Since we are talking about attachment this week in the podcast, I thought that I would give a brief description of it as a teaser for the incredible conversation with Duey. Attachment theory is one of the most important frameworks ever developed for understanding human behavior, emotional development, and mental health. At its core is a deceptively simple idea: human beings are biologically wired to seek safety and connection through relationships. The quality of those earl

Birth Order Is Biology, Not Birthright - so says a new paper in MedRxIV (Kramer et. al. 2026) Here is a short field guide to how sequence shapes the immune system, and maybe the brain in children. We’ve treated birth order like personality trivia. First-borns are “responsible.” Youngest are “free spirits.” Middle children… well, we forgot them. This paper suggests something more interesting: birth order is a biologic exposure. Not destiny. Not diagnosis. But signal. A

In a recent episode of the All in Podcast, David Friedberg discussed the new paper in Nature Medicine by Dr. Maas and colleagues which paints a modern picture of colon cancer and the why? It is super important as a stand alone study as well as a blueprint for further future analysis of chemical disease associations across the 80,000 chemicals in circulation. (Dept Tox Subst) Colorectal cancer used to be a disease of age. Now it’s a disease of timing. Over 20 years: >80% inc

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,

I started medical school in 1992 at Emory University. The system was imperfect. But it was clear. Doctors took care of patients. Doctors taught students. And the system made room for both. Time was the currency. The currency bucket was massive. And we spent it on people, the patient and the student. Attendings taught. Residents practiced and learned. Students watched, tried, failed, and grew. Failure was expected and utilized to press mental growth. The hierarchy wasn’t a

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

Covid 19 Post Mortem As you all know, after reading countless articles that I have posted about COVID and the policies that were put in place by "well meaning" bureaucrats, I have been highly critical of the events that took place and the US Government's failure on so many fronts. There are two seminal articles that have been written on these topics to date: 1) COVID-19 Origins: Investigating a “Complex and Grave Situation” Inside a Wuhan Lab, 2) COVID Lockdowns Were a Gian

What Should We Remember The COVID Post-Mortem: What We Missed (and What We Still Can Fix) We ran the largest public health experiment of our lifetime. We failed. Not everywhere. Not always. But in the places that mattered most, children, truth, and upstream health, we got it wrong. And if we don’t name it clearly, we’ll do it again. The First Mistake: Forgetting the Child When the world shut down, we told ourselves it was temporary. Two weeks. Flatten th

There is a quiet but profound truth at the center of pediatrics: there is only one true stakeholder, the child. Not the parent. Not the physician. Not the hospital system. Not the insurer. The child. And yet, in the modern healthcare landscape, that truth is often blurred, diluted, or, if we’re being honest, forgotten. Jeff Bezos famously kept an empty chair in executive meetings at Amazon. That chair represented the customer, the ultimate stakeholder whose needs should gui

Brene Brown - Leadership Tools to Teach Your Children and SELF “Stand firmly enough to lead, loosely enough to listen.”  Strong Ground by Brené Brown published in 2025 Breaking down this new book by the excellent Brene Brown, we find that strong leaders don’t eliminate tension or risk. They hold it. And this is key! What does the hold look like? How does it show up to the team? The theme in my mind is "toughness with tenderness" · Clarity is kindness. Vaguen

Goal Preserve microbial diversity, reduce inflammatory signaling, and promote resilient host–microbe balance. 1. The First 1000 Days Pregnancy: Focus on fiber-rich, whole foods. Avoid ultra-processed foods and unnecessary antibiotics. Birth: Encourage vaginal delivery when safe; prioritize skin-to-skin and early breastfeeding. Infancy: Breastfeeding preferred; if formula, consider HMO-supported options. Avoid early sugar exposure. 2. Feed the Microbiome Aim for fiber in

1) " Background: The gut microbiota plays a crucial role in brain development and function, especially in early life. Disruptions in the pediatric microbiota–gut–brain axis have been linked to neurodevelopmental and psychiatric disorders. We hypothesize that early-life dysbiosis can perturb neurodevelopment via the pediatric microbiota–gut–brain axis, increasing risk and/or severity of neuropsychiatric outcomes, and that microbiota-targeted strategies may mitigate this risk.

"Change occurs from the outside in" Dr. Bland Medicine has a habit of believing it has arrived. Every generation of physicians looks around the room, surveys the white coats and microscopes and MRI machines, and quietly assumes the puzzle is mostly solved. History laughs at that assumption. The truth is that medicine is always mid-sentence in a very long story. Dr. Jeff Bland has spent decades helping rewrite that sentence. In a recent conversation on The Root Cause B

After returning from Jackson Hole, Wyoming this week, I was struck by the beauty of the Elk refuge, a place where thousands of elk relax in the winter lowlands. Staring at them, I pondered a question: why do the elk shed their antlers yearly? Seems like a lot of wasted energy in a resource scarce world. The answer, mating. Nature has a peculiar sense of theater. When reproduction is the goal, evolution doesn’t whisper, it builds costumes, props, and entire stage productio

1) In a new article in Cell, we see that prenatal maternal inflammation alters the maternal gut microbiome in ways that can be transferred to offspring, predisposing them to exaggerated intestinal inflammation later in life. Specifically, maternal immune activation reshapes microbial communities that drive pro-inflammatory immune responses in offspring with neurodevelopmental abnormalities. The mechanism involves epigenetic reprogramming of CD4⁺ T cells in the offspring, mak

There are moments, usually late, usually quiet, when honest thinking can be had. When you zoom out and see the ecosystem around children not as a collection of caring institutions, but as a set of incentive machines. And incentive machines, unlike grandmothers, do exactly what they’re built to do. MAKE MONEY Tonight I sat with some difficult thoughts about the state of primary services for children in the United States. The deeper I look, the clearer it becomes that money

Picture this: A story that lands for me and many. Youth is a roaring engine fueled by the audacious belief that time is infinite and sleep is optional. You burn the candle at both ends, then try to invent a third end just to prove you can. You mutter, “I’ll sleep when I’m dead,” as if biology were a suggestion rather than a contract. The thrill of output, work, projects, ambition, fun, music, feels limitless. Productivity becomes virtue. Rest becomes a nuisance. You perfo

Relational balance falters when one person needs the other to feel safe or whole. A parent in a strained marriage or carrying childhood wounds may lean on a child for comfort. The child, loyal and loving, tries to meet that need. Over time, this can harden into dysfunction. Years ago, I cared for a mother and son locked in a budding enmeshed relationship. She could not draw boundaries. She absorbed his pain, projected her own trauma onto him, and smothered him with anxious

It has long been established that metabolic health plays a crucial role in vaccine effectiveness and overall immunity against infectious diseases. Poor metabolic status impairs immune activation, antibody production, and long-term protection. In older adults, vaccine responses are often weaker. Aging frequently coincides with rising rates of metabolic disorders (such as insulin resistance, obesity-related issues, and inflammation), reduced immune cell function, and lower an

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 hypothesize