E73: Navigating Allergy and Autoimmune Challenges with Dr. Kara Wada

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Kara Simonson Wada to discuss Dr. Wada's journey as a pediatric and adult allergy, immunology, and lifestyle medicine physician, and her personal experience with Sjogren's disease. They explored the importance of lifestyle changes in managing autoimmune diseases, practical tips for reducing exposure to toxins, and maintaining a healthy microbiome. Dr. Wada emphasized gradual, practical changes, and shared resources available on her website, drkarawada.com, for those seeking to improve their health through lifestyle adjustments.



0:28 - Introduction and Welcome
0:43 - Dr. Wada's Background and Professional Journey
2:10 - Dr. Wada's Autoimmune Diagnosis Journey
7:30 - Understanding Sjogren's Disease
12:43 - Lifestyle Medicine and Autoimmune Disease Management
18:53 - Practical Tips for Healthier Living
21:49 - Allergy, Inflammation, and Microbiome
27:34 - Supplements and Caution
27:57 - Professional Insights and Personal Experiences
28:47 - Additional Roles and Resources
29:37 - Closing Remarks and How to Connect with Dr. Wada

Connect with Dr. Wada
Facebook Page: https://www.facebook.com/KaraWadaMD/?locale=sw_KE
Instagram: https://www.instagram.com/crunchyallergist
Youtube: https://www.youtube.com/@drkarawada
LinkedIn: https://www.linkedin.com/in/crunchyallergist/
Website: https://www.drkarawada.com/

Connect with Dr. Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

Transcript

Kerry: 0:28

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Dr. Kara Wada. I should have asked you how to say Wada, but anyway, welcome to the podcast.

Kara: 0:41

Thanks so much for having me. I'm excited to talk

Kerry: 0:43

Yeah. Yeah. I'm so excited. I sought you out to have on the podcast today. Why don't you tell us a little bit about who you are and what you do as much as you want to say in the beginning, because I know you have lots to say,

Kara: 0:54

So I am by training pediatric and adult allergy, immunology, lifestyle medicine physician. I practice at the Ohio state university in Columbus, Ohio. I'm also a mom of three younger kids, eight, five, and two. And along my journey and kind of a couple of years out from my training, I also joined the community of autoimmune patients. And so that really has led me kind of on this journey towards lifestyle medicine and understanding more about how our brains work and sharing that information that I've learned with more people kind of doing things like this and hosting my own podcast and trying to educate and empower as best I can.

Kerry: 1:41

Love it. And I mean, obviously we need people like you to do those things because you've navigated both sides, right? As a patient and as a physician. I also have three kids, so that's fun. Mine are four, seven and nine. I have to keep counting these days. Yeah, but

Kara: 1:56

similar. Just a little seer step.

Kerry: 1:58

Yeah. So why don't you tell us about like the beginning of your journey? And I guess one of my questions was you weren't lifestyle medicine at the beginning, right? Yeah. You kind of fell into that. Okay. So tell us about your journey.

Kara: 2:10

Yeah. So I was about two years out of training. I had just come back from maternity leave after having my second little girl, Josie. She was about nine months old and I was sitting in the dentist chair and the hygienist just kind of off the cuff mentioned, Hey, Hey, You know, your mouth tissues look a little dry. Is everything okay? Are you on any new meds? You know, what's going on? And it was that, you know, seemingly like relatively benign, you know, comment that kind of was this last little puzzle piece that kind of put the picture together, at least in my mind, of what I had been experiencing for the last, now I look back, you know, even back into college, but at least kind of during that last few years. And that moment I, you know, was recalling, oh, well you also have dry eyes. You haven't been able to really wear mascara or contacts for years, and you've had this nagging back stiffness that always got better when I was pregnant, which just seemed odd, right? Like all my girlfriends were complaining, you know,

Kerry: 3:14

Oh, better when you're

Kara: 3:15

pregnancy. And I was like, gosh, I feel great. I actually have a little more energy. You know, once I got through the nausea part and that just seemed kind of odd. And with my background and training in immune system health, you know, some little red flags started popping up across the way. And so what I was worried about, you know, and especially in that context of dryness was could this be Sjogren's, which was something I had learned about, but also, you know, I learned enough for the test, right? Like I wasn't actively treating patients who had that, but I made an appointment with my primary care doc and said, Hey, I'm worried about this. I've been feeling really tired. I hurt. I have this dryness that even the, the dental hygienist mentioned, could we order this lab work? I kind of knew what I needed to have run. Right. And she pushed back a little bit, you know, like, oh, I think you're probably fine, but I guess, you know, kind of reluctantly ordered the blood work. And sure enough, it was concerning. I had positive autoantibodies or proteins that showed that my body was no longer tolerating parts of itself or attacking parts of itself. And interestingly, What I know now, several years out, in large part, actually probably only in part, due to learning from other patients in the Sjogren's Foundation, is that 30 to 40 percent of patients with Sjogren's disease have normal blood work. And so this, you know, that was, that blew my mind, you know, having learned about this condition and not really thought of it much in, in my diagnostic process. But also this like, oh gosh, how grateful, you know, it sounds weird, but grateful I was that my diagnosis was pretty straightforward in that my labs are positive. I knew my rheumatologist cause we did our training together. And was able to navigate the system fairly well with that knowledge and, you know, all the other privilege that I had, health insurance, a supportive spouse, all these things. So I got on some meds, you know, started like doubling down on lifestyle, realizing that there wasn't a lot of medications that were available to treat Sjogren's unlike rheumatoid arthritis and now even what we've seen a little bit with lupus as well is there hadn't been kind of this big influx of effective medications. And so I thought, okay, what are, what are all the things that I can do to maybe turn down that inflammation? And I like doubled down, you know, I'm like type A relatively perfectionist with certain things and started on some superfood smoothies and like working out really hard on my Peloton. Focusing on eating better. And I don't even know what particular diet I was like fixated on at that point. And by the end of that summer, so I got diagnosed in may, by the end of that summer I turned yellow and I was itchy and I was fevering off and on for a few weeks. And then my urine turned dark and I was like, Oh, four letter word. What is going on? And so I got my butt to the university urgent care because of course I couldn't cancel clinic to like, you know, go see my own doc, you know, couldn't do that. And sure enough, my liver enzymes were like through the roof. And it really kind of was that, four to eight week long saga of going through visits, needing a liver biopsy, you know, all the feeling terrible, all these things that really then having so much more just somberness about like, okay, I had to, I had to text colleagues to like get my liver biopsy scheduled and I had their cell phone number, you know, like this ultimate privilege. And I still was like struggling to like get what I needed from the system. Right. And so, it's been kind of reflecting on that experience. That really has kind of fueled the fire of, Wanting to leave this world a better place than where I found it whenever my time's done, you know, like hopefully many, many decades from now. But yeah,

Kerry: 7:30

Yes. Hopefully many, many decades from now.

Kara: 7:34

a lot to get done still.

Kerry: 7:35

Yes. So, I mean, you definitely had and are still navigating the system. And like you said, even with privilege, it's, it's still a struggle. Like you, you knew what to order. I'm surprised that your primary was even pushing back on that. I feel like, yeah, sure. Okay. You're an, you know, well educated person. You know what you're talking about? You know what, let's just do it. It's not. Going to be like the end of the world to just order it. I know a lot of med students and doctors do get a little hypochondriac, but I mean, you've had, like you said, you had the symptoms and stuff. So I'm surprised that they kind of hesitated, but glad that they did. And glad yours was kind of like a straightforward diagnosis, but I didn't realize that, you know, people could still be suffering with Sjogren's if they don't even have positive markers. And well, first of all, what is Sjogren's exactly just in case anybody doesn't know?

Kara: 8:25

Yeah. So first of all, if you were trying to look it up, it does, it's not spelled like it sounds it when you read it and see it spelled out, it looks like a chair from Ikea. It's S J O G R E N S, and it's a scientist name who described it, and he happens to be Scandinavian, so that's the name. For many years it's been considered a syndrome and that nomenclature, that naming has changed over the last several years because there really has been I think a lot of bias in part due to the use of that term syndrome. So now is referred to as Sjogren's disease and it is an autoimmune condition meaning the body is triggering that inflammation itself. And it attacks primarily glands that produce moisture, but also aspects of our nervous system, and in particular, our automatic or autonomic nervous system. So, for instance, Sjogren's is the number one cause, or number one autoimmune cause of POTS, or postural orthostatic tachycardia syndrome. It's when folks, when they're changing position or have other triggers will have POTS. Inappropriate response of their heart rate and blood pressure. I've seen that a lot with long COVID, too. So I think there's been more discussion about, you know, these nervous system issues, but not only affects heart rate and blood pressure, but your ability to sweat, your ability to make other secretions, so like your saliva. And additionally can affect digestion and pain perception too. So often folks will have symptoms that really look and sound a whole lot like fibromyalgia.

Kerry: 10:13

so the digestion part, is that how the liver got affected for you? Like, I don't really remember learning that in

Kara: 10:18

yeah, it can. So there, there can be an association with other autoimmune liver conditions. Turns out that superfood supplement that I had put in my smoothies wasn't so super for me. And that was kind of the end conclusion with the biopsy. The folks at Ohio State looked at my little piece of liver, they also shipped it to the NIH, the National Institutes of Health. I'm looking over, they like looked for every virus possible and they said, no, actually, this looks consistent with An injury from a medication or supplement, and we were able to rule out the meds I had been on, which weren't many and the reality is that a good portion, and I want to say upwards of 20%, but don't, don't bet on that. My memory for numbers is not always totally on track, but there's a good portion of liver injury that happens every year. That is due to supplements, vitamins, things that are outside of kind of the prescription realm.

Kerry: 11:20

Yeah. I mean, I am trying to learn more about supplements and things like that, but it's, it's hard. They're not usually well studied. So it's, it's real hard, but good to know to always be careful with it. That's a good lesson right there.

Kara: 11:33

yeah, I think, you know, do I still take some? Yeah, but I think we have this bias in our brains that is very very, you know, inherent to us. That something natural is safe or safer, and it's not always the case. So I think just hitting the breaks or hitting the pause button and giving the same type of consideration you would to starting a supplement as you would another medication is really kind of, you know, the key and talking with your health care team because they're, they are biologically, physiologically active. substances. That's why you're wanting to take it, right? You're hoping it will have some sort of effect on your body. And so that means also it can have interactions sometimes with other medications or other conditions that you have that may increase risk. So

Kerry: 12:27

Yeah, that's definitely a really good point. Thank you for stating that. So with autoimmune disease how does that, or how do you get it to tie back into kind of what you do in your profession? Well, I guess you have many different hats, but. Yeah,

Kara: 12:43

yeah, I think all come together. So what we're really realizing now there's been this big paradigm shift in how we understand and conceptualize the development of autoimmune disease and allergy. And really, they're both types of inflammation. Inflammation is our body's natural response to infection, to injury, right? They're things that are going to help us heal help us fight off whatever cold or skin infection, whatever we have going on. But it also is our body's response to what we categorize as insults. So insults include allergies, they include autoimmunity, also includes changes to our microbiome so dysbiosis, and changes in our metabolism, which I know you're really interested in as well. When we look at, you know, why are we seeing such, you know, rapidly increased rates over the last You know, a couple decades and even more so kind of thinking back with allergies, but allergies and autoimmune conditions even some types of cancer. We're understanding that a lot of that disruption or misbehaving of our immune system goes back to disruption of our barriers. So our barriers are our skin, our airway, and our gut. And these are the ways that our body interfaces with our outside environment. We kind of forget sometimes, but our gut is just a one continuous tube. So it's actually kind of on the outside of us, but all these surfaces are also essentially covered with a microbiome. It's the bacteria the archaea, the viruses, the fungi, you know, all this living environment of its own and when there become increased breaks or leakiness in those barriers, There also are associated changes that happen in all sorts of different ways to that microbiome. We don't know what's the chicken or the egg, and it may not really matter. But when we see those changes and that increased leakiness, then our immune system is seeing parts of the world, parts of the bacteria there, you know, other aspects that it wasn't seeing before. And that oftentimes will perpetuate or worsen that inflammation, increase leakiness. We see this a lot, eczema, like, cause you can see it on their skin, right? And you can see downstream effects as a result of that. I think what's even more mind blowing though, is to realize that increased permeability in those alterations in our gut may affect development of an autoimmune condition that some are totally different in the body. Alterations through our airway, like exposure to different air pollutions and such, may increase our risk of something like MS. Like, they aren't necessarily organ specific. And what we've learned, for instance, about eczema kiddos with eczema and babies with eczema are at far greater risk of developing food allergy. In part because they're being exposed to food through their skin initially, you must sloppy eating, you know, babies eating rather than through their gut, which is more primed to tolerance. So we're still, still scratching the surface and the science, but it's. So fascinating. And I think really kind of bringing together our overall conceptualization of, you know, why and how all this is going on.

Kerry: 16:20

Yeah, I definitely have heard and read and I know this is all like an area under research and stuff, which it is fascinating. Like my thoughts of like more peanut allergy was always like, okay, everybody's avoiding them because it's a choking hazard but that didn't happen with grapes, you know, so. Why are they not as big of an allergy problem or anything like that. But I definitely read about the barriers. I really liked the way that you described it, right. To the gut is actually like kind of outside of us. It's its own tube. And the microbiome is like super important at balancing everything, if you have too much of this bacteria or too much of that one, it can kind of alter everything. Like everything has this homeostasis. And we mess with it with whatever way without knowing right and it can really be affected in that manner and I know some people probably more on the functional medicine side even bring things down to like the mitochondrial level to see, you know, if that's where the problem is. Right? I don't know if you have any comment on that or if you read anything.

Kara: 17:21

still like deeply immersed in in actively learning more about that. There has been Some papers implicating mitochondrial dysfunction specifically with Sjogren, so I'm like extra interested, but I'm still not at a point where I'm ready to like jump in and teach. And it's interesting, you know, I continue to do, you know, we're all an N of one, an experiment of one, and so for me I definitely have seen some difference. Like I switched my fish. I take fish oil and vitamin D. Those are pretty evidence based interventions to help try to prevent more autoimmune stuff from happening. And I switched it up and I'm taking one that has a little turmeric and glutathione in it. Glutathione is thought to be helpful, I think, with mitochondrial dysfunction. And I I ran out recently and switched back to the Similar, you know, just plain old fish oil. I was like, why am I so tired?

Kerry: 18:16

It's hard to relate little changes like that to what's going on right but I mean we don't know

Kara: 18:21

might have

Kerry: 18:22

yeah, yeah,

Kara: 18:23

a crazy week.

Kerry: 18:24

right, I know you got three kids who knows but it's hard that's why the evidence in the studies are just, you know, anecdotal sometimes, but you know, everybody's different. So I just say, you know, try things or whatever. So and what you do with the autoimmune and the allergy inflammation, like how do you suggest to patients or people that you coach, right? Cause you coach as well of like what, what sort of changes do you suggest that they make? I mean, you mentioned supplements, but what other things?

Kara: 18:53

I actually rely very little on supplements. I think in really the focus is, okay, if we want to really focus in on that root cause, how can we get rid of things that are disrupting our barriers? you know, Mama three. I'm also from the Midwest. Like I'm like pretty practical and I like a good deal. So what are some things that we can like simply kind of swap out to minimize those things that are going to break down our barriers or contribute to that? And then what are some things we can do to help build those back up or, you know, increase our resiliency? And so, we kind of slowly, but surely try to make some of those simple, safer swaps over time. I love the work of both James Clear and BJ Foggs, Atomic Habits and Tiny Habits of You know, they, different books and take a slightly different spin on things, but, you know, this idea that if we start small and build our confidence with just little changes, adding those two behaviors we're already doing, that really multiplies over time. And we absolutely have seen that in our family's lives of like, over the last, you know, four or five years. Oh, okay. The Tupperware, it's looking kind of, oh, we need some new stuff. Let's get glass. Or, you know, okay, we're needing a new toothpaste. Okay, which is going to be the best, you know, talking with our dentist, but also maybe doesn't have sodium lauryl sulfate, which is The foaming agent. It's a really great soap. Sometimes it's too good So sometimes it's over stripping. This is you know, it's a simple thing I recommend often in the clinic for patients who have maybe Burning mouth or they get kinkersaurs more often than not. Or even maybe if they have oral allergy syndrome where when they eat fresh fruits and vegetables their mouth gets really itchy because they have pollen allergies. The other tool that I love in the office is immunotherapy. I know you're in an allergy practice. So being able to help, you know, retrain the immune system to go from fighting the allergen to ignoring it really turns down systemic inflammation. And so, you know, those are just a couple of ways, you know, from the oral mucosa, the airway cutting out fragrance at home, so as you're replacing your soaps or detergents, you know, looking for things that are fragrance free. You actually want to look for fragrance free as opposed to unscented. Unscented can have fragrance in it to mask the normal or the natural smells of whatever the other ingredients are. Those are kind of some easy, low hanging fruit just to start to slowly but surely.

Kerry: 21:49

Yeah, so what is it since you brought it up about the plastics that cause it a problem?

Kara: 21:55

so a few things we know microplastics like in water bottles or maybe that would be scraped off if you have like old takeout Tupperware you're trying to reuse are disruptive to the gut lining. So, That would be one. The other thing, if you're putting the plastic in the microwave to reheat, it is releasing some of those endocrine disrupting chemicals. So those endocrine likely have downstream effects on how our hormone systems are functioning. And the reality is our endocrine system, our hormone system, our immune system, our nervous system, our microbiome, all these things are like, we used to think that they all kind of were on their own kind of doing their own thing, but they all have receptors that are. Interacting amongst one another. They're all, we're all, they're all talking to one another. And that's why the science gets really complicated. So, you know, shout out to all those folks in the lab that are trying to tease out all these interactions because

Kerry: 22:57

Yeah, absolutely.

Kara: 22:59

Yeah.

Kerry: 23:00

I think as an aside, I'm not really focusing on this today, but the, the, the 4 different pathways of obesity. One of the obesogens model, you know, is those endocrine disruptors. And we talk about the plastics and things like that as well. I don't think I was aware of this toothpaste thing though. So that's very good for me because I've had people come to me with burning mouth syndrome and you know, when nobody knows what's going on and then the same thing with the oral food allergy. So that will be a definitely a new suggestion that I can bring to patients as well. So thank you for that. Yeah, so. One thing you did mention with the fragrancing one, you know, I was thinking about contact dermatitis and all the different chemicals that people can be allergic to and fragrance or whatever is one of those things that we test for and it can, you know, definitely be a barrier or not a barrier, break down your barrier if it's on your skin and you're allergic. So yeah,

Kara: 23:53

I will say I have a case that I can kind of de identify taste. I can talk about even this week, a patient came back. She had seen one of my mentors for years. My mentor retired. She started following with me and this, this poor woman had been dealing with these rashes since she was 15. rashes, you know, kind of contact dermatitis type rashes. So eczema y kind of type rashes. And we thought there was probably an allergic component. She also had, you know, regular kind of sinus allergies, mild asthma. And we, you know, the last few years had always mentioned like, Hey, you know, what do you think about your, your nails? Your nails look beautiful, but do you think that could be contributing? No. And then we kind of had to give it to her a little bit because often when we think of the allergies we see with nails or acrolates, they tend to be around the eyes. around the nail, you know, kind of in these more characteristic distribution and it didn't really fit quite that. But we finally did get her in, got her patch tested, and sure enough, she alarmed positive to acrolates. And what we ended up figuring out after the fact is that her couch that she's had for some time I can't, it's either leather or leather like had acrolates in it and so it made sense because she had had some rashes on the back of her arms, the back of her legs, you know, kind of those areas where her skin was in contact with the couch as well. And so she put a blanket over the couch. She switched her nails from what she was doing to some dip that didn't have accolades, so they still look nice and she's like, my life is forever changed. I feel so great. And you know, it's one of those little, sometimes when you finally follow that thread to find, you know, what, you know, sometimes it is as simple as a, you know, this one root cause or allergens like, ah, life changing.

Kerry: 25:47

I definitely find with a contact dermatitis, sometimes it takes a real long discussion of what their history is and what they've been exposed to, what they wear, what they do. It's a complicated thing. Luckily, the testing is pretty good. Like you do the patch testing, a whole panel and then maybe some personal products and it really, really makes a big difference, I think. And it's enlightening to see what all these chemicals that we use. So it's kind of. scary that you could be, you know, affecting that. And that's just like, if someone has a rash, like what if, what is it all doing to us otherwise? But

Kara: 26:21

Yeah, no, I agree. It's like sometimes it can be overwhelming. And I think in particular, especially as a woman and, you know, I like to wear some lip gloss or we didn't mention, but I like to compete in pageants from time to time. I like a little sparkle in my life. And so I think there's always this you know, this mindset that I go back to of thinking about and rather than or so, you know, what are some safer things I can do to decrease my risk? And also be okay that I'm, I'm going to live my life in kind of our modern world. And I'm going to accept like progress over perfection. Because really, you know, even thinking back to that whole liver episode, like a lot of that was driven out of this, like, intense fixation on doing things perfectly and thinking that if I did things perfectly, it would make everything magically disappear. And that's not the case.

Kerry: 27:17

I know I say all this, but then in reality, I just, I have to be able to live in the modern world, like you're saying too. So I'm not going to throw out everything that I'm using now. But I mean, try to make small changes, like you said, with atomic habits, you know, to make things a little bit better as best you can. Yeah.

Kara: 27:34

there, there are some companies that are really walking the walk and talking the talk. And so, you know, kind of listening, learning figuring out who those are and experimenting. I mean, it really comes down and you kind of had mentioned this earlier of trying things out, see what works for you and have fun while you're doing it too. It's a big adventure.

Kerry: 27:54

Yeah. Is there anything else you'd like to share with the audience?

Kara: 27:57

No. Well, if people want to connect or kind of see what I'm up to drkarawada. com is kind of the hub for the podcast and blog. And. let's see that. I mean, those are the big things. I have a little ebooklet of kind of 25 simple swaps that they might find really helpful, kind of, especially with all the things we've talked about. And those are things that our family's done over the last, like, 4 years or so, probably gonna have to update it. Always learning and growing and but it's a good place to start. Yeah,

Kerry: 28:30

you mentioned you do beauty pageants, right? Is that what you were talking about? Okay. Pageants and you have a TEDx talk. You got the podcast, you got a coaching business, your reg, your regular physician as well. I guess regular isn't the word, but a phenomenal physician. And what else did we miss?

Kara: 28:47

I mean, I think those are the big things. Yeah, clinically kind of gearing more towards helping, helping folks on that diagnostic journey, kind of being one of the doctors that is like a detective and in particular, a focus on mass cell disorders. We're also launching a new type of immunotherapy, which I'm going to have to talk to you about offline. It's like directly focused on the lymph nodes, so it speeds things up. Yeah, so those are the exciting things going on in the clinic. And as a coach, I run a program with a dietitian who focuses on anti inflammatory nutrition. from a standpoint of what can we add versus what can we eliminate. And that's all titled becoming immune confident which is the name of the podcast.

Kerry: 29:31

Right. Well, everybody look, look for drkarawada. com, right?

Kara: 29:36

Yeah.

Kerry: 29:37

Okay. All right. Thank you so much for joining us today. And yeah, this was wonderful. And stay tuned for next week.