Ep 138: Integrative approach to a healthy gut microbiome, with Elisa Song MD

In this episode, Dr. Elisa Song is a holistic pediatrician and discusses her new book, 'Healthy Kids, Happy Kids,' and the importance of understanding the gut-brain connection and the role of the gut microbiome in overall health. This conversation explores the gut-brain connection and the importance of supporting a healthy gut microbiome for optimal neurotransmitter levels and overall well-being. The conversation also discusses the role of probiotics in gut health and the need for personalized recommendations based on specific health concerns. We also discussed key takeaways for gut health, identifying gut dysbiosis, and the importance of foundations for gut health.

Takeaways

• The gut-brain connection is significant, with the gut microbiome playing a crucial role in neurotransmitter production and overall health. The gut microbiome plays a crucial role in producing neurotransmitters and can impact mental health.
• Supporting a healthy gut microbiome is essential for optimal neurotransmitter levels and overall well-being.
• Probiotics can be beneficial for specific health concerns, but personalized recommendations based on strains and clinical indications are important.
• Identifying gut dysbiosis may require comprehensive stool analysis, but focusing on foundations such as diet, sleep, and stress management is key.

To learn more from Dr Elisa Song, please visit her instagram @healthykids_happykids.  Her book, Healthy Kids, Happy Kids can be found on amazon or in most major book stores!

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

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The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody if you can believe it today's episode 137 of Ask Dr. Jessica and for today's episode I'm excited to welcome back Dr. Lisa song. And we're going to talk about her new book healthy kids happy kids. And integrative paediatricians guide to whole child resilience. Now if you listened to last week's episode, we talked about the gut brain connection. So today we're going to talk more about the importance of gut health. But from an integrative perspective. Now many people talk about terms like gut health, gut microbiome, probiotics, but I think many of us aren't clear on what it all means exactly, and how this can all translate to being healthier. We'll talk about it all today. And for even more details, be sure and check out Dr. Song's new book, healthy kids happy kids. So Dr. Song, I'm so excited to talk to you about your book, tell everybody about it, what inspired you to write a book, it's such an endeavour to write a book, it is such an endeavour, I will say it's not for the light hearted. So but there's also no better feeling than actually getting, you know what you want to down on paper and being able to share it with the world. So it's called Healthy Kids, happy kids and integrative paediatricians guide to whole child resilience. And one of the reasons I wrote it, one, one of the primary reasons is, you know, for me as a solo, paediatrician, you know, working in an integrative functional medicine way, it's been, it's been really challenging, because my practice, you know, has been, you know, quickly, very inundated and full. And, you know, I really haven't been able to take new patients in a very, very long time. And so, to have patients call and say, can, you know, can you please take me and I also know that I just was just one of me, I can't, you know, see patients day and night and still be able to come home and see my kids and make it to their soccer games and be the person that I want to be. So, so it's so because of that, I thought, you know, let me write it down. So that, you know, they can have all the tools that I really firmly believe, will help kids be able to, you know, live in our modern world with all the forces against their health, and, and, you know, thrive without to being deprived. Right. You know, in a realistic way, I'm I wrote this for I wrote this for moms, for grandparents, for kids, just to know, like, this is it's practical, you can do it, you know, everyone can do it. And I also wrote it for practitioners so that, you know, they have a guide to to say, hey, look, you know, in my visit right now, I don't have all the time to go through all the nutrition things that I would love to but, but here's a resource for you. So So yeah, I mean, a lot of different reasons as paediatricians. If we don't have the time, you know, it's hard, right? We don't have we, we can't address everything. And then we also have to have the knowledge and, and the belief, the experience, the confidence that comes through experience that you know, things work to say, look, let's try this, right, I, you know, I know can work and you know, let's just let's really go through this together, it's not necessarily going to be easy, but the reward is going to be feeling so much better at the other end. So I agree with you, I think your book is so helpful for families. And also for a practitioner like myself, I found it really interesting. I kept thinking throughout the book, how so much of this I wish I had learned in medical school. Yeah. Especially honestly, the conversation about the gut and how it relates to our immune system and the gut, how it relates to the brain. I really enjoyed learning from you, because I think this connection is so important and understanding this is going to help so many medical conditions. So great knowledge that you're that you're imparting to all of us. Yeah, I think once you know that connection, and you know, just like you, you know, for me, too, when I first started learning about the gut, brain connection, gut immune system connection, and seeing diving into the research and realising that a lot of this Reacher's research has been there, you know, for a very long time. And, you know, thinking, Oh, my gosh, I, I wish I had known this, but we only know what we know, right at the moment, and we're all trying our best. But once you know, something, you can't unknow it, right. And so, you know, with the gut immune system connection, there's one study that it was it's from 2016. So at this point, now, it's been almost a year because there's, I remember I presented this paper at a talk, it was spring of 2016. And it was a really large study. So military study, they have all these, you know, their databases, they can keep track of the data, and so nearly 800,000 children, and they follow them. And what they looked at were children who received either antibiotics or antacid medications in the first six months of life, and then they followed them for the next several years, and found that that use of antibiotics or antacid medications increased the risk significantly for every single allergic disease, including, you know, a topi eczema, asthma, allergies. and hay fever, anaphylactic food allergies, hives. By the time they were four years of age, some, some of them were, you know, double the risk. So that was once they were on like, oh, wow, okay, how many of our kids are on antibiotics are can so this one Danish study looked at Mother infant pairs and antibiotic exposure even in utero So moms who got you know, antibiotics for sinus infection or UTI counted as antibiotic exposure, and found the antibiotic exposure in the early years in infancy could significantly increase the risk of many, many mental health disorders. By the time those kids were older, older kids are teenagers. And the most significant risk factor was antibiotics received under six months of age. And the more the rounds of antibiotics, the higher the risk. Now, I always have to pause here because you know, then as a parent, listen, you're like, oh, my gosh, my kid, my kid got antibiotics when they were three months. And I'm thinking my when I was pregnant, I had to get antibiotics for being GBS positive. So which absolutely, I'm sure a lot of people are thinking that oh, my goodness. Yeah. About myself. And I would say exposure. Yeah, for sure. And I would say I mean, those those that's absolutely necessary. I would never tell them. I'm don't take antibiotics. If you're GBS positive, we're not going to trade you know, not taking the antibiotics for the risk of sepsis in your baby. Like there's no way right. But then if you know, and, and, you know, my kid by both my my babies, right, I mean, they're not babies anymore, but both of them, you know, Kenzi when she was two and a half, three weeks of age, she just she had this prolonged jaundice, right? And we're calling a breast milk jhanas post colic. So we did a urine culture she had a UTI, right? I mean, a turn. And so two and a half week old baby with with a bacterial infection, you bad, you know, you need to do antibiotics. And my emboli when he was five weeks of age. We I mean, big family wedding. And I had family staying and one of the one of the kiddos had strep throat. So when we we of course, had strep that went around the house and Bodie, you know, kids, right, kids don't really get strep throat. But what he had, he had this greenish discharge from his ear. And I went and I got it cultured. And sure enough, it grew out group A strep. So wait, so one kid at two and a half weeks and the other kid at five weeks? Yeah, yeah. Both of them. Right on it to deal with. Yes. But but here's the thing, right? So I mean, I was knock on wood. so fortunate to know, all right, let's restore their gut microbiome because of the knowledge of how disruptions to infant or child's gut microbiome can have on their future immune health, and their future brain health, even the future metabolic health. So I was able to, you know, give them probiotics and breast milk to is a great supporter in colonising with the beneficial bacteria. But not all of us had that opportunity. Right? I mean, you know, a lot of parents just didn't know. And really, it's through no fault of their own. It's an it's through no fault of the paediatricians or the OBGYN is because they're not taught this right. So now we have to go back and realise, you know, if your kids are having some some issues, what I always like to do is just go back in time, and sort of tell the story of their immune health or their brain health. And that starts with the prenatal environment and exposures. And so for moms who are listening and thinking, Oh, my gosh, I got antibiotics. Okay, so that's, that's part of it. Right? And, you know, if your kid has a problem, I mean, we as moms can't help but feel guilty about stuff. I mean, that's just, it's just the nature of being a mom. But then you just you kind of you, you pause, you acknowledge, okay, this happened, I can't go back and change it. It's part of their story. It's maybe part of what led them to having X, Y, and Z right now. But now I know. So now I'm gonna go look at their gut microbiome and see how to optimise that you can always heal a disrupted gut microbiome, it just might take a little longer if your kids are older, and it's more long standing. But at the same time, it's so much easier to to get kids back to a healthier state that is for adults. So I mean, it's never too late to start. So for people that are listening, that might still be questioning how is there a relationship and how is there a connection between the gut and the brain? Can you explain that a little bit more? I was so fascinated, I was so fascinated your book when you said that 90% of neurotransmitters are actually made in our gut. Yeah, that's a staggering number to me, I noticed that, you know, there are certain you know, facts or, you know, evidence that I'll cite to parents and to kids at that will get kind of the wide eyed like, really? Okay. And that is one of them. Right when I tell them look, the reason why we need to think about our gut microbiome, which by the way out numbers, you know us in terms of cells, right? We I mean, the hundreds of trillions of microorganisms in our microbiome in our gut microbiome. And then we have, you know, 10 times more microbial cells than human cells. So, you know, I have them think of, you know, Nemo and the anemone. They're kind of symbiotic. They need each other. It's crazy what you're saying, because there's 10 times as many bacterial cells in our body that they're our own human cells. Yes. Because we're so conditioned to think that bacteria is a bad thing, but it's actually a necessity. I love that you, I love that you say that, because, especially coming out of the pandemic, you know, we're thinking we we've been trained to think germs are bad, like, you know, bacteria, you know, X virus acts like, you know, parasites act. But you know, what's fascinating is, it's, it's, I mean, there's never any clear cut answer. And so we have all of these bacteria that are really good for us. We even have viruses that are really good for us in our gut microbiome, right, that we actually want in there. And even certain parasites that can be I mean, you know, some kids who grew up in farms and have more exposure to parasites, their immune system gets trained a different way, and they're less likely to have allergies and asthma, eczema. So I mean, it's not all bad. But in terms of, you know, thinking about the gut brain connection, our our gut microbiome has certain types of bacteria that are now called psycho biotics, so psycho for the brain, not in a negative way. But you know, psycho biotics, because they help support optimal neurotransmitter levels, like serotonin, which many of you know is the neurotransmitter that helps us stay relaxed and calm and manage stress and, you know, fall asleep? Well, that, you know, 90% of all of our body's serotonin is made by our gut microbiome, those microbes, right? At least 50% of dopamine, which is what's implicated in ADHD, right? focus attention, even implicated in addictions. So 50%, at least is made by our gut microbiome. Over four 400 times the amount of melatonin is made in our gut than in our brain. And so, so then we have to think, Alright, you know, we're anxious or we're having trouble focusing, or we're having trouble sleeping, are we going to look for brain things to do? Well, yes. And, you know, we also need to look at the gut microbiome, because if we're not supporting a healthy level, a healthy balance of the bacteria that will provide a healthy level of neurotransmitters for us, it doesn't matter how many medications we take, or even supplements we take, it's going to be an uphill battle. If we want to get to the root, and help our bodies have optimal levels of neurotransmitters, we have to look at our microbiome, a lot of people now referring to the gut as our second brain. So yeah, and what's fascinating is, your brain has these these neurons, these cells called Astro glia. And our gut has a nervous system of its entire own right, it's called the enteric nervous system. And those nerve cells look almost identical, very similar to our brain, nerve cells. And they communicate back and forth. What is so fascinating, our guts, nervous system can live without our brain. But our brain cannot live without our guts, our enteric nervous system, I mean, so who are we? Who are we calling the second brain? Right? Like, who's in charge here? I mean, we need to reframe I mean, I tell this to kids, right? If you're, if you're thinking about like, I just, I'm kind of, you know, I'm bummed out, or I'm really anxious, I just want to be happy. And they think that that, you know, bag of talkies are that you know, boba tea or whatever is going to make them happy, temporarily, right? In the short run, well, if they really want to be happy long with think about what's going to make their gut microbiome happy, right? Because that is what's going to make you have more lasting happiness than just that short term. You know, instant gratification, I feel better for five minutes, and then I'm back to back to being anxious. Again. There's a couple examples that I think of that really, sort of prove to people that the brain relates to the gut or that the brain is connected to the gut. I think most people can think of a time when they're nervous, and they all of a sudden have to make a trip to the bathroom. I think that's a very common example of how Yeah, the brain is very powerful. And another example I think of is how when people have and you talked about this in your book, but when people have IBS are often called like, you know, the nervous stomach. If they the treatment for it is an antidepressant. And so a lot of patients look at me concerned do I think they're depressed? I think they're making up their stomach pains, but it's very real and we treat the IBS with an antidepressant. because it's affecting the neurotransmitters in the gut, correct? Absolutely. I mean, it's, it's so it is really interesting, right? It's true. Because, you know, if you prescribe Prozac, you're like, Wow, I'm not depressed, I have stomach aches. But so intertwined. I mean, that feeling of butterflies in your stomach, and we can all kind of think about different examples, right? Or, you know, the, when kids are anxious about a report. I mean, what symptom is most common? Mom, my tummy hurts, right? I mean, they get a tummy ache when they get nervous and don't want to go to school. And it's not not necessarily just an avoidance behaviour. Right. What I also think is fascinating is, I mean, yes, most of the communication occurs from the gut to the brain, you know, many people have heard of the vagus nerve, I feel like that's getting a lot more attention, you know, in, in just, you know, everyday life now. But the vagus nerve is that information superhighway between the brain and the gut. And something like 89% of the communication is this way from the gut to the brain, and by 10%, from the brain to the gut, but we can't discount the power, also of our brain, and how you know, our mood and our mental health to also impact our microbiome. So you know, psychological stress when it's unmanageable, can actually cause disruptions to our gut microbiome within one hour, right? And they've looked at, you know, college students microbiomes, you can before exams, and afterwards and during exams, and their microbiome shift during the exam period. So there's, it's just, it's so we're so interconnected. And absolutely, Okay, so question for you. I know, there's a lot that we can do to protect our gut and to help our gut. But if you were to tell everybody, what are some key points of advice to help protect the gut to help keep our gut healthy? So okay, so in the book, I talk about, you know, the five things to create microbiome magic. And so the reason I broke it up into five things is because we do these five things every single day, so I just wanted them to think about, we're not changing, we're not adding on more homework, we're not saying you have to do you know, a tonne more what we're saying what I'm saying is, well do these five things you're already doing but now let's think about how we can do them so that we support our microbiome so that all of your trillions of little buddies will be happy. And so the two that I think will be most important to talk about is you know, of course food right? Food is medicine. But when we think about let's say these neurotransmitters we just spoke about serotonin Well, yes, our probiotics in our gut can make serotonin but they what do they need, I mean, they need ingredients to you know, make that serotonin. So those ingredients that are probiotics feed on that's fibre, I mean our probiotics eat fibre, the fibre and legumes, and whole grains and you know, fruits and vegetables, and they convert that fibre, which we can call a prebiotic into these post digestion, post fermentation products, like serotonin, right like dopamine. So they require the fibre and also phyto nutrients. So colour in our diet, all of those will, will be used by that probiotic to create all of these, you know, amazing health compounds for our body and our brain and our immune system. So so when we think about that, okay, if your kids aren't, you know, right now that the most varied eater just yet, we can still talk to them about you know, this is why it's not because mom's telling you, it's because you're, you know, all of your trillions of friends, they need you to help them. Of course, I would love if kids a more fermented foods, but that sometimes is a slower climb. But I think even probably even more important for many kids than what we're trying to get in like the fibre, the phytonutrients, and the fermented foods. If your kids are really selective right now, then thinking about how do we swap out what they're currently eating from packages, even the packaged food that you're buying? That look healthy? Because the front of the bottle box says it's healthy, right? How do we flip the box over and look at really see is this a microbiome nourishing packaged food? And if we learn how to do that, we can remove all the different food additives that can directly harm the gut microbiome. So I love teaching kids how to read food labels, you know, for their microbiome. It's so empowering because I had parents, you know, calling me Oh, my gosh, I can't believe you know, Johnny's like looking at the label and seeing how much added sugars there and oh my gosh, this thing that was that said artificial colour, he put it right back, even though before the class he would have wanted it because it had, you know, SpongeBob on it or whatever. And so so that's, that's really empowering for kids. I love that you're teaching the kids because it's true if you, if you give them the knowledge, it's so much better than us telling them what to do. They actually understand what they're doing. Yes, it's so much easier. I mean, just like for us as adults, if we understand why, and how important is, and this shows that someone shows you the how to do it, it's so much easier to say, Yeah, I'm going to try that I'm going to do that. You know, and especially for our kids, I mean, we want to give our kids way more credit, for being able to, you know, to understand, you know, what we're trying to explain. And that gets rid of a lot of the power struggles that we can have over food with our kids. And it's always I mean, I'm sure you've had this experience, too, right? When when you you recommend something like maybe getting a little more sleep? And the kids like, Okay, I'll try, right, and the moms like, I've been telling you, you know, for like for the past two months to do this. And, you know, now, you know, Dr. Jessica says it and you're like, okay, yeah, because it's better when it's not for mom off to think what, what you're recommending is very solid, very helpful. And it's something that we say all the time, you know, eating plentiful fruits and vegetables, a variety of colour, lots of nutrients, high fibre diet and watching additives, preservative. So I think this is something that everybody can stand behind. I mean, I think when when parents and kids, they understand that, because we've all heard eat more fruits and vegetables, right? But when you understand that in the context of like, the why, you know, really why, you know, if you're having anxiety, or like, let's say teenagers having acne, like, really, why is this important is because if you feed your microbiome, they're gonna, they're gonna help you be healthier, right, they're going to support whatever whatever you want to accomplish. It's more as an added motivating factor, and understand the why behind it. The other thing I was gonna say, just as what else parents can do, and kids can do to really move the needle in supporting healthy gut microbiome is working on that gut brain connection by doing more, if your kids are into, you know, mindfulness walks in nature, laughing like anything that we can do to engage our vagus nerve. But do it every day, something. And that's why I like to teach kids how to do belly breathing, or diaphragmatic breathing because, I mean, you can sit there and if you're kind of stressing out in your seat, because you're about to have an exam. If nobody has to know what you're doing, right, you just pause and you take that, that 10 Slow belly breaths, regulate your nervous system helps you be more calm and focused, and also supports your micro biomes. You know, if we breathe, and diaphragmatic breathing or belly breathing for you guys, it just means instead of you know, a lot of us kind of breathe with our shoulders, and we keep our belly sucked in because we're that's what we've been told to do, just from like an aesthetic standpoint, but keep your shoulders down. And you just have you can keep one hand on a chest if you want to as you're starting out and one hand on your belly. But you know if this is if this is my belly, you want to imagine a balloon in your belly. And as you're inhaling slowly, chests, hand on your chest, stay still and the hand on your belly. Slowly expands inflates the balloon, and then as you exhale, the balloon deflates, your chest is staying still. And I can't tell you how many parents I've tried. I've had them do this in the office and like, they're kind of go like this, or they're trying to push out their belly and like now just let the breath do it. So it takes practice, but that the belly breathing diaphragmatic breathing has been has been found in studies to really effectively engage your vagus nerve. And when we do that, and we engage our brain that does support a healthy gut microbiome. Amazing. It's amazing. You really do treat the whole child, you know, like you said, there's always so much to learn. And I'm always so fascinated to, you know, learn more and more. And so I mean, what I teach is what I know what I've found to be successful in clinical practice, but, you know, five years and maybe adding some other things, right? I hope right? You always hope to expand your toolkit to help kids. Now, the big question I get that I've been so excited to ask you about because I'm so curious, your thoughts on this, but probiotics. A lot of parents will ask you about probiotics. They want specific recommendations on what probiotic to take. And we all know there's so many different strains out there. What is the evidence exactly on when probiotics are helpful? And are there certain health situations when you recommend one over the other? Yeah, you know, it's interesting, I someone asked me a couple of days ago. What's one thing in your practice, you know, as a functional medicine doc, that's that's changed, changed most significantly over the years. And I would say it's my view on probiotics, because it used to be when I was starting out in functional medicine, of course, of course we need You probiotics every single day, take a supplement. But I really I've, I've changed that because we just like anything else we want to know, for what indication, right? And what's the evidence in kids? Because I mean, frankly, the evidence for kids is lags. And we can't necessarily just extrapolate adults probiotic data to kids, because kids microbiomes look different than adults, at least for the first three and a half years of age or so. But even then, you know, there's a lot of a lot of transition that's going on so. So now, no, I totally agree with you, because I'm someone who always looks for the evidence before I recommend a treatment for a kid because it sounds so benign to people just take a probiotic, but we know that taking anything can have a side effect at some point. Yeah, I mean, yeah, I don't want to be you know, I'm not one of these people that will tell you just because it's natural, it's going to have no side effects. I mean, we we, and we don't know a lot of the I mean, we're still in the infancy of microbiome research. And you know, it's it's exploding, for sure. But, you know, the long term effects and what's really fascinating now is, when we think about optimising gut microbiomes I mean, the real question is, should be optimising for whom? And we're finding more and more on that kind of precision genomic level what that means. But we're, we're still not there yet. But even for our microbiomes, it doesn't make sense that all of our microbiome should look the same. Right? Our our microbiomes are as unique to us as anything else. So just thinking that everyone can take the same probiotic. It doesn't make sense, right. And there's also some evidence, that, that if you take too many probiotics, or or maybe just too much of like, one strain, let's say, even if it's a, quote, good strain, it could start crowding out some of the other good strains. So we have to think about that, too. So when I think about, you know, specific indications Well, if you have a, you know, any sort of chronic health concern, chances are your microbiome needs support. So that's when I will look for probiotic supplementation. And the research now is beginning to identify specific strains of these probiotics that have specific benefits. And so far, I think, to date with maybe I think there have been about 8000 different strains that have been identified. I mean, there are so many more, if you think about hundreds of trillions of bacteria, there's gotta be more than 8000 strains in our, in our gut microbiome, but not all 1000 are commercially available. This is just what we've identified in the research and, you know, for instance, there is one lactobacillus root array, which, you know, a lot of us as paediatricians know, because it's in BioGaia. And it's been found to be helpful for colic and, and, you know, kind of reflects the, you know, fussy and fit symptoms really helpful. But it's a particular strain, and I'm going to don't want to get this wrong. So it may not be this, but it's like a lactobacillus. I'm gonna make this up DSM 17369. It's something like that. Right. So the lactobacillus, ruder i That's a probiotic, right, the genus and the species, the strain is this third part of it, which you don't always see in the bottle, right? However, if you were to pick up a bottle of lactobacillus, let's, I'm gonna make this one up to like, RC 19. Okay, and you think, oh, lactobacillus ruder i Oh, that's good for colic. I'm gonna give that to my baby. Well, guess what? That strain is actually used to optimise your vaginal microbiome. So it's gonna have nothing to do with your baby's babies, colicky symptoms. So the strain matters. If, for instance, we know certain strains might be more beneficial for kids with eczema. And I like to look for those. If you know kids have ADHD or anxiety, there are certain psycho biotic strains that you can buy now. So I'll look for those, I try to look for more strain specific and use it for that clinical indication. supporting them with all of the food as medicine, fibre probiotics to make sure that they stick and grow. And then you know, maybe use it for three to six months to rebalance the microbiome and then see, so it's not kind of a forever thing. I do use probiotics. When kids are taking antibiotics, I think that's very, very important. Because antibiotics can wipe out the bad bacteria that you want to kill in your sinuses or your lungs or whatever. But they can also wipe out the good the beneficial probiotics. And in fact, some antibiotics will kind of preferentially preserve some of the pathogenic bacteria, like C diff, right clostridia. So and and you know, at the expense of killing off all of your good bacteria. And so the way I do that with antibiotics is there are some strains that have been studied to perhaps restore the microbiome Allah more effectively, there are several strains that have been found to reduce the incidence of antibiotic induced diarrhoea. But in general, when it comes to restoring your gut microbiome after antibiotics, I just choose one that has, you know, many, many different strains. If you're under two or three, I use an infant specific one, which should have more bifidobacteria. When they're over about three, they can take the same probiotic as, as you know, older kids and adults in the household. And so you look for a lot of different strains. Because we don't want to just repopulate with just that one or two strains after antibiotics. And I take I do start the probiotics, most of the studies have found it's more effective recolonizing your gut microbiome, if you take it alongside your antibiotic, so when you start the antibiotic, you also start the probiotic, but at a different time of day so that the antibiotic isn't killing the probiotic. Right? That's interesting. But I always recommend if you're going to do a probiotic, take it when you're done with the antibiotic course. Because while you're taking the antibiotic, it would kill the bacteria. But that's interesting. So just a time it a little bit differently, a little differently, just start when you're doing the course. And you know, gut microbiome restoration after antibiotics, you know, some it probably takes at least one or two months. So I usually recommend at least for one month after the antibiotic course is done. Some species actually can take four or five years to come back. So But so then, I mean, with that, we just really want to make sure we're eating the foods that are going to encourage those good stuff to come back and then stick around. Wow, okay, and what about for constipation? Is there a probiotic that you recommend? You know, it's interesting, I'd say for constipation, I would, I would probably look more for a prebiotic, so prebiotic fibre blends that will help support and feed some of the beneficial bacteria. You know, for constipation, I find it really it's so interesting, because I've had some kids, when they start providing, they actually tend to get a little more constipated. You know, so it kind of, you know, depends, but I think prebiotic fibres can be really helpful to support constipation for constipation. I mean, they're just in magnesium, you know, most kids are insufficient or low in magnesium. So magnesium is going to help soften the stool pull water into the intestines help you poop, you can up your vitamin C, because that also can loosen the sub I usually start with magnesium as a supplement. And then you hear a slightly cleaner one because the mag citrate in the bottles, they have other ingredients besides magnesium citrate that really don't have to be there. And then Epsom salt baths, so Epsom salts, or magnesium sulphate salts. And so I mean, we've all heard that our skin is our largest organ, everything that goes on your skin potentially goes does get absorbed, you know, through your skin, and when your pores are really wide open and the nice warm bath, then you absorb all of that magnesium, and I've had kids who you know, they poop right off the bat, because the magnesium and then the relax, their anal sphincter can relax, and you know, they can feel the urge. I love recommending Epsom salts. So good. Yeah, when I go to hotels, I always because we don't have a great bathtub in our house. It's not you know, it's small. So I can't luxury, it's a I love when their hotels are like, Oh my gosh, they have a bath and I take a bath every single night. But you know, acupuncture is really helpful for constipation is one of the most helpful things. But if you you know, don't have an acupuncturist near you, or your channel of squeamish, what you can do is the there is a point here, it's called Large Intestine for it's between your, the web space between your thumb and your index finger. And if you just hold that massage that firmly, right, and you do that every day, you could do it multiple times a day, that helps to kind of stimulate the flow and is one of the best points for constipation. That's so helpful. So okay, so how would so are people that are listening that like, let's say they're like myself, or they've taken an antibiotic every once in a while they try to eat pretty healthy? How will we know if our gut is out of balance from our lifestyle up until now? What are the symptoms of gut dysbiosis? As you talked about in your book? Yeah, so and gut dysbiosis just means an abnormal balance of the microorganisms in your gut. So it could be not enough probiotics, it could be some abnormal bugs in there. And it could be you know, bacteria, viruses, parasites, or yeast that are off balance. And so, you know, we can't know, bottom line unless you look with a stool test, right? A comprehensive stool analysis because that that will grow out, you know, the different organisms and we can see, oh, this there's some, you know, there's this particular bacteria that you know, it's not terrible, but it really shouldn't be present in high numbers. Or, oh, there's actually a lot more yeast than than there should be. So but now Not everyone has access to a stool test. Is there a way that myself as a paediatrician that I can order one for patients? Well, you can I mean, so through practitioners, I mean, any practitioner, you know, health practitioner can open up accounts with different companies, right, that these different lab companies that either you can you can you need to be a practitioner so that you'll send in, you know, your licence and a copy of your licence, there's a form to fill out, and they'll approve you as a practitioner. And then a lot of these companies, lab companies, you don't even have to have test kits in your office, you can just, which we'll do sometimes. So you can order them and then they'll drop shipped to your patient. So there's like, I mean, it's super duper easy. And they also have online portals, too. So so yeah. So then, as far as the stool test goes, there's a few that I use. The two that I used for the longest time were Genova and doctors data, I think they're great tests. The but remember, we've been talking about how the gut microbiome of children is different than older kids microbiomes. And, and up until now, there's really been no way to test for a, like a toddler and an infant's gut microbiome that was specific for them. So for the little kids, I use tiny health, which I'm gonna full disclosure, I'm one of their their medical advisors, but they're the only one that really are specific for the infant microbiome. Because what's interesting, you know, I alluded to the fact that we want to give infants but you know, more an infant specific probiotic to infants, well, infants should have much, much, much more bifidobacteria. And, and they should have much less bacterial diversity. And yeah, so that's what I would use if you were younger. And then for older kids, it can, it can vary. And this is so interesting, because I feel like what you're describing sounds like all the things that we talk a lot about in paediatrics, making sure that we are mindful of our diet, that we drink enough water that we get our rest, that we're mindful, keep our stress low, that we prescribe antibiotics when they're needed, and just there's a role for them, but not over prescribing. And that I think it's really helpful to hear that probiotics, we're still learning that there may be a role for them, but there's still plenty to learn that will hopefully become clear to us in the future. Yeah, yeah, absolutely. You know, sometimes it's what I was telling someone is really a lot of these the concepts that, you know, I try to discuss are I mean, there are concepts that are have been around and they're simple, right? But simple isn't always easy. And the simple is often with needed to get back to the foundations. I mean, we, you know, many people have heard, that you can't out supplement a bad diet and lifestyle. You really can't know, you could try, but you really can't. But these are the foundations. And, you know, the foundations are what for a lot of a lot of people, they kind of put aside because like, you know, does that really matter how you know how important is is my sleep will really matters. Once you understand, then you then you set those foundations and when you set the foundations, I mean, well, they're all much better, right? So much easier. And the truth is those foundations, I think are the hardest things to change, right? Eating a healthy diet, prioritising sleep, exercising, I don't want to say it's easy, but it's much taking a supplement is the is the easy part to change in your in your life. Yeah, absolutely. I mean, it's, I mean, I mean, let's be real, it's so much easier to pop a pill than to, you know, prioritise, getting up, you know, a little early every morning to, you know, go for that walk or, you know, prioritise and carve out time, you know, for you to, you know, do 20 minutes of meditation. Yes, yes. I'm so amazed that you put this together that you wrote a book. And it's such a gift, because as you said, not everybody can have access to Dr. Lisa song. But now I feel like we can get as close as we can without actually having, you know, without actually maybe being able to refer patients to you. Now I can have this book that I can refer to and it was so generous of you to write this. Oh, thank you. I mean, this this, this is my I my life's work, and I guess I'm so glad I did. And I'm so glad I'm so grateful that you liked the book. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr. Jessica. Also, if you could take a moment and leave a five star review wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica See you next Monday.