Episode 119
Kara Wada:
From Exhausted Physician to Empowered Patient: Charting a New Path in Autoimmune Health
In today's episode, we're joined by Dr. Kara Wada, a quadruple board-certified pediatric and adult allergy, immunology, and lifestyle medicine physician who also has personal experience with Sjogren's.
We dive deep into an explorative conversation that sheds light on the nuances of allergy, autoimmunity, immune deficiency, and cancer. We also discuss the driving factors behind the increasing incidence of these health challenges.
First Aired on: Dec 25, 2023
Episode 119
Kara Wada:
From Exhausted Physician to Empowered Patient: Charting a New Path in Autoimmune Health
In today's episode, we're joined by Dr. Kara Wada, a quadruple board-certified pediatric and adult allergy, immunology, and lifestyle medicine physician who also has personal experience with Sjogren's.
We dive deep into an explorative conversation that sheds light on the nuances of allergy, autoimmunity, immune deficiency, and cancer. We also discuss the driving factors behind the increasing incidence of these health challenges.
First Aired on: Dec 25, 2023
Table of Contents:
In this episode:
Personal Journey and Diagnosis:
- Dr. Kara Wada recounts her burnout experience post maternity leave and the transformative period following her diagnosis with systemic Sjogren’s.
- She explores how her formal medical education fell short in preparing her for the lived experience of Sjogren’s.
- Dr. Wada talks about the onset of symptoms that were unrecognized during her college days until her mid-thirties diagnosis.
Misconceptions in Medical Education:
- Discusses the narrow education on Sjogren’s, meant to answer board questions, which oversimplifies patient experience.
- Emphasizes the commonality of patients with normal lab resultswho are frequently misdiagnosed, leading to feelings of frustration and being misunderstood.
Symptoms and Recognizing Disease Patterns:
- Describes often overlooked symptoms like dysautonomia/POTS, migraines, and digestive issues that are frequently associated with Sjogren’s.
- Elaborates how patients typically present with symptoms unrelated to dry eyes or mouth, which complicates establishing a diagnosis.
Healthcare Journey and Advice:
- Illustrates how our immune system functions and how it can malfunction in cases of allergies, autoimmunities, immune deficiencies, and cancer.
- Discusses the shift towards integrative and lifestyle medicine as a means to bridge the gap left by conventional medical training.
- Underscores the importance of healthcare professional wellness to ensure better patient care.
Insights on Modern Lifestyle and Disease:
- Tackles the growing evidence that changes in lifestyle over the past few decades, like diet, sedentary life, and toxin exposure, have contributed to the rise in allergic and autoimmune disorders.
- Highlights the emerging theory about the epithelial barrier hypothesis and its potential link to modern diseases.
Wellness and Integrative Health Approach:
- Advocates for a “wellness 2.0” paradigm where there’s a balanced doctor-patient dynamic, and the physician’s humanity is recognized.
- Encourages listeners to take active steps toward their health by being more communicative about the real impact of their symptoms on their life quality.
Other Resources:
Connect with Kara Wada
Episode Transcript
Julie Michelson: Welcome back to the inspired living with autoimmunity podcast. I'm your host, Julie Michelson. And today we're joined by Dr. Kara Wada, quadruple board certified pediatric and adult allergy, immunology, and lifestyle medicine physician who also happens to have Sjogren's. In today's conversation, we discuss the differences between allergy, autoimmunity, immune deficiency, and cancer, as [Page//00:01:00] well as what might be driving the ever growing incidence of these health challenges.
Dr. Wada, welcome to the podcast.
Kara Wada: Thank you so much for having me. I'm thrilled to be able to connect and to talk today.
Julie Michelson: I would love for you to share with listeners and me a little more about your personal journey. Not just with, you know, why are you quadruple board certified? But your wellness journey, your personal journey and, and what has led you to this world that you are now just totally rocking only,
Kara Wada: so about four years ago is when I was diagnosed with systemic Sjogren's. At that point, I was two years into my, you know, full fledged allergy immunology practice. I was just back from maternity leave from having my second child and I was at a bit of a crossroads because I At that point in time, [Page//00:02:00] I was so exhausted.
I was professionally and personally just zapped, totally burned out. And thought that I might actually step away from clinical medicine. I dropped my clinics, like the number of clinics and time that I was in clinic by half. And really realized that I needed to focus on my own health. I needed to refill my own cup.
And... It has been a really, in many ways, a slow but fast evolution since that time. And I think I continue to just peel back the layers like an onion and realizing how, even though at the time I was only triple board certified, I guess, but like but at the time that that education that I had really [Page//00:03:00] did not prepare me for one living in the role of a patient, nor did it really.
Like the education I received on Sjogren's really did not reflect at all the lived experience of Sjogren's, and I think did not help me all that much in realizing that that was what was going on with my own health, because in hindsight, I actually had symptoms that, you know, was it full blown Sjogren's or not at that time?
Who knows? And it doesn't really matter, but I had symptoms that I now recognize as related in some way or prodrome back to when I was in college in my late teens, early twenties, and I was in well into my mid thirties when I was diagnosed. What I will share, you [Page//00:04:00] know, with, with folks within the patient community, and actually, I just I just wrote an article for Kevin MD on this as well that we'll, we'll publish tomorrow, but what we learn about Sjogren's in medical education is how to answer the question on your boards correctly, which is, they're going to describe a postmenopausal woman.
She's coming in complaining of a gritty sensation in her eyes. You notice on physical exam that she has poor, poor dentition, poor teeth, and then you have some lab data to say that her blood work shows that she has this antibody SSA positive. And then you'll get, you circle the question, you're like, oh, yes, I got it.
Julie Michelson: I don't ever have to think about Sjogren's again.
Kara Wada: Or if you're a pediatrician this will come up in the SSA antibody can cause congenital heart block. So that will be the question that you learn is, you know, did mom baby [Page//00:05:00] has congenital heart block and then the question may ask, you know, what was wrong on mom's lab work, but here's the reality.
And here, you know, thinking back to the puzzle pieces of symptoms I've had over the years yeah. a lot of digestive distress. So, you know, symptoms that we describe as irritable bowel, but really wicked stomach aches migraine headaches, profound fatigue, back stiffness that I actually do recall going and kind of seeing a primary care about at one point during my medical training, which must have been pretty significant because as residents, like resident physicians, you like never go to the doctor cause you don't have time, like, and you're trying to take care of yourself.
Like we're the worst patient. So it must've been pretty bad. I had an episode of idiopathic anaphylaxis after having my first child. And I also [Page//00:06:00] over time realized that I couldn't wear mascara without looking like a raccoon because I was always touching my eyes, rubbing my eyes. Wasn't able to tolerate wearing contacts at a certain point because of the dry eye.
Yeah, and. What is fascinating, especially as I now clinically am seeing patients, no one ever comes in with this, you know, their, their main complaint of like dry eyes or dry mouth. They're complaining about their dry cough or their body pain, their fatigue maybe their sinus issues because I'm an allergist by trade, right?
So they're coming to see me for their sinus stuff. And the other reality is that 30 to 40% of patients have totally normal labs.
Julie Michelson: Thank you.
Kara Wada: yeah, totally normal labs. So, you know, they get [Page//00:07:00] that. Oh, your labs are normal.
Julie Michelson: Must be in your head.
Kara Wada: must be normal. Yeah. Let's try this antidepressant or maybe you should try losing a few pounds.
So all that to say that, you know, this. And it's been the patient community that has welcomed me and embraced me that I've learned so much more from than, you know, those several hundred thousand dollars I spent in my education. Now granted, you know, I learned some other things along the way too, but so.
Once I was diagnosed and, and I will say I feel incredibly fortunate, and this is seems odd to say, but my labs were totally wacky. And that like, they were terrible at the time. I think took my my rheumatologist slash friend by surprise had those not been abnormal. I don't know. I don't know how long it would have taken me to be diagnosed.[Page//00:08:00]
Julie Michelson: There's so many parts and pieces of your story that I'm like, let's talk about that. Let's talk about that. I want to first just kind of reinforce. Because I have this conversation with clients a lot that because standard Western medical training doesn't teach about how to, you know, they don't teach about gut health.
They don't teach about how to heal autoimmunity, how to, you know, reduce inflammation, all of the things. And so I know that by the time people find me and probably you, they're frustrated because
Kara Wada: Absolutely.
Julie Michelson: They had normal labs. They were offered antidepressants. They were searching and searching. And so I just, I want to highlight that part of your journey and every other physician that has been on here that has, you know, an autoimmune journey or a health [Page//00:09:00] recovery journey is that it's not, I said this yesterday, you know, nobody becomes a doctor if they don't want to help people.
Thank you. And somebody said, well, that's not true. I said, Oh, there's easier ways to make money. I promise. You know, but, but it's this, the education system has to change as we now we have information and, and this is where integrative medicine, functional medicine. lifestyle medicine, whatever you want to call it is, is key.
And, and I love you touched on it. And I think this is really important for people. You kind of said it, but didn't say it like, you know, it doesn't matter if you have a diagnosis or when you get the diagnosis, this idea of. We ignore and normalize symptoms, and if we don't hear the whispers, we will get shouts, and that's what
Kara Wada: Yes. [Page//00:10:00] Yes,
Julie Michelson: and yeah, yeah, it's like, you know, shocker, your autoimmunity, you used to have gut issues, no way, you know, there's a connection yeah,
Kara Wada: yeah. And you know, I think part of it I will refer to myself as the ostrich with their head in the sand for a long time. I.
Julie Michelson: I
Kara Wada: In part, I was totally in denial, but also, like, I didn't have time to be sick. Now that I say that, but then it's a little like tongue in cheek because there would be afternoons where I was totally incapacitated because.
I ate something that didn't sit well, or I had a terrible headache or. I was just totally zapped from really overdoing it, and so I was having, I was forced to take rest, right? Because of symptoms, [Page//00:11:00] and that's what your body needs and is like demanding at that point.
Julie Michelson: Yeah. Which is so true. I had a client last week who was very sick, like, you know, ER had a really high D dimer, like a scary moment in time where, and, and two days later she was like complaining that she was still sick. And I'm like, are you in bed? Well, no, I'm working and I'm like, yeah, like , you're not gonna get better if you don't rest.
And especially when we've got these chronic, whether it's autoimmune or not, just these chronic symptoms, we do tend to just try, ignore and try to push through. And our body will always take us down if we're not gonna give it the rest that it wants. For sure. So I, I wanna touch on, 'cause it. There's, again, so many questions I want to ask you.
You have this whole host of, of symptoms[Page//00:12:00] that you've experienced, and this is what you're seeing in your other patients with Sjogren's is this, you know, because it sounded like, I always think by the time you get the really dry eye, There was always this other host of, of things. And so is that what you're seeing is, you know, it doesn't, I almost, I don't, I don't want to offend you.
I don't know you well enough yet, but to me it's like, I, I, you know, it's all, it all comes back to the same stuff when we're talking about autoimmunity. And so I don't care if. You know, they show grants is one of the things they threw, you know, that was like my fifth diagnosis. As you know, things just progressed and progress.
And it's like, I don't, I don't care what name they gave what you have, like, let's just go after what's going on here. You know, why? Let's answer the question. Why? And then we can start shedding some of those labels. But it sounds like [Page//00:13:00] that that's accurate. You see the same, almost the same host of,
Kara Wada: yeah, and the data supports that too. The other symptom that I left off the list is Dysautonomia, or POTS, is incredibly common in Sjogren's. It's the number one autoimmune cause of POTS. And although I don't, as far as I know, I haven't had I wear my aura ring and some of my trackers, so I don't think POTS is going on, but I have had significant issues with orthostatic intolerance and I would have to scrub out of Thank you.
Thank you. Surgery is a medical student because in that hot, especially it wasn't so much an issue on the actual surgery rotation, but on the rotation where they keep the war, the room much warmer for the babies that are, you know, about to be born. I had to scrub out on multiple occasions because I [Page//00:14:00] think.
In hindsight, combination of prolonged sitting or standing. The warm environment all those things kind of came into play where my blood pressure would drop and I would, to the point where I thought I was going to pass out. Thankfully, I didn't.
Julie Michelson: Yeah. Thank you for so many reasons.
Kara Wada: right, they drill into you, like as a med student going through, you know, the OR procedures, like you cannot pass out in the operating
Julie Michelson: Not allowed. You got to get out first, drop in the hall.
Kara Wada: Yeah, but I distinctly remember my preceptor say, you know, asking if I happen to be pregnant because I was having to scrub out so often, which, of course, now that would kind of be frowned upon, but but it was memorable to now, you know, Oh, yeah, that probably was all related.
Julie Michelson: Yeah, shocker, shocker. So, so you have such a unique background and [Page//00:15:00] practice and I want to dig in a little bit to like allergy versus autoimmunity versus immune deficiency because it's all
Kara Wada: I'll enter. We're all one human organism. Yes.
Julie Michelson: all so
Kara Wada: in addition to our microbes. But so when we think about our immune system, its purpose is to help protect us, obviously, against infection, its purpose also is to help us heal, like from injury as well. So if you think about a cut that you may get, you'll get an inflammatory response at that cut, it's going to get better.
It's ouchy. First of all, it's painful. It's red, swollen, typically and it's warm. Those are all the signs and symptoms of acute inflammation. And so, you know, during that response, you're having this coordinated effort of cells and proteins and these things called [Page//00:16:00] cytokines and chemokines, like this beautiful orchestra of our physiology taking hold so that it can stop the bleeding.
It can bring in the cells that are going to help repair the tissue damage. It's going to fend off any microbes from the surface of our skin that maybe have made their way in or other infection. And it's going to allow that area to heal. And it's this magical thing that happens, right? But when we think about allergy and we think about autoimmunity and throw cancer in there too and immune deficiency, that system, it has gone haywire.
It's misbehaving. And so an allergy, our immune system has recognized something in the outside world as the, the danger signal, the enemy, and it mounts. a particular flavor of an inflammatory response against that, whether it's a pollen or [Page//00:17:00] kitty cat allergen or dust mites, or in some cases foods, as we've seen in the last 20 or so years, this really steep rise in true food allergy, where if someone is exposed to this minute amount of peanut or egg, that they have a life threatening allergic response. In the case of autoimmunity, When we are incubating, when we are in in mom's womb, our immune system is already hard at work determining what is Self from non self and what is safe. And so things that are too good of like recognized too easily. Those types of cells are eliminated and those that are not recognized self are eliminated as well.
So that you end up with this immune system that can tell. Okay. What what is us and what is not us and. In [Page//00:18:00] autoimmunity, essentially the immune system loses that tolerance over time, so that then the immune system is seeing our own bits and pieces as that enemy. And it depends, you know, each autoimmune condition has a little bit different flavor of this.
It has particular targets that are implicated, and that then explains some of the symptoms we end up with. In immune deficiency, We don't have all the parts or pieces or they aren't quite working and in a perfectly coordinated fashion. So we are at an increased risk of infection, whether it be, you know, more frequent infections, more severe infections.
Eyeball infections that most people wouldn't be, you know, wouldn't have any issue with and a lot of times the collateral damage and inflammation that occurs is not appropriate either. So, sometimes there's, like, too much or there's too little and so that then can expose the [Page//00:19:00] immune system to.
actually creating an autoimmune response to because it's not cleaning things up properly. So the really obnoxious thing for many of my immune, my patients with primary immune deficiencies, especially is that a lot of them coincide, like co occur, occur in the same person. as autoimmune disease. You end up with autoimmune and immune deficiency in the same human.
It's a real kick in the pants. And then you, you're forced you know, to make some really difficult decisions as a team with your immunologist, maybe your infectious disease doctor or the rheumatologist in deciding how can we try our best to like restore balance as best we can because sometimes you have to like Tap down the inappropriate inflammation, try to boost things up the best way we can and so that is.
They can be incredibly challenging and [Page//00:20:00] frustrating. And then in cancer, essentially, the you have cells that have gone rogue. They are reproducing at levels and numbers that they're not supposed to. Usually there's some kind of glitch in the system. And the immune system is unable to recognize and take those out appropriately.
And so what you're seeing with some of the newer Immunotherapy cancer treatments is they actually turn the immune system back on to help then target the cancer more appropriately.
Julie Michelson: Yeah. And that's. I think at least in regards to cancer and the general population, I think the more we have these conversations where people can realize, like, we, we have bad cells all the time, we all
Kara Wada: Yeah. Yeah. Yeah. And a lot of times our immune system sees them and takes them out and you never know.
Julie Michelson: What it's supposed to do, right? And that's the, you know, that approach [Page//00:21:00] of that.
I look forward to the day when there is a more integrative approach across the board with cancer so that we are supporting the whole human while we are helping the body go after the cancer.
Kara Wada: Yeah.
Julie Michelson: you know, it's, it's a, it's an interesting conversation, but I, I, that to me, the key for People to start to understand is, you know, we still need to support the body to do its job.
And, and so there was a reason your body didn't catch those cells, I guess, is what I'm, you know, at which to me ties into this whole conversation of what are the things that, you know, we can do, what is that approach, whether we are, you know, for wellness. Right. Because I, and I'm guessing it sounds like you have people that show up, they're coming to you for allergies.
And I'm guessing often they have, like you did, like I did have [Page//00:22:00] issues brewing that they didn't realize were autoimmune.
Kara Wada: Oh my gosh. Yes. I would have to say so I am currently I see patients two and a half days per week. So I'm not totally full time in the clinic. In part, that's how I keep my cup full.
Julie Michelson: It's awesome.
Kara Wada: but I would say at least out of maybe those 36 patients I might see in a week that at least probably six of them have specifically come in wondering about food allergies, but what they're really dealing with are gut issues.
It's not, it's not like they need an EpiPen. And I would say probably a good 4 to 5 of those patients are maybe the 5th, 6th, 7th, 8th opinion on their symptoms, which to me, they describe symptoms of too much inflammation in one way, shape, or form [Page//00:23:00] and or dysautonomia, so issues with like blood pressure, heart rate, fatigue unfortunately, so I'm, I'm located in Columbus, Ohio.
I work at the Columbus, Ohio. large university there. And we don't have anyone locally who's taken the lead on dysautonomia, which is really unfortunate. So my patients to see a specialist have to go all the way up to Toledo and wait about two years to get care.
Julie Michelson: seems insane. And, but
Kara Wada: It is. Yeah, we were in a in a metro area of several million people. And so
Julie Michelson: Right, you're not in the
Kara Wada: especially, yeah, we already had a lot of these folks pre pandemic that, you know, weren't really getting great care or great recognition. I think there's a better, more discussion about what these symptoms represent and folks seeking care.
But we've also had a really, you know, an increased prevalence of these symptoms to with long COVID.
Julie Michelson: And for listeners, and I apologize I didn't ask this [Page//00:24:00] sooner, explain what dysautonomia is for people that aren't familiar.
Kara Wada: So dysautonomia is essentially a, an umbrella term used to describe the automatic nervous system going haywire. So, and it could show up in all sorts of different ways. But most common, and I would say probably affects quality of life most significantly are issues with blood pressure and heart rate.
So folks may have issues with Feeling like they're going to pass out, or they actually pass out and may have issues with digestion, can have differences in how, like, their pupils dilate and constrict. issues with sweating. I have a few patients who will wake up in the middle of the night drenched in sweat.
Now there are some other reasons why that can be that you
Julie Michelson: I was gonna say, you're not, not talking about
Kara Wada: Yep. Not necessarily, you know, change of life. Yep. And not necessarily blood [Page//00:25:00] sugar issues would be the other main thing you would think about. And. Ruling out cancer but and they are symptoms that have, we've known that they exist for some time, but they are like many autoimmune conditions, things that affect different organ systems and are not well understood, not super well researched.
And so when you have a medical system that is incredibly siloed. Where the cardiologists are in one space, the neurologists are in another space, the immunologists somewhere else, and we kind of stay within our groups, it's challenging to have. really good coordinated care for these folks.
Julie Michelson: Yeah. So, so well [Page//00:26:00] said and you mentioned long COVID being one reason I feel like in general, even like pots, pandas, these kinds of things, you know, it's that question of, are we just more aware? And so now we, you know, more people, we, more diagnoses are happening or is it. Like real food allergies, autoimmunity, autism, is there just really more, you know,
Kara Wada: Yeah.
Julie Michelson: think this increase in, I mean, I have, I have two, I still call them kids, two adult offspring who carry EpiPens and have, you know, one, Didn't, well, did when he was little, seemed to outgrow stuff, and then randomly, again, you know, different, different allergies.
It is
Kara Wada: Yeah. It's really fascinating too, because there is this really almost like a not quite a land line in the sand, but so I am, [Page//00:27:00] I'm 39. So I'm an elder millennial and I don't remember a single kid in my class having food allergy. My sister's 36 and I think she probably would say about the same, but you go another like 2 or 3 years and that's when those numbers really kind of blossom, you know, kind of those born early 90s.
Onward, and this has been a really interesting topic of conversation at our national. Allergy asthma immunology meetings and this past spring, you know, the real big discussion point was. One of the ways that we have conceptualized this increase over the last 30 years or so is the hygiene hypothesis, right?
The reason why we're seeing more is because we're all cleaner. And yeah, like, that helps explain it to some degree, but it wasn't the whole picture. And so there is [Page//00:28:00] a physician researcher, Dr. Adkis. Who is out of, I believe, Switzerland who took kind of the center stage and really spoke a lot about the epithelial barrier hypothesis.
So this idea that we have interfaces on our bodies, our skin, our respiratory tract, our gut, that are how we communicate with our outside world. And. Those barriers are permeable or semi permeable. We want communication from one side to the other. That's how we interact with our environments. Right. But if you have too many chinks in the armor, then you get into trouble.
And so what happens when you end up with. leakiness or breaks is that you see a change in the microbes that are living on that surface and you see a change in [Page//00:29:00] inflammation. And a lot of times in particular, what we talk about a lot in allergy is eczema. It's easy to see like what's going on. A little bit easier to study sometimes than, than gut related things, cause you're not having to do endoscopies all the time.
Julie Michelson: but it is a gut related thing.
Kara Wada: But from like a bi, yeah, but
Julie Michelson: I know, you can see it. I
Kara Wada: it's a little
Julie Michelson: easier.
to get to.
Kara Wada: Yeah, easier to see and conceptualize and but what you'll see, for instance, Staph aureus lives on our skin. It's kind of a natural commensal. It's kind of like a generally a friendly ish bug, but you see.
That's like the strains and the types of toxins that they may change when that skin is inflamed and essentially what happens is you end up with a snowball effect and so when you have breaks in the skin, the bugs change, there's inflammation, it makes it more leaky, so on and so forth. And that continues.
But as you mentioned, there's crosstalk. So you can [Page//00:30:00] see then changes maybe in gut microbiome and development of eczema, or you can see changes or exposures through the respiratory tract that then will increase the risk of developing something like multiple sclerosis. So there, there's, you know, this growing body of evidence that problems at these barriers and increased.
inflammation leakiness kind of at these barriers is the issue. So then the question is, okay, what's making them more leaky? And there's a whole bunch of things. We think about how different our day to day lives are compared to like my great great grandma who was living on the farm in Northern Georgia, growing all her own vegetables, canning things.
She was out with the cow and they would, you know, kill the chicken and my Even my dad, when he was growing up, he'd have to go kill the [Page//00:31:00] chicken and pluck all the feathers and bring it in for dinner, like they were, he was outside on the farm working all summer, like they didn't have air conditioning.
Julie Michelson: the earth.
Kara Wada: Yeah.
It just was. Totally different. And here we are, you know, in our creature comforts. I'm in air conditioned space. And I have my ear, but you know, I'm sitting and in that's not to villainize everything about our modern way of living. It's just a lot has changed. And we're seeing now the downstream effects of that significant amount, you know, change the different exposures that we are Are exposed to rapid change in diet increased sugar, oil, refined grains.
And on the whole, we're very sedentary. We spend upwards 90 plus percent of our time indoors. And so, and then the newest and the, and what Dr Adkis is [Page//00:32:00] kind of, I think pet project is looking at the role of dishwasher rinse aid. In particular, those used in commercial dishwashers but the, the, the residue left on glasses is very damaging to the gut.
And so commercial dishwashers came about late 1980s. Is that then implicated in what we've seen with increased rates of food allergy, eosinophilic esophagitis, drug
allergy.
Julie Michelson: two kids with that when they were little.
Kara Wada: Who knows, right? Yeah. And so you know, there still is a lot of work to be done to really hone in, but
Julie Michelson: Well, and I think that's a, a very specific product. But I think it, it underscores the whole. Exposure to toxins, right? So they're studying commercial dishwashing, but, you know, but what are people using at home even day in and day out? And, and, you know, that's a whole we could talk for another hour [Page//00:33:00] about that.
But I do think it's this combination and. You can't, so you mentioned, you know, the changes in our food system, the dogs are piping in and, and to me, you can't separate the changes in the food system and toxins. It's the same, you know, the bad oils, the ultra processed foods, you know, all of that is toxic.
And so you know, when I say toxins, I'm not always talking like chemicals, right? And forget and EMF, all, all the things,
Kara Wada: Yeah. And I think then it's, it's, we all probably need to sit down, metaphorically probably,
and, or stand up, yeah, and just think about, you know, what, what are our non negotiables? What are the things we're willing to change? What is our comfort level with risk to? And I think that's where more data would be helpful.
But [Page//00:34:00] as I I've talked a lot with my patients about the dishwasher stuff in particular, I have three young kids. I'm working. I have a business. I don't want to go back to hand washing dishes.
Julie Michelson: Right.
Kara Wada: So, you know, on the flip side, I'm trying to look for generally more eco friendly products that typically, you know, in broad brush strokes, things that are healthier for the planet tend to be healthier for our physiology.
And, you know, similarly with the things we put on our skin, like those are easy, simple swaps and switches that
Julie Michelson: But I love that you brought up the also know what your non negotiables are. I mean, one of, one of the pieces and we all need to be doing it for wellness, you know, the, the smart ones are doing it ahead of time before they have any symptom they're ignoring. But one of the things I do with my clients is we're reducing that exposure, right?
As we're supporting the body's detox pathways, we [Page//00:35:00] are, and it is a process. It's a process. There's no way you could wake up tomorrow and say, I'm going to reduce my exposure. And by next week, you've done it. Like, there's so much that we come into contact with and that's fine. Every change is an improvement.
I had one client who, and she did, she was a vegan when I met her and I was like, I'm not the one to help you as a vegan. Let's find you somebody. Oh no. Just tell me what to eat. So she would eat meat. But when we were cleaning up products, I said, what kind of shampoo and conditioner are you using? And I never did find out because she said to me, that's not negotiable.
Not negotiable. That for her, she loved her shampoo and conditioner. It literally cleaned up every other product she was using on her body in her home ever. And I'm like, great. Like, it's not about, A, we can't reach perfect. And B, we don't need to [Page//00:36:00] is the, you know, cause sometimes we get the, we have these conversations and it can start to sound doom and gloom and you know, we've got all of these hits we're taking, but we really don't have to fix everything in order for, for the body to be able to heal, which is, you know, the, that's the exciting part, right?
That's why we're here.
Kara Wada: We are resilient, amazing species that has made it this far.
Julie Michelson: Right.
Kara Wada: is sometimes, you know, the enemy of good. And I will say, I was the first to fall down that rabbit hole, not too long after, yeah, after my diagnosis, I doubled down I've had a Peloton bike for quite some time, since probably like 20, 2018, 2019
Julie Michelson: early adopter.
Kara Wada: maybe, yeah, early, maybe it was 2019, anyways, doesn't matter, but I
Julie Michelson: pre pandemic Peloton.
Kara Wada: And I was like shooting for, you know, PRS like, okay, like [Page//00:37:00] I'm in a like workout hard.
I was drinking green smoothies that I was adding some super fluid, you know, stuff to and. To make a long story short, I ended up with an acute liver failure from the supplement. So that's always just my word of caution of just, you know, don't, don't overdo it and just be conscientious
Julie Michelson: And more of something good isn't always better.
Kara Wada: Yes. And then
Julie Michelson: good for everybody either.
Kara Wada: it, that is absolutely. And then I took that perfectionism and then put it totally into kind of the elimination diet game and got. Really restrictive, lost a bunch of weight, which, of course, as you know, a woman in our society was, of course, like. You know, like, oh, you look great, you know, all those sorts of things.
But I ended up spending so much mental energy fixated on what I was eating, what I wasn't eating. That at a certain point, my symptoms [Page//00:38:00] were like rearing back. And I, and I honestly think I was just constantly in fight or flight. It didn't matter that I was eating like a really anti inflammatory diet and like.
You know, working out and doing these things like I had to kind of address all of it and I also just had to let go of the perfectionism like that was, I think,
Julie Michelson: And I think everybody, I'm sure you have the same thing. I think that the perfectionism, if we could. Somehow like diagnose perfectionism first, we could prevent a lot of this chronic illness because it really does that stress level. I've yet, and it may present totally different. Like, it's not like everybody you meet, you're going to know right away, but pretty much everybody that I've worked with is a perfectionist.
And that letting go is such an essential healing step.
Kara Wada: [Page//00:39:00] Yeah.
Julie Michelson: So,
Kara Wada: wonder if there are like, particular personality traits that also may, they, they absolutely provided a survival advantage at some point, you know, across our lifespan, right. Bye. Do those also, like, increase the potential sometimes for
Julie Michelson: yeah. And that's where we just need to learn.
Kara Wada: wonder.
Julie Michelson: Yeah. Oh, I, I think, I think for sure. I, I really do. I, it doesn't mean that if you don't care about anything, you don't get sick. I'm not
Kara Wada: No, no, no, no. Just, you know, like, we talk about
risk factors. Like, yeah, if you, if you drink a certain amount, you're more apt to get breast cancer, colon cancer. You know, like, those sorts of things where you just kind of take those into account, and...
Julie Michelson: Yeah.
Kara Wada: Yeah.
Julie Michelson: So, but I, I love the, what you're bringing to the world. And I just think, you know, the more [Page//00:40:00] anytime, especially like somebody who thinks they're just coming to see an allergist, right? Like anytime somebody can walk into a doctor's office and have contact with somebody like you who can help them understand.
True wellness, you know, and the body is such a gift. So I am so grateful that you are out there in Ohio doing what you're doing. Clearly you need more counterparts
Kara Wada: Well,
Julie Michelson: in your neck of the woods.
Kara Wada: the wonderful, wonderful thing about my position is that I get to work with trainees. So nearly nearly every day there is a medical learner of one one shape or another. So from undergraduates who are applying to med school, I will on occasion have them shadow with me all the way up through our allergy and immunology fellows.
We have two per year and actually. [Page//00:41:00] The season just opened for interviews. So we have you know, 100 plus applicants for, for these, you know, two spots every year. It's pretty incredible. And so to be able to share my story with them, share some tips and tricks as to how to think about and conceptualize these things that we have.
We may not have all the answers to. I think as human beings, our brains really hate uncertainty and and that is absolutely the case with physicians as well. And to push them to get. More comfortable with feeling uncomfortable, I think is is clutch. And to help instill and support their curiosity, I think is really important to and what really, really needs to take place to [Page//00:42:00] ensure that all of us as health care professionals can stay curious and compassionate and kind of leaning in is we need to ensure that our health care professionals have wellness as well.
Julie Michelson: Oh,
Kara Wada: Because if they are unable to fill their own cup, that is when you get someone who is burnt out, unhappy, maybe unhappy with their situation or their job. And I, I would almost guarantee that you are not going to get the best care that you could get from someone
Julie Michelson: They're going to end up sick. Like I always,
Kara Wada: Oh yeah, yeah,
Julie Michelson: like, why? When you just, you look at medical school and how it's set up, it's like, why are we trying to kill people who are training to help people? And it's not just this country, it's, it's medical school across the board is set up that way. It just doesn't make sense.
I was thinking about that with your a hundred plus applicants for the two spots. Like every one of those applicants really needs to be filling their [Page//00:43:00] cup and doing stress management. You know, it's such a high stress. And, and that's a great the flip side to that, that I can say is I'm not a physician is also, we need to remember that our physicians are human and they're people and, and
yeah. You know, and we have this training of decades of, you know, this mentality that you and I are trying to change, which is you show up at the doctor because you want the doctor to fix you. Right, like,
Kara Wada: yes, you need a partner.
Julie Michelson: Right. You know, we have to take responsibility for our own wellness and we, and we have to realize that our doctors don't necessarily have all the answers.
But when you can find one like Kara, like that's, it's gold. It really is. So,
Kara Wada: There's this really cool paradigm that has been written about and talked about called wellness 2. 0 where essentially it outlines this idea of the physician is human. There is this [Page//00:44:00] equalization the power dynamics between patient physician will never be equal, right? Like, there's there's no way to fully.
Equalize that just to the nature of. These systems. But it brings it into closer balance. And I think the more that we can lean into that is really important. But the reality is we live in a very capitalistic society and money talks. So they're also, you know, we're going to have to grapple with making the case.
Unfortunately, probably. from the financial side of things in order to really see systemic change. And that's kind of the tough love aspect of all of this.
Julie Michelson: yeah. Yeah. But the good news is that when, when that does happen and that the broken system [Page//00:45:00] finally collapses, we already, we know, you know, what can work and what is working. So I love that. So give listeners, if you will, and it can be anything can be directly shoguns related, not doesn't matter. What is one step that they can take starting today to start to improve their health.
Kara Wada: So I think the one thing is taking a few minutes just to sit, give yourself a little bit of that white space, that quiet to just listen to that inner voice and what he or she needs. I think that is
Incredibly important and I think it's really helpful to do that before a medical visit medical appointments [Page//00:46:00] almost on the whole tend to put us into fight or flight and when we get into fight, flight, freeze, fawn, we may not always. We may forget, like, what our objectives were for that visit, so jotting down some notes can be really helpful ahead of time to think about, okay, what are your questions?
What are your goals? How are your symptoms really impacting your quality of life? Being able to communicate how they are showing up in, in your, in, in showing your humanity can be really helpful, especially to maybe tug on that doc who is on, on the brink of burnout, or who maybe just needs that reminder that you are human.
And this is showing up in very human ways. Yeah, so that's
Julie Michelson: Yeah, and I'll
throw the other [Page//00:47:00] piece in because I see it a lot and it's, I don't think people do it intentionally. We tend to, even though we're showing up at the doctor's office for help, we do have this natural tendency, most of us, to downplay. Just what you're talking about. We may say, you know, these are the symptoms, but we don't share how it's impacting our life or, and so it's like, Oh, we said the word and then that's it.
And the doctor that's, they're not getting like, Oh my gosh, this is really impacting your life.
Kara Wada: So I'll share a really quick example. Low back stiffness was one of the main issues that was totally impacting my quality of life. And so I could tell the doc. Oh, I'm having low back stiffness. I sit down for prolonged periods of time and it's really hard to get moving again. It's worse in the morning.
Yes. All that's helpful. But what really illustrates how much it was impacting my life was I [Page//00:48:00] was not wanting to sit on the floor to play with my young children. And that like was breaking my heart. And so to share, you know, that little extra nugget of like, this is how problematic this is. Like that helps light the fire, hopefully under that.
That person's bottom to like, to do something about it, whether it's to refer you or get imaging or start meds, what have you, but to make to have some sort of action.
Julie Michelson: I love that. I love that. Amazing. Before we wrap up, where can listeners find you? Where's the best place?
Kara Wada: Yeah, so the best place is probably Dr. Kara Wada dot com on there. I have a freebie. So the 25. Things that we did in our family over the last four years or so to make simple swaps to like less toxic things that we were talking about just simple, easy. I'm a Midwest girl born and bred and I love a good deal.
[Page//00:49:00] So things generally are, you know, not going to cost a ton to really help start making those changes. And, on there. Also, you'll find so each year the last two years we've hosted the virtual shogun summit. So it is a, we have a ton of great resources on there and coming up this fall. We are launching a fall event called the demystifying inflammation summit.
So you're going to want to get on the email list. So you can stay in the loop. It's going to be a free event. Tons of experts across. The, you know, the spectrum of things of too much inflammation. So allergies, autoimmunity, asthma gut health issues. So I'm super excited and in the weeds of planning that right now.
Julie Michelson: I love that. I am definitely signing up. Love it. Love it. Cara. Thank you so much. You have given us amazing gold today.[Page//00:50:00]
Kara Wada: Thank you so much. I have loved talking and we're going to, we're going to have to have you on the Becoming Immune Confident podcast so that we can hear your story too.
Julie Michelson: Yeah, I would love it. I'd love to continue the conversation
Kara Wada: Yes.
Julie Michelson: For everyone listening. Remember, you can get the transcripts and show notes by visiting inspired living dot show. I hope you had a great time and enjoyed this episode as much as I did. I'll see you next week. [Page//00:51:00]
Dr. Wada, welcome to the podcast.
Kara Wada: Thank you so much for having me. I'm thrilled to be able to connect and to talk today.
Julie Michelson: I would love for you to share with listeners and me a little more about your personal journey. Not just with, you know, why are you quadruple board certified? But your wellness journey, your personal journey and, and what has led you to this world that you are now just totally rocking only,
Kara Wada: so about four years ago is when I was diagnosed with systemic Sjogren's. At that point, I was two years into my, you know, full fledged allergy immunology practice. I was just back from maternity leave from having my second child and I was at a bit of a crossroads because I At that point in time, [Page//00:02:00] I was so exhausted.
I was professionally and personally just zapped, totally burned out. And thought that I might actually step away from clinical medicine. I dropped my clinics, like the number of clinics and time that I was in clinic by half. And really realized that I needed to focus on my own health. I needed to refill my own cup.
And... It has been a really, in many ways, a slow but fast evolution since that time. And I think I continue to just peel back the layers like an onion and realizing how, even though at the time I was only triple board certified, I guess, but like but at the time that that education that I had really [Page//00:03:00] did not prepare me for one living in the role of a patient, nor did it really.
Like the education I received on Sjogren's really did not reflect at all the lived experience of Sjogren's, and I think did not help me all that much in realizing that that was what was going on with my own health, because in hindsight, I actually had symptoms that, you know, was it full blown Sjogren's or not at that time?
Who knows? And it doesn't really matter, but I had symptoms that I now recognize as related in some way or prodrome back to when I was in college in my late teens, early twenties, and I was in well into my mid thirties when I was diagnosed. What I will share, you [Page//00:04:00] know, with, with folks within the patient community, and actually, I just I just wrote an article for Kevin MD on this as well that we'll, we'll publish tomorrow, but what we learn about Sjogren's in medical education is how to answer the question on your boards correctly, which is, they're going to describe a postmenopausal woman.
She's coming in complaining of a gritty sensation in her eyes. You notice on physical exam that she has poor, poor dentition, poor teeth, and then you have some lab data to say that her blood work shows that she has this antibody SSA positive. And then you'll get, you circle the question, you're like, oh, yes, I got it.
Julie Michelson: I don't ever have to think about Sjogren's again.
Kara Wada: Or if you're a pediatrician this will come up in the SSA antibody can cause congenital heart block. So that will be the question that you learn is, you know, did mom baby [Page//00:05:00] has congenital heart block and then the question may ask, you know, what was wrong on mom's lab work, but here's the reality.
And here, you know, thinking back to the puzzle pieces of symptoms I've had over the years yeah. a lot of digestive distress. So, you know, symptoms that we describe as irritable bowel, but really wicked stomach aches migraine headaches, profound fatigue, back stiffness that I actually do recall going and kind of seeing a primary care about at one point during my medical training, which must have been pretty significant because as residents, like resident physicians, you like never go to the doctor cause you don't have time, like, and you're trying to take care of yourself.
Like we're the worst patient. So it must've been pretty bad. I had an episode of idiopathic anaphylaxis after having my first child. And I also [Page//00:06:00] over time realized that I couldn't wear mascara without looking like a raccoon because I was always touching my eyes, rubbing my eyes. Wasn't able to tolerate wearing contacts at a certain point because of the dry eye.
Yeah, and. What is fascinating, especially as I now clinically am seeing patients, no one ever comes in with this, you know, their, their main complaint of like dry eyes or dry mouth. They're complaining about their dry cough or their body pain, their fatigue maybe their sinus issues because I'm an allergist by trade, right?
So they're coming to see me for their sinus stuff. And the other reality is that 30 to 40% of patients have totally normal labs.
Julie Michelson: Thank you.
Kara Wada: yeah, totally normal labs. So, you know, they get [Page//00:07:00] that. Oh, your labs are normal.
Julie Michelson: Must be in your head.
Kara Wada: must be normal. Yeah. Let's try this antidepressant or maybe you should try losing a few pounds.
So all that to say that, you know, this. And it's been the patient community that has welcomed me and embraced me that I've learned so much more from than, you know, those several hundred thousand dollars I spent in my education. Now granted, you know, I learned some other things along the way too, but so.
Once I was diagnosed and, and I will say I feel incredibly fortunate, and this is seems odd to say, but my labs were totally wacky. And that like, they were terrible at the time. I think took my my rheumatologist slash friend by surprise had those not been abnormal. I don't know. I don't know how long it would have taken me to be diagnosed.[Page//00:08:00]
Julie Michelson: There's so many parts and pieces of your story that I'm like, let's talk about that. Let's talk about that. I want to first just kind of reinforce. Because I have this conversation with clients a lot that because standard Western medical training doesn't teach about how to, you know, they don't teach about gut health.
They don't teach about how to heal autoimmunity, how to, you know, reduce inflammation, all of the things. And so I know that by the time people find me and probably you, they're frustrated because
Kara Wada: Absolutely.
Julie Michelson: They had normal labs. They were offered antidepressants. They were searching and searching. And so I just, I want to highlight that part of your journey and every other physician that has been on here that has, you know, an autoimmune journey or a health [Page//00:09:00] recovery journey is that it's not, I said this yesterday, you know, nobody becomes a doctor if they don't want to help people.
Thank you. And somebody said, well, that's not true. I said, Oh, there's easier ways to make money. I promise. You know, but, but it's this, the education system has to change as we now we have information and, and this is where integrative medicine, functional medicine. lifestyle medicine, whatever you want to call it is, is key.
And, and I love you touched on it. And I think this is really important for people. You kind of said it, but didn't say it like, you know, it doesn't matter if you have a diagnosis or when you get the diagnosis, this idea of. We ignore and normalize symptoms, and if we don't hear the whispers, we will get shouts, and that's what
Kara Wada: Yes. [Page//00:10:00] Yes,
Julie Michelson: and yeah, yeah, it's like, you know, shocker, your autoimmunity, you used to have gut issues, no way, you know, there's a connection yeah,
Kara Wada: yeah. And you know, I think part of it I will refer to myself as the ostrich with their head in the sand for a long time. I.
Julie Michelson: I
Kara Wada: In part, I was totally in denial, but also, like, I didn't have time to be sick. Now that I say that, but then it's a little like tongue in cheek because there would be afternoons where I was totally incapacitated because.
I ate something that didn't sit well, or I had a terrible headache or. I was just totally zapped from really overdoing it, and so I was having, I was forced to take rest, right? Because of symptoms, [Page//00:11:00] and that's what your body needs and is like demanding at that point.
Julie Michelson: Yeah. Which is so true. I had a client last week who was very sick, like, you know, ER had a really high D dimer, like a scary moment in time where, and, and two days later she was like complaining that she was still sick. And I'm like, are you in bed? Well, no, I'm working and I'm like, yeah, like , you're not gonna get better if you don't rest.
And especially when we've got these chronic, whether it's autoimmune or not, just these chronic symptoms, we do tend to just try, ignore and try to push through. And our body will always take us down if we're not gonna give it the rest that it wants. For sure. So I, I wanna touch on, 'cause it. There's, again, so many questions I want to ask you.
You have this whole host of, of symptoms[Page//00:12:00] that you've experienced, and this is what you're seeing in your other patients with Sjogren's is this, you know, because it sounded like, I always think by the time you get the really dry eye, There was always this other host of, of things. And so is that what you're seeing is, you know, it doesn't, I almost, I don't, I don't want to offend you.
I don't know you well enough yet, but to me it's like, I, I, you know, it's all, it all comes back to the same stuff when we're talking about autoimmunity. And so I don't care if. You know, they show grants is one of the things they threw, you know, that was like my fifth diagnosis. As you know, things just progressed and progress.
And it's like, I don't, I don't care what name they gave what you have, like, let's just go after what's going on here. You know, why? Let's answer the question. Why? And then we can start shedding some of those labels. But it sounds like [Page//00:13:00] that that's accurate. You see the same, almost the same host of,
Kara Wada: yeah, and the data supports that too. The other symptom that I left off the list is Dysautonomia, or POTS, is incredibly common in Sjogren's. It's the number one autoimmune cause of POTS. And although I don't, as far as I know, I haven't had I wear my aura ring and some of my trackers, so I don't think POTS is going on, but I have had significant issues with orthostatic intolerance and I would have to scrub out of Thank you.
Thank you. Surgery is a medical student because in that hot, especially it wasn't so much an issue on the actual surgery rotation, but on the rotation where they keep the war, the room much warmer for the babies that are, you know, about to be born. I had to scrub out on multiple occasions because I [Page//00:14:00] think.
In hindsight, combination of prolonged sitting or standing. The warm environment all those things kind of came into play where my blood pressure would drop and I would, to the point where I thought I was going to pass out. Thankfully, I didn't.
Julie Michelson: Yeah. Thank you for so many reasons.
Kara Wada: right, they drill into you, like as a med student going through, you know, the OR procedures, like you cannot pass out in the operating
Julie Michelson: Not allowed. You got to get out first, drop in the hall.
Kara Wada: Yeah, but I distinctly remember my preceptor say, you know, asking if I happen to be pregnant because I was having to scrub out so often, which, of course, now that would kind of be frowned upon, but but it was memorable to now, you know, Oh, yeah, that probably was all related.
Julie Michelson: Yeah, shocker, shocker. So, so you have such a unique background and [Page//00:15:00] practice and I want to dig in a little bit to like allergy versus autoimmunity versus immune deficiency because it's all
Kara Wada: I'll enter. We're all one human organism. Yes.
Julie Michelson: all so
Kara Wada: in addition to our microbes. But so when we think about our immune system, its purpose is to help protect us, obviously, against infection, its purpose also is to help us heal, like from injury as well. So if you think about a cut that you may get, you'll get an inflammatory response at that cut, it's going to get better.
It's ouchy. First of all, it's painful. It's red, swollen, typically and it's warm. Those are all the signs and symptoms of acute inflammation. And so, you know, during that response, you're having this coordinated effort of cells and proteins and these things called [Page//00:16:00] cytokines and chemokines, like this beautiful orchestra of our physiology taking hold so that it can stop the bleeding.
It can bring in the cells that are going to help repair the tissue damage. It's going to fend off any microbes from the surface of our skin that maybe have made their way in or other infection. And it's going to allow that area to heal. And it's this magical thing that happens, right? But when we think about allergy and we think about autoimmunity and throw cancer in there too and immune deficiency, that system, it has gone haywire.
It's misbehaving. And so an allergy, our immune system has recognized something in the outside world as the, the danger signal, the enemy, and it mounts. a particular flavor of an inflammatory response against that, whether it's a pollen or [Page//00:17:00] kitty cat allergen or dust mites, or in some cases foods, as we've seen in the last 20 or so years, this really steep rise in true food allergy, where if someone is exposed to this minute amount of peanut or egg, that they have a life threatening allergic response. In the case of autoimmunity, When we are incubating, when we are in in mom's womb, our immune system is already hard at work determining what is Self from non self and what is safe. And so things that are too good of like recognized too easily. Those types of cells are eliminated and those that are not recognized self are eliminated as well.
So that you end up with this immune system that can tell. Okay. What what is us and what is not us and. In [Page//00:18:00] autoimmunity, essentially the immune system loses that tolerance over time, so that then the immune system is seeing our own bits and pieces as that enemy. And it depends, you know, each autoimmune condition has a little bit different flavor of this.
It has particular targets that are implicated, and that then explains some of the symptoms we end up with. In immune deficiency, We don't have all the parts or pieces or they aren't quite working and in a perfectly coordinated fashion. So we are at an increased risk of infection, whether it be, you know, more frequent infections, more severe infections.
Eyeball infections that most people wouldn't be, you know, wouldn't have any issue with and a lot of times the collateral damage and inflammation that occurs is not appropriate either. So, sometimes there's, like, too much or there's too little and so that then can expose the [Page//00:19:00] immune system to.
actually creating an autoimmune response to because it's not cleaning things up properly. So the really obnoxious thing for many of my immune, my patients with primary immune deficiencies, especially is that a lot of them coincide, like co occur, occur in the same person. as autoimmune disease. You end up with autoimmune and immune deficiency in the same human.
It's a real kick in the pants. And then you, you're forced you know, to make some really difficult decisions as a team with your immunologist, maybe your infectious disease doctor or the rheumatologist in deciding how can we try our best to like restore balance as best we can because sometimes you have to like Tap down the inappropriate inflammation, try to boost things up the best way we can and so that is.
They can be incredibly challenging and [Page//00:20:00] frustrating. And then in cancer, essentially, the you have cells that have gone rogue. They are reproducing at levels and numbers that they're not supposed to. Usually there's some kind of glitch in the system. And the immune system is unable to recognize and take those out appropriately.
And so what you're seeing with some of the newer Immunotherapy cancer treatments is they actually turn the immune system back on to help then target the cancer more appropriately.
Julie Michelson: Yeah. And that's. I think at least in regards to cancer and the general population, I think the more we have these conversations where people can realize, like, we, we have bad cells all the time, we all
Kara Wada: Yeah. Yeah. Yeah. And a lot of times our immune system sees them and takes them out and you never know.
Julie Michelson: What it's supposed to do, right? And that's the, you know, that approach [Page//00:21:00] of that.
I look forward to the day when there is a more integrative approach across the board with cancer so that we are supporting the whole human while we are helping the body go after the cancer.
Kara Wada: Yeah.
Julie Michelson: you know, it's, it's a, it's an interesting conversation, but I, I, that to me, the key for People to start to understand is, you know, we still need to support the body to do its job.
And, and so there was a reason your body didn't catch those cells, I guess, is what I'm, you know, at which to me ties into this whole conversation of what are the things that, you know, we can do, what is that approach, whether we are, you know, for wellness. Right. Because I, and I'm guessing it sounds like you have people that show up, they're coming to you for allergies.
And I'm guessing often they have, like you did, like I did have [Page//00:22:00] issues brewing that they didn't realize were autoimmune.
Kara Wada: Oh my gosh. Yes. I would have to say so I am currently I see patients two and a half days per week. So I'm not totally full time in the clinic. In part, that's how I keep my cup full.
Julie Michelson: It's awesome.
Kara Wada: but I would say at least out of maybe those 36 patients I might see in a week that at least probably six of them have specifically come in wondering about food allergies, but what they're really dealing with are gut issues.
It's not, it's not like they need an EpiPen. And I would say probably a good 4 to 5 of those patients are maybe the 5th, 6th, 7th, 8th opinion on their symptoms, which to me, they describe symptoms of too much inflammation in one way, shape, or form [Page//00:23:00] and or dysautonomia, so issues with like blood pressure, heart rate, fatigue unfortunately, so I'm, I'm located in Columbus, Ohio.
I work at the Columbus, Ohio. large university there. And we don't have anyone locally who's taken the lead on dysautonomia, which is really unfortunate. So my patients to see a specialist have to go all the way up to Toledo and wait about two years to get care.
Julie Michelson: seems insane. And, but
Kara Wada: It is. Yeah, we were in a in a metro area of several million people. And so
Julie Michelson: Right, you're not in the
Kara Wada: especially, yeah, we already had a lot of these folks pre pandemic that, you know, weren't really getting great care or great recognition. I think there's a better, more discussion about what these symptoms represent and folks seeking care.
But we've also had a really, you know, an increased prevalence of these symptoms to with long COVID.
Julie Michelson: And for listeners, and I apologize I didn't ask this [Page//00:24:00] sooner, explain what dysautonomia is for people that aren't familiar.
Kara Wada: So dysautonomia is essentially a, an umbrella term used to describe the automatic nervous system going haywire. So, and it could show up in all sorts of different ways. But most common, and I would say probably affects quality of life most significantly are issues with blood pressure and heart rate.
So folks may have issues with Feeling like they're going to pass out, or they actually pass out and may have issues with digestion, can have differences in how, like, their pupils dilate and constrict. issues with sweating. I have a few patients who will wake up in the middle of the night drenched in sweat.
Now there are some other reasons why that can be that you
Julie Michelson: I was gonna say, you're not, not talking about
Kara Wada: Yep. Not necessarily, you know, change of life. Yep. And not necessarily blood [Page//00:25:00] sugar issues would be the other main thing you would think about. And. Ruling out cancer but and they are symptoms that have, we've known that they exist for some time, but they are like many autoimmune conditions, things that affect different organ systems and are not well understood, not super well researched.
And so when you have a medical system that is incredibly siloed. Where the cardiologists are in one space, the neurologists are in another space, the immunologists somewhere else, and we kind of stay within our groups, it's challenging to have. really good coordinated care for these folks.
Julie Michelson: Yeah. So, so well [Page//00:26:00] said and you mentioned long COVID being one reason I feel like in general, even like pots, pandas, these kinds of things, you know, it's that question of, are we just more aware? And so now we, you know, more people, we, more diagnoses are happening or is it. Like real food allergies, autoimmunity, autism, is there just really more, you know,
Kara Wada: Yeah.
Julie Michelson: think this increase in, I mean, I have, I have two, I still call them kids, two adult offspring who carry EpiPens and have, you know, one, Didn't, well, did when he was little, seemed to outgrow stuff, and then randomly, again, you know, different, different allergies.
It is
Kara Wada: Yeah. It's really fascinating too, because there is this really almost like a not quite a land line in the sand, but so I am, [Page//00:27:00] I'm 39. So I'm an elder millennial and I don't remember a single kid in my class having food allergy. My sister's 36 and I think she probably would say about the same, but you go another like 2 or 3 years and that's when those numbers really kind of blossom, you know, kind of those born early 90s.
Onward, and this has been a really interesting topic of conversation at our national. Allergy asthma immunology meetings and this past spring, you know, the real big discussion point was. One of the ways that we have conceptualized this increase over the last 30 years or so is the hygiene hypothesis, right?
The reason why we're seeing more is because we're all cleaner. And yeah, like, that helps explain it to some degree, but it wasn't the whole picture. And so there is [Page//00:28:00] a physician researcher, Dr. Adkis. Who is out of, I believe, Switzerland who took kind of the center stage and really spoke a lot about the epithelial barrier hypothesis.
So this idea that we have interfaces on our bodies, our skin, our respiratory tract, our gut, that are how we communicate with our outside world. And. Those barriers are permeable or semi permeable. We want communication from one side to the other. That's how we interact with our environments. Right. But if you have too many chinks in the armor, then you get into trouble.
And so what happens when you end up with. leakiness or breaks is that you see a change in the microbes that are living on that surface and you see a change in [Page//00:29:00] inflammation. And a lot of times in particular, what we talk about a lot in allergy is eczema. It's easy to see like what's going on. A little bit easier to study sometimes than, than gut related things, cause you're not having to do endoscopies all the time.
Julie Michelson: but it is a gut related thing.
Kara Wada: But from like a bi, yeah, but
Julie Michelson: I know, you can see it. I
Kara Wada: it's a little
Julie Michelson: easier.
to get to.
Kara Wada: Yeah, easier to see and conceptualize and but what you'll see, for instance, Staph aureus lives on our skin. It's kind of a natural commensal. It's kind of like a generally a friendly ish bug, but you see.
That's like the strains and the types of toxins that they may change when that skin is inflamed and essentially what happens is you end up with a snowball effect and so when you have breaks in the skin, the bugs change, there's inflammation, it makes it more leaky, so on and so forth. And that continues.
But as you mentioned, there's crosstalk. So you can [Page//00:30:00] see then changes maybe in gut microbiome and development of eczema, or you can see changes or exposures through the respiratory tract that then will increase the risk of developing something like multiple sclerosis. So there, there's, you know, this growing body of evidence that problems at these barriers and increased.
inflammation leakiness kind of at these barriers is the issue. So then the question is, okay, what's making them more leaky? And there's a whole bunch of things. We think about how different our day to day lives are compared to like my great great grandma who was living on the farm in Northern Georgia, growing all her own vegetables, canning things.
She was out with the cow and they would, you know, kill the chicken and my Even my dad, when he was growing up, he'd have to go kill the [Page//00:31:00] chicken and pluck all the feathers and bring it in for dinner, like they were, he was outside on the farm working all summer, like they didn't have air conditioning.
Julie Michelson: the earth.
Kara Wada: Yeah.
It just was. Totally different. And here we are, you know, in our creature comforts. I'm in air conditioned space. And I have my ear, but you know, I'm sitting and in that's not to villainize everything about our modern way of living. It's just a lot has changed. And we're seeing now the downstream effects of that significant amount, you know, change the different exposures that we are Are exposed to rapid change in diet increased sugar, oil, refined grains.
And on the whole, we're very sedentary. We spend upwards 90 plus percent of our time indoors. And so, and then the newest and the, and what Dr Adkis is [Page//00:32:00] kind of, I think pet project is looking at the role of dishwasher rinse aid. In particular, those used in commercial dishwashers but the, the, the residue left on glasses is very damaging to the gut.
And so commercial dishwashers came about late 1980s. Is that then implicated in what we've seen with increased rates of food allergy, eosinophilic esophagitis, drug
allergy.
Julie Michelson: two kids with that when they were little.
Kara Wada: Who knows, right? Yeah. And so you know, there still is a lot of work to be done to really hone in, but
Julie Michelson: Well, and I think that's a, a very specific product. But I think it, it underscores the whole. Exposure to toxins, right? So they're studying commercial dishwashing, but, you know, but what are people using at home even day in and day out? And, and, you know, that's a whole we could talk for another hour [Page//00:33:00] about that.
But I do think it's this combination and. You can't, so you mentioned, you know, the changes in our food system, the dogs are piping in and, and to me, you can't separate the changes in the food system and toxins. It's the same, you know, the bad oils, the ultra processed foods, you know, all of that is toxic.
And so you know, when I say toxins, I'm not always talking like chemicals, right? And forget and EMF, all, all the things,
Kara Wada: Yeah. And I think then it's, it's, we all probably need to sit down, metaphorically probably,
and, or stand up, yeah, and just think about, you know, what, what are our non negotiables? What are the things we're willing to change? What is our comfort level with risk to? And I think that's where more data would be helpful.
But [Page//00:34:00] as I I've talked a lot with my patients about the dishwasher stuff in particular, I have three young kids. I'm working. I have a business. I don't want to go back to hand washing dishes.
Julie Michelson: Right.
Kara Wada: So, you know, on the flip side, I'm trying to look for generally more eco friendly products that typically, you know, in broad brush strokes, things that are healthier for the planet tend to be healthier for our physiology.
And, you know, similarly with the things we put on our skin, like those are easy, simple swaps and switches that
Julie Michelson: But I love that you brought up the also know what your non negotiables are. I mean, one of, one of the pieces and we all need to be doing it for wellness, you know, the, the smart ones are doing it ahead of time before they have any symptom they're ignoring. But one of the things I do with my clients is we're reducing that exposure, right?
As we're supporting the body's detox pathways, we [Page//00:35:00] are, and it is a process. It's a process. There's no way you could wake up tomorrow and say, I'm going to reduce my exposure. And by next week, you've done it. Like, there's so much that we come into contact with and that's fine. Every change is an improvement.
I had one client who, and she did, she was a vegan when I met her and I was like, I'm not the one to help you as a vegan. Let's find you somebody. Oh no. Just tell me what to eat. So she would eat meat. But when we were cleaning up products, I said, what kind of shampoo and conditioner are you using? And I never did find out because she said to me, that's not negotiable.
Not negotiable. That for her, she loved her shampoo and conditioner. It literally cleaned up every other product she was using on her body in her home ever. And I'm like, great. Like, it's not about, A, we can't reach perfect. And B, we don't need to [Page//00:36:00] is the, you know, cause sometimes we get the, we have these conversations and it can start to sound doom and gloom and you know, we've got all of these hits we're taking, but we really don't have to fix everything in order for, for the body to be able to heal, which is, you know, the, that's the exciting part, right?
That's why we're here.
Kara Wada: We are resilient, amazing species that has made it this far.
Julie Michelson: Right.
Kara Wada: is sometimes, you know, the enemy of good. And I will say, I was the first to fall down that rabbit hole, not too long after, yeah, after my diagnosis, I doubled down I've had a Peloton bike for quite some time, since probably like 20, 2018, 2019
Julie Michelson: early adopter.
Kara Wada: maybe, yeah, early, maybe it was 2019, anyways, doesn't matter, but I
Julie Michelson: pre pandemic Peloton.
Kara Wada: And I was like shooting for, you know, PRS like, okay, like [Page//00:37:00] I'm in a like workout hard.
I was drinking green smoothies that I was adding some super fluid, you know, stuff to and. To make a long story short, I ended up with an acute liver failure from the supplement. So that's always just my word of caution of just, you know, don't, don't overdo it and just be conscientious
Julie Michelson: And more of something good isn't always better.
Kara Wada: Yes. And then
Julie Michelson: good for everybody either.
Kara Wada: it, that is absolutely. And then I took that perfectionism and then put it totally into kind of the elimination diet game and got. Really restrictive, lost a bunch of weight, which, of course, as you know, a woman in our society was, of course, like. You know, like, oh, you look great, you know, all those sorts of things.
But I ended up spending so much mental energy fixated on what I was eating, what I wasn't eating. That at a certain point, my symptoms [Page//00:38:00] were like rearing back. And I, and I honestly think I was just constantly in fight or flight. It didn't matter that I was eating like a really anti inflammatory diet and like.
You know, working out and doing these things like I had to kind of address all of it and I also just had to let go of the perfectionism like that was, I think,
Julie Michelson: And I think everybody, I'm sure you have the same thing. I think that the perfectionism, if we could. Somehow like diagnose perfectionism first, we could prevent a lot of this chronic illness because it really does that stress level. I've yet, and it may present totally different. Like, it's not like everybody you meet, you're going to know right away, but pretty much everybody that I've worked with is a perfectionist.
And that letting go is such an essential healing step.
Kara Wada: [Page//00:39:00] Yeah.
Julie Michelson: So,
Kara Wada: wonder if there are like, particular personality traits that also may, they, they absolutely provided a survival advantage at some point, you know, across our lifespan, right. Bye. Do those also, like, increase the potential sometimes for
Julie Michelson: yeah. And that's where we just need to learn.
Kara Wada: wonder.
Julie Michelson: Yeah. Oh, I, I think, I think for sure. I, I really do. I, it doesn't mean that if you don't care about anything, you don't get sick. I'm not
Kara Wada: No, no, no, no. Just, you know, like, we talk about
risk factors. Like, yeah, if you, if you drink a certain amount, you're more apt to get breast cancer, colon cancer. You know, like, those sorts of things where you just kind of take those into account, and...
Julie Michelson: Yeah.
Kara Wada: Yeah.
Julie Michelson: So, but I, I love the, what you're bringing to the world. And I just think, you know, the more [Page//00:40:00] anytime, especially like somebody who thinks they're just coming to see an allergist, right? Like anytime somebody can walk into a doctor's office and have contact with somebody like you who can help them understand.
True wellness, you know, and the body is such a gift. So I am so grateful that you are out there in Ohio doing what you're doing. Clearly you need more counterparts
Kara Wada: Well,
Julie Michelson: in your neck of the woods.
Kara Wada: the wonderful, wonderful thing about my position is that I get to work with trainees. So nearly nearly every day there is a medical learner of one one shape or another. So from undergraduates who are applying to med school, I will on occasion have them shadow with me all the way up through our allergy and immunology fellows.
We have two per year and actually. [Page//00:41:00] The season just opened for interviews. So we have you know, 100 plus applicants for, for these, you know, two spots every year. It's pretty incredible. And so to be able to share my story with them, share some tips and tricks as to how to think about and conceptualize these things that we have.
We may not have all the answers to. I think as human beings, our brains really hate uncertainty and and that is absolutely the case with physicians as well. And to push them to get. More comfortable with feeling uncomfortable, I think is is clutch. And to help instill and support their curiosity, I think is really important to and what really, really needs to take place to [Page//00:42:00] ensure that all of us as health care professionals can stay curious and compassionate and kind of leaning in is we need to ensure that our health care professionals have wellness as well.
Julie Michelson: Oh,
Kara Wada: Because if they are unable to fill their own cup, that is when you get someone who is burnt out, unhappy, maybe unhappy with their situation or their job. And I, I would almost guarantee that you are not going to get the best care that you could get from someone
Julie Michelson: They're going to end up sick. Like I always,
Kara Wada: Oh yeah, yeah,
Julie Michelson: like, why? When you just, you look at medical school and how it's set up, it's like, why are we trying to kill people who are training to help people? And it's not just this country, it's, it's medical school across the board is set up that way. It just doesn't make sense.
I was thinking about that with your a hundred plus applicants for the two spots. Like every one of those applicants really needs to be filling their [Page//00:43:00] cup and doing stress management. You know, it's such a high stress. And, and that's a great the flip side to that, that I can say is I'm not a physician is also, we need to remember that our physicians are human and they're people and, and
yeah. You know, and we have this training of decades of, you know, this mentality that you and I are trying to change, which is you show up at the doctor because you want the doctor to fix you. Right, like,
Kara Wada: yes, you need a partner.
Julie Michelson: Right. You know, we have to take responsibility for our own wellness and we, and we have to realize that our doctors don't necessarily have all the answers.
But when you can find one like Kara, like that's, it's gold. It really is. So,
Kara Wada: There's this really cool paradigm that has been written about and talked about called wellness 2. 0 where essentially it outlines this idea of the physician is human. There is this [Page//00:44:00] equalization the power dynamics between patient physician will never be equal, right? Like, there's there's no way to fully.
Equalize that just to the nature of. These systems. But it brings it into closer balance. And I think the more that we can lean into that is really important. But the reality is we live in a very capitalistic society and money talks. So they're also, you know, we're going to have to grapple with making the case.
Unfortunately, probably. from the financial side of things in order to really see systemic change. And that's kind of the tough love aspect of all of this.
Julie Michelson: yeah. Yeah. But the good news is that when, when that does happen and that the broken system [Page//00:45:00] finally collapses, we already, we know, you know, what can work and what is working. So I love that. So give listeners, if you will, and it can be anything can be directly shoguns related, not doesn't matter. What is one step that they can take starting today to start to improve their health.
Kara Wada: So I think the one thing is taking a few minutes just to sit, give yourself a little bit of that white space, that quiet to just listen to that inner voice and what he or she needs. I think that is
Incredibly important and I think it's really helpful to do that before a medical visit medical appointments [Page//00:46:00] almost on the whole tend to put us into fight or flight and when we get into fight, flight, freeze, fawn, we may not always. We may forget, like, what our objectives were for that visit, so jotting down some notes can be really helpful ahead of time to think about, okay, what are your questions?
What are your goals? How are your symptoms really impacting your quality of life? Being able to communicate how they are showing up in, in your, in, in showing your humanity can be really helpful, especially to maybe tug on that doc who is on, on the brink of burnout, or who maybe just needs that reminder that you are human.
And this is showing up in very human ways. Yeah, so that's
Julie Michelson: Yeah, and I'll
throw the other [Page//00:47:00] piece in because I see it a lot and it's, I don't think people do it intentionally. We tend to, even though we're showing up at the doctor's office for help, we do have this natural tendency, most of us, to downplay. Just what you're talking about. We may say, you know, these are the symptoms, but we don't share how it's impacting our life or, and so it's like, Oh, we said the word and then that's it.
And the doctor that's, they're not getting like, Oh my gosh, this is really impacting your life.
Kara Wada: So I'll share a really quick example. Low back stiffness was one of the main issues that was totally impacting my quality of life. And so I could tell the doc. Oh, I'm having low back stiffness. I sit down for prolonged periods of time and it's really hard to get moving again. It's worse in the morning.
Yes. All that's helpful. But what really illustrates how much it was impacting my life was I [Page//00:48:00] was not wanting to sit on the floor to play with my young children. And that like was breaking my heart. And so to share, you know, that little extra nugget of like, this is how problematic this is. Like that helps light the fire, hopefully under that.
That person's bottom to like, to do something about it, whether it's to refer you or get imaging or start meds, what have you, but to make to have some sort of action.
Julie Michelson: I love that. I love that. Amazing. Before we wrap up, where can listeners find you? Where's the best place?
Kara Wada: Yeah, so the best place is probably Dr. Kara Wada dot com on there. I have a freebie. So the 25. Things that we did in our family over the last four years or so to make simple swaps to like less toxic things that we were talking about just simple, easy. I'm a Midwest girl born and bred and I love a good deal.
[Page//00:49:00] So things generally are, you know, not going to cost a ton to really help start making those changes. And, on there. Also, you'll find so each year the last two years we've hosted the virtual shogun summit. So it is a, we have a ton of great resources on there and coming up this fall. We are launching a fall event called the demystifying inflammation summit.
So you're going to want to get on the email list. So you can stay in the loop. It's going to be a free event. Tons of experts across. The, you know, the spectrum of things of too much inflammation. So allergies, autoimmunity, asthma gut health issues. So I'm super excited and in the weeds of planning that right now.
Julie Michelson: I love that. I am definitely signing up. Love it. Love it. Cara. Thank you so much. You have given us amazing gold today.[Page//00:50:00]
Kara Wada: Thank you so much. I have loved talking and we're going to, we're going to have to have you on the Becoming Immune Confident podcast so that we can hear your story too.
Julie Michelson: Yeah, I would love it. I'd love to continue the conversation
Kara Wada: Yes.
Julie Michelson: For everyone listening. Remember, you can get the transcripts and show notes by visiting inspired living dot show. I hope you had a great time and enjoyed this episode as much as I did. I'll see you next week. [Page//00:51:00]
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Kara Wada
Quadruple board-certified pediatric and adult allergy immunology & lifestyle medicine physician, Sjogren’s patient and life coach shares her recipe for success combining anti-inflammatory lifestyle, trusting therapeutic relationships, modern medicine & our minds to harness our body’s ability to heal.
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