January 25, 2024 • 50 mins
Unlock the secrets to navigating the complex world of food allergies as we sit down with Dr. Rubin, a renowned TikTok allergist. This episode promises to arm you with key strategies for reducing allergy risks, including the surprising benefits of early food exposure. Dr. Rubin dives into the gut microbiome's role and the intricate connection between eczema and food allergies, shedding light on the delicate balance our immune system strikes to protect us.
Bite into the curious case of Alpha Gal Syndrome with us as we explore how a tick's tiny chomp can unleash an allergic storm, and how climate change plays a part in its spread. We tackle everything from the syndrome's baffling reaction times to the hopeful possibility of outgrowing the allergy, plus a candid look at the soaring costs of EpiPens and the ethical quagmires of medical trials. Let's navigate these waters together, facing the challenges head-on with knowledge and a touch of humor.
Finally, we wrap up with some purr-fectly good news for cat lovers battling allergies. Could egg yolk be the unlikely hero for those sneezy fits? We debate the merits of feline companionship, the Canadian art of snow eating, and why sometimes, parenting with a dash of playfulness is just what the doctor ordered. Join us for a heartfelt reminder to savor the day-to-day – and don't worry, we'll steer clear of any yellow snow advice!
You can find Dr. Rubin
https://www.tiktok.com/@rubin_allergy
https://www.instagram.com/rubin_allergy/?hl=en
You can find us on social media here:
Rob Tiktok
Rob Instagram
Liam Tiktok
Liam Instagram
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:02):
Welcome to In Moderation, the show where we
give you a moderate dose of infosarcasm, and we already know
we're not approved.
Hey everybody, welcome to thepodcast in moderation episode.
Rob, help me out here a littlebit.
Speaker 1 (00:25):
I'm done helping you.
You're on your own.
I quit.
I know I'm not approved 16.
Speaker 2 (00:30):
That's probably not right but we're going.
Speaker 1 (00:31):
That's not right.
Speaker 2 (00:32):
Today, it doesn't matter, we're still moving along
.
We have our resident TikTokallergist, dr Rubin, on today.
Dr Rubin, how you doing.
Speaker 3 (00:41):
I'm doing great Thanks for having me on again.
This is a lot of fun.
Speaker 1 (00:45):
Well, this time you're actually a guest, last
time you were the host.
Speaker 3 (00:48):
I was the host.
Yes, because you two were injail because you impersonated.
Bobby at Costco.
Speaker 1 (00:55):
I just wanted to point out that our email got one
of those spams from peopletrying to book onto the podcast
for money.
The header was Dear Dr Rubin,Rob and Liam, you are officially
one of the hosts of this show.
Speaker 3 (01:17):
Wow, holy cow folks, I'm really excited.
Speaker 2 (01:21):
Being a scammer has got to be great.
When people fall for it, you'vegot to be like really, but then
you just take their money andit's awesome.
That's going to be fantastic.
Speaker 1 (01:30):
By the time we're on episode 50, Liam's just going to
have gone over to the dark side.
Speaker 2 (01:35):
I don't know when we'll be on episode 50, so it
doesn't matter that could betomorrow.
Speaker 3 (01:39):
That point.
You may be selling supplements,folks.
Let's be real.
Speaker 2 (01:44):
Well, I mean, whatever it pays, come on,
listen, come here.
But yeah, we figure we'd haveDr Rubin back on to talk about
maybe some more serious things.
Dr Rubin, I've heard thatallergies are a thing, that some
people have them.
Am I correct in this?
Speaker 3 (02:02):
You are absolutely 100% correct.
Considering what y'all do interms of the nutrition field and
wellness, it really overlapsquite a bit because there are
unfortunately, millions ofpeople in the United States
living with the food allergy.
We're estimated now to be about32 to 33 million people, which
is roughly one in 10 to one in13.
(02:23):
That's like saying two kids ina classroom and an average
classroom size are going to havefood allergies right now.
Speaker 2 (02:29):
Does that mean like to a significant degree, or just
like any amount?
I mean, I'm just kind ofcurious.
Speaker 3 (02:34):
Correct.
When we're talking about foodallergy, we're all going to say
on the same page here.
This is potentiallylife-threatening situation where
even the smallest amount forsome people could develop a
severe allergic reaction, alsoknown as anaphylaxis.
That's what I'm saying.
That is a severe problem.
When we were kids, most of usdidn't know anybody that had
(02:55):
food allergies.
The rates have tripled in thelast 30 years.
Speaker 2 (03:01):
And there's some theories as to why.
Could you maybe give us like acouple as to like why we were
thinking maybe food allergiesare going up?
Speaker 3 (03:08):
Sure.
So there's multiple potentialreasons why this may be the case
, so it's never one thing.
So if you ever look at acomment section when people are
asking about this, they'll sayoh, it's the water.
It's the chemtrails or the seedoils.
It's always that.
Or vaccines no, it's not onething.
I'll give a few examples.
So the American Academy ofPediatrics for a long time had
(03:30):
made a recommendation for babiesto have peanuts.
Delayed introduction to like twoto three years of age and we
found that over the last 10years there have been some
really good studies comparingkids who were randomized to
either getting peanut proteinwithin the first six months of
life to those who were delayedto five years of age.
And there's my years.
(03:52):
Yes, and there's an absoluterisk reduction in the
development of peanut allergy byabout 80% when you do early
introduction.
Wow, so 80% I would not havegotten Right so so those
guidelines have changed About 10years ago or so.
So we'll get more data in thenext five to 10 years about
(04:12):
where we are at with thoseguideline changes.
But it seems to be that many ofthese highly allergenic foods,
such as peanut, it's better tointroduce it during the first
year of life, not delay it.
So the immune system we'restill learning a lot about it.
It's rather malleable early onin life.
So if we can challenge theimmune system early on to these
foods, probably less likely todevelop food allergies.
(04:35):
But we haven't eliminated foodallergies just from that yet,
which again shows you why it'snot just one issue that we're
talking about.
Another issue potentially issome of the early exposures to
antibiotics and acid suppressor.
So if a baby has reflux, weoften will give them a
medication like an antacid toreduce the reflux that the baby
(04:57):
has, and there have been somestudies showing an association
between these medications andpotentially developing food
allergies.
It doesn't mean that there's alink.
It's not necessarily causative,it's a possibility.
But again we have to thinkabout everything involved with
what we're trying to do here.
Early antibiotic use can becrucial if there's any concern
(05:19):
for sepsis in a newborn.
So we're not going to say,because of food allergies, we're
going to stop givingantibiotics to babies when they
need it, but we want to havejudicious use to make sure that
we're not overusing it.
But it can still have itspurpose.
Antibiotic usage couldpotentially change the gut
microbiome, the bacterial milieuand how our immune system
(05:41):
processes the food early on inlife.
So that's another potentialexample.
Another issue is the fact thatwe're seeing more and more kids
developing eczema.
It's this dry, itchy skincondition that has a lot of
redness, a lot of irritationoften is seen on the cheeks, and
we see a strong associationbetween those who have eczema
(06:02):
and developing food allergylater in life, probably due to
the fact that those who livewith eczema have a skewing of
their immune response tosomething called TH2
inflammation, which can generatea lot of allergy antibodies.
So oftentimes we could developlater in life.
I do think a small portion ofit, though, is when parents
(06:23):
bring their kids in to getpotentially allergy tested.
They're given a whole panel oftests by a physician with all
the different foods, and it'llshow up that they're allergic to
10 different foods and they mayunnecessarily avoid some of
these foods.
So we have to be careful aboutfood allergy testing because you
could all have to have a littlebit.
Speaker 2 (06:41):
Oh, I would love to talk about that a little bit.
Yeah, we'll talk a bit more toit.
Yeah, the food allergy tests Iknow they're not, let's just say
, super accurate, but I don'tknow to the extent, just kind of
how bad it is I mean frankly?
I did want to quickly.
Yeah, sorry, I just wanted toquickly go back to the
introducing it when they'reyounger.
So I've heard it's around sixmonths you should try and
introduce.
Is that correct, right?
(07:02):
So?
Speaker 3 (07:02):
between four to six months.
It depends on how well thechild is doing developmentally,
if they're able to sit up, ifthey're not tonguing out too
much because they have to beable to swallow solid foods.
That's something that you talkwith your pediatrician about and
have them assess themdevelopmentally and have that
conversation with them about isit appropriate to even introduce
it at four months old?
Speaker 2 (07:23):
I'm going to definitely talk about that with
my pediatrician, becauseOakley's about four months now
and I refuse to her for her tobe allergic to peanuts.
Speaker 1 (07:30):
There's too many peanuts.
I could put peanuts.
He ended up being one of theallergic to peanuts when they
dried up.
Speaker 2 (07:36):
So I'm going to do everything I can.
So after I go, avoid that so alittle bit of peanuts around
four to six months I'm going totalk to.
Speaker 1 (07:42):
But yeah, here's the real trick Liam Raw milk.
Speaker 2 (07:48):
Okay, so do I give it to her now, or is that
something that we wait tilllater to give the raw?
Speaker 1 (07:55):
milk, you just bathe her in it.
How about now?
Oh, I bathe her in it, see,these are the questions.
Speaker 2 (08:00):
This is why I have you around.
I was just going to have herdrink it.
Speaker 1 (08:04):
Oh God, don't drink raw milk.
You bathe in it, Okay.
Speaker 2 (08:08):
Yeah, enema and bathing contracts, exactly.
Speaker 3 (08:13):
So, to get back to the introduction issues, if a
child has a history of eggallergy or they have what we
call moderate to severe eczema,you definitely need to be
talking with your doctor aboutwhether or not you can safely
introduce peanut, because thoseare the kids that are at highest
risk and those are what thecurrent evidence-based
guidelines talk about.
You may need to get sometesting for peanut allergy prior
(08:37):
to introduction in thosesituations.
So those are all things thatyour pediatrician should be
well-versed in start talkingabout because, yes, peanut is
one of the prime examples,because it's one of the most
common food allergens.
In the country, about 2% ofpeople allergic to peanuts.
Now.
Speaker 2 (08:54):
Could you run us through the top food out?
So I know peanuts, I know soyis up there Like wheat, wheat,
cow's milk, tree nuts, fish,shellfish.
Speaker 3 (09:07):
We also have sesame, wasn't sesame just added?
Speaker 2 (09:11):
It was added as the ninth most common allergen Okay.
Yeah.
Speaker 3 (09:15):
And now this is crazy .
So what might be number 10, theCDC recently reported last
summer, is red meat Really.
Speaker 2 (09:23):
Is it because of those ticks?
Yes, is it because of thoseticks.
Speaker 3 (09:26):
Yes, so it's something called Alpha Gal
Syndrome, which I hope that youraudience will start to get
interested and know more about,because this is affecting a lot
more people than we realize.
So there may be close to half amillion people in the United
States living with Alpha GalSyndrome.
What we believe is happening isthat there's a particular tick
called the Lone Star tick, orAmblyoma Americanum.
(09:46):
It's mainly found in the EastCoast, but it's gone further
north.
It's also in the Midwest aswell, and as we have rising
temperatures, these ticks aretraveling further north.
These ticks in their salivathey carry a sugar molecule
called Galactose Alpha 1,3Galactose, also known as Alpha
Gal and when they bite you,Sounds like an anime.
(10:09):
It does actually Power up, powerup.
Or you know, like we have BetaBros and Alpha Gal right.
Speaker 2 (10:14):
Oh, I get that comment all the time.
Look at the Stammy we got tostart making animes.
Speaker 3 (10:20):
So in the saliva of these ticks when they bite you
they introduce the sugarmolecule Alpha Gal into your
bloodstream.
Humans and certain primates donot have Alpha Gal, but pretty
much every other mammal has thesugar molecule.
So our immune system sees it asforeign and creates these
allergy antibodies called IgEthat are specific and combined
to Alpha Gal.
(10:40):
And what's weird about thistype of syndrome is it's not
like a traditional food allergywhere I eat the food and even
the smallest amounts.
You get these kind ofreproducible reactions of hives,
swelling, problems, breathing,vomiting, combination of that,
or drop in blood pressure, whichcan be life-threatening.
This is inconsistent and it canbe delayed up to four to six
(11:03):
hours.
So prior to noting this existed, there were many patients who
would come in and say you know,I'd wake up at two, three in the
morning and I'd be covered inhives and I have no idea why
that's happening.
Or I'd wake up at two, three inthe morning and I couldn't
breathe.
I was wheezing, my chest wastight, my face is swollen.
They'd end up in the ER gettingpumped with steroids and
(11:25):
epinephrine and it would becalled idiopathic anaphylaxis
Idiopathic meaning, we justdon't know the underlying issue
Until a bunch of researchers outon the East Coast I believe it
was at University of Virginiawere able to connect the dots,
because they were seeing a lotof these patients in that area,
where the Lone Star tick wasprevalent, there was also a
colorectal cancer drug calledSintoximab that was causing
(11:49):
similar reactions, and theyfound out that that sugar
molecule was part of thatmedication, and so they were
able to characterize this fairlyrecently, like over the last 10
, 20 years or so, to really putthings together, to come up with
this, and a lot of physiciansstill don't know about this.
The majority of doctors stilldon't understand this condition
(12:10):
or don't feel comfortable withit, so it's important for people
to recognize this, as we nowestimate a lot more people
probably have this.
Speaker 1 (12:19):
Is it permanent?
I know one doctor whodefinitely does not know
anything about this Dr Salad, drSalad.
Speaker 3 (12:27):
Oh, Is it permanent?
You were asking.
Speaker 2 (12:30):
Yeah, is it permanent so far?
Speaker 3 (12:32):
So we don't have a ton of data on whether it's
permanent or not, but we knowthat some people are able to
outgrow it.
So I've actually have done oralfood challenges for people, I
suspect, in the past, where I'dsay, you know, their allergy
antibody to alpha-gal has gonedown significantly.
What they would do is theywould eat a steak dinner or you
(12:52):
know a bunch of hamburgers inthe morning and come into the
clinic and sit there all day andjust sit there all day because
the reactions are delayed, andideally you have to do this
multiple times because it'sinconsistent.
So people can sometimes haveaxial ingestion and not have a
reaction, and other times theycan get really, really sick.
And it's not just food.
(13:13):
This is an issue where there'sa lot of you know, pills and
medications, gelatin right as anexample.
There's a whole list, waylarger than you'd think.
You essentially have to govegan.
If you have this issue, it'svery, very difficult to live
with.
Speaker 2 (13:29):
So there's no like real treatments for it now or
prevent anything.
It's just we're still figuringit out.
Speaker 3 (13:34):
The best thing you can do, don't get bit by a tick.
Speaker 1 (13:37):
Exactly, exactly, right.
Speaker 3 (13:38):
You do not want to get bit by ticks, because ticks
can resensitize you to theallergy potentially.
Speaker 2 (13:45):
Oh, that's fast.
I find this fascinating.
It sounds like something inlike a sci-fi novel series,
something like that, wherethere's just you get bit and you
can no longer eat these foods.
It sounds made up.
If you just told me, ifsomebody, if I saw it on TikTok
they're like oh, that's fake,Like there's no way that's real.
But I did actually see it awhile back and I was like that's
it's, it's fascinating, it'scrazy.
Speaker 3 (14:05):
Yeah, Last summer I made one of the longest posts
I've ever made about this andthe history of it and it really
does sound like you know, adocumentary, sci-fi, you know
type story and I even put likethe moonlight sonata music in
the background and made it kindof here because it's just, it is
wild how they were able to comeup with it.
But also a lot of people whohave this don't feel heard and
(14:29):
people think that they're crazysometimes and it's just, it's
far from the truth.
Speaker 2 (14:32):
Yeah, this is a serious problem.
It's really so frustrating forthe person because they're not
being heard and other people arelike there's just no way that
can be true.
That has to be like made up.
So, yeah, I mean yeah.
Speaker 3 (14:44):
There's, unfortunately, a lot of issues
in in the patients I treat withallergic conditions that can be
rare or becoming more recognized, where people are told ah,
that's in your head, like Iliterally yesterday saw a
patient who said don't call mecrazy, but I'm pretty sure my
child is allergic to the cold,and I said you're not crazy.
There is something called coldinduced urticaria.
(15:05):
You can get hives just from thetemperature, our immune system.
Speaker 2 (15:09):
This is why it's so frustrating when people make up
allergies.
That's why I have people likefake that, for whatever reasons
they have, because that's stupid.
Speaker 1 (15:17):
seed oil allergy card they print off the internet.
Speaker 3 (15:20):
Yeah, this is a big challenge because, yes, some
people want to use allergy asthe term for potentially a
lifestyle choice and that'scaused a lot of confusion and
anger that's now put towardspeople who actually having these
lived experiences that are sochallenging and potentially
debilitating.
People who live with foodallergies are at a significantly
(15:42):
higher risk of developinganxiety and depression and may
not be able to go out withfriends as much as they want to
because they have such anxietyor they're bullied for for
having these issues.
There was a high school studentin Texas who was on the varsity
football team who, essentially,other players were hazing him
(16:02):
they were putting like peanutsin his locker room and all sorts
of peanut products and hisstuff.
He got hives from it and thekids got kind of a slap on the
wrist.
But now the parents have beenspeaking out and kids being
bullied over this.
Even though he did nothingwrong, he was being picked on
and he's being picked on evenmore.
Speaker 2 (16:20):
For some Anything that makes you different it
sucks.
It's just like anything thatmakes you different from other
people.
They will they especially asteenagers they'll just latch
onto that.
And when it's something like anallergy, you know it can be
absolutely deadly.
And then not even just that,but all the psychological damage
that can be done to someone inthat situation.
Speaker 3 (16:38):
Absolutely.
The media portrays allergies aspeople being weak, as looking
like I mean, yes, I kind of havethe stereotypical look that
you'd see on TV of someone withallergies.
You know, I do fit some of thatpersona, so to speak.
I'll live it, I don't care,that's fine.
But anybody could have a severe, potentially life-threatening
allergy, and it affects millionsof people.
(16:59):
But doesn't mean you're weak,it just means that you have an
immune system that is actuallyhyperactive to an extent.
It has these reactions that arereally strong.
It just can cause theselife-threatening situations.
If you actually look at howyour body goes through these
disease states, it's terrible,it really is, and so people need
(17:20):
to be able to learn more aboutthis so that they can take it
more seriously and have moreempathy towards it.
Where I'm at in Illinois, weactually passed a law where high
school students at every publicschool have to learn how to use
an epi-pen and identifyanaphylaxis.
Speaker 1 (17:35):
Now, Wow, I want to say, like it may be in the US,
you look like the stereotypicalallergy person for Canadians,
you look like Mr Dress Up andthat is like a big compliment.
Thank you, my friend, thank you.
Speaker 2 (17:54):
I find it's interesting to me because people
are interested in allergies.
Many people are suffering fromhealth conditions and they want
to improve their health.
So that leads to them to thinkmaybe I do have an allergy, and
that leads them to buying anallergy test and they get this
thing and they take it and itturns out they're allergic to
(18:14):
just everything, everythingaround them.
I see people post their resultsand they're like I'm allergic
to 74 things, and usually it'sjust always the common stuff.
They're like I'm allergic tomilk, I'm allergic to this.
So could you just give us alittle bit on these allergy
tests and how?
What's the deal with them?
Speaker 3 (18:33):
Yeah, so I'm glad you're bringing this up because
there is a lot of just like inthe wellness industry.
This overlaps, where manycompanies try to profit off of
people who are trying to findanswers and it's not necessarily
the best test, especially whenthere's not clinical context.
So just a little bit ofbackground about medical testing
(18:55):
.
There are so many differenttests out there, but the
question is what is the pre-testprobability Meaning?
What's the likelihood that thisparticular person will get
their question answered byhaving a positive test or having
a negative test?
If the test has a low pre-testprobability, in that person's
situation, you probably don'twant to do that test, and this
(19:16):
happens in the allergy world allthe time.
So I could do either a bloodtest or a skin test, which are
both trying to measure thatallergy antibody that I was
talking about, called IgE orimmunoglobulin E.
That's the classic allergyantibody that causes those
potentially severelife-threatening situations.
And there are companies whowill sell you a panel that you
(19:36):
could look at 30 foods, 60 foods, 90 foods, whatever you want
you could.
You could make an elaborateassay to any of those foods.
The immune system can makethose antibodies and it can show
up on a test.
But are you actually going tobe reactive?
There's a difference betweensomething we call sensitization
meaning the antibody is present,and the allergy.
(19:58):
That's the clinical syndromewhere you have symptoms after
consuming it, and there's a hugedisconnect between the test
itself and the clinical syndrome.
So you need to have a goodstory before you get the test to
improve that pre-testprobability, the likelihood that
it's going to tell you yes, I'mallergic to it.
(20:19):
A panel of testing for mostpeople is not helpful.
So when a company goes and theysell that big test for allergy
again, I'm only talking aboutthis antibody, I'll get into
another test in a second.
That's related to what you guysdeal with all the time.
If you have that test that'ssent by a company without a
doctor interpreting it, then youget a lot of garbage
(20:42):
information and you may end upfalse positives.
Exactly False positives, whereyou're unnecessarily avoiding
food.
That can lead to nutritionalproblems, food aversion,
especially if this is onchildren.
It's a lot of problems when youover test people with that one.
There's another test that Ithink you're going to ask about,
called food sensitivity testing.
(21:03):
Yes, yes, that's kind of theoverlap, so I talked about IgE
antibody.
The other one is called foodsensitivity testing, which is
measuring a different antibodycalled IgG.
So when we eat food, how doesour immune system know that it's
not a germ?
Speaker 2 (21:23):
Because we have some antibodies for antigens.
I'm assuming there's antigens,our antibodies, attached to the
antigens.
Hey, this is bad.
Speaker 1 (21:32):
I'm pretty sure the answer to everything on this
podcast is magic Black magic,black magic, fairy dust.
Speaker 3 (21:39):
So, besides the black magic and fairy dust, one of
the ways it may tolerate food isthrough what we call a
tolerance antibody, which iscalled IgG4.
Immunoglobulin G has foursubclasses and IgG4 is one that
may help induce a state oftolerance.
So it's like hey guys, rest ofthe immune system, don't worry
about this, this guy can movealong and get digested.
(22:00):
That's one way, potentially.
Another way is you're eatingthe food and you have all these
digestive enzymes that break itdown enough so that the
molecules aren't big enough forthe immune system to see.
It kind of just slides past.
Interesting For some people,and that's a big reason why
sometimes you can have apositive allergy test and not
necessarily get allergicreactions because you're
(22:22):
digesting it before the immunesystem sees it.
That's potentially.
Speaker 2 (22:27):
There's always the common ones.
Why people the food allergytest and whatnot are always like
you're allergic, you haveproblems with these foods.
And it's always the commonfoods because those are just.
You know, maybe those are themost.
Speaker 3 (22:38):
It might be.
It might be so with this IgGtest, the companies will say,
well, if you have a positivetest to coffee on our food
sensitivity test, you shouldavoid it, and if you feel better
after two weeks and then youeat it again and it gets you
feeling sick, then it's, you'resensitive to coffee.
Well, the reality is and I seethis in my practice on a regular
(23:00):
basis people will come in witha sensitivity test for like 90
foods, over 100 foods, and it'llsay things like coffee, tea,
vanilla, all these, all theseyou know obscure things.
And I'd say do you eat thesethings on a regular basis?
And almost every time they'llsay, yeah, I do.
And the issue is is that that'sthe stuff that they're commonly
(23:21):
eating?
So the immune system makes theantibody, that's all it's doing
to tolerate it?
Okay, there's.
There's no validated way to saythat IgG testing actually
improves people's symptoms orwhatever sensitivity means.
That term sensitivity isloosely defined.
We don't have an underlyingmechanism of looking at the
biochemical pathways in our bodyto say I eat this food.
(23:44):
It generates this process tocause these symptoms, unlike
with food allergy.
I know your B cells produce IgGantibody.
There's.
They sensitize mass cells.
They sit on the mass cellsurface.
Food comes in and cross linkswith those antibodies, releases
chemicals in the mass cellcalled degranulation, like
histamine, different cytokines,and those cause the symptoms
(24:08):
I've described high swellingproblems, breathing, vomiting,
all that stuff.
So we can describe that and wehave the test to describe that.
Igg testing or any foodsensitivity tests where we pluck
a hair out of your out of yourhead and measure that.
These sensitivity analysesthere's.
There's no scientific proofthat those actually really help
people.
Speaker 2 (24:25):
So you wouldn't recommend anyone get a food
space basically anyone.
You would say, just skip thefood sensitivity test.
I agree, yes.
Speaker 3 (24:33):
Absolutely.
There's really no reason to doit, and I'm not the only one
saying this.
This is endorsed by all themajor allergy societies American
College of Allergy AsthmaImmunology, as well as the
American Academy of AllergyAsthma Immunology.
These are unproven tests.
Speaker 1 (24:47):
I just think that goes pretty much everybody who
doesn't sell one.
Speaker 2 (24:52):
Right, but that shows you the power of marketing,
because I see these things likequite a bit I hear people
talking about them andeverything like that, and I
think that really shows you thepower of marketing.
And again it goes back to thiswe, a lot of us, are dealing
with an issue and just be ableto say, oh, it's this food
you're eating.
Oh, that makes sense, because Ialways eat it, you know, and I
and they play on that and that'sreally unfortunate.
Speaker 3 (25:13):
Right, right.
My feeling on this is that youknow you're spending all this
money to give you things thatdon't necessarily help and it
may appear to help some people,but that's anecdotal evidence.
That's the strongest force inmarketing on the internet.
Speaker 2 (25:28):
Yes, when people say Say that again, say that again,
but louder.
Hey, I'm a parent.
Speaker 3 (25:33):
You know when somebody comes on and says I'm a
parent, I'm busy and I don'tfeel well, but I did this one
thing that changed my life, ohgosh, that's not the basis of
scientific evidence, folks,unfortunately so powerful, Like
you said.
Speaker 2 (25:46):
It's so powerful, Like it's more powerful than any
meta analysis.
I could cite like five of those.
But a mother comes on and sayswe were struggling so hard and
we had, we were at our wits endand we did this one thing.
And look at them now and youjust see this before and after
picture.
It's more powerful thananything, Like you tug on those
(26:07):
heartstrings.
Speaker 3 (26:09):
One of the ones that I'm trying to really confront
right now, because we'reshifting our guidelines from
this from an evidence basedstandpoint is eliminating food
to treat eczema, which has beena very common practice to do.
And so I see this where parentswill go on and say my child is
eczema and we've been struggling.
But you know, I got rid ofdairy and in 24 hours their
eczema was completely clear, itwas fixed.
(26:31):
Is what?
I hear from time to time, andthere's a lot of nuance that's
lost in that that we're learningmore about Eliminating foods at
an early age unnecessarilycould potentially increase the
risk of developing a potentiallypermanent food allergy.
That could happen and noticehow I'm trying to be very
careful with my language becausethere's no absolutes it may.
Speaker 2 (26:54):
Only the sex deals in absolutes.
Speaker 1 (26:55):
It's almost like it's not black and white.
Speaker 2 (26:58):
Joy, the dog side, yes, and you can then say this
causes eczema.
Speaker 3 (27:05):
Right.
But we found that in variousstudies when you eliminate foods
to treat eczema, it doesn'tsignificantly improve it for a
population, a large populationof kids, as an example, and the
flip side is that there'spotentially negative
consequences.
So trying to focus on otherways to treat that skin
(27:26):
condition, I think, is moreimportant.
You could do a skin test andfind that, yeah, they've got
antibodies to these foods andmaybe it might help their eczema
Mildly.
I don't know.
But I'd rather not take thatrisk and create a problem that
didn't exist before.
That's more likely to bepermanent and potentially
life-threatening.
I'm not downplaying eczema.
(27:47):
It's a terrible condition.
I grew up with eczema myself.
I didn't wear jeans for myentire childhood because it
scratched my skin so badly I'ditch all day wearing those types
of fabrics and I'd be itchingall the time.
It was hard to focus.
So I can empathize with peopleliving with eczema.
Fortunately, I mostly outgrewit when I became an adult, but I
remember that feeling and so Iempathize with that.
(28:10):
But knowing what I know now, Iwouldn't.
For most people I'm not sayingeverybody, but for most I
wouldn't go straight to avoidingfood unless I was doing X, Y
and Z things.
Speaker 2 (28:21):
And I tell people that because I get asked what
about acne?
A lot People ask me like,what's the deal with acne and
food?
And I'm not an expert on it.
I'm from the experts that I seeand talk to.
There may be a connectionbetween acne and things like a
high sugar diet.
Or they say maybe whey protein.
I hear that but we're not sure.
(28:42):
It's not likely.
Yeah, so, are you going to cutall that out of your diet, for
maybe it possibly to help?
Speaker 1 (28:50):
On the topic of acne quickly.
Before you even cut food out ofyour diet, change your bedding
more often.
That is one of the biggestcauses of acne.
Speaker 3 (29:02):
Lifestyle changes in other ways besides.
Diet can be helpful in terms ofhaving things that are a little
bit more clean have a skincareroutine.
There are so many other things.
We have medications that we canuse for acne.
It's the same thing with eczema.
There are so many differentthings.
We can do the skincare now andthere just has to be a lot more
education and teaching andthat's one of the big drivers
(29:24):
for me going on social media totry to give general educational
tips for people, to understandand debunk people who go out and
say I have a food allergy andI'm going to eat the food and
we're going to see what happens.
It's like no, don't do that.
Speaker 2 (29:39):
Don't.
Speaker 1 (29:39):
Yeah, no.
Speaker 2 (29:40):
Especially with EpiPens being $800,000 or
whatever they are.
Speaker 3 (29:44):
It's crazy.
Now, it's been terrible.
What are the?
Speaker 2 (29:46):
$600 now.
Speaker 3 (29:47):
So they can, depending on the person, be as
much as $600 to $700.
Most of the time with mypatients it's like $200 to $300.
You can get generics for as lowas $150.
But that's still ridiculous.
But then I have also somepatients who are like, yeah, my
insurance is great.
I only pay like $5 or it's free.
That's lucky.
(30:07):
I wish I had there at healthinsurance, because most
insurance companies don't coverall of those costs for something
like that even though it's alife saving medication.
So the expiration date isusually about a year, but they
typically can last longer thanthat, especially if you're able
to keep it in the righttemperature conditions.
If you live in your car, you'regoing to ruin it faster than
you think.
But if you're holding onto itand you look at it and, like I,
(30:31):
have a trainer with me on mydesk, I always have that to show
people.
But the real device would havean indicator.
We can see the medication, youcan look up to the light and if
it's clear, not cloudy, notyellow, it probably will be
helpful.
We just don't know how helpfulit is.
It's better to use that thannothing.
But if it's yellow or cloudyyou can't use it.
(30:52):
But soon we will have devicesthat will be needle free.
Within the next 12 months thereshould be a nasal spray
containing epinectrum coming out.
Speaker 2 (31:00):
I saw your video on the nasal spray.
That's fascinating.
That's so cool.
Speaker 3 (31:03):
Yeah, it should have come out already, but the FDA
asked for an additional doserepeating study and I'm not too
happy about that.
They should have just approvedit and let the physicians, like
myself, just counsel patientsvery carefully on what's going
on within what we know, what wedon't know, Because in order to
really know how these medicineswork like EpiPen, same thing
there is no randomizedplacebo-controlled trial to
(31:24):
approve EpiPens.
It's not ethical to run thosetrials Because that would be
saying hey, I want you to eatpeanut butter and go into
anaphylaxis and you may or maynot get the real device, so you
might die doing this.
That's OK.
Speaker 2 (31:41):
That would be tough to give people the sign up.
No, no, it's unethical.
Speaker 3 (31:44):
So they do something called pharmacokinetic,
pharmacodynamic studies or PKPDstudies, to look at secondary
measures like blood pressure,heart rate, for example, and
time that from when you get themedication.
So we see the physiologicalchanges outside of anaphylactic
conditions.
You see what I'm saying.
Speaker 1 (32:02):
I'm just glad that stuff like that is a lot cheaper
in Canada.
Speaker 3 (32:08):
Yeah, a lot of times I hear from people outside of
the US who are like, yeah, I getthis for free or it's like it's
$10.
Speaker 2 (32:14):
No, here in America we jump out of ambulances
because we know we're going toget charged $4,000 just for a
ride to the hospital.
Yeah, I was talking to somebodyabout that and I was like what
I've had friends jump out ofambulances like, no, I'm not
going to go, you won't take, Iwon't pay $4,000 for a ride.
Speaker 3 (32:32):
It's crazy how much the cost of health care could be
.
One of the representatives fromFlorida introduced a bill to
try to cap EpiPens and otherrelated devices at $60 a TwinPak
.
That would be federally Rightnow.
There's a few states, like inIllinois here, where they're
capping it at $60, which isfairly reasonable because the
device itself does take costs.
(32:53):
I think about $20, $30 to make.
Speaker 2 (32:56):
So that's a fairly reasonable price for a
life-saving medication, but $600.
Like $600 is crazy, it'sgouging.
Speaker 1 (33:02):
It's totally gouging, that is yeah.
Speaker 3 (33:04):
So I'm hoping that gets passed.
It's called the EpiPen Act, andso anybody who's in the United
States listening to this rightto your local Congress people in
support of what's calledliterally the EpiPen Act.
I don't remember the exactacronym, but I think it's
important for people to be awarethat we're trying to help.
It's not just for people livingwith food allergies.
(33:25):
You can have anaphylaxis,severe life-threatening
situations to medications, tobee stings, latex, all sorts of
things.
So this affects millions ofpeople.
Speaker 1 (33:36):
It'd be great for them to be more affordable, just
so people who maybe not haveallergies can even carry one
around, just in case ofemergency.
Speaker 2 (33:45):
Absolutely, it is.
Yeah, that's very interesting.
Oh, so before, yeah, before we,I want to make sure I get to
something, because I rememberwatching a video you did that I
want to ask you about aboutBenadryl, because I you talked
about how there's possibly aconnection between Benadryl and
like dementia.
If you take it, you know,consistently this isn't like
(34:07):
once in a while thing, but youtake it consistently.
I was fascinated by that.
I was kind of like looking itup, I was like wow, there's
actually like a decent amount ofresearch and the fact that this
isn't more well known is verysurprising, because you, uh,
talk about that a little bit.
Speaker 3 (34:18):
Yeah, so a lot of times people call me the
Benadryl bogeyman because of theamount of posts.
I talked about it at one point.
Speaker 2 (34:25):
I don't blame you, though, for you know.
Speaker 3 (34:27):
Yeah, so.
So I remember a while ago therewere several allerges who had
written an editorial.
It was, but I think it wasentitled like Diffin hydramine
time to move on, or somethinglike that.
Okay, and so Diffin hydramineis the generic name for branded
Benadryl.
Benadryl is one of the oldestantihistamines.
It's been around, I think,since around the 40s.
It's part of the class of firstgeneration antihistamines.
(34:50):
There's other similar ones,like chlorfeniramine,
hydroxazine as examples.
These are medications that, yes, they block the chemical
histamine from attaching to itsreceptor, but they also have
properties calledanti-cholinergic properties.
They block something calledacetylcholine, which is a
neurotransmitter.
That that is, you know, foundall over the place.
(35:13):
And so Benadryl, when you takeit, especially at higher doses,
can have all sorts of sideeffects, such as you dry out,
you can have constipation,urinary retention, it can
actually cause sexualdysfunction, heart palpitations,
seizures, coma and, yes, death.
People have died from takingBenadryl overdose.
(35:33):
There was, unfortunately, ateenager who passed away trying
to do a benadryl challenge.
That there's been a socialmedia challenge.
Speaker 2 (35:41):
Where people try to take it.
Speaker 3 (35:43):
And people and the FDA actually put out a warning
for that.
Okay, so what you're talkingabout is there are some
longitudinal data of similarmedications, anticholinergic in
nature, where they looked atseveral adults who would take
these anticholinergicmedications like benadryl For
long periods of time and thensay, okay, who developed
(36:04):
dementia later in life, right,and there were significantly
higher numbers of peopleDeveloping dementia who had
taken these anticholinergicmedications.
So we call that an association.
Can we say?
Speaker 2 (36:15):
there's a direct mechanism of action like a.
Do we have any any ideas on howit could?
Speaker 3 (36:20):
probably has to do with the Anticholinergic
property and how it alters brainchemistry?
Most likely, but we don't fullyunderstand this right.
This is an association, sowhenever you see on the news
someone saying, oh, this islinked to it, I don't like that
word because that makes it soundlike it's causing it.
This is an association where wesee that some groups of people
have these conditions and theyalso happen to have taken this,
(36:42):
so I bring this up in a lot ofmy content because it's not like
we don't have a lot of saferalternatives nowadays.
Speaker 2 (36:50):
We have so many medications.
Speaker 3 (36:52):
The second generation antihistamines like zirtech or
satirazine, zizol,levosatirazine, claritin, which
is loratidine, allegra, which isfexofenidine, these newer
medications that have beenaround for a few decades now,
since basically the 90s andearly 2000s, that work basically
the same.
They are antihistamines.
(37:13):
They work just about as quickly, they're just about as
effective.
They last longer than benadrylusually, but they don't have
those anticholinergic propertiesand they don't you.
You don't die from overdoses onthem like you can with benadryl
.
Speaker 2 (37:26):
So those second generation, they don't cross the
blood brain barrier, correct Isthat's what I've.
Speaker 3 (37:30):
They're engineered to not cross the blood brain
barrier, but some people stillhave that issue.
So as an example for me, I I Ioffer zirtech to my patients all
the time, but for me, if I takeit, I'm tired for 12 hours,
really tired.
But if I take Allegra I'mtotally fine.
Everybody's brain chemistry isa little bit different and you
have to, you know, check thisout.
(37:51):
I have so many people asking mewhat's the best allergy
medication and I can't answerthat because everybody is
different and I have to counselyou based on what are your
specific symptoms, what you'reallergic to, what is your
overall medical history.
So I have to think about allthose things before giving that
as a recommendation but as ageneral broad stroke.
Most people don't need to takebenadryl as their go-to, and if
(38:14):
you're taking it as a sleep aid,which a lot of people do, like
I was just about to starttalking about that.
Speaker 2 (38:18):
Yeah, because I work in sleep medicine and I people
tell me like I take it to helpme see them, like I really
wouldn't recommend that, likethere's other things you can do
it is not a good thing.
Speaker 3 (38:26):
It's like, basically, zik will is like drinking
alcohol in terms of how itaffects the brain.
You fall asleep more quickly,yes, but is your sleep quality
actually improved and do youwake up refreshed?
Not usually, and one of thereasons why is because benadryl,
just like alcohol, has similarproperties.
It increases what we call theREM latency.
It's the time when you fallasleep to getting the first
(38:49):
phase of your sleep cycle, whenyou first enter REM, rapid eye
Move in sleep when you dream,and you have to go through
several sleep cycles In order toget restful sleep.
And not everybody has to beexactly eight hours a day.
There's some.
There's some variation on it,but to get to the right number
of sleep cycles by taking thesemedications you're disrupting
that significant like again, Iwork in sleep medicine.
Speaker 2 (39:10):
Like I see people every night with the, with their
sleep and their brain waves.
Typically it's like you know,around 90 minutes after you fall
asleep is your typical firstREM cycle.
Each REM cycle is a little bitlonger than the next, um, but I
will tell you people who are ondifferent medications, they're
REM, it sucks.
Like I look at it and they'relike up and down and they get
maybe like 20 minutes of REMhere and like, uh, 15 minutes
(39:30):
there.
It's, it's awful.
So if you can reduce those andjust try and get a solid, you
know seven to eight hoursGenerally for most people is a
good window.
You're doing great.
I know we all struggle, but doyour best.
Speaker 3 (39:41):
Yeah, some tips for general sleep hygiene, and
people like you should say sleephygiene like it's I wish it.
Speaker 2 (39:46):
Yeah, whenever I say sleep hygiene, people like no,
it's just for your routine.
Exactly so you're recentlycalled that sleep hygiene.
Speaker 3 (39:52):
Yeah, waking up at the same time every day helps
start going to bed, waking upthe same time, right, right,
usually if you first start offsaying I'm gonna wake up at 8 am
Every day, then your your bodywill naturally eventually get
you to fall asleep at the sametime every day.
Um, we're all creatures ofsocial media and like to be on
our phones.
Really should not be on anyelectronic devices, for you know
(40:15):
, ideally at least an hourbefore bed.
Speaker 2 (40:18):
I will tell you what's kind of helped me,
because I'm I used to do that alot beyond my phone.
So now I find a podcast I likeand I play that on the side of
my bed and I just listen to itbefore bed and that kind of
helps me relax.
Try something like that.
Listening something is great.
Having something you do beforebed can be very helpful the same
night.
Whether it's taking a shower,reading a book, walking,
whatever it is, it just kind oflets sets your brain into that.
Speaker 1 (40:41):
I'm about to go to sleep mode and it can help the
biggest thing that helped me wasGetting rid of lights in the
room.
Speaker 3 (40:49):
Yeah, like even just a little.
Speaker 1 (40:50):
You know, You've got the the wall taps and they have
that surge protector light.
I'd put a little bit of tapeover them so they aren't
projecting light all over theplace.
Speaker 3 (41:01):
So you don't have like the neon lights like in
your background right now inyour bedroom.
Speaker 2 (41:05):
It's flashing all the time, man, I don't know why I
can't sleep.
I don't know what's going on.
Speaker 1 (41:09):
Right yeah, hey, google Office off.
Speaker 3 (41:14):
Da-da.
Speaker 2 (41:17):
Very nice, very nice.
Oh, that looks terrible.
Go back to the other way.
Speaker 1 (41:22):
Hey Google Office on we truly live in the future.
Speaker 3 (41:31):
Yeah, so it's just just to you know.
Make sure everybody's on thesame page.
Who's listening?
When you see light at nighttime, that's not good for your
circadian rhythms.
It really throws off your bodysleep cycle.
That's why we keep saying putyour phones down.
I like the idea of listening topodcasts because oftentimes you
know this is a veryentertaining podcast.
Speaker 2 (41:50):
Obviously, Don't listen to ours.
You'll be awake for hours.
Speaker 3 (41:55):
I know this is just riveting, riveting yes.
Speaker 2 (41:58):
Yeah, but other boring podcasts that I've been
told do exist.
Listen to those and you knowrelax.
Speaker 1 (42:06):
Like every other fitness podcast, they all suck
ours is the best.
Speaker 2 (42:10):
All the others suck.
Speaker 1 (42:13):
You can just put them on and at night we don't care.
Listen to ours in the gym,though.
Speaker 3 (42:17):
Guys, it's always fun hanging out with you.
Thanks for having me on always.
Speaker 1 (42:20):
Oh, I mean we had you tell everybody where to find
you last time you were here.
But just refresh everyone.
Speaker 3 (42:28):
Yeah, so I'm mainly on instagram and tiktok.
I've just recently started ayoutube page.
It's all Ruben r u b I nunderscore allergy.
Speaker 1 (42:38):
Well, there you go.
Make sure you go follow drRuben, my my personal favorite
thing.
Like I already knew this beforeyou posted about it, but my
personal favorite thing that youposted was about the Igy
regarding cats.
If you know that I'm a big catperson.
Speaker 2 (42:55):
Yes, yes, yeah, before.
Okay, so we were, we weretalking about this before the
podcast started, but I think weneed to talk about.
We need to talk about this now.
Yes, why don't you Rob?
Yeah, give us the little thingabout the eggs and the cats and
the yeah.
Speaker 3 (43:07):
So here's the, the cat eggs eggs thing.
Actually I think kind ofpropelled my my social media
accounts I think I'm going totalk about this last spring
because somebody had brought upthey.
They looked at the bag ofpurina pro plan live clear and
we're like wait, it says that ithas egg yolk in it.
So like if I just put like Eggonto my cat's kibble, would that
just be the same thing.
(43:29):
And I then went into thescience of it, which I'm going
to explain here for those whohaven't heard before.
So what we know about catallergies is that, though there
are several proteins that catsmake that humans could be
allergic to, the one that 90 95percent of people are allergic
to is a protein found in theirsaliva, skin cells and urine,
(43:49):
called Fel D1 and in the allergynomenclature, which is actually
an international classificationsystem.
So any doctor, scientist willrecognize this and say oh yeah,
I know what Fel D1 is.
That's that's a shorthand forthe latin word for for
domesticated, cat felisdomesticus, and the number is
just the order of which we'veidentified it.
(44:09):
So Feldi1 is the protein thatcauses most people all of these
different symptoms, even peoplewho come into a house and they
start wheezing, which used to beme.
I used to wheeze whenever I goto my brother's house and he has
two cats and it would make mereally sick.
So cat allergies can reallymake people really sick.
But besides, the point whatscientists have discovered is
(44:30):
that chickens, when they'reexposed to cats, they make a
specific neutralizing antibodycalled IgY.
Humans don't have that antibody, but chickens make that
antibody in the presence of catsand, just like with humans and
IgG antibodies, when someone ispregnant they pass IgG
(44:50):
antibodies to the placenta.
Chickens will pass IgYantibodies to the egg yolk and
so when the egg yolk is thensprinkled onto the cat food,
cats will then eat that and thatneutralizing antibody will coat
the saliva and latch on to theFeldi1 proteins, making them
(45:11):
functionally inert, so that whenyour immune system comes into
contact with those proteins, itdoesn't recognize it as anything
.
It's just like whatever.
So with this food that theymake, or the DIY approach where
you take literally sprinkle theegg yolk onto the food from
chickens exposed to cats, Aftera month, that has to be a
(45:34):
chicken that has been exposed tocats.
Right.
If it's just a chicken that'snever been exposed to cats for
at least a few months, it's notgoing to work, Right?
You're just eating eggs Afterabout a month of daily use.
Where these cats eat this food,the Feldi1 protein is reduced
by almost 50%.
So for many people this newfood that's by Purina, or those
(45:59):
who've tried the DIY approachthey've actually seen
significant improvements intheir allergy symptoms.
Speaker 1 (46:04):
Then you combine that with stuff like air purifiers
and constant cleaning, makingsure you're vacuuming up after
you're your cat.
This gives everybody who has acat allergy.
You no longer have an excuse goget a cat.
Cats are awesome.
Speaker 2 (46:19):
All I'm saying.
You know there is that option,but there's also the better
option of being dogs for life.
Speaker 1 (46:24):
Listen, I don't understand.
It's a controversial topic.
Speaker 2 (46:27):
I've got four dogs.
I'm sticking up for them.
Man's best friend Cats aren'tcalled man's best friend Dogs
are called man's best friend.
Speaker 3 (46:35):
Okay.
Speaker 2 (46:35):
First domesticated like animal ever wolves, dogs.
I rest my case.
Speaker 3 (46:41):
I love animals in general, but if you, if you ask
me, which one I like better, Iam a dog lover First.
Speaker 2 (46:47):
Oh, no, oh, about the dogs.
You got all the different typesof dogs.
You got a little big dog.
Speaker 3 (46:51):
I will say the best, though, is when cats act like
dogs, then you've got the bestanimal.
But that's what I'm saying islike what?
Speaker 2 (46:58):
when you love a cat you say, acts like a dog, it's
so good Like exactly.
Speaker 1 (47:01):
So you're saying dogs are the best, you're like, you
want to get the best.
A lot of people don't realizethat you can train cats To some
cats to a certain extent, butthey are real.
Speaker 2 (47:14):
They can be assholes.
Speaker 1 (47:15):
Listen, there's a lot of tips and tricks to it and I
could like I could literally doan entire episode on training.
Speaker 2 (47:21):
We're going to do a whole episode on.
Speaker 1 (47:26):
But the big thing is that cats do not respond to
negative reinforcement like dogsdo.
You have to use positivereinforcement, which is to say
that shouting at a cat no, doesnot work.
But I try cats to like walk onleashes with me.
(47:47):
I take my cats camping.
I take my cats canoeing I takemy cats.
My last one was kayaking withme.
Speaker 2 (47:55):
Yeah, I mean that's really cool, but I'm sick, I'm
just, I'm a dog, I love dogsPlus cats catch mice when you
live out in the rural areas.
So if you're going to live inCanada in the middle of nowhere
like Rob, get a cat.
Speaker 3 (48:12):
Exactly.
You won't have any diet sodaoptions, but you'll have a cat
that can catch all the mice andlots of good snow to eat too,
right.
Speaker 1 (48:23):
Good old yellow snow.
The great.
The best part, though, is youknow you?
Actually it's an actual thing.
You get maple syrup, you pourit into the snow, you get this
maple syrupy snowball and youeat it, as long as it's not
(48:43):
yellow.
Speaker 3 (48:45):
That's what my followers were telling me.
Like.
All my Canadian followers arelike, yeah, it's great, and I
was trying to give like the mostdiplomatic approach in one of
my recent posts and everybodywas mad Like nobody was happy
with it.
Speaker 2 (48:54):
I saw you post about the snow, about like eating snow
and everyone's like so upset inthe comments.
Seriously, seriously, I wastrying to get.
Speaker 3 (49:01):
I was trying to be respectful of this person, not
be a jerk, because some peoplelike that's you know it's part
of their memories and it's likethat's not the worst thing if
you do it like responsibly, andyou know, try it once or
whatever.
Speaker 2 (49:14):
You know, like, and I see it like this stuff of like
people like will like play withtheir kids and stuff and any
sort of playing with their kids.
They're like don't do that,because the kid's going to break
, he's fragile, he's got that,and they're just like everybody.
We all need to relax a littlebit.
We need to eat a little snow,we need to play with our
children.
It's going to be okay,obviously, like you know, it's
within reason.
But, come on, yeah, you gottaform these memories and have
(49:34):
some fun, right.
Speaker 1 (49:35):
Yeah, have them in moderation.
Good night everybody.
Speaker 2 (49:40):
In moderation.
Like I've heard, there's abouta good podcast you should not
listen to before bed.
Welcome to In Moderation, the show where we
give you a moderate dose of infosarcasm, and we already know
we're not approved.
Hey everybody, welcome to thepodcast in moderation episode.
Rob, help me out here a littlebit.
Speaker 1 (00:25):
I'm done helping you.
You're on your own.
I quit.
I know I'm not approved 16.
Speaker 2 (00:30):
That's probably not right but we're going.
Speaker 1 (00:31):
That's not right.
Speaker 2 (00:32):
Today, it doesn't matter, we're still moving along
.
We have our resident TikTokallergist, dr Rubin, on today.
Dr Rubin, how you doing.
Speaker 3 (00:41):
I'm doing great Thanks for having me on again.
This is a lot of fun.
Speaker 1 (00:45):
Well, this time you're actually a guest, last
time you were the host.
Speaker 3 (00:48):
I was the host.
Yes, because you two were injail because you impersonated.
Bobby at Costco.
Speaker 1 (00:55):
I just wanted to point out that our email got one
of those spams from peopletrying to book onto the podcast
for money.
The header was Dear Dr Rubin,Rob and Liam, you are officially
one of the hosts of this show.
Speaker 3 (01:17):
Wow, holy cow folks, I'm really excited.
Speaker 2 (01:21):
Being a scammer has got to be great.
When people fall for it, you'vegot to be like really, but then
you just take their money andit's awesome.
That's going to be fantastic.
Speaker 1 (01:30):
By the time we're on episode 50, Liam's just going to
have gone over to the dark side.
Speaker 2 (01:35):
I don't know when we'll be on episode 50, so it
doesn't matter that could betomorrow.
Speaker 3 (01:39):
That point.
You may be selling supplements,folks.
Let's be real.
Speaker 2 (01:44):
Well, I mean, whatever it pays, come on,
listen, come here.
But yeah, we figure we'd haveDr Rubin back on to talk about
maybe some more serious things.
Dr Rubin, I've heard thatallergies are a thing, that some
people have them.
Am I correct in this?
Speaker 3 (02:02):
You are absolutely 100% correct.
Considering what y'all do interms of the nutrition field and
wellness, it really overlapsquite a bit because there are
unfortunately, millions ofpeople in the United States
living with the food allergy.
We're estimated now to be about32 to 33 million people, which
is roughly one in 10 to one in13.
(02:23):
That's like saying two kids ina classroom and an average
classroom size are going to havefood allergies right now.
Speaker 2 (02:29):
Does that mean like to a significant degree, or just
like any amount?
I mean, I'm just kind ofcurious.
Speaker 3 (02:34):
Correct.
When we're talking about foodallergy, we're all going to say
on the same page here.
This is potentiallylife-threatening situation where
even the smallest amount forsome people could develop a
severe allergic reaction, alsoknown as anaphylaxis.
That's what I'm saying.
That is a severe problem.
When we were kids, most of usdidn't know anybody that had
(02:55):
food allergies.
The rates have tripled in thelast 30 years.
Speaker 2 (03:01):
And there's some theories as to why.
Could you maybe give us like acouple as to like why we were
thinking maybe food allergiesare going up?
Speaker 3 (03:08):
Sure.
So there's multiple potentialreasons why this may be the case
, so it's never one thing.
So if you ever look at acomment section when people are
asking about this, they'll sayoh, it's the water.
It's the chemtrails or the seedoils.
It's always that.
Or vaccines no, it's not onething.
I'll give a few examples.
So the American Academy ofPediatrics for a long time had
(03:30):
made a recommendation for babiesto have peanuts.
Delayed introduction to like twoto three years of age and we
found that over the last 10years there have been some
really good studies comparingkids who were randomized to
either getting peanut proteinwithin the first six months of
life to those who were delayedto five years of age.
And there's my years.
(03:52):
Yes, and there's an absoluterisk reduction in the
development of peanut allergy byabout 80% when you do early
introduction.
Wow, so 80% I would not havegotten Right so so those
guidelines have changed About 10years ago or so.
So we'll get more data in thenext five to 10 years about
(04:12):
where we are at with thoseguideline changes.
But it seems to be that many ofthese highly allergenic foods,
such as peanut, it's better tointroduce it during the first
year of life, not delay it.
So the immune system we'restill learning a lot about it.
It's rather malleable early onin life.
So if we can challenge theimmune system early on to these
foods, probably less likely todevelop food allergies.
(04:35):
But we haven't eliminated foodallergies just from that yet,
which again shows you why it'snot just one issue that we're
talking about.
Another issue potentially issome of the early exposures to
antibiotics and acid suppressor.
So if a baby has reflux, weoften will give them a
medication like an antacid toreduce the reflux that the baby
(04:57):
has, and there have been somestudies showing an association
between these medications andpotentially developing food
allergies.
It doesn't mean that there's alink.
It's not necessarily causative,it's a possibility.
But again we have to thinkabout everything involved with
what we're trying to do here.
Early antibiotic use can becrucial if there's any concern
(05:19):
for sepsis in a newborn.
So we're not going to say,because of food allergies, we're
going to stop givingantibiotics to babies when they
need it, but we want to havejudicious use to make sure that
we're not overusing it.
But it can still have itspurpose.
Antibiotic usage couldpotentially change the gut
microbiome, the bacterial milieuand how our immune system
(05:41):
processes the food early on inlife.
So that's another potentialexample.
Another issue is the fact thatwe're seeing more and more kids
developing eczema.
It's this dry, itchy skincondition that has a lot of
redness, a lot of irritationoften is seen on the cheeks, and
we see a strong associationbetween those who have eczema
(06:02):
and developing food allergylater in life, probably due to
the fact that those who livewith eczema have a skewing of
their immune response tosomething called TH2
inflammation, which can generatea lot of allergy antibodies.
So oftentimes we could developlater in life.
I do think a small portion ofit, though, is when parents
(06:23):
bring their kids in to getpotentially allergy tested.
They're given a whole panel oftests by a physician with all
the different foods, and it'llshow up that they're allergic to
10 different foods and they mayunnecessarily avoid some of
these foods.
So we have to be careful aboutfood allergy testing because you
could all have to have a littlebit.
Speaker 2 (06:41):
Oh, I would love to talk about that a little bit.
Yeah, we'll talk a bit more toit.
Yeah, the food allergy tests Iknow they're not, let's just say
, super accurate, but I don'tknow to the extent, just kind of
how bad it is I mean frankly?
I did want to quickly.
Yeah, sorry, I just wanted toquickly go back to the
introducing it when they'reyounger.
So I've heard it's around sixmonths you should try and
introduce.
Is that correct, right?
(07:02):
So?
Speaker 3 (07:02):
between four to six months.
It depends on how well thechild is doing developmentally,
if they're able to sit up, ifthey're not tonguing out too
much because they have to beable to swallow solid foods.
That's something that you talkwith your pediatrician about and
have them assess themdevelopmentally and have that
conversation with them about isit appropriate to even introduce
it at four months old?
Speaker 2 (07:23):
I'm going to definitely talk about that with
my pediatrician, becauseOakley's about four months now
and I refuse to her for her tobe allergic to peanuts.
Speaker 1 (07:30):
There's too many peanuts.
I could put peanuts.
He ended up being one of theallergic to peanuts when they
dried up.
Speaker 2 (07:36):
So I'm going to do everything I can.
So after I go, avoid that so alittle bit of peanuts around
four to six months I'm going totalk to.
Speaker 1 (07:42):
But yeah, here's the real trick Liam Raw milk.
Speaker 2 (07:48):
Okay, so do I give it to her now, or is that
something that we wait tilllater to give the raw?
Speaker 1 (07:55):
milk, you just bathe her in it.
How about now?
Oh, I bathe her in it, see,these are the questions.
Speaker 2 (08:00):
This is why I have you around.
I was just going to have herdrink it.
Speaker 1 (08:04):
Oh God, don't drink raw milk.
You bathe in it, Okay.
Speaker 2 (08:08):
Yeah, enema and bathing contracts, exactly.
Speaker 3 (08:13):
So, to get back to the introduction issues, if a
child has a history of eggallergy or they have what we
call moderate to severe eczema,you definitely need to be
talking with your doctor aboutwhether or not you can safely
introduce peanut, because thoseare the kids that are at highest
risk and those are what thecurrent evidence-based
guidelines talk about.
You may need to get sometesting for peanut allergy prior
(08:37):
to introduction in thosesituations.
So those are all things thatyour pediatrician should be
well-versed in start talkingabout because, yes, peanut is
one of the prime examples,because it's one of the most
common food allergens.
In the country, about 2% ofpeople allergic to peanuts.
Now.
Speaker 2 (08:54):
Could you run us through the top food out?
So I know peanuts, I know soyis up there Like wheat, wheat,
cow's milk, tree nuts, fish,shellfish.
Speaker 3 (09:07):
We also have sesame, wasn't sesame just added?
Speaker 2 (09:11):
It was added as the ninth most common allergen Okay.
Yeah.
Speaker 3 (09:15):
And now this is crazy .
So what might be number 10, theCDC recently reported last
summer, is red meat Really.
Speaker 2 (09:23):
Is it because of those ticks?
Yes, is it because of thoseticks.
Speaker 3 (09:26):
Yes, so it's something called Alpha Gal
Syndrome, which I hope that youraudience will start to get
interested and know more about,because this is affecting a lot
more people than we realize.
So there may be close to half amillion people in the United
States living with Alpha GalSyndrome.
What we believe is happening isthat there's a particular tick
called the Lone Star tick, orAmblyoma Americanum.
(09:46):
It's mainly found in the EastCoast, but it's gone further
north.
It's also in the Midwest aswell, and as we have rising
temperatures, these ticks aretraveling further north.
These ticks in their salivathey carry a sugar molecule
called Galactose Alpha 1,3Galactose, also known as Alpha
Gal and when they bite you,Sounds like an anime.
(10:09):
It does actually Power up, powerup.
Or you know, like we have BetaBros and Alpha Gal right.
Speaker 2 (10:14):
Oh, I get that comment all the time.
Look at the Stammy we got tostart making animes.
Speaker 3 (10:20):
So in the saliva of these ticks when they bite you
they introduce the sugarmolecule Alpha Gal into your
bloodstream.
Humans and certain primates donot have Alpha Gal, but pretty
much every other mammal has thesugar molecule.
So our immune system sees it asforeign and creates these
allergy antibodies called IgEthat are specific and combined
to Alpha Gal.
(10:40):
And what's weird about thistype of syndrome is it's not
like a traditional food allergywhere I eat the food and even
the smallest amounts.
You get these kind ofreproducible reactions of hives,
swelling, problems, breathing,vomiting, combination of that,
or drop in blood pressure, whichcan be life-threatening.
This is inconsistent and it canbe delayed up to four to six
(11:03):
hours.
So prior to noting this existed, there were many patients who
would come in and say you know,I'd wake up at two, three in the
morning and I'd be covered inhives and I have no idea why
that's happening.
Or I'd wake up at two, three inthe morning and I couldn't
breathe.
I was wheezing, my chest wastight, my face is swollen.
They'd end up in the ER gettingpumped with steroids and
(11:25):
epinephrine and it would becalled idiopathic anaphylaxis
Idiopathic meaning, we justdon't know the underlying issue
Until a bunch of researchers outon the East Coast I believe it
was at University of Virginiawere able to connect the dots,
because they were seeing a lotof these patients in that area,
where the Lone Star tick wasprevalent, there was also a
colorectal cancer drug calledSintoximab that was causing
(11:49):
similar reactions, and theyfound out that that sugar
molecule was part of thatmedication, and so they were
able to characterize this fairlyrecently, like over the last 10
, 20 years or so, to really putthings together, to come up with
this, and a lot of physiciansstill don't know about this.
The majority of doctors stilldon't understand this condition
(12:10):
or don't feel comfortable withit, so it's important for people
to recognize this, as we nowestimate a lot more people
probably have this.
Speaker 1 (12:19):
Is it permanent?
I know one doctor whodefinitely does not know
anything about this Dr Salad, drSalad.
Speaker 3 (12:27):
Oh, Is it permanent?
You were asking.
Speaker 2 (12:30):
Yeah, is it permanent so far?
Speaker 3 (12:32):
So we don't have a ton of data on whether it's
permanent or not, but we knowthat some people are able to
outgrow it.
So I've actually have done oralfood challenges for people, I
suspect, in the past, where I'dsay, you know, their allergy
antibody to alpha-gal has gonedown significantly.
What they would do is theywould eat a steak dinner or you
(12:52):
know a bunch of hamburgers inthe morning and come into the
clinic and sit there all day andjust sit there all day because
the reactions are delayed, andideally you have to do this
multiple times because it'sinconsistent.
So people can sometimes haveaxial ingestion and not have a
reaction, and other times theycan get really, really sick.
And it's not just food.
(13:13):
This is an issue where there'sa lot of you know, pills and
medications, gelatin right as anexample.
There's a whole list, waylarger than you'd think.
You essentially have to govegan.
If you have this issue, it'svery, very difficult to live
with.
Speaker 2 (13:29):
So there's no like real treatments for it now or
prevent anything.
It's just we're still figuringit out.
Speaker 3 (13:34):
The best thing you can do, don't get bit by a tick.
Speaker 1 (13:37):
Exactly, exactly, right.
Speaker 3 (13:38):
You do not want to get bit by ticks, because ticks
can resensitize you to theallergy potentially.
Speaker 2 (13:45):
Oh, that's fast.
I find this fascinating.
It sounds like something inlike a sci-fi novel series,
something like that, wherethere's just you get bit and you
can no longer eat these foods.
It sounds made up.
If you just told me, ifsomebody, if I saw it on TikTok
they're like oh, that's fake,Like there's no way that's real.
But I did actually see it awhile back and I was like that's
it's, it's fascinating, it'scrazy.
Speaker 3 (14:05):
Yeah, Last summer I made one of the longest posts
I've ever made about this andthe history of it and it really
does sound like you know, adocumentary, sci-fi, you know
type story and I even put likethe moonlight sonata music in
the background and made it kindof here because it's just, it is
wild how they were able to comeup with it.
But also a lot of people whohave this don't feel heard and
(14:29):
people think that they're crazysometimes and it's just, it's
far from the truth.
Speaker 2 (14:32):
Yeah, this is a serious problem.
It's really so frustrating forthe person because they're not
being heard and other people arelike there's just no way that
can be true.
That has to be like made up.
So, yeah, I mean yeah.
Speaker 3 (14:44):
There's, unfortunately, a lot of issues
in in the patients I treat withallergic conditions that can be
rare or becoming more recognized, where people are told ah,
that's in your head, like Iliterally yesterday saw a
patient who said don't call mecrazy, but I'm pretty sure my
child is allergic to the cold,and I said you're not crazy.
There is something called coldinduced urticaria.
(15:05):
You can get hives just from thetemperature, our immune system.
Speaker 2 (15:09):
This is why it's so frustrating when people make up
allergies.
That's why I have people likefake that, for whatever reasons
they have, because that's stupid.
Speaker 1 (15:17):
seed oil allergy card they print off the internet.
Speaker 3 (15:20):
Yeah, this is a big challenge because, yes, some
people want to use allergy asthe term for potentially a
lifestyle choice and that'scaused a lot of confusion and
anger that's now put towardspeople who actually having these
lived experiences that are sochallenging and potentially
debilitating.
People who live with foodallergies are at a significantly
(15:42):
higher risk of developinganxiety and depression and may
not be able to go out withfriends as much as they want to
because they have such anxietyor they're bullied for for
having these issues.
There was a high school studentin Texas who was on the varsity
football team who, essentially,other players were hazing him
(16:02):
they were putting like peanutsin his locker room and all sorts
of peanut products and hisstuff.
He got hives from it and thekids got kind of a slap on the
wrist.
But now the parents have beenspeaking out and kids being
bullied over this.
Even though he did nothingwrong, he was being picked on
and he's being picked on evenmore.
Speaker 2 (16:20):
For some Anything that makes you different it
sucks.
It's just like anything thatmakes you different from other
people.
They will they especially asteenagers they'll just latch
onto that.
And when it's something like anallergy, you know it can be
absolutely deadly.
And then not even just that,but all the psychological damage
that can be done to someone inthat situation.
Speaker 3 (16:38):
Absolutely.
The media portrays allergies aspeople being weak, as looking
like I mean, yes, I kind of havethe stereotypical look that
you'd see on TV of someone withallergies.
You know, I do fit some of thatpersona, so to speak.
I'll live it, I don't care,that's fine.
But anybody could have a severe, potentially life-threatening
allergy, and it affects millionsof people.
(16:59):
But doesn't mean you're weak,it just means that you have an
immune system that is actuallyhyperactive to an extent.
It has these reactions that arereally strong.
It just can cause theselife-threatening situations.
If you actually look at howyour body goes through these
disease states, it's terrible,it really is, and so people need
(17:20):
to be able to learn more aboutthis so that they can take it
more seriously and have moreempathy towards it.
Where I'm at in Illinois, weactually passed a law where high
school students at every publicschool have to learn how to use
an epi-pen and identifyanaphylaxis.
Speaker 1 (17:35):
Now, Wow, I want to say, like it may be in the US,
you look like the stereotypicalallergy person for Canadians,
you look like Mr Dress Up andthat is like a big compliment.
Thank you, my friend, thank you.
Speaker 2 (17:54):
I find it's interesting to me because people
are interested in allergies.
Many people are suffering fromhealth conditions and they want
to improve their health.
So that leads to them to thinkmaybe I do have an allergy, and
that leads them to buying anallergy test and they get this
thing and they take it and itturns out they're allergic to
(18:14):
just everything, everythingaround them.
I see people post their resultsand they're like I'm allergic
to 74 things, and usually it'sjust always the common stuff.
They're like I'm allergic tomilk, I'm allergic to this.
So could you just give us alittle bit on these allergy
tests and how?
What's the deal with them?
Speaker 3 (18:33):
Yeah, so I'm glad you're bringing this up because
there is a lot of just like inthe wellness industry.
This overlaps, where manycompanies try to profit off of
people who are trying to findanswers and it's not necessarily
the best test, especially whenthere's not clinical context.
So just a little bit ofbackground about medical testing
(18:55):
.
There are so many differenttests out there, but the
question is what is the pre-testprobability Meaning?
What's the likelihood that thisparticular person will get
their question answered byhaving a positive test or having
a negative test?
If the test has a low pre-testprobability, in that person's
situation, you probably don'twant to do that test, and this
(19:16):
happens in the allergy world allthe time.
So I could do either a bloodtest or a skin test, which are
both trying to measure thatallergy antibody that I was
talking about, called IgE orimmunoglobulin E.
That's the classic allergyantibody that causes those
potentially severelife-threatening situations.
And there are companies whowill sell you a panel that you
(19:36):
could look at 30 foods, 60 foods, 90 foods, whatever you want
you could.
You could make an elaborateassay to any of those foods.
The immune system can makethose antibodies and it can show
up on a test.
But are you actually going tobe reactive?
There's a difference betweensomething we call sensitization
meaning the antibody is present,and the allergy.
(19:58):
That's the clinical syndromewhere you have symptoms after
consuming it, and there's a hugedisconnect between the test
itself and the clinical syndrome.
So you need to have a goodstory before you get the test to
improve that pre-testprobability, the likelihood that
it's going to tell you yes, I'mallergic to it.
(20:19):
A panel of testing for mostpeople is not helpful.
So when a company goes and theysell that big test for allergy
again, I'm only talking aboutthis antibody, I'll get into
another test in a second.
That's related to what you guysdeal with all the time.
If you have that test that'ssent by a company without a
doctor interpreting it, then youget a lot of garbage
(20:42):
information and you may end upfalse positives.
Exactly False positives, whereyou're unnecessarily avoiding
food.
That can lead to nutritionalproblems, food aversion,
especially if this is onchildren.
It's a lot of problems when youover test people with that one.
There's another test that Ithink you're going to ask about,
called food sensitivity testing.
(21:03):
Yes, yes, that's kind of theoverlap, so I talked about IgE
antibody.
The other one is called foodsensitivity testing, which is
measuring a different antibodycalled IgG.
So when we eat food, how doesour immune system know that it's
not a germ?
Speaker 2 (21:23):
Because we have some antibodies for antigens.
I'm assuming there's antigens,our antibodies, attached to the
antigens.
Hey, this is bad.
Speaker 1 (21:32):
I'm pretty sure the answer to everything on this
podcast is magic Black magic,black magic, fairy dust.
Speaker 3 (21:39):
So, besides the black magic and fairy dust, one of
the ways it may tolerate food isthrough what we call a
tolerance antibody, which iscalled IgG4.
Immunoglobulin G has foursubclasses and IgG4 is one that
may help induce a state oftolerance.
So it's like hey guys, rest ofthe immune system, don't worry
about this, this guy can movealong and get digested.
(22:00):
That's one way, potentially.
Another way is you're eatingthe food and you have all these
digestive enzymes that break itdown enough so that the
molecules aren't big enough forthe immune system to see.
It kind of just slides past.
Interesting For some people,and that's a big reason why
sometimes you can have apositive allergy test and not
necessarily get allergicreactions because you're
(22:22):
digesting it before the immunesystem sees it.
That's potentially.
Speaker 2 (22:27):
There's always the common ones.
Why people the food allergytest and whatnot are always like
you're allergic, you haveproblems with these foods.
And it's always the commonfoods because those are just.
You know, maybe those are themost.
Speaker 3 (22:38):
It might be.
It might be so with this IgGtest, the companies will say,
well, if you have a positivetest to coffee on our food
sensitivity test, you shouldavoid it, and if you feel better
after two weeks and then youeat it again and it gets you
feeling sick, then it's, you'resensitive to coffee.
Well, the reality is and I seethis in my practice on a regular
(23:00):
basis people will come in witha sensitivity test for like 90
foods, over 100 foods, and it'llsay things like coffee, tea,
vanilla, all these, all theseyou know obscure things.
And I'd say do you eat thesethings on a regular basis?
And almost every time they'llsay, yeah, I do.
And the issue is is that that'sthe stuff that they're commonly
(23:21):
eating?
So the immune system makes theantibody, that's all it's doing
to tolerate it?
Okay, there's.
There's no validated way to saythat IgG testing actually
improves people's symptoms orwhatever sensitivity means.
That term sensitivity isloosely defined.
We don't have an underlyingmechanism of looking at the
biochemical pathways in our bodyto say I eat this food.
(23:44):
It generates this process tocause these symptoms, unlike
with food allergy.
I know your B cells produce IgGantibody.
There's.
They sensitize mass cells.
They sit on the mass cellsurface.
Food comes in and cross linkswith those antibodies, releases
chemicals in the mass cellcalled degranulation, like
histamine, different cytokines,and those cause the symptoms
(24:08):
I've described high swellingproblems, breathing, vomiting,
all that stuff.
So we can describe that and wehave the test to describe that.
Igg testing or any foodsensitivity tests where we pluck
a hair out of your out of yourhead and measure that.
These sensitivity analysesthere's.
There's no scientific proofthat those actually really help
people.
Speaker 2 (24:25):
So you wouldn't recommend anyone get a food
space basically anyone.
You would say, just skip thefood sensitivity test.
I agree, yes.
Speaker 3 (24:33):
Absolutely.
There's really no reason to doit, and I'm not the only one
saying this.
This is endorsed by all themajor allergy societies American
College of Allergy AsthmaImmunology, as well as the
American Academy of AllergyAsthma Immunology.
These are unproven tests.
Speaker 1 (24:47):
I just think that goes pretty much everybody who
doesn't sell one.
Speaker 2 (24:52):
Right, but that shows you the power of marketing,
because I see these things likequite a bit I hear people
talking about them andeverything like that, and I
think that really shows you thepower of marketing.
And again it goes back to thiswe, a lot of us, are dealing
with an issue and just be ableto say, oh, it's this food
you're eating.
Oh, that makes sense, because Ialways eat it, you know, and I
and they play on that and that'sreally unfortunate.
Speaker 3 (25:13):
Right, right.
My feeling on this is that youknow you're spending all this
money to give you things thatdon't necessarily help and it
may appear to help some people,but that's anecdotal evidence.
That's the strongest force inmarketing on the internet.
Speaker 2 (25:28):
Yes, when people say Say that again, say that again,
but louder.
Hey, I'm a parent.
Speaker 3 (25:33):
You know when somebody comes on and says I'm a
parent, I'm busy and I don'tfeel well, but I did this one
thing that changed my life, ohgosh, that's not the basis of
scientific evidence, folks,unfortunately so powerful, Like
you said.
Speaker 2 (25:46):
It's so powerful, Like it's more powerful than any
meta analysis.
I could cite like five of those.
But a mother comes on and sayswe were struggling so hard and
we had, we were at our wits endand we did this one thing.
And look at them now and youjust see this before and after
picture.
It's more powerful thananything, Like you tug on those
(26:07):
heartstrings.
Speaker 3 (26:09):
One of the ones that I'm trying to really confront
right now, because we'reshifting our guidelines from
this from an evidence basedstandpoint is eliminating food
to treat eczema, which has beena very common practice to do.
And so I see this where parentswill go on and say my child is
eczema and we've been struggling.
But you know, I got rid ofdairy and in 24 hours their
eczema was completely clear, itwas fixed.
(26:31):
Is what?
I hear from time to time, andthere's a lot of nuance that's
lost in that that we're learningmore about Eliminating foods at
an early age unnecessarilycould potentially increase the
risk of developing a potentiallypermanent food allergy.
That could happen and noticehow I'm trying to be very
careful with my language becausethere's no absolutes it may.
Speaker 2 (26:54):
Only the sex deals in absolutes.
Speaker 1 (26:55):
It's almost like it's not black and white.
Speaker 2 (26:58):
Joy, the dog side, yes, and you can then say this
causes eczema.
Speaker 3 (27:05):
Right.
But we found that in variousstudies when you eliminate foods
to treat eczema, it doesn'tsignificantly improve it for a
population, a large populationof kids, as an example, and the
flip side is that there'spotentially negative
consequences.
So trying to focus on otherways to treat that skin
(27:26):
condition, I think, is moreimportant.
You could do a skin test andfind that, yeah, they've got
antibodies to these foods andmaybe it might help their eczema
Mildly.
I don't know.
But I'd rather not take thatrisk and create a problem that
didn't exist before.
That's more likely to bepermanent and potentially
life-threatening.
I'm not downplaying eczema.
(27:47):
It's a terrible condition.
I grew up with eczema myself.
I didn't wear jeans for myentire childhood because it
scratched my skin so badly I'ditch all day wearing those types
of fabrics and I'd be itchingall the time.
It was hard to focus.
So I can empathize with peopleliving with eczema.
Fortunately, I mostly outgrewit when I became an adult, but I
remember that feeling and so Iempathize with that.
(28:10):
But knowing what I know now, Iwouldn't.
For most people I'm not sayingeverybody, but for most I
wouldn't go straight to avoidingfood unless I was doing X, Y
and Z things.
Speaker 2 (28:21):
And I tell people that because I get asked what
about acne?
A lot People ask me like,what's the deal with acne and
food?
And I'm not an expert on it.
I'm from the experts that I seeand talk to.
There may be a connectionbetween acne and things like a
high sugar diet.
Or they say maybe whey protein.
I hear that but we're not sure.
(28:42):
It's not likely.
Yeah, so, are you going to cutall that out of your diet, for
maybe it possibly to help?
Speaker 1 (28:50):
On the topic of acne quickly.
Before you even cut food out ofyour diet, change your bedding
more often.
That is one of the biggestcauses of acne.
Speaker 3 (29:02):
Lifestyle changes in other ways besides.
Diet can be helpful in terms ofhaving things that are a little
bit more clean have a skincareroutine.
There are so many other things.
We have medications that we canuse for acne.
It's the same thing with eczema.
There are so many differentthings.
We can do the skincare now andthere just has to be a lot more
education and teaching andthat's one of the big drivers
(29:24):
for me going on social media totry to give general educational
tips for people, to understandand debunk people who go out and
say I have a food allergy andI'm going to eat the food and
we're going to see what happens.
It's like no, don't do that.
Speaker 2 (29:39):
Don't.
Speaker 1 (29:39):
Yeah, no.
Speaker 2 (29:40):
Especially with EpiPens being $800,000 or
whatever they are.
Speaker 3 (29:44):
It's crazy.
Now, it's been terrible.
What are the?
Speaker 2 (29:46):
$600 now.
Speaker 3 (29:47):
So they can, depending on the person, be as
much as $600 to $700.
Most of the time with mypatients it's like $200 to $300.
You can get generics for as lowas $150.
But that's still ridiculous.
But then I have also somepatients who are like, yeah, my
insurance is great.
I only pay like $5 or it's free.
That's lucky.
(30:07):
I wish I had there at healthinsurance, because most
insurance companies don't coverall of those costs for something
like that even though it's alife saving medication.
So the expiration date isusually about a year, but they
typically can last longer thanthat, especially if you're able
to keep it in the righttemperature conditions.
If you live in your car, you'regoing to ruin it faster than
you think.
But if you're holding onto itand you look at it and, like I,
(30:31):
have a trainer with me on mydesk, I always have that to show
people.
But the real device would havean indicator.
We can see the medication, youcan look up to the light and if
it's clear, not cloudy, notyellow, it probably will be
helpful.
We just don't know how helpfulit is.
It's better to use that thannothing.
But if it's yellow or cloudyyou can't use it.
(30:52):
But soon we will have devicesthat will be needle free.
Within the next 12 months thereshould be a nasal spray
containing epinectrum coming out.
Speaker 2 (31:00):
I saw your video on the nasal spray.
That's fascinating.
That's so cool.
Speaker 3 (31:03):
Yeah, it should have come out already, but the FDA
asked for an additional doserepeating study and I'm not too
happy about that.
They should have just approvedit and let the physicians, like
myself, just counsel patientsvery carefully on what's going
on within what we know, what wedon't know, Because in order to
really know how these medicineswork like EpiPen, same thing
there is no randomizedplacebo-controlled trial to
(31:24):
approve EpiPens.
It's not ethical to run thosetrials Because that would be
saying hey, I want you to eatpeanut butter and go into
anaphylaxis and you may or maynot get the real device, so you
might die doing this.
That's OK.
Speaker 2 (31:41):
That would be tough to give people the sign up.
No, no, it's unethical.
Speaker 3 (31:44):
So they do something called pharmacokinetic,
pharmacodynamic studies or PKPDstudies, to look at secondary
measures like blood pressure,heart rate, for example, and
time that from when you get themedication.
So we see the physiologicalchanges outside of anaphylactic
conditions.
You see what I'm saying.
Speaker 1 (32:02):
I'm just glad that stuff like that is a lot cheaper
in Canada.
Speaker 3 (32:08):
Yeah, a lot of times I hear from people outside of
the US who are like, yeah, I getthis for free or it's like it's
$10.
Speaker 2 (32:14):
No, here in America we jump out of ambulances
because we know we're going toget charged $4,000 just for a
ride to the hospital.
Yeah, I was talking to somebodyabout that and I was like what
I've had friends jump out ofambulances like, no, I'm not
going to go, you won't take, Iwon't pay $4,000 for a ride.
Speaker 3 (32:32):
It's crazy how much the cost of health care could be
.
One of the representatives fromFlorida introduced a bill to
try to cap EpiPens and otherrelated devices at $60 a TwinPak
.
That would be federally Rightnow.
There's a few states, like inIllinois here, where they're
capping it at $60, which isfairly reasonable because the
device itself does take costs.
(32:53):
I think about $20, $30 to make.
Speaker 2 (32:56):
So that's a fairly reasonable price for a
life-saving medication, but $600.
Like $600 is crazy, it'sgouging.
Speaker 1 (33:02):
It's totally gouging, that is yeah.
Speaker 3 (33:04):
So I'm hoping that gets passed.
It's called the EpiPen Act, andso anybody who's in the United
States listening to this rightto your local Congress people in
support of what's calledliterally the EpiPen Act.
I don't remember the exactacronym, but I think it's
important for people to be awarethat we're trying to help.
It's not just for people livingwith food allergies.
(33:25):
You can have anaphylaxis,severe life-threatening
situations to medications, tobee stings, latex, all sorts of
things.
So this affects millions ofpeople.
Speaker 1 (33:36):
It'd be great for them to be more affordable, just
so people who maybe not haveallergies can even carry one
around, just in case ofemergency.
Speaker 2 (33:45):
Absolutely, it is.
Yeah, that's very interesting.
Oh, so before, yeah, before we,I want to make sure I get to
something, because I rememberwatching a video you did that I
want to ask you about aboutBenadryl, because I you talked
about how there's possibly aconnection between Benadryl and
like dementia.
If you take it, you know,consistently this isn't like
(34:07):
once in a while thing, but youtake it consistently.
I was fascinated by that.
I was kind of like looking itup, I was like wow, there's
actually like a decent amount ofresearch and the fact that this
isn't more well known is verysurprising, because you, uh,
talk about that a little bit.
Speaker 3 (34:18):
Yeah, so a lot of times people call me the
Benadryl bogeyman because of theamount of posts.
I talked about it at one point.
Speaker 2 (34:25):
I don't blame you, though, for you know.
Speaker 3 (34:27):
Yeah, so.
So I remember a while ago therewere several allerges who had
written an editorial.
It was, but I think it wasentitled like Diffin hydramine
time to move on, or somethinglike that.
Okay, and so Diffin hydramineis the generic name for branded
Benadryl.
Benadryl is one of the oldestantihistamines.
It's been around, I think,since around the 40s.
It's part of the class of firstgeneration antihistamines.
(34:50):
There's other similar ones,like chlorfeniramine,
hydroxazine as examples.
These are medications that, yes, they block the chemical
histamine from attaching to itsreceptor, but they also have
properties calledanti-cholinergic properties.
They block something calledacetylcholine, which is a
neurotransmitter.
That that is, you know, foundall over the place.
(35:13):
And so Benadryl, when you takeit, especially at higher doses,
can have all sorts of sideeffects, such as you dry out,
you can have constipation,urinary retention, it can
actually cause sexualdysfunction, heart palpitations,
seizures, coma and, yes, death.
People have died from takingBenadryl overdose.
(35:33):
There was, unfortunately, ateenager who passed away trying
to do a benadryl challenge.
That there's been a socialmedia challenge.
Speaker 2 (35:41):
Where people try to take it.
Speaker 3 (35:43):
And people and the FDA actually put out a warning
for that.
Okay, so what you're talkingabout is there are some
longitudinal data of similarmedications, anticholinergic in
nature, where they looked atseveral adults who would take
these anticholinergicmedications like benadryl For
long periods of time and thensay, okay, who developed
(36:04):
dementia later in life, right,and there were significantly
higher numbers of peopleDeveloping dementia who had
taken these anticholinergicmedications.
So we call that an association.
Can we say?
Speaker 2 (36:15):
there's a direct mechanism of action like a.
Do we have any any ideas on howit could?
Speaker 3 (36:20):
probably has to do with the Anticholinergic
property and how it alters brainchemistry?
Most likely, but we don't fullyunderstand this right.
This is an association, sowhenever you see on the news
someone saying, oh, this islinked to it, I don't like that
word because that makes it soundlike it's causing it.
This is an association where wesee that some groups of people
have these conditions and theyalso happen to have taken this,
(36:42):
so I bring this up in a lot ofmy content because it's not like
we don't have a lot of saferalternatives nowadays.
Speaker 2 (36:50):
We have so many medications.
Speaker 3 (36:52):
The second generation antihistamines like zirtech or
satirazine, zizol,levosatirazine, claritin, which
is loratidine, allegra, which isfexofenidine, these newer
medications that have beenaround for a few decades now,
since basically the 90s andearly 2000s, that work basically
the same.
They are antihistamines.
(37:13):
They work just about as quickly, they're just about as
effective.
They last longer than benadrylusually, but they don't have
those anticholinergic propertiesand they don't you.
You don't die from overdoses onthem like you can with benadryl
.
Speaker 2 (37:26):
So those second generation, they don't cross the
blood brain barrier, correct Isthat's what I've.
Speaker 3 (37:30):
They're engineered to not cross the blood brain
barrier, but some people stillhave that issue.
So as an example for me, I I Ioffer zirtech to my patients all
the time, but for me, if I takeit, I'm tired for 12 hours,
really tired.
But if I take Allegra I'mtotally fine.
Everybody's brain chemistry isa little bit different and you
have to, you know, check thisout.
(37:51):
I have so many people asking mewhat's the best allergy
medication and I can't answerthat because everybody is
different and I have to counselyou based on what are your
specific symptoms, what you'reallergic to, what is your
overall medical history.
So I have to think about allthose things before giving that
as a recommendation but as ageneral broad stroke.
Most people don't need to takebenadryl as their go-to, and if
(38:14):
you're taking it as a sleep aid,which a lot of people do, like
I was just about to starttalking about that.
Speaker 2 (38:18):
Yeah, because I work in sleep medicine and I people
tell me like I take it to helpme see them, like I really
wouldn't recommend that, likethere's other things you can do
it is not a good thing.
Speaker 3 (38:26):
It's like, basically, zik will is like drinking
alcohol in terms of how itaffects the brain.
You fall asleep more quickly,yes, but is your sleep quality
actually improved and do youwake up refreshed?
Not usually, and one of thereasons why is because benadryl,
just like alcohol, has similarproperties.
It increases what we call theREM latency.
It's the time when you fallasleep to getting the first
(38:49):
phase of your sleep cycle, whenyou first enter REM, rapid eye
Move in sleep when you dream,and you have to go through
several sleep cycles In order toget restful sleep.
And not everybody has to beexactly eight hours a day.
There's some.
There's some variation on it,but to get to the right number
of sleep cycles by taking thesemedications you're disrupting
that significant like again, Iwork in sleep medicine.
Speaker 2 (39:10):
Like I see people every night with the, with their
sleep and their brain waves.
Typically it's like you know,around 90 minutes after you fall
asleep is your typical firstREM cycle.
Each REM cycle is a little bitlonger than the next, um, but I
will tell you people who are ondifferent medications, they're
REM, it sucks.
Like I look at it and they'relike up and down and they get
maybe like 20 minutes of REMhere and like, uh, 15 minutes
(39:30):
there.
It's, it's awful.
So if you can reduce those andjust try and get a solid, you
know seven to eight hoursGenerally for most people is a
good window.
You're doing great.
I know we all struggle, but doyour best.
Speaker 3 (39:41):
Yeah, some tips for general sleep hygiene, and
people like you should say sleephygiene like it's I wish it.
Speaker 2 (39:46):
Yeah, whenever I say sleep hygiene, people like no,
it's just for your routine.
Exactly so you're recentlycalled that sleep hygiene.
Speaker 3 (39:52):
Yeah, waking up at the same time every day helps
start going to bed, waking upthe same time, right, right,
usually if you first start offsaying I'm gonna wake up at 8 am
Every day, then your your bodywill naturally eventually get
you to fall asleep at the sametime every day.
Um, we're all creatures ofsocial media and like to be on
our phones.
Really should not be on anyelectronic devices, for you know
(40:15):
, ideally at least an hourbefore bed.
Speaker 2 (40:18):
I will tell you what's kind of helped me,
because I'm I used to do that alot beyond my phone.
So now I find a podcast I likeand I play that on the side of
my bed and I just listen to itbefore bed and that kind of
helps me relax.
Try something like that.
Listening something is great.
Having something you do beforebed can be very helpful the same
night.
Whether it's taking a shower,reading a book, walking,
whatever it is, it just kind oflets sets your brain into that.
Speaker 1 (40:41):
I'm about to go to sleep mode and it can help the
biggest thing that helped me wasGetting rid of lights in the
room.
Speaker 3 (40:49):
Yeah, like even just a little.
Speaker 1 (40:50):
You know, You've got the the wall taps and they have
that surge protector light.
I'd put a little bit of tapeover them so they aren't
projecting light all over theplace.
Speaker 3 (41:01):
So you don't have like the neon lights like in
your background right now inyour bedroom.
Speaker 2 (41:05):
It's flashing all the time, man, I don't know why I
can't sleep.
I don't know what's going on.
Speaker 1 (41:09):
Right yeah, hey, google Office off.
Speaker 3 (41:14):
Da-da.
Speaker 2 (41:17):
Very nice, very nice.
Oh, that looks terrible.
Go back to the other way.
Speaker 1 (41:22):
Hey Google Office on we truly live in the future.
Speaker 3 (41:31):
Yeah, so it's just just to you know.
Make sure everybody's on thesame page.
Who's listening?
When you see light at nighttime, that's not good for your
circadian rhythms.
It really throws off your bodysleep cycle.
That's why we keep saying putyour phones down.
I like the idea of listening topodcasts because oftentimes you
know this is a veryentertaining podcast.
Speaker 2 (41:50):
Obviously, Don't listen to ours.
You'll be awake for hours.
Speaker 3 (41:55):
I know this is just riveting, riveting yes.
Speaker 2 (41:58):
Yeah, but other boring podcasts that I've been
told do exist.
Listen to those and you knowrelax.
Speaker 1 (42:06):
Like every other fitness podcast, they all suck
ours is the best.
Speaker 2 (42:10):
All the others suck.
Speaker 1 (42:13):
You can just put them on and at night we don't care.
Listen to ours in the gym,though.
Speaker 3 (42:17):
Guys, it's always fun hanging out with you.
Thanks for having me on always.
Speaker 1 (42:20):
Oh, I mean we had you tell everybody where to find
you last time you were here.
But just refresh everyone.
Speaker 3 (42:28):
Yeah, so I'm mainly on instagram and tiktok.
I've just recently started ayoutube page.
It's all Ruben r u b I nunderscore allergy.
Speaker 1 (42:38):
Well, there you go.
Make sure you go follow drRuben, my my personal favorite
thing.
Like I already knew this beforeyou posted about it, but my
personal favorite thing that youposted was about the Igy
regarding cats.
If you know that I'm a big catperson.
Speaker 2 (42:55):
Yes, yes, yeah, before.
Okay, so we were, we weretalking about this before the
podcast started, but I think weneed to talk about.
We need to talk about this now.
Yes, why don't you Rob?
Yeah, give us the little thingabout the eggs and the cats and
the yeah.
Speaker 3 (43:07):
So here's the, the cat eggs eggs thing.
Actually I think kind ofpropelled my my social media
accounts I think I'm going totalk about this last spring
because somebody had brought upthey.
They looked at the bag ofpurina pro plan live clear and
we're like wait, it says that ithas egg yolk in it.
So like if I just put like Eggonto my cat's kibble, would that
just be the same thing.
(43:29):
And I then went into thescience of it, which I'm going
to explain here for those whohaven't heard before.
So what we know about catallergies is that, though there
are several proteins that catsmake that humans could be
allergic to, the one that 90 95percent of people are allergic
to is a protein found in theirsaliva, skin cells and urine,
(43:49):
called Fel D1 and in the allergynomenclature, which is actually
an international classificationsystem.
So any doctor, scientist willrecognize this and say oh yeah,
I know what Fel D1 is.
That's that's a shorthand forthe latin word for for
domesticated, cat felisdomesticus, and the number is
just the order of which we'veidentified it.
(44:09):
So Feldi1 is the protein thatcauses most people all of these
different symptoms, even peoplewho come into a house and they
start wheezing, which used to beme.
I used to wheeze whenever I goto my brother's house and he has
two cats and it would make mereally sick.
So cat allergies can reallymake people really sick.
But besides, the point whatscientists have discovered is
(44:30):
that chickens, when they'reexposed to cats, they make a
specific neutralizing antibodycalled IgY.
Humans don't have that antibody, but chickens make that
antibody in the presence of catsand, just like with humans and
IgG antibodies, when someone ispregnant they pass IgG
(44:50):
antibodies to the placenta.
Chickens will pass IgYantibodies to the egg yolk and
so when the egg yolk is thensprinkled onto the cat food,
cats will then eat that and thatneutralizing antibody will coat
the saliva and latch on to theFeldi1 proteins, making them
(45:11):
functionally inert, so that whenyour immune system comes into
contact with those proteins, itdoesn't recognize it as anything
.
It's just like whatever.
So with this food that theymake, or the DIY approach where
you take literally sprinkle theegg yolk onto the food from
chickens exposed to cats, Aftera month, that has to be a
(45:34):
chicken that has been exposed tocats.
Right.
If it's just a chicken that'snever been exposed to cats for
at least a few months, it's notgoing to work, Right?
You're just eating eggs Afterabout a month of daily use.
Where these cats eat this food,the Feldi1 protein is reduced
by almost 50%.
So for many people this newfood that's by Purina, or those
(45:59):
who've tried the DIY approachthey've actually seen
significant improvements intheir allergy symptoms.
Speaker 1 (46:04):
Then you combine that with stuff like air purifiers
and constant cleaning, makingsure you're vacuuming up after
you're your cat.
This gives everybody who has acat allergy.
You no longer have an excuse goget a cat.
Cats are awesome.
Speaker 2 (46:19):
All I'm saying.
You know there is that option,but there's also the better
option of being dogs for life.
Speaker 1 (46:24):
Listen, I don't understand.
It's a controversial topic.
Speaker 2 (46:27):
I've got four dogs.
I'm sticking up for them.
Man's best friend Cats aren'tcalled man's best friend Dogs
are called man's best friend.
Speaker 3 (46:35):
Okay.
Speaker 2 (46:35):
First domesticated like animal ever wolves, dogs.
I rest my case.
Speaker 3 (46:41):
I love animals in general, but if you, if you ask
me, which one I like better, Iam a dog lover First.
Speaker 2 (46:47):
Oh, no, oh, about the dogs.
You got all the different typesof dogs.
You got a little big dog.
Speaker 3 (46:51):
I will say the best, though, is when cats act like
dogs, then you've got the bestanimal.
But that's what I'm saying islike what?
Speaker 2 (46:58):
when you love a cat you say, acts like a dog, it's
so good Like exactly.
Speaker 1 (47:01):
So you're saying dogs are the best, you're like, you
want to get the best.
A lot of people don't realizethat you can train cats To some
cats to a certain extent, butthey are real.
Speaker 2 (47:14):
They can be assholes.
Speaker 1 (47:15):
Listen, there's a lot of tips and tricks to it and I
could like I could literally doan entire episode on training.
Speaker 2 (47:21):
We're going to do a whole episode on.
Speaker 1 (47:26):
But the big thing is that cats do not respond to
negative reinforcement like dogsdo.
You have to use positivereinforcement, which is to say
that shouting at a cat no, doesnot work.
But I try cats to like walk onleashes with me.
(47:47):
I take my cats camping.
I take my cats canoeing I takemy cats.
My last one was kayaking withme.
Speaker 2 (47:55):
Yeah, I mean that's really cool, but I'm sick, I'm
just, I'm a dog, I love dogsPlus cats catch mice when you
live out in the rural areas.
So if you're going to live inCanada in the middle of nowhere
like Rob, get a cat.
Speaker 3 (48:12):
Exactly.
You won't have any diet sodaoptions, but you'll have a cat
that can catch all the mice andlots of good snow to eat too,
right.
Speaker 1 (48:23):
Good old yellow snow.
The great.
The best part, though, is youknow you?
Actually it's an actual thing.
You get maple syrup, you pourit into the snow, you get this
maple syrupy snowball and youeat it, as long as it's not
(48:43):
yellow.
Speaker 3 (48:45):
That's what my followers were telling me.
Like.
All my Canadian followers arelike, yeah, it's great, and I
was trying to give like the mostdiplomatic approach in one of
my recent posts and everybodywas mad Like nobody was happy
with it.
Speaker 2 (48:54):
I saw you post about the snow, about like eating snow
and everyone's like so upset inthe comments.
Seriously, seriously, I wastrying to get.
Speaker 3 (49:01):
I was trying to be respectful of this person, not
be a jerk, because some peoplelike that's you know it's part
of their memories and it's likethat's not the worst thing if
you do it like responsibly, andyou know, try it once or
whatever.
Speaker 2 (49:14):
You know, like, and I see it like this stuff of like
people like will like play withtheir kids and stuff and any
sort of playing with their kids.
They're like don't do that,because the kid's going to break
, he's fragile, he's got that,and they're just like everybody.
We all need to relax a littlebit.
We need to eat a little snow,we need to play with our
children.
It's going to be okay,obviously, like you know, it's
within reason.
But, come on, yeah, you gottaform these memories and have
(49:34):
some fun, right.
Speaker 1 (49:35):
Yeah, have them in moderation.
Good night everybody.
Speaker 2 (49:40):
In moderation.
Like I've heard, there's abouta good podcast you should not
listen to before bed.
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