Ep 266: A Balanced Approach to Healthcare with Integrative Pediatrician Dr. Joel Warsh

Dr. Nicole (00:00): If you like the way I approach pregnancy and birth, then you're going to love this conversation about parenting with pediatrician. Dr. Joel Warsh.

(00:15): Welcome to the All about Pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com / disclaimer. Now let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 266. Whether it is your first time listening or you have been here before, you know I am so glad you're spending some time with me today.

(01:11): Joel Walsh, AKA. Dr. Joel Gator of the Popular Parenting Instagram account. And by popular I mean over 220,000 followers. He's a board certified pediatrician in Los Angeles, California who specializes in parenting, wellness and integrative medicine. He's the author of Parenting at Your Child's Pace, the Integrative Pediatrician's Guide to the first three years, which you can pre-Order now and release this in August. We have a great conversation about ways to approach parenting. We chat about what is integrative medicine, what is integrative parenting, the differences between natural medicine and modern medicine, some frustrations with the US medical system as well as social media and the media in general, how they approach information for parents. We talk about ways parents can apply an integrative parenting approach. We talk about what is a non-toxic home, and then we end with some thoughts on pediatric controversies like cord blood banking, placenta encapsulation, circumcision, co-sleeping and home birth.

(02:23): Dr. Joel has a really balanced common sense approach to pediatrics that centers the needs of families, and I know you are going to find this conversation helpful. Now, before we get into the episode, I want to remind you that I will be doing my live birth plan class coming up soon. Make a birth plan the right way. A birth plan is a great way to help you have the birth that you want and you need to approach making a birth plan in a way that is more than just filling out one of those templates or forms. That is not enough. In my class. I teach you a step-by-step process in order to ask the right questions in your prenatal visits. So at the end you have a birth plan that actually supports the things that you want for your birth. You can register for the next live class at drnicolerankins.com/birth plan. Okay, let's get into the conversation with Dr. Joel Walsh. Well, thank you Dr. Walsh for agreeing to come onto the podcast. I am excited to have you be on the show today. I followed you on social media. I like people who think outside the box, so I'm excited to hear what you have to say.

Dr. Joel (03:36): Thank you so much for having me on. I'm

Dr. Nicole (03:37): Honored. Why don't you start off by telling us a bit about yourself and your work and your family if you'd like.

Dr. Joel (03:42): Sure. So I am an integrated pediatrician. I did all the regular pediatrics training, trained at Children's Hospital Los Angeles, a great program, but I did get a little bit frustrated with the regular system and the super short visits and medications for everything all of the time and giving out medications. Sometimes it felt like it was like candy and it was just kind of left and, and that was really all I had in my toolbox. And so I really decided to start learning a little bit about integrative medicine and natural medicine and that has really led me down this path to learning more about some of the other modalities out there. Also, I met my wife, met my now wife in residency, and that also changed my trajectory I think a little bit too because she is holistic minded and so just seeing some of the way that she lived and kind of her beliefs and really fixing up my diet a little bit, really, I think those two things together really led me down this path of doing integrative medicine.

(04:40): And I always say I'm not against Western medicine at all. I think that's really important to say upfront. I think we have magical, wonderful medications that can save your life if you need to and if you need to go to the emergency department, I'm glad we have MRIs and X-rays. I'm not against any of that. I just think that there's a time and a place, and there are so many other modalities and other potential options that we can use that have been used for centuries and generations. And even here in America. I mean there are a lot of supplements and herbs that actually have a lot of evidence and research that can be beneficial. And so sometimes these can be a great option when there's nothing else to do. So that's kind of my background. And then I started posting things online. I got really interested in it after seeing how much people were interested in it in my office, and I opened up my own practice and people were flocking here and I never had to advertise. And I thought that was really cool. That was surprising. And then after seeing how much people were interested on the line, then that's what led me to write one to write a book because when you're online you can only have small snippets and you can't really dive into things and you can't have conversations. So a book I feel like is a little bit more in depth. And so those are kind of the paths to lead me here. And then well, you did ask about family, so I have two kids. I'm a dad too.

Dr. Nicole (05:51): Alright. All right. I love it. I love it. And you talked about your training. It's always important for me, for my to know people's background and training that they bring to this work. Not that there's anything against people who don't necessarily have formal training, but there is something to be said about taking a serious structured approach to the way we look at information, the way we relay information. So you said you did your residency at Children's Hospital Los Angeles. Did you do any additional training in integrative medicine?

Dr. Joel (06:24): So before residency I actually did a master's in epidemiology in public health. So I did some training in that. And then for integrative medicine, it's kind of all over the place. You don't have to necessarily do any training. I think a lot of the training is self-learning. So I did some programs, I did functional medicine, I've done a bunch of courses, I've read a lot of books. So it's hard, especially with pediatrics, there's really very minimal out there. And so I think that it's a lot of self-learning. And I think that's a big issue in medicine and of itself is that there just isn't a lot of training in some of this stuff. And a lot of it is very common sense. A lot of it is very much like, well, why didn't we talk about that? And integrative medicine, it can get really woo woo, right?

(07:07): It can get really out there. And that is where I completely agree with you that having some formalized training or having a balanced approach to me is really important because just because something is natural doesn't mean it's not dangerous. And just because something is natural doesn't mean there isn't something that you need from the medical world that could save your life. So I do think it is a balance, but I also think that medicine has become out of balance also in this very medicalized system and very quick to treat and very almost arrogant I think sometimes about how it's the only way, and yet there's so many modalities that I use forever. And let's say for kids a great examples like, okay, let's give everybody vitamin D. This is this magical thing we need to give to babies. But then all the other supplements are crazy.

(07:53): That doesn't add up to be. And yes, we want research. I mean, I think research is great and that is helpful to point us in a direction. And a lot of supplements and herbs actually do have a lot of research, but it's also really important for us to recognize that we are in a pharmaceutical model and it takes a lot of money to do clinical trials, and there aren't a lot of people lining up to do a clinical trial on vitamin C. There's no money to be made. And so it doesn't mean that it doesn't work, but it also doesn't mean that it does. And so I think that's where we have to find that balance of the pros and the

Dr. Nicole (08:26): Cons. Yeah, I love that. There's definitely a lot of arrogance, a lot of ego and traditional western medicine superiority complex even to some degree and not a recognition that we can do both. We can pull the best parts of all of it. And we're also very much, and I'm getting a little bit soapboxy, but we're very much symptom management and not undercover, not trying to get to why you're having certain things and if there's some underlying issues that can be addressed. So you don't necessarily need all of these medications. So I think these are all really great points. And I also think it's really important to talk about it in the context of being a pediatrician because this is how it often starts, even from a very young age of some of these things. And when you involve children, you often involve the whole family and helping the whole family get healthy. So along those lines, how do you define integrative medicine and integrative parenting? Also,

Dr. Joel (09:22): I define integrative medicine as the balancing the best of moderate medicine with alternative practices. And then I extended that into integrative parenting because I think that with modern technology, with social media and everything that we're seeing these days, there is so much comparison and so much division and so much anger. And yet there is often no one exact right way to do things, especially when it comes to parenting. I mean, there's certainly some research that can help point you in directions or help give you some good information, but there are very few instances in parenting or pediatrics where there's only one right way all the time. And so for me, I have found that there's just so much division online and it makes it really stressful for parents because grandma says one thing, the internet says the complete opposite thing, then you dunno what to do.

(10:12): And it's like you kind of feel frozen and don't know which way to go. And that's where integrative parenting comes in. You kind of blend those together. You take in all the information and then you figure out what makes the most sense for you. And you don't always know what that is. And that doesn't always exactly follow the guidelines because your family doesn't necessarily follow the guidelines. It's just those kinds of things can help inform you and give you good information to help you make decisions. But it's not always the exact right thing for your family because a guideline doesn't know your family or some practitioner online doesn't know your family. You do. And so that's where we have to synthesize things. And I agree with you, those first few years are so important. That's why I wrote the book for those age ranges, because I really wanted to get to parents early, during pregnancy, early life because we need to set the stage for health and wellness, and I see that we're going in the wrong direction in terms of health.

(11:03): And again, this isn't against medicine at all. I mean, let's say pediatricians, they're good people. These are good people that are taking care of kids and nobody wants to see unhealthy kids. But we have done a lot of good with medicine in terms of, we used to live to, we were like 30 or 40, and now we live for 70. So it's not all bad. There's a lot of good stuff that we've done, but we're also seeing life expectancy go back down. We're seeing chronic disease rates go up. And so I feel like a lot of medicine was built around infectious disease was built around acute illnesses, and we have gotten much better at that, but it was never really built for chronic disease. We have a lot of problems that we never really had before. And so I do think we're a little out of balance and maybe need to come backwards a little bit on some of those things and say, Hey, our parents and grandparents didn't have some of these conditions. They were not getting diagnosed with type two diabetes when they were 15. So maybe there are some things that we're not doing so great that maybe we could come back into balance. Doesn't mean get rid of all of modern medicine, but maybe we need to reframe some of our discussions, our thinking definitely to help our kids and make life expectancy go back up. That's what it's always been until now

Dr. Nicole (12:08): And make it go up back up and live as healthy as you can, not be in a state of just unwellness but alive. You know what I mean? You want to be able to do things and be active and all of those things. So it's really, really important. So what do you define as the difference between natural medicine and modern medicine?

Dr. Joel (12:29): Well, I think that natural medicine draws from all of the other modalities out there in the world and also takes into account a much wider array of options in terms of treatment or support. So I think one part of it is there's a much greater focus on prevention, I would say. I think modern medicine, certainly we talk about it a little bit, but it's not really the focus. Treatment seems to be the focus. You have these symptoms and then here's your medication or your pill.

Dr. Nicole (12:56): And our payment models are very treatment

Dr. Joel (12:58): Focused. Yeah, right, exactly. You need your diagnosis to get treatment as opposed to if you look at almost any of the other philosophies or systems out there, or there's Chinese medicine, Ayurvedic medicine, naturopathic medicine, a lot more is focused on prevention, A lot more is focused on root cause. So I think that is one part of it. And also just having a bigger toolbox, whether that's herbs or supplements or daily practices like meditation or yoga or even homeopathics, whether you believe in it or not, there are just other things that are out there that can be used in your toolbox. And I see it slowly starting to trickle into modern medicine, which is good. I think the best example is acupuncture, right? Because that was pretty woo woo even 20%.

Dr. Nicole (13:39): Oh, very much so, yes,

Dr. Joel (13:42): We had an opioid epidemic and now we're a little smarter about just giving these medications again like candy, and we had to kind of pull back on that. And there's a big void there in terms of pain. And now you see acupuncture, acupressure in almost every hospital, right? It's not woo anymore. We know. So this isn't something new. This was always around, but we didn't really know about it or didn't fall. It's moving in that direction, which is good. Just slowly.

Dr. Nicole (14:06): Yeah, definitely. Definitely. Now you mentioned some of the things that frustrate you about our US medical system. What frustrates you about social media and the way the media approaches giving information to parents?

Dr. Joel (14:18): My biggest frustration over the last few years has been the fear-based model that it seems like social media and the internet and the news really have taken on. It's like you get these really fear-driven headlines constantly. And so it seems like the world is coming to an end all the time, and there's always all these horrible things. Of course there are things to be mindful of and stressful over the world. There are things going on, but oftentimes the headline is way out of proportion to the actual article. If you read the actual article and you read the headline, you're like, that actually has nothing to do with it. Or there's something very clickable. So you click on the headline, but they assume you're not going to read it, and then the actual text, the complete opposite of it. So I think that is very difficult for parents because when we're in this world where there's so much, there's so many things going on that it's hard to grab our attention, there's this push to grab your attention.

(15:11): And so if you're not reading full articles, which nobody has time to do, then you only see the headlines and you start to be nervous and worried about everything. And I think a really good example when it comes to modern medicine and pediatrics has been the discussion around respiratory viruses in the winter time, just the general ones. Because as somebody who worked in the hospital, it's like it's not new that respiratory viruses go up in the winter. That's how it open is. And there's always RSV and there's always all sorts of things, but all of a sudden you just hear about crazy increases in something like RSV in the winter. And again, it's good to be mindful of it if it's way outside of normal, but if flu is going up and RSV is going up and it's December, well that's always how it is and you should know about it, but it doesn't mean that you need to necessarily be worried that the hospital is more full or that is how it is.

(16:02): You're very busy in the winter, I dunno about you, but I mean when I worked at the hospital, it was like the summer, you could clear the board in the emergency room and there's nobody there sometimes. And in the winter everybody's waiting for four hours or eight hours. So that's not new. It's not great. I mean that's good to know, but it shouldn't scare a parent that there's some horrible virus going around that's been around forever when this is the normal. So I just think it's a little bit sometimes about finessing it and not stressing parents about things that we don't need to be stressed about. And I talk about this a lot on social medias. It is good to be aware, it's good to be mindful, it is good to know that there's an uptick in flu, but it doesn't mean that you have to be nervous about it. It just means that you're just aware, so you're more cautious.

Dr. Nicole (16:45): Yeah, definitely. Definitely. It's the same approach I take to maternal mortality. It's really important and it's really something that we have to talk about especially and the disparities, all of those things are really important, but especially black women, I have to remind them, you are likely not going to die while you have a baby. It's actually pretty rare. So although it's important, don't internalize it. That's something that's necessarily going to happen. So we are not minimizing, we're just saying let's just look at it and not let that fear, like you said, overwhelm you.

Dr. Joel (17:15): Yeah, I mean I've definitely seen that in the news as well more, which is good. I mean, it's certainly for African-American, there are increased risks for birth and that's come out in the news in media, which is good, right? That's good. I think we want it to be equal for everybody. There's no reason why the color of your skin or your race or your faith or anything should have any difference on your birth. I mean, of course, or some genetics and things like that. But for the most part it should be the same or pretty close. But that also still, you need to put it into perspective of how minimal your risk is. So there's sometimes where we talk about like, oh, you have 10 times the risk of whatever getting sick with this, but your risk is one in a million still, so you still have more risk to get in a car accident. So I think those are two pieces of information that sometimes don't go together always where we want the headline. That's scary. So you say your risk is so increased, but then realistically you basically have no risk, or there are many things that have you much greater risk of today and you're not thinking about those

Dr. Nicole (18:08): Things. Right, right. I also think social media is frustrating because people, it's just such bite-sized pieces of information. So I hear you about writing a book to get more in depth with things, to try to get people to engage. That's part of why I do a podcast, to try to get people to engage on a more in depth level is important because things can get taken out of context and those little bite-sized pieces, it just really isn't enough to be fully educated.

Dr. Joel (18:35): Oh, no, I agree. I mean I've done lots of podcasts, lots of news, and for the most part I dislike doing the news. I think it's fine, but it's really very difficult to get into any topic in the two or three minutes that you have. I find that yes, I mean the downside of doing a podcast is it takes a long time. So it's like you're doing 50 podcasts, that's a lot of your life to do it. But I think if you want to get a message across and you want to help people, then bite-size, little pieces are not overly helpful and are much easier to get taken out of context. Especially when you're talking about integrative medicine, I feel that it's very quick. People are very quick to give you a label or whatever it is and kind of throw away what you're talking about.

(19:17): And I always find it crazy. There is no reason that there needs to be two sides. This isn't about sides, there's no integrated medicine and modern, there's no such thing. It's health. We should just be figuring out what the best things to do are so we can have healthy kids. If you're going to point me in a direction that says, this is bad for you and this is better, I would be happy to do that. It's just we're supposed to all be working together to figure out what the best things are, and that's what research and science is. But if you label something and you throw it all away, then the kids are the ones that are suffering by not discussing these things.

Dr. Nicole (19:51): Yeah, definitely. Definitely. Alright, well let's get into some practical advice and practical applications about how you approach things. And I thought we would start off by how would you apply an integrative parenting approach to a common problem like having a fussy baby or a crying baby?

Dr. Joel (20:06): Yeah, so if you have a younger baby who is fussy, I think the first thing to think about is you really want to think through some of the more serious things if there is something serious. So you want to kind of put it into context. Is my baby okay? Are they having fevers? Are they sick? Or is there something I'm extremely worried about? And not usually right? Usually it's regular baby fussiness. So of course if you're very worried about something, then you go to the emergency department, you call your doctor, that would not change. But in general, for a regular fussy baby, then you want to think, okay, what could be the potential causes? What age are they? What are the things that could be going on? So it could be colic, could it be teething? Are they not feeling great? Are they hungry? Are they sleeping?

(20:46): I it's thinking through that root cause of what's going on because again, sometimes it's very, if you go to your doctor and you say, oh, they're a fussy, then they might give you medication and that might not be the thing that they need. Maybe they're sensitive to their formula, maybe they're sensitive, something in your milk. So just having that discussion, thinking it through, thinking of the different options and also thinking through how serious something is to give yourself some time. And then using that integrator approach again, we'll start with the most benign in terms of what you can try and then work up to a medication. So I would always use a medication as a last resort. Sometimes something is serious and you would do it, but to me, I would start with maybe some herbs. You could start with camal tea, you could start with grapee water, you could start with colic, calm or other things like that. So there are a lot of mild options with very minimal risk of side effects. And then of course if it gets worse, then we might have to do some medical workup or things like that. So I think it's just thinking about the whole picture and bringing in multiple different options as opposed to let's say rash, right? It's like what's the rash? Okay, let's do steroids. Right? Okay, but why

(21:55): Did you just touch something?

Dr. Nicole (21:57): What

Dr. Joel (21:57): Happened? Something? And that's not to say that medicine doesn't ever think about those things, but a lot of times you don't spend that kind of time to really think

Dr. Nicole (22:05): It through. Yeah, I agree. We definitely have a lot of symptom cover up without trying to figure out why so that things don't happen again. And so that maybe you can change things that it doesn't come back. Now I'm really interested to hear what you mean by a non-toxic home.

Dr. Joel (22:22): To me, one of the most important things. So let's step back actually. So I think for me, some of the most important modifiable life risk factors for our health, I think the two big ones are diet and toxins. I think that we're not eating very healthy these days. Even in the best case scenario, our food is mass produced, there's a lot of chemicals, they're sprayed in a lot of things. You're eating things that are preservatives, so we don't get the nutrients that we need. And then you add to that all the chemicals and the toxins that we're exposed to in our water, in the air, in our homes. And so to me, the best thing that we can do, the most important thing that we can do as parents is to figure out, well, what are the small things that we can change to make little differences that will add up? And one of those big areas is our home where we spend so much time and within reason and within your budget, there are a lot of things that you can do to make small changes in your home. So again, you can't change the air that you breathe out there, but you can put plants in your home, you can get an air filter. So those are small changes. You can't change the water in the pipes, but you can get a water filter.

(23:31): You are still maybe going to use some products, so maybe you can buy cleaners or you can buy sunscreens or you can buy makeup or whatever using that are nontoxic or have lower chemicals. All these things are possible for reading labels and just thinking these things and adds, it makes a big difference. And there's a great study, I don't know if you know the Harvard Soup Study. It's a really cool one. So what they did was they took a bunch of patients and they gave them five days of canned soup, and then they gave those same patients five days of homemade soup and they were looking at BPA levels in the urine and there's BPA lining in the canned soup. So they were getting an ingestion of BPA for those couple of days. And the difference between five days of canned soup versus homemade soup was a thousand percent difference in the urine.

(24:16): Oh my god. And I just thought that was such a brilliant, very simple study because it really illustrates the point that a little change can make a big difference. A little bit of BPA is not going to be the end in the world. No, probably not. But if you're eating that soup every single day, that's one chemical that adds up over years. Then what about every other chemical? So if we do make these little changes, it matters. I think it really does. And your body is, we we're very lucky. We have amazing bodies and we can detoxify most things. We have fantastic livers and kidneys and we poop and pee and sweat. We can get most stuff out, but at some point it's too much for everybody. And I think that is one of the big problems that we're facing today is that it's too much for most people.

(25:00): It's too much for the kids. There are too many toxins. We're just exposed to things that we can no longer handle and then it just overflows. And then at some point it expresses itself at whatever condition, whether it's diabetes or a mental health concern or an autoimmune condition, whatever it is, yes, of course are genetic conditions that have nothing to do with that or minimally to do that. But I think a lot of what we're seeing, especially with chronic disease, is this overflowing. There's too many chemicals and not enough nutrients and it just leads to these conditions. And I feel that way because you definitely see patients go to practitioners that go outside the regular model that work on changing up a lifestyle, eating healthier, exercising more, and some of those conditions go away. And that maybe seemed more like woo back in the day, but I don't know why.

(25:44): We know that with diabetes, you take type two diabetes and you have two conditions. You have type one, a little more genetically involved, and then you have type two, which is a little bit more lifestyle involved, and it's not out there to say, oh, we need to exercise more. We change our diet, and you see that diagnosis go away. I think that's probably true of a lot of conditions that we see where some of it is very genetically driven and then another portion of it is very lifestyle driven. And if we do make those changes, those conditions will go away. But even if not, I mean if you eat healthier, it's going to help everybody, right? There's no downside to that.

Dr. Nicole (26:18): Definitely. Definitely. Yeah. I think the concept that food is medicine in a way, it's one of the first things that we put into our body and the long list of chemicals on processed food. I don't think any of us are saying you never eat potato chips again or whatever. But things have to be done in moderation. And I am not a conspiracy theorist or anything like that, but we also have to realize that there's not really an incentive to prove that those chemicals and things are bad for us because that's going to hurt sales, that's going to open up people to lawsuits, all of those kinds of things. And it's very hard to argue with the fact that the more natural things are or the closer to the ground with less chemicals, it is just better for you also. What are your thoughts on, I think sometimes people think it's really complicated to cook meals every day or to have natural foods. I actually don't think it's that hard. It does take some planning and I think things are less expensive. You can find more generic organic thing. So what are your thoughts on trying to implement those things into your daily life or even just moving your body, it doesn't even have to be sweaty, just get your body up and moving kind of things.

Dr. Joel (27:34): You made a lot of great points there. So first of all, I agree with everything you said a hundred percent. I think that is so wise, and that is the message that I try to echo. The two biggest excuses that we all hear or we all have really is it costs too much or I don't have the time. And trust me, I get it. I'm busy too. We're all busy and we all are. Wherever we are with our finances, I totally get that. But at the same time, we see what the numbers are. They're not good. Chronic disease is going in the wrong direction. Like 50% of kids or so have a chronic disease. And so everybody can do whatever they want to do in terms of taking care of their own family, but if we live the same way that everybody else is living, we're going to see these same diseases pop up and the numbers are what they are.

(28:17): So if you don't want that in your family, then we have to do something different. And so it really does mean making it a priority. And it does take a little bit more time to cook, but it's important. It's something that's really, really important. And I really try to focus on not overwhelming parents and not saying that you have to do everything because you absolutely don't. Wherever you are, just move the needle forward. That's it. Just move in a little bit better direction. If you never cook, cook one meal. If you cook a meal or two a week, cook two or three. If you are buying something that's you, like your kids love chicken nuggets, okay, we'll try to make those chicken nuggets. Each step can move in the right direction. Just like you said, we don't have to never eat chips again, I don't believe in that.

(28:58): I think that we need to do things in moderation and that's fine. And you go to a party, you have a piece of cake, so be it. But if you're controlling most of the food and most of the prep 99% of the time, then you, you're getting that good food. Most of the time you eat a piece of cake and every now and again, that's not the end of the world. And you're also not going to have kids that go out in the world that have never experienced it and then are the ones in school that are training their lunches every day for all the stuff you don't want to do. So I think it's good to do both. I agree. But yeah, I think it is very important and yeah, I agree totally. It does not have to be more expensive. It can be.

(29:30): Sometimes it is. Of course it is. And sometimes we have to prioritize that the best that we can. But if you are mindful, I mean you can order things directly from farmers and you can order farmers' boxes. You don't always have as much choice, but it can be cheaper. You cut out the middleman. And I talk about very often people ask me, what is the one thing I could do today to make the biggest difference? And I think it's to start reading labels. I think that is something that everybody can do. Or everything that you buy from now on, you just read the label. You don't need a PhD in biochemistry or something to understand everything on the label. If it's a long word that you don't know what it is, it's probably not good for you. You avoid that thing. If it has real words, then you're going in a better direction. And you don't have to go from cookies or chips to broccoli. You can look at two bags of chips in the same mile. Maybe they're the same price and look at the ingredients and pick the one that has the words. You actually know what they

Dr. Nicole (30:22): Are. Potatoes and

Dr. Joel (30:23): Salt,

(30:24): Right, exactly. And then start working your way up. And then once you start doing that, then you start to become mindful, oh my goodness, I'm buying this thing and there's 20 grams of sugar in there. I don't want that. Right? So then you start to just buy the things that are better. And then you do start to learn about, oh, this had this chemical. I wonder what that is. Oh wow. I don't want that at all. It's not rocket science. Sometimes it takes a little learning, but you start to learn and you become a more savvy consumer. And again, those things add up every little bit. If you are, you're eating the better bag of chips for the next five years, that makes a difference. It really does. Even if it's still chips, it's still the better version and every little bit adds up. Every little decision makes a

Dr. Nicole (31:03): Difference. Yeah, definitely. Definitely. It's funny, my mom, she says that she grew up, they grew up poor because her grandmother used to, they used to raise chickens and her grandmother would just go out and ring a chicken's neck and then just cook the chicken. And then she realized actually that's what helps keep people healthy. They were just eating literally what was in their backyard. So if we can get back to that, then it can definitely make a difference

Dr. Joel (31:28): Or at least some sort of mixture. I think that when our parents and grandparents grew up, we moved from just like you said, it was more local and people had their own food and there were local farms and that kind of stuff. And then we moved to convenience and cheaper. And that can be good. Sometimes, I mean cheaper and I mean it is good, but you lose something for that. And that is health. And now we have moved so far to convenience and we're so removed from our food, and you cannot mass produce something that is very healthy. It's not possible. It can be healthier, but you lose something if it's not grown properly. It has to be sprayed, lot of chemicals. It has to be shipped across the world. It's like if you pick a berry off, if you have a bush at home, like a raspberry or something, if you pick it off that bush, how long does it last?

(32:14): Two, three, maybe four days. You think the berry that's in your grocery store was picked two days ago? It was picked in some other country, flown across the world, went to some warehouse, then went to your store, then you picked up, then you ate it. It has to be sprayed in all sorts of stuff. We don't think about it, but it just has to. So we have to get back to on a bigger scale, I think local produce and having that as an option, and that's a bigger issue. But for our families, I think the issue is just focusing on getting the healthier products that you can get. Farmer's markets, get to know some farmers if you can at the farmer's market, buy real food whenever you can cook. Humility and parenting too. I mean, not all of us are the best cooks,

Dr. Nicole (32:55): So

Dr. Joel (32:56): We didn't learn so much about cooking, so take some time or watch YouTubes or whatever. There's available information. But I think it is funny sometimes you think that your kids won't eat something, but maybe you just don't prepare very well.

Dr. Nicole (33:07): And I think we also don't give kids enough credit for being able to try different things. My husband and I took the approach that we have two girls are teenagers now y'all are going to eat what we eat. And we've always been, thankfully more of a cooking kind of. But we also different foods. We like Indian, we like spice, we and from younger ages, they would eat those things. They eat vegetables. We never said like, oh, you have to eat your vegetables. It was like, this is what we have to eat and this is what you're going to eat. So you don't have to make a big deal about it or anything. Just incorporate it as a natural part of your family and how you approach food. I think children, if you give them more credit, you can offer them more than chicken nuggets and they'll give it a try. They're not going to be harmed by something that's a little more adult in terms of eating.

Dr. Joel (33:59): Yeah, we did the same thing. I mean, we've never done that. They always eat what we eat. That's just how it's been. I mean, even from the beginning, if we were eating something then it was mushy. That's what it was. But it, there's no special food, special meals for our kids or well, our older one. And he eats everything and he eats as well as anybody. And it's never been an issue. It's never been in discussion. I'm sure there's a couple of things he doesn't love, but he tries everything. He'll eat basically what I eat and I eat what my wife eats, which is quite healthy. I feel very lucky to met her. She's a very good cook. And you really do realize how much of a difference it makes by the way you prepare things and what you expose kids to. There are just so many examples of my life for a great example is when my dad came to visit and he's not the healthiest eater and never really was.

(34:47): And he's certainly come around, but we have these kale chips at this location that we go and at Air one, I dunno if you know Air one, we have it here in California, and they make things like really small batch and they really did. And he ate these things. It's like, oh, this is what the kale chip tastes like. If I had this at home, I would eat that. It's like, it sounds so crazy, but it's not the kale chip. It's the way that it's prepared. And if you prepare it well in this way that you like it, then it's not like you're depriving yourself of something or not having a snack. You're like, oh, I like this and this is pretty healthy. Well of course I'll eat that then why wouldn't I? Most people are like that. They just want something to taste good. And most of the healthy stuff doesn't taste good unless you learn how to prepare it properly or you get it

Dr. Nicole (35:32): From properly. Exactly. Spices and things are your friend,

Dr. Joel (35:37): But

(35:37): A lot of people didn't learn to cook. We just didn't our generations.

Dr. Nicole (35:41): Yeah, I agree. And I will say my husband, I'm in this similar situation, married to someone who's a very good cook, but I also, sometimes you just have to put yourself out there and just do things. Sometimes there'll be a big miss sometimes. I've made some things, I've made this kale pesto and my children were like, don't ever make this again, kind of thing. So sometimes you'll try and it'll be terrible, but a lot of times you just find the recipe, there's 50,000 online. Just try it. Go for it. If

Dr. Joel (36:06): You're trying something, nobody gets it right the first time. For most things, they don't, don't care. I mean it's also funny too, you make it and you're like, ah, that's no good.

(36:15): Sorry guys.

Dr. Nicole (36:16): Exactly. Didn't work. Alright, so I thought we would finish up with just talking about a few things where you say maybe you have different opinions or hearing your opinions about some things, especially related to around the pregnancy newborn area. So what are your thoughts on cord blood banking,

Dr. Joel (36:32): Core blood banking? So I think that's a great interesting topic because there's a lot of discussion on it these days, but to me at least all the research I've seen, for the most part it's very theoretical still. Certainly if you have one child that has a condition that can treat them, that that's really the main use case that I've seen at this point. But a lot of it is very theoretical in terms of possible benefits in the future. And we don't even know if that's ever going to happen or even if you're storing it, it'll be useful. So to me, I think that there's no downside to doing it, it's just the cost. So if somebody has the finances and they really want to, I think you can go for it. But I don't personally recommend it. I didn't do it. I think that the benefits are probably likely to be pretty minimal and to be, if anything, the best benefit would be to donate. That's what we did. You can always donate and then they can use it for research or use it for someone that needs it. And a lot of the actual benefits come from donation. So to me that seems like a happy medium. But of course if you want to do it, go

Dr. Nicole (37:30): For it. Yeah, I agree. So it's actually very unlikely that you'll be able to use it. And the New York Times just did a big article so they're finding so many are contaminated and those kinds of things. So it's just if you can find a public bank then that's great. If not, then you can spend your money how you want, but you're probably not going to get much of a return on it. That's my theory. Yeah, yeah. What about placenta encapsulation?

Dr. Joel (37:54): So placenta encapsulation also very interesting kind of newish phenomenon. I would say based on some celebrities that have posted about it or talked about it, I have read and I have seen, I heard from people that they feel like it does help them, but the research doesn't really show that anything that I've seen, the research is pretty neutral on it and doesn't really show a lot of benefit. So I think that's useful to know. Again, if somebody wants to do it, go for it. If it's helped you in the past, I think that's fine, but I would not expect it to be helpful based on what I've heard from most people. Most people say it didn't really help them that I have spoken to that tried it, the theory, there are other animals that eat their placenta, so that is where it has come from.

(38:35): But they eat it raw usually. And so we don't really do that. I would wonder if, I dunno if who's going to sign up for this study, but I would wonder if people actually did eat it raw, if there theoretically could be some benefit there. I don't know. But to me, I would also think that there would be more potential in very specific circumstances. So I think it's worthwhile to do research. People definitely state that it has helped them in terms of their mood or postpartum. So maybe if you're a more susceptible individual to that or you've had it in the past or maybe you have some nutrient deficiencies that it could help that maybe those could be some good use cases for it. But at least in general, based on my research, I have not seen it really listed as a huge benefit. And so I tell people again, if you want to do it, go for it, but I don't think you need to.

Dr. Nicole (39:21): Yeah, and I agree there's not much evidence that it helps in the evidence around harm is maybe a couple of case studies where people had GBS and then they ingested that and then somehow the baby got GBS, which wasn't the newborn, got it through maybe breastfeeding, that kind of thing. But I appreciate that we're able to just discuss it because sometimes people get very, in the medical profession, we get very judgy and angry and why did you do something like that? And I think it's important to help people understand so we can have a conversation because if you have an infection for instance, then you probably shouldn't do placenta encapsulation because you're going to be ingesting those same bacteria, things like that so that we can just help people make choices in a nonjudgmental way.

Dr. Joel (40:14): What are your thoughts around home birth? Because that's a discussion that comes up a lot.

Dr. Nicole (40:17): Yeah, that's on my list to ask. So I don't have, home birth is a great option. It is safe for people who are low risk and don't have medical problems done with a trained provider and also with good backup plans in place. I personally have gone out to birth centers, home births in the community, sat with them. We serve as a backup place where they can bring people if need be. It's a seamless kind of transition. So if you are informed and you are a good candidate, and then I don't have a problem with home birth and actually we should be supporting home birth as a profession because, and I can get on a soapbox about this, but when we talk about best outcomes in terms of health, we should really support it, whether it's home birth, birth center, hospital, an integrated collaborative system with physicians and midwives that centers the needs of the person giving birth to help them have the breast experience. So what are your thoughts about home birth?

Dr. Joel (41:15): Yeah, it's one of the most interesting topics that I have learned as a pediatrician since I've started where my thoughts were around it to where they are now is so different because you are learned to be scared of it in residency. It is really weird to me that you're kind of trained around it being very woo woo and out there, and this is for people that don't care about medicine and all these things that you would hear. And even coming into practice and seeing it over the last decade, very few pediatricians will take care of a patient who does a home birth. They're scared of it, they won't do it. They'll kind of, yeah, a lot of pediatrician won't take a patient does a home birth, they won't see them for a few weeks or a month there. They won't. I mean, I've taken care of a good chunk of patients that just for one time because their doctor just doesn't want to, wants the mom see them and they're afraid that they didn't do all the hospital stuff and so therefore they don't want to take their responsibility on it.

(42:09): Which again, to me is very interesting because once you really do learn about home birth and you do look at the stats, it is very clear that it's actually safer in many instances. Just like you said, you said it perfectly. And that's what I tell people too is if you have a uncomplicated birth and there are no known issues, then at least as safe if not safer on almost everything I've seen to do a home birth. So there shouldn't necessarily be any concerns as long as the person's trained, as long as you can get transferred and as long as you are aware that you might get transferred. Because that to me is not for a parent. You're mid labor and you're like, all right, well we need to send you the hospital and now you're mid labor, not an ideal time to do it, but if they're trained then they'll send you and that's fine.

(42:51): So I have never seen a problem with a home birth. I've never seen to be an issue. People love it. Yes, some people have been sent to the hospital. That certainly happens and it happens a good chunk of the time. So it, it's not maybe 10% of the time or I don't know what it is, but I've definitely seen it around those numbers for my own patients. But I think it is a mistake in medicine to be afraid of this population. I think it's weird if we're on the way to the hospital and you couldn't make it there and you had the baby and everything was okay, the doctor would be okay with that. But if you had a home birth with a trained professional, then they wouldn't necessarily be okay with that. That doesn't add up to me. So I think that there's just a lot of, whatever you want to call it, just fear misinformation around home birth and the stats don't actually prove that.

(43:42): So I think that's something that could be very useful for a lot of families, especially if they're more holistic minded, natural minded, or want to just avoid the craziness of the hospital. And there's a lot of good in the hospital, but we had our babies in the hospital and there's a lot of beeping and a lot of people and a lot of checking and a lot of pokes. And if you're not interested in that, if you have a low risk birth, then it's totally reasonable I think to do a home birth or a birth center

Dr. Nicole (44:04): Or something like that. Yeah, I agree. And then we have to also support lower intervention hospital birth. So if people want to come to the hospital that we're not poking and prodding and we're just kind of letting things happen and are available if needed as well. So definitely important. Now what do you think about circumcision?

Dr. Joel (44:24): It's a very interesting topic, right? Because I had no idea it was controversial. I dunno if you've ever posted about it.

Dr. Nicole (44:31): Yes,

Dr. Joel (44:32): I first did. It went crazy. I did not know that people were so angry about it. And to me it's always been, and it still is, it's personal choice. I think the medical literature is pretty established at this point that there's really not a huge medical benefit. I mean very little in terms of urine infections and little other things and rashes, but the risk already with those things is quite low. So medically speaking, there's not a huge reason to do it. The trend has been moving away from doing it. So I think it's still like 60 40 something in that range. So 60% do it 40%. But to me, if you want to do it for your religious reasons, if you want to do it because you want to do it, if you want to do it because dad has it, then that's totally fine.

(45:12): If you don't, then you don't. And to me, that's fine. I don't know that that's that controversial, but I am aware of the controversies and I'm mindful of it and I get that some people are very against it because they feel like the child should be the one to decide or it shouldn't be done to children. So I get that side of things. So I think that's more your personal beliefs, personal choice, but I also think that a lot of people want to do it and it's religious belief and so it should be an option that you do if you want to.

Dr. Nicole (45:38): Yeah, I definitely, and my thinking overall of this has evolved and similar kind of way. I did my residency training and it was very medicalized and this is what you do and God forbid you have a birth plan, that kind of thing. And I've gone quite a bit away from that. But circumcision is an area where I changed as well, mostly because I don't do them anymore because the autonomy issue just gets to me about being able to make choices over what's happening in your body. But if someone wants it, I say you can go see someone else, but I personally don't do it anymore. Yeah, yeah. Alright. And then the last one I thought we talked about is co-sleeping because that's a big one.

Dr. Joel (46:19): Yeah, co-sleeping. Again, maybe the most interesting topic in pediatrics in terms of what people actually don't listen to their doctors about. Because if you look at the research or you look at the articles written about it, it is the most lied about topic in medicine.

Dr. Nicole (46:37): It's the

Dr. Joel (46:37): Most topic in medicine, which is so interesting to be, you look at the research and 70 to 90% in most studies say they do some co-sleeping. I feel like basically everybody does at some point. And that is where one of the places where I feel like modern medicine or guidelines kind of fails people because it make them stressed out based on the guidelines and they don't take into account reality and they don't talk about what people are actually doing. And I understand sids, right? I understand Sid infant test syndrome. I understand we want to prevent that. There's no question about it. And we have done fantastic research to show what the safest position for sleep is. So that's not really questionable at this point. Back on your back in your own space, that's going to decrease your risk of sin death syndrome. But we also need to talk about what people are actually doing.

(47:23): And if 90% of people are co-sleeping, then it is also important to say, okay, we understand that you have this risk, but if you are going to do this, here's how we can still minimize that risk. And we have lots of good research on that too. We know that if you're on a soft surface like a couch, that increases your risk a lot. We know that if you're under the influence, a sedative medication or alcohol or drugs, and that's going to increase your risk a lot. So it's also important to say, but if you co-sleeping, you have a little bit higher risk of Sinin ES syndrome. Still not very big, but it's there. And if you're drinking that night, maybe that's not the best night to be co-sleeping. So let's minimize those risks. And that to me is a more realistic discussion because at the end of the day, we're not supposed to be telling people what to do.

(48:06): We're supposed to be informing them to help them make the best decisions. And everything has some risks. And it is also very hard to quantify a lot of things. And when you're talking about co-sleeping, there's a bonding aspect to it. There's the family sleep, the baby sleep, your own sleep. Sometimes we're all sleeping better if we're co-sleeping. And maybe that's a net positive in terms of our mental health. So that's not really taken down. It's just the sun impedes syndrome really. And I think if a parent is aware that if you're going to cos sleep, it increases your risk by a little bit and you're okay with that, or that's what has to be for you, then you at least can discuss it. And so we can also open up the discussion to say, yeah, well don't drink. And cos I think that's a useful thing to know because then you do still decrease most of your risk and the risk is small. So to me it's with guidelines, sometimes we don't take into account reality. It's very medical and that makes parents very nervous and then they don't want to share about it, and we don't want to share about something that basically every parent is doing that makes no sense. That means there's a mistake somewhere in the PR team of medicine. And then we need to fix

Dr. Nicole (49:07): That. Definitely. Definitely. So then as we wrap up, I ask my guests all these questions. What is the most frustrating part of your work?

Dr. Joel (49:14): The most frustrating part of my work is I would say two things. Number one, dealing with insurance or the paperwork or all that stuff. That's very, very annoying. And just, it kind of gets in between all of the reality of what the good part of medicine should be between doctors and patients. It's like a lot of the anger in any family is around billing or other things have nothing to do with us, but they get mad at us. That's one part. And I thing, I think the division just in general overall with everything, the anger, the fighting, and having two sides on every issue, instead of being more balanced, there's a lot of fighting out there. Anything I post no matter what. And it's like I am just here to open up conversation and I don't have all the answers to things. But if we can't even talk about things, if we censor things like if we co-sleeping, it's, we can't talk about it, then how are we going to help save kids? If someone's going to do it and they weren't willing to talk about it, then we can't actually help them. Versus having an open discussion about all these things and then letting people make a decision. So yeah, I think it's those two things that are the most frustrating for me right

Dr. Nicole (50:21): Now. And then on the flip side, what's the most rewarding part of your work?

Dr. Joel (50:25): The most rewarding part is seeing kids healthy and happy. Seeing a practice where I very rarely have to give them medication. I very rarely see a chronic disease. And just seeing how many people are so interested in health and wellness, and I think we're moving that direction. So I do see a big positive in terms of the direction that we're moving, but I think it's a slow process and hopefully we'll continue to move

Dr. Nicole (50:50): In that direction. Yeah, definitely. Definitely. And then what is your one favorite piece of advice that you would give to expectant moms expectant families?

Dr. Joel (50:57): So we talked about the labels already, so I'll say that we can do it. Oh, I, that's the thing

(51:06): That a lot of parents don't realize. Even if me as a pediatrician, people are like, oh, it might be so nice. Your pediatrician is going to be great to be a dad. You know how to do everything. I'm like, no, being a, not just has nothing to do with being a parent, but a little bit, right? But realistically, we all feel nervous, but yet no one's ever done it until they've done it. We all figure it out. It's this circular thing where you figure it out as you go, you learn your kid, and then you do what works for them. And so we don't need to know everything, but we are going to be able to do it. And so have that confidence in your inner gut that you're going to do the right thing and we really

Dr. Nicole (51:37): Will. I love that. I love that. So where can people find you? Please tell us about your book and the things that you offer.

Dr. Joel (51:42): Sure. You can find me on Instagram or X Dr. Joel Gator, or you could grab the book Parenting at Your Child's Pace. You can get that on everywhere. Books are sold, Amazon, wherever, or you can go to parenting at your child's pace.com and you can grab the book from

Dr. Nicole (51:58): There. Okay, awesome. Thank you so much for agreeing to come onto the podcast. This was a really helpful conversation. I know folks are going to love it.

Dr. Joel (52:04): Thank you for having me on.

Dr. Nicole (52:11): Wasn't that a great conversation? We definitely have a similar approach to the way we practice medicine, and I really appreciate him coming on to talk about his work. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes. Here are my Dr. Nicole's notes from my conversation with Dr. Walsh. Number one, the way that he spoke about approaching medicine, this is really how all medicine should be practiced, whether it's OB, GYN, whether it's pediatrics, whether it's general internal medicine, whatever it is, it should be a balanced approach where we are open to incorporating non-Western based elements that are effective. And we should be about helping people make the best decisions for their own unique circumstances by providing unbiased information. That is the type of doctor or midwife or nurse practitioner or physician assistant, whatever you see, that is what you should be looking for in your healthcare.

(53:14): This is how all medicine should be practiced. Number two, I want to reiterate that really, I promise you, little changes can help do what you can within your means to make improvements in your health. Move your body just a little bit more than you did the day before. Change one thing in your diet from something that's less healthy to something that's more healthy. Those little changes add up over time. And also don't beat yourself up. If you have some slip backs, you just pick yourself up and you start back over again. That's a normal part of life. But those little changes can definitely help. For sure. For sure, for sure. And then the last thing I want to say is pregnancy and having a baby, this is a great time to start making changes towards better health. There's an old Chinese proverb that says, the best time to plant a tree was 20 years ago.

(54:14): The second best time is now. And I take that to mean that yes, ideally you want to be in as healthy state as you can before you get into pregnancy and want to have years of healthy living and healthy life, but maybe that just didn't happen for you. So the second best time to start making changes is right now, I want you to commit right now to making one change in your health and hold yourself accountable for it. You can hold yourself accountable for it. You can send me a DM about whatever change it is that you're going to make in your health. Maybe you're going to start meditating. I have a great guide that can help you get started, dr nicole rankins.com/meditate. Or you can check out apps like Calm or Headspace. Maybe you're going to start going for a walk. I mean, be careful, stay hydrated because it's really, really hot.

(55:01): But maybe you start going for a walk. Maybe you do prenatal yoga videos on YouTube, or maybe you just do some simple stretches, but now is the time to make a commitment to that change. Or maybe you decide to cook a meal. All of those things are small things that you can try that over time can add up and make a big difference. So although the next best time to plant a tree was 20 years ago, the second best time is now. So commit to doing something now and lemme know about it. Shoot me that dm. I'm on Instagram at Dr. Nicole Rankins. I will be waiting to hear from you. Okay, so there you have it. Please share this podcast with a friend. Subscribe to the podcast wherever you're listening to me right now. Leave me a review, an Apple podcast. I love to hear what you think about the show. I also do shout outs from those reviews from time to time. Also, come join me in my next free live class. Make a birth plan the right way. That's drnicolerankins.com/birth plan. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.