What's the Deal with Parasite Cleanses? with Dr. Mona Amin

Welcome to That Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. We're at a time when measles cases are rising to levels that we haven't seen in decades. And leaders inside our public health system are saying that even longstanding protections like the measles vaccine and the polio vaccine should maybe be optional, explicitly accepting that some children may be harmed or even die because personal choice should matter more than public health. We have also a whole new food pyramid that arguably isn't even a pyramid. It's just like an upside down triangle. It's just a really confusing time. It's confusing for parents. It's confusing for pediatricians. It's alarming. We're facing urgent questions about risk and trust, what it means to protect ourselves, our children, and what it means to protect one another and our communities. In the midst of all of this, I'm incredibly honored to be joined by Dr. Mona Amin. She's been a practicing pediatrician for more than 10 years, and she's the face of Peds DocTalk, a platform that provides resources on child development, health, and parenting through online courses, and also really has a focus on trying to ensure that we as parents know what the evidence says, what it doesn't, where there's very clearly a right answer, and importantly, where there's nuance or maybe where we don't know yet. You can find Mona on Instagram, TikTok, YouTube, and her podcast, Peds DocTalk. Basically, and thankfully, she's everywhere. Sorry for our technical difficulties. Oh, I know how this goes. I remote record all my podcasts, and I also hear that you're at home in a different setup because of the storm. So thank you. No, I made it to the office, but all of my children are home from school today. So it's been, you know, just like the tango of it all. Yeah. Oh, yeah. Listen, I'm in Florida and the beauty is we get great weather right now. And on the alternative is some other random policies I don't agree with. So at least I got the weather. At least you have the weather. You are not alone in feeling that way about Florida, I think. Yes, especially being in my small little blue pocket in Florida. It's very, very, especially with what's happening right now all over. So yeah, it's been a wild ride. Mona, thank you so much for being here. I want to, to no one's surprise, who might be a regular listener of this podcast, talk a lot about vaccines and other parts of kind of your practice as a pediatrician that are unfortunately in the news these days. Before we begin, though, I thought we could start on a more lighthearted note, which is to talk about your new tattoo. Oh, thank you. Oh, great. It's show and tell. Still I rise. Still I rise. Chelsea, thank you so much for asking. Thank you for showing it to us. Thank you for sharing with us. That's so sweet. Well, one day I'm going to write a book because there's, you know, it's going to be called probably How My Kids Tried to Kill Me as They Came Out of the Womb. But in any case, I had really bad postpartum experiences. I had a really rare medical condition, which we found out after my second child. It's called Vernix caseosa peritonitis. It's probably going to be on some sort of the pit episode in the future, but very rare. Is that why no one had diagnosed it? Because just truly no one had seen it. Yes. And aren't you? And in medical school, right? You're trained to look for horses, not zebras or whatever that saying is? Yeah. I'm a pediatrician. My husband's in your doctor. We had the best. We have a great OB team. And again, this is not a dig on an OB team. sometimes there's just really rare conditions that not everyone can see. And so we didn't realize it until my second daughter was born, because after my first, I got sick, and we thought it was just because of a traumatic experience. After the second, not traumatic experience, but I got the same postpartum complications. And we're like, that's interesting. Why would this happen twice that I'm having this sort of infectious response? Did some research in my hospital bed, thank God for the internet and put all the pieces together, talk to my doctor. And so Still I Rise is one of my favorite poems from Maya Angelou. She was like my inspiration for becoming a writer. And that poem is really more for oppression for people of color, but it's just oppression in general. And I was very largely dismissed by the clinicians and the nursing staff in the hospital. Even though you're a clinician. Yes. And that was so hard for us, you know, for me and my husband to see us on the other side, being dismissed, being told that you have anxiety because your son's in the NICU. And then after the second one, this can't be happening again. There's no way. Maybe you need to take a shower. Maybe you need to just relax a little bit. And someone told you to just take a shower? Yes. Because they were like, sometimes when you take a shower, it'll make you feel better because my heart rate- Did someone tell you also to take like deep breaths? Like just take a couple deep breaths? Yes. And they gave me medicines to like relax me. And I was like, guys, I know anxiety. I have baseline anxiety. This is something different. In any case, my heart rate started climbing. And that's the indicator that forced my husband, who's an ER doctor, to start screaming all throughout the hospital, finding the higher-ups and saying, listen, my wife is sick. Someone needs to do something. Her heart rate's 180 and no one's doing anything. So the tattoo, the Still I Rise is just obviously an homage to resiliency and rising through moments when people don't believe you and still coming through on the other side. And if you look closely for any of the visual watch, there's EKG symbols on either side. Oh, wow. Almost a symbol of like what prompted us to get help. And also just a homage to my husband who without him, I wouldn't be here. You know, he was the one who truly advocated. And then the flowers on either side. One is an homage to my son. That's the narcissist flower. And then one is an homage to my daughter, which is the rose. And that's their birth flower. And I just love the meaning because narcissist has to do with being reborn. and then the rose has to do with fate and hope. Love that. So those two experiences really changed my life as a pediatrician and as a mother. Obviously, starting motherhood in that way is not the easiest. And so it's a testament to all the women out there who've gone through trauma and also all the women who may not have survived. And so thank you for asking, because it's so meaningful. It's my first very visible tattoo. I have tattoos, but not in very visible places, and it just means so much to my heart. Thank you for sharing. Yeah. You mentioned that those experiences changed you not only as a person, as a mother, but also as a pediatrician. How do you think you doctor differently now? One of the things that really changed is listening a lot more when parents are expressing concern. Now, I was always a great listener, but there was some degree of, are they being dramatic? You know, is there something real here or are they just taking up my time? And after that incident, especially being gaslit in medicine, especially being told that, no, you don't have this, and being really sick, both me and my husband really have changed our listening skills. You know, it doesn't mean that we just do every workup that's not necessary, but we listen. We ask a lot of questions as to something doesn't seem right. You don't like my answer. Like if I give a patient an answer, what can I do to make you feel comfortable today? And sometimes it just means I want another workup or I want to see a specialist or, you know, can I get a second opinion or a blood work or a, you know, imaging. And I say, you know what, I will do this. And I want to be clear that I feel good about the situation. But because you don't, I'm in full support of doing what you need to do so that we can feel comfortable and that we're not missing anything. And that is the reality that changed for us. We're more introspective. We want to be better physicians. And we also want to change the system. We want the system to work better for people, for patients, and for clinicians. And Chelsea, right now, it's not. Like, the healthcare system is so completely broken, opened up in the pandemic to how bad it's been. And now we are just seeing all of that unfold, especially in the ER and also now more so in pediatrics. Like, I'm seeing my profession crumble. And it's not good because who is going to be there for the patients? You know, they need us. And because of insurance companies and because of, you know, corporatization of medicine and because of burnout, we're seeing a horrible trifecta of the loss of really good care from really good doctors. Well, Mona, in addition to the challenges that you mentioned that were exacerbated throughout the pandemic, though certainly not caused by the pandemic, the rise of mis- and disinformation and the degradation of the kind of expertise and experience of healthcare professionals like you and your husband, I think is also clearly a factor in physician burnout. and clearly a factor in kind of the ongoing erosion of trust between patients, families, and healthcare professionals. It has been very painful to me to see how much purposeful disinformation has come out of the current administration around many areas that kind of relate to and affect our health, although especially as it relates to vaccines and vaccinations. And so I do want to move to talk about that now and share a clip from a top official at the Centers for Disease Control and Prevention, who recently didn't seem terribly concerned about the fact that we have measles cases spreading at a rate that we haven't seen in this country in decades since well before you became a practicing pediatrician. So here's what he recently said through an NPR report. During a press call Tuesday, Dr. Ralph Abraham told reporters that the loss of measles elimination status would, quote, not really be significant. You know, it's just the cost of doing business with our borders being somewhat forced global and international travel. Do you agree with Dr. Abraham that losing measles-free status, like, isn't a big deal? Or do you not agree? So first, it's really important to remember that this man, he was the Surgeon General of Louisiana, And he scaled back vaccine campaigns and outreach in the name of personal choice. And public health experts warned that that wasn't fair, you know, because when promotion stops, vaccine rates fall. Because not everyone is going to well visits. Not everyone is going to be seeing a doctor. And so we already have him set up in this sort of against vaccine sort of sentiment. And we saw whooping cough deaths in Louisiana. Exactly. And so what we're seeing is when you start to say you don't need to get them, right, What happens is that people don't think it's important because psychology says, okay, well, someone's telling me I don't need it or there's no one telling me I need it because promotion's stopping. And so then they don't get it. They don't get their boosters. They don't get their TDAP boosters as an adult, whatever it may be. And we're going to see those things come back. And I want to be clear. My MO here is I'm always going to agree, disagree, or provide the nuance. And in this situation, I would love to provide the nuance because he's not wrong in saying that, you know, losing elimination status is going to be this horrible situation that's going to lead to so many deaths and awful things, right? It doesn't mean that measles is going to be suddenly everywhere. And it doesn't change the basic tools we have because that's still going to be there, right? Vaccines are still hopefully going to be available, I hope. Testing, isolation, and contact tracing hopefully will happen. But that's going to be a burden to the healthcare system because we're now going to see more of those diseases spread throughout a community. And they're going to largely spread through unvaccinated communities, which is what we're seeing right now. You know, South Carolina, Texas, there's 416 cases so far this year in South Carolina. And then Texas had a huge outbreak last year and continues to. And so the elimination status concern is more about what the precedent this is going to set right If we we have tried so hard to eradicate it and we did And what eradication means for anyone who's not familiar is that there's not steady transmission for 12 months, right? And we're close to losing that. I believe they're going to be meeting in April to determine if we've lost our measles elimination status because they have to see sustained spread for 12 months. But it sounds and looks like we're going to lose it. And that is really heartbreaking. I've only seen one case of measles, and this was a family who travels a lot internationally. But besides that, I'm not seeing it a lot because of vaccines. So it's not a panic moment to lose elimination status, but it is a signal. It tells us that we're slipping, and slips with measles are going to have real consequences. And it's also, for me, the narrative that we're creating when we start to say, you don't need this anymore. It's personal choice. Enough people who choose personal choice means that enough people can choose to not get vaccinated, which means that community can now be at risk because there's not herd immunity. And for measles, we need at least 94% of people to have vaccinations and the babies are at risk. Immunocompromised people are at risk. So this is, again, not just about personal choice, not just about losing the elimination status. It's about a precedent that's being set here that we are now allowing this to come back. Pertussis is coming back. Smallpox has been eradicated, God bless. But what about things like polio? I don't know if you heard, but there was another staff member in our administration that said that we need to have personal choice of polio. Yes, I did see that. Dr. Kirk Mahon, who is the chair of the federal panel that recommends vaccines, who said last week that not only measles, but also polio vaccinations should be optional, even if it means that some children would die or permanently be harmed because he believes, in his own words, that freedom of choice has to come first. How do you react to that, Mona? It's funny that I still get emotional. And I've been doing this for so long, fighting this disinformation and misinformation. And the reason I get emotional is that I've just felt, especially in the last, you know, I would say in the last month, especially when I see what's happening with, especially the start of this year with the change of the childhood vaccine schedule and then these conversations around, you know, the measles and pertussis, that people are starting to just really not understand the basics of community, the basics of public health. And it concerns me. You know, I not only am concerned about what's happening from the higher up, But I'm also concerned about the people who are believing it. And that is what really scares me as a mother and as a parent and as someone who does a lot of parenting education. Like, what are we raising our kids in to not understand in science and to understand and believe in the people who are making these decisions have to have everyone's best interest in heart. And that's what vaccination is, right? That's what public health at its core is. It's the health of the public. And so that really makes me emotional and sad because we're going to really see a lot of people suffer. And it just makes me feel like we've lost a lot of sense of morality and compassion for the greater good. Not only when it comes to vaccines, but when it comes to other events as well that we've seen in the country right now, that we're losing morality and we're losing what makes sense. And that to me is terrifying. Simona, I certainly share your concern with the kind of absence of a sense of real community and a sense of really feeling like regardless of what our differences may be, we are in this together. I also though am troubled exactly to your last point around stories that are being made up or people I think sometimes even really well-meaning people speaking kind of with authority in an area where they don't have real knowledge. And I see this especially in the minimization of the diseases that even we've already talked about today. And so how have you found in your work to help people understand, hopefully, like we're all in this together to your earlier point, like even if you're homeschooled, you at some point will come into contact with some pathogen somewhere. And also to help parents really understand, And like, measles is really serious. Like, polio is really serious. Yes, whooping cough actually can kill you. Again, we already saw in Louisiana last year. How do you balance all of that? You know, I think my approach to this really changed a lot over the last six years. And I have the pandemic to think. Because what I saw happen in the pandemic, and I think this did a huge disservice to science communication, is that we created a lot of guarantees. There was not as much discussion of let's weigh the benefits and risk. You know, let's talk about the balance in the middle that so many of us are missing. Because what I don't think is fair is for us to say, if you don't get the vaccine, you're going to be fine. Like, it's just a bug. And what I also don't think it's fair is that when people say, if you don't get this vaccine, you're going to end up in the hospital. Because that's not true, right? Like, it is a balanced situation. And how I explain it to families is always that benefit and risk, right? And I used to work for a very large practice that had thousands and thousands of patients, and we are constantly monitoring. And I saw, okay, this kid got this seizure after a DTaP vaccine. Okay, is this happening a lot? Okay, no. But we know that febrile seizures is a common listed side effect. Okay, great. This is part of what makes sense. So I take that information, and then I take the information that you're hearing from people who are spreading misinformation, and then I put it all together. And it's like, I say, hey, look, here's the side effects that we're seeing. Here's what I also see if we do not get vaccination. And I think what's happening is, and it's really hurtful, is that people think that just because it's not thousands of deaths, that it doesn't really matter, right? They're like, well, you know, 32 kids died from the flu this year. 32 kids died from the flu this year so far. 90% were not vaccinated. Like, to me, 32 kids. That's a lot of kids. That is a lot of kids. And if it was your kid, I can't as a mother, if someone said that to me, like, well, you know, it's just the price you pay. No, I want to do everything I can that makes sense safety-wise for my child. And that's what I would want to do for my kids, my patients too, right? So when we think about that, that's not data that can't lie. And that's what concerns me is that people just don't want to believe data anymore, right? They want to just believe the clickbait headlines or the, you know, the podcaster that has a gazillion followers. And so you take both of those, right? You say, hey, here's what I'm seeing as side effects. And listen, there are side effects. I'm not going to sit here and say that you can't get a fever, that there may not be a febrile seizure, that there may not be something, but those things are extremely rare. And a lot of it is fixable. Like using a febrile seizure thing as an example, if a child were to get a febrile seizure after a flu vaccine or the DTaP, I have never seen a situation in my career that that child did not make a full recovery because febrile seizures are benign and you recover from them. Okay. And so this is what the conversation should be, is that where is that middle ground of benefit and risk? But we are getting so lost in the, you must, if you don't, you're horrible. If you don't, you're, you know, your kid, if you get the vaccine, your kid's going to have autism, which is all false information. And we're just, no one in the middle is understanding that, hey, I get it. I get that you have a fear of putting something into your child's body. I understand. When my baby was born, he had so much stuff done to him because he was a seizure stroke kid. And I didn't like it either. I didn't like my kid with needles and injections and interventions. But I also know that what makes sense to keep my kid alive, what makes sense in the grand scheme of things so that I can create the best possible future for my children, but also the children around him. And that's why I choose to do these things. And I found that when I start to do more of that versus the polarizing click baity sort of education is when I started to reach more people and turn people that were vaccine curious or hesitant into vaccinators. And that is who I'm trying to reach. I'm not trying to convince an anti-vaxxer who's so deep into their rhetoric that they won't listen to me. I just want the people who are curious and who want to do good by their child and are just feeling so confused. And Mona, I think, you know, understandably feeling confused, right? Because of like the tornado of, yes, like high quality information to outright falsehoods and kind of everything in between to the shift in the recommended vaccine schedule last week to today, the American Academy of Pediatrics saying, actually, no, we think the vaccine schedule that we had before those changes is still more protective for individual kids and kind of the population of kids. And so I completely understand why it is a confusing time for parents. And some of those parents may say, you know, I don't think actually all of the shots. I just think some of the shots. What are those conversations like for you, either with people who engage with you on your platform or in your doctor's office? So it's so interesting because I get a lot of families on my social media account because I do have a large following online asking me for my delayed vaccine schedules. And I usually respond with like, hey, I don't recommend a delayed vaccine schedule, but I want you to work with your pediatrician if you would like to discuss one. And I say that because in my opinion, I want people to go by the official old routine schedule. I say that because, you know, let's say the AAP. And God bless the AAP for finally growing a spine. I just want to say this, like truly, like in the pandemic, I was getting very frustrated because they weren't creating clear guidelines and clear recommendations with the information we had. And I finally feel like they're like, let's go. Like, we need to stand up for what we believe in, what we know is true to protect the greater good. So kudos to the AP. I really appreciate that. And so when it came to these conversations, one thing I always say is that I vaccinated my kids on schedule. And a lot of parents do like hearing that. Yeah. I did too. Yeah. Like this pediatrician practices what they preach. And I say, I'm like, and I also say like, I get it that you want to have these questions, but the schedule exists for a reason. We're trying to protect our kids at the age they need those protection, right? We can't push off pertussis. We can't push off measles in the toddler years. We can't push off, you know, hip meningitis because those things are more severe in that age group, right? And so then I have families that will come in and talk to me about hep B rotavirus as examples, right? And those are ones that are commonly being discussed as if we really need it. And I have a more nuanced conversation. I say, hey, look, if you don't want the hep B vaccine, I would love for you to get it because I see no problem in getting it. And I do believe that the benefit outweighs the risk. And so that's what I would like for you. Hey, doctor, I really don't want it. Okay. What do you feel about the other vaccines? No, I would like the other vaccines. I'm going to keep asking them if they want the Hep B, but I'm going to say they declined and I'm going to say, hey, look, this is what I want for you, but I'm happy that you're choosing the other ones. I want it to still be a team effort, right? And I found that it really helps people feel like, okay, well, this doctor's on my team. And then with rotavirus, the same conversation that if they're not going to daycare, the risk is low, but it's not zero. And when you frame it like that, hey, the risk is low, but it's not zero, and I just want to protect your child, most people come around. And I want to be clear that these families are wonderful families. I think we position anti-vaxxers as all horrible, but it's not. I don't believe that. I think everyone wants their children they want to do the best for their children And when I see a family who comes in curious and wanting to ask the questions they are interested you know they want to do the best and I am able to meet them with that compassion And sometimes I do do a adjusted schedule which means the family really wants to just do one a day or one every visit. So they come on one day, they come in five days to do another, they come in five days to do another. And I tell them like, you know, you can do them all together. You don't need to do that. But when you decide that you want to do them all together, we can also do that. Like I explained to them that they may change their mind. And so many of my families who did the single, single, single finally at the four month visit, they're like, you know what? Let's just do them all together. It's nothing happened and I feel fine. And you know, I'm like, I really happy you came around, but it's this balanced discussion that I have. And you know, some pediatricians don't do that. Some pediatricians are like, you can't, you have to do the schedule and that's it. But I found that when I do that, what I'm doing is I'm opening up someone who was completely probably against doing any at all to getting some and protecting their child against some things on a schedule that may not be perfect, but likely will give them more immunity, obviously, than not doing it at all. Well, Mona, it goes back to the first part of our conversation about, you know, being an exceptional listener and also not leaving your professional experience or your kind of deep understanding of the science, you know, outside of those conversations. I want to now talk about the new food pyramid, which certainly, shall we say, is different than the food pyramid that I grew up with. I know. It's so much to it. In the 80s and 90s. Yes. And first public school, certainly in Arkansas, where we had Nifty Nutrition, who came and talked to us as a little cartoon character about healthy nutrition. Did you agree with the Health and Human Services Secretary that our old food pyramid or the plate approach was kind of outdated and we needed a change? And do you agree with him that part of the reason we needed a change was because there'd been a sustained war on protein? I would love someone to ask me the question, do you agree with the Health and Human Services Secretary? And for once, I can say yes. I just want that day to come. I want that day to come. I really do. Okay. And it's, it's making me chuckle because I'm just like, it just seems all like I'm living in this sort of upside down world. So the food pyramid is now upside down too, right? It's like an upside down triangle. Exactly. Right. So it works. It's like, you know, the grains are at the little apex with like some other carbohydrates above them. And then we have the biggest tranche of like butter and tallow. Yeah. So first I want to talk about the graphic because it hasn't been used in decades, right? When we talk about the food pyramid, no one's been actually using the food pyramid for quite some time. So now they're turning it upside down, like they're turning up the entire nutrition industry. It almost seemed like a publicity stunt more than actual evidence based, what are we going to do? My plate, which is something that's been used visually in nutrition policy for quite some time, that's where it's a plate with like fruits, veggie, protein, grains, getting equal playing field, that and like a little dairy on the side, that's been used for quite some time. For a very long time. Yeah. So when you flip the pyramid, what it did for me is that it just sounded like this bold move that they're shaking up the industry when in actuality, a balanced plate is what makes sense, which is what we've been preaching on my plate. If you actually put resources into putting that image out there, you know? And the most frustrating thing is that the core recommendations didn't really change. The guidelines still emphasize fruits, veggies, whole grains, limits on added sugar and sodium. That's not the radical shift that, you know, I think they're thinking it is, but this war on protein, you know, this war on protein, it doesn't hold up. America has never had a protein issue. We never have. There's been protein in everything. We see these protein bros. I consume a lot of public health content. I had never even heard a whisper of a war on protein until this. And I was like, well, I missed it. Where were the battles? Who were the antagonists? The industry that was going against us? Exactly. Who was the anti-protein industry or the part of the CDC or the FDA or the USDA or like anybody who might have anything to say about any of this. Like, I don't know. So this came out and then I'll kid you not, I go, you know, get some takeout from like random places. And all of a sudden I'm seeing signs about protein, like advertising protein, protein, protein. And I'm like, this wasn't a fluke. I'm like, what is going on that everywhere I go, like a drive-through or like I went to Chipotle and I'm like the protein logo, like, Hey, get your protein here. I'm like, what is going on? It's never been a war on protein. And I think every person who understands nutrition, even at its basic fundamental level, will say this, that what Americans are not getting is fiber. This is why we have an increased risk of colon cancer because the lack of fiber in our diets. And this is why people have a lot of constipation issues in my pediatric population. We should be talking about fiber. And it's not even a war on fiber. It's let's educate about fiber. Like, let's educate about this balanced, you know, fruits, veggies, protein, grains. And fiber is so key. I mean, I'm like fiber obsessed, not to the point where I'm taking a lot of supplements. I just incorporate in my diet and in my kids' diet. I think it's really important. And like— An apple a day, as the saying goes. Keeps the poop in the toilet, you know? Like, you got to—you know, digestive health is so important to me and for my kids' health, right? And so the problem here is the mismatch and the visuals. And then one thing that really, really will always get to me is that clear, consistent guidance matters, right? But it's not enough on its own. We also need to address the real barriers. And I am grateful to have worked in my life in a very diverse population. And what I say by that, ethnically, culturally, socioeconomic status. And I think because of that, I have this insight into what's happening to all of our Americans, right? That are in this country. We need to fund nutrition education instead of cutting it, which is not happening, unfortunately, right now. We need to reduce aggressive fast food marketing in lower income communities. We can see this if you drive through, all of a sudden there's billboards all over for fast foods, you know, bringing the cost of groceries down, which that was a promise and has not happened. It's actually going up like crazy, improving access to, you know, obviously these whole foods and making those healthy options easier to find in schools and neighborhoods. What's happening is we're dealing with food deserts. We're dealing with parts of the country that are just not able to access these fresh access to fruits and vegetables. And then from a parenting lens, my mission is to teach parents about picky eating. And so, Mona, what are the conversations that you're having with parents? I just want my kids to not eat a grilled cheese three times a day or something. Exactly. I was just going to say, parents so much focus on each meal, right? My kid didn't eat this at this meal, or my kid only ate crackers, didn't eat the other stuff on their plate. And I always remind them to look at the week, look at the big picture over a week, look at the big picture over a day, rather than getting so hyper-focused on like what your kid is eating meal to meal, balance it out throughout the week. And you're going to see, and you're going to be surprised as to how much they actually do consume and the diversity, right? I'm not expecting your kid to eat like the most elaborate meals because not every adult eats elaborate meals. And then just manage the expectation and don't worry. There's no war on protein. I would love to make sure every listener is trying to increase their fiber intake with fruits, veggies, you know, foods that are natural. You don't need to do supplements unless you feel you need them. But fiber, we need fiber in our diet. And it is a huge risk factor for a lot of things, especially in our, you know, when we think about colon cancer and the fact that it's becoming younger age, a lot of the thought is that because there's lower fiber content and also a higher ultra-processed food consumption. So we want to balance those things. It's not black or white. It's balance because I love my chips too. I am so thankful that my pediatrician said the same thing to me many years ago just in a routine visit. I think as we were beginning to introduce food for our then baby daughter, it is important that you try lots of things and she probably won't like everything. And as she gets older, it's important that she is eating a diverse diet over the course of a week. So when you just said that, I had a moment of profound in my heart gratitude that that was the framing that our pediatrician used with us, not in the context of a concern about picky eating, but to kind of preempt those concerns. I am curious before we move off this topic, do you think that the response to, albeit the non-existent but now heavily marketed war on protein, will have an effect in school lunches? Do you think that we'll see a dramatic shift in kind of what kids are being offered? You know, it's exactly the issues that I would hope that would happen, but I don't know if they're actually going to follow what they preach with children because that requires resources, that requires, you know, obviously funding, that requires so much more that it doesn't seem like they're doing because I just have felt for a very long time, and it's not just me. I think everyone, a lot of people can agree that's a lot of smoke and mirrors. It's a lot of, we're changing this up, but okay, what are we going to do about it? Right. And I'm watching closely, but I have not seen, I have just not seen the policy for families and children match what they say they're going to do for quite some time. And it's frustrating because I see it. I know it's going to happen. And you just hope, you hope that you're like, okay, then let's see it happen. Like if we're going to really want, if we really care about children, then let's see the policies that are going to help families and children, which are not happening, you know? And I just want that to happen, but I'm skeptical. I don't know. I think they're going to, obviously the milk is one step of just an increased protein option. But it's, you know, it's going to be, what else are you going to serve? Are you going to serve a filet? Like, what are you serving? Like, I mean, what protein are you serving? And like, what is the, what are the resources here that you're going to do it? And also what are your resources for people who don't eat meat? Like, there's just so many things that it's just like, I just feel like there's not understanding of the bigger picture of nutrition because the people making the decisions do not have that understanding of nutrition right now. They have the understanding of the pseudoscience of nutrition. They have the understanding of the fear-mongering around nutrition. And that is not fair to nutritionists. That is not fair to nutrition education. So our last section, we like to end the show with something called factor fiction. So I'll throw out some claims that kind of we've been seeing online, and you'll tell us whether you think they're factor fiction. Or again, since we've talked a lot about nuance, if you think there's nuance. Oh, I like that. Okay, let's go. All right. Yeah. So we've seen a rise recently in Maha circles of kind of detoxes for kids. What do you think that means? and then fact or fiction, like, should we all be doing that for our children? This is a hard fiction, meaning there's no nuance here for me. And this is because two things. If we're detoxing things from kids, that means that there was something that was toxic that we put into them. And if that's happening, you're going to need medical grade intervention. Like you probably should go to the ER and see your husband. Right. Yes, exactly. You're going to need, let's use a lead. If you are living with lead because you were in Flint, Michigan, you probably needed chelation therapy. And that's a true detox. But if you are a normal human in this world, you do not need the detoxes that are being sold to you. It is a money-making gimmick. It is a lucrative business. Your body is so beautiful. And let's not forget the human body is amazing. It detoxes itself from the daily life of things. And so the common thing you hear is that you need to detox from vaccines We don need to detox from vaccines because one vaccines are not toxic And number two our body is already doing any detoxing we need with liver kidneys all of that So don worry about the detoxes If your kid has lead exposure, if your kid has a serious issue that needs detoxing, you're going to be in the hospital under the care of a medical professional. What about parasite cleanses? Don't need. We are not living in a world where parasites are running wild and our bodies can handle the general things. If you had a parasite, okay, and I have taken care of patients who've traveled internationally, maybe got a parasite, you are going to have severe abdominal complaints, meaning bloating, diarrhea, maybe, you know, obviously fever associated. And you are going to get medical attention. They are going to do a stool study, and that stool study is going to show that there's a parasite. And we are going to give you something called anti-helmints, which are anti-parasite medications that are going to help you. And so this goes back to, you don't need to do anything at home because you're not walking around with these parasites. Because if you were, you would have symptoms and we would get you help. I've also heard some people say that they can do like poop analysis at home, which I really hope you're not doing. I really hope you're not doing. And that probably means, and I've seen the videos, it means that you're just taking a video and that you see something slimy. And like TMI, there's probably slime in your poop and you're just not looking at it. And how I know this is that people always want to bring me their poop in my office of their kids, like in diapers. And I see slime. I see little things because you eat something and, you know, a piece of undigested strip of corn, you know, like the little part that didn't get chewed down comes in. So, like, do not forget the power of modern medicine, please. Yes, it's not perfect, but the person selling you detoxes and parasites, it's completely unregulated and it can do more harm than good. Flu vaccine versus flu mist. Is one better than the other? So this is nuance because my opinion is that the vaccine that your child will take is the best vaccine. But if I had my choice, I will always get the injection and not the mist. And that's just from past data I've seen on efficacy. And so I will always be a get whatever you can. But if you have a choice, do the injection. So lots of conversation online about what babies should and shouldn't be kind of eating or drinking in their first year, right? Okay. Some in the Maha world saying babies shouldn't have any water before six months old. Some saying everyone needs to be eating solid food by nine or ten months. Others saying no, not until after a year. What do you have to say, Mona, about water, solid food, anything else? Love it. Let's do this. So the water before six months is actually, yes, we do not want water before six months unless it's mixed in the formula because then it's at the ratio that makes sense to make that nutritious. Because a reminder, babies who are breastfed, breast milk is like over 90% water, right? So we're not mad at the water. What we are concerned about from a medical standpoint is if a baby is getting extra water. And what I mean by that is that you are filling up a little bottle and giving them water as a beverage or you're putting water in like a cup or whatever, you know, as they approach six months. So this is an important cautionary moment from some in the Maha crowd and elsewhere. No, it's absolutely like and I'm not even like this is something that I've been preaching also like because people have been talking about it well before like the last like seven, 10 years that I've been seeing this. Water intoxication is a real thing. What I mean by that is if you are incorrectly mixing formula, right? So you're not watching how you're supposed to mix it on the packaging, or if you're just giving your baby water because you think they're thirsty and not giving them breast milk or formula under the age of six months, what that causes is electrolyte abnormalities in the body because now the baby's body has so much water and their kidneys are not fully formed until six months to be able to excrete that volume of water. So what happens is when volume levels go up, sodium levels go down. and that's something called hyponatremia. And when that happens, it can lead to seizures. So scary. So mix it appropriately, no extra water needed. After six months, you're still doing your breast milk formula, but you can start to give water with meals. It's nice for them to practice in like a cup, just so that they can get the skill. And then as they approach nine months plus, if you're out for an outing, you feel like they want something, they're not really due for like a big formula feed or breastfeeding session, absolutely okay to give water. Don't worry so much about amounts. But yeah, that's the water thing. And solid food by 10 months? So I'm a big solid food educator. I think it's so important that we create a healthy relationship with food from the beginning. Once your child starts showing signs of eating solids, you are going to want to do that. Now, there's baby-led weaning versus purees. You can start with whatever you like. The signs of readiness will differ. It is really important that we are eating something besides puree by 10 months of age. So I think that to me is true that we should be doing that. Why? Is that if the baby is only tolerating purees or a liquid, we may be dealing with a feeding issue. Which again, maybe you need to go to the pediatrician. Exactly. So you're not going to do anything at home. You're going to go to a pediatrician. They'll probably send you to a feeding therapist because we do like to see them expand to other textures because they're capable of using their gums to choose soft things like, you know, steamed carrots or steamed broccoli or, you know, very, very soft things like avocado. So no finger foods by 10 months. I would say you need to check in with your pediatrician. Is it automatic red flag? No. What I'm looking for is, is there a developmental concern or the very real thing that I see? Is it a parental fear of not wanting to advance to textures because of the fear of choking? Two more quick questions. Something that I have heard a lot recently is that sleep training is harmful for babies. Fact or fiction, is sleep training harmful? Fiction. It is not harmful, okay? And I want to be clear when we talk about this, it's not harmful because it's in a loving home where there's attachment and attunement. When people start talking about the harms of sleep training, and I'm going to talk about cry methods of sleep training because I think that's where some of the, most of the descent comes from, right? Like I can't leave my baby to cry. Remember there are other ways to sleep training. I'm just going to address the crying versions because that's the one that gets the most heat. Um, and Ferber is one of those, which is graduated extinction where you let them cry, leave, go in comfort, cry, go in. Like it's a, it's making sure that they know that you're not leaving them or forever. You know, it is not harmful. How we know this few things. We have evidence to show that the benefits of Ferber, we have evidence to show that there's no harm on attachment down the line. Also, when you think of this as like a overarching parenting lens of like the big picture of development, you're a baby crying for three nights in a routine. What I mean by that is you're setting a routine in that, okay, I'm going to maybe let them cry for 10 minutes. I'll go in. Or maybe you chose a full-on cry out method, which is what I did with my little boy. And people are like shocked sometimes, but that's what worked because anytime I went in, he would scream more when I went in, like scream his bloody eyes out. And I was like, okay, that's not working. So we tried not going in and he stopped crying faster because me going in made him more agitated. So it's all about finding options. And that is my dream is that people know their options that you can or you cannot sleep train. You can choose cry methods. And that every child is different. And every child is different. And also remember that if you choose a method, like my dream is that people know all the methods because you're not going to always stick to the same method depending on the age of the child. For my daughter, when she went through regressions, we did Ferber. Okay. But now that she's two and a half, she obviously has way more speaking ability. Like, you know, mommy come back. I do a lot. I do something different sometimes. So I'll go in, I'll do the padding, you know, I'll talk to her more. I'm not doing the Ferber as much, right? Like letting her cry, come back in because you can always change your method based on the age or the temperament of the child. So just last question, cutting babies are kids' fingernails? Really important to do, not so important to worry about. Are they a huge source of germs or is it really just the concern that they might scratch themselves or someone else? So I am a nail cutter fan and I want to be, there's a lot of germs that live underneath the fingernails, but here's my thought. If your child is younger and a baby, right, they are going to scratch themselves. So I would cut their fingernails because of the scratching. Is the scratching going to harm them? No, they might have a scratch, but it's going to heal. From a hygiene standpoint, if you don't have the time and you wash hands and you get under the fingernails to wash hands. Love those fingernail scrubber things. Yeah, like if you're getting them to wash their hands and wash their fingernails, you don't need to cut it every single, you know, anytime you notice it long. And then the other, you know, the other thing to look out for is if you are noticing that your child is getting sick a lot and they're a nail biter and they're a nose picker, you're going to want to consider hand washing, but also cutting the nails. So it's one of those nuanced answers here that it's like, see what makes sense for your family. Like we, whenever I noticed my kids, my son's nails are long because he's not the type to scratch himself anymore. My daughter still is at two and a half. Sometimes, um, we look at it and like, if it's dirty underneath, I'm like, Hey bud, let's go clean underneath the nails. And then we will sit down and do hygiene day where like, you know, my husband is actually the go-to nail salon or, um, that will do all the cutting. I love that you just call it hygiene day. I'm going to start doing that in my house, hygiene day. Yeah, we do hygiene day. I like that. Yeah. And they love it. We call it the hygiene train. So my husband sits on the ground and one by one, they jump on the hygiene train and they straddle and they sit facing him. Oh, that is great. And then we just talk to them and it's become such a habit in our house that it's not a battle anymore. Both the kids, even my two and a half year old daughter love the hygiene train. And now I just look at it as an overall thing. And I used to be a nail biter and I used to get sick a lot like viruses. And because of that, it's stuck in my head that I know that germs live underneath our fingernails like a lot. So just look at it as if your kid's not getting sick a lot and their nails are fine and they're not scratching themselves and they're not bothered, don't worry about it. And be honest, I guess, if your kid is a nail biter or nose picker. Oh yeah. Be honest. Yes. Mona, thank you just for everything you're doing and thank you for spending time with us today. And I certainly learned a lot and laughed more than I expected. And again, I'm so grateful. So thank you so much. Thanks, Chelsea, for having me. It's such an honor to meet you. And thank you for all the work you're doing, and not only with all the initiatives that you do with your foundation, but just everything that you do. And lastly, just elevating the voices of people, trying to spread the truth, trying to spread health and love and all that in the world. We need that so much now more than ever. So thank you for this platform. I agree. Thank you so much. You can learn more about Dr. Mona at Peds.Talk on Instagram, TikTok, and YouTube. Her podcast has the same name, Peds.Talk. Thanks for listening and talk to you next week. That Can't Be True is a production of Lemonada Media and the Clinton Foundation. The show is produced by Catherine Barnes. Mixed in sound design by Ivan Kuraev. Kristen Lepore is Senior Director of New Content. and Jackie Danziger is VP of Narrative and Production. Maggie Crowl-Shore is our Managing Director of Partnerships. Executive Producers are Jessica Cordova-Kramer, Stephanie Whittles-Wax, and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Ernst-Kahn, Caroline Lewis, Sage Spalter, Barry Leary-Westerberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. 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