Integrative Pediatrics with Dr. Joel Warsh: Rational Wellness Podcast 140

Dr. Joel Warsh discusses Integrative Pediatrics with Dr. Ben Weitz.

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Podcast Highlights

2:26  Dr. Warsh sees Integrative Pediatrics as blending the best of Western medicine with holistic and Functional Medicine.  Dr. Warsh got frustrated with the regular system and was frustrated that the only treatment in most conditions is pharmaceutical medications.  He has found that there are many situations where you don’t need a medication and some dietary changes or a nutritional supplement might be better. If the child is sick with a virus, then an antibiotic isn’t going to help and might make them worse, and this is a great time to use a natural approach. On the other hand, if there is something serious going on, your child may need an x-ray or an antibiotic or may need to go to the hospital.

6:07  A cough is a common symptom of a cold or a flu.  The best way to prevent colds and flus is to focus on what Dr. Warsh calls the SEEDS of health: Sleep, Exercise, Environment, Diet, and Stress.  These are the foundations of health.  When your child first gets a tickle in their throat or a low grade fever before they get really sick, that’s a good time to use vitamin D, vitamin C, elderberry, or some essential oils or colloidal silver to help their body fight it off.   

10:27  Dr. Warsh generally finds most herbs to be safe for children and certainly much safer than many pharmaceutical medications.

12:51  Homeopathy is extremely safe for children, as it is for adults, and can be very effective at times.

17:15  Fever has benefits and helps the body to fight off illness and there is not much risk of harming the child until it gets to 104-105 degrees.  Taking Tylenol or ibuprofen should only be done if the child is extremely uncomfortable or has severe ear pain, but not to lower the fever unless it is 104 or higher. Taking these medications will actually increase the length of your infection. It’s also a good idea to double check the temperature by getting a second thermometer, since some of these thermometers can be inaccurate.  If the fever continues for a month or longer, then you should go the hospital for a full workup.

21:23  Diet is important and Dr. Warsh is a moderate on diet and tends to avoid extremes. He feels the focus should be on eating healthy, whether that includes meat or not. You should eat the rainbow of different colored vegetables and remove the sugar, preservatives, food coloring, and crap out of your diet. If you eat meat, it should be grass fed and sustainably produced.  Fish should be wild and not farmed. You should eat as clean as possible.

23:45  Toxins can play a significant role in the health of our children. We live in Los Angeles and we are surrounded by toxins in the air, food, and water.  Toxins lead to inflammation and it’s one of the reasons children are getting more and more sick.  It is playing a role in the rate of chronic diseases, such as asthma, ADHD, autism, rheumatoid diseases, lupus, and eczema, which are epidemic now. According the CDC, 10% of kids have mental health problems, 7% have anxiety, and 3% have depression and toxins are playing a role in these conditions.  You should have an air filtration system in your house. You should get a reverse osmosis filtration system for your water and you should avoid tap water. Avoid using chemicals to clean your homes and use baking soda, vinegar, and essential oils.  It’s good for kids to get exposed to germs and to play in the dirt, since it stimulates our immune system and our microbiome. Kids that play in the mud and live on farms and in rural areas have lower rates of allergies than kids that live in the city.

29:40  We used to have kids avoid peanuts and common allergens when they were young, but the rates of allergies skyrocketed and now it is recommended that we purposely expose kids to peanuts and other common allergens at six months, since this leads to a lower rate of allergies. The thought process has completely changed. On the other hand, with a little older child who has a lot of allergies or asthma or eczema, the first thing to do is to have them clean up their diet and remove gluten and dairy.

32:17  While serum food sensitivity testing can be helpful, it can be difficult to get kids to have blood drawn and it can be a big expense, so tries to work with the diet first and see if using an elimination diet can resolve symptoms.  But in some cases, food sensitivity testing is warranted and can be helpful.

33:51 Dr. Warsh finds that for eczema, calendula, coconut oil, shea butter, and castor oil are all good to use on the skin, and fish oil can be helpful. Vitamin D and E are beneficial and eating some turmeric, such as in a smoothie, and quercetin and bromelain can also helpful. 



Dr. Joel “Gator” Warsh is the Medical Director of Integrative Pediatrics and Medicine Center in Studio City in Los Angeles, California. Dr. Warsh is certified by the American Academy of Integrative Medicine. He has published research in peer-reviewed journals on topics including childhood injuries, obesity, and physical activity. He has been featured in documentaries, podcasts, and articles, including Broken Brain 2, Dr. Nandi Show, CBS News, LA Parent, Dr. Taz Show, and many others. You can learn more information about Dr. Warsh by going to IntegrativePediatricsandMedicine.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to Apple podcasts or whatever podcast app you use and please give us a ratings and review. Also, if you’d like to see a video version, go to my YouTube page. If you go to my website, drweitz.com you can find detailed show notes and a complete transcript.

Today our topic is integrative pediatrics, which means incorporating holistic and functional medicine along with conventional medical care when providing health care for children. This means using nutrition, nutritional supplements, and various natural healing methods and avoiding prescription meds except when absolutely necessary. There is also a focus on promoting health and preventing illness rather than just treating sickness.

Our special guest is Dr. Joel Warsh. He’s an integrative medical practitioner who’s certified by the American Academy of integrative medicine. Dr. Warsh started the Integrative Pediatrics and Medicine Center in 2018 in Studio City in LA County of California. Dr. Warsh has published research and numerous peer review journals on topics including childhood injuries, obesity and physical activity. He’s been featured in various documentaries, podcasts, and articles including Broken Brain 2, Dr. Nandy show, CBS news, LA parent, Dr. Taz show and many others. He has an upcoming pediatric summit and also a online course, so watch out for those. Dr Warsh, thank you so much for joining me today.

Dr. Warsh:           Thanks so much for having me. I’m looking forward to it.

Dr. Weitz:            Great. What is integrative pediatrics and is it commonly accepted by mainstream medicine?

Dr. Warsh:           It’s a great place to start. The first thing is I don’t think there is a specific definition of integrative pediatrics. I think everybody defines it a little bit differently. But to me it’s blending the best of Western medicine with holistic or alternative medicine. It’s not that you’re picking one or the other, it’s doing whatever you think is best on that day.  What got me into integrative medicine in the first place was just being a bit frustrated with the regular system and really only having pharmaceutical medications to treat everything. My wife is very holistic minded and I had seen some of her friends go to natural paths after being adopters for many years and they would get better. I was like, “There’s got to be something else. What else is there to learn?” That’s what really spurred me to start learning about functional medicine and homeopathy and supplements and then blending those two together.

Because what I found is that a lot of times you don’t need a medication. Parents definitely want to do something when their kid is sick. But a lot of times if it’s a virus then really an antibiotic or another medication isn’t the answer and isn’t going to do anything, it might even make them worse. It’s a really good time to see if there’s something natural that you could do.  But also you want to have that Western side as well because maybe something natural isn’t the right thing to do in a situation where there’s something serious going on, you need to go to the hospital, you need an x-ray, you need an antibiotic. That’s where blending those two together are important.

Then for your second question, it’s not very accepted in regular Western medicine yet. I think it’s moving in that direction. There’s definitely more focus and discussion around prevention and some of the natural modalities are starting to be accepted. Acupuncture is probably the best example of that where it used to be woowoo and crazy and now you see it everywhere with the opioid epidemic and you see it in hospitals. Slowly some things are moving into Western medicine, but it’s not fully accepted by a lot of practitioners yet.

Dr. Weitz:            I think one of the issues is that if you’re going to use preventative, nutritional, integrative medical approaches, it takes more time. The current medical model based on insurance companies controlling things makes it very difficult.

Dr. Warsh:           That’s correct. Number one, with the system as it is today, it’s really hard to spend 45 minutes or half an hour or an hour with a patient, which sometimes is really what you need to go through and get an extensive history. It’s oftentimes a lot easier with a cough or a cold to say, well, just take this antibiotic and then you cover yourself and get them out the door. That certainly is a part of it.

But the other part is there’s a lot of training involved and even learning about natural medicine. You really need to have a lot of communication with your patients when you’re using something natural because things can progress pretty quickly. If you have, let’s say a cough for example it’s a really good example. You have a cough, patient comes in and they’re totally fine, then that might be a great time to do something natural, but you have to be in really good communication because that could change really quickly. They could get pretty sick and then the natural remedy isn’t the right tool that time. Might need an antibiotic.  That Western model where you might have four or five, 10,000 patients in your practice or however many you have, it doesn’t necessarily work as well for natural medicine because you really need to have that good communication to know when you have to step up the treatment to something that’s more Western.

Dr. Weitz:            You brought up a cough and that’s a common symptom of flu. Right now we’re in the midst of cold and flu season. What can be done from your perspective in preventing and treating children with colds and flus, besides giving antibiotics, which probably shouldn’t be indicated at all, since these are caused by viruses?

Dr. Warsh:           That’s correct. For me, what I always focus on with patients is the prevention. We always talk about the foundations of health. A term that I coined was the seeds of health. Sleep, exercise, environment, diet and stress. These are the big factors that we really need to think about because nowadays we have almost forgotten about these basics. Whether you look at Functional Medicine or Ayrevedic or all of the other modalities, this is the foundation of all of those but in Western medicine we’ve forgotten a lot about it.  Certainly if you go to the doctor, they might talk to you for 30 seconds about physical activity or making sure you can exercise. But that’s not really what we mean when we talk about the foundations. It’s really setting up a good lifestyle. You might need a 30 minute or hour discussion with a nutritionist or a health coach just about a child’s diet really making those major changes overall.

That’s really where to me it starts and it starts with those checkups or the well visits where you discuss a little bit more about these foundations. Because if you have a good foundation then you’re not as likely to get sick. We know this, this is not woo woo, this is not alternative medicine. This is Western medicine. There’s plenty of studies where they took viruses and they put them into nodes of patients. Some that were stressed, some of them were not stressed, some that were sleep deprived, some of them were not sleep deprived.  Anytime these foundations are not there, you’re much more likely to get sick. That comes into play with something like the flu. We know this because what happens when you have a test and you’re studying? You’re going through, you’re really stressed. Five minutes after you’re done studying and your body calms down after the stress, you get sick. It’s common knowledge.  We just need to remember this common knowledge is things that we used to talk about and get back to the foundations just like diet. Because we’re literally built of what we eat. If we don’t eat healthy and we don’t have the nutrition then our body doesn’t have those building blocks for our immune system to fight off the infection. That to me is the key overall, is really thinking about the seeds of health and the foundations and setting yourself up for success.

Then when you first get sick, before you really know what’s going on, you start feeling that little bit of tickle in your throat or a little bit of a low grade fever, that’s a great time to try to really do some great view and support. It depends what the situation is, but things like vitamin D, vitamin C, elderberry, essential oils, all sorts of things can be helpful that first three, four hours. If you get some of that stuff in your system, then hopefully your body’s able to fight it off a little bit better before you get really sick.

Dr. Weitz:            Do you have a favorite formula? Should we just hit the vitamin C? Should we hit the vitamin C, vitamin D and the elderberry?

Dr. Warsh:           It’s hard because with kids especially, it’s always been… Anybody it’s going to be different and unique to each patient. With kids, every age group is very different. It really would depend on how old the patient is because obviously a newborn or a two month old would be very different than a 15 year old. You’re very limited with the babies and that’s why I think this advice is very cautionary in terms of you really need to speak to your practitioner before doing any of this stuff, especially with a baby. Because it’s a completely different scenario with one month old who is sick than a 15 year old who says, yes I have a little tickle in my throat.  But in general for the older kids, I think a good multivitamin is going to be helpful. Vitamin D will be helpful. Vitamin C, elderberry. Some people like colloidal silver. It depends on what the scenario… But we’re talking about flu and those are some things you can think about.

Dr. Weitz:            Okay. Do you recommend a high dose vitamin C for that type of situation?

Dr. Warsh:           Usually. I mean it depends and there’s so many different formulations out there, but I’ve used Metagenics before with patients that I have in my office. It will depend on the age, but I don’t usually… Each patient is different so it’s hard to say what the dose would be. But yes, a good dose of vitamin C at least once or twice is going to be helpful.

Dr. Weitz:            Are herbs safe and effective for children?

Dr. Warsh:           I think so. I think to me this is one of the biggest misnomers out there. I think it’s a little bit funny when having discussions with my Western practitioners about this, because these are things that have been used for thousands of years and we call it alternative, but really Western medicine is what’s alternative. That’s the thing that’s been around only 50 years or a hundred years or however long you want to go back.  Sometimes you hear things like, “Oh, you’re going to get… You’re going to try peppermint oil with a child. That’s so dangerous. How could you do that?” That makes me laugh because comparing it to the Western treatment which… Look, everything has risks, right?

Everything has risks, everything has side effects. Everything could possibly have an allergic reaction. When you have a 10 year old who has a little bit of sniffles and you’re trying a little peppermint essential oil, that versus using over the counter cough syrup, the medication has a list of known side effects this long. We don’t even look at it and it’s like, it could cause death, could cause allergic reaction, all these hundred things.  These are known risks versus maybe one child at some point somewhere had a reaction to some not so good herb that was made improperly or had some contaminant. Which one is at more risk? To me it’s crazy and again there’s certain situations where certain herbs and natural things are not safe for sure. Of course that’s true. That’s where we need good science and we need good research and we need good practitioners to know what are the right things to use when.

But in general, for a child who’s not severely ill, a natural item, a natural herb, a natural supplement is almost always going to be way safer than the medication. There’s so many risks to every medication. For whatever reason we’ve forgotten that because you see on the news that anything bad happens with the essential oil or homeopathic, but realistically, if we use our brains for one second, we know that that’s not true. But that’s why the practitioner’s important. You can’t just use the herb because it might be serious. You have to go see a Western doctor, make sure there’s no pneumonia going on, then that’s a good time to try the natural thing.

Dr. Weitz:            What about homeopathics? Do you like those for children?

Dr. Warsh:           That’s a… It’s an interesting topic and I think homeopathy of all the modalities is probably the most controversial, I would say. Just because it’s not used that commonly in Western society. It’s very commonly used in Europe and in other countries. But it’s not that commonly used here. Philosophy is a little bit counterintuitive to anyone who has a scientific mind.  For those that don’t really know, basically using very small diluted doses, using like to cure like or to work with like and so, if you have something that causes… You have a cough, you give something that might cause a cough or stimulate a cough to try to help the body balance. Some people are extremely into this and think it works amazingly, I don’t think it’s all hooey. I think there’s very minimal risk and if you work with a trained homeopath that knows what they’re doing and it seems to work for you, then there’s no reason not to try it.

It’s far and above the safest modality out there. I think really the big question for most people is, does it really do anything or are you just wasting your money? That’s a question that each person has to decide on their own. But you talk to people who take homeopathics and work with homeopathics and most of them love it. Say it works amazingly, say it works better than most medications.  I think if it’s done correctly with somebody who’s trained in it, then it’s reasonable. Just going to the store and picking up a random homeopathic, is that going to work? Maybe, maybe not. But again, it’s safer and if it helps even a little bit, avoid using a medication, then that’s a good thing.

Dr. Weitz:            I agree that homeopathics are super safe. They’re typically using a product that’s so dilute. All there is is the original energy of the original substance in there. On the other hand, looks like our government is said to be banning homeopathy pretty soon here.

Dr. Warsh:           I mean, there’s always discussion about that. I don’t know… Who knows whether it’s actually going to happen or not.

Dr. Weitz:            Well no. Apparently the FDA now has made a ruling that homeopathics are going to have to be approved as drugs. No homeopathy companies have the money to do that type of study to prove this. Homeopathy has been banned in England. This started in Australia, there’s actually a movement to try to ban homeopathy around the world.

Dr. Warsh:           I mean it’s a tough fight because it’s not the same as Western science and so anything that’s different and that can be proven that way has its issues with-

Dr. Weitz:            No, I think what you’re referring to especially is the fact that when you take a homeopathic formulation and you dilute it another hundred times, it’s considered to be more stronger, more powerful. The more you dilute it, the more powerful it gets supposedly. That’s one of the parts of homeopathy that seems very counter to Western scientific thought.

Dr. Warsh:           It is, it’s very different. But then again, the interesting part to me is things like allergy shots and stuff like that where it’s a fairly similar concept where you’re giving very dilute minute doses of something to help the body and immune system create a tolerance to it. It’s so hard because energy is such a foreign concept and it’s like, oh, this is all crazy we’re talking about energy.  But then again, you talk about the moon and how the moon affects the tides. We’re obviously all made of energy and particles and so there is some definite science there. I just don’t think we’re smart enough to understand everything yet. I think it’s frustrating that we’re not open to these discussions, especially when things are safe. I think we need to spend more time studying these as opposed to just thinking they’re crazy because they’ve been used successfully for so many generations in so many places. Just to ban to me is not the answer, is to study it more thoroughly.

Dr. Weitz:            The reason why it would be getting banned is most likely because it’s competition with medications. Since we’ve been talking about colds and flus, I’d like to bring up the concept of fever. What do you think about the whole concept of fever? Typically parents have a kid with a fever and right away they’re rushing for Acetaminofene or other medications to bring the fever down.

Dr. Warsh:           Sure.

Dr. Weitz:            But fever actually has a lot of benefit. It’s part of the way the body fights off an illness.

Dr. Warsh:           For me, that’s a big part of discussion in my office all the time. It’s probably one of the top three most common messages and texts that I get from parents all the time about fever in their kids. A little bit of is education about it. I think it’s a great topic to bring up because it’s so important to recognize that fever is beneficial. Fever is not the thing that we should be worried about. Fever gives us an indication that our kids are sick or that we’re sick.  A fever in and of itself, unless it’s super high, is not really dangerous. It’s pretty hard to get a fever high enough that it’s dangerous to your brain. Once you’re getting over 105 that’s pretty high. But in general, unless you’re talking about a newborn baby in the first few months, when a child first gets a fever, you don’t necessarily need to do anything about that.

It’s not the fever that the doctor is worried about. It’s the fever and the symptoms. I am much more concerned about a child with a 101 fever who’s lethargic, having trouble breathing than a kid with a 104 that’s running around and playing. If the reason to use Tylenol, Motrin, Acetaminophen and ibuprofen would be because your child is extremely uncomfortable.  If your child has a 102 fever, a little bit of congestion, then the reason your body is raising your temperature is to fight off the infection to make an inhospitable environment for the infection that way it kills it faster. There are plenty of studies out there now that those who take Motrin, Tylenol, it does increase the length of your infection by a little bit as well. Is it really damaging to children? It’s probably not super damaging, but any medication can have side effects.  Certainly over a million kids, one kid takes Tylenol, it’s going to affect that kid pretty severely. But here and there using medication, it’s not going to be a huge issue, but use it when you need it. Just because your kid has a little sniffles in a 101, to me that’s not a good time to use Tylenol. It’s if they’re miserable 104, if severe ear pain, something like that, it’s a good time.

Dr. Weitz:            You’re saying 104 would that be the cutoff for when you think fever might be high enough where it could cause brain damage?

Dr. Warsh:           Based on the research that I have seen and what we learn in residency, it’s above 105 where you start to worry. I mean when you’re getting into 106, 107 that’s when it’s pretty high. But the reality is most of the time when you have a temperature that high, it’s the thermometer that’s off. It’s not actually the temperature that’s that high. If you’re getting a really high temperature, my first advice always parents, get a second thermometer and make sure that that’s correct.  If it is correct and the child is very miserable, lethargic, other symptoms, you get seen right away. There’s no question. If you have above a 103 that getting to a higher fever. You don’t necessarily have to rush to the emergency department unless there’s other symptoms, but if it’s staying above 103, it’s been 103 for a day or two, 103 with symptoms, that’s more indicative of a bacterial infection. Something to get seen for. 100, 101 fever, kids okay. Little cough, a little cold. Usually a virus is going to last three to five days. You can watch that.

If you’re ever worried, always safest to go to see your doctor, go to urgent care. No doctor is going to be upset if you give us a call and say, “Hey, my kid’s got a fever of 101. I’m pretty sure they’re fine, but I just want to get their ear check.” Absolutely reasonable. The only caveat to this whole thing that I’m saying is for a baby. In the first couple of months, two, three months, any baby with a fever, that’s a much bigger deal. That’s something they get seen right away. Especially in the first month to month and a half, you want to be going to the hospital for that because babies get sick much more quickly and they can’t tell you how sick they are.  A little bit of a fever can turn into something very serious very quickly. That’s why standard of care in America is first month, month and a half a fever. You’re going in the hospital getting a full workup.

Dr. Weitz:            You mentioned diet. Right now there seems to be more information about diet than we’ve ever had and yet there seems to be more and more confusion. It seems like the diet debate is as polarized as a political debate. We have the carnivore diet on one side, we have the plant-based folks on the other side and everything in between. So where do you stand on diet?

Dr. Warsh:           For me, I’m in between. I, for the most part when I talk to diet about families is eat whole foods, eat real foods, try to eat as healthy as you can and have a variety. We’re in LA, so there’s lots of people that are vegans and vegetarians and I’m totally fine with that. You can be very healthy and never eat any meat and that’s fine for most people. There are some people that they get fairly sick if they don’t have any meat, they need some other nutrients. That I’ve seen it before.  But in general, for almost every kid, if they want to be vegan or vegetarian, that’s fine as long as they’re making sure to get a very diet for that. But I think the more important thing is not to worry about dieting, it’s to think about eating healthy. Eat your fruits, eat your vegetables, eat the rainbow, all sorts of different colors. Get out the crap out of your diet. Get out the sugar, get out the preservatives, get out the packaged foods, the things with fancy coloring and big logos.

Any of that stuff in the middle of the supermarket is generally not going to be good for you. I’m big on telling my patients to read labels. I think it’s super important for them to learn and for the parents to really turn the box over, look at the back and see what’s in there. If there are words on it that you don’t know, it’s not going to be good for you. Don’t buy that. If it says almonds, peanuts, cashews, coconut oil, it’s generally going to be a lot better for you.  I’m more of a peaceful in between thing where I think a little bit of everything is fine. When you’re going for the meats and fish, if you’re going to go for that, then you just want to think about sustainably produce, grass fed meats, not having farm raised fish, Just as good a quality as you can that you can afford. I don’t know if we’re going to go into talking about toxins next, but I think toxins is a big issue that we’re dealing with. I think trying to eat as clean as you can afford is very useful.

Dr. Weitz:            Sure. Let’s hit the toxin issue. We live in a big city, Los Angeles, and like most big cities, there seems to be tons of toxins in the food, water, air, et cetera.

Dr. Warsh:           Yes. It’s one of the big issues. That to me, the environment piece is where I think about toxins for families. That’s absolutely a core foundation that everybody needs to start thinking about because we are surrounded by toxins and toxins are in everything. Unless you’re planning to move to the mountains or go somewhere way out in the country, this is going to be something that you’re going to have to deal with. The good news is human bodies are amazing and we have great filtration systems. Our liver and our kidneys do a great job for the most part. We can handle a fair amount of toxins, but at some point it overflows.

At some point there’s too much inflammation. That to me is one of the big reasons why we’re seeing children getting more and more sick. There have been statistics that I’ve read up, almost 50%, adults certainly around 50% chronic disease and kids somewhere between 25 and 50%. That number has skyrocketed in the last 50 to a hundred years. Used to be three to 5%. The only thing that’s changed is our environment. Genetics can’t change that fast. I mean maybe they’re small little things, but in general it’s our environment. What has changed? It’s the chemicals that we’re surrounded by all day and all the things that you mentioned.

Dr. Weitz:            When you say chronic diseases, what diseases are you referring to?

Dr. Warsh:           Everything. Asthma, ADHD, autism, rheumatoid diseases, lupus and eczema, everything. We’re seeing more and more kids with something. I mean every other kid seems to have an allergy. Every other kid seems to have asthma. Every other kids seems to have something. I mean there’s also all the mental health diseases as well go into that category as well. I think the CDC statistics are 10% of kids have mental health disease, 3% have depression, 7% have anxiety. It’s staggering numbers of children have something, that has to have some part to do with toxins.

Let’s go through a couple of big ones and talk about some tips and solutions because I think this is a big one. To me, environment with diet are the two big pieces that we have a big ability… We have a huge ability to change those things around us. Not everything, but there are certainly small changes that you can make at home for free today that can make a big difference in your kids’ lives.

Number one, the air that we breathe. Our air. We’re certainly surrounded by in LA, lots of chemicals and toxins. You have some control over your house so you can get an air filtration system. You can put a bunch of air cleaning plants in there, aloe plants, snake plants, things like that. It does make a big difference overall. We’re breathing all day, lots of breaths every day. If you are decreasing the toxins even a little bit, that’s going to make a big difference.

 Second, you have the water in your house. You can get a filtration, reverse osmosis or some sort of filtration system. The water that we get in LA is not the best. If you’re going to drink any tap water, which probably isn’t super recommended, but if you’re going to then filtration system is going to help at least to some degree, in filtering out some of those chemicals and toxins around your home.

Go through your closets and think about all the things that you use as cleaners. Look at the labels. We’ve been so trained to think about we need to kill 99.9% of bacteria. We need to kill everything and we’re surrounded and we’re made of germs. You probably don’t want to stick your hand in the mud and eat it, but we don’t need to use all these harsh cleaners all the time. You know how grandma’s always used to use baking soda, vinegar, essential oils. That does a great job for the most part, maybe not for some crazy stain, but for your daily cleaners get rid of all that expensive stuff and just go back to the basics.

You don’t have to kill every single thing. There’s a lot of research now in the allergy world where kids that live Brooklyn farms that live in the mud have much lower rates of allergies than kids in the city. The theory is that we’re too sterile, we’re not being exposed to the germs and then that leads us to having more and more allergies. It’s just an interesting theory to think about because we think about sterilization as being best, but it’s not necessarily.

Dr. Weitz:            Absolutely, hand sanitizer. What you’re saying is it’s really beneficial for us to get exposed to germs and microbes. It helps prime our immune system and it stimulates our microbiome, which is so important for overall health.

Dr. Warsh:           Think about babies. What do they do in the first couple of months? They put everything in their mouth. That has to be biologically relevant. Otherwise, if we were dying and babies are all dying from touching all these bacteria, then we wouldn’t have this reflex to take every single thing and put in our mouth and put our hands in her mouth. It’s very logical that that’s one of those things that’s been selected for, but you’re touching your environment around you. You’re getting exposed to some of those bacteria, then your body’s getting used to it.  Again, you don’t want to go beside someone with the flu and wipe your hands all over their cough and then put that in your mouth. That’s not very smart, but in general, we’re talking about just your general daily life. We don’t have to be sterile everywhere. This isn’t… We’re not living in a hospital.

Dr. Weitz:            In fact, just the opposite. We’re now seeing this huge increase in autoimmune diseases and a hygiene hypothesis seems to be one major reason why, which is the fact that we’re not playing in dirt and getting exposed to germs and bacteria as much as we used to.

Dr. Warsh:           Right. For just general allergies, when we were growing up, it was don’t eat the allergenic foods. Wait until you’re older. Don’t give them peanuts until they’re one or two. And then allergies skyrocketed. All the new research came out that said, expose your kids to it early. Give them peanuts at six months. Try this because the earlier you do it, the lower your allergies are. Even in the regular Western science, the thought process has been completely changed to exposing things earlier. I think to me there hasn’t been as much research on the other topics. I think you can infer that would apply to everything else as well.

Dr. Weitz:            What is some of your favorite natural treatments for kids with allergies and asthma and eczema?

Dr. Warsh:           For allergies, eczema, anything really with autoimmune disease, I think number one, again, so going back to the foundations, absolutely important. Number two is talking about diet. Thinking about the allergenic foods. We know that the number one and two things always are gluten and dairy. If you’re going to pick one thing to think about, if your kids eat a lot of wheat or dairies, try to pull those out of their diet for a month and see what happens. It’s not the easiest thing to do, but you’re going to get the most bang for your buck. You can always just start there. You can see if you can take that out and see if the symptoms improve. It’s crazy how often they do improve.

Dr. Weitz:            Now do you get skeptical parents saying, “Isn’t this just a scam now I’m supposed to avoid gluten?”

Dr. Warsh:           Sometimes. But honestly I think the information’s been out there enough and there have been enough people who have seen significant benefits that people don’t necessarily think it’s a scam. I think the bigger issue is usually with the toddlers. They only eat this. They only eat bread. They only pasta.

Dr. Weitz:            Right.

Dr. Warsh:           Taking that out of their diet means they’re going to eat nothing. That can be hard but if you really have difficulty, sometimes working with a nutritionist can be helpful to see if you can think about things. But most kids don’t starve themselves. If you don’t have it around or you provide other things, they might not eat for a couple meals, but they’ll usually eat eventually if they get hungry enough.  Sometimes it just takes them some tough parenting to hang in there. You’re doing this for your kid and it’s not easy, but it can be helpful. Sometimes it’s just, okay, well we eat pasta every day, so let’s move it to once a week. You have to meet people where they are. It’s very different working with kids than adults because sometimes you just have to do whatever works. When we’re talking about supplements or anything like that, not every kid is going to take it. You have to be careful about what you use and work with the family to use something that they’re actually going to take.

Dr. Weitz:            Do you ever do food sensitivity testing to have it on black and white paper that they have issues with certain foods?

Dr. Warsh:           Definitely. I think a big thing again is different for kids and adults is you really have to be sensitive to blood work with kids. Because it’s a big deal for some kids to take them, give them a poke and get a whole bunch of tubes of blood and send off testing. You have to really think about what is the utility of this test and is it going to be very helpful or helpful enough to warrant the cost and the poke and everything like that.  In some cases it definitely is warranted. I’m big on trying to do whatever we can do first without doing any blood testing. If it’s not improving, you’re not getting better or something is serious, then that’s a good time to do it. Sometimes patients come to me after they’ve been through the whole medical system and they really want to do it and then that’s fine, then we’ll do it then.

It really just involves a lot of discussion and going through the pros and the cons of doing food sensitivity testing because there’s lots of great testing and information you can get out there, but it’s certainly not perfect. You would just, I think want to make sure that patients understand the utility of it and the benefit of it, but sometimes it can be super helpful.  You might come back and have things you would never think of that you’re sensitive to. Sometimes pulling those things out makes a big difference. Sometimes pulling them out makes no difference. Other times you’d send sensitivity testing and everything comes back normal. It just depends. You have to take it with a grain of salt, but when you’ve tried everything else and nothing’s working, then sometimes getting more lab information can be very helpful to push you in a direction to try something else.

Dr. Weitz:            What are some of your favorite nutritional supplements for allergies, asthma, Eczema?

Dr. Warsh:           That’s a good question. Each of those are a little bit different, but for general inflammation, let’s say which-

Dr. Weitz:            Okay, pick any one of those that you want to address.

Dr. Warsh:           Well for eczema, I would say the rashes, lots of creams and lotions that are natural are great. Calendula cream is really good. Coconut oil, Shea butter, Castor oil, fish oil tends to help with the skin rebuilding. Almost everybody is deficient in vitamin D these days. So you can probably just take some vitamin D and E that’d be safe. Turmeric is really wonderful too. That’s something to consider. I always try to get people to eat it as opposed to just taking a supplement if they can.  If you can get some smoothies in with your kids and maybe throw some turmeric. When you’re talking about allergies, things like quercetin and bromelain can be helpful to that kind of stuff.

Dr. Weitz:            Okay, good. You mentioned autism. Do you treat kids with autism?

Dr. Warsh:           Definitely. That’s a statistic that we’re seeing in skyrocketing numbers. Used to be 100 kids with autism, then it was 150, then 140. I’ve seen numbers now as low as 130 to somewhere within 140. It’s becoming very prevalent. Certainly have a fair amount of kids in my practice with autism.

Dr. Weitz:            Why is it becoming so prevalent?

Dr. Warsh:           I don’t think we know. We have no idea why it’s becoming so prevalent. Logically it’s the chemicals, toxins, things we’re exposed to, but they’re… I don’t think there is one thing that is the reason, because I don’t think autism is one thing. It’s a term for a group of diagnoses or a group of symptoms that we give a diagnoses to. I think there are multiple different causes.  My guess and assumption is, because this is becoming so prevalent, we’re going to have a lot more research on this and autism is going to turn into five or six or 10 different things. Because sometimes you’ll see it be a chemical ingestion. Some led toxicity, some sort of toxicity, and you take that toxicity out, the kid gets back to 100%. Other times it’s maybe the environment that they’re in. Most of the time we have no idea.

Dr. Weitz:            Have you used low dose immunotherapy for autism or other conditions?

Dr. Warsh:           Every once in a while I have used it, but in general I send off to other practitioners that specialize in that. We have a pediatric naturopathic doctor in our office and he takes care of a lot of the children that have any developmental disorders. He has a very interesting background history. He’s a toxicologist, he had children that had developmental issues and so he went back to naturopathic school and this is his passion. A lot of the patients will see him for more of their natural medicine and then see me just for their regular medical treatment.

Dr. Weitz:            You mentioned that certain psychological conditions like depression and anxiety are on the rise and really common. What’s your approach for seeing kids like that?

Dr. Warsh:           First thing really is to get a really good history, go back and really see where this stems from, how long has it been going on for, and then to really see how serious it is. For me, anything with mental health, it’s really important to have a good team. I think of myself as the captain of the team and make sure from a medical standpoint we’re not missing anything.  Once you go through the history then thinking about doing the blood work just to make sure that we’re not missing sleep or not missing a vitamin issue. Make sure that their sleep is okay, make sure they’re connected with the right team. If they need a psychiatrist, a psychologist, a nutritionist, whatever it is, having them connect with that team. Then for me, I’m thinking about the medical standpoint and because I’m an integrative doctor sometimes thinking about the integrative health and what we can do from a foundational perspective, and what we can potentially do from a supplement perspective to try to boost that.

It depends because if somebody is severely depressed, that’s not going to be necessarily the right time to do a supplement. They got to go, they got to get their psychology or psychiatry evaluation and then we can work on natural methods to try to help or work in conjunction with the practitioner. To me that’s really important. I think that’s where a lot of people in the natural world don’t do a great job. Is you have to know your limits and stay within your lane and it’s not a good time to start something natural. If something is severe, like someone’s suicidal, that’s not a good time to say, “Okay, well let’s think about some [inaudible 00:38:21].” Or, “Let’s think about some magnesium.” Those are great things to do but maybe not right now.

Dr. Weitz:            Well, how do you work up a kid with say anxiety?

Dr. Warsh:           Usually it will start with… Depends again, because each kid is different so it’s going to be very much dependent on their history and what they’re telling me because some of the tests that we might do would be diet testing, like you said. So sensitivity testing. Sometimes it’s going to be nutrient testing. Sometimes it’s going to be stool testing. Sometimes it’s going to be metal testing. It just depends on when you go through their story, you hear what other symptoms they’re having along with it. Then you think about where do I think is going to be the best bang for my buck.  A lot of times it’s going to be nutrient testing in that case because you’re thinking, maybe there’s a B vitamin deficiency, maybe there’s a D deficiency. Those kinds of things are what goes through my mind with someone with [inaudible 00:39:14].

Dr. Weitz:            Do you have a favorite nutrient panel you like to use?

Dr. Warsh:           I use Genova usually, but they’re-

Dr. Weitz:            [inaudible 00:39:18] NutrEval.

Dr. Warsh:           NutrEval, yes. I like that one. It gives you a lot of information. You get some toxins with it as well. It’s pretty extensive and in general it does a pretty good job of matching up what I’ve seen with other just basic quest or lab quest or lab core workup. It’s not super expensive and generally a lot of insurances will cover at least a portion of it. To me that’s the one I like. They’re easy to use, but there’s a lot of good ones out there.

I think that the bigger key is to think about something that’s going to give you a more broad panel than what you’re going to be able to get from your regular Western lab. I think it’s important to get that a lot of this testing is validated and it’s really good testing, but it’s not something you can necessarily do even from the Western perspective just because… With insurance it’s not medically necessary stuff. They’re not going to cover it. It becomes really risky when you’re trying to run a lot of these tests through your insurance because they usually don’t cover it or they might say they’re going to cover it and then not cover it.

For a lot of my patients, I feel it’s a little safer to say, just go do this test. You know exactly what the cost is going to be and you’re going to get this huge panel. That’s what we do, but not everybody can afford that. Sometimes you just do whatever you can do with [inaudible 00:40:32]. You can do a lot of great stuff through the regular testing too, but you just not going to do nearly as extensive of a workup.

Dr. Weitz:            Right. I think one thing you’re pointing to is this issue with insurance and testing is if you have a patient, you send them to your standard quest or lab core and you do say… You put together say 20 different markers for vitamins and nutrients and they get covered by insurance, fine. If they don’t get covered, the patient could end up having a huge bill. Whereas Genova puts this panel together and say the most it’s going to cost him is 400 bucks and that way you know you’re going to get a lot of info and they’re prepared okay. It’s going to cost me at most 400 bucks. I can handle that or I can’t.

Dr. Warsh:           It’s really important if you’re going to go to your regular pediatrician or regular doctor that you have a discussion about the lab work because it happens all the time where we’ll send… Even just the regular stuff, you send them vitamin D and they won’t cover it. There is… I think people don’t get this. We don’t know. As a doctor, we have no idea what they’re going to cover. You can call them, you can talk to your insurance person. “Oh yes, we’re going to cover it.” Then five months later they send you a bill and say, “Oh, actually by the way, we’re not going to cover it. It’s going to be $1,000 for this one test.” Then the fighting starts.

Usually they can work with the patient and send in a letter or do something with the insurance to fight it and change up the codes or whatever it is. But there is no way, absolutely no way to know. Every insurance is different, every plan is different. Every time it’s different. Basic testing, which should obviously be covered sometimes isn’t covered. It’s just how it is and there’s no way to know that. That’s why when you’re doing these extensive things, as you say, sometimes it’s better just to, if you can afford it just to send the panel because you know exactly what the cost is going to be.

Dr. Weitz:            Right. Great. I think this has been a really good discussion. Any additional thoughts or issues? Is there anything you’re really excited about right now in your field of integrated pediatrics?

Dr. Warsh:           I’m really excited that I think people are starting to become savvy to this and are very interested in learning more about holistic and alternative modalities. Kids are getting sicker and sicker and so people are starting to seek this out on their own. Parents are starting to take health into their own hands and to seek out additional information. I’ve seen this when my practice exploded so quickly. We just opened a new practice where I am, I used to be in Beverly Hills and now I’m over here. People are flocking to this because-

Dr. Weitz:            You’re in Studio City as I mentioned.

Dr. Warsh:           Yes. They’re so excited to be able to discuss alternative modalities. They don’t want just that. Most people don’t want just natural, they want both, but they want someone who’s open to that. The more patients that want it, the more practitioners are going to learn it. To me, I just had a baby and I want him to be healthy and grow up healthy. This is one of the reasons why I’m working on so many other projects on the outside. We’re working on a summit, which is going to be hosted… Well, you can find on integratedpediatrics.com.

We’re working on a wellness care which is basically a course that’s going to go through many different modalities like [inaudible 00:43:56], homeopathy and how those work in with Western medicine and also going through the major conditions, things that we talked about. Like asthma, inflammation and talking about both sides and here’s the Western treatments and here’s some of the alternative treatments and here’s some things you can think about.

Because a lot of parents don’t even know, I could go to a acupuncturist or Chinese medicine doctor for this condition. So just making people think a little bit more about it because if that’s the thought process, I think more Western doctors are going to start to learn this because we need to work as a team. We’re all on the same team, us, chiropractors, acupuncturists. We’re all on the same trying to get kids healthy and adults healthy and hopefully practitioners are going to know where their acupuncture and the yoga studio is as opposed to where their cardiologist is. Right now that’s not the case. We know where our GI referrals are. We know where our allergy referrals are, but you don’t know where your health coach is, where your chiropractor is. If we work together, we’re going to have much healthier patients.

Dr. Weitz:            Just for practitioners out there say who are caught up in our current healthcare system. They’re a pediatrician, they’re taking insurance, racing from room to room, they’d love to talk to their patients about some of this natural stuff. How do you make it work? If you don’t mind talking a little bit about how do you make it work financially? You’re in Los Angeles, there’s a lot of rant, you’re taking insurance. We know insurance is not paying very much. You’re under pressure to see a lot of patients. How do you make it work?

Dr. Warsh:           I think it’s a matter of building up the office in a certain way and using technology to its fullest so that you can cut some of the costs that you have. For me, number one-

Dr. Weitz:            You are a provider for most insurance companies?

Dr. Warsh:           We take the major PPOs. I think the one thing that’s been really helpful is being involved in the American Academy of pediatrics in the background of the business side and seeing what a lot of practitioners do. Just having systems in place. It’s a big conversation so it’s going to be hard to [inaudible 00:46:03].

Dr. Weitz:            I understand.

Dr. Warsh:           But just having systems in place that cut out a lot of the redundancy and having a lot of staff so that way it can keep the costs down to a place where you can do things. I do a lot of other projects on the outside too, so it’s a mix of the two together. Just having other practitioners in here as well. So keeping my costs of rent and things like that down because one of the things that I wanted to do was have a integrative practice actually. So we have a naturopathic doctor in here, a nutritionist in here. A lot of them are renting space from here so it keeps my rent really low.

Dr. Weitz:            Do you charge a concierge fee on top of the insurance?

Dr. Warsh:           We have a small one. A lot of the… Whether it’s an integrative or not, most of the many practices now that are private practice are having some small administrative fee. It’s not a huge thing but these are things that are being charged anyways throughout the year. You’re charging for forms, you’re charging for access after hours, you’re charging for things that insurance doesn’t cover.  Whether integrative or not, most private practices at this point are moving to the hybrid model where they have some small fee that covers the little things. 100 bucks, 300 bucks, whatever it is for the year for the family. It just covers those little things so that families don’t have to come in, 20 bucks for this form and 20 bucks for the vaccine form and 20 bucks for this. They just pay it at the beginning. That gives you a big chunk of… a little chunk of change that can sustain you to buy your supplies and then you don’t have to worry as much. Then the insurance covers the rest.

Dr. Weitz:            Okay, great. How can patients get ahold of you and find out… be able to see you and find out about your programs?

Dr. Warsh:           Sure. You can either go to integrativepediatrics.com. That’s going to be the website we’re working on that right now to get all of these summit and course together, but my website for the office, integrative pediatrics and medicine.

Dr. Weitz:            Okay, great. Thank you, Dr. Warsh.

Dr. Warsh:           Thank you so much for having me. It was a fun time.


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