Dr. Kara Wada: Navigating Life As A Doctor with Sjögrens Syndrome

In today's episode I'm joined by Dr. Kara Wada, a quadruple board-certified physician specializing in allergy, immunology, and lifestyle medicine.

Dr. Wada shares her personal journey with Sjogren's syndrome and how it transformed her approach to patient care and understanding of autoimmune conditions.

For the complete show notes and links visit inspiredliving.show/152

Creators and Guests

Host

Julie Howton

What is Inspired Living with Autoimmunity?

The podcast for high achievers who want to stay sharp, focused and full of energy despite their diagnoses. Those who know there has got to be something better than simply accepting decline.

Hosted by Julie Howton, a National Board Certified Functional Medicine Health Coach who used to suffer from crippling Rheumatoid Arthritis until she learned the tools and strategies to take her power back from autoimmunity.

In this podcast, Julie brings you interviews with thought leaders in the Functional Health and Wellness space. You will get actionable recommendations to Take Your Power Back and catapult your health. No fluff, just concrete, useful steps to improve your health!

I was professionally and personally
just zapped, totally burned out

thought that I might actually
step away from clinical medicine.

I needed to focus on my own health.

I needed to refill my own cup and it
has been a really In many ways, a slow,

but fast evolution since that time.

Welcome back to the inspired
living with autoimmunity podcast.

I'm your host, Julie Michelson.

And today we're joined by Dr.

Kara Wada quadruple board certified
pediatric and adult allergy immunology

and lifestyle medicine physician,
who also happens to have show grins.

In today's conversation, we discuss the
differences between allergy, autoimmunity,

immune deficiency, and cancer, as well
as what might be driving the ever growing

incidence of these health challenges.

I would love for you to share
with listeners and me a little

more about your personal journey.

Um, not just with, you know, why
are you quadruple board certified?

Um, but your wellness journey,
your personal journey, and, and

what has led you to this world that
you are now just totally rocking.

So about four years ago is when I was
diagnosed with systemic Sjogren's.

At that point, I was two years
into my, you know, full fledged,

um, allergy immunology practice.

I was just back from maternity
leave from having my second child.

And I was at a bit of a crossroads
because I thought at that point

in time, I was so exhausted.

I was professionally and personally
just zapped, totally burned out

and thought that I might actually
step away from clinical medicine.

I dropped my clinics, like the number
of clinics and time that I was in

clinic by half and really realized that
I needed to focus on my own health.

I needed to refill my own cup and it
has been a really In many ways, a slow,

but fast evolution since that time.

And I think I continue to just peel back
the layers like an onion and realizing

how, even though at the time I was.

Um, only triple board certified, I guess,
but like, um, but at the time that that

education that I had really did not

prepare me for one living in the
role of a patient, nor did it really.

Like, the education I received on
Sjogren's really did not reflect at

all the lived experience of Sjogren's.

And I think did not help me all that
much in realizing that that was what

was going on with my own health.

Because in hindsight, I actually had
symptoms that, you know, was it full

blown Sjogren's or not at that time?

Who knows?

And it doesn't really matter.

But I had symptoms that I
now recognize as Sjogren's.

Related in some way or prodrome back to
when I was in college in my late teens,

early twenties, and I was in well into
my mid thirties when I was diagnosed.

What I will share, you know, with, with
folks within the patient community, and

actually I just, um, I just wrote an
article for Kevin MD on this as well

that we'll, we'll publish tomorrow.

But what we learn about Sjogren's
in medical education is how to

answer the question on your boards
correctly, which is they're going

to describe a postmenopausal woman.

She's coming in complaining of
a gritty sensation in her eyes.

You notice on physical exam that she
has poor, poor dentition, poor teeth,

and then you have some lab data to
say that her blood work shows that

she has this antibody SSA positive.

And then you'll get, you circle the
question, you're like, oh, yes, I got it.

Um.

Done.

I don't ever have to think

about Sjogren's again.

Correct.

Or, if you're a pediatrician, Um,
this will come up in the SSA antibody

can cause congenital heart block.

So that will be the question that
you learn is, you know, did mom

baby has congenital heart block?

And then the question may ask, you know,
what was wrong on mom's lab work, but

here's the reality and here, you know,
thinking back to the puzzle pieces

of symptoms I've had over the years.

Um, a lot of digestive distress, so,
you know, symptoms that we describe

as irritable bowel, but really wicked
stomach aches, migraine headaches,

profound fatigue, back stiffness, um,
that I actually do recall going and

kind of seeing a primary care about at
one point during my medical training,

which must have been pretty significant
because as residents, Like resident

physicians, you like never go to the
doctor cause you don't have time,

like, and you're trying to take care of
yourself, like we're the worst patient.

So it must've been pretty bad.

Um, I had an episode of
idiopathic anaphylaxis, um,

after having my first child.

And I also, over time realized that I
couldn't wear mascara without looking

like a raccoon because I was always
touching my eyes, rubbing my eyes.

Um, wasn't able to tolerate
wearing contacts at a certain

point because of the dry eye.

Sure.

Yeah.

And

what is fascinating, especially as
I now clinically am seeing patients,

no one ever comes in with this, you
know, their, their main complaint

of like dry eyes or dry mouth.

Right.

They're complaining about their
dry cough or their body pain, their

fatigue, um, maybe their sinus issues
because I'm an allergist by trade.

Right.

So they're coming to see
me for their sinus stuff.

Um, and the other reality is
that 30 to 40 percent of patients

have totally normal labs.

Thank you.

Um, yeah, totally normal lab.

So, you know, they get that,
oh, your labs are normal.

Must be in your head.

Must be normal.

Yeah.

Let's try this antidepressant, or maybe
you should try losing a few pounds.

Um, so all that to say that, you know,
this And it's been the patient community

that has welcomed me and embraced me
that I've learned so much more from.

Yeah.

Then, you know, those several
hundred thousand dollars education,

no credit, you know, and some
other things along the way too.

But, um, so.

Once I was diagnosed, um, and and I
will say I feel incredibly fortunate

and this is seems odd to say, but
my labs were totally wacky and that

like they were terrible at the time.

I think took my my rheumatologist slash.

Friend, um, by surprise.

Um, had those not been abnormal, I
don't know of, I don't know how long

it would've taken me to be diagnosed.

There's is so many parts and
pieces of your story that I'm

like, oh, let's talk about that.

Let's talk about that.

Yeah.

I wanna first just kind of reinforce.

Um, because I have this conversation
with clients a lot that because

standard Western medical training
doesn't teach about how to, you know,

they don't teach about gut health.

They don't teach about how to heal
autoimmunity, how to, you know, reduce

inflammation, all of the things.

Um, and so I know that by the time
people find me and probably you,

they're frustrated Absolutely.

They had normal labs.

They were offered antidepressants.

They were searching and searching.

Um, and so I just, I, I want to highlight
that part of your journey and every

other position that has been on here
that has, you know, an autoimmune

journey or a health recovery journey.

Um, is that it's not, I said this
yesterday, you know, nobody becomes a

doctor if they don't want to help people.

Um, And somebody said,
well, that's not true.

I said, Oh, there's
easier ways to make money.

I promise.

Um, you know, but, but it, it's this, the
education system has to change as we now

we have information and, and this is where
integrative medicine, functional medicine.

lifestyle medicine, whatever
you want to call it is, is key.

And, and I love you touched on it.

And I think this is really
important for people.

You kind of said it, but didn't say
it like, you know, it doesn't matter

if you have a diagnosis or when you
get the diagnosis, this idea of We

ignore and normalize symptoms, and if
we don't hear the whispers, we will

get shouts, and that's what happens.

Yes,

yes,

absolutely.

Yeah, yeah, it's like, you know,
shocker, your autoimmunity,

you used to have gut issues?

No way, you know?

Yeah.

There's a connection.

Yeah.

Um,

yeah.

Yeah.

Yeah.

And, um.

You know, I think part of it, I, I will
refer to myself as the ostrich with

their head in the sand for a long time.

I, in part, I was totally in denial.

Um, but also like, I didn't have time
to be sick now that I say that, but

then it's a little like tongue in cheek
because there would be afternoons where

I was totally incapacitated because
I ate something that didn't sit well,

or I had a terrible headache or.

I was just totally zapped
from really overdoing it.

And so I was having, I was
forced to take rest, right?

Um, because of symptoms and
that's what your body needs and

is like demanding at that point.

Yeah.

Um, which is so true.

I had a client last
week who was very sick.

Like, you know, ER had a really high
D dimer, like a scary moment in time

where, and two days later she was like
complaining that she was still sick.

And I'm like, are you in bed?

Well, no, I'm working and I'm
like, yeah, like , you're not

gonna get better if you don't rest.

And especially when we've got these
chronic, whether it's autoimmune or not,

just these chronic symptoms, we do tend to
just try, ignore and try to push through.

And our body will always take
us down if we're not gonna

give it the rest that it wants.

For sure.

So I, I wanna touch on.

Because it, there's, again, so
many questions I want to ask you.

Um, you have this whole host of, of
symptoms, um, that you've experienced, and

this is what you're seeing in your other
patients with Sjogren's is this, you know,

because it sounded like, I always think,
um, by the time you get the really dry

eye, there was always this other host of,
of things, um, And so is that what you're

seeing is, you know, it doesn't, I almost,
I don't, I don't want to offend you.

I don't know you well enough yet,
but I, you know, it's all, it all

comes back to the same stuff when
we're talking about autoimmunity.

And so I don't care if.

You know, they show grants is one of
the things they threw, you know, that

was like my fifth diagnosis, um, as you
know, things just progressed and progress

and it's like, I don't, I don't care
what name they gave what you have, like,

let's just go after what's going on here.

You know why let's answer the
question why, and then we can start

shedding some of those labels.

Um, but it sounds like
you're that that's accurate.

You see the same, almost the same host.

Yeah.

Yeah.

And the data supports that too.

Um, the other symptom that I left off
the list, um, is dysautonomia or POTS

is incredibly common in Sjogren's it's
the number one autoimmune cause of POTS.

Um, and although I

don't, as far as I know, I haven't had it.

I wear my aura ring and some of my
trackers so I don't think POTS is going

on but I have had significant issues with
orthostatic like intolerance and um, I

would have to scrub out of Surgery is
a medical student because in that hot,

especially it wasn't so much an issue on
the actual surgery rotation, but on the

OBGYN rotation, where they keep the war,
the room much warmer, um, for the babies

that are, you know, about to be born, um,
I had to scrub out on multiple occasions

because I think in hindsight, combination
of her long sitting or standing.

the warm environment.

Um, all those things kind of came into
play where my blood pressure would

drop and I would get to the point where
I thought I was going to pass out.

Thankfully it didn't.

Yeah.

Thank you.

For so many reasons.

Right.

They drill into you, like as a med
student going through, you know,

the OR procedures, like you can not
pass out in the operating field.

Not allowed.

You got to get out
first, drop in the hall.

Yeah.

Um, but I, I distinctly remember my
preceptor say, you know, asking if I

happened to be pregnant because I was
having to scrub out so often, which

of course now that would kind of be
frowned upon, but, um, I can't ask, but

it was memorable to now, you know, Oh
yeah, that probably was all related.

Yeah.

Shocker.

Yeah, shocker.

Yeah.

So, so you have such a unique background
and practice, and I wanna dig in a

little bit to like allergy versus
autoimmunity versus immune deficiency.

'cause

Yeah, it's

all,

all inter, we're all human organism.

Yeah.

It's, it's all so well in addition
to our microbes, but , um.

So when we think about our immune
system, its purpose is to help protect

us, obviously, against infection.

Its purpose also is to help us
heal, like from injury as well.

So if you think about a cut
that you may get, you'll get an

inflammatory response at that cut.

It's going to get, it's ouchy.

First of all, it's painful.

It's red, swollen,
typically, and it's warm.

Those are all the signs and
symptoms of acute inflammation.

And so, you know, during that response,
you're having this coordinated

effort of cells and proteins and
these things called cytokines and

chemokines, like this beautiful
orchestra of our physiology taking

hold so that it can stop the bleeding.

It can bring in the cells that are
going to help repair the tissue damage.

It's going to fend off any microbes from
the surface of our skin that maybe have

made their way in, um, or other infection.

Um, and it's going to allow
that area to heal and it's this

magical thing that happens, right?

But when we think about allergy
and we think about autoimmunity and

throw cancer in there too, um, and
I mean deficiency, that system, it

has gone haywire, it's misbehaving.

And so an allergy, our immune system
has recognized something in the

outside world as the, the danger
signal, the enemy, and it mounts.

a particular flavor of an inflammatory
response against that, whether it's a

pollen or kitty cat allergen or dust
mites, or in some cases foods, as we've

seen in the last 20 or so years, this
really steep rise in true food allergy,

where if someone is exposed to this minute
amount of peanut or egg, that they have

a life threatening allergic response.

In the case of autoimmunity,
when we are incubating.

We are in, um, in mom's womb.

Our immune system is already hard
at work determining what is Self

from non self and what is safe.

And so things that are too good
of like recognized too easily.

Those types of cells are eliminated
and those that are not recognized

self are eliminated as well.

So that you end up with this
immune system that can tell.

Okay, what, what is us and what is not us?

And.

In autoimmunity, essentially the immune
system loses that tolerance over time,

so that then the immune system is seeing
our own bits and pieces as that enemy.

And it depends, you know, each
autoimmune condition has a little

bit different flavor of this.

It has particular targets that are
implicated, and that then explains

some of the symptoms we end up with.

In immune deficiency, We don't have
all the parts or pieces, or they

aren't quite working in a perfectly
coordinated fashion, so we are at an

increased risk of infection, whether
it be, you know, more frequent

infections, more severe infections.

Eyeball infections that most
people wouldn't be, you know,

wouldn't have any issue with.

Um, and a lot of times the collateral
damage and inflammation that occurs,

um, is not appropriate either.

So sometimes there's like too
much or there's too little.

And so that then can expose the
immune system to actually creating

an autoimmune response to, because
it's not cleaning things up properly.

So the really obnoxious thing for many
of my immune, my patients with primary

immune deficiencies, especially is that a
lot of them coincide, like co occur, occur

in the same person as autoimmune disease.

So you end up with autoimmune and
immune deficiency in the same human.

It's a real kick in the pants.

That's it.

And then you, you're forced, Um, you
know, to make some really difficult

decisions as a team, um, with your
immunologist, maybe your infectious

disease doctor, the rheumatologist in
deciding how can we try our best to like

restore balance, um, as best we can,
because sometimes you have to like tap

down the inappropriate inflammation, try
to boost things up the best way we can.

Um, and so that is a They can be
incredibly challenging and frustrating,

um, and then in cancer, essentially the,
um, you have cells that have gone rogue.

They are reproducing at levels and
numbers that they're not supposed to.

Usually there's some kind of
glitch in the system and the immune

system is unable to recognize
and take those out appropriately.

And so what you're seeing
with some of the newer.

Immunotherapy cancer treatments is they
actually turn the immune system back

on to help then target the cancer more

appropriately.

Yeah.

And that's pretty cool.

I think at least in regards to
cancer and the general population,

I think the more we have these
conversations where people can realize.

Like we, we have bad cells all the time.

We all do.

Yeah.

Yeah.

Yeah.

And a lot of times our

immune system sees them and
takes them out and you never know

what it's supposed to do.

Right.

And that's the, you know, that approach of
that I look forward to the day when there

is a more integrative approach across
the board with cancer so that we are.

Supporting the whole human while we are
helping the body go after the cancer.

Um, yeah, I know.

Absolutely.

It's a, it's an interesting
conversation, but I, I, that to

me, the key for people to start to
understand is, you know, we still need

to support the body to do its job.

And, and so there was a reason
your body didn't catch those cells.

I guess is what I'm, you know, at which
to me ties into this whole conversation

of what are the things that, you know,
we can do, what is that approach?

Whether we are to, you
know, for wellness, right?

Because I, and I'm guessing it sounds
like you have people that show up,

they're coming to you for allergies.

And I'm guessing often they have, like
you did, like I did have issues brewing

that they didn't realize were auto immune.

Oh

my gosh, yes.

I would have to say, so I am currently, I
see patients two and a half days per week.

So I'm not totally full
time in the clinic in part.

That's how I keep my cup full.

It's awesome.

Um, but I would say at least out of
maybe those 36 patients I might see in

a week that at least probably six of
them have specifically come in wondering

about food allergies, but what they're
really dealing with are gut issues.

It's not, it's not like
they need an EpiPen.

Um, uh, and I would say probably a good
four to five of those patients, um,

are maybe the fifth, sixth, seventh,
eighth opinion on their symptoms,

which to me, they describe symptoms
of too much inflammation in one way,

shape, or form and or dysautonomia.

So issues with like blood
pressure, heart rate fatigue.

Unfortunately, so I'm I'm
located in Columbus, Ohio.

I work at the large university there.

Um, and we don't have anyone locally
who's taken the lead on dysautonomia,

which is really unfortunate.

So my patients to see a specialist
have to go all the way up to

Toledo and wait about two years.

To get care.

That seems insane.

Um, but I get it is.

Yeah, we're in a, in a metro
area of several million people.

And so it's great.

You're not in the middle, especially.

Yeah, we already had a lot
of these folks pre pandemic.

Um, that.

you know, weren't really getting
great care or great recognition.

I think there's a better, more
discussion about what these symptoms

represent and folks seeking care.

Um, but we've also had a really,
you know, an increased prevalence of

these symptoms too with long COVID.

And for listeners, and I apologize,
I didn't ask this sooner,

explain what dysautonomia is
for people that aren't familiar.

So dysautonomia is essentially a, an
umbrella term used to describe the

automatic nervous system going haywire.

So, and it could show up in all
sorts of different ways, um,

but most common, and I would say
probably, affects quality of life.

most significantly are issues with
blood pressure and heart rate.

Um, so folks may have issues with
feeling like they're going to pass

out or they actually pass out.

Um, and, um, may have issues
with digestion, can have

differences in how like their
pupils, uh, dilate and constrict.

issues with sweating.

I have a few patients who
will wake up in the middle of

the night, drenched in sweat.

Um, now there are some other
reasons why that can be the,

yeah.

Not necessarily, you know, change of life.

Yeah.

And, um, not necessarily, um, blood
sugar issues would be the other,

um, main thing you would think
about, um, and ruling out cancer.

Um, but, um, and.

They are symptoms that have, we've
known that they exist for some time,

but they are like many autoimmune
conditions, things that affect

different organ systems and are not well
understood, not super well researched.

And so siloed, where the cardiologists
are in one space, the neurologists are

in another space, the immunologists.

and we kind of stay within our groups.

It's challenging to have really good
coordinated care for these folks.

So, so well said.

Um, and you mentioned long COVID being
one reason I feel like in general,

even like POTS, pandas, these kinds
of things, it, you know, it's that

question of, are we just more aware?

And so now we, you know, more people,
we, more diagnoses are happening or is it

like real food allergies, auto immunity,
autism, is there just really more, you

know, What do you think this increase in,
I mean, I have, I have two, I still call

them kids, two adults offspring who carry
EpiPens and have, you know, one didn't

well did when he was little, seemed to
outgrow stuff and then randomly again,

you know, different, different allergies.

It is scary.

It's really fascinating too, because
there is this really, almost like a, uh,

not quite a land, uh, line in the sand,
but so I am, I'm 39, so I'm an elder

millennial and I don't remember a single
kid in my class having food allergy.

My sister's 36 and I think she
probably would say about the same,

but you go another like two or three
years and that's when those numbers

really kind of blossom, you know,
kind of those born early nineties.

Onward.

Um, and this has been a really
interesting topic of conversation at

our national allergy, asthma, immunology
meetings and this past spring, you

know, the real big discussion point
was one of the ways that we have.

conceptualized this increase
over the last 30 years or so is

the hygiene hypothesis, right?

The reason why we're seeing more
is because we're all cleaner.

And yeah, like that helped, that
helps explain it to some degree,

but it wasn't the whole picture.

And so there is a
physician researcher, Dr.

Adkis, um, who is out of, I believe
Switzerland, who took kind of the center

stage and really Spoke a lot about
the epithelial barrier hypothesis.

So this idea that we have interfaces on
our bodies, our skin, our respiratory

tract, our gut, that are how we
communicate with our outside world.

And those barriers are
permeable or semi permeable.

We want communication from
one side to the other.

That's how we interact
with our environments.

Right.

But if you have too many chinks in
the armor, then you get into trouble.

And so what happens when you end
up with leakiness or breaks is that

you see a change in the microbes
that are living on that surface and

you see a change in inflammation.

And a lot of times in particular,
what we talk about a lot

in allergy, uh, is eczema.

It's easy to see like what's going on.

Um, a little bit easier to study,
um, sometimes than, than gut related

things, cause you're not having
to do endoscopies all the time.

But it is a gut

related thing.

It,

um, sorry, from like a bio, yeah, but
from like a bio, it's a little easier

to see and conceptualize and, um,
but what you'll see, for instance,

staph aureus lives on our skin.

It's kind of a natural commensal.

It's kind of like a, generally a.

friendly ish bug.

But you see that like the strains
and the types of toxins that they may

change when that skin is inflamed.

And essentially what happens is
you end up with a snowball effect.

And so when you have breaks in the skin,
the bugs change, there's inflammation, it

makes it more leaky, so on and so forth.

And that continues.

Um, but as you mentioned,
there's crosstalk.

So you can see then changes maybe in
gut microbiome and development of eczema

or you can see changes or exposures
through the respiratory tract that then

will increase the risk of developing
something like multiple sclerosis.

So there, there's, you know, this
growing body of evidence that problems

at these barriers and increased
Inflammation, leakiness, kind of

at these barriers is the issue.

So then the question is, okay,
what's making them more leaky?

And there's a whole bunch of things
we think about how different our day

to day lives are compared to, like, my
great great grandma who is living on

the farm in northern Georgia, growing
all her own vegetables canning things,

she was out with the cow and they would,
you know, kill the chicken and my.

Even my dad, when he was growing up, he'd
have to go kill the chicken and pluck all

the feathers and bring it in for dinner.

Like they were, he was outside
on the farm working all summer.

Like they didn't have air conditioning.

Touching the earth.

Yeah.

Um, it just was totally different.

And here we are, you know, in our creature
comforts, I'm in air conditioned space.

Me too.

Um, and I have my ear bud, you
know, I'm sitting, um, and.

And that's not to villainize everything
about our modern way of living.

It's just a lot has changed and we're
seeing now the downstream effects of that

significant amount, you know, change the
different exposures that we are, um, are

exposed to, rapid change in diet, um,
increased sugar, oil, refined grains, um,

And on the whole, we're very sedentary.

We spend upwards 90 plus
percent of our time indoors.

Um, and so, and then the
newest in the, in what Dr.

Adkis is kind of, I think, um, pet
project is looking at the role of

dishwasher rinse aid, in particular
those used in commercial dishwashers.

Um, but the, the, the residue left on
glasses is very damaging to the gut.

And so commercial dishwashers
came about late 1980s.

Is that then implicated in what we've
seen with increased rates of food allergy,

eosinophilic esophagitis, drug allergy?

Oh, two kids with that
when they were little.

Who knows, right?

Yeah.

And so, um, you know, there still is a lot
of work to be done to really hone in, but.

Well, and I think that's

a very specific product.

Um, but I think it, it underscores
the whole exposure to toxins,

right?

So they're studying commercial dishwasher,
but you know, but what are people

using at home even day in and day out?

And, and, you know, that's a whole, we
could talk for another hour about that,

but I do think it's this combination and,
you know, You can't, so you mentioned,

you know, the changes in our food
system, the dogs are piping in, um,

and, and to me, you can't separate the
changes in the food system and toxins.

It's the same, you know, the bad
oil, the ultra processed foods,

the, you know, all of that is toxic.

And so, um, you know, when
I say toxins, I'm not always

talking like chemicals, right.

And you forget and EMF all.

All the things.

Yeah.

And I think then it's, it's, we all
probably need to sit down metaphorically,

probably or stand up or stand up.

Yeah.

And just think about, you know,
what, what are our non negotiables?

What are the things we're
willing to change and What is

our comfort level with risk too?

And I, I think that's where more
data would be helpful, but as I, I've

talked a lot with my patients about
the dishwasher stuff in particular,

I have three young kids, I'm working,
I have a business, I don't want

to go back to hand washing dishes.

So, you know, on the flip side, I'm
trying to look for generally more eco

friendly products that typically, you
know, in broad brushstrokes, things

that are healthier for the planet tend
to be healthier for our physiology.

Um, and, you know, similarly with
the things we put on our skin,

like those are easy, simple.

swaps and switches that, but

I love that you brought up the also
know what your non negotiables are.

I mean, one of the pieces and we all
need to be doing it for wellness,

you know, the, the smart ones are
doing it ahead of time before they

have any symptom they're ignoring.

But one of the things I do with my clients
is we're reducing that exposure, right?

As we're supporting the body's detox
pathways, we are, and it is a process.

It's a process.

It's a process.

There's no way you could wake up tomorrow
and say, I'm going to reduce my exposure.

And by next week, you've done it.

Like there's so much that we come
into contact with and that's fine.

Every change is an improvement.

I had one client who, and she did, she
was a vegan when I met her and I was like,

I'm not the one to help you as a vegan.

Let's find you somebody.

Oh no.

Just tell me what to eat.

So she would eat meat.

But when we were cleaning up
products, I said, what kind of

shampoo and conditioner are you using?

And I never did find out because she
said to me, that's not negotiable.

Not negotiable that for her, she
loved her shampoo and conditioner.

Yeah.

It literally cleaned up every
other product she was using

on her body in her home ever.

And, and I'm like, great.

Like it's not about a, we can't reach
perfect and B we don't need to is

the, you know, cause sometimes we get
the, we have these conversations and

it can start to sound doom and gloom.

And, you know, we've got all
of these hits we're taking.

But we really don't have to fix
everything in order for, for the

body to be able to heal, which is,

you

know, the, that's the
exciting part, right?

That's why we're here.

Absolutely.

We are resilient, amazing species
that has made it this far.

Perfection is sometimes,
you know, the enemy of good.

And I will say I was the first to fall
down that rabbit hole, not too long after,

yeah, after my diagnosis, I, um, doubled
down, um, I've had a Peloton bike for

quite some time since probably like 20,
2018, 2019, um, early, early adopter.

Yeah.

Early.

Maybe it's 2019.

Anyways, it doesn't matter.

But I

pre pandemic and, um,

and I was like shooting for,
you know, PRs like, okay, like

I'm in a like workout hard.

I was drinking green smoothies
that I was adding some super

fluid, you know, stuff too.

And yeah.

Um,

to make a long story short,
ended up, um, with an acute liver

failure from the supplement.

So that's always just my word
of caution of just, you know,

don't, don't overdo it and just be
conscientious of what you're doing.

And more of something
good isn't always better.

Yes.

And then, um, Nothing's
good for everybody either.

That is absolutely.

Um, and then, um, I, Took that
perfectionism and then put it totally

into kind of the elimination diet game
and got really restrictive, lost a bunch

of weight, which, of course, as you know,
a woman in our society was, of course,

like You know, like, oh, you look great.

You know, all those sorts of things.

Um, but I ended up spending so much
mental energy fixated on what I

was eating what I wasn't eating.

Um, that at a certain point, my
symptoms were like rearing back and

I, and I honestly think I was just.

Constantly in fight or flight.

It didn't matter that I was eating
like a really anti inflammatory

diet and like, you know, working
out and doing these things like I

had to kind of address all of it.

And I also just had to let go
of the perfectionism like that

was, I think, and I think everybody,
I'm sure you have the same thing.

I think that the perfectionism,
if we could Somehow like diagnosed

perfectionism first, we could prevent
a lot of this chronic illness.

Yeah.

Cause it really does that stress level.

I've yet, and it may
present totally different.

Like, it's not like everybody you meet,
you're going to know right away, but

pretty much everybody that I've worked
with is a perfectionist and that letting

go is such an essential healing step.

Yeah,

so I do wonder

if there are like particular
personality traits that also may,

they, they absolutely provided a
survival advantage at some point,

you know, across our lifespan, right?

But do those also like increase
the potential sometimes for

these conditions?

Yeah, and that's what we just need to

learn.

I kind of wonder.

Yeah.

Oh, I think, yeah, I think for sure.

I really do.

Um, I, it doesn't mean that if you don't
care about anything, you don't get sick.

I'm not saying that.

No,

no, no, no.

Just, you

know, like we talk about risk

factors, like, yeah, if you, if you drink
a certain amount, you're more apt to get

breast cancer, colon cancer, you know,
like those sorts of things where you

just kind of take those into account.

And.

Yeah.

Yeah.

Yeah.

So, but I, I love the, what
you're bringing to the world.

Um, and I just think, you know,
the more anytime, especially like

somebody who thinks they're just
coming to see an allergist, right?

Like anytime somebody can walk into
a doctor's office and have contact

with somebody like you who can
help them understand true wellness.

You know, and the body is such a gift.

So I am so grateful that you are out
there in Ohio doing what you're doing.

, clearly you need more counterparts, , it's
well in your, in your neck of the woods.

The wonderful, wonderful thing
about my position is that I

get to work with trainees.

Oh, that's fantastic.

Near nearly every day.

There is a medical learner.

Of one, one shape or another.

So from undergraduates who are applying
to med school, I will on occasion have

them shadow with me all the way up through
our allergy and immunology fellows.

We have two per year and actually The
season just opened for interviews.

So we have, um, you know, a hundred
plus applicants for, for these,

you know, two spots, um, every
year it's, um, pretty incredible.

And so to be able to share my story
with them, share some tips and

tricks as to how to think about and
conceptualize these things that we have.

We may not have all
the answers to I think,

as human beings, our brains
really hate uncertainty.

Yes.

And, and that is absolutely the
case with physicians as well.

And to push them to get.

more comfortable with feeling
uncomfortable, I think is clutch.

Um, and, um, to help instill
and support their curiosity, I

think is really important too.

And what really, really needs to
take place to ensure that all of

us as healthcare professionals
can stay curious and compassionate

and Um, kind of leaning in is we
need to ensure that our healthcare

professionals have wellness as well.

Because if they are unable to fill their
own cup, that is when you get someone

who is burnt out, unhappy, maybe unhappy
with their situation or their job.

And I, I would almost guarantee that you
are not going to get the best care that

you could get from someone who is in that

state.

Like, I always, I always ask, like, why?

When you just, you look at medical
school and how it's set up, it's

like, why are we trying to kill people
who are training to help people?

And it's not just this country,
it's, it's medical school across

the board is set up that way.

It just doesn't make sense.

I was thinking about that with your a
hundred plus applicants for the two spots.

Like every one of those applicants
really needs to be filling

their cup and doing stress man.

You know, it's such a high stress.

And, and that's a great, um, the flip
side to that, that I can say is I'm

not a physician is also, we need to
remember that our physicians are human.

Yeah.

Yes.

And

yes,

yeah.

You know, and we have this training of
decades of, you know, this mentality

that you and I are trying to change,
which is you show up at the doctor

because you want the doctor to fix you.

Right.

Like, yes, you need to partner.

You know, we have to take responsibility
for our own wellness and we, and

we have to realize that our doctors
don't necessarily have all the

answers, but when you can find one
like Kara, like that's, it's gold.

It really is.

So.

There's this really cool paradigm
that has been written about and

talked about called Wellness 2.

0, where essentially it outlines
this idea of the physician is human.

There is this equalization, the
power dynamics between patient and

physician will never be equal, right?

Like, there's, there's no way to fully
equalize that, um, just to the nature of.

These systems, but it brings
it into closer balance.

Um, and

I think the more that we can lean
into that is really important.

But the reality is we live in a very
capitalistic society and money talks.

So they're also, you know, we're going
to have to grapple with making the case.

Unfortunately, probably.

From the financial side of things in
order to really see systemic change.

And that's kind of the tough
love aspect of all of this.

Yeah.

Yeah.

But the good news is that when,
when that does happen and that the

broken system finally collapses,
we already, we know, you know,

what can work and what is working.

Yeah.

So I love that.

So give listeners, if you
will, and it can be anything.

Can be directly shoguns
related, not doesn't matter.

Um, what is one step that they
can take starting today to

start to improve their health?

Yeah.

So I think the one thing is taking
a few minutes just to sit, give

yourself a little bit of that
white space, that quiet to just

listen to that inner voice and what

he, she, they needs.

Um, I think that is incredibly important.

And I think it's really helpful
to do that before a medical visit.

Medical appointments, almost on the whole,
tend to put us into fight or flight.

And when we get into fight,
flight, freeze, fawn, we may not

always We may forget like what our
objectives were for that visit.

So jotting down some notes can be
really helpful ahead of time to think

about, okay, what are your questions?

What are your goals?

How are your symptoms really
impacting your quality of life?

Being able to communicate how they
are showing up in, in your, in, in

showing your humanity, um, can be
really helpful, especially to maybe

tug on that doc who is on, on the
brink of burnout, or who maybe just

needs that reminder that you are human.

And this is showing up in very human ways.

Um, yeah, so that's my chair,

the other piece in because I
see it a lot and it's, I don't

think people do it intentionally.

We tend to, even though we're
showing up at the doctor's office

for help, we do have this natural
tendency, most of us to downplay.

Just what you're talking about.

We may say, you know, these are the
symptoms, but we don't share how it's

impacting our life or, and so it's like,
Oh, we said the word and then that's it.

And the doctor that's.

They're not getting like, Oh my gosh,
this is really impacting your life.

So I'll share a really quick example.

Low back stiffness was one of
the main issues that was totally

impacting my quality of life.

And so I could tell the doc, Oh,
I'm having low back stiffness.

I sit down for prolonged periods of time
and it's really hard to get moving again.

It's worse in the morning.

Yes.

All that's helpful.

But what really illustrates how much
it was impacting my life was I was.

Not wanting to sit on the floor
to play with my young children.

And that like was breaking my heart.

Yep.

And so to share, you know, that little
extra nugget of like, this is how

problematic this is, like that helps
light the fire, hopefully under that, that

person's bottom to like, to do something
about it, whether it's to refer you or

get imaging or start meds, what have you,
but to make, to have some sort of action.

Yeah.

I

love that.

I love that.

Amazing.

Before we wrap up, where
can listeners find you?

Where's the best place?

Yeah.

So the best place is probably drcarawada.

com on there.

I have a freebie.

So the 25.

Things that we did in our family over
the last four years or so to make simple

swaps to like less toxic things that we
were talking about, just simple, easy.

I'm a Midwest girl born and
bred, and I love a good deal.

So things generally are, you know,
not going to cost a ton, um, to really

help start making those changes.

Um, and, um.

On there.

Also, you'll find so each year,
the last two years we've hosted

the virtual shogun summit.

So it is a we have a ton of
great resources on there.

And coming up this fall, we are
launching a fall event called the

demystifying inflammation summit.

So you're going to want to get on the
email list so you can stay in the loop.

It's going to be a free
event, tons of experts across.

The, you know, the spectrum of
things of too much inflammation.

So allergies, autoimmunity,
asthma, um, gut health issues.

Um, so I'm super excited and in the
weeds of planning that right now.

I love that.

I am definitely signing up.

Love it.

Love it.

Cara.

Thank you so much.

You have given us amazing gold today.

Thank you so much.

I have.

Loved talking.

And we're going to, we're going to
have to have you on the becoming

immune confident podcast so
that we can hear your story too.

Yeah,

I would love it.

I'd love

to continue the conversation
for everyone listening.

Remember you can get the transcripts and
show notes by visiting inspired living.

show.

I hope you had a great time and
enjoyed this episode as much as I did.

I'll see you next week.