Methylation Status

Methylation Status

Thanks to internet genomic services such as 23andme and genetic genie many of you have not only heard of the various methylation mutations, you know you have the dreaded MTHFR and you’re heterozygous for C677T!  The big question that is facing us, as our personal health information pool continues to grow, is what do we do with this data?  If you haven’t already, before you run out and perform these tests or begin supplementing with methylated folate, understand there are some risks and there are alternatives available.

If one knows they carry a risk of increased clotting, miscarriage, or Alzheimer’s, can this type of information influence our health outcomes?  Anxiety itself is a “dis” ease state.  Also, once we know we carry a defect are we inadvertently gathering kindling, fueling the fires of self-fulfilling prophecy of health mishaps?  Or on the brighter side, is it possible that this information will allow us to heal or prevent disease in more meaningful ways?  When I discovered I was under-methylating, I started making real changes in my diet and most importantly, my relationship with stress. I had known intuitively it was at the heart of my illness but there was more urgency for change when I saw my off the chart histamines come back from the lab.  The physical realm began to ground the more ethereal wisdom I had gained in my own healing process.  With my methylation status, I was immediately gifted insight into the physical pathways that stress was using to cause my disabling disease.  Yin yoga was given medicinal status and I could suddenly justify the time and the expense consistently.  Since that time of discovery and understanding of my methylation status, I have taken exponential strides in my own healing.  As an intuitive, I do not feel the need to confirm my exact mutations. Simply identifying myself as an under-methylator has been enough to create incredible change.  After 6 years of disabling bladder disease, I am truly healing and my genome has remained secret.

At this time insurance companies cannot use genetic information to calculate the cost of your health care.  Nor can they deny you access to coverage.  However, in the future, as we understand genetic disease susceptibility and methylation better, it is possible that this data will be released to insurance companies.   Remember these billion dollar industries have been known to influence Congress.  It is not impossible that in the future the laws that currently protect your family from genetic discrimination will be null and void.  There is no going back once your genomic data is collected.    

Importantly, you should know there exists another way of understanding your methylation status without releasing your genome.  It is simply done using whole blood histamines.  This practice was developed for clinical use by Dr. William Walsh, PhD.  In addition to Dr. Walsh’s work, functional psychiatrist, Judy Tsaffir, MD wrote a beautiful and approachable article summarizing much of his work.  Also, both of these authors responsibly discuss the complexity of supplement use.  Methylation pathways are vast, and in reality incredibly complicated.  Simply adding methylated folate to one’s diet can sometimes be disastrous.  I highly recommend if you are going to supplement that you are followed closely by a functional practitioner who understands the complexity of methylation issues.  Also be aware that supplements serve as an income for many practices.  Get clarity around this conflict of interest with your chosen provider before you buy something that your body may not agree to. 

My own healing has come completely through herbs, food sources and lifestyle changes.  Much damage is reversible in this way.  However do know there are extreme cases where the systems are so irrevocably damaged, that supplements are the only viable way they can begin to heal. Also, in these complex cases, the benefit of revealing the genome may be worth the risk. 

As you learn about methylation, you will see much of the exciting current research is in neuropsychiatry.  As a pediatrician, the most interesting data has been the relationship between methylation defects and the rise of autism.  Methylation is an enormous subject matter with discoveries being made currently! As you read you will see that authors conflict with one another.  Like anything, ultimately healing is intuitive.  However,  sometimes the right information from the physical realm can better point the intuitive beam.


MTHFR Reading:

Local Provider Resource:

Barry Smeltzer, MPAS, PAC



My Kid Never Gets Sick

My Kid Never Gets Sick


“My kid never gets sick.” This is the most common sentence I hear from prospective families when they reach out the first time.  I always smile when I hear it and here’s why. This sentence is partially true. The kids I care for in my private practice are well-nourished in body, mind and spirit.  Most have intact immune systems and very few battle chronic diseases.  The parents I serve are vigilant and catch illnesses early. In addition to this, many utilize holistic methods that prevent illnesses from going deeper and causing complications and secondary infections. The truth in this statement is my kid doesn’t seem to get terribly sick and they usually get better without issues on their own.  The reality is unless your kids are completely cloistered they are going to pick things up due to viral shift and drift (more to come on these as we head into this coming flu season).  That runny nose that looks like mild allergies is your healthy kids’ innate immune system effectively flushing out something that could land a more vulnerable child in an ICU.  Just because your kid isn’t flat out in bed doesn’t mean they are not “sick.”  This becomes very important in preventing the spread of communicable diseases. But, there is more at stake in starting conversations with this sentence.

This sentence contains evidence of a subtext and it is this deeper level that often proves most relevant.  I want to relieve my holistic community from a specific burden.  One of the reasons we start conversations with “my kids never get sick” is we hold a belief that others think we’re crazy and that we need to prove ourselves and our decisions through our kids’ brilliant health.  This belief is self-limiting.  Honor where it came from.  Most likely our need to defend or prove came as the result of cruelty and attack.  When we choose to let this hurt go we can breathe more freely in our power, we can stand in true confidence not on the defensive of our choices.  There is nothing to prove when one is acting from the seat of intuition.  With regards to this sentence, the next place to do some psychological dusting is around the idea that we have control over everything.  This related and common thread manifests in the holistic community within the concept that everything happens for a reason.  And this belief is great as long as you’re not holding yourself at the center of the reason that good or bad happens.  Sh*t happens sometimes. It’s not your fault and whatever you’re blaming yourself for happened and is most likely beyond your immediate control.  Again, feel free to let this one go into the bigger mystery that contains us. Breathe deeply into the gentler truth, which is most of this, we are merely here to witness.  Our conscious breath; our coming home to truly embody this life, this is where our true power lays.  Our job is to simply explore what keeps us from coming home.  That’s it.  Trust me, the rest is a crap shoot!  And yep, included in this is the fact that even healthy kids sometimes get sick.

Much love and tenderness as you explore around these spaces.  So many of us have been badly hurt by ignorance.  You are not alone.  You are living your truth and I love you for it.      

Back to School Immune Defense

Back to School Immune Defense


August means back to school season is upon us.  For normal people, this time of year brings happy visions of backpacks and fresh crayons.  At the urgent care clinic, gloom descends as we count down to packed waiting rooms and families made grumpy by the wait time.  In equal proportion to our sadness, little viruses can be found joyfully singing and dancing in the metaphoric streets. They know school means close contact for people who still put their hands in their mouths.  It doesn’t matter what you tell a kid about these sorts of things.  By their nature, they are all at least occasionally gross.  

Immunity for a kid is often a hard-earned battle.  As I was beginning to gather my own essential defense kit for my family’s return to disease season, this blog was born.  My family has methylation issues and so I am as judicious with supplements and herbs as I am with Western drugs.  For example something as simple as B12 can throw someone with my genetic makeup out of balance.  (Click here if curious about how and why.)  These chosen defense herbs/supplements I use are generally safe and well tolerated.  However, it is always a good idea to test a small amount of any supplement in your own body before giving it to your child. And go low and slow with initial dosing. For example, a popular children’s immune syrup that contained myrrh made me feel worse than the cold I had.  Remember just because it is natural doesn’t mean it’s gentle.

My Top 3 Picks for the School Year

Kids Defense  By Gaia Kids

kids defense

A wonderful all around product with good taste.  We use this tincture with raw honey to make a nice warming morning beverage my son affectionately named Stink Tea.  This does contain both echinacea and elderberry so this is not an everyday drink. Even natural antimicrobials can affect gut flora with prolonged use.  This is however a great option if you see sniffles or know you have been around someone who was sick.  Click the link above if your interested to see the entire ingredient list.  Though a tincture not meant for anyone less than 1 year old.

Garden of Life Chewable Kids Probiotic


I highly recommend buying your probiotics locally.  These are living organisms and they really need to be alive to do their job.  If transported without temperature control many of these guys die.  Probiotics have been shown to decrease incidence of both colds and GI illnesses; particularly in preschool-age children.  This one is delicious.  I actually take this as an adult.  I had kept forgetting to take mine.  Now my son doses us both daily. Anything that simplifies my life is a win.  Central Market and many HEBs carry this locally.  This is appropriate for anyone that can safely chew hard tablets.  

Garden of Life Vitamin C Spray


A tasty and convenient way to administer Vitamin C. This is best if used immediately following an exposure or as soon as one notices immune activation. Scratchy throat, energy dip, runny nose are often signs your innate immune system is kicking in. Vitamin C is gas to the cellular components of our immune system and is quickly depleted during an active infection.   Of note, I would not recommend taking high dose Vitamin C at the same time as your probiotic if you want those guys to make it to the gut alive.  Also, if you are sensitive to acid/base changes, I love estered-C as it is truly gentle on the gut and urinary tract. When you look at the milligrams of Vitamin C this product contains, it will seem low. However, these guys did their research to increase the bioavailability of natural Vitamin C by providing co-factors, sourcing from real food and managed to do it without GMO sources.       


Toddlers and Tin Cans

Toddlers and Tin Cans

Sean Locke/ Istock

I have seen more horrific finger lacerations from improperly opened canned foods than I can count.  It happened again this week.  It’s usually the same story.  Mom is busy cooking dinner.  Curious toddler finds the recently opened can in the bin.  The lid is still partially attached.  Mother hears the child screaming as the initial laceration injury occurs. Then in the panic, as the can is pulled away, the attached lid severs the child’s trapped finger(s) further in what could be described as an incomplete degloving injury. The result is a deep peeling of the flesh from the surface of the digit analogous to the removal of a glove.  This week it was multiple fingers.  Sometimes they get lucky and it is only one.  As a health conscious family we do not eat a lot of canned foods but our Trader Joe’s coconut milk and cream both come in tin cans.  I am and I urge you to be very cautious in the disposal of these types of cans.  For the very safety conscious family I highly recommend the smooth edge type of can openers.  The one I linked to is only about 12$ on Amazon.  This takes all the worry out.  There is a slight learning curve to using it but once you get the hang of it there isn’t much of a difference from the regular can opener.  Another trick I employ when using a conventional can opener is to completely remove the lid.  Rinse the can and then carefully poke the lid (with a tool of your choice) to the bottom of the tin can before burying it in the recycling.  You’d basically have to use a knife to the lift it back up and out of the can.  The top edge is still sharp but the guillotine potential has been removed.  It is really the trapping of the finger between those sharp edges that causes the worst injuries.  Also remember it is important to teach your caregivers as well.  I found a tin can in guillotine confirmation that the sitter had opened.  If older kids in your household are opening cans I would highly recommend the smooth opening type tool.  It could save a finger or at least an unwanted trip to the urgent care.  

If you are ever faced with this type of injury.  Rinse the wound immediately and then apply pressure.  Keep the pressure.  Don’t be tempted to peek.  Small arteries can be involved.  Seek immediate care.  

Top 10 Items in my First Aid Kit

Top 10 Items in my First Aid Kit

first aid

Summer is here and in the pediatric urgent care I have begun to see more soft tissue injuries, broken bones and lacerations. While kids are out of school they have markedly more freedom to explore and with this they find creative ways to injure themselves.  It is important to have first aid supplies ready. I am going to share the top 10 items in my first aid kit and what I include for my family’s long trips away from civilization.  Please know the ready made first aid kits they sell in stores are overpriced and often fail to contain important items.

  1. Liquid Benadryl

  2. Decent tweezers

  3. Bacitracin ointment

  4. Peroxide/alcohol mix

  5. Epsom salt

  6. Ace wrap *velcro type

  7. Telfa

  8. Coban

  9. Hibiclens

  10. DoTerra Lavender Essential Oil


Benadryl liquid (generic is fine) is top of my list especially if we are going back country. Blame my likely too early exposure to My Girl that awful movie where the little girl dies from an anaphylatic reaction to bee stings. Literally if someone could have immediately gotten a teaspoon of Benadryl into her she might have lived.  Anaphylaxis happens more often today than it ever has in the past. The risks are real but the immediate treatment if you don’t already carry an EpiPen is oral diphenhydramine.  If you can’t figure out the dose remember this: 1 tsp for a little kid and 2 tsp for a bigger kid is a great place to start.  2tsp is equal to one adult 25mg capsule if that helps you to do the emergency calculation.  I got stung by a large black scorpion deep in the back country of the Grand Canyon and Benadryl made a nice difference in my ability to breathe easier.  I still got sweats and nausea but at least I could breathe.


Good tweezers made the list from another fun story of my own life in which I had taken the four year old hiking at Enchanted Rock State Park.  Despite my best efforts of telling him to stay on the trail he meandered off.  I heard such a shriek that I thought for sure he had been bitten by a snake.  Instead he turned back towards me and looked like a pin cushion.  God bless the Texas Prickly Pears.  I had my Swiss Army knife and if you have ever had to use the tweezers from it to pull thousands of microscopic cactus spines from a screaming kid you will understand why “good tweezers” made my top 10 list.


I am not crazy about Neosporin nor triple antibiotic ointment.  My husband is sulfa allergic and triple contains a sulfa antibiotic and so we don’t carry it.  Also kiddos can be sensitive to the Neomycin component of Neosporin.  A safer bet is plain Bacitracin.  This is a narrow spectrum OTC antibiotic ointment that does a great job on the typical skin flora invaders.  This will not help MRSA.  So if you have a known MRSA+ history best to carry Rx Mupirocin.



I carry a tiny little squirt bottle of 50/50 peroxide and rubbing alcohol to sterilize equipment like my tweezers and in the summer time to help ear canals.  In my Swimmer’s ear blog I discussed that this condition is preventable but you have to clean the ear canals right after swimming.  I have witnessed many a river camping trip ending in the urgent care with painful rotten ear canals.


5. salt-on-wooden-spoon

Epsom salt.  Yes I actually carry it in a zip lock bag.  Foot puncture wounds do well to be soaked immediately.


In the old days Ace Wraps had these miserable toothy clips.  Now days they are equipped with Velcro (ie hook and loop) closure systems.  These are inexpensive and worthy item to have in your kit. Can also be used as a tourniquet/compression above an arterial bleed. Familiarize yourself with wrist and ankle wraps as they are most commonly injured extremities.  Learn how to check for perfusion in the extremity you wrapped.


Telfa or non-adherent pads are way better than band-aids for dressing open wounds.  The last thing you want to do is accidentally peel off the healing that the body has already done.  It is also incredibly painful to remove sticky band-aids from a flesh wound.  But you may be thinking, how is this going to stay on an active kid?  You hold it on with Coban.



Coban is amazing. This stuff is flexible (great over knees) and sticks to itself like Saran Wrap. Plus it comes in many fun colors. Best price is Walmart for this and most of these items. You wash the wound with your Hibiclens and flowing water, air dry then add a bit of bacitracin ointment to the Telfa pad/wound and then cover the area with Coban to hold it all in place.  Works amazingly well and is super easy to change/remove.


Hibiclens does not sting yet it really works.  That is why I love this soap.  Studies have shown that wounds cleaned with fresh fast moving water and soap do better than any other form of torture a parent can come up with.  I swear by this stuff.   We use this as prep before suturing large open wounds.  No child has ever complained to me about this soap.  We also use it for soaking ingrown toenails prior to procedures.  A small bottle is sufficient as a little bit goes a long ways.


10. lavender

I travel with lavender essential oil.  In reality I travel with more EO’s but this one made my top ten for the first aid kit.  This stuff has great anecdotal evidence for everything from bug bites/bee stings, allergies to abdominal cramping.  It is also a great gentle cleanser. The 2007 data in the NEJM regarding Lavender causing precocious puberty should be approached with some careful consideration.  Indiscriminate use of any EO can be harmful as they are powerful medicines in their own right.  Especially one that has known estrogenic effects.  However, small scrupulous use on a bee sting is very different than slathering a young boy’s body (ie entire surface area) daily with lavender lotion.


Epsom Salt Baths

Epsom Salt Baths


Epsom salt (Magnesium sulfate) is one of the most inexpensive natural healing agents that one can buy at the grocery store.  This is a timeless treatment that my own grandmother used for a laundry list of ailments and injuries during the 98 years of her life.  I am a member of an amazing Facebook group called the Crunchy Moms of SA.  You can bet if someone asks a question to the group about a regular sick kid a following comment will mention Epsom salt baths.  I love intuitive medicine. In addition, I have this science nerd that lives in my head and always wants to know well now how does that work exactly?

It is very interesting that for more than a century folks have claimed a detoxification effect from Epsom salts.  Recently there has been much debate about the data on the common methylation defects that are emerging from the human genome project, specifically on the many MTHFR SNPs.  These folks, myself now included, have many associated vitamin defects.  These single nucleotide polymorphisms can lead to any combination of calcium, magnesium (Mg), zinc, N-acetyl cysteine (NAC), glutathione, iron and vitamins B1, B2, B12, D and folate deficiencies.  Methylation is not only important for our vitamin synthesis.  It is one of the bodies main avenues of detoxification and to make matters worse many of these vitamins act as co-factors and regulators in the processes.  Way back in 1992, Molecular and Cellular Biology published an article where Mg deficient rats had significantly elevated inflammatory markers (IL-1, IL-6, TNF-α) and went on to develop significant cardiac lesions.  Current research has expanded the role of magnesium as anti-inflammatory and immune modulator.  So what does this gobbledygook have to do with Epsom salt and your kid?

For a kid with a typical short-lived virus (fever <72hrs) and its associated acute cytokine driven inflammation an Epsom salt bath can provide a safe anti-inflammatory effect via magnesium’s effect on the cascade.  For a kid with any combination of MTHFR SNPs and an impaired ability to clear drugs this type of bath is a safer way to gently bring down a temperature and relieve the suffering of inflammation.  Also there is the extra bonus that the bit of magnesium absorbed can safely bring them towards better cellular levels and immune function.

I like the skin as a barrier and filter for supplementing children.  Oral supplementation is tricky and often requires bloodwork to be done properly.  Where in a bath the skin acts as a filter so that too much magnesium is not absorbed too quickly causing side effects or disrupting calcium balance.  Adults are to add 1-2 cups of Epsom salt to a bath and to soak for 10-20 min.  A small child is to use proportionately less.  I usually recommend a measured  ½ cup to a full bath.  Using too much Epsom, too little water, staying in too long, or doing this too often can result in lethargy and diarrhea.  I want to add this warning. Though many of us already have learned the hard way not to put a kid with diarrhea in any sort of bath, for first time parents trust me don’t do it.  A shower is a better choice.  Especially do not put them into an Epsom salt bath as the absorption of the magnesium will worsen the diarrhea.  Magnesium is a well-known laxative.  For children under 1 year of age I would consult with your provider.


My grandmother passed away this past year.  I can feel her presence as I write this particular blog.  The same woman that taught me the incredible beauty of maternal intuition and common sense also taught me to question everything.  This article is very much in her honor.

Food Delight

Food Delight


Over the past years I have met many different children and their families who have found eating to be an adversarial part of their lives.  As someone who truly loves food (maybe even too much) I feel for these children and their families.  Eating is an valued act in many cultures. Unfortunately eating issues are complex.  Often many factors have led to a child not enjoying eating.  Chronic allergies causing food to lose flavor, anaphylaxis leading to the fear/awareness that food can kill, gut dysmotility, gut inflammation, sensory integration issues, trauma from a choking event and these are just a few on a mountainous list of reasons why a child may not enjoy eating.  Children often out of fear will become extremely restrictive in their eating.  As a parent with nutrition knowledge it is terrifying to watch your kid eating the same three foods day after day.  Meals become stressful for everyone involved.  Food delight is eventually lost for all involved.

I have recently been coaching on this concept of food delight as a likely healing pathway.  I would argue that food delight has been lost for many Americans as a whole.  The concept of savoring each bite of our supper seems absurd in our busy lives.  I was reading Thich Nhat Hanh’s Savor: Mindful Eating, Mindful Life and came across what he calls The Apple Meditation (chapter 2).  Even with my own mindfulness practice I can tell you I cannot remember the last time I actually savored an apple.  When he suggests to smile at the apple prior to biting in I actually laughed out loud.  But why do I find this hilarious?  Is this revered teacher being ridiculous?  Or is it that my own American lifestyle has me too busy to slow down and find the pleasure that is available to me in the beauty of the apple itself and in each bite I take?  What is my relationship with pleasure in general?  Eek.  Cricket. Cricket.

Pleasure and enjoyment are absolutely contagious.  This way of creating desire is what the entire American advertising industry is based upon.  The folks in the commercials aren’t just bored with their new phone or car.  They are loving every second of it.  So that we might as well…

My simple theory is we can all benefit from more food pleasure.  More mindfulness can provide actual enjoyment if we stop ourselves long enough to create space for the experience of eating.  Food pleasure is contagious even to the most picky of eaters.  Make food that is beautiful and delicious to you and your family.  Show pleasure when you eat and describe what you are experiencing to your child.  They may not jump right onto that broccoli but I bet you will at least have their attention when you begin describing the pleasure you get from its funny shape and brilliant green and the crunchiness.  Man…now I want some broccoli.  I’m telling you.  Ham it up.  It’s ok to be over the top with this.  It’s ok to feel totally silly.  But if your picky eater starts adding foods to their favorite three by you having fun and enjoying yourself wouldn’t it be worth it?

The apple in your hand has the body of the Cosmos.

-Thich Nhat Hanh

ebook available for download at the San Antonio Public Library