixing it in. Sometimes, if you actually mix it in with your fish oil, it does dissolve a little better in oils. But the dosages. Even for an infant, I would say… So a toddler. We’re looking at maybe 50 milligrams. For an older kiddo, 500 to 100 milligrams. For teenagers, I mean 200 to 1,000 milligrams. I mean, you can go really high up.

I will also say that as part of my regimen, not necessarily with every antibiotic round, but as I’m really working to heal kids’ gut microbiomes, I do love serum-derived bovine immunoglobulin, the SPI, because so many kids have endotoxin-producing dysbiotic organisms. And we think of them mostly as our gram-negative bacteria, like Klebsiella and Citrobacter. But we also know that Candida and Strep, which is gram-positive, so Strep species, can produce these endotoxin-like compounds too. And so SPI will absorb those endotoxins before they can slip through a leaky gut lining and cause all sorts of mischief in your brain or your joints, or wherever they land. And so for my kiddos with chronic conditions, I do love to incorporate SPI.

Evelyne: And we know in adult dose, it’s the 2.5 grams which have 1.1 grams generally of the IgG. Is that also the dosing that you use in kids, or do you use less?

Elisa Song: I use less. I use less. For my teenagers, I use the adult dose. But I’ll probably use about half of that for kids.

Evelyne: Great. These are amazing pearls that you just shared. Thank you so much.

Elisa Song: You’re welcome.

Evelyne: This is the stuff that we want to hear as practitioners, right?

Elisa Song: Sure. Yeah. I mean, I love pearls, right?

Evelyne: Yeah. I want to give a plug for your book too. Because in your book, towards the back, you list the top 25 most common concerns in kids and have diet and lifestyle supplements, herbs, essential oils, homeopathy, and acupressure point suggestions. So I just think it’s an amazing reference for parents and for practitioners. So very much appreciated.

Elisa Song: Thank you. Yeah. I mean, the goal with that, with all of those conditions, is not to say that we don’t necessarily want to use the conventional treatments, but we know… What’s interesting is it’s not just antibiotics that disrupt the gut microbiome, but also your over-the-counter antihistamines, like Claritin and Zyrtec, SSRI antidepressant medications, steroids, whether they’re oral or inhaled, of course, your low-dose antibiotics, like minocycline, OCPs, your birth control pills. And so how many of our kids are in so many of these, especially in our teenage years?

And so they have so many other factors that can disrupt their gut microbiome. So in really trying to support a more integrative approach to these common concerns like acne or eczema, or colds and flus, one of the goals was really to help parents, empower parents to be able to avoid unnecessary microbiome-disrupting medicines, while also… I mean, these tools are amazing to get your kids feeling better, much faster than they would’ve otherwise.

Evelyne: Yeah. So thank you for putting that out there in a book. It’s amazing. I want to go back to the probiotics. So what are some of the best probiotic strains for infants and for children? And what are the doses that you recommend? And also, does that change throughout, say, baby to infant to child to teenager even?

Elisa Song: Yeah. What’s interesting is… I mean, I would say the thing that’s really shifted the most in my career is how I think about probiotics. Because I used to say, “Everyone should be on a probiotic every single day.” And now I’m really moving more towards, “Well, we have to feed our microbiome first and keep the bugs that we want to.” So we really have to up our fiber game. The World Health Organization has recognized a fiber deficit, a fiber gap worldwide. I mean, 95% of Americans do not meet the daily fiber requirements.

Evelyne: Wow.

Elisa Song: 95%. And our daily fiber requirements, I mean, they’re not much compared to really what we probably should be having. It’s kind of funny. As I was doing research for the book and looking at portion sizes, you’ll see on the bottles, on every nutrient label, the food facts label, manufacturers have to list serving sizes. Well, guess what? Serving sizes are not based on what we should be eating. They’re based on what people typically eat, which, really, I mean, is probably not the same as what we ideally want to eat. So yeah. So when we talk about… Now, I’ve just lost my train of thought because I like to go off on tangents. Oh, probiotics.

Evelyne: Yeah.

Elisa Song: So probiotics. Well, I’m moving much more towards nurturing our probiotics with fiber, phytonutrients, all those colors because we also have a color gap in every single color, right?

Evelyne: Mm-hmm.

Elisa Song: And fermented foods. I mean, fermented foods with not just probiotic benefit; in fact, probably more so is their postbiotic benefit to us. But that’s going to be the key to really restoring and maintaining a healthy gut microbiome. And then using probiotics strategically with specific strains that have been studied to improve the indication that you’re hoping to improve. And for sure, for infants, from about zero to two or three years of age, they really should have an infant-specific probiotic that is heavier on the bifidobacteria strains. And then once they’re over three, they can really move more towards an adult probiotic. I mean, that can be similar. In fact, you’ll notice some of the kid probiotics, after they are chewable, are basically the adult one that’s in a chewable form. So you could take the chewable too, as an adult.

And then, when we look at strains for infants and for children, the most widely studied strain is Lactobacillus rhamnosus GG. So I always want that in a probiotic for kids, no matter what we’re looking at, because it’s been studied for infant eczema and asthma and for ADHD, and so many different benefits. Just another little side story, because I found this research fascinating. It’s an old, old study. Isolauri who’s one of the first, really, most prolific probiotic researchers. Anyhow, the team looked at Lactobacillus rhamnosus GG, so that’s a specific strain, because Lactobacillus rhamnosus… Gosh, I can’t remember the strain number. But there’s another Lactobacillus rhamnosus that actually is more beneficial for the vaginal microbiome. So you want to know the specific strain, right?

So, Lactobacillus rhamnosus GG. They gave a group of infants Lactobacillus rhamnosus GG from zero to six months of age, and the other group, they didn’t get probiotics too. And they followed them for 13 years.

Evelyne: Wow.

Elisa Song: This was a small study. And they measured their gut microbiomes at different intervals. So in the first, I think it was 3, 6, 9, 12, and then they spaced it out afterwards. What’s really interesting is by six months of age, their gut microbiomes looked very different. So the non-supplemented group had almost no bifidobacteria.

Evelyne: Wow.

Elisa Song: Which is fascinating because this was not a study about bifidobacteria supplementation. So something about the Lactobacillus rhamnosus GG. It was a friend to your bifidobacteria. And then they followed them out. At 13 years, there was not any significant difference in the gut microbiomes of teenagers who were supplemented from zero to six months and teenagers who were not. No difference. Except that in the non-supplemented group, they had a significantly higher rate of autism and ADHD.

Evelyne: Wow.

Elisa Song: So it shows you how profound that early-life microbiome can have. We spoke about the impact on the developing immune system, but the developing brain, right? I mean, so profound. So that’s where, looking at specific strains, the Lactobacillus rhamnosus GG is one I would look at for all age groups. And then for babies, more bifidobacteria heavy. And then, as you get older, incorporating some of the Lactobacillus strains. Saccharomyces boulardii has also been widely studied in infants and children, especially to reduce antibiotic-induced diarrhea. So that’s also another really helpful one.

I’ve been really interested in the use of psychobiotics, so these probiotics that have specifically been found to improve and optimize serotonin and dopamine levels. And so there are specific strains for that. I can’t remember them off the top of my head, but they’re the Rosell. So there’s a Lactobacillus Rosell. Helveticus 52, I think. And then there’s a Bifidobacterium Rosell strain as well that has specifically been found to optimize neurotransmitter levels. There’s also the Lactobacillus paracasei. I think it’s the Lpc-37. Again, I’m pretty sure. I know it’s the Lpc-37, but that also is… That’s in the ProbioMed Kids, right? So a lot of these strains are in the ProbioMed Kids. The GG, the Lpc-37. I’ll have to look the Saccharomyces boulardii. So yeah. So I would say probiotics.

Now, I mean, should kids take a probiotic every day? Maybe. In our daily lives, I mean, everything is working to disrupt our gut microbiomes, right? So maybe in that sense. But in general, I really like to stick with, really, you got to support a healthy diet and lifestyle that has to be the foundation, especially when you’re taking these probiotics. I let kids know that taking these probiotics, it’s not like Jack’s magic beans. You can’t just throw them into your gut and expect this amazing, flourishing microbial community. You have to nurture them, right?

Evelyne: Mm-hmm.

Elisa Song: And so if we want these probiotics to not just be and turn into expensive poop, then we need to make sure that we’re supporting our terrain in our gut.

Evelyne: Yeah, thank you for sharing that. I want to talk a little bit more about how do we encourage the growth in other ways. So you talk about fiber. You talk about fermented foods. How do you get kids to eat fermented foods? Is it a matter of introducing it early? Do you have tips and tricks?

Elisa Song: Yes. So yes, early. I mean, for sure, if you can get it early. I grew up eating kimchi, even at a young age. Of course, watered down to reduce the heat. But that was always a part of our flavor training as kids. It was just part of our diet. So I think if you can, early on. When you’re introducing those first foods, take a little spoonful of kraut juice. Or as your kids are… Let’s say they’re starting on some chicken and they’re doing really well. Okay, why not get some sauerkraut and mash that up with the chicken that your child is eating? So having that be a regular part of your family’s diet. And I will not lie, my kids are not huge fermented food eaters. They love their kombucha, though. And as they’ve gotten older, they are thinking, “Oh, the sauerkraut’s not so bad.”

There is something called flavor learning that I love. My friend Katie Kimball, who teaches an amazing kids cooking course called Kids Cook Real Food, she was talking to me about her daughter. I think it was her daughter, or maybe it was her son, who didn’t like fermented foods just yet. And we always use that language. Our words matter, right? So we always say, “Okay, you don’t like it yet.” Because when we say the yet, it doesn’t close the door as I’m just not a fermented food eater, right?

Evelyne: Mm-hmm.

Elisa Song: You can be. You’re just not one yet. So what she did was she just put… Her kid loved ketchup, so she just put a little kraut juice into the ketchup and then just slowly added a little more. So that’s called flavor pairing, flavor learning, where you’re pairing because your child has a positive experience with this one particular food. We’re not overpowering it with another flavor, but just tiny bit, and then gradually increasing it. So there’s still that positive experience with it. And eventually her kid actually was like, “Oh, sauerkraut doesn’t taste too bad.”

Evelyne: Nice.

Elisa Song: So trying that. And then there’s so many different kinds of fermented foods. I mean, kombucha, like I mentioned, is one of them. But virtually every culture has a fermented food. I mean, idlis, dosas from India.

During COVID, there was one paper that looked across different countries. And it was a correlation study, but found that cases of COVID seemed to be less severe in countries where fermented foods were a larger part of their diet. So again, total correlation study, but I believe it, kimchi. There’s a kimchi research institute that found that… This is a long time ago, so some practitioners may not remember this. But there was an H1N1 epidemic, an outbreak, and it was so scary, and you couldn’t get the H1N1 flu shot. It was being parsed out. I mean, it was a crazy time. I guess it was a prelude to what we experienced the past few years. But kimchi was found to kill the H1N1 virus in vitro-

Evelyne: Wow.

Elisa Song: … better than Tamiflu. So I’d rather have kimchi any day. And so the fermented foods, you just have to keep trying, trying, trying. And I always say one of the best ways to get kids to try something is to have them make it with you. And fermented foods, I mean, they can seem really daunting to make, and I don’t culture a lot of my own vegetables and fruits, but when we do, it’s super fun. I mean, getting that wooden mallet and mashing down the cabbage, and adding your brine. We also ferment fruits. So you can ferment fruits. And you don’t have to use whey. I have used whey. And one of my friends was teaching me how she makes fermented fruit. And here I got some yogurt, and I’m dripping it with the cheesecloth into the bowl, collecting the whey. I’m like, “Oh my gosh, there has to be a better way to do this,” I mean, it was time-consuming, but it was fun to do, a little fun experiment to do.

But you can take a probiotic capsule and have a little salt and sugar and mix with fruit and create your fermented fruit that way, and use it as a fruit compote with your pancakes or your waffles, and make smoothies with it, popsicles. I mean, lots of different ways to do that. But have your kids make it. I mean, we’ve never had more fun than I taught my kids’ third and fourth grade class this six-week curriculum, all about their microbiome, their microscopic friends in their gut. And they loved making kombucha. I mean, that was one of the funnest things we’ve done.

And so if you haven’t brewed your own kombucha, it takes a little preparation. You just want to be careful because you don’t want things exploding, but they won’t. It’s only on the second ferment that you have to think about that. But do it with your kids. So you brew the kombucha with the tea and the sugar, and you watch your SCOBY making babies, which is fascinating. And then on the second ferment, what’s really fun is have your kids decide. We each get to make a new flavor and have them choose blueberry mint or watermelon strawberry, whatever it is, and they can flavor their own. It’s super fun.

Evelyne: I loved in the book that you shared that you went to your kids’ classes and that you taught them that. I find that very inspiring, and I hope that some practitioners listening might consider doing the same. And you talked about your little curriculum. I thought that was really cool. And it’s so great when you get kids involved, right? Because then they take ownership of it, and it sticks with them.

I have a question, switching gears, about elimination diets. Something that we often use, that’s sometimes necessary, maybe not for too long. But I’m wondering, how do you eliminate certain foods in kids yet not impact their development potentially? Can you talk a little bit more about that?

Elisa Song: Yeah. I mean, it’s a really tricky one because, as an adult, even if we’re not really happy about our elimination diet, we have that knowledge that, okay, there’s a goal in the end that we’re trying to achieve, whether it’s being joint-free or having a restful night’s sleep, or just getting rid of the brain fog. And so I think it’s really, really important for kids to understand the why. If they understand, “Look, honey, this is why we’re doing this because…” and find their words to use it for what they want, whether it’s to not get in trouble in school as much, or to get along with their friends better, or to not have such big worries, or have clearer skin, so that they have the goal in mind that they want to work towards, that’s really important.

I mean, kids can understand so much. I mean, when I taught these third and fourth graders, they’re eight to 10 years of age. I mean, they were going home talking to their parents about, like, “Look at all the added sugar here. You didn’t know that we shouldn’t have more than, whatever, 25 grams of added sugar in one day?” I mean, I had parents calling me, “I cannot believe my kid is reading labels,” or-

Evelyne: That’s amazing.

Elisa Song: … “I cannot believe that they told me to put the artificial-colored unicorn, SpongeBob thing that they normally would want. They chose to put it back.” I mean, isn’t that what we want? So with elimination diets, having them understand makes it so much easier to get their buy-in. But we want to explain it in terms that really make more sense to them, because being healthy, like getting strong, getting healthier, that doesn’t mean anything for a kid. For most kids, right?

Evelyne: Mm-hmm.

Elisa Song: Not getting sick as much so they don’t have to miss as many birthday parties, that’s going to do it, right?

Evelyne: Yeah.

Elisa Song: And so, using their language. And then, with an elimination diet… And here’s the thing. I used to do a ton of food IgG testing. I do when I’m stuck now. But typically, what I start with is the gluten and the dairy, because those can directly trigger leaky gut, and then other foods that parents might have suspicions about. Because sometimes parents know. “I think it might be the corn they’re eating. Or they eat so many oranges. I wonder if it’s that.” So I just try to work on a few. And I do talk to them about gluten and dairy quite a bit because that can be, for kids, one of the hardest. And frankly, it can be for parents and for grandparents.

And so you got to have the parents truly on board and believing and positive too. We need to be positive that this change, it’s to help reach that level of health that we’re moving towards. Because if there’s any skepticism or feeling like, “Oh my gosh, I’m depriving my kid. How can I do this?” it’s not going to work. I mean, there’s no way your kids are going to be happy about it. And sometimes that struggle and that fight, and the negativity around the elimination diet, frankly, I mean, it can be more inflammatory than the foods you’re trying to eliminate in the first place. So we have to think about that.

And with another strategy that we always add in foods that your kids can eat before we take away. If I were told by my practitioner, “Hey, for X, Y, and Z, you should go on this elimination diet. Cut out these foods,” I mean, I could do it tomorrow because I would know what substitutes to add in and how to keep my diet balanced. But for a kid and for families who’ve never done this before, we need to make sure that they have a rotation of foods that are acceptable and that are balanced before they take away. And sometimes it takes way longer than you, as a practitioner, want them to get to that elimination phase, but they’ll get there.

And simply by adding and working with them to get a more nutrient-dense diet in, they’re going to get better anyway. They’re going to feel better on some levels. So then once they start to see, “Oh, wow, my skin actually is getting a little better,” or “Oh, they’re not having as much diarrhea,” or whatever it is, it gets easier to then set that date. From June 15, this is when we’re going to do the elimination diet, and we just gear up for it. And really try to have the whole family involved so that little brother or older sister, they’re not munching away on a Dunkin Donut while this kiddo is not able to have that, right?

Evelyne: Right. Yeah. I have another question that we frequently get from practitioners, which is around antimicrobials. So I know that you do stool testing. So sometimes there are organisms that we need to get rid of, and of course, we want to feed the good bacteria, which will help crowd some of those out. What are your thoughts on antimicrobials in kids? Do you use the same ones as adults? I know in your book you talked about MCT and caprylic acid. Is that generally what you always use, or do you vary it?

Elisa Song: I vary it when I don’t have a stool test in front of me, because honestly, for some kids, especially older kids or teenagers, it’s… I mean, getting a stool test is so hard. It’s harder than a blood test. So I might just be working on my clinical presumptions, and then I will use MCT. I mean, MCT is just an all-around great go-to. But I do use a lot of the same antimicrobials that I would for a teenager or for an adult, just in lower dosages. The problem is that many of them, if they’re in tincture form, they’re so bitter. And I’ve used the GI Microb-X on kids, but when you open it up, it’s a hard swallow when it’s not in a pale form. So that’s the major thing.

But I do. Some of my favorites are… MCT olive leaf extract and oil of oregano are ones that I find can be super helpful for a broad array of organisms. And then, of course, if I have the stool test and I look at the sensitivities, if available. I do also sometimes use prescription antibiotics for my kids with autoimmune, like juvenile arthritis or Crohn’s. If I see that they have really high levels of Klebsiella or Citrobacter, which we know are two organisms that are highly correlated with autoimmune risk, I just want those out.

And I have one kiddo who he… Actually she. It was a sister who had Crohn’s and rheumatoid arthritis. When we used Bactrim or SEPTRA for her Klebsiella, that’s when she went into remission. And then we were able to keep her there with all of the guts and the immune support, and the diet and lifestyle. But it can be really important. And like I said, sometimes you have to weigh the benefits of prescription antibiotics. There is a time and a place. And in some cases, I do choose that over the herbals.

Evelyne: Yeah, thank you for sharing that. Okay. I have some rapid fire questions that we ask all of our guests. What are your top three supplements that you personally take?

Elisa Song: That I personally take?

Evelyne: Yeah.

Elisa Song: Okay. Top, SPM. Love SPM. For kids, for adults. I mean, through COVID, if anybody was following me, I talked about SPM all the time.

Evelyne: That’s actually what I learned from you. Because I visited you in your office that one day with my colleague, and you talked about how you actually super high dosed it, because that was probably in 2021. And ever since then, I’ve been telling everybody that. So I learned that from you. Thank you.

Elisa Song: Yeah, absolutely. It’s interesting when you listen to… I was listening to Kara Fitzgerald’s podcast, the New Frontiers in Functional Medicine, and she interviewed the discoverer of SPMs. He’s somewhere in New England. Maybe he’s at Harvard. I can’t remember. I feel like it’s Boston. But I mean, just fascinating and just really reassured me that high dosage is super safe. I mean, they’re starting to do research on cancer treatments with SPM, and really interesting.

Evelyne: Interesting.

Elisa Song: Yeah. So I love my SPMs. Parents ask me all the time, “Well, if I’m taking an omega-3, if they’re taking a fish oil, should I not take the SPM? Or can my SPM replace the fish oil?” And no. SPM is different than fish oil. I tell patients that the SPMs, they’re tiny little molecules derived from the EPA and the DHA omega-3s found in fish oil. And at that level that you’ll find in supplements, you really will get the therapeutic benefits. You do get SPMs when you take fish oils, but not in enough quantity if you’re using them for therapeutic purposes. And then the omega-3s have so many other benefits too. So really, I view them as synergistic. It’s not either or.

But SPMs, I love. I love my CoQ10. And it’s funny, the things that you sometimes read or hear, whether it’s in a research paper or even randomly on TV, that stick with you. And I remember reading that virtually all of the signs of cellular aging can be related to the depletion of CoQ10. So I’m like, “Okay, I’m going to take my CoQ10. Yep.” So SPM, CoQ10, and glutathione. I think we could all use some more support with glutathione. So those are my favorites that I use. Yeah, very consistently.

Evelyne: Awesome. And what are your top health practices for your personal health and wellbeing, especially being a mom, being a practitioner, writing this book? You’re busy.

Elisa Song: Yeah. So lots of adrenal stress. So one of the things that I start virtually every morning with, and when I don’t start the morning with it, it does make a difference for how the rest of the day goes. It’s literally a five-minute breathing meditation. It’s on my Insights Timer app. And it’s five minutes for me to center that regulation, focus on the breathing, and it walks you through a guided meditation for breathing. And I probably do it for maybe 10, 15 minutes. But the meditation itself is a five-minute one. So I love starting my day off like that. It sets a different tone for the day when I do.

The second one that I started doing recently that I think is making a huge difference for me is as soon as the sun goes up, because I get up before the sunrise. I don’t necessarily recommend that for everybody, but it’s just… And I never used to be a morning person when I was older, but since the kids. Literally, it’s the only quiet moment in the house that I have. So I relish the morning peace where it’s dark outside, nobody’s awake. I have my Americano, and it’s just quiet, right? And so I get up before the morning sun. But as soon as the sun starts to come up over the horizon, I go outside and I just sit there and I face the sun, and I do some more breathing with the sun. So that is great.

And then the third, which is a game changer for me, and I’m a different person when this doesn’t happen, is really prioritizing sleep. I mean, I literally am a different mother, wife, or sister. I mean, I’m a different person when I don’t get enough sleep, even just from a cognitive standpoint. And so we know that, right? But when I actually prioritize sleep, which I do, I try to. I mean, at this point now, with my kids who are tweens, I mean, I’m asleep before them. I’m like, “See you. Mom’s getting up at 5:00, so I’m going to be asleep by 9:00.”

Evelyne: Yeah, that’s funny. Thank you. And usually I always ask, what’s something you’ve changed your mind about? But we already covered that with the probiotics, and I know we’ve run out of time. So, Elisa, thank you so much. Thank you for sharing all these clinical pearls. Where can practitioners learn more about you?

Elisa Song: So the best way to find me is on my website, so www.healthykidshappykids.com. And also on Instagram. That’s where I’m most active, and I share and I teach. So that’s healthykids_happykids. And of course, in my book, I give lots of pearls. So a lot of things that we discuss are in there, but there’s also bonuses that you can download too.

Evelyne: Great. Thank you. Thank you for tuning into Conversations for Health. Check out the show notes for resources from this conversation. Please share this podcast with your colleagues. Follow, rate, or leave a review wherever you listen or watch. 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.