Addressing the root cause of our children’s physical and mental health challenges, rather than just treating the symptoms, can allow the human body to function as it should and positively impact energy, mood, and overall feelings of wellness.

Joining me to discuss the benefits of taking a holistic and integrative approach to pediatric medicine is Dr. Pejman Katiraei, a board-certified pediatrician and the co-founder of WholisticMinds.

We’ll explore how physiological and environmental factors like mold, Lyme, and other toxins can impact children’s bodies leading to behavioral issues, and what this understanding means for the diagnosis and treatment in children of things like autism, ADHD, OCD, anxiety, depression, and more.

Dr. Pejman (00:00:00):

There’s so much good we can do. And ultimately for me it’s like how many people can we help? How many lives can we change? How many kids could we give a brighter future for and help them be the happiest, healthiest person they could be?

Dr. Sarah (00:00:18):

How do we address some of the most common physiological and environmental issues that can be preventing our children from being able to truly thrive? When I’m working with families, the first place I always start is by zooming out and looking at the full picture and really thinking holistically about why a child might exhibit certain behaviors. But how do other disciplines like the field of medicine approach searching for that root cause? And how can we learn from this practice to inform our parenting? I am thrilled to have Dr. Pejman Katiraei on the podcast today. Dr. K is one of the most highly trained integrative pediatricians in the country, and he’s focused on helping children with learning and behavioral challenges. Dr. K is the founder of WholisticMinds, and we are going to learn all about the incredible work that he’s doing today. My conversation with Dr. K absolutely had my mind spinning in a good way, and I cannot wait for you to hear it.

(00:01:13):

Hi, I am Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights so you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(00:01:51):

Hey everybody. So today we have a guest that’s a little different from some of the guests we’ve had on in the past. This is going to be a really interesting conversation. I’m really, really excited to dive in. Our guest today is Dr. K. You have so many interesting and very, very, very useful ways of working with families, and so can you first of all just Hi, welcome.

Dr. Pejman (00:02:14):

Hello.

Dr. Sarah (00:02:15):

Hello. Can you tell us a little bit about what you do as a pediatrician and why the work you do as a pediatrician is different than perhaps what most people think of in pediatrics generally?

Dr. Pejman (00:02:29):

So everything that happens in a child or in the human body happens for a reason. There’s always a reason for everything. And in medicine, there are so many times that we just say, well, that’s normal, except it’s not right. But we call it normal, we don’t know what else to call it, right? The kid who can’t have their hair washed because they’re so sensitive, the kid who has tantrums that last 30 minutes, when you dissect things down, there’s all kinds of that happen that are, we can say, not optimal. You can see there’s something, and the parents in their heart always know like, Hey, this is weird. There’s that feeling in the parent’s heart that says, you know what? There’s something about my child that’s just not right, right? It’s not impending disaster, I c U kind of thing. And that’s the difference in medicine.

(00:03:21):

Doctors are taught to, if the child is about to die and end up in the ICU call that abnormal and anything outside of that is normal. My practice is everything outside of impending disaster and really dissecting down why do these odd things happen that cause kids to experience the world the way they do? That’s not optimal, right? That’s not what you see as the child that’s full of vitality and full of joy and is just, they’re just thriving in every regard. And all parents know in their heart, you know what? My kid is healthy. Thank God my kid is doing well. It’s not a disaster, but God, there is that one thing or few things about him or her that just doesn’t feel right to me. And that’s really where my practice kind of gets into the heart of dissecting down these little things and explaining why these little things happen. And then more importantly, taking actions to address those things so the kid could be optimally healthy, God willing, forever.

Dr. Sarah (00:04:27):

Got it. You are in the field of holistic and integrative medicine, functional medicine. If parents aren’t familiar with that field of pediatric medicine, how would you define it as different from the wellness visits that they have with their primary care provider who’s a pediatrician?

Dr. Pejman (00:04:48):

That’s a pretty awesome question. So the analogy I’ve given to parents is it’s like you hire a contractor and one contractor shows up with three tools. They’ve got the screw, they’ve got the drill and saw, and then there’s another contractor that shows up with a hundred tools, and chances are the contractor that has the a hundred tools will have an easier job addressing whatever issues there. I look at my practice of pediatrics as the more tools you have and the more ways you are able to see a problem, chances are the better off you are in address understanding and addressing the issue. And it’s weird to me that in pediatrics, we just clinging on to this model of allopathic medicine, right? Pharmaceuticals are king. Pharmaceuticals address everything, and the medical model is perfect. And when you just stand back, you kind of just very logically you say, well, God, that’s kind of strange.

(00:05:50):

So you’re saying that all of these other models of medicine, some of which have been around for thousands of you, right? Chinese medicine, Ayurveda osteopathy, has been around much longer than allopathic medicine, some of these medical models. So you’re saying all of these are useless because this conventional medical model is all that there is. And when you just look at it from that simple perspective, you say, well, that’s strange. My practice has been essentially to embrace everything because what I have learned over time is there is no perfect system. Every system has its weaknesses, every system, even functional medicine, there are flaws in functional medicine, there are flaws in osteopathic medicine. Every system has a flaw. Now, when you start piecing all of the medical models together, so it’s like coming in with 15 different lenses, and you look at one lens, you’re like, eh, that doesn’t make the picture clear. Put it on another lens that’s still not clear. Third lens, oh, now I can see it. That’s kind of my approach. And what I’ve done over the years is just accumulate more lenses so I can look at problems from different lenses to say, well, that’s not, no, that doesn’t click. Oh, but look at this one. Oh, yeah, now the picture makes sense.

Dr. Sarah (00:07:06):

Yeah, that’s really interesting because I don’t know how much we’ve ever been able to talk about the psychology piece of things, but there’s a real parallel to that in the practice of psychotherapy and psychology and mental health because I have a very integrative, and I’ve never put together the correlation between integrative medicine and our integrative approach to psychology that we do in our practice, but it’s very similar in that no one in my practice is strictly in one camp, and there are camps in the field of psychology and they are sometimes very, very entrenched and siloed from one another. And I think when you look at psychology from an integrative perspective in a very similar way, I love that metaphor. It makes me think of going to the eye doctor and they’re doing your vision test, and does this one look right? How about this lens?

(00:07:58):

How about this one? And each one gets a little clear. It’s like when you have all the lenses where you’re pulling on cognitive behavioral strategies and relational strategies, and you’re looking at the attachment lens and all these other pieces, including probably where our fields overlap, like functional health and wellness, because the things you’re describing, the kid who’s got sensitivities when they’re in the bathtub or that’s having tantrums, those are things parents come to me for too. And so it’s really being able to take this holistic view, whole view of a child that resonates with me so deeply.

Dr. Pejman (00:08:40):

I love that. And as you’re sharing this, what really has come up for me is if I could dream of the perfect world, that perfect world would be a blend or marriage of psychology and everything related to mental health, married to the physiology. And right now, speaking of silos, I mean, as you were sharing everything, I’m just thinking of all of the silos in my world where this camp doesn’t talk to that camp and that camp doesn’t believe in this camp. And everyone’s egos are kind of entrenching them in their own little world. And not that I don’t have an ego, I wish my ego was smaller, but for whatever weird reason, my brain just doesn’t attach itself to these silos, and I just jump into one silo and kind of consume everything and then jump into another silo and do that. But right now what I find is the world of psychology is still totally disconnected from the world of physiology.

(00:09:44):

And even though there’s a plethora of clinical studies that have shown, I mean, everyone knows the microbiome affects the brain and microbiome affects mental health, but how has that come into the clinical practice of what we do with mental health? And if I could have my dream come true, it would be that psychologists, and if you want to say physiologists or holistic pediatricians or whatever you want to call us, got together and started looking at like, okay, well, these are the things that are purely psychosocial. Something awful happened and that resulted or a parent didn’t know how to communicate with a child, and that has resulted in whatever behavior, or oh geez, there’s actually a physical physiological element to why this child is doing whatever it is that they’re doing, and now this is the piece of their physical body we need to take care of to improve their mental health behavioral piece.

Dr. Sarah (00:10:42):

Yes. I mean, I want to be a part of that world too, because that is so fun. And if people have listened to this podcast for a while, they might be like, yeah, yeah, we know We have to understand the nervous system. We have to. And I probably skew more towards the physiology of it in my practice with helping parents understand the brain body nervous system piece. But I don’t know anything about the medical health piece. I don’t know about the gut biome. I mean, I know of it and I know that it is a thing that matters, but I couldn’t tell you why or how because that’s just not part of my training at all. And so I know about the brain and I know about the nervous system, and I know about the biochemistry of that, which is still moving into that space, that physiology piece, adrenaline, cortisol, all these hormonal shifts that happen when the brain is in that threat state can shift the biochemistry. So please, I want to hear your thoughts on that piece and what else could we layer onto that? Because there are a lot of clinicians that listen to this podcast too. It’s not just parents. And I definitely would be curious what your take is, is how do we marry those worlds better? What do we all need to be studying together?

Dr. Pejman (00:12:13):

Well, I loved everything you said and just I think this opening for this conversation, and I mean the reality is this isn’t just psychologists having just this kind of awareness, but not knowing how to put it into action. I mean, most clinicians, I mean speaking for my own world of holistic pediatrics, honestly speaking, most forget about the conventional pediatricians because I believe the conventional pediatricians and even the holistic pediatricians want to help. And this isn’t about people being ignorant or resistant. It’s people want to help, but that access to information has been kind of locked up. And that’s one of the fundamental things that I see a lot of people know there’s something off, but how do you go about addressing that something off if you don’t even know what information to look for?

(00:13:10):

Have you heard of Bryan Johnson, the blueprint guy? He’s this guy. He’s the most studied human being. Basically. He spent a whole bunch of money studying himself. Long story short, I was listening to a podcast that he had with my friend Drew, and there was one thing that he said that really stuck out to me, which is ultimately understanding health should be looked at as more of an engineering problem rather than anything else. And when he said that, I’m like, that’s frigging brilliant. And right now in medicine, we’ve got this kind of conformist locked in mechanism where unless something has been definitively proven, you just don’t go there. And we don’t look at health or physiological mental health or functional mental health, whatever the hell you want to call this thing as. How do we engineer solutions through whatever challenge that’s there? And if I was to kind of label myself as I heard this and I’ve kept thinking about this, I actually approach the challenges that the kids have in my practice for more of an engineering challenge of where’s the problem?

(00:14:18):

What system is locked up? Where’s the physiology locked up? And then based on that, what tool or method can you use to unlock that system to then get that system to run well or systems to run well to then restore the health, which then restores the mental health and in approaching problems in this way, one, it’s been a hell of a lot more fun for me. And two, the outcomes that we’ve had are just at times borderline weird, where, I’ll give you an example. There was this beautiful little kid regressive autism as the child was labeled lost language in 19-20 months, had very few words kind of disconnected, turns out that there was some toxic exposure that had derailed this child’s immune system. We found the toxic exposure, got rid of it, it was mold, family moved out of the home. I gave them a few things to stabilize the child’s immune system and really at multiple levels just get that child’s nervous system to function better.

(00:15:20):

And I think it was like six to eight weeks later, child starts saying words, starts making eye contact, starts going up to the parents and giving them hugs and socially became actually engaged and connected to the parents. And the mom and I were both crying on the call because it was the coolest thing you could possibly see. And it’s just how do we really engineer our way through these challenges and start understanding why are these poor kids stuck? Whether it’s as extreme as something as autism or the more subtle things where it’s like, eh, things are off, but I don’t know what the heck that thing is.

Dr. Sarah (00:16:00):

Right? I imagine one that’s kind of incredible, but that you could pinpoint that problem by looking at like, okay, well, we have to look at it from angles that are different from where we are originally going to go. Regressional autism, that’s the initial quote problem. But that wasn’t really the problem. So if we just take it at face value and try to treat that first layer, we might miss something. What are your tools for saying, okay, well here’s the first thing we see, but what could be underneath that? And then what could be underneath that? I imagine this in this kid’s case, you peel back the layers, you got to the core issue, which in this case sounds like it was mold or some other environmental toxin. Is that how you always do it? Do you always come to the same plate? Do you always end up at the same place? Is it totally different for every situation, the mechanism by which you peel back the layers? How do you know when you’ve hit it?

Dr. Pejman (00:17:07):

Really good question. And I’m sure with you, when you approach your patients, you start doing an inquiry, you start poking into different areas and you start trying to understand what is the lay of the land essentially that’s what I do. I create this blueprint of the child and I literally essentially start scanning every single system within their body. So what is their sensory experience of the world? It’s not just how does this child do socially? It’s okay if they go into a crowded environment. How do they do when they go to the beach? How do they do if you wash their hair? How do they do? What is their experience of clothing? How does the experience of food in their mouth? Because that actually tells you a lot about that child’s sensory makeup, the kid that will eat a handful of crunchy foods and nothing else.

(00:17:57):

And as soon as you put something either extremely chewy or dense or slimy, that kid is like, no, thank you. That’s a sensory experience. And we don’t look at things in this way. We just say, well, some kids are picky eaters and some kids just don’t like their hair washed. Some kids just don’t like to go to the beach. And it’s just, when you look at this, we just normalize all of these things as well. This is just how some kids are, and we just do that for everything. What I do is dissect these things down, and sometimes the parents think I’m like nuts because you’re like, why are you asking this? And it’s not even just how the kids are doing. It’s like, okay, mom, how are you doing? How is your memory? How is your energy? How is this, how is that? And in doing this, I’m creating this really detailed blueprint of how is the child sleep when they wake up, are they happy?

(00:18:47):

Are they grumpy? Do they get dark circles? And the older kids that can actually articulate, do they dream? Do they dream in color? And all of these things actually tell us details of how that child’s physiology is working. So by asking these questions, we’re essentially creating this map of the child’s inner workings, right? It’s kind of like you plug in the computer in the car and it gives you the detailed printout of like, okay, here are all the systems, here are how they’re doing. That’s essentially what I’m doing. And then once you create that picture, then you say, okay, these are the systems that are off. This system is off, the mitochondria is off, the gut is off, blah, blah, blah, blah, blah, blah. Now what is underneath that? And that starts then getting into where has this child lived? I’ve had families where they’re like, yeah, every summer we go to Long Island or wherever, and we spend X months and the kids are running in the woods.

(00:19:48):

I don’t know if Long Island heads would, but they’re on the East Coast and yeah, two months every year they’re running in whatever forest with their friends. And I’m like, well, there’s a lot of ticks over there, I imagine. Yeah, we have to pick off ticks every, well, Jesus, that could be lime. I’ve had families where, so tell me about where you live. Yeah, we’re in wherever agricultural belt, and there’s a commercial farm across the street from us. So what happens? Yeah, every day there’s a tractor spraying glyphosates on these crops. So what happens? Yeah, glyphosates just come right into our window. You could smell it. It’s not like, Hey, do you eat organic or not? It’s wafts of pesticides are getting sprayed into the pregnant mom’s face and the baby’s face as they’re living. And I had one family, they’re like, yeah, in our community, kids play with glyphosates because they think it’s fun.

(00:20:45):

I’m like, what? She’s like, yeah, literally they’re spraying glyphosates around each other because it’s a fun thing to do, right? Wow. So it’s building these pictures and understanding who is the child, where do they live, what is their environment, what have they been exposed to? And then you take this understanding and put it together with these factors to say, okay, well this and this can cause this, and now here are the steps we can take to address these issues. And that’s what makes this I think fun because there’s so much good we can do. And ultimately for me, it’s not about so much geeking out over these details. It’s like, how many people can we help? How many lives can we change? How many kids could we give a brighter future for and help them be the happiest, healthiest person they could be?

Dr. Sarah (00:21:36):

Yeah, I mean, sign up for that. That’s amazing. So you’ve been doing this for a long time. What patterns are you noticing? What can parents start to be mindful of when they’re thinking about how to make sense of things that they might not have realized to pay attention to?

Dr. Pejman (00:21:58):

I think great question. I would start with one, how is the child’s vitality? Are they just not hyperactive? Because there’s a difference between a child who has lots of vitality, healthy, strong energy, could play soccer for two hours and still shine, and as an extension of the vitality, children who have vitality just have this joy that just permeates out of them because they just feel good, right? There are kids that just feel good. And I’ll give you an example. My daughter, she unfortunately got my makeup, which is this kind of physiological fragile mess where if we’re taking care of, we’re good. If we’re not taking care of, we’re just a big old hot mess. And I’ll give you an example. When she was probably three and a half, she would have 30 minute meltdowns like tantrums. They just would go on and on and on.

(00:23:00):

Sometimes longer intense sensory issues to the point where one time I started borderline crying because we were at a family party and she was under a table like hunched over a terrified because there was 40 of us Persians all talking at the same time at my aunt’s house, and she just was completely overwhelmed. Now started supplementing it. We also did ot, we did some other things, but one of the things that I’ve seen is when she is supplemented, Lana, how are you feeling? I feel great. I feel great, and she’s all smiles and she’s just this bubbly, happy person. I get lazy and I don’t supplement her for two or three weeks, and all of a sudden, Lana is this kid who now starts crying for very little reasons, becomes irritable. We still have some more work to do because it turns out we had mold in our house and you’d think I’d be the one that would notice it, but it took me a while to notice that.

(00:24:00):

But how is the child’s vitality? Are they beaming with energy? Are they beaming with joy? And if they’re not, then the question is, well, what the heck is mucking up the works that is preventing this child from doing that? And these excuses of like, oh, well, some kids are just irritable. That’s just the way they are. No, they’re not kids. Their baseline, I believe, if they’re feeling well is to just permeate love and joy. That’s just the nature of young children, which is what makes them so beautiful. So when a child can’t do that, first thing we should do is step back and say, what’s going on? And God bless you for the work you do, because you’re looking at it from like, okay, what’s happened inside the home? Is there some kind of discord with the parents, et cetera. But physiologically we can do the same.

(00:24:49):

The next thing that I think is most useful is what is the child’s experience of the world from a sensory standpoint? Because when things go wrong, one of the most telltale signs that there is something off is the child’s sensory experience of the world starts becoming distorted. They become more sensitive to sound, so sound becomes overwhelming. They become more sensitive to touch. So clothing, hair washing, even being touched at times, startles them the experience of taste, because ultimately our experience within the mouth is part of that tactile kind of sensory experience. So you’ll see there are some kids that everything in the world is kind of bothering them, and there’s probably some parents are like, yeah, that’s me too. And through this we can start getting an understanding of are all systems ago everything is peachy or no, actually some little things are off.

Dr. Sarah (00:25:51):

Yeah, it’s interesting. I do have very similar assessment when I’m working with families about sensory stuff because I do think the sensory system is a huge window into how well is this kid doing? Interestingly, obviously, we have different angles that we’re working from. So when I’m looking at the sensory system, I’m thinking of it in terms of when a child is agitated all the time when they’re irritable all the time, it’s a good indication that their sensory system is having a too big of a load to handle my then sort of what do we do then kind of thing is sensory regulation. But it sounds like what you are actually doing isn’t regulate the sensory system. It’s figuring out why is the sensory system being overloaded? And I’m curious about that. Can you tell me more that piece?

Dr. Pejman (00:26:45):

Yeah, yeah. I’m happy you’re asking. So it was probably six years ago that I got introduced to the world of sensory integration and occupational therapy and all of that, and I’m a big fan of it. I mean, both of my kids have had it. I think it’s awesome. The one thing that never really became clear to me, and I’m one of those that just likes to ask an annoying number of questions. As I was working with all the OTs and got into the literature and started reading their papers, the thing that was weird to me is like, well, where the hell does this come from? And everyone says, well, it is just a lack of coordination and integration, and some kids just don’t crawl until you look. You’re like, well, that kid crawled and that kid, my son is a perfect example because this poor little dude was also exposed to mold, and he crawled.

(00:27:39):

He crawled perfectly. He’s really well coordinated. There are none of the things that the OT world describes. That’s when I started really getting into these other domains. It was actually my patients that started helping me see this because I would do supplementation and then the parents would come back and they’re like, Hey, his sensory issues are gone. I’m like, what the hell are you talking about? And they’re like, well, yeah, this and this has happened. And then I kind of backed up into the literature to define what the heck had actually happened. So it turns out there are two primary things that influence sensory experiences. They’re the mitochondria. And it turns out that in the prefrontal cortex of our brain, we’ve got these GABAergic neurons, so they’re like the traffic control cops I call them, of our sensory experience. And literally, these GABAergic neurons will actually slow down the flow of sensory information for the sake of sensory processing and sensory gating as they call it.

(00:28:43):

And when you have energy production issues, so the kids that are dragging, they’re tired all the time, you could see them, they’re just pooped. Well, that pooped experience that you see in the kid is also showing up within the neurons, specifically these GABAergic neurons because it turns out they’re the most energy hungry cells within the brain or one of. And at times when these traffic control cops fall asleep, essentially the sensory regulation of the brain starts changing. And that was through me supplementing the kids because I saw that they were physically weak. And then all of a sudden the parents are like, holy crap, my kid is not getting so overwhelmed. I’m like, oh, that’s kind of cool. There’s another piece which is actually more important. So it turns out that histamine, which we associate with runny nose and coughing and rashes actually happens to be one of the most powerful regulators of the vestibular system.

(00:29:44):

So our middle ear balance coordination and the vestibular system and the sensory pathways are integrally tied together. And when histamine gets distorted, the vestibular system gets distorted. And when the vestibular system gets distorted, that starts changing certain sensory experiences. And it turns out that at deeper levels, histamine can also influence the direct sensory pathways, sight, sound, hearing, olfactory, et cetera, through other means. And I’ll give you an example. We have this one beautiful guy was doing awesome on the spectrum. We did a few things. We controlled the exposure, runny nose coughing, went away, started becoming more calm, started being more just comfortable and happy. Family went to a home. It was a cabin in Lake Arrowhead, lots of dust. Turns out probably lots of mold. Within two days, runny nose congestion came back and all of his sensory issues and anxiety just shot through the roof literally at the same time, these are areas, both of these that are not very well mapped out or understood in at least that I know of, even in the functional kind of holistic pediatric world.

(00:31:05):

And one of the things that I’ve learned is by modulating histamine and modulating the mitochondria and changing part of the immune response, I’m able to calm down the nervous systems of these kids. And we’ve had some kids where they were in two years of sensory occupational therapy, nothing worked. Boom, address these things. And then a month later, the parents are like, holy crap, my kids sensory issues are gone. And early on I’m like, wait, are you sure? Are you sure? Sure, you’re not imagining this because I had a hard time believing this. But it turns out that all of these things are tied together and I’ll be happy to share with you if you want. There’s this beautiful paper written in 2008 by this guy named Hass, that he talks about histamine in the central nervous system, and it’s like 85 pages of geeky discussions of histamine. But he literally maps out, it does this, it does this, it does this, it does this, and that information has just not yet made it into our practice.

Dr. Sarah (00:32:05):

That’s so interesting. Is histamine an inflammatory thing? Is that part of it or is it not related to inflammation?

Dr. Pejman (00:32:11):

It’s totally related to inflammation. It’s a byproduct of inflammation. So when you get toxicity or some kind of inflammatory response are kind of first line defenders are the mast cells, and these are the scouts that are scouting the world and making sure nothing comes to kill us. And when something bothers these mast cells, these mast cells start dumping massive amounts of histamine, which then ultimately makes it into the nervous system and starts hitting all of these receptors and starts changing part of the sensory cognitive experience.

Dr. Sarah (00:32:48):

That’s really interesting because the place that I have the most of, I always think about when you’re taking a new information, brand new information, sometimes we don’t have a bookcase to put it on. And so having references, having some sort of internal cognitive scaffolding for the new information, I need a bookcase to put this information on. But the one that I keep going back to is PANS and PANDAS because that in my field is really relevant to the work we do. And for people who aren’t familiar with that, it’s when a kid gets strep throat and then all of a sudden we see this onset of  OCD like symptoms. And does this fit into this at all? Is this related to the same idea?

Dr. Pejman (00:33:35):

A thousand percent. A thousand percent. So first thing is kind of talking about the bookcase. Just think of histamine from this very, very simple perspective. When you take Benadryl, most people, when they take Benadryl, what happens, right? You just knocked out. It’s like the air out of the balloon is gone, everything down. And that is one way to start contextualizing what histamine does to the nervous system. Because as much as we focus on the allergy issues, it turns out the two primary sympathetic regulators of the nervous system are glutamate, gaba calms it down, glutamate boosts it up, and then there’s histamine. These are the two primary regulators of our sympathetic nervous system. And when you look at these poor kids either on the spectrum or with pans and pandas, what do you see? They’re just hyper hypervigilant.

(00:34:32):

I hate to use this term, but it’s almost like they’re tweaking out. They’re on 15 cups of coffee every day. Their sleep is disrupted, their entire sensory sympathetic experience is completely distorted. And specifically with the PANS and PANDAS kids, that’s actually a big part of my practice. And what’s really weird is we blame strep as the primary causative factor. And it’s not to say in some kids it’s not. But then what you also see in the literature is you can also have cases where there is no strep found, but it is still strep even though you can’t find it. And there are plenty of kids who get strep infections, but never go on to develop pans and pandas. So one of two of my mentors, what they had me ask is what is it about these kids that causes their immune system to get to a place where it starts reacting to this strep?

(00:35:29):

And what are the things that cause the irritability, the aggression, like the weird urinary issues? There’s a lot of weird things about these kids that we just say, well, it’s part of pans and pandas and strep is the cause. And when you start getting into the worlds of lime and mold, and what I’ve come to believe, and this is what my mentors taught me, is probably the two big ugly monsters behind the scenes driving the outward reactions are actually lime and mold, and at least I’d say 60 to 70% of the pans and pandas kids that I see actually have mold as the primary driving factor with whatever infections kind of superficially ultimately becoming the trigger.

Dr. Sarah (00:36:17):

So what do we do? I’m assuming mold is pretty much, it’s in a lot of places.

Dr. Pejman (00:36:26):

So yes and no.

Dr. Sarah (00:36:28):

Okay.

Dr. Pejman (00:36:29):

The common misconception is, well, mold is everywhere. So benign amounts of mold and non-toxic molds are everywhere. They’re in the environment, they’re outside, they’re inside toxic molds that produce certain mycotoxins that are actually highly toxic to our body. Those are not normal, and those should not be found in an indoor environment. And this is where there’s this big misconception, and I talk to a lot of people and everyone says, well, mold is everywhere. What are you talking about, dude? And that is part of the misunderstanding because of certain changes in our building sciences. So for instance, 60 years ago, 70 years ago, we didn’t use drywall. It was all kind of plaster and concrete. And also buildings were way more open. We didn’t get fancy insulation and energy efficiency until what, 15 years ago. And I think back to when we had our first house, that house leaked air left, right?

(00:37:38):

The windows, if you close them, there were still what at least a half inch gap. And buildings were just leaky, which also meant that they constantly breathed, which constantly exchanged air. And as we’ve done these things, and it’s not to say energy efficiency is a bad thing, but as we’ve done these things and now with climate change, what do people do? Windows are always closed, doors are always closed, AC is running all the time. So we’ve created these little capsules which do not breathe, right? There’s no fresh air coming in. And if there’s any water damage now in this capsule, what does that do? It traps all of these toxins within the capsule, which constantly recirculates it in the human beings that are exposed. And when you think of molds, what do molds do in the world? What is the job of a mold?

Dr. Sarah (00:38:33):

My guess is to spread spores and keep growing.

Dr. Pejman (00:38:36):

But ultimately, what do molds do in the environment? They decompose. The job of a mold is to decompose. They break things down. That’s what makes fungi and molds fantastic, because that’s how we get this recirculation of everything. It’s really, really bad when you as the living human being is the thing that’s getting decomposed, right? And when you start getting into the weird nuances of the science of these mycotoxins, and I started geeking out and spent probably more time than I should have looking at this, mycotoxins disrupt the mitochondria. So they shut down our energy production, which makes sense. They want to decompose you, so you shouldn’t have a lot of energy because the less energy you have, the better you are to decompose. They start suppressing your immune response. And I’m talking about borderline. So imagine there’s heart transplant, immune suppression or cancer, heavens forbid, immune suppression, chemotherapy where there’s this term they use absolute neutrophil count A N C. So heart transplant chemotherapy, A N C is between 300. And once they’re out of the woods, they’re kind of above 800 to 1000. Some of the kids that I see that have had heavy ox and exposure, their ANC is 1500, 1200. So yes, they’re not heart transplant chemotherapy immune suppressed. But I think you can make an argument that just barely being outside of that range is not necessarily a good place.

Dr. Sarah (00:40:14):

Are people who are not exposed to mold, what are their numbers? What’s the kind of baseline?

Dr. Pejman (00:40:18):

3000, 5,000. So it’s at least two to three times that. And what you’ve see in a lot of these kids, a lot of parents are like, yeah, why does my kid get sick all the time? He’s had 15 year infections, he’s had one cold after another, after another, after another. My kid is just sick all the time. My kid, he never recovers from a cold. Well, yeah, if you’re immune suppressed, would you expect anything different? And the conventional approach is, well, let’s stick tubes in the kid’s ears to let the ears drain because the kid has have 15 ear infections. Let’s put them on antibiotics because they keep getting sick. And we don’t stand back and say, what is disrupting this beautiful kid’s immune system that is allowing these infections to take place? And then it also affects the gut, it affects the detox PAX ways and all of these other things. And that’s where this entire world of mold medicine gets to be really fascinating to me because one, these are things we can prevent. If we got smart enough to say, okay, this is a bad idea. How do we prevent it? It’s completely treatable and by understanding is happening and understanding the steps we can take to address it. And this is just specifically talking about mold. There’s so much good we can do for our entire population.

Dr. Sarah (00:41:44):

So I didn’t know that there are different types of mold in that yes, there’s mold, whatever, but not all of it’s toxic. How do people test for that?

Dr. Pejman (00:41:56):

An easy, easy way. So there’s these dust tests you can do, and there’s actually a company called The Dust Test, and I have no affiliation with them, but I’m friends with them. They actually have a system where you buy the test, they send the kit to you, you test the house, and then you send it to them and they’ll help you analyze it. That same technology is available through other companies. So if people do a search for ERMI test, IRMI test, there’s a whole bunch of other companies, enviro, bio mix, micrometric, that all do the same thing. And basically it’s direct to consumer. And basically what you do with this is you gather the dust in your house and you send it off and they run a DNA probe on the dust and they check to see if there’s funky amounts of the problematic molds in the dust, right?

(00:42:47):

Because either your home is clean and there’s a little bit of dust or a little bit of mold fragments, but these are not dangerous molds. These, you’ve got the beautiful plant and that plant is dumping out some mold or you’ve opened your window and there’s some mold coming from your garden, but nothing exciting or holy cow, no. There’s the classic black mold Stachybotrys.

Stachybotrys does not come from the environment. Stachybotrys only happens when there’s something happening and there’s water contamination somewhere. So these tests, and they’re very simple. It’s either yes, there’s a problem or no, there isn’t a problem. And through that, people can get an idea of what’s going on.

Dr. Sarah (00:43:29):

Okay, so I have two follow-up questions. If you do tests like this and you don’t have mold and there are still these issues, do we then say, okay, that’s not it. Let’s, let’s keep looking and where else could we look for answers? But then also if there is mold, then what do we do?

Dr. Pejman (00:43:49):

Two awesome questions. So first is if truly there isn’t mold and there are some nuances to understanding that and really being certain of the fact that you did this test and you did it correctly, and there’s clearly not, and there’s kind of an art or science to doing that. And what’s beautiful about this company called the Dust Test is they have a team of people that can help you actually assess what’s going on. So presuming there’s no mold, then the question is, is this lime? Is this heavy metals? Do you have a boatload of arsenic showing up in something from your water, from all the rice you’re eating? Did the kid eat tons of sushi like tuna, right? Asking the questions of like, okay, what else can this be? And then, sorry, what was the second question?

Dr. Sarah (00:44:38):

The second is if there is mold and we’re like, okay, what can we do? What do we do?

Dr. Pejman (00:44:42):

So that’s where working with the right people becomes important. There’s a wonderful organization called iseai.org, and it’s a group of environmental experts that can help you. They can consult with you remotely, and they’re all fantastic. And for what they do, they charge very little. So they charge like two to 300 bucks an hour to help you map out what’s going on within your home. And then there are providers that are relatively well seasoned in the world of mold that can help you figure out how to treat. Part of what I’ve done, because I’ve realized in the domain of pediatric mold, especially as it pertains to mental health, that’s something that a lot of these providers don’t know what the heck to do with. So I’ve actually started a training program where we have 20 amazing providers now working with me to start getting oriented because I just see there’s so much good we can do. There’s so much we can do to help. And I mean, if I could only share the stories of the things that I’ve seen where kids with severe ADHD learning disabilities that were failing out of school a year later, they’re at the top of the curve and everyone is just like, what just happened? Did this kid get a brain transplant?

(00:46:09):

PANS and PANDAS six months later, kids with aggression, anxiety, OCD, suddenly being calm and cognitively normal and functioning well and being happy. And for me, the reason why I’m here, and I’m so grateful for us to be having this discussion and the mentorship and everything is if we can catch this early on, and especially in those first formative years of life, we can do whatever we need to restore the vitality and integrity of that child’s nervous system and help that child start contextualizing themselves in a different way. Because I’m sure you see this kids coming in and they’re like, I’m just stupid. I’m just bad. I’m just dumb. And they use these awful adjectives to describe themselves, and it’s heart wrenching. It’s heart wrenching to see that. And when you’re able to take away these things that are just dragging them down and allow them to feel well and allow them to feel happy and allow them to feel smart, and they now can function and thrive, their entire trajectory in the future has changed. And I can’t imagine anything more important than doing that.

Dr. Sarah (00:47:21):

Yeah, I mean, I agree. I see so much utility in this. I also, my mind has to ask, would you say that all cases of ADHD and ADHD and OCD and all of these disorders that we treat, can they all be explained for by this? Or are there ways in which we could, there are some that are and some that are not. I guess if this were the case, wouldn’t everyone who has autism spectrum disorder be treated and not have it? If we assessed for this stuff?

Dr. Pejman (00:48:09):

It’s an amazing question you’re asking. I think the honest answer is we don’t know. I do believe there’s always an explanation for why something happens. And at least in my experience, in the small circle of people that I surround myself in the domain of mold, there are many of us, some of whom, one of my mentors, Dr. Andrew Campbell, he’s published, God knows how many papers, well over 10 papers on this area. We are both fairly convinced that close to, if not more than 50% of autism is early, early mold exposure. We’re talking in utero and in that first two to three years of life where all of that synaptic pruning, the neurodevelopmental kind of immune priming is all happening. We don’t know. In my experience, I’d say 60 to 70% of what we call pans and pandas is probably mold toxicity. And the reason why we haven’t gotten to the place where we can clearly make this association is with the technology and tools that we have right now.

(00:49:24):

It takes a semi act of God to identify mold. And this is more, the environmental piece is a little bit easier because these IRMI tests are mostly accurate unless you kind of mess up how you do the sampling, but the diagnosis within the child, so the urine tests that we have, the technologies that we have oftentimes give false reads. And I’ve seen a bunch of families where they saw someone else, really good person, wonderful provider, provider does one urine test, urine test comes back, doesn’t look bad, and provider says, well, this isn’t mole, family looks at it all. Everything is normal. They move on. This is one of the things, part of why I started the mentorship is impressing upon the people that I’m working with case after case of your case, how these tests fail. And right now our clinical tools in actually assessing for mold toxicity in children are kind of at the stage of stone men. It’s like Bam-Bam.

Dr. Sarah (00:50:34):

Flintstones. Yeah.

Dr. Pejman (00:50:35):

Yeah. There are gains being made. Dr. Andrew Campbell has a wonderful antibody test that I think has a lot of utility, but we still have a lot to learn. And I think in the next five to 10 years, this entire domain is really going to grow, and through that we will have a lot more data to really confidently say, yep, X amount of these kids all had these findings, lab findings, which then tied it to that.

Dr. Sarah (00:51:06):

So that’s very really very interesting. The other question that popped into my head is, is it mold? You were, one example you were saying is if maybe the mom was exposed to this was she was pregnant or there was early exposure to mold, which sort of shifted or changed maybe the epigenetics or the development. And now we’re here 2, 3, 4, 5 years later and we have seen the effects of that. Does the mold have to still be present if you get out, if you get away from the mold, if you mitigate that piece, is there a regeneration or, because my thought is, what if you have a child who’s exhibiting symptoms, but there isn’t? Does that mean that there’s a presence of mold currently, or could it have been in the past and now we have to just deal with the fallout?

Dr. Pejman (00:52:00):

I love what you’re asking, and the answer is yes, it could have happened in the past and the physiological toxicity that came from the past exposure has still lingered. Early on, I was very naive in thinking like, oh, once you come out of a moldy environment, the body takes care of it and you’re done, especially in children and in some adults who are really badly affected, the body essentially loses the capacity to rebuild itself and to detoxify. What also seems to happen is at some point, especially with these little kids, it seems that they actually get colonized. So there’s a specific kind of mold called aspergillus, and it has been demonstrated that aspergillus can colonize the sinuses, it can colonize the lungs, it also can colonize the gut. The conventional look is when you talk to these specialists that look at these things called the microbiome, and you say, Hey, microbiome specialist can aspergillus colonize the gut.

(00:53:09):

And they say, well, no, my paper says it can’t. Except what was their paper? They looked at healthy adults, 30, 40 something year olds, super healthy people that got exposed to mold for a very brief period of time. And yes, in that scenario, mold doesn’t colonize you. What no one has looked at is what happens when you get this little baby who’s had these toxin exposures in utero, and think about what these things can do to the gut. Where did antibiotics come from? Molds, penicillin came from penicillium. It’s a type of environmental mold. So if a baby was exposed to these antibiotic like compounds in utero, and then they’re born and they’re nursing, and mom has these toxins being released in her breast milk, which baby is getting, which further disrupts the gut of this child, and now they’re living in this moldy environment. And babies, once they start crawling, what do they do? They stick everything in their mouth and they’re inhaling all that dust, which has the mold. What we think happens, we don’t know for sure, is through all of that, these babies can actually start getting colonized, and the mold actually starts setting up shop inside. So now they had the toxins that they can’t clear, and now they’ve actually got the same mold inside their gut, which is producing an ongoing level of toxicity, and that’s what keeps them stuck.

Dr. Sarah (00:54:39):

Okay. And so how do you treat that?

Dr. Pejman (00:54:42):

Great question. The treatment of it is actually the least complicated part. You basically use some things, they’re pharmaceuticals or herbals to start clearing out the gut. You build up the gut and then you use certain things like clay, charcoal or pharmaceuticals to basically start pulling the mycotoxins out. The treatment part of it is actually the easiest part. It’s identifying that this happened, being sure that this child was actually affected, and then most importantly, making sure that the environment that they’re currently in is as clean as you think. That is actually the hardest part because that is where things can fall through the cracks. And what I’ve seen in a lot of my colleagues, for instance, is they missed the exposure of the mold. And it’s so ridiculous. I had one family living in this beautiful home that is more expensive than my brain can comprehend.

(00:55:42):

It was big enough to the point where it had eight air conditioning units. I don’t know how you have air conditioning units, but they did. It turns out that the only air conditioning unit that was feeding the children’s bedrooms happened to be the one that got contaminated and had mold inside the coil. So every time that air conditioning was running, and this is a family that liked to have their temperature a certain setting, so windows were generally closed and that AC was running more often than not, and mold toxins were just constantly getting pumped into just the room of those kids. And it was to the point where you’re like, are you freaking kidding me? I had one family where their beautiful built-in refrigerator for whatever reason, got funky and moisture was trapping behind the refrigerator, and every time that refrigerator was running, mold was just getting pumped out. Rest of us was fine most for the most part. So it’s…

Dr. Sarah (00:56:40):

So it’s hard.

Dr. Pejman (00:56:40):

… it’s the craziest things that you would never imagine. I had one other family, I did the testing. I started becoming suspicious. First mold inspector, there is no mold, second mold inspector, there is no mold. And I started nagging them to death because the kid was really struggling and the dad starts yelling at me, he’s like, we do not have mold. I’m like, please God, just check one more time. Third mold inspector comes. He saw literally just a little faint amount of water damage, just a few little stains around the window in the kids’ bedroom. Everyone else was fine. It turns out that for whatever reason, that window of all windows in the house was not flashed properly. So every time it rained, water was coming in around the window going into the wall. And when they opened up the wall mold everywhere, just behind where that little girl was sleeping, and it’s these things when you encounter, you’re like, how in God’s good earth is like, would this have happened? And it’s almost like you have to be borderline paranoid to detect these things because it’s so easy to miss it.

Dr. Sarah (00:57:46):

Right?

Dr. Pejman (00:57:47):

Yeah.

Dr. Sarah (00:57:48):

I guess I’m paranoid listening. I’m listening to my listeners listening to this episode being like, oh no, we are now going to be paranoid. What do you say to parents to help them feel, okay, this is something you can handle. What can parents do to be educated consumers and be able to try to go and really do an appropriate assessment of this without becoming paranoid?

Dr. Pejman (00:58:16):

I love that you bring that up, and I tell every single one of my families that please don’t live in a place of fear. Please don’t let this create more anxiety and don’t let this become something that disrupts your life. If anything, this is now finally an answer to that why? So when we started off, when parents say, in my heart, there’s something that’s telling me something is not right, there’s just this nagging feeling that something is just not right, except I don’t know what the hell that not right thing is. And then if you step back and you look at the child and yep, my child has had a whole bunch of allergies, ear infections, they’re tired all the time. They’ve got sensory issues. And oftentimes what also happens is when I start asking the parents like, Hey, how’s your memory? There’s usually one of two parents where they’re like, you know what?

(00:59:13):

Yeah, I’ve just had this brain fog that just makes no sense. And they’re like 35 years old. It’s not like they’re 95 and my energy is just off. I have to take a nap during the day, or I have to drink five cups of coffee just to make it. And I always thought it’s just because I’m a busy parent and they all say the same thing. It’s just because I’ve been a busy parent and I’m chasing after my kids. So as you form this picture where you’re like, yeah, this picture kind of fits, that’s when you say, okay, maybe we now have an answer to why it is that our family has been struggling. And I always try to reframe this as one, you can totally do something about this. This is all fixable, this is all treatable, this is all 99.9% of it. It could be fixed. It’s just a matter of getting to a place of understanding. And then once you get to that place of understanding, saying, okay, what are my action steps? And that’s where working with a good provider that knows what they’re doing could really make a difference.

Dr. Sarah (01:00:18):

So how do people find a good provider who knows what they’re doing? I’m assuming one, how do people find you and your practice? But I don’t know if you can practice outside of state lines. I, as a psychologist, people are just, how do people get connected with someone who knows what to do in these situations?

Dr. Pejman (01:00:41):

First thing, there’s that organization that I shared, ISEAI. So they have providers everywhere. They have providers literally around the world in the US and for just general mold medicine. These people are awesome. ISEAI also has environmental experts. And if you just go and as you click, get help, find an environmental expert, and these people can guide you on actually doing the testing of your home and figuring out is there something there? And if there is, what do you do about it? So I would say that’s first and foremost the number one resource. Part of what I have done is the more I’ve had these conversations, the more apparent it’s become to me how much of a need there is in the pediatric domain. And that’s part of why I started this mentorship program because it can no longer be about me, and I don’t want it to be about me, and I don’t want it to be about my private practice because I can see one new person per day if I’m lucky.

(01:01:46):

And that’s not how we bring about change. So part of what I’ve done is we’ve launched this system called WholisticMinds with a W, and WholisticMinds is one, a platform that actually starts capturing all the data and processes. The data starts gathering all the information that’s necessary to allow providers to become more effective and efficient, which is one of the things that keeps us from serving and helping more people. And then on the other side, we’ve got these clinicians that are in the process of getting trained to actually come on board and serve these families. And within the next month to two, we should have the providers actually ready to start helping people because that’s how I see us really changing things that having hundreds, God willing, thousands of people that are really good at doing this, and they can spot the information and do it efficiently and effectively to really help as many people as possible.

Dr. Sarah (01:02:52):

Yeah, that’s amazing. Well, we’ll definitely link all of that in the show description and the show notes so that people can find it. And if people want to just connect with you, follow the work you’re doing, is there anywhere else that you’d want to direct them to where they can follow along?

Dr. Pejman (01:03:07):

Sure. We have an Instagram account, @wholistickids, so W H O L I S T I C kids. That’s kind of the social media piece of it. And that will be another place. But what’s really coming up for me in my heart is there’s so much good we can do for so many people out there, and there’s such a brighter, beautiful feature we can create for so many kids and adults. And there are so many things that right now we just say, well, that’s what it’s, and I’ll give you a personal experience, which was weird to me. So one thing we didn’t talk about is how inflammation changes the fear response. And over time with the work that I’ve done, I’ve become very mindful. And when my anger response kind of comes up, I’m like, oh, there’s my anger. Deep breath. Calm it down. So in the process of treating these kids, I took something to calm down that specific part of inflammation that drives the fear response. And the weirdest thing was a week later, my anger was kind of non-existent. It was so strange where I would encounter scenarios and say, I don’t think I’m going to react right now. That’s not helpful. And why I am bringing this up is there’s so much we can do to help so many people live healthier, better, more productive, just beautiful lives. And I’m so grateful that you are facilitating this conversation and you’re creating this space because that’s how I see change coming through more awareness and information.

Dr. Sarah (01:04:50):

Yeah, I mean, lots of light bulbs are going off in my head right now, and I’m just like, we will have to talk offline a little bit too, because this is a lot of the kids that I work with. I have a very specific number in my head right now being like, okay, I think we need to kind of explore this as at least a rule out. We need to make sure that we’re looking at this piece too. And this has kind of come back full circle to the conversation we had about siloed clinical work. If we layer the work, if we layer the knowledge we have, if we layer it and integrate it together, that is probably the answer to a lot of things because people don’t always know who to go to. They go to the clinician, the provider, the specialist that makes the most sense for them in that moment. But if that provider can have a network of information, then they’re getting all the minds. And that’s really critical. So I’m super glad to have this conversation and yeah, it’s really, really interesting. Thank you.

Dr. Pejman (01:06:08):

Of course. Of course. And by marrying these worlds, how much easier does your job become, right? If that child is now centered and reasonable and rational, how much more effective can you be in the work that you’re doing? And part of this WholisticMinds is really how do you help people, providers, see their blind spots? How do you help them see what they don’t know to see to then empower them to make change in areas they don’t even know to make change in?

Dr. Sarah (01:06:42):

Yeah, a hundred percent. So I think the beginning of a conversation, right? I’m sure there’s so much more, but this feels like a very nice starting point for, and I hope that parents who are hearing this and are like, Ooh, this is something is resonating to just look into this as a possibility, right? It’s not to say that there aren’t lots of ways of coming about it, but at least check for mold. What’s the harm in at least just checking that and will certainly be something that I’ll add to my differential process as well. So thank you.

Dr. Pejman (01:07:26):

You’re most welcome. Thank you for being so open to this and just, again, just creating the space for us to have this wonderful conversation.

Dr. Sarah (01:07:35):

Happy, very happy to.

(01:07:42):

If this conversation with Dr. K has absolutely blown your mind as much as it blew mine, I want to hear about it. Let me know by leaving a review and giving a five star rating on Apple Podcasts. Your reviews not only help me to know what topics you’re interested in having me explore deeper, but also it helps me get some amazing experts on the show. And to thank you for your review, which helps me to spread this message far and wide and reach the ears of other parents just like you. I’m giving anyone that leaves an Apple Podcast review a copy of my Banish Burnout Weekly calendar, absolutely free. All you have to do is DM me the word “review” at @drsarahbren on Instagram, or send me an email with a screenshot of your review, and I’ll send my calendars right to your inbox. Thanks so much for listening. Don’t be a stranger.

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