Kids’ Digestion & Mental Health with Guest Dr. Kristin Struble

Transcript:

LEAH: Welcome to Dishing Up Nutrition brought to you by Nutritional Weight & Wellness. We are a small Minnesota company with a big goal of spreading the real food message and helping people make the connection between what they eat and how they feel. And this includes the little people in our lives as well;

Our teenagers, our kids, our grandkids, our nieces and nephews. Food is so important and has a huge impact no matter your age. Some of our longtime listeners may know this, but Dar Kvist, who is the founder of Nutritional Weight & Wellness, was originally in the education field and she had, and still has actually a particular passion for working with kids with special needs and their families.

So feeding kids and teaching kids about good food that nourishes and supports their growing brains and bodies can set the foundation for lifelong health and give them a lens through which to look at food that will serve them well into adulthood. And I will also say that feeding kids certainly has its challenges.

I know because I'm a mom myself with two young children at home, ages five and two. And our special guest today is also a mom and works with children in health care all day long. So some of the questions that may go through a parent's brain: Do you ever worry if your child is eating enough? Has that ever passed through your mind?

Do you worry that your child is eating too much? Maybe your child or your teenager won't touch a vegetable or maybe they won't touch their meat. Maybe every meal has to include that mac and cheese or a pizza or otherwise you risk a complete meltdown at the table. Or maybe you've had to resort to making two or three or four different looking plates at a meal just to accommodate everyone's preferences.

I could go on and on, and these are just a sample of things I've heard both from clients but also from friends and family members in my life. Then you layer in mental health challenges like autism, ADHD, anxiety, or sensory issues. You add that into the mix, or you add digestive issues into the mix like diarrhea or constipation, IBS, and it can just level up those feeding challenges even more.

I recently met with a client who is telling me that she picks up her grandchildren from school every day and three out of the four grandchildren have some degree of autism. And she said she has to bring snacks in the car for them to eat, otherwise they're completely bouncing off the walls and melting down in the car for that whole 20 minute ride home.

And unfortunately, the snacks that often make it into the car, they only add fuel to the fire in those vulnerable little brains. These are the higher sugar, more processed foods, things like chips, juices, cookies, granola bars. And I get it because these are the easy packaged convenience foods that are easy to bring in the car to just hand to a kid. And chances are they're actually going to eat it.

So when I work with parents and grandparents, I do often hear from these families that they do want to make changes because they do truly believe that food is important to their child's well being and their behavior. But oftentimes we just get stuck and overwhelmed with trying to break out of those current patterns that we're in.

So what I'd like to do today, along with my special guest, is to talk about some of the important connections between the foods that our kids are eating and how their brains react and how their digestive tracts react. And then definitely on the flip side, we want to offer our listeners some doable, actionable things for people to try, to experiment with, and just to work on to help support the important kiddos in your life, so they can be happy and healthy and comfortable in their own skin.

So without further ado, let me introduce myself and our amazing guest. My name is Leah Kleinschrodt, and I'm a Registered and Licensed Dietitian. I am your host for this episode. And joining me today, all the way from sunny Arizona, is Dr. Kristin Struble, who is a practicing pediatrician in the Phoenix area, and who believes in the power of real food. Dr. Struble graduated from the University of Arizona with a degree in nutritional sciences. So can you see why we like her already? And went on to complete her postgraduate medical doctorate degree at the University of Arizona College of Medicine.

She completed her residency at Phoenix Children's Hospital and Maricopa Integrated Health System. And she has been in practice now since 2001. Dr. Struble has been the recipient of numerous awards, including a most recent Top Doc award in 2024 from Phoenix Magazine. So congratulations.

And she's interviewed many times on local news stations and even national publications talking about her book and any medically relevant topics. She wrote a children's book called How to Be a Poop Detective which helps kids to understand how our bodies talk to us through our digestion and through our poop, and how perfect: kids love to talk about that kind of stuff. And when she's not out there being a rockstar pediatrician, I will often see her social media posts of hiking up desert mountains, she's showcasing a new recipe that she's made, or a recent grocery haul that she's had, or she's spending some quality time with her husband, who is also a doctor, and their son.

We had Dr. Struble as a guest on our show back in 2017. It is way past due that she is back and we're so happy to have her back on the show today. So welcome back, Dr. Struble.

DR. STRUBLE: Oh, I'm so excited to be here. Thank you for having me. It’s exciting.

LEAH: Yes. Awesome. Very good. Yes. We're super excited as well. I would love to hear just a little bit more about you and your background, and I am specifically, of course, as a dietitian, and this being a nutrition podcast, I'm really curious about the, you know, you had an interest in nutrition, especially in college. It was one of your first degrees.

And I'm curious just what that looked like, but then also how you morphed into a path that led into pediatric medicine. And the other piece I am really curious about that I've always wondered because whenever I see you in your scrubs and in the office, you have a little Elmo attached to your stethoscope. So I'm just really curious if there's a story behind that also.

DR. STRUBLE: So I, like you said, went to University of Arizona for undergrad and nutritional sciences was already my passion. I fell in love with it because I actually love biochemistry and that was actually my other degree. And if you think about it, we're all one biochemical pathway, right?

I fell in love with nutrition. I did an internship at UCSD studying visceral fat and its relation to insulin sensitivity. And I just really love everything about the body and biochemistry. And I really was inspired to go into pediatrics because what we really fundamentally need to focus on in this country and in the world is prevention, right?

And so many people come to you or healers, whatever, in their twenties, thirties and forties. They already have that pathway of inflammation, of kind of chronic disease there, and I feel if we can start in infancy even a little more and then toddlerhood and so on, our health timeline really progresses in a happy, healthy way versus trying to fix some of the problems that the huge percentage of the population deals with.

LEAH: Yeah.

DR. STRUBLE: So that's where my passion lied and that's what triggered me to write the children's book that I did because one of the things that I see a lot in practice is chronic abdominal pain, chronic constipation. And with that, all disease begins in the gut. So if your intestinal tract is slow, if it's fast, if it's not moving like it should, that means there's inflammation and that means pretty much every other organ system is involved. So we have to look at the child's timeline and go upstream and say, what triggered this and how can we fix it? It's absolutely something we can do.

LEAH: Yeah. I love a lot of what you said there. You talked about increasing people's health span, like we're not just dealing, we're not just trying to make up ground on the health front in our 20s, 30s, 40s and beyond. It's like, how could we get ahead of that ball?

Setting that foundation with our kids, with our infants even. It is a different mindset. It's a different way to think about things than what we traditionally do. And we will definitely talk more about the gut and how that is connected. Like you said, just connected to every other system in the body. That is definitely one thing we will be diving into in this episode. So I just, I love all of that.

DR. STRUBLE: The Elmo I didn't tell you about, but you'll also notice there's a little poop emoji hanging next to my Elmo too that kids love. They know what a poop emoji is at two, which is hilarious, but in pediatrics, we have to have our tools to really try to break the ice with kids. And one thing you might've noticed is I, when I'm washing my hands I blow bubbles with my hands.

LEAH: Yes. I've seen that also.

DR. STRUBLE: Yeah. Yeah. So it hits the reset button and then to make them more comfortable, and then when I'm examining them, I try to distract them with the Elmo, and the Elmo, even if the child has never seen Elmo, still has that, that ubiquitous attraction to calm him down and make him happy. So it's just a tool. Very, very important! I used to have Cookie Monster and Kermit and now I have Elmo.

LEAH: Okay. So this Elmo isn't necessarily super specific, but it's just like you rotate through. And again, it's just like you said, just gets kids engaged, gets them a little more comfortable and because, yeah, that's where the deep work happens. That's where you learn more is when either kids or their parents can really open up and just talk to you about what's going on.

DR. STRUBLE: Yep. Absolutely.

LEAH: Yeah. Very good. I love all of that. So you've now been in practice for over 20 years, so that's long enough now to see trends. Trends evolve in your patient population. Trends evolve in healthcare. So I'm curious when you started in medicine, compared to when you started to now, what do you notice about just the state of our kids health, our mental health especially, and the prevalence of things like autism, ADHD, anxiety, or even just like that chronic stress in kids?

Overviewing some inflammatory conditions & nutritional solutions

DR. STRUBLE: So it's a huge, great question and I'm going to try to stay focused because the trends, the patterns, in my opinion, are much more powerful in the practice of pediatric medicine than the evidence based medicine, because what I see on a daily basis and the experience I've accumulated over this timeframe, especially with nutrition as my background has changed and my whole focus evolved in a good, better way.

It's made me a better doctor. So what do I mean by that? So in infancy, real common issues: colic, reflux, GERD, basically I call it an angry bowel. So an irritable bowel in a baby. So oftentimes we have to modify the formula if the baby's drinking formula to a hypoallergenic casein broken down formula or a whey protein only formula.

Those are the two types of protein that can be inflammatory in cow's milk. If mom's breastfeeding, more often times than not, if the baby's colicky, refluxy, we have to take that out of her diet and then oftentimes add probiotics. If, so as time evolves, you still see some evidence of that angry gut syndrome, that dysbiosis, it'll manifest in, ear infections and eczema and texture sensitivities.

And then at one, one of the biggest recommendations out there by the typical education that we receive in residency and even in medical school is kids need to drink milk. I am an anti-milk doctor because I see the effects of that starting at one. You have chronic abdominal pain, chronic constipation. It's the leading cause of iron deficiency because it's inflammatory. And I'm not alone in this thinking. Many more pediatricians are drink water, eat real food, right?

LEAH: Yeah.

DR. STRUBLE: At a year of age, one of the easiest modifications I believe you can make in the American diet is to say, drink water. Because it is so hard. I'm a parent and you are too. It's so easy to shame parents and say, you're giving them all these snacks that aren't good. You're giving them gluten. You're giving them, you know, glyphosates, you're giving them like whatever. But if there's one thing that we can change that, and then number two juice. Anything that you know, is pro inflammatory, which refined sugar and protein from the cow's milk.

I'm not against dairy. It's the cow's milk protein that's large and inflammatory. The second thing I've really dove into with functional medicine in my training is the importance of information from gluten. So those are the two most common things that I see in moms who are breastfeeding, babies who have reflux.

Sometimes we have to take gluten out of mom's diet too, and it's marked, the changes, the sometimes the eczema will go away, ear infections, all the same things we see with the concept of all disease begins in the gut.

LEAH: Yeah.

DR. STRUBLE: So anyway, so if I have a child come in to see me and I've never seen them at five and I do a physical exam, right? Because that's a huge part of what we do, and they have big tonsils and they have texture sensitivities and they have a history of ear infections, that I have to go upstream and look at their timeline and 90 percent of the time they were refluxy, colicky, spitty, fussy. And then they oftentimes have behavioral issues, focusing issues, they’re bedwetting, the gut is off, so the brain is off, everything's off.

LEAH: Yeah.

DR. STRUBLE: And if sleep's affected, we know what that does to the microbiome. If socialization is affected, that affects the microbiome. If overstimulation with iPads, technology, that's hard on the microbiome. We are a chronically stressed nation.

LEAH: Yes. I love that term that you use, like angry bowel syndrome and how, again, anything where that gut is disrupted can have those carryover effects into a lot of different other areas in the body, especially things that we chalk up to maybe this is just childhood, like it's common to have lots of ear infections. It's common to have skin issues like eczema is very common.

And so some of these things we chalk up to this is just childhood. This is just something you manage. But like you said, we look upstream and how much of that is, is there the gut playing a role in that? And then you've mentioned too, like that also can carry over to some of those mental health disorders or just some of those brain imbalances that we see also with autism, ADHD, anxiety, sensory types of things like you see that carry over as well.

“All disease begins in the gut”

Yeah. So yes. And you said all disease begins in the gut. So you said that back on our last show and you reiterated it now. So that is very clear that you believe in this and this is how you practice. This is what goes through your mind as you're putting together a game plan for a child and their family. And this saying, it's an old saying, actually. Hippocrates said this a long time ago.

DR. STRUBLE: In 460 AD. And he's the father of modern medicine. But it's something that's, it's easy to ignore and just use a pill to treat symptoms.

LEAH: Yep. Exactly. So this is so we, there were, there have been practitioners through the years that like this has been there, it just isn't necessarily as mainstream as hopefully now it is coming out to be. If you had to take a guess, how many kids that you see in your practice, how often If you see ADHD, autism, like again, some of those like anxiety or some of these brain imbalances, how often are you coming across a digestive issue and are there any digestive issues that show up a little bit more often than others?

DR. STRUBLE: I would say probably a hundred percent of the time. We make the majority of our neurotransmitters, the chemicals that actually talk to the brain, in our gut. And so there's a direct connection between the vagal nerve and the, gut neurotransmitters and the microbiome and, we have to have a healthy gut in order to have the brain balanced.

So if you think of all those supplements like omega-3s, they're anti-inflammatory, right? But helpful to the gut. They're decreasing the inflammation in the brain. We have to add things like methyl folate and methyl B12 because our gut is not using those vitamins well because it's imbalanced which affects the neurotransmitter production in the brain. I would say the most texture sensitive kids, the ones that are hardest to get to, you know, eat more than 10 things, had some manifestation in infancy.

Whether it's spitting up or eczema or just fussy, angry bowel syndrome. And then fast forward, they're getting more and more of those. It's just a, it's just basically a little fire that's burning and it continues to burn out of control. And I would say that a huge percentage of those kids have chronic constipation, have chronic abdominal pain, have reflux.

It's evidenced by big tonsils, by snoring oftentimes, by mouth breathing, by a high arched palate. There's a history and a physical exam that is consistent with it and with that brain. So anyways.

LEAH: Yeah. That's amazing. And folks, you heard it here, Dr. Struble saying that for her, what she's seeing with her pediatric population that, okay, if somebody is coming in or if a parent is bringing their child in, or if it's a teenager, and we are seeing some of these brain imbalances, we're always doing that history and looking back to see what's going on in their gut or what happened in their gut, again, tracing it back into toddlerhood, infancy, and things like that.

I think that is so powerful. And again, just not the way that us parents are taught anything about that or that there's a lot of information out there. So I'm really glad that you said that. We do have to take a quick break, but when we come back, we will continue talking more about the gut and just some of these great connections. And then we definitely want to bring in the food piece of it also, like, how do we help our kids have a better gut microbiome and a better terrain?

So you are listening to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. I am Leah Kleinschrodt, alongside our special guest today, pediatrician Dr. Kristin Struble. And we are covering the connection between kids digestion and their mental health, and also talking about what good nutrition can do to support the whole child. And we'll be back in a moment.

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LEAH: We are back with your weekly Dishing Up Nutrition episode. Before we went to break, we were talking about all things gut health with our special guest, Dr. Kristin Struble; all things gut health with our kids and how that gut health then plays a role in so many other different systems in the body, but also connecting that to our kids’ mental health, so kids that deal with ADHD or autism or anxiety or chronic stress or sensory issues and what those specific connections are.

What typically causes imbalance in the microbiome?

Dr. Struble, I did want to ask you, we do, we, you've mentioned now a couple of times, yes, we look back at the gut when we're looking at some of these brain imbalances. What in your experience has shown you what throws the microbiome off in the first place? Like what kind of throws that gut off? Because again, we even see infants with issues with the gut or like they just have again, colic or they have trouble digesting things. What are some of the big culprits are you seeing?

DR. STRUBLE: First and foremost I think that a lot of the antibiotic exposure, not only taking it to help fight germs, but also in our, our livestock. And then, the chemicals like glyphosates that we are now very aware that impacts the gut microbiome and if we're pregnant, we consume a lot of those things. If we have a cesarean birth and mom is exposed to antibiotics with that and baby didn't go through the birth canal. So things like that disrupt the gut microbiome.

And then, just a lot of the food additives and trans fats and MSG and, high fructose corn syrup and processed meats and again, gluten and cow's milk and I think there's just, there's so many but the good news is, there's ways to fix, there's ways to prevent.

But those are probably the biggest contributors in my mind. Also plastics. That's another one. I think a lot more people are going back to drinking water from tap versus bottled water, just because there's high levels of plastics that are really hard for our body to get rid of and that definitely affects the gut.

YEAH: Yeah. Yeah. Even thinking, yeah, about just some of those exposures that we're getting from the outside world and plastics being one of those examples. Definitely. Yeah. Yeah. Super interesting things to think about, again, even going back to infancy or how the birth process went and things like that, like we go back that far or we could even go back into gestation, pregnancy, what did that look like for mom and baby and just start asking some of those questions, what was going on there.

For this episode, we took some Dishing Up Nutrition listener questions. We said we were bringing on a special guest on our Facebook page. And so we had a couple of questions. I, this was one that I did want to pose to you just to get a sense for where your brain goes with this.

This listener asked, “Are some kids just prone to getting constipated?” This listener says she has three children, relatively the same diet, but only one out of the three has chronic constipation issues. So what goes through your brain when you would see an example of this?

DR. STRUBLE: I'd look at birth order because I do think oftentimes the middle child is more prone to gut issues that, they, they feel a little, they're the middle, they're not the first, they're not the last. And I think birth order, what's going on in that kid's life in general, because diet is critical, but also stress decreases blood flow to the gut, increases cortisol. So that can imbalance the gut.

Were they tougher to potty train? They withhold a lot of times because it's a way to control things and that's stressful. The gut needs to move. It to do its thing. It needs to propulse normally so that the gut is balanced. I would do a physical exam and look to see if they, like I said, had big tonsils or eczema. I would ask about their timeline. Were they the refluxy, colicky baby? I mean, they're, they're genetically similar, but there's definitely social aspects and then obviously variations in disease burden.

Then I'd look at their growth chart, as you know, and just see if there's any, anything there that was off. But sleep, exercise, socialization, diet, those are the most pivotal things and just relieving stress and decreasing overstimulation. Those are really big concepts. I'd look at that kid relative to those five and then look at their timeline.

LEAH: Absolutely. Yeah. So like you said, diet definitely is, it's an important piece of that, but there could also be a lot of other factors that are just playing into that. And you go back in that timeline and say, yeah was that child just a little bit different or maybe they had a couple extra rounds of antibiotics that their siblings didn't have.

Foods that can contribute to increased digestive or mental health symptoms

Or again, like there could be some differences there as well. So yeah, absolutely. One of the questions I was going to pose to you, and I think maybe we'll just rehash this a little bit, because you have said several things already, but one question that I wanted to ask you specifically about food is, again, if you are sitting down with a child and their parents, what are some foods or just some things that you're thinking about that are possibly contributing to more digestive symptoms if they are, again, are more prone to constipation or IBS or things that might be causing more of those brain symptoms or those mental health symptoms?

So I know you mentioned one thing like cow's milk in general is just one thing that you say let's just steer away from the cow's milk. Let's just get to drinking water a little bit more. You did mention gluten at least once or twice and so let's just kind of rehash some of like the big things that you're looking for in a kid's diet.

DR. STRUBLE: Yeah. So I'll start again with no shame because us moms, we like to beat ourselves up and say, “I did this. This is why they're that way.” I can say 20 things about my son that, oh my gosh, whatever, we just do that to ourself. Dairy is oftentimes over pushed as like the holy grail of food and drink. So, I would say I, my son's never had a glass of milk in his life and he's 6'1 and he has really strong bones.

So we've been told that, that it's necessary for that. There's a really good book I would read called Don't Drink Your Milk, written by Frank Oski. He's a doc that wrote it years ago and it's very fortuitous. It talks about the autoimmune disease, the constipation, anemia, whatever. He was phenomenal and it's an easy read and so I do think that for parents that they could just eliminate that and then limit dairy.

There's other wonderful choices of yogurt, for instance, and you don't have to buy the full sugar. You can buy the unsweetened yummy coconut yogurt and add your own fruit and a little honey and make it just as delicious. You guys have so many great recipes in your cookbook. I, so we sell your cookbook in my office because I think it’s, how you make things gluten free?

How do you make things dairy free? Why? Because you guys identified what I have, which is we've got to control that, that inflammation in the gut so we can create that healthy gut garden. And it is tough, though, as moms it's tough because we need the fast meals. We're on the go.

Lunch is so hard to prepare. Because they can't oftentimes refrigerate it and if it's, we've got to have the easy quick foods, and then the school lunch program is pretty much, it's needs to be revamped, but it's tough basically doing what you guys recommend, which is prepping meals and knowing what you're going to eat and trying to have those snacks available that, are healthier.

LEAH: Yep. Absolutely. Yeah. And that gets to one of the other questions that I had jotted down for us too, cause again, this was from one of our listeners. This listener said, how do you transition from a more processed foods diet or a higher sugar diet to a more full foods diet, especially when dealing with this particular person has at least one child or children with autism?

Yeah. She says, I have children stuck in their ways and it makes for a crummy meal if they don't get exactly what they want. It's like the frozen pizzas and the mac and cheeses and the chicken nuggets and things like that. And this person goes on to say, “I would love them to drink plain water. It doesn't happen without a fight.”

So this is, I would say even autism or not, this can be a big switch for families and this parent is not alone. The parents in your practice are not alone in this. I love what you keep saying about no shame. It is, it's like, it is a continuous practice. We're continuously learning about this and we're always just trying to do the next step better.

How can we take the next right step in the direction that we want to go? I definitely want to talk about some little doable things, but anything, so you said one of the biggest things that you encourage for parents and I get, it's it's a simple change not always necessarily easy to do, but switch from whatever you're drinking, especially if it's the juices or the cow's milk over to just plain water, like that's one way where we're just making a substitution. Any other little tips or anything else that you that you encourage or have, that you have found works well for just trying to ease that transition a little bit?

Tips to get kids drinking water instead of unhealthy beverages

DR. STRUBLE: Sure. One other thing I'll mention is the sugar addiction starts pretty much in the toddler years. That's why if we can start at a year basically saying, this is what we drink in our house, you know, when they go to the birthday party at three or five, when they taste Gatorade or juice, they're not going to like it because it's too sweet, but if they are exposed to even cow's milk because it's sweet, then it's harder to break that cycle.

But I understand why parents do the PediSure and cow's milk because they are worried why that their kids are not eating. You can keep these two concepts in mind. Kids cannot starve themselves. They have to eat to grow. They're not going like us when we try to diet, which we know is, which is not the best approach, but we're like, I'm not going to eat. I'm going to be hungry. And we can do that because we're not in that exponential growth phase. They literally can't.

Same thing with water. We all drink different amounts of water. We all have different needs of water consumption. So, watering down juice, they're still getting the sugar. They're still getting that addiction. Put fresh fruit, like strawberries, in water, and then soak it overnight. Or, you can squeeze some lemon, or some oranges, like orange juice, in the water.

Get healthy foods into kids when we can

Not, just real, whole orange if you need that, but just know that they will drink, just have the water available. And then kids in this country eat a tan diet. It is right around 18 months. They decide that they're in control. They want to tell you what they're going to eat and we can try our best to fight them.

But oftentimes, it does make for a tough meal, sitting down at dinner isn't going to happen because it's frustrating. And then you think okay, I'm going to give in because I'm worried they're not getting enough. I went through it too.

LEAH: Yep.

DR. STRUBLE: But if we can just accept the fact that it's just a stage. It’s just a phase, and just keep trying to put one or two things in front of them at a time and try to get the colorful foods, the raspberries, blueberries, things that actually are from the earth: great. But if at the end of the day, they've eaten the tan diet, the chicken nuggets, the, the mac and cheese, those kinds of things, if you can balance it with other foods, the child will be okay. If they do have lots of chronic infections, then you really should try to modify it a little bit more;

Maybe with gluten free pasta and limiting dairy, finding other sources as what's like dairy like that they like the taste of. And I will tell you, Costco is smart. Costco has a lot of really healthy, good alternatives to gluten full products. And they also have like just great chicken nuggets that you can throw in the air fryer.

There's lots of, I, Costco's everywhere. And I do think that they, you know, if you walk around, I put it on my Instagram page all the time. There's people that do it too. You know, healthy alternatives, like you can do nut butters. They're great. But look for these ingredients. Look for, you can do these tortillas, but look for Siete tortillas because they have five ingredients.

And if you're going to do, you know, et cetera, et cetera, et cetera. There's lots of ways to, to at least make things a little better because it's not going to be perfect, right? It's too hard.

LEAH: Nobody eats perfect, and I love that. I think what you're saying, too, is there's, there, in today's food world there are lots of ways, luckily, that we can just level up and do a little bit better the next time we go to the grocery store each time we get something that has like, few, either fewer ingredients or ingredients that we recognize. Or, we can make some of those better choices. It doesn't necessarily have to be a completely do a 180 on everything you're doing. It tends to be more of a gradual shift.

And I find that too with families and children and teenagers that I work with. One of the things that I like to do also is like sometimes we might not even make headway at meals out of the gate. Sometimes the snacks are a little bit easier gateway to try to change because like you mentioned in our cookbook on our website, we've got some great protein muffin recipes.

So that those are tasty and they're yummy and they're a great substitute for more of those giant muffins. The little energy balls, we've got some energy ball types of recipes on there, a balanced smoothie that has some protein in it, that has some healthy fats in it, and it's still sweet because you can mix in the fruit.

Sometimes those are easier ways. Sometimes we can make some more inroads with the snacks sometimes versus the meals. But I feel like once kids get a little more stable in between meals also, like that opens the door a little bit more at meal. So I love everything that you say and that's just another piece that I think about with working with kids sometimes. That could be one way we can make some inroads.

DR. STRUBLE: That's why we refer to you because you guys spend so much time doing these things and it's it does take a partnership. It takes a team to really help parents and give them ideas and work with the kids. Cause we also have to overcome those texture sensitivities with the kids who have a tendency towards being on the spectrum, narrowly typical.

There are oftentimes more than not, they have texture sensitivities and they do only eat, five things. And then it's easy to just, because we're worried, give them the stuff that we don't want to, but we feel like we have to because we feel like they need calories. But it's just getting over that oral aversion and trying to help them do so with, repetitive attempts to get them to try those foods and then to modify them to see if there's ways that we can, make them more palatable.

LEAH: Yep, it's, and I love what you said too, is that we, this is a team effort and we need everybody on board and everybody kind of yearning for that same goal. So we need you and pediatricians like you and doctors like you just as much as we need you need us for some of the, on, on the boots groundwork type of stuff too. Yeah.

DR. STRUBLE: Yep.

Supplements to consider

LEAH: As we're getting to the end of our show, I did want to ask you, cause we did get several questions from listeners just about supplements for kids. So there were some specific ones, but I'm just going to pose a more general question to you. I just want to know how often, you know, do you recommend any kind of supplements for the kiddos that you work with or are there any particular ones that you find helpful for the digestive stuff or anything, any ones that you find helpful for supporting the brain, just how much do you work with supplements?

DR. STRUBLE: So definitely I'm a, I think in functional medicine and I think in the complementary medicine world. Supplements are definitely looked upon as what one said it should, a supplement. But I think if we overdo it, it can actually make us sick. So, so I think what I try to do is limit them to no more than really three.

So it depends on the age. So if I have an infant who was, born via C section, I have mom make sure she's on a probiotic if she's breastfeeding or even if not just to recreate that gut microbiome. And then also I will start the baby on a probiotic as well. And then if they're colicky, refluxy, I definitely start them on a probiotic early on.

I like Klaire Labs, BioGaia makes a really good individual, they're, they have just one type of bacteria and there's called L reuteri, whereas Klaire has more of a multitude of diverse seeds for the gut. So that's what I like to call probiotics. But fast forward, if a child or any human is on antibiotics, I always recommend Florastor or a type of non-pathogenic yeast called Saccharomyces boulardii.

So, But I've recommended Florastor for 20 years and I actually take it cause I have a little bit of gut sensitivity and it helps. If kids are older and they have digestive issues, I will definitely switch back from the multiple seeds to the fertilizer I like to call it, which again is Florastor, Florastor Kids.

I actually prefer the adult capsule, and you just open and mix it up into foods. Because we do know that, you know, prebiotics, probiotics definitely have been shown to do a multitude of good for the gut, right? And so that affects every organ. So probiotics definitely if they're having digestive issues, even if they're not, but I don't necessarily think it's a must every day or for every kid.

If they are having any GI issues or even neurodevelopmental issues, I will start them on a probiotic and then also an omega-3. A multivitamin I feel like for all kids can't hurt. But again, if parents haven't been giving their kids multivitamins, don't worry. They're okay.

LEAH: Yep.

DR. STRUBLE: I do think that Smarty Pants makes a good multivitamin. I like Wellements. They actually make a lot of really good infant and now kids products that are very clean. There's a lot of them out there, but there's a lot of them that aren't great either. I'm happy to make a list of the ones I like for you, but I've been keeping it simple. I don't think we need to overdo vitamin D because I would bet you, you agree it's a fat soluble vitamin and we have a hard time eliminating it.

And I think it’s good to a certain degree, but with fat soluble vitamins, I don't ever feel it's good to mega dose. So with kids, I do have a limit. And the most important ones to consider would be a multi, an omega-three and a probiotic. Magnesium is another one though, that I will recommend if kids have chronic constipation or sleep issues, ADD, all that. There is definitely more of a magnesium deficiency out there, which again, if we have a deficiency, if our gut's off, everything's affected. And then making sure kids get enough fiber.

LEAH: You know, it's funny before we jumped on, I was just, I was jotting down just a couple of my own thoughts in response to that question and you hit every single one of the ones that I had jotted down. There's a lot of different ways our gut microbiome can get disrupted. And so I think probiotics, especially if we are seeing gut issues and again, and mental health challenges or brain imbalances, that's a no brainer.

The gut and the brain are directly connected. And I always tell my clients anything we do to help the gut helps the brain, anything we do to help the brain helps the gut, so it's just like, it is one and the same.

The omega-3s and DHA specifically, that's one of those omega-3s, great for the brain; our brain is mostly DHA, that healthy fat. So we need that in there. I love vitamin D. I mean, you live in Arizona. We live in Minnesota. So there's probably definitely a difference in the level of sunshine that kiddos up here get, or I would say anybody up here gets versus you.

So, I mean, vitamin D I think is important, but you're right. We don't want to pour mega doses, especially into our little people. And magnesium. I mean, I've seen time and time again just how magnesium can just be such a helpful nutrient to calm some of that inflammation, calm some of those brain symptoms down.

Magnesium citrate especially can be helpful for constipation. There was one question that did come through about a magnesium supplement for constipation that's either a powder or chewable. So again, thinking our kids now can't necessarily swallow pills just yet. So one that I will recommend for clients, we carry it at our office, it's called Natural Calm.

DR. STRUBLE: I recommend that too.

LEAH: We're on the same page. I love it. And so that is, there, there are some gummies. I have used that in some kiddos. There is a gummy option, but there is a powder option also there, and it does have some different flavors to it, so that can be tasty. You're not just chucking down some powder in some water, so that's nice.

So no, all of those I, I 100% agree with you on and and then exactly like you said, there's, it's kind of the wild, wild west out there in terms of supplement land. So I do usually recommend my clients either go through a practitioner if they're able to, or at least, go to a Whole Foods or go to your food co-op. You'll, you stand a better chance of getting some higher quality supplements there for sure.

DR. STRUBLE: Well, and not counterfeit because, Amazon is probably the worst place to get supplements. I agree with you 100%. That's something that people don't realize and is that very point. So thank you.

LEAH: Yeah. Amazon is great for a lot of things, but perhaps not supplements.

DR. STRUBLE: No.

LEAH: Yeah. So as we round out our show today, Dr. Struble, I just wanted to peg you, any questions or any advice or words of wisdom for parents or grandparents who are just literally in the trenches right now of supporting and raising children with anxiety, with autism, ADHD, constipation, anything like that. Any last words?

DR. STRUBLE: Yeah. So again don't feel bad cause you are, the fact that you're worried and you know, you feel guilty, those are two signs to me that you are trying to do your best and that you love your kids. It's such a hard job, but it's the best job, but we all, we try our best. I would just, if you can try to make modifications, little ones, baby steps with their diet, really try to limit the overstimulation in their lives.

If they have technology, make them take technology breaks and go outside or run down the hall or whatever they need to do depending on the climate or their weather. And make sure that they're having conversations, looking at each other, socializing, make sure that they're getting some exercise. And then, very important: sleep hygiene. Make sure that they get the rest they need because all of those things are really important in maintaining health and happiness, a healthy gut, a happy brain but again, at the end of the day, we're all doing our best so take a breath and just know that.

LEAH: Yep. It's hard to not give yourself enough credit for the things that you are doing and that you are doing “right” like you said, the caring piece of it is important as well. I love those words. Yep. I hear that in my mama heart also. And it's something I have to remind myself of often as well. Yep.

Yes, and we did get a question or two about sleep and that connection with kids and stuff like that too, so we're probably just going to have you back on at some point to do a little bit deeper dive into sleep or some of those other things, but this has been an information packed episode here.

And I hope there were a lot of great takeaways for our listeners out there. So many great little nuggets. So again, if you're in the Phoenix area, if you're lucky to be down in Arizona, you can look up Dr. Struble and her practice. Otherwise, her book that she wrote for kids is How to Be a Poop Detective. And Dr. Struble, is there any other places where we can just find out more about you or follow you or just learn more about your work?

DR. STRUBLE: So the book is no longer for sale because I'm actually trying to redo it, make it more, now people understand a little bit more with the gut microbiome and it being more mainstream. I just really want to build on it so that it'll be even more relevant today. But if you want to follow me, I think my Instagram is just Get Health Detective MD. You can just put my name in though and it'll pop up. It's not a professional fancy Instagram page. I try to keep it real. But I do try to put little tips and tricks on there and just add some life into it.

LEAH: It's real life. You're showing a lot more real life than maybe what social media tends to, which we appreciate.

DR. STRUBLE: Yeah. Well, thank you. I just really enjoy you guys, and I thank you so much for having me on, and I'm so glad to know about you. It's been a real joy to just know you all and be able to refer to you. So I wish you were in Phoenix, though.

LEAH: Yeah. The beauty, the, one of the beauty things that came out of COVID is like the thing where we're more interconnected via web and phone and everything like that than ever before. So yes, we're very lucky to have you in our corner as well and to refer to, so I'm so happy that we're all on the same team, speaking the same language, speaking the same message, and we're just trying to do the work, trying to get people's health in a better place than where they are, or trying to set them up in the best place possible, and this includes our kids, which you're doing an amazing job.

So thank you again so much for being on our show. Our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple, yet powerful message. Eating real food is life changing. So thank you all for listening, and if you enjoyed this show, please head over to iTunes or your favorite podcast app and leave a review and help others find our show.