Tag Archives: Pediatrics

Dr. M’s SPA Newsletter Volume 16 Issue 12 – Creatine and Microbiomes


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Creatine and Microbiomes

A new 2026 Cell Metabolism study explores a compelling and increasingly central idea in modern biology: the gut/brain/immune/metabolism axis is not just associative, it is mechanistic. Specifically, Dr. Lu and colleagues investigate how the gut microbiota can directly influence depressive behavior by reshaping systemic and neural metabolism. This is another in a long running list of papers describing the amazing work that bacterial commensal microbes do for us. In this case, our minds and moods.

“Although peripheral-brain crosstalk regulates energy metabolism, its role in depression remains unclear. Here, we used metabolic profiling to reveal elevated fecal creatine alongside reduced plasma and cerebrospinal fluid creatine in both patients with depression and mouse depression models. Exogenous creatine produced antidepressant-like effects mediated by gut microbiota. Bifidobacterium pseudolongum was identified as a significantly reduced gut bacterial species in depression, correlating with impaired creatine absorption. Subsequent supplementation with Bifidobacterium enhanced the antidepressant effects of creatine. Mechanistically, B. pseudolongum-derived acetate promoted the creatine transporter (Slc6a8) expression in intestinal epithelial cells via histone acetylation. The Slc6a8 mediated the antidepressant-like effects of creatine. Neuronal creatine deficiency influenced energetic metabolism and neurophysiological function. In patients with depression taking antidepressants, co-administration of creatine and Bifidobacterium increased plasma creatine levels and reduced depression scores. These findings identify the Bifidobacterium-creatine combination as a promising antidepressant strategy and highlight the critical role of gut-brain energy metabolism in depression.” “The brain, as an energy-intensive organ, relies on precise metabolic regulation to maintain synaptic plasticity, neurotransmitter synthesis, and stress response systems. Accumulating evidence implicates energy metabolism dysregulation as a hallmark of depression. Neuroimaging studies using positron emission tomography (PET) have identified marked glucose hypometabolism in the medial prefrontal cortex (mPFC) of patients with depression. Cerebral mitochondrial dysfunction and ATP imbalance have been mechanistically linked to depression progression. Notably, emerging studies emphasize the bidirectional interplay between peripheral metabolic signals and central energy regulation, which is fundamental to neural metabolism. Clinical observations such as fatigue, appetite dysregulation, and unexplained weight fluctuations in patients with depression further suggest systemic metabolic disturbances spanning peripheral organs and the CNS..” (Lu et. al. 2026)

This is next-level medicine. Mental health can no longer be framed as a disorder of genetics, experience, or circumstance alone. This work opens a clearer window, showing how the microbiome participates as an active partner, shaping brain function through the metabolites it helps produce and deliver. Compounds like creatine are no longer just peripheral players. They become signals, fuel, structure, and information, bridging gut and brain, metabolism and behavior…. and more

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 11 – Magnesium

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Magnesium

Magnesium is a major cofactor in over 300 enzymatic reactions in the body, less a supplement than a piece of physiologic infrastructure. It is required for energy production (ATP), insulin signaling, protein synthesis, blood pressure regulation, and proper muscle and nerve function, essentially touching every major system we care about.

And it goes deeper: magnesium is necessary for the creation and protection of DNA and RNA and for the production of glutathione, one of our most important intracellular antioxidants/detox mechanisms. About half of our magnesium is stored in bone and most of the rest in soft tissues, with less than 1% circulating in the blood, tightly regulated by the kidneys, so the serum level we commonly measure is a very limited window into total body status….

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 4 – Relationships

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Literature Review:

A) “Establishment of the gut microbiome during early life is a complex process with lasting implications for an individual’s health. Several factors influence microbial assembly; however, breast-feeding is recognized as one of the most influential drivers of gut microbiome composition during infancy, with potential implications for function. Differences in gut microbial communities between breast-fed and formula-fed infants have been consistently observed and are hypothesized to partially mediate the relationships between breast-feeding and decreased risk for numerous communicable and noncommunicable diseases in early life. Despite decades of research on the gut microbiome of breast-fed infants, there are large scientific gaps in understanding how human milk has evolved to support microbial and immune development.” (Davis et. al. 2022)

Main Takeaways:

First 1000 days matter a lot for microbial and immune development: Infancy is a critical window when the gut microbiome is assembled and the immune system is learning to respond to microbes and external exposures. Patterns set early can ripple into infection risk, inflammatory diseases, and atopy later in life.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 1 – Beyond Behaviors Part 3, Mona Delahooke, PhD

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Chapter 3 – Individual Differences

Dr. Delahooke starts Chapter 3 by allowing Margaret Mead to remind us that each child is absolutely unique: “Always remember that you are absolutely unique. Just like everyone else.” This is more than a witty paradox, it is the hinge upon which all effective pediatric care swings. When we take individual differences seriously as neurobiological fact, we can finally stop confusing adaptive survival responses with defiance, stop labeling children as problems, and begin the real work of supporting the mind body systems that shape behavior from the inside out.

Let us review what we have learned in Beyond Behaviors so far – We are invited to descend below the waterline of the behavioral iceberg. What we see at the surface: the tantrum, withdrawal, rigidity, hyperactivity, the refusal to transition is merely a set of observable outputs from deeply personal internal variables. The sensory wiring, physiological states, immune triggers, thoughts, feelings, memories, and the child’s moment-to-moment sense of safety. Without diving into these subterranean layers, we risk treating smoke while ignoring the fire, which is the general state of current pediatric psychiatric medical therapeutics. We mostly treat the smoke. We don’t often ask about the fire. Her central thesis is simple, clinically robust, and profoundly humane:

Children behave according to the state of their nervous system, and their nervous system is shaped by individual biological, emotional, and sensory differences.

Once we understand this, behavior becomes not a moral test but a window into the child’s internal world…..

Dr. M

Dr. M’s Women and Children First Podcast #104: Maeve O’Connor, MD – Allergy and Immune Literacy


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Today, I’m joined by Dr. Maeve O’Connor, a board-certified allergist and immunologist practicing in Charlotte, North Carolina.
Dr. O’Connor’s training reflects both rigor and range. She completed dual undergraduate degrees at the University of South Carolina Honors College with a Bachelor of Science in Biology and a Bachelor of Arts in Spanish before earning her medical degree at the University of South Carolina School of Medicine. She then completed her internship and residency at the University of Texas and its affiliated hospitals in Houston, where she served as Chief Medical Resident.

Her subspecialty training in Allergy and Immunology was completed at the National Jewish Medical and Research Center in Denver consistently ranked the number one respiratory hospital in the United States where she developed deep expertise in asthma, allergic disease, and immune dysregulation. She further expanded her clinical lens through fellowship training in Integrative Medicine at the University of Arizona from 2013 to 2015.

Clinically, Dr. O’Connor works at the intersection of pediatrics, immunology, and real family life where eczema isn’t just a rash, food reactions aren’t just labels, and immune symptoms rarely fit neatly into algorithmic boxes. Her work emphasizes careful diagnosis, evidence-based treatment, and avoiding both over-medicalization and missed pathology.

In a time when allergy medicine is often reduced to test results and avoidance lists, Dr. O’Connor brings a grounded, thoughtful approach helping families and clinicians distinguish what’s truly allergic, what’s inflammatory, what’s developmental, and what’s simply noise.

Today, we’ll explore how allergic disease actually presents in children, why mislabeling is so common, how early immune signals shape long-term health, and how pediatricians and specialists can collaborate more effectively without fear-based medicine.

This is a conversation about immune literacy, clinical nuance, and doing better for children in a world where their immune systems are under increasing pressure.

I’m excited to welcome Dr. Maeve O’Connor.

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 31 – Poly Vagal Theory, Stephen Porges, PhD

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I think that this is an important time to pause and relook at Polyvagal Theory before continuing with Beyond Behaviors.

Polyvagal Theory: Current Status, Clinical Applications, and Future Directions (Porges, S. 2025)

“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges


When I dove into Stephen Porges’s 2025 review of the Polyvagal Theory (PVT), I felt like I’d stepped into a crossroads where neurobiology, clinical practice, trauma science, and human experience collide. This paper isn’t merely a summary of three decades of work (all of which I have read); it’s a spirited defense of a paradigm that’s been both celebrated (by me) and contested (by others). What follows is an honest appraisal of what the article teaches us, where it sparks real insight, and where it may fall short, especially through the lens of evidence-based medicine and developmental neurophysiology. (I also went deeper into his 2022 paper in Frontiers in Integrative Neuroscience for the biophysiology of the ANS)

At its heart, the article argues that the autonomic nervous system (ANS), through a set of hierarchically organized circuits centered on the vagus nerve, is not just a background player in stress and homeostasis, but a core regulator of social engagement, physiological flexibility, and behavior. Dr. Porges situates his theory as an alternative and expansion to classical views that treat sympathetic (fight/flight) and parasympathetic (rest/digest) branches as functional opposites. Instead, he proposes a three-component hierarchy: the ventral vagal complex (VVC) supporting social engagement, a mobilization circuit mediated by the sympathetic nervous system or fight or flight state, and a dorsal vagal circuit that facilitates shutdown or immobilization under extreme threat…..

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 30 – Beyond Behaviors Part 2, Mona Delahooke, PhD

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Review of Chapter 2 of Beyond Behaviors
by Mona Delahooke, PhD


“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges

Top Down or Bottom Up?

“Before We Respond to Behavior, We Need to Understand Its Origin.”

With a deceptively simple observation, Dr. Delahooke reshapes the entire field of behavioral intervention: children’s actions come from two very different places in the brain. Some behaviors are top-down, intentional, planned, thoughtful. But many, especially the ones adults find most perplexing, arise bottom-up from stress responses generated by the body’s autonomic nervous system. We often think of this state in terms of fight or flight, however, it is not that simplistic. It is truly any significant response to the outside environment that leads to a neuroceptive reaction that is not governed by the neocortex, top down. If we don’t distinguish the source, our interventions are guesswork at best and often counterproductive at worst.

She illustrates this through a case, a child whose impulsive, disruptive behaviors were treated as failures of will or desire. School teachers and teams repeatedly urged him to “use his words,” as though language were a faucet he simply refused to turn on. What no one stopped to ask was the foundational question: Was his nervous system regulated enough to access language at all? Was he gated at the level of the amygdala blocking the ability to use his mind consciously and even have the opportunity to respond to a meaningful request? Is he capable of the ask, not in terms of willingness, but in terms of physiological access to the skill itself?
….. and more

Enjoy,
Dr. M

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