Dr. M’s SPA Newsletter Volume 16 Issue 20 – Healthcare Policy

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Failing Them

Why Are We?

We are failing our children, the next generation.

I have been spending an inordinate amount of time studying cellular biology and mitochondrial function in order to understand worsening disease trends. Thus, I want to revisit a landmark study that is one of the most comprehensive assessments of pediatric health ever conducted in the United States. Rather than examining a single disease or health outcome, Dr. Forrest and colleagues integrated data from multiple nationally representative surveys, mortality databases, and electronic health records encompassing millions of children to evaluate whether the health of American children has changed over the past 17 years. The answer was strikingly consistent: across virtually every major health domain, children in the United States are becoming less healthy. The investigators examined mortality, chronic physical and mental health conditions, obesity, functional status, sleep, puberty, physical symptoms, and emotional well-being between 2007 and 2023. Nearly every indicator worsened over time.

“From 2007 to 2022, infants (<1 year old) were 1.78 and 1- to 19-year-old individuals were 1.80 times more likely to die in the US than in the OECD18. The 2 causes of death with the largest net difference between the US and OECD18 were prematurity and sudden unexpected infant death for infants 12 months or younger, and firearm-related incidents and motor vehicle crashes for 1- to 19-year-old individuals. From 2011 to 2023, the prevalence of 3- to 17-year-old individuals with a chronic condition rose from 39.9% to 45.7% within PEDSnet, and from 25.8% to 31.0% within the general population. Rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness all increased during the study period.” (Forrest et. al. 2025)… and literature review.

Enjoy,

Dr. M

 

Dr. M’s SPA Newsletter Volume 16 Issue 19 – Pain

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Pain

Do we listen to its signal?

Pain: Your Body’s Built-In Warning System

Pain is one of the body’s oldest and most important protective mechanisms. It isn’t your enemy. It is a messenger.

Imagine walking barefoot across your living room and accidentally kicking the corner of the coffee table. The sharp pain that shoots through your toe isn’t there to punish you, it is there to protect you. Within fractions of a second, nerves carry a signal to your brain, telling you that cells and tissue have been injured. Your body immediately encourages you to stop what you’re doing. Protect the area and allow it to heal.

This is acute pain, and it serves an essential purpose for both protection and survival.

The problem arises when we stop thinking of pain as information and begin viewing it as something that simply needs to be eliminated. Over the past several decades, this mindset has increasingly influenced modern medicine. Around the turn of the century, pain was widely promoted as the “fifth vital sign,” emphasizing the importance of recognizing and treating it. While this movement helped address the undertreatment of pain, it also contributed, in some settings, to an emphasis on suppressing pain rather than understanding why it existed in the first place.

From an evolutionary perspective, pain is not a design flaw, it is a sophisticated communication system. It evolved to capture our attention, protect us from further injury, and encourage behaviors that promote healing. When we focus solely on silencing the signal without investigating its source, we risk missing the very message our bodies are trying to deliver, and deliver it will.

Pain is information

Every pain signal is your body’s way of saying, “Something isn’t quite right.”

Sometimes the cause is obvious like a sprained ankle, a cut, a burn, or a broken bone.

Other times the message is much more subtle.

….

Dr. M

Dr. M’s Women and Children First Podcast #115: Michelle Chalfant – The Adult Chair


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Welcome back to Dr. M’s Women and Children First Podcast, where we explore the science, stories, and strategies that help children thrive and families flourish.

Today, we’re diving into something that affects every parent, every marriage, every friendship, and really every human being: our emotional triggers. Why do seemingly small moments sometimes provoke such big reactions? Why do we repeat the same patterns even when we know better? And perhaps most importantly, how do we become the kind of adults who respond with wisdom instead of reacting from old wounds?

To help us answer those questions, I’m thrilled to welcome Michelle Chalfant. Michelle is a licensed therapist, holistic life coach, creator of The Adult Chair® model, and author of the bestselling book The Adult Chair. Her work has helped hundreds of thousands of people understand how childhood experiences shape adult relationships and how emotional healing doesn’t require becoming someone new—it requires reconnecting with the healthiest version of ourselves.

As a pediatrician, I spend my days thinking about children’s physical health, but I’ve become increasingly convinced that emotional health deserves equal attention. The way parents regulate their own emotions becomes the blueprint for how their children learn to navigate disappointment, conflict, fear, and joy. In many ways, raising emotionally healthy children begins with becoming emotionally healthy adults.

Whether you’re a parent trying to break generational patterns, someone hoping to improve your relationships, or simply curious about why certain situations seem to push your buttons, I think you’re going to find today’s conversation both practical and deeply hopeful.

Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 18 – Autism and Microbiomes

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Autism and Diagnosis

Metabolites and Phenotypes

In a brand new paper entitled. “Elevated Microbially-Derived Metabolites in Autism: A Possible Diagnostic Screening Test for a Distinct ASD Phenotype,” Dr. Flynn and colleagues investigated whether specific urinary metabolites produced by intestinal microbes could serve as predictive biomarkers for autism spectrum disorder. The study proposes that a large subset of children with autism may represent a biologically distinct phenotype characterized by markedly elevated microbial metabolites, which the authors term ASD-MDM (Autism Spectrum Disorder associated with Microbially-Derived Metabolites).

The investigators analyzed urine samples from 52 children with ASD and 47 typically developing (TD) controls, ages 2–11 years. They measured microbial metabolites derived primarily from phenylalanine metabolism, tryptophan metabolism, and yeast metabolism. These were chosen because decades of autism, microbiome, and metabolic research have repeatedly implicated abnormalities in microbial metabolism of aromatic amino acids, especially phenylalanine and tryptophan, along with evidence of elevated fungal/yeast metabolites in subsets of children with ASD.

The findings were striking. Children with ASD demonstrated significantly higher concentrations of many microbial metabolites than controls. Some metabolites were elevated by hundreds to thousands of percent, and in certain children concentrations were reported to be 100–1000 times higher than the highest levels observed in any control participant. Twenty-three of twenty-four measured microbial metabolites were higher in ASD participants. Ninety percent of the ASD participants (45 of 50) had one or more extremely elevated MDMs. Particularly notable were elevations in compounds related to p-cresol, p-cresol sulfate, phenylacetylglutamine, indole derivatives, and arabinitol, suggesting abnormalities in microbial metabolism involving aromatic amino acids and yeast overgrowth…. Also, Inflammation and Allergy.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 17 – Processing Death

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DEATH

or Better Yet, Live for Today

Recently, there has been more death and morbidity in my life than usual.
There is no easy way to discuss this topic. Death is finite and simultaneously infinitely painful for the survivors. Everyone learns in the moment how to deal with death. There is no on-the-job training. We are not born ready to accept this reality.

It is simply thrust upon us.

While I deal with illness and death more frequently than the average American, an occupational reality, it never becomes easy. Each loss has its own weight. Each reminds us of truths we would rather not face.

I found myself sitting quietly with these recent events and wondering what I would want for myself and my family if this had happened to me today. What would I have wanted for my friends and family if I had died at 17? At 35? At 55?

What words would I say to my parents if I could speak to them one final time?
What would I want my children to know?
What would I hope my friends remembered?

As these thoughts swirled in the sadness of loss, I kept returning to one simple idea:

Live every day as if it could be your last, with honor and respect for yourself and others…..

Dr. M

Dr. M’s Women and Children First Podcast #114: Aimie Apigian, MD – Biology of Trauma

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Today’s podcast guest is Dr. Aimie Apigian, a physician who has become one of the leading voices in helping us understand the biology of trauma.

Dr. Aimie is double board-certified in Preventive Medicine and Addiction Medicine, with advanced training in biochemistry, public health, and functional medicine. She earned her medical degree from Loma Linda University, where her education also included behavioral health, child psychiatric therapy, play therapy, and addiction family counseling. Before medical school, she studied Cell and Molecular Biology at the University of Washington, where she worked in the laboratory of renowned cancer researcher Dr. Larry Loeb.

She is the national bestselling author of The Biology of Trauma, featuring a foreword by Dr. Gabor Maté. The book has appeared on the USA TODAY Best-Selling Book List and has received multiple national book awards.

What makes Dr. Aimie’s work unique is her ability to bridge neuroscience, functional medicine, attachment science, and trauma therapy into a practical framework that explains how our bodies store survival patterns after stress and adversity. Rather than viewing trauma as simply a psychological experience, she teaches that it is a biological state—one that can be identified, measured, and, importantly, healed.

She is the creator of the Biology of Trauma® framework, which integrates somatic therapies, parts work, nervous system regulation, and targeted biological interventions into a structured sequence designed to restore the body’s innate capacity for healing. She is also the founder of Trauma Healing Accelerated™ and the host of the popular Biology of Trauma® Podcast, where she has educated thousands of clinicians and individuals around the world.

Today, we’re going to explore what trauma actually is from a biological perspective, how it influences immune function, metabolism, chronic disease, and childhood development, and perhaps most importantly, what it truly takes to move from surviving to thriving.

Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 16 – Fake it Till You Make it

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Fake It Till You Make It?

One of the most misunderstood pieces of advice in our culture is the phrase “fake it until you make it.”
At face value, it sounds dishonest. It sounds like pretending to be something you are not. It sounds like confidence without competence.

But after nearly three decades in medicine, I have come to believe there is a deeper truth hiding inside that phrase.

Most success in life is not built on pretending. It is built on being willing to step into situations where you are not yet fully prepared, knowing that growth happens only when you are slightly or deeply beyond your comfort zone.

If I am being honest, much of my professional life has felt this way, and the depth vacillated based on the context.

When I finished my pediatric residency at the University of Virginia, I was 29 years old and knew just enough to realize how much I did not know. Medical school and residency provide an enormous foundation, but they also expose you to the staggering volume of knowledge that exists in the world. And that volume has only skyrocketed in the past 30 years.

The farther I traveled in medicine, the more I realized the horizon kept moving, often unattainable.
One experience from those early years remains crystal clear, almost like a scar from a wound.
I had been asked to give a lecture to the pediatric residents at UVA on electrolyte solutions and exercise physiology. I spent time preparing and thought I knew the material reasonably well. I walked into the room feeling confident.

Then the questions started….. and a literature review.

Enjoy,
Dr. M

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