Latest / Doctor Turned Health Coach / The 3-Bucket Fix For Seasonal Allergies: Load, Reactivity, Inflammation

Transcript

The 3-Bucket Fix For Seasonal Allergies: Load, Reactivity, Inflammation · Doctor Turned Health Coach

0:21
Today we're going to do a deep dive into seasonal allergies.
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If you've ever dealt with allergies, you know how miserable it is.
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And maybe you've been frustrated because some days your allergies seem perfectly
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fine and other days they are really on fire.
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You're getting that itchy throat, your brain fog, you're coughing,
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you're sneezing, maybe you're even wheezing.
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And you're getting exposed to the same allergens, but for whatever reason,
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your reaction is either delayed or you're not getting a reaction one day,
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you're getting a reaction another day.
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So the way I break this down is I talk about the allergen load,
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the immune reactivity, and the baseline inflammation.
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So this is kind of the threshold model that I talk about. So there are these
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three factors that affect your symptoms and whether you need to do something about it.
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The allergen load is however many chemicals or substances you're getting exposed to.
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The way your body responds to these allergens is the second factor.
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And then the third factor is how much inflammation you can tolerate.
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And of course, when you exceed that tolerance, you're certainly going to need
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some medication or something to calm things down.
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If you understand this triple model system,
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then you'll be able to take from each of these buckets and improve your symptoms
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to the point of hopefully not needing medications or needing very few medications
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that are going to give you much better responses.
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So what is it that's actually happening in the body, though?
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What's happening in the body that this whole array of symptoms is happening?
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You're getting the allergen that comes into your body and
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it's going to bind to certain receptors and
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it's going to activate your mast cells which are going to release a bunch of
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histamine this histamine is going to go on certain receptors in your sinus way
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in your airway in your throat and they're going to create the inflammation now
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this is happening because your body is actually protecting against these substances.
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In some of us, our reactivity to these substances, to these allergens,
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is excessive. It's so bad that we get atopic dermatitis, which is kind of that
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skin allergy, eczema type.
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We get sneezing, runny nose, congestion. We get the itchiness,
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really, really bad itchiness of the eyes, of the sinuses, of the ears.
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We get that scratchy throat burning sensation, we get the sinus pressure,
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the cough, and then of course that crazy fatigue that a lot of people talk about.
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So now that we know maybe the mechanism, but what is it that we can do to regulate this?
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Well, the most important factors are going to be the hormones in your body.
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And your gut microbiome. We're going to talk about these two because these two
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are going to regulate the way your body responds.
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And then we're going to address how to lower the allergens in your environment.
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And this is the way I do it with all of my patients and health coaching clients.
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We talk about cortisol, estrogen, progesterone, thyroid hormone, and insulin.
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For example, cortisol will actually increase your steroid level in your body.
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So it will suppress inflammation. You actually will feel better.
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The problem is when towards the end of the day, that cortisol dips,
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your symptoms come back with a vengeance, which is why many people towards the
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end of the day have worse symptoms.
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Then we have estrogen. And both men and women have estrogen.
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Men with a lot of visceral fat are going to convert a lot of their testosterone
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to estrogen. and this will cause fluctuations in the inflammatory chemicals in your body.
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And this is why some women around their menstrual cycle will experience their symptoms differently.
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Progesterone plays a small part in women. You might notice this more in perimenopause,
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especially with nasal congestion.
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Thyroid hormone, especially in people who have a low thyroid state or for whatever
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reason, their thyroid is not having a proper effect in the end organs or in
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your actual organ systems.
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So in hypothyroidism, you're going to notice a lot more swelling of the mucous
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membranes, congestions, eye puffiness, etc.
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With insulin, with high insulin levels or insulin resistance,
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this is sort of the metabolic health problems, we see more systemic inflammation.
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So the same allergen is going to cause a lot more inflammation in your body
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if your insulin is too high. and,
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what we call it basically insulin resistance, which most of us have or all of
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us have to some degree, but most of us have some amount of insulin resistance.
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And controlling that is one of the best ways to actually calm allergy symptoms.
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Now, I talked about the gut microbiome. The gut microbiome is very diverse,
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but there are certain key bacteria that will increase your tolerance, Meaning,
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they release certain chemicals, they're called short-chain fatty acids like
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butyrate, and these will reduce the amount of systemic inflammation that your body experiences.
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So think of the common bacteria that you probably heard about,
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Lactobacillus, Bifidobacterium, Acromantia, certain Clostridium bacteria.
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These bacteria love diverse plant fibers.
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You give them more plant fibers, and what they'll do is they'll create more
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of these short-chain fatty acids, which are the chemicals that are going to
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reduce the inflammation.
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They'll also protect your gut barrier, right? So when your gut barrier is protected,
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the same chemicals, the same foods that you're eating may not cause the same
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allergy response in your body.
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So with diverse plant bacteria, I'm talking about resistant starches.
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I'm talking about inulin, which you can find in garlic, onions.
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Think of oats, beans like legumes, and a lot of the polyphenols like berries and green tea.
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You can experiment with these because not all of us are going to respond the
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same way. For example, if I eat green bananas, I might get constipated.
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Or if I eat too much beans, I might get really bloated and I may not...
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També really make me feel a lot worse, even though my allergies might be better.
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So you do have to experiment, keep a good food journal to figure out which of
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these foods improve your allergy symptoms.
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All right, so we talked a little bit about lifestyle factors in the sense that
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if somebody is insulin resistant, what do we do?
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But let's talk about the actual things that you can do in your environment because
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if you know what things help improve your symptoms,
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now you need to know what environmental triggers can you manipulate to decrease
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the load of allergens in your system. What am I talking about?
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I'm talking about home air quality, outdoor exposure, your bedding.
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So home air quality we can control with a good filtration system.
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A lot of people talk about HEPA filters, H-E-P-A, and that's fine.
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But remember, HEPA filter is usually very small. It's really not going to do
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the job because it can't pull a lot of air, sometimes just having a regular
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old air filter is still going to work.
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Because yes, a HEPA filter is going to take out 99.99% of items out of the air.
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But a regular air filter is probably still going to remove 30%.
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And if it moves a lot more air, you're actually reducing a lot more allergens in the air.
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So get a good baseline air filter.
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Those are the big air filters that you put in your house, and that's already going to do a lot.
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And if you need a little bit more, you can put a smaller HEPA filter next to
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your bed or in specific rooms where you spend a lot of time.
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And of course, make sure you change these filters regularly. That's a big one.
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And then during high pollen times, of course, you have to close windows.
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You have to regulate how much pollen exposure you get. And I know most people know that.
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But one of the things I'm surprised that a lot of my patients didn't know is
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you can actually wear a mask during peak pollen days.
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You can shower right after you come home.
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You're going to wash off all that dust and allergen and pollen out of your hair,
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out of your beard, out of your body.
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And especially before going to bed you can do that routine
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you can shower one more time and changing your clothes when
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you come from outside change your clothes those clothes are going
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to have dander they're going to have things they're going to carry items
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that are going to set off your allergies washing your
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bedding a lot of people know about it i really
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don't know anyone who does it except some parents do it for their kids
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so wash your bedding weekly use hot water
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54 celsius 130 fahrenheit that's
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going to kill the dust mites the dust mites are
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going to have that dander that you don't want to react to you can
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even use just dry heat so you can
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throw your pillows into the dryer a lot of people know about
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that but they don't do it right you can allergy proof your mattress and pillow
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there are these encasements that that do that but honestly if you're just washing
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them and using dry heat that's more than enough and pay attention to your bedroom
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If you have a lot of fabric everywhere,
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like a fabric sofa, you got a fabric, what are those things called? Headboards.
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You have like a big thick carpet. Those things might be a problem.
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Of course, you can use a really good HEPA vacuum to get that out regularly.
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Use a damp microfiber on surfaces. That's going to help a lot.
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Clean ceiling fans. Look at the vents.
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And then carpets, right? If you can avoid carpets, that is ideal.
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Feather dusters are not as good compared to the microfiber cloth because feather
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dusters sort of move the dust all around and it can make things a little bit worse.
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So that's what we can do to our environment. But what can we do to our actual body?
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What are some things that we can do? These kind of what we call sinus hygiene or airway hygiene.
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I'm talking about nasal sinus irrigation. So at least once or twice a day,
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you can get a sinus rinse.
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I like NealMed, N-E-I-L-M-E-D.
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And it comes with the little saline packages.
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They really want, you really want them to be isotonic. So if you make your own,
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it's fine. But if they burn or get really uncomfortable, that's unnecessary.
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Always use sterile or distilled water. And then you just lean forward into the sink.
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You press this bottle and it squirts this stuff up your nose.
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And then if you tilt your head a little bit, that's it. It comes out and then
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you can just rinse it under tap water and let it air dry.
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That's more than enough for kind of this hygiene part of it.
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And of course, the other hygiene part is the clothing, washing the hair,
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washing your body. That can also help quite a bit.
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Now, we're going to get into some dietary stuff that we can do because we just
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talked about certain things to help feed your gut bacteria and protect your gut lining.
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But there are certain foods that some people, not everyone, is going to react to.
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These are the high histamine foods.
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Aged cheese, cured meats, smoked meats. Think of fermented foods like sauerkraut
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and kimchi for some people, not everyone.
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Very high vinegar foods, alcohol, like certain wines, canned fish,
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foods that have been left over for more than maybe 24, 48 hours.
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These foods are going to contain a little bit more histamine.
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Now, are you the histamine sensitive type or maybe your body is not really that
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sensitive to histamines from food? You're just going to have to experiment.
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But if you want to do it, just try to eat more whole, fresh,
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minimally processed foods. that's for the most part going to help you quite
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a lot and especially in high pollen season and when your allergies are really
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bad just avoid alcohol altogether.
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For some people, I should mention strawberries, tomatoes, eggplant.
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These are the kind of vegetables and fruits I'm mentioning that actually are
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histamine-releasing for some reason.
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So shellfish, chocolate, certain citrus fruits, eggplant, spinach,
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tomatoes, strawberries.
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Those are the ones that I always mention to my patients. And you can find these
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lists of foods online anywhere.
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But you can try experimenting with these and see if your symptoms might improve.
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Weirdly enough certain times in
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the season you might have strawberries and they
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don't do anything to you and then you have strawberries again and they do something
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to you so again it comes with experimentation and of course talking about food
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allergens or allergies certain foods might actually directly trigger meaning
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you are allergic to these foods and i always mention these top five These are the top five foods.
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Dairy, gluten, eggs, soy, and nuts.
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Dairy, gluten, eggs, soy, and nuts.
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If you're going to be allergic to certain foods, these five are going to be
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there. And you can experiment.
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Sometimes having less of it is better.
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Sometimes you need a washout period of three months where you really calm down your allergies.
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Then you slowly introduce one of these foods a little bit at a time to let your body get used to it.
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And you might see that you can actually tolerate them quite a lot more.
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And again, food journal for something like this is going to be key.
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And you can work with your health coach or a nutritionist to exit these things
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out of your system and then reintroduce them back in.
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Okay, so we talked about pathways and different things that we can do to the environment.
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But what is it that we can do now in this third category of actually treating the inflammation?
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Okay, it's time to treat the inflammation.
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I'm going to start with nettle tea.
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The reason I'm starting with nettle tea is not because it's the most effective.
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By far, it's probably not the most effective. But for whatever reason,
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it works really well for some people. I know some people take capsules,
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and you should know nettle tea can be a bit of a diuretic. It can make you pee.
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So it's maybe something you can use in very small amounts early in the day,
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just a little bit of a tea.
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It might work for you. It might not. If your symptoms are mild,
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you can try a little bit of nettle tea.
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You can try it every day, take a week off every few months, and try it again.
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So with that set aside, kind of that herbalism approach, let's focus on medications.
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Intranasal corticosteroids. We're talking about fluticasone,
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mometasone, budesonide.
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You may have heard of Flonase, Rhinocord, Nasonex.
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These are topical steroids. You spray them up your nose just once or twice a day.
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They're really good for decreasing inflammation, not just in your nose and the
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congestion, but also in the back of your throat.
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They're very safe for long-term use and they're
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great for minimizing absorption into the system so instead of taking something
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what we call systemic like a pill we use something topical and flonase is great
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for that but you do have to use it pretty regularly you can take breaks but
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then you want to start it back up and it might take a week or so for it to calm down your symptoms,
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on top of flonase or any of these nasal steroids what else can you use well there is the.
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Intranasal antihistamines.
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So the two most common ones that I've prescribed that my patients are familiar
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with is azelastine and the other one is olopatidine.
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So azelastine and olopatidine, both of these come in nasal sprays.
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Both of these are usually available
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over the counter and they will just decrease sudden onset symptoms.
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So if you're just really bad and you just need something immediately. They're fast-acting.
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They'll help with itching and sneezing, and you can combine them with the steroids.
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But it's not something I would use all the time. It's just something you use
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when symptoms get really bad.
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What about eyes, right? So we got the same eye drops in the same antihistamine
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family. We got olipatidine eye drops.
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There is the catotafin. You might know like aloe or zatador.
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And then even azelastine has some ophthalmic drops that you can get over the
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counter, some of them are by prescription, and these are very safe for itchy
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eyes, for that redness, that watering. It's really good.
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If, I guess, runny nose is the biggest deal, I usually just go for ipratropium.
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That's probably the best one, Atrovent nasal spray. That works really good.
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But really mostly for runny nose, not so much for the antihistamine effects.
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Okay, so we covered these topical medications, but what if you need something more systemic?
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Well, the good news is that you can actually take pills that will calm this down.
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It won't permanently fix it, but it will calm it down. there
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are two classes of meds that we're going to talk about we're going to talk
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about the first generation antihistamines like benadryl and the newer generation
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or second generation antihistamines which i prefer and that's allegra zyrtec
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claritin i'm going to mention those names because everybody knows those names
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but it's fexafenadine cetirazine and loradadine in that order um these are non-sedating.
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While Benadryl or diphenhydramine is sedating.
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One of the things with Benadryl is that it can also mess up your sleep a little bit.
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It interferes with your REM sleep and it has some of those stronger what we
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call anti-cholinergic or drying effects.
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Some people have problems urinating, it constipates them.
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So it's okay when your symptoms are really severe.
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Now look, everybody reads online that, oh, Allegra, Zyrtec and Claritin don't
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have any of these symptoms. Well, that's not true.
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Lots of my patients tell me I still get constipated, I still get groggy,
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I still get irritable when I take these medicines. Yes, they can actually make you irritable.
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So you have to experiment with it. But I usually start with fexafenadine,
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180 milligrams, or I do fexafenadine, sorry, is Allegra.
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Or I do cetirizine, which is Zyrtec, about 10 milligrams.
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Claritin works fine. Claritin works just fine. But those are the ones I usually start with.
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And again, in about 10% of people, it can cause irritability,
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agitation, or severe drowsiness.
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So just remember that. Even though they say, oh, there's no such thing,
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these things don't cause it. Yes, they can cause it.
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Um, oh, a lot of people know Montelukast. They use Montelukast.
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Um, and that's fine. I think that's a good one, especially if you have asthma
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and severe allergy symptoms.
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Um, it's a good one to have your allergist prescribed.
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I don't prescribe it to my patients because by the time somebody is not responding
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to these first line agents, I prefer for them to be followed by an allergist
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because yes, we could use Montelukast pills, uh,
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but it might be better for them to maybe get allergy shots which we'll talk
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about in just a minute because at this point we sort of have to say okay we
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did everything we addressed the allergens in the environment,
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we addressed how our body responds and we addressed the local inflammation to
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the point that we can't tolerate it anymore when these things aren't helping
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these treatments these regimens aren't helping i like to have an allergist involved
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so usually if you have asthma usually if you're getting a lot of sinus infection,
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especially if we think there's food allergy involved,
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they can do weekly allergy, these subcutaneous under-the-skin injections.
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It's called immunotherapy.
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There is even sublingual immunotherapy for certain things, not everything,
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but like grass, dust mites, I think even ragweed. It can be really effective for those.
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My patients ask, okay, well, if I take these immunotherapy, am I cured forever?
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No, but you may need a lot fewer medications or not need any medications, which is great.
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Now, I know this podcast is kind of long, but I hope that it's something that
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you refer back to multiple times because there's a lot of information I'm sharing
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here. You're going to forget stuff.
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I wrote down some of the common patient concerns that over the years I've collected.
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Number one, are antihistamines addictive? No, they're not addictive.
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And the good news is you can stop them and start them at any time.
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But if you use something for a very long time, it's a good idea to come off
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of it slowly so you don't get a rebound effect.
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Okay, well, what about Afrin, right? The classic nasal decongestant spray.
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You can use that for a few days in a row if your congestion is super, super bad.
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But I don't like using it for a long time. it actually is more effective when
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you use it for fewer days.
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What about tolerance? Will I build tolerance? Yes, you're going to build tolerance.
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The more you take these medications like Zyrtec, Allegra, Benadryl,
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there's going to be a slight tolerance that you build.
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But the good news is that it's not that severe.
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And if you stop it for a few days and restart it again, that tolerance usually goes away.
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And of course, I hear about nasal steroids. Hey, I don't want my bone to thin.
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You know, it's not that well absorbed into your body, into your bloodstream.
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So it's probably not going to cause any such issues. If I had severe allergies,
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I definitely would reach for these nasal steroids.
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And I'm somebody who stays away from medicine whenever I can.
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I get this question. Okay, if I perfect my diet, if I do everything perfect, will I cure allergies?
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No, unfortunately, probably not. But you might make it very,
21:45
very tolerable. You might make it much, much lower.
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Your diet lowers the baseline inflammation, but it rarely replaces all of these
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other things that you have to do to mitigate the amount of exposure you get and the inflammation.
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And then another question I've gotten is, are these medications going to suppress
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my immune system? Are these treatments going to suppress my immune system?
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No, antihistamines block just the
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histamine receptors. They don't suppress anything in your immune system.
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We don't have any. In fact, you might get fewer sinus infections and even cold and flu.
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So in closing, remember that allergies really are this threshold problem.
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You got the allergen load. You got the immune reactivity and the inflammation
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that can often exceed your tolerance level.
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And so we want to, number one, reduce the exposure. Number two,
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we want to support your immune system through the hormones and everything else that we talked about.
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And we want to use a targeted local approach first.
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That's number three. And number four, if that's not enough, we're going to go
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for what I call the big guns, even though they're not really big guns.
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We're going to go for the systemic or oral medications.
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So give these a try. Remember, work with your health coach, work with your physician,
23:01
and keep that journal to get the best out of it.