Holistic Approach to Children’s Thyroid Health

Elisa Song, MD

Thank you, Dr. Jen. I am an integrative pediatrician. What does that mean? It means that I am very conventionally trained. I trained at NYU School of Medicine and did my pediatric residency at UCSF and really learned how to be a great conventional pediatrician. Yet walking down that path realizing that this is now I am dating myself, this is back in like the late 90s, and I have been at this for a while. But then recognizing as I came out of my pediatric residency that we were so ill-equipped to really, truly not just provide chronic disease but also know the foundation to help kids thrive. It is very different than just kind of preventing living at a level of prevention and living at a level of thriving. And I sought out and they actually kind of found me. Every life has its way of doing that, but functional medicine, homeopathy, acupuncture, herbal medicine, essential oils and I integrate all of that. That means I do not throw the baby out with the bathwater, I recognize, for instance, that there is a time and a place for things like antibiotics yet there are many times when they are unnecessary and even when they are necessary. We need to understand how to do the mop-up and the microbiome recovery that will get into that is so essential for helping kids thrive. We take the best of whatever worlds we can and we really personalize that care for kids. That is my passion. I recognize that there are not a ton of integrative pediatricians out there, there are more and more but sometimes not in time for parents and kids right now. And that is why I started back in 2016, I guess, my online Healthy Kids Happy Kids site to bring that education to parents and practitioners who are looking for that merging, that evidence-based merging of conventional and natural pediatrics.

Jen Pfleghaar, DO, FACEP

Yeah. You are amazing. And I love that you help kids thrive. It is so important because like you said, it is the best of both worlds because you can not have conventional medicine. I mean, kids are a little bit crazy, they get strep throat, and they break bones, they are handfuls. Yeah. A friend today just was FaceTiming with me her kid had a gouge in the back of his head and I am like, yeah, you have to get staples, I am like, give him some arnica right now, and then it would not hurt as much for the staples. That is like it is the best of both, you need both. That is why I love what Dr. Song does. We are here to talk about autoimmunity and thyroid disease and Hashimoto’s. And I know parents get nervous, especially me I had Hashimoto’s and I tell my kids, I am like, yeah, we are eating a certain way because I do not want you guys to get an autoimmune disease. Let us kind of break it down. How common is autoimmunity in children, should parents be concerned about it?

Elisa Song, MD

Yes and no, because here is the thing, we know that chronic childhood disease is on the rise and in fact, I would call that the unspoken epidemic, I mean, we need to really recognize this, right now we have a little over one and two kids with some chronic health concern. And what do I mean by chronic health concern? And I have been shifting away from calling it chronic to more of a persistent health concern because chronic in a lot of people’s minds makes you think that it is permanent like you always have this and it is just under control. But we can clear and heal and reverse many of these persistent health problems even if we are given that diagnosis. And just in a couple of years if we are going on a trajectory the projections are that over eight and 10 kids by 2025 may have a chronic health concern. Now, where does autoimmunity fit into this? The numbers are not really clear. You will see some graphs that are really alarming in the adult population. When you look at I mean, it is like the straight line trajectory from the 1980s on with this huge rise of virtually every single autoimmune disease, Sjogren’s, Hashimoto’s, lupus, multiple sclerosis, there are as clear graphs tracking for pediatrics. But I will tell you it is happening at younger and younger ages when I check for antithyroglobulin and antithyroid peroxidase antibodies. And that is something that I will check starting right around puberty for kids who have a family history of Hashimoto’s. I mean, ACIP-positive, thyroglobulin antibodies, and antithyroid peroxidase antibodies in kids as young as maybe nine does not mean they have Hashimoto’s yet.

This is also what I tell parents, you can have positive autoimmune antibodies for decades before you have an autoimmune disease. And the reason I check is because that is my opportunity, it is our opportunity, it is this amazing opportunity to say, okay, your child’s immune system is showing that they are kind of tipping over to the autoimmune scale, now, let us chip it back because we know there are ways that we can do that and we are seeing this rise of. And I will tell you this one article that was very alarming to me, this was, as we are speaking in the fall-ish, I think of 2022. ANA, antinuclear antibody is a very general autoimmune biomarker for those of you who are familiar with that. And we know that over the last decades, since the late 80s, the number of people who have positive ANA markers has been increasing in the United States. What was really alarming in this study is they can look at different populations where that number is increasing at a faster rate, the fastest growing, the group with the largest increase in ANA over this study time period were teenagers 12 to 19 years of age. And since the late 1980s, up until now, their rates have tripled. And the authors even note, well, kids’ genes have not changed that much in the last 30 years, what is going on? It is not just our genetics. You can say, alright, we know that genetically, grandma has Hashimoto’s, mom has Hashimoto’s, and aunt has thyroid problems, it is not our genes alone, it is what we do to help our genes work for us or work against us. There is everything to do with how we are living, and how we are eating, and how we are thinking, and how we are sleeping. That is why your summit is so important because this is the message that we need to hear, the parents need to hear who are worried that their kids are going to go down that road. We do have the power to change our genetic destiny.

Jen Pfleghaar, DO, FACEP

Yeah. I love what you said about it is an opportunity when you find a little bit of antibodies. It is like our bodies are like SOS, help us, there are so many signs and symptoms of our bodies saying this even headaches in children, I see a lot of that in my office, it is not normal. I think the problem is, is we are medicating the symptoms that are alarm signals from our body and we are just medicating them and it is sweeping under the rug, it is covering them up so then this autoimmunity or disease is brewing. And like you said the amount of chronic disease in children is heartbreaking. It is heartbreaking for me. I see it in kids walking and my kids’ classes, I see it when we are at a park kids walking around and maybe they are not neurotypical and it breaks my heart. Yeah. I mean, I think as parents and those parents watching the summit I am so glad you are here because this is the first time you are learning about this stuff. You can really make a difference at a young age because especially with autoimmunity it takes years for it to show up. What you do today really matters.

Elisa Song, MD

And it matters for your kids too because they learn how to take care of their bodies, their genes, their thyroid, and whatever else we are trying to really optimize.

Jen Pfleghaar, DO, FACEP

Yeah. I have been doing some cold plunging lately and my kids think it is normal now, it is so funny, but they watch you, your kids watch you, they watch what you eat, what you cook. Yeah, as parents it is, I mean, it is the hardest job I have ever had, I would do residency like walk of faith. Having children is hard, it is, it is always something. What do you think the biggest three risk factors are for autoimmunity in children that kind of break it down for parents that are like, what do I do?

Elisa Song, MD

Yeah. I mean, of course, there are more than just three. But when I look at what are going to be the factors that potentially if we do not intervene with our functional medicine integrative pediatric approach could further tip the scale for this child to tip over into autoimmunity. And the number one is really looking at are they optimized in all of their nutrients to help support their healthy immune functioning and support healthy thyroid functioning. I mean, even for kids who are eating the healthiest diet even for kids where you are like, well, they are getting a rainbow, they love salads. In our world nowadays with so many inflammatory and toxic influences, we did not evolve to manage back in the caveman days, our genes have not changed that much. We are so overburdened by this need for more nutrients and many of us can get from our food for a variety of reasons. Soil is depleted of micronutrients that we need to get from our plant-based foods to support our thyroid and immune system. I mean, many people know that with our standard American diet, the sad diet, we are some of the most overfed and undernourished populations in the world and it is just getting worse. With the creation of these ultra-processed fake foods, I mean, I just read an article this morning that something like 20%, 25% of the elderly are addicted to ultra-processed foods right now. And what are we doing for them? We want to preserve their brains. 

The most important nutrient, though, that I look at in terms of autoimmunity and a healthy immune response is vitamin D. That hands down if we can optimize our children’s vitamin D levels, our own vitamin D levels that will go a long way in having a healthy immune response. Why do I say healthy? It is because we do not want to squash all inflammation. Inflammation has gotten a bad rep. Inflammation is our body’s natural response to fighting infection, getting stressed about something, having a cut, we get a little red and maybe a little, and that is our body creating inflammation to fight whatever thing we need to resolve. It is just when that inflammation does not come down and simmers at a chronic low level or starts telling our immune system to attack ourselves, that we run into problems. Vitamin D is I would say is the master immune regulator. It keeps our immune system healthy and happy, with just the right amount of inflamed formation, not too much, shut it off when it is done. Okay. That is number one. 

And then a lot of people ask, what do I consider a good vitamin D level? Because I do check when I have the opportunity. There is a lot of unfortunate controversy around vitamin D levels. But if you were to go to a very conventional lab called Quest or Stanford Labs here, or LabCorp, whichever lab, you will see that the range of vitamin D is at least for Quest right now, I am thinking about 20 to 100 nanograms per milliliter, I mean, that is a very wide range and I will have many OB-GYNs or other docs say, “Oh, you are at a 21, you are fine, your normal.” Not even be outright deficient but that is way not optimal, especially when you are trying to prevent or reverse autoimmunity and Hashimoto’s. And I mean, Jenny, I love to get my kids up to 60 to 80 and k

Jen Pfleghaar, DO, FACEP

I agree with that. And I like my patients to be 50 to 70. Dr. Songs is in California and I am in Northwest Ohio, it is really rare for me to get a patient to have a normal vitamin D level that is not on supplementation in Ohio unless they live and they are banking all their vitamin D in Florida or something half the year. But one good thing to know for the listeners, vitamin D is so necessary for thyroid hormone synthesis and for the thyroid to work properly. You do want to check levels, though, because vitamin D is fat-soluble. Your body stores it and then it releases it. But some people are just deficient and we are not getting it from our food as much. And if you are in cloudy Ohio you get it once a week if you are lucky and that is if you are outside. I love that. And I do find kids low, especially if they are not just taking a general multivitamin and they are not getting a lot from their food.

Elisa Song, MD

And it is interesting. Because I mean, you would think that in California that our kids would be really chock full of vitamin D because vitamin D is the sunshine vitamin, you get it through skin conversion. And really in the northern hemisphere, the summer is really the only time we are going to stock up as much vitamin D through skin conversion but I mean, it is alarming, shocking, surprising, whatever would you say. Surprising to me how many kids are insufficient or outright deficient, like you said, without that supplementation. And I just think we need so much vitamin D for healthy brains, healthy immune systems, healthy everything, and healthy moods. 

There are some studies showing that vitamin D acts as a prebiotic for our gut microbiome in so many different benefits. And we just do not get enough from the sun. Even kids I check in the middle of the summer, they are running around outside of camp and they have this golden tan color there is still because of our life forces, I mean, we are just we are sucking up and using all the vitamin D that we have. And to your point for the listeners, Vitamin D is actually not a vitamin, it was misnamed, it is a pro hormone. It is one of the most important starting steps for all of our other hormones like thyroid hormone and all our sex hormones. I love that you explain that for listeners.

Jen Pfleghaar, DO, FACEP

Yeah, it is so important. What are some other factors?

Elisa Song, MD

Two other factors that I look at, especially when it comes to hormone health. Okay. And this is Hashimoto’s, even things like precocious puberty and early puberty or I have seen more kids with delayed puberty. I mean, environmental toxicity, I mean, our environment is filled with I am sure you, on this with hormone disruptors, endocrine disruptors, our lives are plastic now, our cosmetics are filled with parabens and phthalates. I think many people are very savvy now. When you go to the Environmental Working Group and you will get skin deep and you get your clean sunscreen and your cosmetics and but still it is ubiquitous, what does that mean? We cannot escape it, it is in our soil, it is in our water, and no matter how we like to, we keep our homes and how green we are living this is a world we are living in and sadly this is a world that as a society have created. We need to make sure that wherever we can we are reducing those sources of toxicity, the sources of endocrine disruptors. And they can come in kids’ toys, in kids’ clothing, in your makeup, in your skin, and in hair care products, you just being savvy about it. And then understanding that we just need to make detox a lifestyle. Kids in general, the reason why they are more susceptible to environmental toxins is that, I mean, literally pound-for-pound, adult child, kids eat more food, I think like maybe two and a half to three times more food, they drink more water, they breathe more air, they are getting all of these different sources of toxic, their skin is thinner and more porous, they absorb anything you put on their skin more easily, they are absorbing more. And then they have these critical times of development for their gut, their brain, their hormones, their immune system where toxins could make a really big impact. The more we can do just on a daily basis, say, okay, look, we are going to help my kids clear out these toxins in the best way that we can, what does that mean? They need to be peeing, pooping, and sweating a lot every day. We need to make sure they are hydrated because why? Because that is how we get rid of our toxins. Make sure they are hydrated. I love making sure that kids are drinking fluids with electrolytes, not those fluorescent green rehydration drinks you are seeing but things like coconut water. Because the minerals help us detoxify. Red minerals are essential for them. 

We need to poop. Constipation is a multibillion-dollar healthcare industry in the United States. And MiraLax is not the answer. And we need to make sure kids are getting enough fiber, there might be magnesium supplementation. Kids are very insufficient in magnesium. Pooping and excreting your toxins are especially important for hormones because many of our estrogens, our quote bad estrogen, are excreted through our poop that we need to sweat. 

We have a movement deficit in our society and especially during the pandemic. And initially, when life was shut down, I mean, my favorite family hikes every day, then Zoom school started, and butts in seats like telehealth visits all day long, and for some kids that has not changed. And we need to get moving and sweating. And really kids should be moving and sweating at least an hour a day not necessarily consecutively but they should be huffing and puffing. That is number two. Do what we can to minimize our toxic exposures, and clear out the toxins that we do get exposed to just by living in our world every day. We do not want to live in a world in fear but we need to understand how we can empower ourselves. I forgot, Epsom salts bath, is another great way. I love Epsom salt baths. Because that is a supplement your kids do not have to take. But Epsom salts are magnesium sulfate. You sit in that bath, for salts really calming and relaxing. But magnesium and sulfate get absorbed through your skin. Magnesium helps with calming. And then the sulfate enhances glutathione which is our master antioxidant and detoxification compound. Lots of great things when we do Epsom salt baths.

Jen Pfleghaar, DO, FACEP

Yeah, and that is an easy one for younger kids too because it is tough. And, yes, MiraLax, your kids are not deficient in MiraLax. But anyway, there are a lot of natural alternatives. But talk to your kids about poop, that is the one thing. Make it like a funny conversation, like, how is your poop? My kids will say if they have asked poop, they will say I had a messy poop and I am like, it is because of all the stuff you got over the holidays at my parent’s house. But if you are 80, 20, just do not sweat the small stuff just do what you can at your house, you are not going to be able to control when they are at their friend’s house and at school or grandparents.

Elisa Song, MD

Well, we are going to dive into it because that is the third thing, is optimizing gut health. That is the foundation for all immune health. And just talking about the 80, 20 rule, it is important as we know more and more about the factors that can affect our health and our kids’ health. It is very easy for us as parents, as moms to say, okay, never this, no, you can not have that, we get our grandma’s case. Let us go over that. I have to say, I was like that in the beginning too, you kind of go swing, and then you realize, I think there is a center place that we can come from. And it is really important because we do not want our kids having unhealthy relationships with food in their environment and we do not want them to feel deprived, we want them to feel empowered. And sometimes a psychological stress around what you should be avoiding in your food and your environment is bigger causes more inflammation than if you just had that thing, it is all about balance.

Jen Pfleghaar, DO, FACEP

I agree with that. I will have patients come to me and maybe they saw someone before me and they were put on super restrictive diets and they did not get better and I am like if this is going to be the dealbreaker or cause you stress that is going to be worse than your gut health and especially with kids you cannot be unrealistic with what a child is going to do. And you probably have these conversations every day with your patients, you sit across from them like, what are you willing to do? What is a dealbreaker? You need to have pizza with your baseball team on Friday nights, well, what can we do to work around that? I think that for parenting and trying to navigate this you have to be really realistic and cut some slack, not be too hard on them for sure.

Elisa Song, MD

It is so important. And you know what? With your kid, it is one thing for grown-ups to say, great, I am going to go on an elimination diet, I am going to get rid of gluten, I am going to get over the dairy, the sugar, the whatever it is and it is going to happen tomorrow, some adults can do that, easy. Most adults can, it takes a little prep but for kids, it is not a race. We want them to have healthy habits for a lifetime. If it takes them months or a year, that is okay, you just keep planting the seeds, you educate them and you make it relevant for them. I mean, I am going to tell you, I had this one teenager who is, she is amazing but she is showing signs of autoimmunity and it runs very strongly in her family, but she is a teenager, she is 17. We are going through her diet and we are just kind of thinking through what she is eating, how she is eating, and where can we intervene, and she said, “Well, I start off every morning with a Red Bull, that is my breakfast,” and I looked at her and I said, “Is there any way that we are going to be able to change that right now?” And she said honestly, she said “No, because that is one thing I look forward to my life,” and I said, “Alright, well, I am not going to say never ever, I am going to say not yet and we are going to just keep having this conversation.” We never want to come to a place where we make people feel guilty about their choices, we just let them know, okay, this is how this could be affecting your body, I will let you sit with that and then we are going to keep talking about it. It is a journey. 

Jen Pfleghaar, DO, FACEP

Absolutely. I love that. Especially with children, it is a journey for sure. Hippocrates said all disease starts in the gut and I say that all the time to my patients. The gut is so important. Can you explain how this applies to children, especially relating to autoimmunity and Hashimoto’s?

Elisa Song, MD

Yeah, absolutely. Well, let us take a step back because many of your listeners already are familiar with the importance of gut health and may have heard terms like leaky gut or gut dysbiosis. But let us make it really relevant for children. When children are born they have a clean slate in their gut, I mean, it is come into question whether or not their gut is really completely sterile when they are born. But we know that mama’s gut microbiome and vaginal microbiome and the way babies are birthed vaginal C-section, or the way that they are, fed breast or formula, has a big impact on how that baby’s gut microbiome starts off in life and the path of development that their gut microbiome takes. Why is that important? Well, our gut microbiome has its shaping and developing, has an intimate connection, a direct two-way highway to our brain called the vagus nerve. 

And for babies with their developing brain, their gut microbiome plays an essential role in how their brain actually connects and makes us new synapses and really grows and explodes and all of those connections. The same thing is happening with your gut and immune system connection. Their immune system comes out naive to the world. What does that mean? They do not know what is friend or foe or what they should attack or not attack their gut microbes sense what is passing through. And if you think about it, we are one big long tube from mouth all the way down to the other end. And our gut is actually our largest interface with what is passing through our world, what we are swallow, what we eat, the microbes, the pathogens, the viruses, the bacteria, and the environmental toxins were exposed to, they all travel through our guts. 

70% of our immune system lies in our gut. As a baby, as a child even as a teenager as their immune system is developing what happens with the gut is that gut microbiome senses what is going on. Let us say it is a piece of gluten and it passes through that transit system does not really know what to do with that piece of gluten and your microbiome gets to decide, communicate with your blood’s immune system, and say, okay, this is foe, I want you to attack that and clear that. Let us take a different, let us say stomach virus, okay, or a bacteria like Klebsiella. Okay. Our resistance says, I do not like you, not a good thing tags it as a foe, starts attacking. Or let us say, it is a piece of, I do not know, let us say an apple comes through and your gut senses it and says, well, this is a friend, I am going to digest you let you pass, and get all the nutrients and no problem. 

Okay. If your gut is imbalanced, okay, dysregulated there are abnormal bugs in there or maybe there is a little bit of a leakiness that is happening. And babies actually have more of a leaky gut than adults. And that same bacteria, that Klebsiella bacteria comes through and your immune system says, this is foe, I am going to attack, but then because your immune system is just regular, your gut microbiome dysregulated tells your immune system the wrong thing, it says, now you should attack me, you should attack my thyroid, you should attack my joints. We know that there are certain bacteria in the gut that can trigger or worsen autoimmunity. We know that having a leaky gut that is perpetuated because maybe we are eating the wrong foods or we have exposed to toxins or too much psychological stress can also predispose our children to autoimmunity. When it comes to immune modulation balance and autoimmune risk we want to make sure that your child’s gut is in the healthiest state possible so that they can resolve their autoimmunity, resolve their Hashimoto’s. I had this talk about Klebsiella and this is related to other unfortunately common autoimmune illnesses, I am seeing in kids has Crohn’s disease and juvenile arthritis, and doing all of this functional medicine work. The one thing that put that child into remission was when we cleared the gut of Klebsiella. That is the one thing that tips the scale and keeps them in remission. And now she is a teacher in Arkansas doing amazingly, well, like no problems. The gut is really powerful. All disease starts in the gut and by the flip side, on the flip side, all health starts in the gut. We also want to look at our gut as what can we do to help our gut thrive or kids can thrive.

Jen Pfleghaar, DO, FACEP

Yes, I love that positive flip. Health begins in the gut. You should tell Hippocrates that.

Elisa Song, MD

Yeah.

Jen Pfleghaar, DO, FACEP

But I get really frustrated when. It is like normal mom talk for people to be like, my kid’s constipated and they are on PEPCID. And I was there too, 15 years ago I did not know, we are not taught this in conventional medicine. It is really important for parents to look at the gut health if something is off, whether it is swallowing, whether it is a stomach ache, whether it is constipation, whether it is bloating, whether it is stomach cramps., that is a warning sign. And that is a warning sign that something is off.

And not only worried about diseases in the future but your immune health right now. And I was hoping during the pandemic that everyone would double down on health and stop eating fast food and stop drinking a lot of alcohol and all this stuff to help their gut health. And actually, I feel like everyone’s gut health got worse.

Elisa Song, MD

Yeah, I think so. I mean, for so many reasons. I mean, just not moving their bodies, stressing about X, Y, or Z. And I mean, I have something who took that opportunity to help cook every meal and it is a big slide and many kids left the pandemic in a much less healthy state, unfortunately. I mean, now it is time to get back on track.

Jen Pfleghaar, DO, FACEP

Yes. And they can learn from you in this summit. When we look at how important kids’ gut microbiome is to their developing immune systems and their brains, what are the biggest factors that impact their gut microbiomes? And how can parents and kids optimize the kids’ gut microbiome?

Elisa Song, MD

Yeah. I always like to think of like, what can I add in, what can I take away? There is different. And for some kids adding in is harder than making these simple swaps. And I should take away what are the healthy swaps we can do. Now what I look at in this is, there is a group of things we would like to try to avoid when possible and then I call the microbiome mischief-makers because they do they kind of wreak havoc on our gut microbiome, we just need to be aware of them. And honestly, the number one acute disruptor to attack our gut microbiome and the kind of across-the-board the biggest disruptor are antibiotics. And there are times when antibiotics are necessary 100% and when they are you take them without hesitation and you know how to recover your gut microbiome afterwards. 

But most parents do not know the disruption that antibiotics can do to your gut microbiome and the downstream effects on the developing immune system in their developing brains. And this is just for parents to know if your kids have been on antibiotics do the mop-up now, chances are your child needs a little bit more support. And work with your pediatrician and ask them, is this really necessary? I mean, there is a whole list of questions I have I give to parents if they are coming from other places and in another primary care doctor to know like, is this really necessary? Because what they showed that physicians were more likely to prescribe antibiotics when they thought their patients wanted them even when they thought antibodies were totally necessary because it was a viral condition. 

If they know your question you are like, I am just wondering, doc in a very respectful way, I am just. Do you think it is really necessary? Like are there other alternatives? Then they might say, actually, yeah, your kid is an erratic and looks rad but you can wait, watch and see and let us hold off them, so just ask them. And if you had antibiotics while you are pregnant or during labor and delivery or your child has had antibiotics, especially in those early years of life I would recommend working with a functional medicine doctor to see what kind of mop-up has to happen. Because we know that antibiotics, for instance, having antibiotics as a toddler can increase your child’s risk of later mental health concerns by up to 50%. And even there is one say that looked at giving babies under six months of age, antibiotics, fantastic medications. And by the time they were four, they had a significantly increased risk of every allergic disease like eczema, asthma, and allergy. I do not say that to scare parents but just to know, okay, we have this knowledge now we need to know what we can do to either prevent that from happening or reverse that if your child’s already having those 

And then the other big microbiome mischief maker that if we can just swap out would make a huge difference is when we talk about these ultra-processed foods. What is it about ultra-processed foods? It is the scary amount of FDA-approved food additives. Okay. Now I am going to talk specifically about the emulsifiers. Emulsifiers are what keep our food together and prevent them from being in a getting into a goopy mess, fat, and infant liquid ready-to-feed formula found in ice creams, found in yogurts if we are not looking out for them. And emulsifiers inserted like this in Japan have been directly correlated with the increase in the population rates of autoimmunity and emulsifiers can directly cause leaky gut, directly cause autoimmunity. We just be a savvy label reader. If you are craving ice cream, great, look at, I just looked at these labels, Breyers, no, but Haagen-Dazs are your organic AB Strauss great, they do not have mono-diglycerides, polysorbate 80, monostearate. If you see those chemicals just avoid them and swap. I give an example, my son right now his friends love Takis which are the roll tortilla chips, fiery lime, bright red dye number 40, it is artificial flavors, I am like, I just can not do it, what is a healthier swap so he can feel like he is having some chips with his friend? Trader Joe’s has rolled tortilla chips that is a better swap even better are Paqui PAQUI, they have their version which is even cleaner. Just looking at the label you can have these quote treats make them healthier swaps are going to disrupt your child’s gut microbiome. If your kids learn how to read labels and be their gut friend they will have so much better health lifelong, prevent the autoimmune happening, and prevent those chronic health concerns. Because let us face it, I mean, they are going to be downtown with their friends at middle school, hanging out with their friends in high school, going out and college without you and we need to help them know how to make healthy choices that they feel good about and that taste good to them.

Jen Pfleghaar, DO, FACEP

Yes. The swaps are the Takis. I have a high schooler and all these and, yeah, Trader Joe’s, all these has a dye-free version two. Now, still have sunflower oil but does it have to be perfect? Are they going to be eating takis breakfast, lunch, and dinner? No. You tell them it is for a treat when you are with your friends. And the funny thing is, I do not know if this was like it for your son, but my daughter’s friends they liked it better, they were like, this tastes even better. It is really hard. And swapping things so your kids do not feel left out or different from other kids I think makes it a lot easier. But teaching them about your gut health and my husband will eat gluten and then he will have stomach ache and maybe diarrhea and it is a teaching moment, you can use these as teaching moments like, daddy does not feel good because he overdid it with like you said, artificial flavors or coloring and stuff like that. Having a conversation with your kids about how did you feel after you crashed from eating that candy at school or whatnot. Definitely, it is not easy.

Elisa Song, MD

No, it is not easy. I love your point. We have to make it better for them, it is a great teaching moment and we have them observe. I would say, hey, did you notice that it was harder like you just were frustrated on the soccer field because you were not scoring as well do you think it could have been? Maybe from that huge bowl of whatever you had the night before or okay, Your skin’s breaking out right now, as a teenager, you are not really happy about it, do you think they come from whatever you eat the day before or two weeks before, whatever it is. And helping them make that connections really important. And it is not just about what they do not but what they swap into, but also teaching them of what is going to support their gut microbiome and why it is relevant for them if they want to be an amazing violin player, or they want to remember their play lines, or they want to be the fastest on the lacrosse field, whatever it is, chances are optimizing their gut microbiome will help them get there. 

And I talk to my kids about what is going to feed are good cutbacks and that is going to be your fiber fermented foods and phytonutrients. You just get in a variety of plants whatever way you can. And f your kids are picky, I mean, even making that, like if your kids love cauliflower even getting in, like having the white cauliflower but also getting purple cauliflower and getting the green romesco cauliflower that still gives different phytonutrients. We can always think about how do we just move them one step closer to having a little more fiber, having a more variety of phytonutrients.

Jen Pfleghaar, DO, FACEP

Now what if a parent their kid had antibiotics, they think their gut is out of balance? I know that my seven-year-old finally got strep throat. It was the first time he was ever on antibiotics and I was like, it is the first time at seven years old where I know my parents growing up they took me to the urgent care and I got a Z pack and they are like, we are doing something right. I think that it is hard for parents because you want to do something when your kid’s sick but sometimes an antibiotic is not the answer. When that gut might be imbalanced or if an adult thinks that their child’s gut is imbalanced or they have had an antibiotic in the past, what can they do? Is their gut messed up forever or there is hope?

Elisa Song, MD

There is always hope otherwise, we would not be talking. There is always hope. Now I will say, I mean, your gut microbiome has a certain resilience in that it tends to want to move back to the state that it was in before you had those antibiotics or you had whatever it is. Ideally, you start off with a healthy gut microbiome and making sure that you are prioritizing that as your kids get older. But let us say we did it right or they are showing signs that even after the antibiotics their gut microbiome seems to persistently be imbalanced. What does that mean? What signs could you have? We have mentioned some of that, any tummy symptom, constipation, reflux, tummy aches, even diarrhea, and bloating but it could be non-GI symptoms too like you mentioned earlier, the headaches and skin shows very commonly on the skin, rashes, eczema, even occasional hives or mood, I mean, it shows a lot in kids’ moods, behaviors, and sleep problems, especially the change after their antibiotics. 

And, I mean, there is a whole quote leaky gut protocol, I mean, a function of medicine, we call it the five Rs. And there is a simplified way to do it for kids. But essentially, I do not know some of the talking about this on the summit already, but I think about it and I call the gut reset, SET the first S is you still inhale their gut. You remove the things that are irritating, which are usually the foods. And when you have autoimmunity, critically important to get rid of that or that is how are you hearing maybe, and definitely the gluten and the dairy as a gluten is number one. I had a kiddo with anti-thyroperoxidase antibodies, I mean, 900, and thyroglobulin antibodies in the 70s, I mean, really high zero now, zero guys after taking out the gluten and healing her gut. Her thyroid numbers, her TSH, T3, and T4 were really good, we are like, okay, she does not have Hashimoto’s yet but we want to prevent her from doing that and she was really committed because she had seen her mother going through her thyroid journey and not all kids are that committed but it took, I mean, it did take 100%. And we can tell when she has those little gluten streaks, let us say birthday parties or whatever she does not feel good, her thyroid numbers start to get not so good, her antibodies creep up, not into the positive Hashimoto’s range, but they start to creep up. And now she is so she is amazing, she is like, I recognize how I feel, I gluten and I do not want it. Remove the foods that are sensitive and then we repair the gut lining with things like glutamine, fish oil, and zinc oxide, my top three that repair nutrients. I will often add quercetin because it is such an amazing antioxidant. And histamine in muscles are often implicated too when we try to heal the leaky gut. That is the S of the set, the reset.

E is eliminate, eliminating gut dysbiosis. And you might need a functional medicine doctor to do some stool analysis to say, hey, look what is in there that we need to clear out, are parasites, are there is there Klebsiella, is there something else that should not be there? And then the T in set is for transforming the gut microbiome. And what does that mean? Because we can not just we think, we will just throw probiotics, a hundred billion, trillion, 900 billion, whatever it is. We are all about more in the states but transforming your gut microbiome means not just, it is like thinking like Jack in the magic beanstalk because I think you throw these beans on the ground and all of a sudden you can have this amazing stock, that does not happen with probiotics. They need the right environment to grow and that is what the transformation is. 

We need the prebiotics whether it is prebiotics supplements or that is your fiber in your foods and we need your probiotics. Fermented foods will pack more bang for the buck in restoring gut microbial diversity than even fiber or probiotic supplements. Okay. And we need to restore that gut-brain connection, that vagus nerve connection. This is really key because we are living in a state of high stress, sympathetic fight or flight, your gut microbiome is not going to be able to maintain a healthy recovered level and why is that? Because we know it is a two-way street, your gut health informs your brain, it makes all of those good neurotransmitters support a healthy brain. 

However, we also know that having a healthy vagus nerve and optimal heart rate variability, that is what is measured in your ordering, having a healthy vagus nerve can optimize your gut microbiome and get this. The studies have shown it is independent of  dietary intake. I am not saying eat all the crap you want but even if your kid’s diet is not exactly where you might like it to be just by optimizing their heart rate variability, improving vagus nerve function, and improving stress management, that is what this is all about, mindfulness of mindset work, that is probably the most powerful medicine you can give to your child to support a healthy gut microbiome. And guess what, it is free, that is anyone could do that. We just have to make it as important as a prescription as any supplement or medication that we are prescribing.

Jen Pfleghaar, DO, FACEP

I love it because that is so important, the vagus nerve. What are some simple ways that kids can engage their vagus nerve to optimize their gut immune and their gut-brain connections?

Elisa Song, MD

Yeah. I love that. I mean, there are certain apps for parents who love apps. There used to be really great kids but that is no longer so sad. But their insight timer is a free app with meditation instructors from around the world, Tom has free-up paid ones but they are really good children’s meditations and mindfulness app programs exercises there. And then Oak, like the oak tree. A middle school student actually told me about the Oak app and loved it. It is a breathing app. That is a great way if you need to be a little more guided. Okay. But there are a few things you could do at home. The first thing is just teaching your child to breathe with their diaphragm, it is called diaphragmatic breathing or belly breathing. 

And that is really a great way. It is been shown to improve heart rate variability. When we breathe through our belly we keep our shoulders down or imagine there is a balloon in our belly and as we inhale the balloon expands and as we exhale the balloon deflates and without moving our shoulders, okay, this is something that is really hard for adults to do even, so you practice together. But just by slowing down, spending five minutes, belly breathing together, it is a great way to engage your vagus nerve. And that is something you try to do even if they are sitting at their desk in school kind of worried about the tests they are about to take, just start belly breathing and they will be able to stay more focused and calm. 

Another one that I love is a five senses meditation, but I call it the stop look and listen because a lot of kids learn that when they are crossing the street. And any time we can help our kids stop, regulate and be mindful that is an immediate boost to their vagus nerve and this will serve them for the rest of their life. In fact, some studies have looked at, well, what does it take to become a successful adult? One factor is the ability to stop and regulate, stop and think before you do. How many times do we tell that to our kids? But now we are doing this on purpose, we can do it when you are walking to school. 

The first part of it is to stop what you are doing, let us say you are walking to school, hey, honey, let us just stop for a couple of minutes and give yourself permission to just put down your phone, stop doing what you are doing, and behave a mindful moment. And then when we look, we are looking with all of our senses and we close our eyes first because our visual input is the one we use the most every day and we just ask your child, okay, with your eyes closed, what do you hear? And you just notice you might hear the birds chirping in the tree, you might hear the car that just went by and then we ask, what do you smell? I think maybe there is a chimney from the neighbor’s house or they smell the fresh-cut grass. What do you taste in your mouth? Is it the breakfast you just had? Or maybe it is some minty toothpaste because you should brush your teeth. What do you feel on your skin? Are you feeling the hair just blowing against your back in the wind or do you feel maybe the weight of the backpack straps on your back? And then we open our eyes and what do you see? And you might see things that you have never noticed before on that same block every day to school. And then finally, the listen is listening to your body and your brain and noticing how you feel and what you are thinking in that moment. That could take, I mean, a couple of minutes. But if you show your child how to stop and be present in that moment you are engaging their vagus nerve and you are giving them tools that they can use for the rest of their life. There is many others but I would say those are the simplest let us start with.

Jen Pfleghaar, DO, FACEP

Those are great. And like you said, a lot of adults need this also. Good to do with your kids. This has been such a great talk, so many nuggets of information and advice for parents. Thank you so much for being here. And Dr. Song, you have some exciting things coming up. How can everyone find you, earn more, and take your programs?

Elisa Song, MD

The best way to find me. We have all sorts of very and not-very family members that are a part of our lives. The best way to find me is on my, well, a couple of different ways. My Healthy Kids Happy Kids blog is healthykidshappykids.com. And that is where I write articles and share information. You can find out more about my programs there. And on Instagram that is HealthyKids_HappyKids where I share lots of great pearls and just some about my life, lessons you can learn from my mistakes. And also Facebook, you can search for Healthy Kids Happy Kids. Those are the best ways to find me. And the exciting news as this airs I am getting ready to launch my publish, my first book. We do not have a title yet but it is right now as Jenny and I are speaking in the hands of HarperCollins editing team. And I cannot wait to share it with the world. It is all about how to help parents create that microbiome magic for their kids. Really looking forward to sharing that. That should be coming out early 2024. Yeah, just connect with me and I will keep you posted on when it comes out.

Jen Pfleghaar, DO, FACEP

Thank you so much. And I am so excited for you. And grateful for everything you share.

Elisa Song, MD

Jenny For having me.