How To Protect Your Child Against Inflammation

Elisa Song, MD

Thanks, Laura. It is always my honor.

Laura Frontiero, FNP-BC

I know we are going to talk about pediatrics today, specifically pediatrics and a lot of mental wellness and mental health are going to be covered today. It is important to understand the inflammation talks that we are having, the root causes of what is happening with our kids, and why we are seeing this rise in anxiety in our children, depression, suicide attempts, and all these things. We must be covering this. You are America’s pediatrician. You are an Integrated Pediatrician and Pediatric Functional Medicine Expert. You integrate both Western and functional medicine, and you have an integrated pediatric practice called Whole Family Wellness. 

You have helped thousands of kids. I would say your reach is so far because those are just the kids that are hurt that you have seen. But the thousands of families whose families you know tune in to learn from you and listen to you, and you help families get to the root cause of their health concerns. You empower parents. That is a big one. You empower parents to help their children thrive on all levels. It is not just about solving an inflammatory problem in the body; this is about helping them with their mind and their spirit. It is a holistic approach. I love this. I wish I had known you when my big one was a little one, which means she graduated from pediatrics. She is 18.

Elisa Song, MD

Wow! 

Laura Frontiero, FNP-BC

I know. Well, let us start by talking about the mental health state of emergency that we are in now in the United States and around the world. But specifically, we can speak about the United States because that is where we are. This is specifically a problem, not just statistics now.

Elisa Song, MD

We know that one in three teenage girls has an anxiety disorder, but it is not just girls. By the time kids are 18, one in two are teenagers and are going to be diagnosed with any mental health disorder. During the pandemic, childhood mental health was considered and was called into a state of emergency. But we have been in an emergency for a very long time. I am just hoping that this is the light that needs to shine to make it a public health priority. The suicide attempts and the suicide completions are what are so devastating. One in five teenagers, when surveyed, has seriously considered suicide, and one in ten has tried. When we look at E.R. visits for suicide ideation and suicide attempts during the pandemic, those numbers went up significantly.

Now, when we look at the leading causes of death, which is such a morbid thing to do, we have to kind of put this into perspective. Among our youth are young adults, 15 to 24 years of age. I mean, they are just barely young adults; we have teenager-to-young-adult suicide, which is the third leading cause of death. But guess what? Number one and two are unintentional injuries, which often go along with risk-taking behaviors that go along with mental health concerns. Number two is homicide. Number three is suicide. When we look at the statistics, this is from last year, or actually, this is from 2020, so around 6,000 15 to 24-year-olds died by suicide. When we look at COVID-19, which I am not making light of, 501 youths died from COVID-19, and 6,000 died by suicide. Where are we prioritizing our public health dollars?

Laura Frontiero, FNP-BC

The kids who died of COVID probably had preexisting health conditions for the most part.

Elisa Song, MD

Many did. 

Laura Frontiero, FNP-BC

These were not perfectly healthy children. They had similar health problems. I am so glad that you are shedding light on this and speaking about it so factually and candidly; these are things we cannot ignore. You know, the conventional treatment of anxiety and depression—is it working for our kids or adults, for that matter? If you are an adult listening to this without kids or your kids are grown up listening because this is probably pertinent to you as well, I mean, pediatrics, they are just little adults, we have yes. A lot of what affects them affects us as well. But can you talk about what is happening here? Wired: Why are treatments not working?

Elisa Song, MD

Well, I mean, as any of the listeners know, in conventional medicine, there is a time and a place for conventional medicine. I am not saying that there has never been a time for that. However, conventional treatment does not look at why and how kids, teenagers, and adults got to this place in the mental health crisis to begin with. Many times, when we look at it, it goes way back. When we look at the main medicines used for the treatment of depression and anxiety, are SSRI selective serotonin reuptake inhibitors. For our youth, they have a black box warning that they can increase the risk of suicidality. When you start with kids and teens, that is exactly what we want to prevent in the first place. For many kids and many adults who have been on SSRI as a result of this experience, it helps at first; it helps lift some of that depression and some of that anxiety. But after a while, it stops working. Well, guess what? SSRIs, which are meant to trick the brain into thinking that there is more serotonin around than there is, can deplete your serotonin levels over time. If we are not re-pleasing, replenishing, and building up serotonin levels, there’s not anything for that SSRI to even work on. It makes sense that there’s no long-term fix with most of our psychiatric medicines.

Then, when I think of children, most kids with one psychiatric disorder do not just have one. They may have anxiety and ADHD, and then maybe they have OCD or even O.D. I mean, all of these acronyms pile up. then they are on, you know, Prozac for their anxiety, and then they are on Ritalin for their depression, and then they are on, you know, maybe Risperidone for their OCD. The list goes on and on. They are on this polypharmacy of psychiatric medicines that they may have interactions with. We do not know what the side effects are or what the kid’s behaviors are. so we can see it becomes this vicious cycle. Like I said, sometimes there are cases where medications do help and are needed, but the vast majority of the time they are just kind of slapping a Band-Aid on what is going on. They are not a long-term fix.

Laura Frontiero, FNP-BC

This is rampant in so many areas of trying to treat the human body. I mean, in this specific talk, we are talking about teens and kids with anxiety and depression and, moods that are not stable. But if you think about the way Western medicine approaches a lot of these things, it is Band-Aids without solutions. I would love to unpack what is going on here. This is the beauty of your practice: that you are integrative. You have all the training and learnings of a Western medicine pediatrician, but you also bring this functional aspect and this part of you, which is, curious about what the root cause is. That is what this summit is all about—the root cause. Anxiety and depression. This is an inflammatory process in the body. What is the root cause of a functional medicine approach to child and teen anxiety?

Elisa Song, MD

When we look at the root cause, I will say, just as a caveat, that there is typically never just one root cause. There are typically many underlying factors. There might be one thing that stands out in that parent’s mind or stands out in that child’s mind as that was when this happened. That is the straw that broke the camel’s back. I mean, when we think about pans or pandas, where a strep infection may trigger the sudden onset of OCD, anxiety tantrums, and cognitive regressions, well, yes, it was an infection that triggered it. But there was a whole background likely of immune dysfunction that was simmering underneath that inflammatory response that you cannot see because I cannot look at you and see, How much inflammation is inside there. I might conjecture. 

But we have to take a look and see how far back we can go to discover some of these root causes and kind of peel back the onion and say, What can we do to intervene? The first and most important root cause for childhood teen anxiety and mental health concerns is the gut-brain connection. We need to figure out what is disrupting that connection, what are the nutrient deficiencies, and what are the toxins that kids are being exposed to. What are all the sources that are causing a dysregulated gut-brain connection? That is where we can do some digging from a functional medicine standpoint,

Laura Frontiero, FNP-BC

I would love to do that today. Can we dig? 

Elisa Song, MD

We can dig. 

Laura Frontiero, FNP-BC

We have this gut-brain connection that is so important. I know you have spent a considerable amount of time researching this and even developing strategies to support children’s gut health. I mean, you are a leader in this area, so we are thrilled that you can be here talking about this, too. In terms of nutrient deficiencies, is it different from kids’ and adults’ mental health? Is there something specific that you are looking for in kids with nutrient deficiencies? What is that, and is there something unique about kids that sets them up for this?

Elisa Song, MD

What’s interesting? I would guess that the same nutrient deficiencies that are common in children are likely to also be common in adulthood. But for kids, we have to think about children and teenagers. They need nutrients to grow and repair. As adults, we have mostly stopped growing. Yes, our brains are plastic, and hopefully, we are growing in all the right ways. But we have kind of stopped growing in terms of our neurodevelopment, our immune system development, or our gut development. Now it is all about repairing that dysregulation that can occur from living in our modern world for children. They need to grow and thrive and also repair all of the toxic assaults that are facing us in our ultramodern, ultra-processed world. In a sense, they need even more. 

When you think about kids and what they take in, you know, pound for pound compared to adults, kids eat more food, drink more water, and breathe in more oxygen. I would say they probably think more thoughts, and I think that is probably true. But all of these inputs, kids just need a lot more of, so you can see why it would be much easier for kids to become deficient in certain nutrients and, across the board, but especially for kids’ mental health and teenage mental health, there are certain nutrients that we want to focus on. These are the top nutrient deficiencies in children. Vitamin D—I mean, that is a common nutrient deficiency even in adults. But we know how important vitamin D, which is a hormone, is for brain development, mood, and cognition. The same thing with Omega threes is essential. Fatty acids are EPA and DHA, which you have to get from fatty fish. But most kids—many, many kids—do not eat a single serving of fish or seafood in a week.

Laura Frontiero, FNP-BC

I did not eat like that in my lifetime. We did not get food in my house growing up. It is so interesting. I mean, sometimes we have Cod maybe. That was a relatively cost-effective way to feed a big family. But we were not eating salmon every night. When it was finally introduced to me in my teens, I hated it. My mom would make it for my dad and her. She is like, You have been having a hamburger. If you do not like the salmon, it is like filet mignon price. We have it, and I was like, Give me the hamburger. Because I did not like it.

Elisa Song, MD

Yes. That is where we have to introduce these flavors. I mean, my daughter loves Salmon Roe, but that is like, she liked it long before I did because I did not grow up eating it. We just introduced her early. Another big one is iron. It is fascinating that even for teenage girls who are not anemic, their hemoglobin looks fine, but their ferritin is low or on the very low end of normal. Just bringing their ferritin up to maybe 40, 50, or above, significantly reduces anxiety and depression and improves mood and cognition. Iron is important. Then we have magnesium and zinc, which are essential minerals that are necessary for brain and mood and calming and neurotransmitter production, and zinc in particular. 

A lot of kids with mental health concerns also have sensory issues. The tags bother them, and the sounds of mom chewing bother them. I mean, everything’s just too much for them. Zinc is important for any sensory issues that often go hand in hand. For instance, with kids with ADHD or kids with autism, zinc is especially important for teenage boys because you need zinc for testosterone and appropriate puberty. When we think about all of these nutrients, we need to make sure kids are either getting supplements and measuring their levels or trying to find foods to fill that need.

Laura Frontiero, FNP-BC

I think that people listening now are just as surprised as me. Do you mean my kid, who cannot handle tags and seems like the sock has to be on just that? That could be distinctive.

Elisa Song, MD

My, Laura. 1,000%. I know when my son needs more zinc when he starts complaining that his shoes are not tight enough and he takes like 15, 20, or 30 minutes to tie shoes on. Even the kids who cover their ears because of the blender, the vacuum cleaner, public toilets, and the kids who are picky eaters because they only like certain textures. I am not going to say 100% is going to fix everything for your child. But if you make sure that their zinc levels are appropriate, so many of those sensory issues melt away.

Laura Frontiero, FNP-BC

I am just saying that I know adults like that.

Elisa Song, MD

Yes. I am sure they need zinc.

Laura Frontiero, FNP-BC

Just get grouchy. It just becomes like they are who they are now. No, not like quiet people like me.

Elisa Song, MD

I can tell I need more zinc when it is the same. I have a sweater that I wear when it gets chilly in the office. When that tag starts to bother me, I am like, Okay, I need zinc because it only bothers me sometimes. Or when I hear my husband chewing and smacking his lips, it drives me crazy. I am like, I need more zinc.

Laura Frontiero, FNP-BC

I happen to know that I tend to run low on zinc because I run functional medicine tests on myself, and I know that I am chronically low in zinc. Then I ran my DNA and found out I have these, like, zinc metabolism pathways that do not work. I know I am one of those people who gets super irritable about sounds, textures, and noise, and I always just thought, It was because I am analytical and intense. 

Elisa Song, MD

No. It is probably zinc. 

Laura Frontiero, FNP-BC

We get off this, and I am going to go take some zinc. I have lots of things. Zinc is something you have to take with food. When I take zinc on an empty stomach, it makes me sick. I think it is true. That could be if you ever give your kid zinc on an empty stomach; they will never want to take it again because they will feel like they want to throw up.

Elisa Song, MD

Yes. Take it with food. Take it away from your iron because zinc and iron will compete for absorption. You know, a trick that my mom taught me. I mean, I was watching this kid, and her zinc levels when I measured them went up so incredibly well after a few months, and all mom and I read, no supplements because they made her tummy feel too upset. She ground pumpkin seeds into fine powder and put them into everything—meatballs, soups, salads, oatmeal, I mean, whatever it is. Her zinc levels went up.

Laura Frontiero, FNP-BC

Wow. You can eat it. You can do it with food. It is possible. Okay, this is great. Now I want to shift into any more nutrients before I shift into toxins here.

Elisa Song, MD

Those are the main ones.

Laura Frontiero, FNP-BC

Yes. Okay. in the last 5 minutes that we have, and I know I am putting a time if you can do this in 5 minutes, but we can keep talking. But in this first part of our talk here in 5 minutes, if you can dig into the chronic toxins, the main cause is the toxins that cause chronic inflammation and disrupt our kid’s gut microbiomes. Because if brain function is so influenced by the gut, we need to think about what is affecting that. I think kids have some unique exposures over adults, too.

Elisa Song, MD

Yes, absolutely. There I categorize the toxins, the three main categories. The first is the food we are eating. I mean, the food we are eating in packages, for the most part, is poisoning us and our brains. We can dive into the fact that these ultra-processed foods, especially those with too much added sugar, and those artificial colors are poison to kids’ brains. If your kids have any attention behavioral concerns. Just take out the artificial colors, and I guarantee you will see a lift in what’s going on for them. Emulsifiers, mono, and diglycerides carrageenan are those things that keep our food together and prevent it from being a goopy mess. By the way, are you allowed to feed an infant to be ready to feed liquid formulas? They are known to directly trigger zonulin release, causing leaky gut and gut microbiome disruption.

Laura Frontiero, FNP-BC

Can you give some examples of kid foods that have that? Because I am thinking of adult foods like, for example, coffee creamers like nut coffee creamer and oat coffee creamer that are full of these. It is just garbage. What about kid food? Where would we find that? Pudding or something?

Elisa Song, MD

Ice cream? My kids wanted ice cream the other day. I said, sure. I said, You guys go there at 12 or 14. You guys go to the freezer aisle and pick me out. Pick out an ice cream that you guys decide on the flavor of. You know that I will be happy buying; we have, so they came back, like, mom, look, this one had mono-diglycerides, and you look, this is not carrageenan. I mean, you can see I have been talking with them for a while. But they chose the ice cream. They chose that it was organic. I think it was Strauss’s vanilla ice cream. It had sugar, cream, and vanilla. That’s it. But many ice creams have the mono-diglycerides and carrageenan to keep them together. 

That is one of the protein bars that kids think are so healthy or yummy and eat them just to look at them. They may have emulsifiers in them. What else? Yes, puddings, but even some of the solid foods. You just have to look at the labels. I mean, it is astonishing how many foods there are. The FDA allows a particular emulsifier in infant formula at levels that are well above what is known to be dangerous. It is just the regulation of our infant food because when we think about the gut-brain connection and the future metabolic health and brain health of our teenagers, young adults, and adults, it starts in childhood. We need to be aware of what’s going on there. For teenagers and older kids, medications are probably the most acute microbiome disruptors and disruptive to the gut-brain connection, especially antibiotics.

Antibiotics are, they immediately kill all the good stuff along with the bad stuff. If you are not replenishing and restoring your gut microbiome, there’s one saying that this showed that just one round of antibiotics could increase the risk of that child developing a mental health disorder when they are older kids or teenagers by up to 50%. Well, yes, 50%. The more rounds of antibiotics, the higher the risk. The risk was highest if that first antibiotic was given under six months of age because of the profound effects that the gut microbiome has on our baby’s developing brains, downstream synapses, and everything else that is going to, you know, lay the foundations for the future. But it is not just antibiotics. 

Step back and think about your teenage girls. Maybe they are on a little doxycycline for their acne. Microbiome disruptor. Maybe they are on birth control pills. For their skin and also maybe for birth control, or they are PMS. That is another microbiome disruptor. Maybe they are on an SSRI because they are anxious and depressed like all of their friends are. That is another microbiome disruptor. Then if they are on steroids, ibuprofen, or reflux medications, those all disrupt the microbiome. Now, I will say that these are more acute. We can see them. We can all know. That your kids are on them. Let us do something to help restore their gut microbiome. But one of the hidden, most common, inflammatory sources for kids and teenagers and adults is chronic stress psychological stress. Chronic psychological stress is what I would call the biggest, most important chronic microbiome disruptor.

Laura Frontiero, FNP-BC

Toxin.

Elisa Song, MD

Toxin. Yes. We need to treat psychological stress as much as any environmental toxin, such as glyphosate, mold, heavy metals, and infections. Some studies show the psychology of stress triggers a higher inflammatory response than physiologic toxins. What is fascinating is that psychological stress can trigger zonulin release, can cause a leaky gut within a matter of hours, and directly cause gut dysbiosis.

Laura Frontiero, FNP-BC

If a leaky gut is happening, then a leaky brain is happening. 

Elisa Song, MD

100%. 

Laura Frontiero, FNP-BC

One thing that breaks down the gut barrier also breaks down the brain barrier.

Elisa Song, MD

That is right. We have zonulin in our brain, in our gut, and in our kidneys. There are so many organ systems. Guess what else, like you said, is being broken down?

Laura Frontiero, FNP-BC

Everything. Let us give some. I want to wrap up here on this, but I want to know, before we let our audience go to the second half of our talk here, what are some of the psychological stressors? In particular, what was so big about COVID and the pandemic that unveiled what you said has already been there. We have already been in a crisis. But this revealed that there was a lot of psychological stress there.

Elisa Song, MD

Yes, well, some kids sailed through the pandemic. The kids with social anxieties. Maybe that was better for them. But for most kids, especially our youth and teenagers, social connection is so important. Zoom remote connection is not the same. Many kids and teenagers, it is fascinating how many of my kids and how many other pediatricians are telling me so many of their pediatric patients developed OCD during the pandemic. Just being stuck in your head, in your world, just triggered all sorts of mental health concerns and that lack of connection. I have kids who had to be sent to residential treatment because they just could not manage the psychological stress of not being in the world—with their community, with their people, with their friends. 

That is a top off. What did they turn to? They are texting and chatting with friends, but then on social media, We know that, for the most part, when you go off social media, you feel worse about yourself than when you got on. That and the pressure there. Then the boys, who are mostly in gaming, would communicate on Discord and game together. For the girls, it is mostly Instagram and texting. Great ways to stay connected. Yes. However, to understand what it does to brain chemistry and how it changes synapses and dopamine centers, we need to think long-term. Now we are out of the pandemic. We need to reel back in that screen time that took a pass during the pandemic because it is not helping your kid’s brains at all, for development into the future. Boys’ brains develop at least into their late 20s. 

We know that with the same explosion of those synapses, those brain connections that occur in infants in the first few years of life, when you turn around, you can see your baby’s wheels turning, and they learn a new skill. All of a sudden, that same explosion happened during our pre-teen years. But you do not get to keep all of those synapses. They explode. Think about a rosebush just going crazy. You have to prune it. If you are a gardener, you have to prune and just trim and get rid of some of those buds so that the ones that remain are filled, with all the nutrients and thrive and grow the most beautiful flowers. However, we need to make sure that all of those synapses are laid down appropriately. Think about, as your kids grow, whether they are toddlers or teenagers, what connections do you want to foster and grow because they are not going to get to keep all of them? Hopefully, they grow the ones and they keep the ones.

Laura Frontiero, FNP-BC

This is why I have so many comments and questions, but I need to end this here for now. Dr. Elisa ng, thank you so much for joining us today for this talk on pediatrics, mental health, inflammation, gut health, and all of it. 

For our audience. I hope you found our conversation insightful and helpful. If you are a summit purchaser, stay here, because we are about to dive deeper and deeper into this discussion with Dr. Song. I would like to shift the conversation to talking about the vagus nerve. I want to talk about tools for improving vagus nerve function in children and wherever else we can go during the time that we have together. If you are not a summit purchaser, click on the button on this page to get access to a continuation of this conversation and many others, and get the tools you need to reclaim your health. 

If you are watching this continuation of my talk with Dr. Elisa Song, thank you for being a valuable member of our community. We are going to dive back in. 

Dr. Song, real quick, before we shift into the vagus nerve, I just wanted to point something out about, we could probably talk about the psychological distress of the pandemic for an entire hour. But the other thing is, there is that social isolation piece. But the other thing that I am assuming had a huge impact on our kids was watching the adults be in complete fear. There was a fear that gripped the world—not just our country and our community, but everyone was afraid of dying or their loved ones dying. Our children watch how we respond, and when we are responding, we do not know what to do, are stressed out, short-tempered, and disagree with family members within our household about how we should handle this. Yelling at the TV or having that on. Families were divided over this. I am assuming that this made a huge impact on our youth.

Elisa Song, MD

A huge impact. When we think about that secondary trauma that occurs because there is a pandemic and kids, not through any fault of parents, but, many received a lot of secondary trauma, as you said, because of what they were watching on the news. We had the news on 24 seven for a time or the conversation they might have heard you have, with your spouse or the fear that they could feel in you. That second kid takes their cues on how they should respond to a stressful event from their parents. We know this from 911. Since 911, there has been that trauma. But then there were just those weeks of repeated trauma and repeated emotional upheaval that kids could sense and feel from their parents. Now we know that we need to, as parents, be able to model as best as we can how to manage under those stressful circumstances.

Now, the pandemic was not just a one-off event, though. It was years; we have, I mean, years, two plus three years of this. Unfortunately, I still have some families who continue to live in fear. I have this and it is the young kids; we have it is the kids who grew up. They kind of came to be toddlers during the pandemic. That was all they knew up until that point. Well, maybe they are too young, and they do not remember a time before when kids were and everyone was not masked when you were not afraid to touch things, hug people, or scrub your hands before you did anything. For those young kids, often, some of them are afraid to take off their masks. They are afraid to touch or hug. They are afraid I have one little kid say, Well, I do not want to kill Grandma. Those are some of the wording, the language that the media was using. That is what we need to undo. It is going to take some time. 

I remember my first flight once things were kind of lifted. I took a lot of flights during the pandemic because my mother was sick and dying of cancer. My first flight, though, when I did not wear a mask, I remember it was this; you just have these flashbacks. It is like this: this PTSD of going to the terminal. I was like, I can do this. I could do this. I mean, it was just wild to watch myself go through this process of the kind of exposure therapy we have, being okay with it. But now, so many kids and teenagers have not had to have that kind of exposure therapy. They are still stuck in this fear. A lot of adults are, too. I 100% agree with you that that is going to be a lot of the trauma that we need to deal with. Then, of course, there was the trauma of how many kids, lost grandparents and lost parents. There is trauma all around. It is now, folks like you doing the summit and all the trauma work that is going to help us move forward with that.

Laura Frontiero, FNP-BC

Yes, well, it is going to be very interesting. 15 or 20 years from now, when these toddlers grow up and they are adults and we see what happens, then this is going to be a very interesting human experiment, if you will, to see what happens. I know this is a total sidebar to our conversation, but I think it is very important because parents do shape how our children react. Something struck me when you were talking about getting our kids off of their devices. Now that the pandemic is over, well, guess who it starts with? It starts with us and our habits. Have we picked up a habit where we sit for hours in front of a phone, iPad, or computer just mindlessly surfing when we could be connected with our loved ones? Yes. Are we setting the pace?

Elisa Song, MD

100%. When we think about that, chronic psychological stress and trauma, just to bring it back to that inflammation piece, what is fascinating is that stress. We know that these stressful events and these adverse childhood events can change our epigenetics. They can alter the path that our genes might take and then predispose us to diabetes, metabolic syndrome, heart disease, and cancer later on in life. But guess what? Just like, genes are not set in stone anymore. As we learn the tools to reverse and heal from some of this trauma, we can undo a lot of that epigenetic imprint. The sooner you start, the better, though, which is why it is so important for parents and adults at any stage in their healing process to understand that it is never too late. It just gets harder the longer it goes. This is now the time to work on it; we have yes. It is never too late.

Laura Frontiero, FNP-BC

I am so glad you are bringing this up. We have one particular talk on this summit by Jason Prall, where we are talking about neuronal, so-called brain neurons, and patterns and rhythms that can be shifted. We can create new brain pathways if you are someone who feels like you have been stuck and that no matter what you do, you cannot get better. No matter what your children that you have done, all the things that your children do, they are still stuck. This may be a worthwhile talk to listen to because it reprograms those brain pathways as well. Your discussion about epigenetics reminded me of that. There are so many things we can shift. We get into these patterns; we can shift that. I am sure you use brain retraining and rewiring with your families as well. 

I promised we were going to talk about some vagus nerves here. We have been alluding to the fact that the gut and the brain are connected, especially in this mental health space. Tell us a little bit more about the vagus nerve and kids. I always think of the vagus nerve. The parasympathetic state is a healing state. If you cannot get there, then it is going to be hard to heal. But, it is one thing for an adult to decide, I am going to get into a parasympathetic sympathetic state by doing Wim Hof breathing and by doing meditation. But that is not as easy for a kid. You are not going to have a kid do Wim Hof, survival, breathing for meditation, for minutes. 

Elisa Song, MD

If you have a very motivated kid. But yes, it is a bigger lift for kids.

Laura Frontiero, FNP-BC

Harder. Let us talk about the gut-brain axis and why this is so critical to supporting this mental health crisis that we are in. Then what can you do as a parent to help your child get into this healing state?

Elisa Song, MD

Yes. The gut and the brain communicate via a two-way information superhighway called the vagus nerve, as many listeners know. But one thing that listeners may not be aware of is that 80–90% of this communication occurs from the gut to the brain. The vast majority of communication happens in the gut. Who is in charge here? We need to think about that. Our gut has its very own nervous system that looks like the brain’s nervous system. It is larger than our brain’s nervous system. It is called the enteric nervous system. Most of the glial cells in our gut look very similar to the astroglial cells in our brain. I just learned that it was fascinating that our gut enteric system can live without our brain. Our brain cannot live without our enteric nervous system. That is wild.

Laura Frontiero, FNP-BC

Well, that is the opposite of what? Everybody’s nuts; we have what they taught us in biology.

Elisa Song, MD

We are calling the gut our second brain, but like the first. We have the gut that makes the vast majority of many of our neurotransmitters, which we think of as brain chemicals, but they are gut chemicals that influence the brain. 80 to 90% of our serotonin, which is implicated in anxiety, depression, and sleep, is made by our gut microbiome. Same thing with dopamine; at least 50% of all our dopamine, which is our attention, focus, reward, motivation, and neurotransmitter, is made by our gut microbiome. More melatonin is made by our gut microbiome than our brain, and acetylcholine, which is implicated in dementia—cognitive decline. Most of that is made by the gut microbiome. We need to pay good respect to the power that our gut microbiome has to make us feel well or not. As I mentioned, psychological stress can also trigger leaky gut and gut dysbiosis, and if you do not have the bugs in your gut to make the neurotransmitters for your brain, there is no way your brain is going to feel good. 

When we want to improve this communication, we call it the vagal tone. Another proxy for that is heart rate variability, for which some people have an Oura ring that measures heart rate variability. Some teenagers love their Whoop, for athletic performance and also heart rate variability. More and more wearables are measuring heart rate variability because that is one of the best biomarkers of health in kids and adults. One thing that we know about heart rate variability is that when we are in a state of stress and when we are sick with an infection, our heart rate variability declines. When I listen to a child’s heart over here on the left side, when I have not taken a deep breath in and out, I am not just listening to their heart separately and to their lungs separately. What I am listening to is: how do they work together? As you take a deep, slow breath, your heart rate should speed up. Then, as you exhale slowly, your heart rate should slow down. That is the variability of your heart rate, depending on whether you are breathing in or breathing out. I mean, in simple terms. 

When we can engage that vagus nerve and improve heart rate variability, that can improve all of our markers of health; it improves inflammation; it improves our ability to detoxify. I mean, it just improves. It reduces the risk of so many chronic diseases, and the way we want to stimulate that and improve vagus nerve function is, first of all, to figure out how to get out of sympathetic. When we have our sympathetic nervous system, which is fight or flight, flee from the saber tooth tiger, We are almost in a perpetual state of sympathetic overdrive in fight or flight, like almost every day. At almost every moment of the day, there’s a deadline, there’s a school project, there is school drama, and there is a soccer player. Now, we want to step back and know that not all stress is bad. We have. That is another thing that we have not done well to help ourselves. Also, our kids should understand that stress can be good. Stress keeps you motivated. There is a certain amount of stress that we need to have optimal performance and optimal health when it gets unmanageable. By that, it becomes inflammatory. By avoiding all stress, that is not a good thing. As a parent, do not make your child’s life too easy and stress-free. That is not the way to health. Well, a lot of them.

Laura Frontiero, FNP-BC

We have done that.

Elisa Song, MD

Yes, that is. I did that, especially with one of my children.

Laura Frontiero, FNP-BC

We Gen-Xers are kind of screwed up. We were trying to raise ourselves. We were the large kids. We hung out at home alone a lot. We had lots of chores. We had lots of responsibilities. We overdid it on the yes.

Elisa Song, MD

Yes, now we want to not just enable our kids with everything they want in life, but enable our kids with the tools to manage stress that comes their way. But that is challenging to do. We also need exercises that can engage our parasympathetic healing state so that we can spend more time there. When stress comes, we know how to manage the stress and get sympathetic, but we also know how to bring the parasympathetic up and say, Hey, sympathetic, you have done your job; let us settle down again. You mentioned Wim Hof, breathing, meditation, mindfulness, all of those. Absolutely, yes. It can take a little while for kids to get into it. There are some cute Elmo for your younger kids. Has a YouTube video that teaches kids how to belly breathe. He sings a song with rapper Common and singer Colby Caillat. That is one way to kind of get into it. There are kids apps. The Calm app has some apps that can help your kids get into a flow state, meditate before sleep, or do some breathing exercises.

Another app that I like is the Oak app, like an oak tree. A 12-year-old is who showed me that the app has some breathing and meditation apps. Now, one of the things is because we know the gut-brain connection. What is fascinating is that when you engage your vagus nerve and improve heart rate variability, that improves your gut microbiome, independent of diet. While I would love for kids to eat 5 to 9 servings of fruits and vegetables a day and never eat out of a package and eat whole grains and no more than 25 grams of added sugar in a day. Well, if changing food is one of the more challenging things to think about, you can improve your child’s health and lower their inflammatory burden just by working on the vagus nerve and improving heart rate variability. I give concrete exercises for parents to do. 

There is one easy one called the loving-kindness meditation that improves heart rate variability. It is a gratitude exercise. It is so simple. It is just for sentences that you repeat to yourself. You extend that loving kindness out to your family, your friends, your neighbors, anyone in the world, anyone you want to. You just say, May you be happy, may you be healthy, may you feel safe, may you live at ease, just for sentences. We always start with ourselves. I always say, Look, first, extend that loving kindness to yourself. This is the most important thing because some of the meanest, harshest words we hear about ourselves are the ones we tell ourselves. You always say, May I feel happy? May I feel healthy? May I feel safe? May I live with ease? Then you do the same thing for everybody else. I mean, what a great thing to do at the dinner table or bedtime—we have that.  

The other thing I do is use and teach acupuncture in the office, but I also teach parents how to do acupressure. There is a point cost Shen Men, which is on your inner risk crease just on that down by your pinky side, and that is heart seven or Shen Men that we know can help stimulate the vagus nerve. Better yet, there are essential oils that have been found to improve vagal tone. Lavender, essential oils, and sandalwood have been found in studies. You have put a dab on your finger and just held it there. There are also your points that I will use. I will put little crystals or little seeds that you can put in to stimulate those points. Those are more passive ways to engage your child’s vagus nerve so that they can more easily get out of fight or flight and practice loving kindness or a five-sense meditation with you.

I do also use an Apollo neuro device. It is a wearable vibrating device on my wrist. I am wearing it now. But that is one that has been studied in kids and has been found to improve heart rate variability. It is used by adults for mood, sleep, and performance, as well as by kids. It is helpful for attention, focus, and calming. That is another way to improve your child’s heart rate variability passively. We need these things in a passive way that can get kids out of fight or flight so that they are more receptive to the tools that you are teaching them. They know how to access them when they are stressed.

Laura Frontiero, FNP-BC

There is much valuable information here. Dr. Song, we are concluding our talk, and I would love for you to have the final words here on what you would say to our parents who are feeling like they are their child, their teenager, or their younger one. That something is not with what is going on with their mental health, that they feel may be overwhelmed, that this is a lot like, How am I going to do this? How am I going to get my child the help they need? I know you have lots of resources. You cannot possibly see every child in America, but you have a way for parents to get resources and to be helped. Of course, you see kids in your practice. Do you see kids virtually, too?

Elisa Song, MD

I do. But they have to be seen in the office first.

Laura Frontiero, FNP-BC

Yes. Because you run a standard where it is.

Elisa Song, MD

Brick and mortar. Yes. 

Laura Frontiero, FNP-BC

There is hope, and you do put out a lot of content to help our families. Can you share some words of hope and also share with them how they can get connected with all the work that you put out in the world? I know you have all kinds of stuff in the pipeline. You are working on a line of probiotics for kids. I think you are writing another book now.

Elisa Song, MD

No, I am publishing my book, which will launch in May. Let me get down to this first, Laura.

Laura Frontiero, FNP-BC

Okay.

Elisa Song, MD

It can seem like things are spiraling. This is where it is hard for kids and teenagers to open up when they are feeling overwhelmed or stressed. I find one of the best places to have a conversation, interestingly enough, is actually in the car when you are driving, and maybe they are in the backseat. Then you just have a casual conversation, because when you are not saying, Look at me, and let us have a face-to-face conversation, which is overwhelming. Many times, kids will be more available and more open to opening up, and sometimes it is just making noticing comments. 

Hey, I noticed that you have been a little distracted lately, and then just leave it at that. We have, or it seems like you are not enjoying the things that you used to. I am here to talk with you at any time. You are making these noticing comments, but you are not grilling, and then you are laying them? No, I notice, and I care. If you want to speak about it, I am here to listen. Eventually, not always, but eventually some little nuggets will drop. It will be at times when you least expect it, like when you are, going grocery shopping together and they drop a bomb and you are like, what? What did you just say? We have it. Is it safer? It is open. You are not in this tiny, intimate space.

Laura Frontiero, FNP-BC

That is when they are going to drop. It is when you get one out of the way and it feels like it could easily be ignored, and maybe they will get away with not talking about it.

Elisa Song, MD

Yes, absolutely. There is. Even if your children are already on medications, they may need to stay on them. But many times, you incorporate some of these tools. It is so much easier to see them thriving, resilient, and happy in the way that you want them to be, and even potentially wean off of their medications. always moving forward. I do have resources on my website, which is healthykidshappykids.com. On Instagram, I post a lot of useful information for parents that is about healthy kids and happy kids, and my book is called Healthy Kids, Happy Kids: A Whole Healthy Kids, Happy Kids, and Integrative Pediatricians Guide to Whole Child Resilience. It is coming out on May 14. Be on the lookout for it.

Laura Frontiero, FNP-BC

I love it. I love that you, well, first of all, I love that you just said we needed to have this conversation. I think that would go a long way toward adults communicating with adults as well. I noticed. Yes, I love it. The fact that you have, titled this book about resilience as well. Interesting. Earlier today, our mutual friend Ari Whitten and I just did a full talk on resilience. That it is a passion and a project of his now and it is fascinating, and I am just so thrilled that you are teaching about resilience because it is so critical. Thank you so much for always saying yes to every project we do and for always being the voice for parents and pediatrics on all these summits that seem to be overwhelmingly geared toward adults we have.

Elisa Song, MD

Yes. 

Laura Frontiero, FNP-BC

Thank you for just tirelessly creating and putting work out there and taking such good care of your families and our families. I would say America’s families because you do help so many people; your reach and your ripple effect are wide and far. Thank you.

Elisa Song, MD

Thank you so much for having me. It is always an honor to speak with you.

Laura Frontiero, FNP-BC

Until next time, everyone. Take good care. Bye now.