 Hello, everyone. Welcome to another episode of Dr. Jill Live. Super excited to have a long time colleague and friend and just someone I love and respect and here today. And I'll introduce her in just a moment. If you've missed any episodes, you can find them all on my YouTube channel, on Stitcher on iTunes, anywhere you listen to podcasts. Please stop in, rate, leave a review that'll help us reach more people. Any other resources that you like, you can find on jillcarnia.com. So today I have Judy Combers and super super excited to have her here today. Let me just introduce you and then I'll tell you little fun personal bits about how we know each other. Judy is a licensed registered dietitian nutritionist with a bachelor's degree in food science and human nutrition. She also holds a master's degree in public health nutrition. Judy has authored several books and lectured widely on nutritional assessment and strategy for chronic conditions in babies and children, including autism, ADHD, growth and feeding concerns, picky eating, sound familiar, parents out there, food allergy, reflux, constipation, and Crohn's disease, mood and conduct disorders, and much much more. She began her practice in 1999 to help children thrive in spite of chronic conditions. Her practice is a functionally nutritional focused practice and she's been with me in the office of bladder and functional medicine since 2014. I can't believe it's been that long, Judy. I know. I know. It's hard to believe. Welcome. Thank you. Thank you, Jill. This is really fun. I'm glad we're doing this. Me too. And you are such a weapon knowledge. I've been wanting to have you for a while and just a little personal tidbit that we'll go into stories we were joking right before we got on the call. We've done Christmas parties together and all kinds of stuff. We haven't skied yet, but that's on our agenda. Right. We go skiing together and we were joking before we got on this Christmas. We had a little games after our dinner and it was who's the most likely to. And I was asking, do you remember what we picked for you? And there was multiple different cards. I think you got most likely to ask for directions. Yeah, probably. Which is, it tells us, you know, your nature. We were talking about men and women and they're, you know, asking the nod and comparing spouses. And I think you gave me the one most likely to own crayons. Right. Right. So I love that. And I just, I love and appreciate you so much. I would love, we're going to dive into kids. So if your parents out there or your grandparents out there or you're listening and you have kids with either picky eating or some sort of mood or behavioral disorder, so much of this starts in the gut. So we're going to kind of go from the gut to what to do about it and the mood and I'm going to let Judy really educate us. But before we do, Judy, I would love you to tell whatever you're comfortable with about your story of how did you get into being a registered dietician, your function was trained and certified. How did this journey start? I was interested in nutrition a thousand years ago as a kid in high school and kind of the original story is I had an older sister who declared that she was going to become a vegetarian. Now I'm older, so I'm going to really date myself. This was in 1971 and she told my parents she was going to be a vegetarian and they were horrified. That was not a thing. Yeah. Okay. And I'm quite a bit younger than her. But I remember going, why would anybody do that? And that just sort of got me curious about nutrition and food. And I started reading like diet for a small planet and all this stuff back through the 70s. So this is way back. And I just carried that through, did my undergrad degree in human nutrition foods. I loved it. And I didn't really, at that time, there weren't a lot of different kinds of jobs for dieticians. So I kind of wavered off. I did a job for a while, actually worked in a research lab under a Nobel laureate in a neurophysiology lab, briefly as a lab tech. I was like, do I want to do research? What do I want to do? And I just decided, no, I want to be around people and working more clinically or in community. And so I did this public health masters. And that was kind of what the path was. And then when I became a mom, my baby had enormous challenges that he's a young adult now, but we weren't getting any help. And I was really baffled. I thought, okay, who are the people who are helping these moms and these babies? What's happening? And I could see very early, this had a lot to do with his gut and his immune system. And again, this is quite a while ago, it just wasn't really anywhere to turn. So I just dove in and gradually that blew up into my practice and parents started approaching me. I mean, I never planned to do this when I trained to be a dietician. Well, the best journeys come in that way of like our own experiences that drive because there's nothing like us going through any of our own issues or children or parents or illness in our lives that really, like I would say so much of what I learned, I could have never gotten a textbook, but I learned in my own journey, right? So you had such a parallel journey. And I just want to say publicly, you are brilliant in your field. You've written books about ADHD. And I always loved, I mean, when I first came to Boulder, it wasn't too many years after that we met. And I had such a great respect because nowadays there's popping up with nutrition courses online, weekend courses, nothing wrong with that to get people interested. But the kind of degree and education that you have, I mean, you know how to like say a baby's in a hospital back in the day, you would be able to help the parents even do other types of nutrition or those kids. So I loved your knowledge based on a really broad level, but then you really honed in and you're always so practical. One of the other things I always saw that I loved is so often we do elimination diets or restricting, restricting, restricting. And sometimes that needs to happen in a severe Crohn's or a kid with severe issues or allergies or eosinophilicosophagitis, that restriction may be essential for life and for repairing the gut. But what I always loved about when I'd send kids to you is you would try to get them eating more foods versus less. Always. I'm always like, you know, kids, kids are kids, they want to be kids. I am definitely not, you know, yeah, kids should, one of my mottos is your kids get to be healthy, first of all, I mean, really healthy. And then that's normal, you know, that's my norm. And then the other thing is kids should be able to run into like a blue cupcake and it's okay. You know, if they eat, they're going to eat junk. And it's not a way of life, but when they do, it shouldn't blow their heads off. Yeah, exactly. Yeah, when we foresee them, it is a life or death war. We need to restrict to kill the wrong with that either. So just to say, if you're listening out here, first of all, say who you are, tell us where you're from, put in your questions. And even if we don't get all your questions today, Judy and I can both go back. I want to be sure to give Judy the opportunity. So be sure and throw your questions and if you have kiddos with difficult situations. Let's start with the gut because we all know so much of this begins with the gut. Tell us a little about the framework of why, like in you experiences with your own child when he was very young, but why might someone who presents with constipation as a child or maybe even reflux as a baby or some of these things that are just treated with medication, very, very young, unfortunately, be actually a bigger issue and affect the brain and everything else. Just give us a break. Oh my gosh. It's in gut. This is such a big, big topic. My hope, and I think this can happen is that this just continues to open in research and practice because it's really everything. Everything leads to gut. So yeah, those tools being given so early, those reflux medicines and all these things, they redirect the evolution of that gut microbiome, right? Which Jill, you're so the expert on this. And we're all learning about that. And the way out when kids start running into trouble is to go fix that, basically, see if you can, how much of a rewind can you do to repopulate and reestablish a healthy gut biome, remove inflammation, remove toxins, help the gut do its job and let it move through it. Yeah. So that's a really big deal. I find a lot of kids, well, a lot of kids with ADHD actually have a candida burden. That's, I know, a big story for you in your practice is fungal dysbiosis, right? So you have yeast species in there. That is common. I find that more commonly in kids with ADHD. And I think there's some data on that. I know we've posted this little ADHD course that I've got for parents. And just a fair warning, it's a lot. It's a lot of information. It's a little bit of a fire hose. But I created it because parents are asking for the help. And there's a lot in there. But I think I've got a citation in there on fungal dysbiosis happening more often in kids with ADHD. And I think that's no surprise. And all that you know about how that can affect mood, focus, brain fog, and even create constipation. What I observe is kids with that issue, with a fungal dysbiosis, they tend to have really big burn or stool and then they get stuck on muralax. So there's like one drug after another. And that too can affect behavior. And maybe you're familiar with that too, Jill. There's a whole community out there talking about how does muralax affect behavior and mood. So when you use it long term in kids, so it can kind of snowball. And this is such a big topic, all of it. And parents are so interested. So it's great that we can get some good concrete. Oh my gosh, I love everything you're saying. So first of all, I just posted a link to Judy's course. I want to be sure and leave that. I'll make sure. And that's there for you. It's Judy put this together. So if you really want to go deep or your kid has ADHD, and we'll get to ADHD in a few moments more specifically, but this all connects. Second, our docs are doing the best they can, but they don't have answers. They're not trained to say, well, is there dismay? It's like in medical school, we do not learn how to do stool microbiome testing or organic acid testing. That was outside after postgraduate medication. And I do that every day now to look at the guy. And so do you, Judy. But we aren't trained that. So if you go to your regular MD pediatrician, they're going to have tools in their drugs. Nothing wrong with that, especially in an urgent situation. But like muralax, they wrote about ethylene glycol, which is anti-freeze. It's in muralax. So you're giving your child a dose of ethylene glycol. And again, no problem temporarily short term, but there's a lot of other things. And I also love that you talked about Candida and fungal dysphiosis. So just for those of you listening, Candida is a yeast super common in all of our bodies, but it can overgrow. It can get systemic and cause issues. And in my own journey healing from Crohn's, it was a massive issue. And because of that awareness, once again, unfortunately, docs aren't really taught to look for that either because there's not some easy diagnostic test. Like when I'm testing, we do organic acid stool and blood antibodies. And even all of those could come back negative and someone still have a fungal burden. What symptoms or things would you look for in a kid that you suspect with fungal dysphiosis? Yeah, great question. And, you know, so true. I really, I want to applaud what you're saying about the position docs are in, because plus you guys don't have a lot of drugs to treat a fungal dysphiosis. And you only want to use them when you really, really have to, right? Because you don't want to engender resistance to that stuff. But luckily, there's all these other possibilities you can tap. But for what does a kid look like with fungal dysphiosis? They're usually constipated. They may be mirror wax dependent. There's usually bloating gas. They love sweets, of course, because basically microbes that populate the gut, they eat first, they eat what we eat, they eat, and then they leave their toxins or their supportive nutrients and things behind. So that, those are really typical. You might see some of the more outward signs that I think if you're wondering, as a physician, am I supposed to prescribe for this? You're looking for bigger signs, right, Jill? I mean, you're looking for, like, thrush, something white coming out of an orifice somewhere. I have a client I've worked with for years when he was little, now he's a young man, and he had such terrible fungal dysphiosis when he was about three or four. And at the time, a lot of this was even, well, of course, newer. We couldn't get him on a dyflucan prescription. I was really hoping he could. And it persisted and persisted. And over the years, he actually had rush coming out his ears, and he lost his hearing. His hearing, his hearing impaired has hearing aids now as a result of that. So it can be really, it's kind of a blind spot, I think, for, you know, and it's really tough. But looking for those really big outward signs would be white material coming out of really itchy areas on skin or that ring where rash, the flattened nails, some of that may or may not already be in play. But for sure, when I'm seeing these bloated kids who are constipated, who love to have kind of a white, starchy diet, they're picky, they don't want to eat other food. And they tend to go bonkers when they eat sugar. And you've probably seen, Stu, Jill, there's published clinical anecdotes of case reports of, in adults, where there's a measurable, above the legal limit of alcohol in their blood, and it's from a fungal dysphiosis. Have you seen? Yeah, it's called the auto brewery. Auto brewery. Right. So I'm not aware that anyone's ever measured that in children, but I can imagine that it's possible because of some of the behavior and attention and focus issues that happen based on what kids are eating. I've seen it. Yeah, so briefly, it's such a weird thing, but it actually exists. I have several patients in my practice. I've treated for it. And what happens is the fermentation in your gut from by yeast causes production of alcohol, like literal alcohol that can change your blood alcohol limit. And it's crazy because you can literally have a above legal blood alcohol level. So you could feel like you're drunk. And it's interesting the prototype or what kids or adults look like with yeast often looks like either alcohol issues or hangover because of the alcohol issues. So they might have headaches or a foggy thinking or any of this is maybe more adults, the bloating for sure. I look back and again, I had Crohn's, I had breast cancer. I definitely probably had fungal dyspiosis from a pretty young age. I had the big old belly when I was five. Like I look back, I'm like, and I didn't think any of it, but I'm like, oh, she had dyspiosis, right? Like I can see in the pictures of me as a kid. It's so clear. And you're talking about that too. So what does, and I also want to mention, mom, if you have fungal issues, if you have frequent vaginal yeast infections, if you are saying, oh, that's my symptoms, when you give a vaginal birth, you are not killing the baby with whatever you have. So I often, as I'm talking about the kid or same with you, and you ask the mother and you hear the same symptoms. So it's not uncommon for that to actually be a common theme in the family, not because it's genetic, just because it's past to the birth canal. Right. And a lot of, as you know, at delivery, it's common to use antibiotics. If mom has a group B strep positive swab vaginally, or if you have a C-section delivery, or if you get mastitis, your recipe, there's a lot of moments where antibiotics enter the picture in that early phase of our microbiome needing to evolve. And it's disruptive. And sometimes what I have observed is these fungal dysbiosis features will persist for years after that in kids. Yeah, absolutely. So I love that intro, because that's so relevant. What about, so constipation is a common problem. And I just want to address that, because a lot of parents are like, what do I do if my relax is bad? Or it has, you know, what would you do for a kiddo who comes in with constipation? What are some alternatives? Yeah. Oh my goodness. I do use the stool analysis tools that like you were talking about. And we'll look at what degree of that is going on. And is there other dysbiosis in the same mix, like that needs more attention, which should we look at first? But there's, you know, of course, as a licensed dietitian nutritionist, I'm not prescribing medications. But I can use supplements I can use herbal antifungals. And I will use those a lot. And I'll match those to a child's stool study and what they can tolerate and what they're able to take by mouth. And I'm very gentle with that. When you look at protocols for things like cybo or some of these dysbiosis protocols, they're pretty hefty when you're using herbs. And I'll dial that way down for little kids. And I'll also work in what a certain probiotics I might choose to pair, but I will give them a part like one in the morning, one in the evening. That's a common approach. One thing that I got to mention in this, I don't want to get too far off track is kids have big constipation. I'm always eager to know if they're forming these opioid peptides from their diet, right? If you're familiar with that. So those would be, peptides come from protein we eat, right? We digest protein, it turns into peptides, and then it turns into smaller bits called amino acids. But if you have leaky gut, like a lot of kids do, and you have a really picky diet and all you're eating is milk, you know, dairy and meat food, those proteins can form little chunks, molecules that look a lot like opiates. And they can bind to nervous system receptors, it slows down the gut slows down motility, makes big heart stools. So I will be looking at that too. And there's, it's interesting, there's a whole bunch of literature on diet sourced opioid peptides. But you don't hear a lot about it in practice. And when I have a lot of kids who end up in feeding therapy, because they're so picky, the problem is these like opiate medications, these opioid peptides from foods can be really addicting. So there there's scenarios where kids will not I mean, I've had hunger strikes in my practice, I think the longest was nine weeks. And that was in a two year old 22 month kid. So the parents were just like, yeah, just start eating because they're they're not it's literally a withdrawal that they're going to go through. But for super severe cases, where in line means severe, I mean, kids who keep going to the ER for clean outs, I've had, you know, that's what I'm going to put on the table, like you might need a very strict elimination diet to just let's back up, clear this up, get this gut working normally again. And then we'll see if you can reintroduce those proteins. Oh, so good. And those are like the casein caseinomorphines include a gluten P protein is a culprit here too. So that's some things like, I don't want to call out brands because I don't want to make anybody unhappy. But if you have a P protein concentrate in like a milk substitute, a lot of people used to be using soy milk, that's a biggie also. So yeah, whey protein can do a little of this too. So usually I'm looking to use something like a collagen protein source, or I will sometimes go in elemental protein, which is just the free amino acids. And there's different products for that. And pretty quickly, that can resolve the constipation along with tackling that dysbiosis, that can take care of it pretty quick. But your kid is going to feel really crabby at first, because they're very used to that chemistry in the brain of having the yeah. I love this is so good. And you went right to the root, you didn't give like magnesium, which we can talk to briefly about what the symptomatic things, but I love that you went through. Let me just reframe and say just very one because it was so full of pearls. Number one, you go to the root if there's fungal dysbiosis or bacterial dysbiosis. And if you're listening and don't know what that is, it's just overgrowth of the wrong bugs in your colon. And you can treat it could be in the small bowel as well. And Judy saying she uses herbs and things to treat that root cause. Second thing is you're saying certain foods, especially whey and gluten and dairy and even pea protein can actually cause a molecule that looks like morphine or looks like opioids in the child's body. And that can slow down the bowels just like if you took a Vicodin or oxycodon after surgery, constipation, same thing in the kiddos is happening from foods. So just want to frame that for those of you listening, that can actually be a cause of this chronic severe. And what you mentioned is some of these kids, as we know, they have to go to the hospital to get disinfected or get treated. So love that you framed that love you went to root cause. So if it's severe, you might need to go to some of these kinds of things. Let's talk about just practical things instead of mirror lax. What might you use to help move the bowels? Do you ever use lots? Yeah, I love magnesium citrate. And of course, you have to dose that very thoughtfully for children because they're smaller and that it too much can be too sedating can affect heart rate in a way that you don't want. So would be unusual for me to go above 300 milligrams for a child. I love C8 oil, caprylic acid, just as an oil, which is one of the medium chain triglycerides. It has some antifungal properties, but it's also a good laxative. I love vitamin C and that can be dose to everyone's tolerance is a little different for that, right? So you can give a child say 200 milligrams at a time, maybe at first a couple times throughout the day and build it up to see what loosens stool for that child helps them pass stool. What else are my favorites? I often will use digestive fitters. So these are little tinctures that usually taste good that have a blend of herbs in them that help you make your own digestive juice, stimulate stomach acid and things like that. Because a lot of times that's where this starts, especially if kids have used a reflux medicine and their digestion is kind of a shut off. Like I had one child come into my practice age six. He'd been off reflux medicine when I met him for a while, but he had been given it from birth all the way up through age five, nonstop. He was so constipated and he was stunted also. He'd had broken bone and so that really affected his digestion and his biome and it just sort of ground everything to a halt. So kick starting that with some digestive, like some bitters and things that that's a trick I'll use a lot. It's very gentle. I love this because in a kiddo you wouldn't want to give butane because they don't know how to tell you. No, no, and please don't do that because you can't, you definitely can't open those capsules and stuff. We're talking about stomach acid which adults can take in appropriate setting, but kiddos know and so I love Judy that you're addressing that. And I love that you're talking. So just to be clear too, PBI is given at birth or given right after birth or given for reflux. They shut down the production of acid in the stomach which there's a protective mechanism. Acid protects you from overgrowth of bacteria, so you're actually making it more likely that there's overgrowth of bacteria yeast. It also helps you break down proteins and absorb minerals which is why this kiddo pride bone issues because of their minerals. So these are kind of, again in spear cases sometimes these meds are you can't avoid them and temporary use is fine, but there's other ways to go to root. So I like that you addressed someone else because we're talking what to do with kiddos who can't tolerate formulas or breast milk and I think you mentioned some of those. What are some good alternatives to? There's great alternatives. I'm impressed, you know, like when I was a new mom and I had the same scenario, my baby, they wanted me to take him off the breast and do other stuff. There are elemental formulas that can work because they again will shift what the microbiome is trying to do. You need to kind of use them. Usually I'll use them with certain probiotic tools, usually Bifidostrains or because those formulas don't encourage the helper microbes. They tend to encourage problematic microbes and we don't want that at that age, but the formula itself can really be a help. I also love there's some European formulas. So there's like organic goat milk formulas and I think I don't know if we want to get into naming brands here, but there's some good products out there that are goat milk formulas. There's partly hydrolyzed whey protein formulas, which are good. You can now get formulas that use lactose as the main carbohydrate, which is great. That's what's in breast milk is lactose. It's the milk sugar instead of stuff like corn syrup, which often one of the problems that I see is it's not the milk, it's not the protein source in the formula, it's the carb source that's disrupted because the corn is usually from genetically modified. So it has roundup glyphosate and the amount, even if it's small, their body sizes, it really is a big deal. Yeah, it's going to disrupt that microbiome and that's going to cause trouble. If we're talking about infancy, you know, feeding early on, the microbiome is so important to help you start digesting food and kind of teaching the immune system what's what, so to speak. So that's where I'll look for formulas that are less disruptive. There's some that use tapioca maltodextrin instead of corn syrup, which is often preferable to use the tapioca source. So there's a lot of possibilities out there. Perfect. And you introduced me several years ago to camel milk. And tell us why that because as you gave me the literature and stuff that was pretty profound, why is that a better source for some kiddos? Yeah. So camel milk is really interesting because the immunoglobulin, the immune protective proteins in it, which we all make in our own milk and every animal does mammals do, they're those immunoglobulins from camels are much smaller, they're tinier, and apparently are much better at penetrating viruses that might get in the gut or or offending microbes that might enter the gut. So they apparently are very helpful. There's interesting research on that. And the milk protein from the camel is is a lot less allergenic than cow's milk and even goat's milk and even sheep's milk. So a lot of people are interested in it. The caveat is you can't give a baby straight camel milk because it's it's very different in terms of its calories and it's it's a lot higher in sodium. So it needs some adjusting. And I actually have a camel milk formula recipe on my website somewhere which I could find. Oh, good. We'll share and put that wherever you're listening. After Judy, we can get that Lincoln at it. Yeah. So if you really want to try it, you can safely try it. You know, you can't can't give babies stuff that you got to make sure you're giving them equal or better value stuff if you're pulling out breast milk or whatever. And maybe more even for younger kids, you know, two or four or eight or whatever, tolerate other kinds of foods. My question always was like, how do you milk a camel? I know, apparently, there is one dromedary dairy in Colorado. There's one or two of them. And yeah, apparently, it's pretty hard to milk a camel. I know I said a laugh because it's so funny to imagine that. So we talked about formula type of kids. Oh, probiotics. Let's just talk and you can talk specifics or strains, but I don't care what would be a few of your favorites for like infants and then so maybe infants. Obviously, breast milk contains probiotics, but very young children and then maybe above the age of two. Right. So for really, for little babies, especially if they're struggling already with what is looking like a cybo, which we don't really talk about for babies. But I think it's a I think it's a thing. This is my opinion. If you're seeing them very gassy bloated uncomfortable, they have kind of too much spit up or they're crying more than two, three hours a day, which is a lot of work. That's like big calorie burning for a baby to cry that much. It's not good for them. All babies cry some, of course. I'm going to go simpler and I will pick a product that might have two, maybe three strains in it, maybe even one. And I'm picking out of the strains that so far as far as we're understanding are important for that early, early microbiome development. So it's going to be bifidonfantus or bifidobacterium might be lactobacillus remnosus or salivarius or retiree, if I'm saying those right. And I'm going to keep it really simple. They don't seem to tolerate the big multi-strain high doses of probiotics at that point very well. And again, this is also new in terms of actual practice. But as kids get older and their diets are a little bit more diversified, then I'm happy to reach for kind of a bigger lens. I love the probiotic histaminics. It's one of my favorites right now to keep histamines at a dull roar out of the picture. What else? That makes perfect sense. I totally agree with you. Some of the new kids on the block are the spores, but I wouldn't do that in infants because they're just on the dad. I haven't, wait, I have not really seen yet what is the thing to do with that with infants. So yeah, I'm glad you mentioned that. I'm kind of sitting on the edge of my seat waiting. I agree because I'm like, oh, we don't, I love it in adults. But yeah, I would wait till, you know. And another one to acrimacia, same. I started using that in kids, older kids, who have low diversity. But I haven't seen what the scoop is yet on that with younger kids or babies. Yeah, love. So for years, I've been taught about probiotics and getting, I always would say if someone has a, is able to get a strain of acrimancy for probiotic, they're going to be very, very wealthy because it's so, it's like be one of the most important diversity indicators we call a keystone strains. Well, now there are. Now there are. I was like, oh, acrimacia, because for years, I've been wanting to see that we would have something like that. And we do now. We don't have a ton of long term data. So let's shift. I know a lot of you are interested in ADHD. And this is an area of expertise. You have a course for those of you who didn't hear, there's a link at the beginning of here and everywhere you're watching it. If you want to take your look at Judy's course, we're going to link that here. But tell us about, give us the platform, how common, how much is it increasing in precedent? Oh my gosh. Right. So this is a really good topic because there is such a big gap really in terms of like what parents are interested in and what, what is sort of standard of care right now. So a lot of kids in the U.S. are have a diagnosis. It's somewhere between six and seven million children actually carry an ADHD diagnosis. And that's between the ages of three and 17. And about two thirds of them are medicated. So the official standards of care for kids under the age of five, it's behavior therapy. And then over the age of five, it's behavior therapy and medication. And, or once they're over five or six, so the FDA allows you to just write like if you wanted to Jill, you could just put a kid on medication without behavior therapy. So there's no guidance. There's no protocols. There's no standards around nutrition screening for these kids, which is really a thing because there's so, there's such a wealth of information that's evidence-based about how nutrition affects the brain. And it's, it's not new. It's not fringe. It's very, you know, very good evidence base out there. And I always love for parents to start with super simple things. Like we, we've talked about gut dysphiosis, which is a little bit more down the line. Like you said, it'd be hard to get a stool test through your routine pediatric care. So what else can you do? One of the first things I look at is a kid's growth pattern. And usually all seems well until a kid is like absolutely shrunk and falling down to the bottom of the chart. But one of the most basic things I find is that kids who are struggling with attention focus actually don't eat enough. And that can be especially true if they're on medication, because I can depress appetite. And then that kind of makes it worse. So how can you tell? Well, first of all, obvious, are they, are they growing? Do they need new shoes, new pants? Are they, you know, they should be growing? And another way to check if you're at the pediatrician is as far as their wait for age channel on their growth chart, they should pretty much stick in the same zone, give or take 10 points. If they start to lose more than 10, 15, 20 points, that's a possible growth impairment. And that's enough, even though it's not enough for your pediatrician to really say, eh, here's a problem. It is enough. There's plenty of data to show that's enough to affect the brain and how kids start to focus and concentrate. So a kid's brain uses about twice as much fuel every day than you and me. We're just sitting here shrinking and getting but not you, Jill, because you got all the levers pulled for functional medicine and whatnot. But as adults, we use a lot less fuel to just have a brain than a child. So a lot, they need a lot of food. They need a lot of food and a sure sign is if they come home and they have huge tantrums meltdowns, and then they finally eat something and they calm down. So that's a typical easy sign. Okay, I got to do some more work with snacks or food or helping them eat during the day at school. A lot of kids don't like to because they're busy. They're socializing. So that we always tackle that stuff. A second biggie is their height. Like what's their height pattern on their growth chart? Same thing. If they're starting to waffle away 10, 20 points, that pretty much describes they don't get enough protein. And you have to eat protein to make brain chemistry. You have to have protein for neurotransmitters. And then we'll look at that. So that's super easy. Low tech, easy thing to do. If you're moving next steps and you can get your pediatrician engaged, I love for kids to have iron screening, really like not just hemoglobin, which is where they poke the heel or finger and look at hemoglobin because hemoglobin is that carrier molecule, right? For oxygen, it's really important. But if you ever look at the lab report for that, and you know, Jill, the reference range is tiny. We have a tight tolerance for hemoglobin. We don't like, the body doesn't like it to swing around. But if you look at the reference range for iron or ferritin, it's much bigger. So there's this big area the body kind of plays with to keep iron balanced. If your pediatrician is willing to do an iron study, where they look at the hemoglobin, the iron and the transferrin, which is the carrier molecule that gets iron into the brain. That's so helpful for me as a nutritionist dietitian, we can tailor what food or do you need a supplement, what form. Iron is huge for attention and focus. You need it to make and break down neurotransmitters like dopamine, which is the target neurotransmitter for stimulant meds, right? So that's super simple. Again, I know a lot of pediatricians, it's tough for them to work these things into their, their models where they're very busy all day, and they're seeing 40 patients a day and they don't want to stop and write a requisition. You know, how do they code that? But there's ways to do it if, if you can get it done, very informative. And I always include zinc and copper in those, if I can. And I can also order labs under my license, but usually that means it's out of network and it's a little harder to get done. If your pediatrician is on board, that's fabulous. And zinc is also really important for the brain, for memory, for mood. And you can talk all about that, I'm sure, right? And then copper, the, the ratio of copper to zinc in the blood is predictive of aggressive and volatile behavior, especially in boys. So I even though you might get normal labs back, like you have zinc in its end range and you have copper in range, the ratio of the two to each other really matters. So I always like copper, zinc, like lozinc, high copper. Yeah, you have, yes, exactly. You need like at least a one to one or even better ratio of these two minerals to balance brain chemistry. And there's interesting literature published on volatility, aggression, violent behavior in adults and especially males relative just to that ratio. So if I've got a little boy who's, you know, this is typical all my child's school placement, they're kicking him out, they're threatening his placement because he's been hitting other kids. You know, these are one of, this is one of the things I want to look at. I love that. You know, it's interesting as we deal with dementia and the other side of the spectrum and older 60s, 70s, 80s, 60s is early and young, but you know, it goes all the way up early onset and coppers and ratios, we look at them too. It's so, the brain, it's so critical to have these rights and even in midlife, but it's more common on the spectrums. So great, great information about ADHD and kind of where to start and even looking at the growth charts really practical. And I want to encourage you, if you're a mom or a dad listening and you have a kiddo and you be persistent with the pediatrician or find someone who will listen because more and more now I feel like, yeah, maybe 20 years ago we could expect to not be heard and you have to find someone else, but more and more, I just feel like it's really important and Judy's right. A lot of them don't always, you know, they're busy and that I want to honor that, but I want to say if you're the mom, find someone who will listen because there are docs out there and they don't even have to be functional trained. I think more and more the younger docs are a little more open-minded and I think that it's your right to get these things on your child if you want to know the information. Yeah, absolutely. There's again, there's a great evidence base around it. It's, we're not making this up. It's me sitting here. Zinc has been clinically trialed as school-aged kids, with and without stimulant meds. The best outcomes were with zinc and they were giving these kids like 75 or 150 milligrams a day of zinc, so that's a lot. A lot, yeah. Right? A kid's multivitamin is usually two, maybe three milligrams of zinc and I wouldn't encourage parents to just go give their kids, you know, 75 milligrams a day. Yeah, someone should help you with that, but certainly using like 30 milligrams or 25 is reasonable. Now, interesting. I want to tell you a little tiny tidbit of me and you'll be like, oh yeah, that makes sense. When I was a kiddo, I had probably low stomach acid hypochlorhydria. I had undiagnosed celiac, so I was having pretty significant malabsorption. I also had an issue with B12, so many, many things underlying. As you mentioned, your sister, when I was 14, I decided I didn't like meat. I didn't want to eat meat. I'm on the farm with like staking potatoes and it was so bizarre when I went vegetarian at 14. Everybody thought I was crazy and they didn't even know what vegetarian was, so it's so similar. But looking back, you know what, my body intuitively, I was like, I probably had really low zinc. Zinc also helps taste for meat. Like if you have whore, can't stand the taste of meat, that can be an indication of zinc deficiency. And I looked back at myself and I look in low stomach acid, so I wasn't absorbing minerals and then I didn't like meat and it wasn't for any other reason other than I could stand the taste of it that I want vegetarian. But I look back and I bet my zinc was incredibly low. Yeah, I'm not at all unusual. Even in kids who aren't vegetarian in my practice, they just don't eat great diets and they're not necessarily eating a lot of foods that are rich in zinc and that's going to be meat for sure. Or if they've had to use reflux meds, there you go, that will impair absorption of zinc. When they're not eating things like shellfish or pumpkin seeds. Yeah, exactly. So what else do kiddos do? You've given us some really practical tips for parents kind of like looking for warning signs or things to do. What are like interventions? How would you treat a kiddo with 80 and let's say like five to eight, 10, let's say that age range of kiddos. What would you do for interventions? Yeah, I definitely, like I said, I'm going to make sure they're growing as expected and correct their total food intake, like give a family suggestions around, well, here's food you're going to need. And here's let's try this, this, this throughout the day. We troubleshoot on how they can get lunch in at school or to do after school for snacks. I'm always interested in those minerals, like I said, and I also will just give easy things to do at home like magnesium is so important for nerve transmission, right? And a lot of these kids need calming and that's a real easy thing to do. So you can use an Epsom salt bath, you can buy magnesium lotion. So we implement stuff like that. We just work on replenishing all these nutrients that your brain needs to run. And one of them again is fuel, simply fuel. I'm also really interested in fish oils. So that's a popular thing. And I invariably almost always find that kids, they need a lot. And that's what the data show to that kids need. If you're talking about attention diagnoses or things like dyslexia or impulsivity, you need to be pretty high. If you're using some of these products that are made for kids like gummies and things, and they have like 50 milligrams of this way too low, way too low. So I'm like, okay, they can eat the whole bottle every day, or you can buy a high potency liquid. And you have products in your store online, you have good products for that. I use products too for my clients. I'll write up a protocol for them. But there's all kinds of liquids for kids anywhere from 800 to 1200, sometimes 2200 milligrams a day, mixed DHA and EPA. And those you need to use consistently, parents will come back and say, oh, we sort of did it twice a week a little. Use it every day. You're going to literally be rebuilding the nerve cell membranes, the cell membranes in the brain. So it needs time, and it needs consistency to work, and it can work. I have had families give me feedback in as quickly as a week or two about that, especially things like dysgraphia where kids can't, you know, their handwriting falls off halfway across the page, and they go down to the bottom of the page and go back to the left margin. And I've seen that change very quickly with fish oils, especially if you include a vitamin E with that. And there's, there's all sorts of forms of vitamin E. They're called tocopherols. So I'll use a fish oil with mixed tocopherols. And that can pretty quickly help the eye brain coordination. So lots of stuff that can can be easily tried. The thing to remember back to biome, if you're trying supplements, but your kids buying was really disrupted. It's not going to work as well. So, yeah. Well, super helpful, super practical. Any other, what would you do, one last question here, because I think it's so relevant, these picky eaters, right, the ones that just like refuse, how do you help parents to navigate the fear of the kid not eating or flying off the growth jar and yet getting good foods and any kind of practical advice is a big topic. But yeah, navigate the picky eaters when it's so tough. It's so tough, Jill, honestly. And especially if we have that opioid peptide chemistry in the mix, which is usually the case with the super, super picky eaters, I will say in my 20 plus years, I have had one patient, one child who ended up as an inpatient for tube feeding. Because they, this was a five year old who had only had milk formula. It was, again, I'm a hesitant to name products because I want anyone to get in trouble. But they had a common formula given to kids, which is milk and soy protein based, and that was the only food that child ate for five years. And that made that child very sick. Their liver enzymes were all messed up. They weren't growing. So we began to work on stepping back. That was hard. Those parents were fabulous. They were so just grounded, and that that's the hard part. So what advice do I give parents? I encourage parents to become, it's really hard, but as dispassionate as you can, and detach from the tug of war with your kid, you're never going to win. You're never going to win. And I coach parents on what to tell their kids. And depending on the kid's age and their kind of cognitive ability or status, you don't, don't explain that they don't need it. Don't give them information they don't need. I really encourage parents to be comfortable and confident in laying down the rules. And it's not a conversation. It's not an argument. It's not a debate. I don't like that. A lot of parents, I mean, we all are guilty of it as parents where, you know, you've got a three-year-old and you're going back and forth about why you're begging and pleading, right? You're like, that doesn't work. It's never going to work. You might as well argue with your cat. It's never going to work. So yeah, I really, and I use humor a lot too. I just, it's because you got to sit back and go, oh my, okay, you just got to give yourself a break. And I, that's really the gist of it is helping parents feel confident, safe, and comfortable making these very firm boundaries. Because it is really hard when your kid has that chemistry and they're very, very picky. They are going to fight and be difficult and campaign. And your doc might say, give them formula and mirror lax and call me in a couple months. And they're not going to be, maybe, maybe, but I love this because what you're doing is you're empowering those parents out there that are struggling because I think as a parent, we're not given the manual, right? Like if there's this detailed information is not readily available to every person who's having a newborn. So I think a lot of parents, I'm sure you know this so well, feel like afraid. What if I do something wrong? What if I say the wrong thing? What if I set a boundary or give them a diet that could hurt them? So you're instilling the confidence they need to do the things that their kid can be the most vibrant version of themselves. Right, right. That's so true because, yeah, all the kids are in there and I've worked with all kinds of kids with all kinds of developmental disabilities and cognitive issues. And they're all so in there. And I hate to see them given the short end of the stick, whether it's in the school setting or wherever, people assume there's nothing going on in there. Oh, I love that. And you have, you've seen some of the most amazingly difficult cases. And again, that's why I love what you do. If people want to find out more, again, we're going to link to the ADHD course. But where else can they find you if they want your book? Tell us a little bit about where to find you. Yeah, my website is nutritioncare.net. And there's a pretty deep blog up there. There's over 100 blog entries. There's recipes up there. And all the recipes are geared toward kids who can't eat anything. So multiple food allergies. Yeah, nutritioncare.net is a good place to start. Also on Facebook, of course, and Instagram and all the things. Yeah. And on my site, there's a little section for books and things. There's a few ebooks I've put up. There's a couple print books. So there's lots of resources there. I'm always trying to make more. You're very good at that. You're great at educating, which is why I'm so excited to have you here. Judy, thank you so much for your knowledge, your wisdom, all of your heart and soul you put into this over the years. If you want to know more information about Judy, go to nutritioncare.net, right? That's it. Right. And thank you, Jill. This was fun. It was amazing. Thank you all for another episode and we will be back again next week.