Episode 152
Kara Wada:
Navigating Life As A Doctor with Sjögrens Syndrome
In today's episode I'm joined by Dr. Kara Wada, a quadruple board-certified physician specializing in allergy, immunology, and lifestyle medicine. Dr. Wada shares her personal journey with Sjogren's syndrome and how it transformed her approach to patient care and understanding of autoimmune conditions.
First Aired on: Aug 11, 2024
Episode 152
Kara Wada:
Navigating Life As A Doctor with Sjögrens Syndrome
In today's episode I'm joined by Dr. Kara Wada, a quadruple board-certified physician specializing in allergy, immunology, and lifestyle medicine. Dr. Wada shares her personal journey with Sjogren's syndrome and how it transformed her approach to patient care and understanding of autoimmune conditions.
First Aired on: Aug 11, 2024
Table of Contents:
In this episode:
Introduction
In today's episode I'm joined by Dr. Kara Wada, a quadruple board-certified physician specializing in allergy, immunology, and lifestyle medicine. Dr. Wada shares her personal journey with Sjogren's syndrome and how it transformed her approach to patient care and understanding of autoimmune conditions.
Episode Highlights
Dr. Wada's Personal Journey with Autoimmunity
Dr. Wada discusses her diagnosis with Sjogren's syndrome and how it led her to reevaluate her medical practice and personal health.
- Diagnosed with Sjogren's syndrome four years ago
- Experienced burnout and reduced clinical hours to focus on health
- Realized the limitations of traditional medical education in understanding autoimmune conditions
The Complex Nature of Autoimmune Symptoms
Dr. Wada explains the wide range of symptoms associated with Sjogren's and other autoimmune conditions.
- Symptoms can include digestive issues, fatigue, joint pain, and dry eyes/mouth
- Many patients experience symptoms for years before diagnosis
- 30-40% of patients have normal lab results, complicating diagnosis
Understanding the Immune System and Its Dysfunctions
Dr. Wada breaks down the differences between allergy, autoimmunity, and immune deficiency.
- The immune system's primary role is protection and healing
- Allergies occur when the immune system overreacts to external substances
- Autoimmunity involves the immune system attacking the body's own tissues
- Immune deficiency results in increased susceptibility to infections
The Epithelial Barrier Hypothesis
Dr. Wada discusses a new theory explaining the rise in allergies and autoimmune conditions.
- Focuses on the integrity of barriers in the body (skin, gut, respiratory tract)
- Leaky barriers can lead to changes in microbiome and increased inflammation
- Modern lifestyle factors may contribute to barrier dysfunction
Practical Steps for Improving Health
Dr. Wada offers advice on how to approach health improvement without falling into perfectionism.
- Identify non-negotiables and areas where you're willing to make changes
- Consider eco-friendly products that are often healthier for our bodies
- Avoid the trap of perfectionism, which can increase stress
- Take time to listen to your body's needs before medical appointments
Notable Quotes
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.
Dr. Kara Wada
We are resilient, amazing species that has made it this far. Perfection is sometimes, you know, the enemy of good.
Dr. Kara Wada
Other Resources:
Connect with Kara Wada
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Episode Transcript
Kara Wada:[00:00:00] I was professionally and personally just zapped, totally burned out thought that I might actually step away from clinical medicine. 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.
Julie Michelson: Welcome back to the inspired living with autoimmunity podcast. I'm your host, [00:01:00] 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 show grins. In today's conversation, we discuss the differences between allergy, autoimmunity, immune deficiency, and cancer, as well as what might be driving the ever growing incidence of these health challenges.
Julie Michelson: I would love for you to share with listeners and me a little more about your personal journey. Um, not just with, you know, why are you quadruple board certified? Um, but your wellness journey, your personal journey, and, and what has led you to this world that you are now just totally rocking.
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, [00:02:00] full fledged, um, 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 thought at that point in time, I was so exhausted.
Kara Wada: 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.
Kara Wada: And I think I continue to just peel back the layers like an onion and realizing how, even [00:03:00] though at the time I was. Um, only triple board certified, I guess, but like, um, but at the time that that education that I had really did not prepare me for one living in the role of a patient, nor did it really.
Kara Wada: 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?
Kara Wada: Who knows? And it doesn't really matter. But I had symptoms that I now recognize as Sjogren's. Related in some way or [00:04:00] 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 know, with, with folks within the patient community, and actually I just, um, I just wrote an article for Kevin MD on this as well that we'll, we'll publish tomorrow.
Kara Wada: 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.
Kara Wada: And then you'll get, you circle the question, you're like, oh, yes, I got it. Um. Done. I don't ever have to think
Julie Michelson: about [00:05:00] Sjogren's again. Correct.
Kara Wada: Or, if you're a pediatrician, Um, 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 has congenital heart block?
Kara Wada: 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. Um, 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, um, 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 [00:06:00] don't have time, like, and you're trying to take care of yourself, like we're the worst patient.
Kara Wada: So it must've been pretty bad. Um, I had an episode of idiopathic anaphylaxis, um, after having my first child. And I also, over time realized that I couldn't wear mascara without looking like a raccoon because I was always touching my eyes, rubbing my eyes. Um, wasn't able to tolerate wearing contacts at a certain point because of the dry eye.
Kara Wada: Sure. Yeah. And
Kara Wada: 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. Right. They're complaining about their dry cough or their body pain, their fatigue, um, maybe their sinus issues because I'm an allergist by trade.
Kara Wada: Right. So they're coming to see me for their sinus stuff. [00:07:00] Um, and the other reality is that 30 to 40 percent of patients have totally normal labs. Thank you. Um, yeah, totally normal lab. So, you know, they get that, oh, your labs are normal. Must be in your head. Must be normal. Yeah. Let's try this antidepressant, or maybe you should try losing a few pounds.
Kara Wada: Um, 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. Yeah. Then, you know, those several hundred thousand dollars education, no credit, you know, and some other things along the way too. But, um, so. Once I was diagnosed, um, and and I will say I feel incredibly fortunate and this is seems odd to say, but my labs were totally [00:08:00] wacky and that like they were terrible at the time.
Kara Wada: I think took my my rheumatologist slash. Friend, um, by surprise. Um, had those not been abnormal, I don't know of, I don't know how long it would've taken me to be diagnosed.
Julie Michelson: There's is so many parts and pieces of your story that I'm like, oh, let's talk about that. Let's talk about that. Yeah. I wanna first just kind of reinforce.
Julie Michelson: Um, 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. Um, and so I know that by the time people find me and probably you, they're [00:09:00] frustrated Absolutely.
Julie Michelson: They had normal labs. They were offered antidepressants. They were searching and searching. Um, and so I just, I, I want to highlight that part of your journey and every other position that has been on here that has, you know, an autoimmune journey or a health recovery journey. Um, is that it's not, I said this yesterday, you know, nobody becomes a doctor if they don't want to help people.
Julie Michelson: Um, And somebody said, well, that's not true. I said, Oh, there's easier ways to make money. I promise. Um, you know, but, but it, 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.
Julie Michelson: And, and I love you touched on it. And I think this is really important for people. [00:10:00] 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 happens.
Julie Michelson: Yes,
Kara Wada: yes,
Julie Michelson: absolutely. Yeah, yeah, it's like, you know, shocker, your autoimmunity, you used to have gut issues? No way, you know? Yeah. There's a connection. Yeah. Um,
Kara Wada: yeah. Yeah. Yeah. And, um. You know, I think part of it, I, I will refer to myself as the ostrich with their head in the sand for a long time. I, in part, I was totally in denial.
Kara Wada: Um, but also like, I didn't have time to be sick now that I say that, but then it's a little like [00:11:00] 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.
Kara Wada: And so I was having, I was forced to take rest, right? Um, because of symptoms and that's what your body needs and is like demanding at that point. Yeah.
Julie Michelson: Um, 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 two days later she was like complaining that she was still sick.
Julie Michelson: 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 [00:12:00] 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.
Julie Michelson: For sure. So I, I wanna touch on. Because it, there's, again, so many questions I want to ask you. Um, you have this whole host of, of symptoms, um, 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, um, by the time you get the really dry eye, there was always this other host of, of things, um, 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.
Julie Michelson: I don't know you well enough yet, but I, you know, it's [00:13:00] 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, um, 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.
Julie Michelson: You know why let's answer the question why, and then we can start shedding some of those labels. Um, but it sounds like you're that that's accurate. You see the same, almost the same host. Yeah.
Kara Wada: Yeah. And the data supports that too. Um, the other symptom that I left off the list, um, is dysautonomia or POTS is incredibly common in Sjogren's it's the number one autoimmune cause of POTS.
Kara Wada: Um, and although I don't, [00:14:00] as far as I know, I haven't had it. 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 like intolerance and um, I would have to scrub out of 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 OBGYN rotation, where they keep the war, the room much warmer, um, for the babies that are, you know, about to be born, um, I had to scrub out on multiple occasions because I think in hindsight, combination of her long sitting or standing.
Kara Wada: the warm environment. Um, all those things kind of came into play where my blood pressure would drop and I would get to the point where I thought I was going to pass out. Thankfully it didn't.
Julie Michelson: Yeah. Thank you.
Kara Wada: For so many reasons. Right. They drill into you, like as a med student going through, you know, the OR procedures, like you can not [00:15:00] pass out in the operating field.
Kara Wada: Not allowed.
Julie Michelson: You got to get out first, drop in the hall.
Kara Wada: Yeah. Um, but I, I distinctly remember my preceptor say, you know, asking if I happened to be pregnant because I was having to scrub out so often, which of course now that would kind of be frowned upon, but, um, I can't ask, but it was memorable to now, you know, Oh yeah, that probably was all related.
Kara Wada: Yeah.
Julie Michelson: Shocker. Yeah, shocker. Yeah. So, so you have such a unique background and practice, and I wanna dig in a little bit to like allergy versus autoimmunity versus immune deficiency. 'cause
Kara Wada: Yeah, it's
Julie Michelson: all,
Kara Wada: all inter, we're all human organism. Yeah. It's, it's all so well in addition to our microbes, but , um. So when we think about our immune system, [00:16:00] its purpose is to help protect us, obviously, against infection.
Kara Wada: 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, 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.
Kara Wada: And so, you know, during that response, you're having this coordinated effort of cells and proteins and these things called 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.
Kara Wada: It's going to fend off any microbes from the surface of our skin that maybe have made their way in, um, or other [00:17:00] infection. Um, 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, um, and I mean deficiency, that system, it has gone haywire, it's misbehaving.
Kara Wada: 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 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.
Kara Wada: In the case of autoimmunity, when we are [00:18:00] incubating. We are in, um, 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.
Kara Wada: So that you end up with this immune system that can tell. Okay, what, what is us and what is not us? And. In 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.
Kara Wada: It has particular targets that are implicated, and that then explains some of the symptoms we end up with. [00:19:00] In immune deficiency, We don't have all the parts or pieces, or they aren't quite working 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.
Kara Wada: Eyeball infections that most people wouldn't be, you know, wouldn't have any issue with. Um, and a lot of times the collateral damage and inflammation that occurs, um, is not appropriate either. So sometimes there's like too much or there's too little. And so that then can expose the immune system to actually creating an autoimmune response to, because it's not cleaning things up properly.
Kara Wada: 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 [00:20:00] disease. So you end up with autoimmune and immune deficiency in the same human. It's a real kick in the pants.
Kara Wada: That's it. And then you, you're forced, Um, you know, to make some really difficult decisions as a team, um, with your immunologist, maybe your infectious disease doctor, the rheumatologist in deciding how can we try our best to like restore balance, um, 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.
Kara Wada: Um, and so that is a They can be incredibly challenging and frustrating, um, and then in cancer, essentially the, um, 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.
Kara Wada: And so what you're [00:21:00] 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
Julie Michelson: appropriately. Yeah. And that's pretty cool. I think at least in regards to cancer and the general population, I think the more we have these conversations where people can realize.
Julie Michelson: Like we, we have bad cells all the time. We all do. Yeah. Yeah. Yeah. And a lot of times our
Kara Wada: 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 of that I look forward to the day when there is a more integrative approach across the board with cancer so that we are.
Julie Michelson: Supporting the whole human while we are helping the body go after the cancer. Um, yeah, I know. Absolutely. It's a, it's an [00:22:00] 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.
Julie Michelson: 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 to, 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.
Julie Michelson: And I'm guessing often they have, like you did, like I did have issues brewing that they didn't realize were auto immune. Oh
Kara Wada: 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.
Kara Wada: It's awesome. Um, but I would [00:23:00] 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. Um, uh, and I would say probably a good four to five of those patients, um, are maybe the fifth, sixth, seventh, eighth opinion on their symptoms, which to me, they describe symptoms of too much inflammation in one way, shape, or form and or dysautonomia.
Kara Wada: So issues with like blood pressure, heart rate fatigue. Unfortunately, so I'm I'm located in Columbus, Ohio. I work at the large university there. Um, and we don't have anyone locally who's taken the lead on [00:24:00] 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.
Kara Wada: To get care.
Julie Michelson: That seems insane. Um, but I get it is.
Kara Wada: Yeah, we're in a, in a metro area of several million people. And so it's great. You're not in the middle, especially. Yeah, we already had a lot of these folks pre pandemic. Um, 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.
Kara Wada: Um, but we've also had a really, you know, an increased prevalence of these symptoms too with long COVID.
Julie Michelson: And for listeners, and I apologize, I didn't ask this 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.
Kara Wada: So, and it [00:25:00] could show up in all sorts of different ways, um, but most common, and I would say probably, affects quality of life. most significantly are issues with blood pressure and heart rate. Um, so folks may have issues with feeling like they're going to pass out or they actually pass out. Um, and, um, may have issues with digestion, can have differences in how like their pupils, uh, dilate and constrict.
Kara Wada: issues with sweating. I have a few patients who will wake up in the middle of the night, drenched in sweat. Um, now there are some other reasons why that can be the,
Julie Michelson: yeah.
Kara Wada: Not necessarily, you know, change of life. Yeah. And, um, not necessarily, um, blood sugar issues would be the other, um, main thing you would think about, um, and ruling out cancer.
Kara Wada: Um, but, um, and. [00:26:00] 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 siloed, where the cardiologists are in one space, the neurologists are in another space, the immunologists.
Kara Wada: and we kind of stay within our groups. It's challenging to have really good coordinated care for these folks.
Julie Michelson: So, so well said. Um, and you mentioned long COVID being one reason I feel like in general, even like POTS, pandas, these kinds [00:27:00] of things, it, you know, it's that question of, are we just more aware?
Julie Michelson: And so now we, you know, more people, we, more diagnoses are happening or is it like real food allergies, auto immunity, autism, is there just really more, you know, What do you think this increase in, I mean, I have, I have two, I still call them kids, two adults 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.
Julie Michelson: It is scary.
Kara Wada: It's really fascinating too, because there is this really, almost like a, uh, not quite a land, uh, line in the sand, but so I am, 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 [00:28:00] 36 and I think she probably would say about the same, but you go another like two or three years and that's when those numbers really kind of blossom, you know, kind of those born early nineties.
Kara Wada: Onward. Um, 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?
Kara Wada: The reason why we're seeing more is because we're all cleaner. And yeah, like that helped, that helps explain it to some degree, but it wasn't the whole picture. And so there is a physician researcher, Dr. Adkis, um, who is out of, I believe Switzerland, who took kind [00:29:00] of the center stage and really Spoke a lot about the epithelial barrier hypothesis.
Kara Wada: 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.
Kara Wada: 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 inflammation. And a lot of times in particular, what we talk about a lot in allergy, uh, is eczema. It's easy to [00:30:00] see like what's going on. Um, a little bit easier to study, um, sometimes than, than gut related things, cause you're not having to do endoscopies all the time.
Kara Wada: But it is a gut
Julie Michelson: related thing. It,
Kara Wada: um, sorry, from like a bio, yeah, but from like a bio, it's a little easier to see and conceptualize and, um, 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 like the strains and the types of toxins that they may change when that skin is inflamed.
Kara Wada: 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. Um, but as you mentioned, there's crosstalk. So you can see then changes maybe in gut [00:31:00] 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.
Kara Wada: 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 is 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.
Kara Wada: Even my dad, when he was growing up, he'd have to go kill the chicken and pluck all the feathers and bring it in for dinner. Like [00:32:00] they were, he was outside on the farm working all summer. Like they didn't have air conditioning. Touching the earth. Yeah. Um, it just was totally different. And here we are, you know, in our creature comforts, I'm in air conditioned space.
Kara Wada: Me too. Um, and I have my ear bud, you know, I'm sitting, um, and. And 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, um, are exposed to, rapid change in diet, um, increased sugar, oil, refined grains, um, And on the whole, we're very sedentary.
Kara Wada: We spend upwards 90 plus percent of our time indoors. Um, and so, and [00:33:00] then the newest in the, in what Dr. Adkis is kind of, I think, um, pet project is looking at the role of dishwasher rinse aid, in particular those used in commercial dishwashers. Um, but the, the, the residue left on glasses is very damaging to the gut.
Kara Wada: 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? Oh, two kids with that when they were little. Who knows, right? Yeah. And so, um, you know, there still is a lot of work to be done to really hone in, but.
Kara Wada: Well, and I think that's
Julie Michelson: a very specific product. Um, but I think it, it underscores the whole exposure to toxins,
Kara Wada: right?
Julie Michelson: So they're studying commercial dishwasher, but you know, but what are people using at home even day in [00:34:00] and day out? And, and, you know, that's a whole, we could talk for another hour about that, but I do think it's this combination and, you know, You can't, so you mentioned, you know, the changes in our food system, the dogs are piping in, um, and, and to me, you can't separate the changes in the food system and toxins.
Julie Michelson: It's the same, you know, the bad oil, the ultra processed foods, the, you know, all of that is toxic. And so, um, you know, when I say toxins, I'm not always talking like chemicals, right. And you 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 or stand up or stand up.
Kara Wada: Yeah. And just think about, you know, what, what are our non negotiables? What are the things we're willing to change and What is our [00:35:00] comfort level with risk too? And I, I think that's where more data would be helpful, but 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.
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 brushstrokes, things that are healthier for the planet tend to be healthier for our physiology. Um, and, you know, similarly with the things we put on our skin, like those are easy, simple.
Kara Wada: swaps and switches that, but
Julie Michelson: I love that you brought up the also know what your non negotiables are. I mean, 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 [00:36:00] things I do with my clients is we're reducing that exposure, right?
Julie Michelson: As we're supporting the body's detox pathways, we are, and it is a process. It's 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.
Julie Michelson: 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.
Julie Michelson: Not negotiable that for her, she loved her shampoo and conditioner. Yeah. It literally cleaned up every other product she was using on her body in her home ever. And, and I'm like, great. Like it's not about [00:37:00] a, we can't reach perfect and B we don't need to is the, you know, cause sometimes we get the, we have these conversations and it can start to sound doom and gloom.
Julie Michelson: 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,
Kara Wada: you
Julie Michelson: know, the, that's the exciting part, right? That's why we're here.
Kara Wada: Absolutely. We are resilient, amazing species that has made it this far. Perfection is sometimes, you know, the enemy of good.
Kara Wada: And I will say I was the first to fall down that rabbit hole, not too long after, yeah, after my diagnosis, I, um, doubled down, um, I've had a Peloton bike for quite some time since probably like 20, 2018, 2019, um, early, early adopter. Yeah. Early. Maybe it's 2019. Anyways, it doesn't matter. But [00:38:00] I
Julie Michelson: pre pandemic and, um,
Kara Wada: and I was like shooting for, you know, PRs like, okay, like I'm in a like workout hard.
Kara Wada: I was drinking green smoothies that I was adding some super fluid, you know, stuff too. And yeah. Um, to make a long story short, ended up, um, 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 of what you're doing.
Kara Wada: And more of something good isn't always better. Yes. And then, um, Nothing's good for everybody either. That is absolutely. Um, and then, um, 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 [00:39:00] great.
Kara Wada: You know, all those sorts of things. Um, but I ended up spending so much mental energy fixated on what I was eating what I wasn't eating. Um, that at a certain point, my symptoms 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.
Kara Wada: And I also just had to let go of the perfectionism like that
Julie Michelson: was, I think, and I think everybody, I'm sure you have the same thing. I think that the perfectionism, if we could Somehow like diagnosed perfectionism first, we could prevent a lot of this chronic illness. Yeah. Cause it really does that stress level.
Julie Michelson: I've yet, and it may present totally different. Like, it's [00:40:00] 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: Yeah,
Julie Michelson: so I do wonder
Kara Wada: 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?
Kara Wada: But do those also like increase the potential sometimes for
Julie Michelson: these conditions? Yeah, and that's what we just need to
Kara Wada: learn. I kind of wonder.
Julie Michelson: Yeah. Oh, I think, yeah, I think for sure. I really do. Um, I, it doesn't mean that if you don't care about anything, you don't get sick. I'm not saying that. No,
Kara Wada: no, no, no.
Kara Wada: Just, you
Julie Michelson: know, like we talk about risk
Kara Wada: 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. [00:41:00] Yeah. Yeah. So, but I, I love the, what you're bringing to the world.
Julie Michelson: Um, and I just think, you know, the more 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.
Julie Michelson: So I am so grateful that you are out there in Ohio doing what you're doing. , clearly you need more counterparts, , it's well in your, in your neck of the woods.
Kara Wada: The wonderful, wonderful thing about my position is that I get to work with trainees. Oh, that's fantastic. Near nearly every day. There is a medical learner.
Kara Wada: Of one, one shape or another. So from [00:42:00] 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 The season just opened for interviews. So we have, um, you know, a hundred plus applicants for, for these, you know, two spots, um, every year it's, um, pretty incredible.
Kara Wada: 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,
Kara Wada: as human beings, our brains really hate uncertainty. Yes. And, and that is absolutely the case with physicians as well.
Kara Wada: And to push them to get. more comfortable with feeling uncomfortable, I think is clutch. [00:43:00] Um, and, um, to help instill and support their curiosity, I think is really important too. And what really, really needs to take place to ensure that all of us as healthcare professionals can stay curious and compassionate and Um, kind of leaning in is we need to ensure that our healthcare professionals have wellness as well.
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 who is in that
Julie Michelson: state. Like, I always, I always ask, like, why?
Julie Michelson: 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 [00:44:00] 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.
Julie Michelson: Like every one of those applicants really needs to be filling their cup and doing stress man. You know, it's such a high stress. And, and that's a great, um, 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. Yeah. Yes. And
Kara Wada: yes,
Julie Michelson: 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.
Julie Michelson: Right. Like, yes, you need to partner. 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, [00:45:00] 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.
Kara Wada: 0, where essentially it outlines this idea of the physician is human. There is this equalization, the power dynamics between patient and physician will never be equal, right? Like, there's, there's no way to fully equalize that, um, just to the nature of. These systems, but it brings it into closer balance. Um, and I think the more that we can lean into that is really important.
Kara Wada: 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. [00:46:00] 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 finally collapses, we already, we know, you know, what can work and what is working. Yeah. So I love that. So give listeners, if you will, and it can be anything. Can be directly shoguns related, not doesn't matter. Um, what is one step that they can take starting today to start to improve their health?
Kara Wada: Yeah. 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 [00:47:00] voice and what he, she, they needs. Um, I think that is incredibly important. And I think it's really helpful to do that before a medical visit. Medical appointments, almost on the whole, tend to put us into fight or flight.
Kara Wada: 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?
Kara Wada: Being able to communicate how they are showing up in, in your, in, in showing your humanity, um, can [00:48:00] 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. Um, yeah, so that's my chair,
Julie Michelson: the other piece in because I see it a lot and it's, I don't think people do it intentionally.
Julie Michelson: 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.
Julie Michelson: 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 [00:49:00] 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.
Kara Wada: It's worse in the morning. Yes. All that's helpful. But what really illustrates how much it was impacting my life was I was. Not wanting to sit on the floor to play with my young children. And that like was breaking my heart.
Julie Michelson: Yep.
Kara Wada: 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.
Kara Wada: Yeah. I
Julie Michelson: 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 [00:50:00] drcarawada. 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.
Kara Wada: I'm a Midwest girl born and bred, and I love a good deal. So things generally are, you know, not going to cost a ton, um, to really help start making those changes. Um, and, um. 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.
Kara Wada: 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 [00:51:00] spectrum of things of too much inflammation. So allergies, autoimmunity, asthma, um, gut health issues.
Kara Wada: Um, 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.
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,
Kara Wada: I would love it. I'd love
Julie Michelson: to continue the conversation for everyone listening. Remember you can get the transcripts and show notes by visiting inspired living. show. I hope you had a great time and enjoyed this episode as much as I did. I'll see you next week.
​[00:52:00]
Julie Michelson: Welcome back to the inspired living with autoimmunity podcast. I'm your host, [00:01:00] 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 show grins. In today's conversation, we discuss the differences between allergy, autoimmunity, immune deficiency, and cancer, as well as what might be driving the ever growing incidence of these health challenges.
Julie Michelson: I would love for you to share with listeners and me a little more about your personal journey. Um, not just with, you know, why are you quadruple board certified? Um, but your wellness journey, your personal journey, and, and what has led you to this world that you are now just totally rocking.
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, [00:02:00] full fledged, um, 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 thought at that point in time, I was so exhausted.
Kara Wada: 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.
Kara Wada: And I think I continue to just peel back the layers like an onion and realizing how, even [00:03:00] though at the time I was. Um, only triple board certified, I guess, but like, um, but at the time that that education that I had really did not prepare me for one living in the role of a patient, nor did it really.
Kara Wada: 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?
Kara Wada: Who knows? And it doesn't really matter. But I had symptoms that I now recognize as Sjogren's. Related in some way or [00:04:00] 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 know, with, with folks within the patient community, and actually I just, um, I just wrote an article for Kevin MD on this as well that we'll, we'll publish tomorrow.
Kara Wada: 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.
Kara Wada: And then you'll get, you circle the question, you're like, oh, yes, I got it. Um. Done. I don't ever have to think
Julie Michelson: about [00:05:00] Sjogren's again. Correct.
Kara Wada: Or, if you're a pediatrician, Um, 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 has congenital heart block?
Kara Wada: 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. Um, 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, um, 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 [00:06:00] don't have time, like, and you're trying to take care of yourself, like we're the worst patient.
Kara Wada: So it must've been pretty bad. Um, I had an episode of idiopathic anaphylaxis, um, after having my first child. And I also, over time realized that I couldn't wear mascara without looking like a raccoon because I was always touching my eyes, rubbing my eyes. Um, wasn't able to tolerate wearing contacts at a certain point because of the dry eye.
Kara Wada: Sure. Yeah. And
Kara Wada: 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. Right. They're complaining about their dry cough or their body pain, their fatigue, um, maybe their sinus issues because I'm an allergist by trade.
Kara Wada: Right. So they're coming to see me for their sinus stuff. [00:07:00] Um, and the other reality is that 30 to 40 percent of patients have totally normal labs. Thank you. Um, yeah, totally normal lab. So, you know, they get that, oh, your labs are normal. Must be in your head. Must be normal. Yeah. Let's try this antidepressant, or maybe you should try losing a few pounds.
Kara Wada: Um, 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. Yeah. Then, you know, those several hundred thousand dollars education, no credit, you know, and some other things along the way too. But, um, so. Once I was diagnosed, um, and and I will say I feel incredibly fortunate and this is seems odd to say, but my labs were totally [00:08:00] wacky and that like they were terrible at the time.
Kara Wada: I think took my my rheumatologist slash. Friend, um, by surprise. Um, had those not been abnormal, I don't know of, I don't know how long it would've taken me to be diagnosed.
Julie Michelson: There's is so many parts and pieces of your story that I'm like, oh, let's talk about that. Let's talk about that. Yeah. I wanna first just kind of reinforce.
Julie Michelson: Um, 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. Um, and so I know that by the time people find me and probably you, they're [00:09:00] frustrated Absolutely.
Julie Michelson: They had normal labs. They were offered antidepressants. They were searching and searching. Um, and so I just, I, I want to highlight that part of your journey and every other position that has been on here that has, you know, an autoimmune journey or a health recovery journey. Um, is that it's not, I said this yesterday, you know, nobody becomes a doctor if they don't want to help people.
Julie Michelson: Um, And somebody said, well, that's not true. I said, Oh, there's easier ways to make money. I promise. Um, you know, but, but it, 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.
Julie Michelson: And, and I love you touched on it. And I think this is really important for people. [00:10:00] 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 happens.
Julie Michelson: Yes,
Kara Wada: yes,
Julie Michelson: absolutely. Yeah, yeah, it's like, you know, shocker, your autoimmunity, you used to have gut issues? No way, you know? Yeah. There's a connection. Yeah. Um,
Kara Wada: yeah. Yeah. Yeah. And, um. You know, I think part of it, I, I will refer to myself as the ostrich with their head in the sand for a long time. I, in part, I was totally in denial.
Kara Wada: Um, but also like, I didn't have time to be sick now that I say that, but then it's a little like [00:11:00] 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.
Kara Wada: And so I was having, I was forced to take rest, right? Um, because of symptoms and that's what your body needs and is like demanding at that point. Yeah.
Julie Michelson: Um, 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 two days later she was like complaining that she was still sick.
Julie Michelson: 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 [00:12:00] 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.
Julie Michelson: For sure. So I, I wanna touch on. Because it, there's, again, so many questions I want to ask you. Um, you have this whole host of, of symptoms, um, 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, um, by the time you get the really dry eye, there was always this other host of, of things, um, 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.
Julie Michelson: I don't know you well enough yet, but I, you know, it's [00:13:00] 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, um, 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.
Julie Michelson: You know why let's answer the question why, and then we can start shedding some of those labels. Um, but it sounds like you're that that's accurate. You see the same, almost the same host. Yeah.
Kara Wada: Yeah. And the data supports that too. Um, the other symptom that I left off the list, um, is dysautonomia or POTS is incredibly common in Sjogren's it's the number one autoimmune cause of POTS.
Kara Wada: Um, and although I don't, [00:14:00] as far as I know, I haven't had it. 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 like intolerance and um, I would have to scrub out of 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 OBGYN rotation, where they keep the war, the room much warmer, um, for the babies that are, you know, about to be born, um, I had to scrub out on multiple occasions because I think in hindsight, combination of her long sitting or standing.
Kara Wada: the warm environment. Um, all those things kind of came into play where my blood pressure would drop and I would get to the point where I thought I was going to pass out. Thankfully it didn't.
Julie Michelson: Yeah. Thank you.
Kara Wada: For so many reasons. Right. They drill into you, like as a med student going through, you know, the OR procedures, like you can not [00:15:00] pass out in the operating field.
Kara Wada: Not allowed.
Julie Michelson: You got to get out first, drop in the hall.
Kara Wada: Yeah. Um, but I, I distinctly remember my preceptor say, you know, asking if I happened to be pregnant because I was having to scrub out so often, which of course now that would kind of be frowned upon, but, um, I can't ask, but it was memorable to now, you know, Oh yeah, that probably was all related.
Kara Wada: Yeah.
Julie Michelson: Shocker. Yeah, shocker. Yeah. So, so you have such a unique background and practice, and I wanna dig in a little bit to like allergy versus autoimmunity versus immune deficiency. 'cause
Kara Wada: Yeah, it's
Julie Michelson: all,
Kara Wada: all inter, we're all human organism. Yeah. It's, it's all so well in addition to our microbes, but , um. So when we think about our immune system, [00:16:00] its purpose is to help protect us, obviously, against infection.
Kara Wada: 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, 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.
Kara Wada: And so, you know, during that response, you're having this coordinated effort of cells and proteins and these things called 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.
Kara Wada: It's going to fend off any microbes from the surface of our skin that maybe have made their way in, um, or other [00:17:00] infection. Um, 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, um, and I mean deficiency, that system, it has gone haywire, it's misbehaving.
Kara Wada: 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 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.
Kara Wada: In the case of autoimmunity, when we are [00:18:00] incubating. We are in, um, 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.
Kara Wada: So that you end up with this immune system that can tell. Okay, what, what is us and what is not us? And. In 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.
Kara Wada: It has particular targets that are implicated, and that then explains some of the symptoms we end up with. [00:19:00] In immune deficiency, We don't have all the parts or pieces, or they aren't quite working 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.
Kara Wada: Eyeball infections that most people wouldn't be, you know, wouldn't have any issue with. Um, and a lot of times the collateral damage and inflammation that occurs, um, is not appropriate either. So sometimes there's like too much or there's too little. And so that then can expose the immune system to actually creating an autoimmune response to, because it's not cleaning things up properly.
Kara Wada: 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 [00:20:00] disease. So you end up with autoimmune and immune deficiency in the same human. It's a real kick in the pants.
Kara Wada: That's it. And then you, you're forced, Um, you know, to make some really difficult decisions as a team, um, with your immunologist, maybe your infectious disease doctor, the rheumatologist in deciding how can we try our best to like restore balance, um, 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.
Kara Wada: Um, and so that is a They can be incredibly challenging and frustrating, um, and then in cancer, essentially the, um, 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.
Kara Wada: And so what you're [00:21:00] 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
Julie Michelson: appropriately. Yeah. And that's pretty cool. I think at least in regards to cancer and the general population, I think the more we have these conversations where people can realize.
Julie Michelson: Like we, we have bad cells all the time. We all do. Yeah. Yeah. Yeah. And a lot of times our
Kara Wada: 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 of that I look forward to the day when there is a more integrative approach across the board with cancer so that we are.
Julie Michelson: Supporting the whole human while we are helping the body go after the cancer. Um, yeah, I know. Absolutely. It's a, it's an [00:22:00] 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.
Julie Michelson: 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 to, 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.
Julie Michelson: And I'm guessing often they have, like you did, like I did have issues brewing that they didn't realize were auto immune. Oh
Kara Wada: 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.
Kara Wada: It's awesome. Um, but I would [00:23:00] 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. Um, uh, and I would say probably a good four to five of those patients, um, are maybe the fifth, sixth, seventh, eighth opinion on their symptoms, which to me, they describe symptoms of too much inflammation in one way, shape, or form and or dysautonomia.
Kara Wada: So issues with like blood pressure, heart rate fatigue. Unfortunately, so I'm I'm located in Columbus, Ohio. I work at the large university there. Um, and we don't have anyone locally who's taken the lead on [00:24:00] 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.
Kara Wada: To get care.
Julie Michelson: That seems insane. Um, but I get it is.
Kara Wada: Yeah, we're in a, in a metro area of several million people. And so it's great. You're not in the middle, especially. Yeah, we already had a lot of these folks pre pandemic. Um, 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.
Kara Wada: Um, but we've also had a really, you know, an increased prevalence of these symptoms too with long COVID.
Julie Michelson: And for listeners, and I apologize, I didn't ask this 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.
Kara Wada: So, and it [00:25:00] could show up in all sorts of different ways, um, but most common, and I would say probably, affects quality of life. most significantly are issues with blood pressure and heart rate. Um, so folks may have issues with feeling like they're going to pass out or they actually pass out. Um, and, um, may have issues with digestion, can have differences in how like their pupils, uh, dilate and constrict.
Kara Wada: issues with sweating. I have a few patients who will wake up in the middle of the night, drenched in sweat. Um, now there are some other reasons why that can be the,
Julie Michelson: yeah.
Kara Wada: Not necessarily, you know, change of life. Yeah. And, um, not necessarily, um, blood sugar issues would be the other, um, main thing you would think about, um, and ruling out cancer.
Kara Wada: Um, but, um, and. [00:26:00] 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 siloed, where the cardiologists are in one space, the neurologists are in another space, the immunologists.
Kara Wada: and we kind of stay within our groups. It's challenging to have really good coordinated care for these folks.
Julie Michelson: So, so well said. Um, and you mentioned long COVID being one reason I feel like in general, even like POTS, pandas, these kinds [00:27:00] of things, it, you know, it's that question of, are we just more aware?
Julie Michelson: And so now we, you know, more people, we, more diagnoses are happening or is it like real food allergies, auto immunity, autism, is there just really more, you know, What do you think this increase in, I mean, I have, I have two, I still call them kids, two adults 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.
Julie Michelson: It is scary.
Kara Wada: It's really fascinating too, because there is this really, almost like a, uh, not quite a land, uh, line in the sand, but so I am, 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 [00:28:00] 36 and I think she probably would say about the same, but you go another like two or three years and that's when those numbers really kind of blossom, you know, kind of those born early nineties.
Kara Wada: Onward. Um, 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?
Kara Wada: The reason why we're seeing more is because we're all cleaner. And yeah, like that helped, that helps explain it to some degree, but it wasn't the whole picture. And so there is a physician researcher, Dr. Adkis, um, who is out of, I believe Switzerland, who took kind [00:29:00] of the center stage and really Spoke a lot about the epithelial barrier hypothesis.
Kara Wada: 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.
Kara Wada: 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 inflammation. And a lot of times in particular, what we talk about a lot in allergy, uh, is eczema. It's easy to [00:30:00] see like what's going on. Um, a little bit easier to study, um, sometimes than, than gut related things, cause you're not having to do endoscopies all the time.
Kara Wada: But it is a gut
Julie Michelson: related thing. It,
Kara Wada: um, sorry, from like a bio, yeah, but from like a bio, it's a little easier to see and conceptualize and, um, 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 like the strains and the types of toxins that they may change when that skin is inflamed.
Kara Wada: 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. Um, but as you mentioned, there's crosstalk. So you can see then changes maybe in gut [00:31:00] 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.
Kara Wada: 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 is 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.
Kara Wada: Even my dad, when he was growing up, he'd have to go kill the chicken and pluck all the feathers and bring it in for dinner. Like [00:32:00] they were, he was outside on the farm working all summer. Like they didn't have air conditioning. Touching the earth. Yeah. Um, it just was totally different. And here we are, you know, in our creature comforts, I'm in air conditioned space.
Kara Wada: Me too. Um, and I have my ear bud, you know, I'm sitting, um, and. And 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, um, are exposed to, rapid change in diet, um, increased sugar, oil, refined grains, um, And on the whole, we're very sedentary.
Kara Wada: We spend upwards 90 plus percent of our time indoors. Um, and so, and [00:33:00] then the newest in the, in what Dr. Adkis is kind of, I think, um, pet project is looking at the role of dishwasher rinse aid, in particular those used in commercial dishwashers. Um, but the, the, the residue left on glasses is very damaging to the gut.
Kara Wada: 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? Oh, two kids with that when they were little. Who knows, right? Yeah. And so, um, you know, there still is a lot of work to be done to really hone in, but.
Kara Wada: Well, and I think that's
Julie Michelson: a very specific product. Um, but I think it, it underscores the whole exposure to toxins,
Kara Wada: right?
Julie Michelson: So they're studying commercial dishwasher, but you know, but what are people using at home even day in [00:34:00] and day out? And, and, you know, that's a whole, we could talk for another hour about that, but I do think it's this combination and, you know, You can't, so you mentioned, you know, the changes in our food system, the dogs are piping in, um, and, and to me, you can't separate the changes in the food system and toxins.
Julie Michelson: It's the same, you know, the bad oil, the ultra processed foods, the, you know, all of that is toxic. And so, um, you know, when I say toxins, I'm not always talking like chemicals, right. And you 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 or stand up or stand up.
Kara Wada: Yeah. And just think about, you know, what, what are our non negotiables? What are the things we're willing to change and What is our [00:35:00] comfort level with risk too? And I, I think that's where more data would be helpful, but 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.
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 brushstrokes, things that are healthier for the planet tend to be healthier for our physiology. Um, and, you know, similarly with the things we put on our skin, like those are easy, simple.
Kara Wada: swaps and switches that, but
Julie Michelson: I love that you brought up the also know what your non negotiables are. I mean, 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 [00:36:00] things I do with my clients is we're reducing that exposure, right?
Julie Michelson: As we're supporting the body's detox pathways, we are, and it is a process. It's 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.
Julie Michelson: 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.
Julie Michelson: Not negotiable that for her, she loved her shampoo and conditioner. Yeah. It literally cleaned up every other product she was using on her body in her home ever. And, and I'm like, great. Like it's not about [00:37:00] a, we can't reach perfect and B we don't need to is the, you know, cause sometimes we get the, we have these conversations and it can start to sound doom and gloom.
Julie Michelson: 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,
Kara Wada: you
Julie Michelson: know, the, that's the exciting part, right? That's why we're here.
Kara Wada: Absolutely. We are resilient, amazing species that has made it this far. Perfection is sometimes, you know, the enemy of good.
Kara Wada: And I will say I was the first to fall down that rabbit hole, not too long after, yeah, after my diagnosis, I, um, doubled down, um, I've had a Peloton bike for quite some time since probably like 20, 2018, 2019, um, early, early adopter. Yeah. Early. Maybe it's 2019. Anyways, it doesn't matter. But [00:38:00] I
Julie Michelson: pre pandemic and, um,
Kara Wada: and I was like shooting for, you know, PRs like, okay, like I'm in a like workout hard.
Kara Wada: I was drinking green smoothies that I was adding some super fluid, you know, stuff too. And yeah. Um, to make a long story short, ended up, um, 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 of what you're doing.
Kara Wada: And more of something good isn't always better. Yes. And then, um, Nothing's good for everybody either. That is absolutely. Um, and then, um, 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 [00:39:00] great.
Kara Wada: You know, all those sorts of things. Um, but I ended up spending so much mental energy fixated on what I was eating what I wasn't eating. Um, that at a certain point, my symptoms 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.
Kara Wada: And I also just had to let go of the perfectionism like that
Julie Michelson: was, I think, and I think everybody, I'm sure you have the same thing. I think that the perfectionism, if we could Somehow like diagnosed perfectionism first, we could prevent a lot of this chronic illness. Yeah. Cause it really does that stress level.
Julie Michelson: I've yet, and it may present totally different. Like, it's [00:40:00] 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: Yeah,
Julie Michelson: so I do wonder
Kara Wada: 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?
Kara Wada: But do those also like increase the potential sometimes for
Julie Michelson: these conditions? Yeah, and that's what we just need to
Kara Wada: learn. I kind of wonder.
Julie Michelson: Yeah. Oh, I think, yeah, I think for sure. I really do. Um, I, it doesn't mean that if you don't care about anything, you don't get sick. I'm not saying that. No,
Kara Wada: no, no, no.
Kara Wada: Just, you
Julie Michelson: know, like we talk about risk
Kara Wada: 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. [00:41:00] Yeah. Yeah. So, but I, I love the, what you're bringing to the world.
Julie Michelson: Um, and I just think, you know, the more 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.
Julie Michelson: So I am so grateful that you are out there in Ohio doing what you're doing. , clearly you need more counterparts, , it's well in your, in your neck of the woods.
Kara Wada: The wonderful, wonderful thing about my position is that I get to work with trainees. Oh, that's fantastic. Near nearly every day. There is a medical learner.
Kara Wada: Of one, one shape or another. So from [00:42:00] 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 The season just opened for interviews. So we have, um, you know, a hundred plus applicants for, for these, you know, two spots, um, every year it's, um, pretty incredible.
Kara Wada: 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,
Kara Wada: as human beings, our brains really hate uncertainty. Yes. And, and that is absolutely the case with physicians as well.
Kara Wada: And to push them to get. more comfortable with feeling uncomfortable, I think is clutch. [00:43:00] Um, and, um, to help instill and support their curiosity, I think is really important too. And what really, really needs to take place to ensure that all of us as healthcare professionals can stay curious and compassionate and Um, kind of leaning in is we need to ensure that our healthcare professionals have wellness as well.
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 who is in that
Julie Michelson: state. Like, I always, I always ask, like, why?
Julie Michelson: 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 [00:44:00] 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.
Julie Michelson: Like every one of those applicants really needs to be filling their cup and doing stress man. You know, it's such a high stress. And, and that's a great, um, 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. Yeah. Yes. And
Kara Wada: yes,
Julie Michelson: 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.
Julie Michelson: Right. Like, yes, you need to partner. 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, [00:45:00] 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.
Kara Wada: 0, where essentially it outlines this idea of the physician is human. There is this equalization, the power dynamics between patient and physician will never be equal, right? Like, there's, there's no way to fully equalize that, um, just to the nature of. These systems, but it brings it into closer balance. Um, and I think the more that we can lean into that is really important.
Kara Wada: 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. [00:46:00] 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 finally collapses, we already, we know, you know, what can work and what is working. Yeah. So I love that. So give listeners, if you will, and it can be anything. Can be directly shoguns related, not doesn't matter. Um, what is one step that they can take starting today to start to improve their health?
Kara Wada: Yeah. 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 [00:47:00] voice and what he, she, they needs. Um, I think that is incredibly important. And I think it's really helpful to do that before a medical visit. Medical appointments, almost on the whole, tend to put us into fight or flight.
Kara Wada: 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?
Kara Wada: Being able to communicate how they are showing up in, in your, in, in showing your humanity, um, can [00:48:00] 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. Um, yeah, so that's my chair,
Julie Michelson: the other piece in because I see it a lot and it's, I don't think people do it intentionally.
Julie Michelson: 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.
Julie Michelson: 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 [00:49:00] 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.
Kara Wada: It's worse in the morning. Yes. All that's helpful. But what really illustrates how much it was impacting my life was I was. Not wanting to sit on the floor to play with my young children. And that like was breaking my heart.
Julie Michelson: Yep.
Kara Wada: 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.
Kara Wada: Yeah. I
Julie Michelson: 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 [00:50:00] drcarawada. 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.
Kara Wada: I'm a Midwest girl born and bred, and I love a good deal. So things generally are, you know, not going to cost a ton, um, to really help start making those changes. Um, and, um. 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.
Kara Wada: 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 [00:51:00] spectrum of things of too much inflammation. So allergies, autoimmunity, asthma, um, gut health issues.
Kara Wada: Um, 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.
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,
Kara Wada: I would love it. I'd love
Julie Michelson: to continue the conversation for everyone listening. Remember you can get the transcripts and show notes by visiting inspired living. show. I hope you had a great time and enjoyed this episode as much as I did. I'll see you next week.
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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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