Lisa: Yeah. So every single fussy eater that comes to see me, we do two tests straight away, straight off the bat. And that’s a gut test and a hair tissue mineral analysis. Because a lot of the children that come to see me will have been to see feeding therapists in the past who may be speech therapists or occupational therapists, but they wouldn’t have, like, dug into things like nutrient deficiencies, toxicities, or gut health in general. So that’s often a real missing piece of the puzzle that hasn’t been investigated. And it’s so important because if your child has a sore tummy, they’re not going to want to eat a wide range of fruits and vegetables. Or if they’re constipated, they’re not gonna have an appetite, or if they don’t have any zinc in their body, they’re not going to want to eat and they’re not gonna be able to digest their food. So, it’s a non-negotiable, those are the two tests I do with every fussy eater.

Andrew: Okay. So straight off the bat, I mean, there’s a multitude of questions we can go down or avenues we can go down, but I really take your point, like kids particularly can’t isolate where pain is. So constipation, cramping, all of those sort of painful syndromes or symptoms, they can’t say it’s in my lower left or it’s in my general tummy rather than up here in my lungs. So how do you get a sense of what’s happening? How do you dig deeper?

Lisa: Yeah. And it’s not even that they can’t articulate where the pain is, but they actually don’t know that the pain that they’re experiencing is not normal. Because if you’ve had a pain your whole life, you don’t actually know that when you eat, you don’t get a pain in your tummy. Kids start to think that that’s normal. And then with the older kids, you know, the 9, 10-year olds, whenever we, you know, do their gut test and fix their constipation, they’ll be like, oh, they’ll tell their parents, “Oh, I can poo now, it doesn’t hurt.” And the parents are like, “It hurted when you pooed?” Like they’d never mentioned it because it didn’t seem relevant. Because that was just their normal. So yeah. Kids don’t know what’s often what it feels like to be able to eat and that not to cause pain and discomfort. So to cut through all of that, you just get the data from the stool tests and then you just treat that.

Andrew: That is so sad that anyone, but in this case, kids have a life so far of always having a painful motion or a painful tummy. I mean, to me it’s smacks of what women go through with endometriosis and it’s sad. It’s really sad. So that must be such a relief, a breakthrough when you hear that news, “Oh my goodness, I can actually poo.”

Lisa: I know. Yeah. And it’s a conditioned response then, you know. If you know that you’re going to get reflux every time you ate something, you’ll avoid eating. So it just becomes that conditioning that kids obviously don’t realize yet. It’s amazing.

Andrew: Can I ask, because these kids are constipated from a very early age and or with pain, abdominal pain, do you find that they spend an inordinate amount of time on the toilet, either trying to poo or just in that, as you say, that sort of conditioned response of defecation?

Lisa: Sometimes. But more often they’ll just avoid it like, just in entirety try and avoid going to the toilet because it’s going to hurt, which obviously just compounds the problem because then the stool just sits there, gets hard, difficult to pass. They end up with fissure. So, you get a lot of toileting avoidance and then there’s smearing, you know, yeah, incontinence because they get so backed up.

Andrew: All right. And so when we’re talking about gut and hair analysis, let’s talk about hair first. I’ve spoken with, and forgive me, I cannot for the life of me remember her name right at this moment. But I spoke to her, I interviewed her with a Building Biology conference put on by Nicole Bijlsma, and she’s the lady who basically runs lead.org.au, incredible mind, this woman. And she was talking about the persistence of lead in our environment because lead obviously doesn’t go away, it just moves. It’s an element. So tell us about what you find with hair analysis. What sort of toxicants do you see?

Lisa: Yeah. So lead’s probably the most relevant one because with the age group of children that I’m dealing with, they’re the kids who are at ground level, licking the dust off the floor, you know, chewing the furniture, chewing the wood and then lead leads to the neurodevelopmental issues, which are common in my population. And it leads to the constipation. So it’s kind of, it ticks a lot of boxes with the children that I work with. So lead is probably the most concerning one that I see, but also arsenic and cadmium crop up quite a lot.

And, you know, kids who are fussy eaters eat a very limited range of foods obviously, so they can hone in on something like rice, which contains arsenic naturally. They might be having rice milk, rice crackers, rice is kind of the, you know, 80% of their diet. So, you know, they’re high risk of then getting arsenic exposure as well as the fact that they’re deficient in a lot of the minerals that you need, you know, to defend yourself against these contaminants. So yeah, lead, arsenic, cadmium are probably be the ones that I see most often in my fussy eaters.

Andrew: Okay. And what about nutrient deficiencies? You mentioned some, you know, that you’ll get them as a by the by, but do you find that there’s a, forgive my vernacular here, you know, a seesaw in, like for instance, was it calcium and lead antagonize each other? Calcium?

Lisa: Yeah, and iron as well. So yeah, definitely. I mean, they can be deficient in everything. We all, like, are familiar with zinc deficiency and fussy eating, but they can be deficient in calcium, magnesium, iron, although very often the doctor has tested that and they’ve been supplementing for iron. And selenium, selenium is another one that a lot of the kids are very deficient in which, you know, we need to detoxify. So again, just by bumping up their selenium can help clear some of the heavy metals.

Andrew: Okay. How careful do you have to be though with supplementation? Do you have to go really gently here and sort of possibly give some general gut therapies with regards to movement, with transit time and things like that before you start hitting things like detox?

Lisa: Yeah. So, you know, if a child can’t do one or two poos every day, then it can be quite problematic to start shifting some of those heavy metals. So certainly bringing in easy-to-administer supplements like prebiotics and probiotics to make sure that their gut health is improved before you start detoxing. And very often with the kids that I’m dealing with, because they’re so young and their metabolisms are so fast, that might be all you need to do, is some gut work and to replenish their nutrient deficiencies and that might be sufficient. You don’t necessarily need to do any more detoxing than that in some cases.

Andrew: All right. With regards to, you know, getting the bowels moving though and initiating something where it’s already compacted, prebiotics and probiotics are gonna take a little while to work. Have you ever used things like lactulose or, I mean, I wouldn’t suggest things like castor oil, it’ll be way too crampy if nothing else, but lactulose, have you ever used that?

Lisa: I use lactulose, but I don’t find it… It’s obviously great to feed the good bacteria in your gut, but I don’t find it that helpful for constipation.

Andrew: Oh, okay.

Lisa: So I do, compared to partial hydrolyzed guar gum, I find that a lot more effective. But I will use lactulose because it’s so easy for kids to take, so I will give it a shot. And castor oil, I won’t give it to them internally, but I will do castor oil packs on their tummy.

Andrew: Uh-huh. Right.

Lisa: So things like the castor oil packs, even some flour remedies. If the child is withholding because they’re trying to avoid the painful movement, then a flour remedy can be really, really good. Even a bath, like an Epsom salt or a magnesium chloride bath can be helpful to relax things. So yeah. We attack it from a lot of different angles just to get that, you know, bowel moving without distress.

Andrew: And you just said the keyword there that I was just catching… I’m pinching myself actually that I didn’t twig to it earlier. These kids are gonna be under an inordinate amount of stress around their whole alimentary tract, eating, pooing, the whole kit and caboodle. They’re gonna be not just focused on it, but stressed about it as well.

Lisa: Yeah. It can become a major focus for the whole family because, you know, the mother’s trying to, and the father’s trying to do all these things to help their child poo. Their child’s trying to avoid pooping because it’s so stressful. And the day-to-day of that family can revolve about the child doing a poo and often their behaviour will escalate if they’ve gone 3, 4, 5 days without doing a poo, their behaviour escalates. So, it can be a whole… Like, it can take over the lives of these families.

Andrew: No, absolutely. I wanna just take a little step back because I’ve just, again thought of something else. When we are thinking about investigations. Further than just, you know, gut microbiota and hair with toxicity, what about more macro investigations? Abdominal investigation. I don’t know what they do in kids, you know, this would obviously require a GP intervention, but things like Hirschsprung’s disease, you know, megacolon, functional constipation, dyssynergic defecation, all of these other conditions rather than just fussy eating. How do you drill down, what investigations do you do to say, okay, it’s not that we can proceed, it’s not this we can proceed. What sort of things do you do?

Lisa: Yeah. Quite often my clients will have already been to see a pediatric gastroenterologist, so a lot of those, you know, things like Hirschprung have been ruled out already. But I do often send them to a pediatric physio to assess them, especially for, like, hypermobility because if they’re hypermobile and they’ve got, you know, maybe a connective tissue issue, then constipation’s going to be an issue. As well as just being able to physically sit at the table to eat your dinner is going to be an issue. And I send ’em to the GP to get their thyroid checked often as well just to see if that is actually a problem. Probably the pediatric physio is where I send my clients most of all for that kind of alternate view on things.

Andrew: Right. Can you take us through, getting back to the heavy metals, can you take us through a bit of a symptom picture as to how kids present? Are there any little key symptoms, behaviours, some sort of chestnuts that we can get as to what might be the type of heavy metal that they’re exposed to at all?

Lisa: Yeah. So the classic is lead with ADHD and I have seen this like many times where kids with hyperactivity and they’ve been diagnosed with ADHD and we do the hair test and they’ve actually got lead toxicity. So, that’s very well accepted as well in, like, mainstream medicine. But with arsenic anemia and lack of appetite and stomach pain can be consequences of having the arsenic toxicity. And with cadmium, I’ve seen children with, you know, intellectual disabilities and when I’ve tested them, they’ve had cadmium. So obviously there’s gonna be a lot of variation, but certainly with lead and hyperactivity, it’s a really strong link.

Andrew: You’ve actually just given me a little hint as to what I might be looking for in a patient I’m seeing. Hmm…interesting. And you’ve mentioned cadmium, sources of cadmium, we know smoking, what else?

Lisa: So areas that have been industrial in the past. So I’m down in the Illawarra, so we’ve got Port Kembla, which is still, you know, emitting huge amounts of pollution. And things like oil, like industrial oil, if there’s been oil contamination of the soil, that’s another source of cadmium. You know, there’s a place nearby where there used to be a bus depot and then all the diesel and everything was stored underground and that has leaked over time. So then people who live nearby that, if they’re drinking the groundwater, that’s gonna have cadmium contamination. And grains, and unfortunately potatoes, potatoes can be a source of cadmium as well, which is sad.

Andrew: Okay. Any particular source, type, production? Like, I’m thinking here about aluminium with tomatoes, you know, when you prepare tomato paste in the aluminium… Forgive me, when you prepare tomatoes in an aluminium pot the first time isn’t the issue, but the sort of acid oxidizes a layer. And so the next time you cook in that pot, the aluminium is released with the tomato paste and subsequent… You get subsequent absorption from any…

Lisa: Yeah. But I mean that’s a great point because in cafes and restaurants where they’re making huge batches of food, they always use aluminium because it’s so much lighter and easier to handle. So if you’re eating out a lot, then you’re gonna be more at risk of aluminium. And if you’re drinking a lot of UHT milk like the almond milks, the oat milks, which are all in aluminium-lined UHT containers, you’re gonna be more susceptible. You’re gonna be picking up more aluminium. But yeah, I mean aluminium sauce pans are a big no-no.

Andrew: Yeah. Gotcha. And forgive the visual, but let’s dive deeper into constipation. How do you actually assess the constipation and then how do you treat? You’ve given us a few hints and tips. But can you go into like further assessment of constipation?

Lisa: Yeah. So a lot of the kids that see me are actually already on OsmoLax or Movicol. So they’re on a daily laxative to do a poo. So it’s often not that they’re not pooing at all, but it’s just that they’re not pooing without assistance from the laxative. And the first thing I do in that situation is get them to stop dairy, and in 80% of cases just stopping the dairy will fix the constipation. But with a fussy eater, their diet might be dairy with a sprinkling of wheat. So, although that sounds straightforward, you remove the dairy and you fix the constipation. If your child’s only eating dairy, that’s actually incredibly difficult. So I’ve got people to do things like for kids who are still having, you know, multiple bottles of milk every day at an age where it’s not really necessary, I get them to water it down, preferably with chicken stock. So by the end of a couple of weeks the child’s actually drinking just a whole lot of chicken stock and not that much dairy and it’s been, you know, reasonably stress-free process. So going cold turkey’s usually not gonna be good, but just trying to water down their milk over time. And yeah, dairy is the big thing to remove to get that big gain at the start.

And then obviously gluten as well, if you can get gluten out of the diet, that’s gonna help. And I always try and get people to wean off the laxative as well. So, you know, a lot of parents want to just stop the laxative as soon as they start working with me, but I make sure that they just reduce the dose. So if they’re on a scoop of OsmoLax when they come to see me, I get them to reduce it down really, really, really slowly. So maybe after a month they’re off the OsmoLax and they’re off the dairy and then the child can go to the toilet more easily.

Andrew: Can I ask, these kids are off and on, as you said, the macro goal type supplements or, you know, interventions. But I have found in adults at least, it’s not uncommon, I won’t say it’s necessarily common, but it’s not uncommon that I’ve had reported back to me about nausea. Do you ever get that in these kids?

Lisa: Not really. But again, they’re probably not going to be able to communicate that very well because, you know, I’m talking about, you know, 3-year-olds, they probably wouldn’t really be able to say that it’s making them feel sick. And again, they might have been on one of these laxatives since they were 6 months old. So the feeling of nausea might just be so normalized for them.

Andrew: Wow. Oh gosh. It’s sad. It’s tearing up my heart. I have another question that’s just popped up. Sorry about my back-and-forth brain at the moment.

Lisa: All right.

Andrew: But you mentioned that you send the kids to a pediatric physiotherapist. Do they give them any exercises or hints and tips or maybe even just physical, you know, pushing through of the fecal material? Do they ever give them any hints and tips to help manage their constipation?

Lisa: Not really sort of specific to actually going to the toilet, but they do give them exercises to just improve their muscle tone in general. So, you know, building assault courses like around your house or, you know, even doing swimming lessons, just anything that’s going to improve their muscle tone is generally what I’ve seen physios do. There’s also occupational therapists that deal with toileting and they would probably give more of those sort of exercises, but I haven’t really dealt with many of those or any of those.

Andrew: Gotcha. And of course, I haven’t even asked of yet about gut testing that you do. What sort of testing do you prefer? What results do you get? What do you find works in treatment?

Lisa: So I do a specific stool test that I’m sure a lot of people are familiar with, but it gives all the pathogens and you know, it gives the parasites and it measures how leaky your gut is if you’re reacting to gluten or not. And the things that crop up are crazy. I had a child today and they had campylobacter, but not only did they have campylobacter, but it was at 10,000 times the reference range. So, you know, that boy has been very sick for a long time and, you know, that’s clearly why.

I also see enterohemorrhagic E. coli come up a lot and even E. coli 0157 and giardia. So campylobacter, not very often. I think that was the first time I’d say not, but the E. coli and the giardia crop up quite a lot to be honest. And it’s, again, it’s because these kids are licking things that they shouldn’t be licking. They might have pico where they’re like chewing on stuff in the playground. The little boy with campylobacter, when I talked to his mom, she was like, “Oh my god, he had a tantrum yesterday because he was chewing on a park bench that had bird poo all over it and I was making him stop.” So that’s, you know, a classic example of where he would’ve picked up the campylobacter in the first place.

Andrew: Right. Okay, so here’s something that I don’t understand. Campylobacter jejuni very often causes diarrhea, not constipation. And it’s also related to damaging the major motor com… Sorry, is it major motor complex?

Lisa: Migrating motor complex.

Andrew: Migrating, thank you. Motor complex in the small intestine, which then leads to SIBO. So do you ever deal with sort of a bi-phasal diarrhea constipation picture or is it mainly by that stage the damage is done and they’re suffering from constipation?

Lisa: Well, this little boy actually, he had vomiting and diarrhea frequently, so he didn’t have constipation.

Andrew: Right, that makes more sense to me.

Lisa: Yeah, yeah. But when I do see the alternating constipation, diarrhoea, more so when parents are trying to get the dose of the laxative right. So they’re kind of overdosing the laxative and their child’s getting the diarrhoea and then they pull back and they get constipated. So that’s when I see a lot of the fluctuations.

Andrew: Okay. And you were mentioning the E. coli as well, the intertoxic, what?

Lisa: Yeah.

Andrew: I would’ve thought bloody stool, mucus, really sick kids.

Lisa: Yeah. So no, in the cases where I’ve seen it hasn’t been that sort of acute illness, it’s just been, you know, the kids where I’ve seen it, they have pretty much all been diagnosed with autism spectrum disorder and all about the ages of 2 or 3. So, they’ve been drinking water that’s been contaminated. One of them was drinking raw camel’s milk, which I assume might have been contaminated. But yeah, it’s just, they’re just not well kids.

Andrew: I’m quite stunned. Raw camel’s milk.

Lisa: Yep. Yep.

Andrew: There’s a gotta be a cultural thing there.

Lisa: No. It’s, you know, in forums for parents whose children have autism, it’s, you know, bandied about as something that… It was very popular about 10 years ago to drink raw camel’s milk, it’s not that popular anymore, but you can still get it in Australia.

Andrew: Right. Because I do understand there was a movement for camel’s milk, but I didn’t know it was unpasteurized.

Lisa: Yeah, yeah.

Andrew: Right. Okay. I mean, there’s a dead end, didn’t it? It’s just like why? And with regards to other infections, you mentioned that a lot of the kids that you deal with have autism. These kids are very often shown to have higher incidents of even things like C. diff, Clostridium difficile. Do you find that? What do you find you use as an intervention? Where do you start?

Lisa: Yeah, I don’t find that very often. Like, I see high clostridia species, but not the Clostridia difficile very often.

Andrew: Ah, gotcha.

Lisa: Thank goodness.

Andrew: Yeah, gotcha. And so I know that we are talking about interventions mainly, but let’s talk about… Sorry, investigations mainly, but let’s just talk about some interventions because we need to correct this. So, you’ve mentioned partially hydrolyzed guar gum, what about probiotics? What about other foods? You mentioned, you know, let’s say avoidance of dairy, but what about butter or ghee, what sort of things do you use to help normalize the microbiota and expand their variants in species?

Lisa: And so, obviously with most people, you would say eat more fruits and vegetables, but that’s not going to work with the kids that I work with initially, I mean, ultimately that’s the aim. But yeah, I use a range of prebiotics depending on the situation. So for campylobacter, GOS, so galactooligosaccharides has researched that it’s actually good for reducing campylobacter. So in that situation, I would use that. I don’t use inulin very much. I do use a lot of acacia gum and partially hydrolyzed guar gum together. And then I use herbs, so different herbs that are going to increase certain species of bacteria and decrease certain species of bacteria. So, I make all these kids a herbal mix, which is fun trying to get that into them. But one that’s going to, you know, alter the microbiome in the desired direction. And to be honest, herbs is actually, people shy away from giving herbs to kids because it seems so difficult. But because the doses are so small, so you might only need to give a child 3 mil a day and the parents can just put it into a syringe, syringe it into the back of their mouth, wash it down with a glass of water or like a drink of water. So herbs are not that bad for getting into kids.

Andrew: Give us a hint as to what sort of herbs you use. Are we talking the chamomiles, the gut herbs or are we talking more microbial-type herbs?

Lisa: So yeah. I don’t use the sort of the hardcore herbs so much, but something like chamomile, echinacea, licorice, those sorts of, like, gut-modulating herbs is what I use a lot for these kids. And if they like licorice then you know, it’s easy.

Andrew: Yeah. Do you find that you have certain subsets of kids that prefer licorice and others prefer things like ginger? Do you ever get that? Do you ever find…

Lisa: Yeah. I mean you cannot assume anybody is going to like or dislike anything because NAC is the classic one. When give a child NAC, I always say, “ugh,” and then some people go back, “Oh my god, that was delicious. That was so good.” Like, some people love it and some people think I must be absolutely, you know, a maniac to think that anyone would take it, and you can’t pick it. So yeah. And, like my kids love licorice, so if I make them a herbal blend with licorice in it, they’re like, you know, gimme all the herbs. They love it, but then, you know, some people just can’t stand it. So yeah, just depends.

Andrew: Right. And have you ever found a way of hiding NAC for those people that have a, forgive me, my brain’s gone for the day, an inhibition to it?

Lisa: Yeah. I had one little boy and his diet was primarily 7 Up and doughnuts, and so you can get NAC in lemon-lime flavour. So the mother was putting the NAC in the 7 Up. So, you know, obviously, a lot of work to do there, but because the NAC actually goes quite well in 7 Up, so that was, you know, that was a means to an end.

Andrew: Anyway you gotta. Any more strategies? Any other strategies you can give us about how to help get supplements, particularly those that might have a stronger taste into these fussy eaters?

Lisa: So transdermals are great if you can get your hand on some transdermal nutrients. So zinc, I do a lot of transdermal zinc with fussy eaters just as a very initial strategy. Because once we can get their zinc up a little bit transdermally, then we can go to the oral zinc and it won’t be quite as offensive. Well, if you can teach a child to swallow a capsule, then your life is much easier and it’s a skill that you have to learn. So you don’t have to be a certain age to swallow a capsule, you just need to learn that skill. So I’ve had 4-year-olds who’ve come to me and they’re able to swallow capsules and then I’ve got 14-year-olds who can’t swallow capsules. But you can, you know, there’s YouTube videos from major children’s hospitals teaching children how to swallow capsules. So that’s definitely worth trying and sometimes it will work, sometimes it won’t.

But if you can get your child onto a smoothie a day, then most things, maybe not NAC but most things like prebiotics, probiotics, you know, some magnesium, some herbs, that can all go into a smoothie and as long as the smoothie is small enough that a child can finish it, then that’s again quite easy. You can get everything in one hit. And then yeah, syringing like cod liver oil, just syringe it into the back of their mouth. And if you aim, you know, for way back here and then blow in their face, especially with the younger kids, you syringe it and then blow and they go and they swallow it. It’s like a reflex.

Andrew: Wow. Okay. I didn’t know that.

Lisa: When my daughter was a baby, she had to take medication for the first three months, so the hospital taught me that one to syringe it into the back here and then blow it. You go that and you swallow it.

Andrew: So to the back and to the side?

Lisa: Yeah.

Andrew: Right. I love that. That’s great.

Lisa: So I have parents, I don’t know how many syringes they have in the house. They must have a lineup of 10 different syringes because they just syringe in everything. So, you know, they’ll open the zinc capsule and mix a bit of water, syringe it in. Syringe in the herbs, syringe in the cod liver oil and they just syringe it all in and the child just gets trained to do that. That’s what you do after dinner. You get everything syringed into you.

Andrew: That’s very cool. Lisa, I have to ask, where can practitioners find out more? You’ve given us so many great hints and tips and it’s obviously good, responsible evidence-based care. Where can we learn more? Have you written a course or would you suggest that people learn to be an SOS feeder, feeding therapist or have you written eBooks to help patients and or pracys, help us? Where can we find out more?

Lisa: So I do have a lot of articles on my website, The Paediatric Naturopath. But I’ve also, you know, from a practitioner point of view, I’ve just inhaled any education that I can on children’s health over the last few years. I think as a practitioner, obviously, there’s so many courses and, you know, webinars and symposiums that you can go to and it can get quite addictive. So I’ve always been very strict with myself that I just do the ones that are focused on kids’ health. So, you know, a lot of the different herbs and supplement companies have pediatric webinars on their website, so you can learn a lot from that. And yeah. But for patients or practitioners who are maybe just starting out in this area, then have a look at my website maybe to learn more. I should put together some eBooks to put on my website. Yeah.

Andrew: Nodding furiously here.

Lisa: Yeah.

Andrew: Lisa, I can’t thank you enough for sharing your pearls of wisdom. Thank you so much for taking us through fussy eating investigations today. I look forward to chatting with you sometime again in the future.

Lisa: Thank you for having me again.

Andrew: Thank you, everybody, of course, for joining us today. You can catch up on the show notes for this podcast. We’ll put up as much as we can, and also the other podcasts on the Designs for Health website. I’m Andrew Whitfield-Cook and this is “Wellness by Designs.”