Sjogrens Syndrome and Treatment: What Women Need to Know | Dr. Kara Wada

Dr. Wada: [00:00:00] There are between one to 4 million Americans with Sjogren's disease and around half of those individuals are not yet diagnosed. Of that total number, 90% of those patients are women autoimmune 

Dr. Brighten: diseases on the rise, and 

Dr. Wada: it's primarily affecting women. A third of patients will stay the same, a third will get worse, and a third will get better even if they have that same underlying diagnosis.

Dr. Brighten: I was a vegetarian for 10 years. I developed autoimmune disease. I could not manage blood sugar stability on a vegetarian diet anymore. And why don't people look sick? And what do people need to understand about autoimmunity? 

Dr. Wada: I was the skinniest I had been since my teens, and of course that came with significant, oh, Kara, you look great.

And yet I was probably the unhealthiest I had been. 

Narrator: Dr. Kara Wata is a quadruple board certified allergist, functional medicine expert and founder of the Immune Confidence Institute, where she helps patients with [00:01:00] chronic inflammatory diseases reclaim their health. 

Narrator 2: After experiencing acute liver failure and medical gaslighting herself, she became a powerful advocate for physician-led rebellion, compassionate care, and patient empowerment.

Dr. Brighten: That's the worst thing about being sick and then having to fight just to be heard that you are actually sick, unfortunately is what we're seeing. We 

Dr. Wada: really just need to be seen. And heard and witnessed. The other piece that I don't think gets taught, and frankly I was quite surprised to learn, is that welcome 

to the Dr.

Dr. Brighten: Brighten Show, where we burn the BS in women's health to the ground. I'm your host, Dr. Jolene Brighten, and if you've ever been dismissed, told your symptoms are normal or just in your head or been told just to deal with it, this show is for you. And if while listening to this, you decide you like this kind of content, I invite you to head over to dr Brighten.com where you'll find free guides, twice weekly podcast releases, and [00:02:00] a ton of resources to support you on your journey.

Let's dive in. This conversation I'm very excited for. We are going to get it into autoimmunity. We're gonna talk about an autoimmune condition that's considered rare, but predominantly affects about 90% of women. So this is gonna be a really important conversation for women to listen into, but for everybody listening right now, where I wanna start is what are the mistakes that people are making that they think are helping their immune system, but is actually making it worse?

Dr. Wada: So I'm gonna share what I did wrong, um, which was really to lean into perfectionism. Mm. Uh, when I was first diagnosed, I, you know, had felt all the feelings, uh, fear, um, felt disappointed and very sad. And like I had brought this on myself, but like, you know, most of, uh, you know, especially type A women, I was, you know, okay, I'm gonna eat perfectly.

I'm gonna work out so hard on that Peloton, you know, my metrics are gonna [00:03:00] be off the chart. I'm gonna do all the green smoothies and everything. And the reality is that it pushed me into a much more severe flare, and I ended up actually with an acute liver injury from all of it. Oh, wow. All of those things are adding additional stress to the body.

If we're overworking out, if we're focused so much on what we're eating, what we're not eating, and all, all of the, the chatter about food in our minds, um, that increases our stress. It increases our stress response. And I think one of the biggest lessons I had to learn. And I'm still learning, frankly, is how to manage my mind around the uncertainty that is living with a chronic illness, but frankly is also just living in general.

Dr. Brighten: What is perfectionism doing that makes us more susceptible to autoimmune flares and immune dysfunction? 

Dr. Wada: I think some of it is related to that internal dialogue. 

Dr. Brighten: Mm-hmm. 

Dr. Wada: Um, for me, [00:04:00] and, and I can speak primarily, you know, from that lived experience is that I, I don't think I knew what self-compassion was at all.

Oh, yeah. And, and we know there, there's a great body of scientific literature that says, goodness, the, the kinder we can treat ourselves, the more we can treat ourselves like we would our best friend or sister, maybe not always our sibling siblings, but our sisters. Right. Um, that that is not only good for our mental health, it is really beneficial for our physical health.

Mm-hmm. And goodness, I was doing the exact opposite for. Essentially the first 35 years of my life. Yeah. Um, and that has been a, a continued area of growth. I think the other thing, um, for me was really dev developing and coming out of diet culture a as a product of, you know, the mid eighties and growing up in the nineties and, uh, and, and all the low cal, low fat, Atkins, all that sort of, um, business was really becoming [00:05:00] super fixated and focused on, gosh, I need to do this elimination diet.

I must do it perfectly. And what we realize and what we know from large studies is that it's really the diversity, especially in the types of plants you're eating mm-hmm. That really help feed that beneficial microbiome. And that in itself is, is great in regards to the anti-inflammatory, creating those short chain fatty acids and, and pumping out those healthy immune system, um, kinda rebalancing our immune system.

Dr. Brighten: Mm-hmm. I love that you brought up the self-compassion. Yeah. It's, it's so interesting when you look at the research that shows that when you talk kind, I like to say, you know, say pretty words to yourself. Yeah. It actually drops inflammation. Yeah. And what's crazy to me is I'll see doctors out there and they're like, oh, it's woo woo to think that like mantras or positive affirmations or saying nice things to yourself is gonna do anything for your health.

And I'm like, I remember when you all. We're [00:06:00] saying that about nutrition 20 years ago now, some of the same people that I saw online five years ago that were like, nutrition does nothing, are now like, we're experts in this. And I'm like, oh, slow down for a second there. Yeah. But it, we have research that substantiates this.

Mm-hmm. The other thing that I have seen, so, you know, I've been very vocal in the health space for over a dozen years, and I would talk about the gut microbiome and how important it is in immune health, autoimmune health. We are just now seeing doctors starting to acknowledge that Yeah, actually your, your gut health is important.

I mean, it's, it's interesting 'cause as you bring up Akins, that's when I was in nutrition school and that is when we were told that the microbiome was a bunch of freeloaders. It made a little bit of vitamins for you, but it really did nothing. Yeah. What do we know now today about how important the gut microbiome is for our immune system health?

Dr. Wada: Yeah. What I think is really frustrating, um, and, and especially just coming out of a, a role [00:07:00] within academia and, and teaching our future allergy and immunology physicians, is that this area of science is lagging behind in what we're teaching our trainees that are coming out into practice. It is now being talked about at our national meetings, which is fantastic, but that timeline and that gap between when we see discovery and when it's actually implemented within medical education.

It takes far too long. 

Dr. Brighten: So you're saying that science comes out, but it's taking far too long for the future physicians to actually be taught this information, current physicians at conferences. 

Dr. Wada: It, it's interesting. It's, it's things that I was starting to learn about in my own health journey, kind of within that integrative space that then I, you know, a couple years later I'm at one of the national allergy meetings, like, oh, well I've already been hearing about this.

But also very excited to see that like, oh, this, this truly is getting a larger platform. What we're learning [00:08:00] is that a break in our barriers or chinks in our body's armor are really disrupting that communication that our body is always undergoing between what's going on in our external environment and the inside of our bodies and determining are we safe?

Are we not safe? And that job is kind of co-managed by both our immune system and our nervous system together and. When there is that disruption and you know, for the longest time that term leaky gut was like a, a like four letter word. Right? I 

Dr. Brighten: know also you had like all these people saying like, that's woo woo that's out there.

Yeah. And I think a lot of the problem is, is that, um, there's just too much ego in medicine and science to where when the lay person is like, let me adopt this language of leaky gut because I can wrap my head around this intestinal hyperpermeability. Like, that's weird in the mouthful. Right? And, and that's the word we're using.

[00:09:00] That's the word, you know, the phrase that you see in the scientific literature. And for doctors to be like, oh, I'll acknowledge that intestinal hyperpermeability is real, but leaky gut is not real. And I'm like, dude, just let your patient use the language they're most comfortable with. 

Dr. Wada: Absolutely. I think we have to meet people where they are and there's, there's so much mistrust, um, in, in large part because so many people, especially women in other marginalized communities, have not.

Had the best experiences within the, you know, this, the, the typical medical system. I think we really need to take a long, hard look at how we can rebuild that trust and it's going to take, you know, some concessions and that ego for sure. Yeah. 

Dr. Brighten: Well, I wanna bring you back to what you were saying on leaky got, 'cause they took a little detour there, but it's mostly to acknowledge people who are listening who have felt dismissed and is exactly what you said.

It's women in marginalized groups [00:10:00] who have been treated so poorly by medicine and now they have this. It this distrust, the only way to rebuild it is for us to acknowledge the things we got wrong, the harm that was done, and then vocalize and take action on making that better. But to the point of leaky gut.

So we were talking about the microbiome, leaky gut, and what role is that playing in terms of our immune health? 

Dr. Wada: Yeah. So it's not only occurring in our gut, but this leaky barrier also occurs in our skin when we see someone with eczema or psoriasis, same type of processes going on, it's also occurring in our airway.

Uh, for me, that's been the bread and butter of the medicine that I, you know, that I've practiced mm-hmm. For, um, over a decade. And increasingly understanding this also is occurring in our genital urinary tract. 

Dr. Brighten: Yeah. 

Dr. Wada: Especially as women. Hmm. Um, and goodness, we are just scratching the surface. And I know that's more of an area of your expertise, but in all of those areas, if there is, are those chinks in our armor, [00:11:00] there is that increased connection and discussion between the outside world and our inside world.

There also is associated with that changes in our microbiome, and we don't know what's the chicken or the egg, and frankly they're probably feeding off of one another. Mm-hmm. But we see typically a decrease in diversity. We see a change in the behavior of those microbes and, uh, we see a change or a difference in the types and of species and, um, and strains as well.

And with that, their activity then also creates different postbiotics, so. Mm-hmm. Uh, we'll backtrack just a minute. So when you, we eat food, um, and if, if we were to take things in supplement form, our prebiotics would be the fiber that we're eating or if it's in our, in a supplement we're taking. Right? And then probiotics are the live bacteria that hopefully are still live by the time they reach your intestines.

And then postbiotics are the things that those [00:12:00] microbes create when they are fermenting those prebiotics or the fiber. And so when we see those changes in the downstream effects, that then changes how our immune system is responding to those interactions. Mm-hmm. Is it friend? Is it foe? And if it is deemed a problem or deemed dangerous, then that turns up inflammation.

Dr. Brighten: I had a episode where I talk about how every organism has a tube, that's all the gut is, is a tube. And the main function of the, well, one of the main functions, I should say, 'cause as many functions is assessing the environment and we think about how babies are going around putting everything in their mouth.

Yeah. You know, I know there's some moms listening right now. What would you say about, you know, babies who are putting everything in their mouth? Because we, as we saw a lot, I think it still goes on this like, let's keep the environment [00:13:00] sterile as clean as possible. Never let baby put stuff in their mouth.

What would you say to that? 

Dr. Wada: Do the best you can, but also it's okay to take a deep breath. And when my kids are, you know, crawling on the floor or doing things, you know, out in public that I frankly would rather they not pick up the flu or what have you, stomach bug that's going around, take a deep breath and say, okay, their immune system is seeing, uh, some of those.

Good stimuli, so. Mm-hmm. We know, um, from research that looks at families that live in more rural settings, for instance, Amish communities, they have exposure to more bacterial endotoxin that tends to shift the immune system in a different direction. The data on pets seems to go back and forth, uh, but generally speaking, um, exposure to pets from even before conception onwards tends to lead away from, um, allergies as well.

And part of it is the thought that it is bringing in more of those particular types of bacterial, um, components that shift [00:14:00] that immune response away from allergy. 

Dr. Brighten: Hmm. I wanna hear more about the Amish because this is the first time I'm hearing this. So what are the Amish doing differently and how is that impacting their gut health overall?

Dr. Wada: Generally they're living in communities and in close proximity with animals. Mm-hmm. They're living alongside, uh, cattle, horses, you know, other farm animals, and they're, they're doing that work. They're interacting with them. They also, um, certainly have other aspects to their culture that is very different from, from, frankly, how I, I live in the middle of Ohio, right?

Yeah. Um, in a more suburban setting. But it is thought that that close proximity to animals. Being outdoors more is really probably one of the major driving factors that we're seeing in shifting away from that allergic response. 

Dr. Brighten: And so do you see less allergies, asthma, eczema among Amish? We do. Wow, that's really interesting.

Um, and it makes me think about like, you know, [00:15:00] where, where are we raising our children now? What are ways that, like we can, you know, maybe replicate that you live in an urban area, should you take your kids to petting zoos? 

Dr. Wada: I think you probably do wanna wash your hands afterwards. Yeah, certainly I'm a fan of hand watching them say, um, that, that's, that's always a test question on the pediatric boards of like, you know, a kid went to the petting zoo and ended up with a diarrheal illness.

Yeah. I think that those experiences of getting them out in nature, we know that nature has many beneficial impacts on our health from our natural killer function. If we mm-hmm. Spend out time outdoors, letting our kids play in the dirt, letting them get dirty, letting them have fun. I also, you know, I think there has already been a, a, a, a better correction kind of in that pendulum in our response to infections.

So not being, you know, super quick to the draw when it comes to, you know, reaching for antibiotics if it, if it truly, if the child looks. [00:16:00] Generally pretty well. You've checked in with their pediatrician and you can kind of watch and wait and make sure, like do they really need that amoxicillin or can they make it through this infection without, mm-hmm.

We know that the less courses of antibiotics we're exposed to that, that has benefits as well. Mm-hmm. And then trying to keep the skin barrier intact. We know that children who have eczema, babies with eczema are at an increased risk of food allergy. Mm-hmm. And so if we're able to, you know, decrease that barrier dysfunction from the get-go, we have seen that that can decrease the risk of food allergy as well.

So 

Dr. Brighten: is that because the skin barrier being broken down means that the potential allergens, the food proteins are being exposed to the immune system in a way they shouldn't be? 

Dr. Wada: Yeah. So the working hypothesis is that for food allergy, that, that food, rather than being introduced orally, the oral mucosa, oral immune [00:17:00] system is more built for building tolerance.

Mm-hmm. We think of those babies crawling around, putting everything in their mouth. Right. The skin is not. Mm-hmm. And so that skin barrier is broken and you see peanuts through your skin first. Prior to your gut, then that increases the potential of shifting towards allergy. And so that's why the data from the LEAP trial, which came out right as my, my oldest, was like itty bitty, um, really shifted our perception from what we were, what we were teaching, uh, our parents, which was to avoid peanut, which that's a whole nother misstep, but to really start introducing that.

Early. Mm-hmm. Orally, um, once the child was developmentally ready, um, in order to try to prevent or decrease the likelihood of developing food allergy. Yeah. Particular peanuts in that study. 

Dr. Brighten: My children are eight years apart. The first one, it was all about don't introduce this until they're year, don't introduce that.

And [00:18:00] like, and then I remember, um, the study on mice. So if people aren't familiar with this, they just, these little mice and they rub them down with peanuts and they expose their skin to peanuts and then they're like, lo and behold, peanut allergy. We should have never been telling people to avoid foods.

And this is where, you know, I don't think ancestrally speaking, everything our ancestors did is a perfect fit for today. But I'm like, man, if you do look back at that, and you look back at the generations and then you looked at what changed in medicine, it was medicine's recommendations to withhold these things that then resulted in the increase in food allergies, which is something that, you know, we were talking about at the top of this.

Like we have to acknowledge like, oh dang, we got that wrong. So then with my, you know, my next one comes around, he hits six months and I'm like, let's just put stuff in front of you and like, and you know, just same. I mean, even. We have a gluten-free house, but we would go to a restaurant and they put bread on the [00:19:00] table.

And my oldest was like, you know, he, he's got other stuff, other reasons he can't have, uh, gluten at this time. Like, good, I wanna get that back in if I can. But the youngest, my, I was like putting the bread in front of him and my oldest is like, this is so not fair. Like, you did this so different with me.

And I'm like, I know. But the, the thing that I see happen a lot with parents is that because they did it one way for one child, they don't wanna admit that like they got bad information that that was wrong and then not course correct for the next child. And I'm like, I will always try to be the example of like, when we learn better, we do better.

We were working off this information, we thought it was really brilliant. We were absolutely wrong and it really messed up generations of kids. Um, so I'm glad that you brought that up 'cause I think that is really helpful for people to hear and for parents to hear. I want to ask you, you set the bar is far too low for autoimmune disease.

What do you mean by that? 

Dr. Wada: So this was with a conversation with uh, another virtual friend of mine who, um, is [00:20:00] healthcare professional. She also lives with a significant autoimmune disease. And really, you know, it was out of this idea that goodness, we really just need to be seen and heard and witnessed.

Dr. Brighten: Mm-hmm. 

Dr. Wada: We need someone to believe our truth. Even when, and especially when that doesn't necessarily check all the boxes. I've been very humbled as, as I've embarked on kind of opening my own practice and having more time with patients because it really is just letting people share their story. Mm-hmm.

That in itself is so incredibly powerful. They need and deserve more than just sharing their story. Mm-hmm. But goodness, that that off the bat has been a real key change that I think the greater healthcare system could really benefit from. 

Dr. Brighten: I absolutely agree. I [00:21:00] always encourage people like, share your story because it's not just healing for you, but you never know who will hear your story and be like, healing is possible like this.

This is possible. Whereas as women, I think that's why we're seeing some of the biggest changes happen in medicine is because we have social media now, so that one-off gaslighting and isolating us and keeping us in shame and society telling us we don't talk about things, it's not working anymore. We're talking about things and here we are in 2025.

I don't, I don't know if you've had an experience with an IUDI had an IUD worse, worse than childbirth. It was so excruciatingly painful. Mm-hmm. I cannot believe what I was subjected to and I was told just to take NSAIDs as if it even touched the pain and. All of us who have had IUDs, there's people out there that are unicorns and they're like, I didn't feel anything.

I love that for them. But we've talked about this. Yeah. Where, I mean, mine was, you know, more than a decade ago, and I've talked about this and patients have talked about this, and it wasn't until [00:22:00] it took off during the pandemic 2020 TikTok, every woman starts telling her story. It took five years of millions and millions of women and the rest of the world being like, y'all are barbaric.

What is the US doing? Like, what are you doing to women? Like, and those women saying, no, we have pain management. No, we get things better. And it was through that conversation that finally, here we are in 2025 and they're like, oh yeah, we're gonna change our guidelines. You should do pain management. And I'm like, what is going on?

Yeah. So I wanna know from your perspective, like you are, you're kind of trailblazing in terms of the information that you have, what you are learning about autoimmune disease, how you are working with patients so differently. What is that like for you to see where your colleagues are at, to hear some of the things they're still recommending, to see these seven minute visits still taking place and for you to be doing things so differently?

Dr. Wada: It's exciting. It's also, frankly, a bit nerve wracking and you feel vulnerable. Mm-hmm. Because [00:23:00] there's a story of Dr. Alweiss, uh, who is, uh, he was a physician back in the 18 hundreds, and he was the one who said, oh, look, look, the midwives, their patients aren't dying. Mm-hmm. But all the physicians' patients are.

And what was the difference? The physicians were doing autopsies between deliveries and they weren't washing their hands. Mm-hmm. And so he encouraged everyone to wash their hands, and he was completely ostracized over that to the point that he, he ended up in Yeah. Institute, I think Institutionalized.

Yeah. And, and subsequently, um, you know, as, as a result of that, had an, an early death and you, you see some of that. And, and so I feel like I, I am always in this balance of where's the evidence, what feels also right and true and what, you know, in, in finding, finding that individual balance with each patient.

I remember [00:24:00] many, many years ago, something totally unrelated to, to medicine, I think it was a high school leadership workshop, learned this idea of the platinum rule. Mm-hmm. Which is meeting people where they are not necessarily what you would want, but where they would li want. And so I think that that's really important as we think about how we best take care of people is meeting them where they are.

Mm-hmm. When. It comes to some of the trailblazing. It is interesting seeing the difference in how care can look in different areas. And I've seen that a lot with an allergy treatment for typical allergies, traditionally has been shots where you go to the office once a week, occasionally we get it out to once a month and you go for allergy shots for three to five years.

Mm-hmm. It's really helpful. Helps decrease the amount of medications you need. It really helps shift the immune response. But frankly, it's a lot of visits, it's a lot of pain. Mm-hmm. Um, terrible. Not IUD level pain certainly. Um, but it, it, it's still, [00:25:00] it's dozens if not hundreds of shots over time. And one of the things that my colleagues primarily as ear, nose, and throat doctors were doing, uh, a, a bit earlier than we were as, as board certified allergy immunology, kind of the nonsurgical ones, um, was administering allergen under the tongue.

So sublingual allergy drops. Mm-hmm. It's interesting through my, uh, onboarding, uh, where I was on faculty at Ohio State, I ended up taking over the position of an ear, nose and throat allergist and was put in charge of the sublingual immunotherapy, um, program. And this was before it was accepted mm-hmm.

Within my peer group. And, and so I feel like even from the very beginning of my career, I've kind of been in this place of like. Pushing the limit a a bit. Yeah. Um, but also trying to walk that line of, of being a trailblazer while also not being too [00:26:00] out there so that people actually will listen to you still.

Mm-hmm. I am still trying to learn that balance. Yeah. Frankly. Yeah. 

Dr. Brighten: Well, and what you illustrated in that story, 18 hundreds, right? First you're criticized, then you're villainized, then you're, you're punished usually in some way. And then medicine adopts it acts like you never said anything, you never existed.

And that they had always been on top of this. And that's what I talk about is the ego. What's crazy is absolutely wild. This still is taking place even today. Yeah. We see the same thing. We see, uh, lifestyle medicine is one of those things where it was criticized, villainized and then adopted, and anybody who was talking about it born beforehand, that was villainized.

Like, they're just like pushed to the side and now like, here come the people who just arrived to the party, but they have decided that they're the host. Like they've, they've been, they've been planning this thing for months. They're, they're in charge here. Um, I wanna ask you, efficacy [00:27:00] of sublingual versus shots.

I think people listening with allergies are gonna wanna know that. 

Dr. Wada: Yeah. So when, what's really challenging is we don't have great head-to-head data. Mm. There is a lot of thought in that. The data that we do have would say that perhaps for folks that have year-long allergies, dust mite cat's, dogs, perhaps shots are a little bit more, um, effective with seasonal allergies, pollens, grass, those sorts of things, trees, um, that those may be more equal in nature.

Everyone is an N of one, so everyone is their own individual. Mm-hmm. And I think the big difference is what fits with your lifestyle drops are in. And the tablets that are FDA approved, um, that do go under the tongue are not perfect either. They require folks to continue to take them daily, um, for, again, three to five years.

So, and if someone has mouth irritation, [00:28:00] itching, swelling, um, or they're just frankly not great at remembering to take something every day that still may not be the best fit for them, but they could do it at home and it's a bit safer. That's why we're able to do it at home rather than an office. So I think there's trade offs.

I think what I'm even more excited about and frankly really kind of, you know, another turning point kind of in my practice, um, was learning about something called intra lymphatic immunotherapy. Mm-hmm. Which essentially speeds up the process from three to five years to eight weeks. Oh, wow. It's three injections.

Mm-hmm. There's an ultrasound to direct the allergen and a smaller amount of allergen directly into the lymph node. My question, when I learned about this and I saw the data that was. Pretty darn consistent with effectiveness that you see from regular shots and sublingual. I was like, why? Why isn't everyone doing this?

I, I learned about this treatment in 20 14, 20 15 from some researchers in Switzerland, again, Europe, um, kind of, you know, [00:29:00] pushing, you know, the, the innovation and the speaker and an innovator, Dr. Thomas Kundig, who was speaking, said, the problem is there's no financial benefit for anyone to offer this. The companies that make the allergen you, we would use far less of it, right?

Because there's fewer doses, there's less amount in each dose. The al little ultrasound companies, they don't care like, you know, a few allergists mm-hmm. That that's not gonna move the dial. And even frankly, within an allergy, a traditional allergy practice shots are covered by insurance and they're reimbursed, or at least traditionally, have been reimbursed fairly well.

And that, frankly is, is a big part of that business model. And so it's like, gosh, if we have a treatment that might actually be safer. It's faster and the efficacy looks right on par. What are we waiting for? Yeah. And really, you know, we are just now starting to [00:30:00] see a bit more of, uh, you know, build in, in people realizing this exists, wanting to get trained in it, um, and wanting to be able to offer that to their patients.

It's just been a slow burn. Yeah. Again, I'm waiting for the others to, to come in and pretend that they 

Dr. Brighten: the party. Well, what you, what you just touched on though, gets called a conspiracy theory anytime anyone brings it up, that there is financial incentive within the US that obstructs our innovation in medicine are improvements.

And when you look at why would Switzerland, well, if you have a country that is taking people's taxes. Paying for their healthcare. Mm-hmm. You are gonna be incentivized to make that as cheap and as efficient as possible. Mm-hmm. When you look at a for-profit healthcare system, which is the United States, how can you tell me when capitalism is the rule of healthcare that financial incentives are not being considered?

Of course they're [00:31:00] being considered. Mm-hmm. But for you to bring that up, I'm like, man, that is something I see all the time where people are like, no, like that's, that's never at play and pharmaceutical companies are not doing that. I'm like, they're a business. They're business first. And in fact, there's irrefutable evidence out there.

So if you are evidence-based, why don't you look up, like why don't you look up lawsuits and case law and what's been won? Because it's absolutely all been financially driven. So it's not, it shouldn't be controversial. It should be something that we are able to talk about. But right now there is a huge push of like, we are never to question pharma.

They are never doing anything and even. Clinical practice. And where I want people to really not get this twisted is thinking it is the doctor. 'cause often they're like, it's the doctor who's greedy. And I'm like, ho, we gotta back this up. There's healthcare insurance and then there is healthcare admin and these are the people pulling the strings of the [00:32:00] poor doctor who would often like to do better by you, but they're stuck in this financial paradigm.

Dr. Wada: I'm, I'm just envisioning that chart that shows the growth in admin, um, salaries or overall costs compared to physicians, nurses, cost of treatment, those sorts of things. Mm-hmm. And frankly, even within academia, you know, a, a place where you would hope that perhaps there's a little insulation from that.

Unfortunately that's not necessarily the case. And, and that's in large part why I ended up having to change, change gears kind of from what I anticipated my career trajectory might look like. Because it got to a point where frankly I was making a third less than my peers because I really enjoyed caring for those patients that didn't read the textbook.

Mm-hmm. And those conversations took longer. And our current. Set up for how [00:33:00] reimbursement works, that means that you generate less revenue. Mm-hmm. For whoever you're working for if you're working under an insurance-based model. 

Dr. Brighten: Yeah. And you know, you bring up academia, it has the same problem that the healthcare model has.

I remember protesting alongside the teachers of the, where I was an undergrad, because the teachers were told they couldn't get a raise, but the president received a four, like 400% increase in his pay. Something like that. And that's what we continue to see. And that is why college is so expensive in the United States.

Yeah. Why is healthcare so expensive? Look at the overhead of the admin and what they're being paid. I wanna go back to this, uh, injection therapy you were talking about, that you learned about, um, how, so you're injecting straight into the lymph node. Mm-hmm. Explain to people why that works. Yeah. And, and what's actually going on there.

What, what a lymph node is actually, it's something you dunno what a 

Dr. Wada: So when we think about our immune system, um, there are organs [00:34:00] that are a part of our immune system and lymph nodes are kinda like the meeting places. I think if at a pla a place where our immune system cells, especially our T-cell and our B cells are speed dating.

Mm-hmm. So if we receive a vaccine, if we're trying to fight off a cold or flu infection, um, if we receive an allergy shot, that protein or that bit of protein that the immune system has recognized and is trying to make a response to is brought back to the lymph node. And that's where the speed dating process occurs.

When that match is made and it's a good match, um, then some factors change and essentially that immune system matures or responds. So as you're fighting off a cold, for instance, um, you may notice that you have swollen. Lumps or bumps in your neck. Um, or I know for instance, kind of when we were in the midst of the pandemic, it wasn't uncommon to say, oh, hey, I got, you know, my vaccine in my arm and now the lymph node under my arm [00:35:00] mm-hmm.

Is swollen. So when we do more traditional allergy treatments, shots that go under the arm drops that under the tongue. Some of those immune system cells, um, are essentially, um, capturing that allergen and bringing some of it back to the lymph node. That's where that change is happening. If you inject allergen directly into the lymph node, if you can visualize that using an ultrasound, you can see your needle going in.

You're cutting out the middleman of the immune system. Mm-hmm. And it's working more akin to how a vaccine response may work. So you need much fewer injections in order to get that good response and that lasting response. There's actually some data out of the initial group of patients that they. Treated in Switzerland, which goodness was over 20 plus years ago.

They went back 19 years after their initial treatment. Half the group received traditional allergy shots. The other group, um, received this [00:36:00] new, um, interim lymphatic immunotherapy and they found as many of the folks they could a little easier to do that in, um, in a government run healthcare, um, situation.

And they compared, and there wasn't much difference between the improvement people saw and the lasting improvement that was documented between those who had regular, you know, standard of care allergy shots and the lymph node-based treatment. Mm-hmm. So it's pretty cool. Yeah. Yeah. Any risk for people with autoimmune disease?

Not that we're aware of. Okay. I think when, anytime I'm talking with any of my patients that has what I lovingly refer to as a misbehaving immune system, whether it's allergies, autoimmunity, even immune deficiency, anytime we are introducing a treatment of any kind that may affect our immune system response, there is always a potential that we could cause a flare.

Mm-hmm. I think the biggest thing that we need to [00:37:00] talk about is. What are your individual risks? You know, have that shared decision making conversation and see if that feels okay. If it feels like, you know, saying, uh, that my family has always loved it, is the juice worth the squeeze? Does that feel okay and comfortable with you that there may be that risk of flare, but this is what we're hoping and or are there some things that we may do to try to prevent those symptoms from flaring up?

Generally, I wanna make sure that someone's under good control. If they, you know, have allergies that are woefully or asthma, that's uncontrolled, we wanna get that under better control before we go introducing something that could stir the pot. Mm-hmm. 

Dr. Brighten: Autoimmune diseases on the rise and it's primarily affecting women.

What do you wish that every woman knew to prevent autoimmunity? 

Dr. Wada: Goodness. I think one is that we do the best we can, and we do that with whatever bandwidth we have. [00:38:00] Mm-hmm. And even if or when for some, you know, that percentage of us that will end up, um, with a diagnosis to let go of that self blame.

Mm-hmm. Um, I think, I think that that is, is really critical. Some things that can be helpful, trying to keep the diet broad to listen to any signs or symptoms that your body may be sharing with you. Mm-hmm. That to me, I now recognize is, is the potential for precursors. So change in digestion. Mm-hmm.

Symptoms that, you know, may or maybe called irritable bowel syndrome or things that I think about if you are having more skin rashes, if your energy level just seems totally different than where it was. You know, these are all early signs that I, I look back to even when I was in college and think, oh gosh, I knew now then when I know now, now frankly, I don't know if I would've done things differently.

'cause I was 18, 19-year-old, it was 20-year-old brains like, you know, um, you know, there are [00:39:00] some things that we know can increase that gut permeability. So excess alcohol, excess, uh, nonsteroidal anti-inflammatories, so ibuprofen, those sorts of things. I think what's hard is in, in telling folks to listen and to trust their body, that also given the healthcare system and what we've talked about, opens up that potential for them to not have that witnessed.

Mm-hmm. And that, that worries me. Right. But I think that first step is really to listen to your body, to take heed and. Coming back to that self-compassion that we talked about earlier. 

Dr. Brighten: Yeah. I, this next question, I am gonna ask you this, I want this for people who are struggling with autoimmune disease, endometriosis, any of these invisible illnesses, uh, I wanna ask you this question because if they have someone in their life who's dismissive and not supportive, I want them to give them this, this clip so [00:40:00] you don't look sick.

Almost every patient with autoimmune disease has heard that from someone at some point. Why don't people look sick? And what do people need to understand about autoimmunity? 

Dr. Wada: Well, first and foremost, we don't have, you know, it's not like we have a badge we're wearing or, you know, or something that, that, that visually provides that, that recognition.

Right. The other piece of it is these symptoms can wax and wane for years. Mm-hmm. And frankly, I have to say, you know, and again, this is coming from my own lived experience, but I, I hear this from countless patients and, and others in our community too, that we're strong. We try to put on a brave face and we keep pushing until we can't.

Mm-hmm. And I think some of that is cultural. I think what's hard and, and, and I don't know, I don't know the right answer to convince [00:41:00] people to believe someone's lived experience. Um, I think. It truly is going to take a momentous culture shift. And, and I hope that we're in the midst of that. Um, having more conversations like these from what I hear and see in our newer medical trainees that, you know, these, uh, gen Z docs and training health professionals in training, um, are, have, have a different attitude and are, are.

Really, I think, going to be powerful in this change too. Mm-hmm. You know, the thing about 

Dr. Brighten: most of the disabilities affecting people is that they are invisible. And I think that there is always this notion that, uh, if it's a disability or is a disease, then it should be apparent. Yeah. There's also been studies to show that people have more compassion for someone whose disease they can see than those they can't see.

They think if they can't, if you can't [00:42:00] see it, then you should just suck it up. Mm-hmm. And as we're talking about autoimmunity, there's things like lupus that maybe you'll have a rash on the face that's very telling. Most common autoimmune disease affecting women, which I also have Hashimoto's thyroiditis, severe fatigue, hair falling out, constipation, feeling cold, having joint pain, depression and anxiety.

These are not things that you can see visual visually. You might see the weight gain that comes on, but what does that come with? Stigma and judgment? Uhhuh, because you're a woman, why are you taking up so much space? How dare you, you need to shrink your body. Society says you need to be a certain size to have any value 

Dr. Wada: when you lose the weight and they reward you and you're just as unhealthy or maybe even in a, a worse place.

Yeah. I mean, I recall, um, in my own journey of kind of going down the rabbit hole of the super restrictive elimination protocol. I was the skinniest I had been since my [00:43:00] teens. Mm-hmm. And of course that came with significant, you know, oh Kara, you look great. You know, from aunties and mom and you know, and, and everyone.

And, and yet I was probably the unhealthiest I had been. 

Dr. Brighten: Yeah. 

Dr. Wada: And so many mentally and physically at that point. 

Dr. Brighten: Yeah. You see this with Crohn's disease ear, um, you'll see it with, uh, IBD, so inflammatory bowel disease. Mm-hmm. Celiac disease. These people who have gastrointestinal issues that are causing weight loss and they feel horrible.

Mm-hmm. These diseases are horrible. And people are like, you look fantastic. They're like, I don't feel fantastic. You're wasting away. We love this for you. And it's something that we have to start shifting in society because as you said at the top of this, your mental wellbeing, how you talk and perceive yourself has such a tremendous impact on your immune system.

Yeah. You've brought up the [00:44:00] elimination diet a few times. Mm-hmm. Do 

Dr. Wada: you recommend this? I think it can be helpful. I also, it's like holding two things, right? Mm-hmm. It's not always, or, but often it's, and it can be helpful. And also I think you need support, um, and someone to help provide some guardrails because it's not a long-term solution.

Dr. Brighten: Yeah. 

Dr. Wada: We know long-term. The best benefits come from the most broad and diverse diet that is, is reasonable, you know, given how your body's responding. The other thing though that is hard is that we don't have all of the testing modalities that would make things very easy to say, oh gosh, well you know, I need to avoid X, Y, Z.

Mm-hmm. And so sometimes we do need a period of time where we are steering away from dairy or steering away from eggs or soy, what have you, gluten for sure, to determine does that make a [00:45:00] difference or not. And if it does, then perhaps that's worth staying away from for a bit longer. And then, you know, as you alluded to earlier, the potential that we know the microbiome changes and evolves, our gut health can heal and improve over time.

That then over time we may be able to have some of those foods, um, from time to time or. In certain amounts and it not be a problem long term. Mm-hmm. 

Dr. Brighten: I agree with you. I always have framed it to patients that if we do an elimination diet, it is for a finite period of time. The, the least amount of time, uh, necessary is always my goal because you know, we see sometimes people are on the autoimmune protocol.

Yeah. That can be fantastic, but sometimes people are so scared to go back to foods. Yes. And what I say to patients is the goal is that a healthy microbiome, a healthy gut, and a healthy immune system can tolerate any food [00:46:00] coming in. If you have allergies, that's a different story. Different story. Yeah. But you know, when you have food sensitivities, our goal is to work back to that.

You can then have those foods and maybe you're someone who's like, if I binge dairy, I'm gonna have a problem. Lactose intolerance is different than having a food sensitivity. Sensitivity. Yeah. But you might be someone who's like. You know, if I do too much corn, I'm not gonna feel great, but I know that I can have corn on the cob in the summer couple nights and like, that's not gonna be problematic.

And so I think I love your perspective. Definitely. We need diversity, we need variety in the diet. You brought up gluten, that is still a controversial one. I know where doctors say it does nothing yet. Patients are like, it's doing everything, so let's talk about it. I know. 

Dr. Wada: Yeah. I think one thing that I always advocate for is if you are considering a trial of gluten-free, that the potential for celiac disease be explored before you take it out because that has [00:47:00] long-term implications in regards to whether you would want to reintroduce or not.

It also has implications for family history and family screening as well. Mm-hmm. And insurance coverage if you have to 

Dr. Brighten: eat a gluten-free diet. Absolutely. Yeah. 

Dr. Wada: Yeah. And so, and the reason is that if we're doing blood work, which is typically kind of the first line screening test and much less invasive than an endoscopy or a scope where they would look, um, at your small bowel and take a little biopsy, um, those labs.

Can turn normal or normalize with gluten avoidance. Mm-hmm. And actually you want them to, we would wanna capture that before they turn normal so that we could, we could better know what's going on. And I think, so that's typically my first, my first point of advice when I'm thinking of particular elimination diets, you know, it somewhat depends on what's going on with that patient and getting an idea of what their diet looks [00:48:00] like too.

Mm-hmm. Say I have a patient with, uh, an allergic condition called eosinophilic esophagitis or EOE gluten's up there on my list, but actually there's a higher rate of dairy mm-hmm. That's driving it. Even when dairy allergy testing is negative, about a third of the time, if you pull dairy protein out, those patients will have significant improvement.

So there's a little bit of that that comes into play. Mm-hmm. Um, and then asking folks, you know, how do you think this might go? You know, exploring kind of, and having them try it on, you know, rehearsing kind of in their brain as to how they think that might look. For some families, that's, it's not something they, they care to explore others.

Sign me up, let's do this. Yeah. Like, I really want, you know, to take this, this more lifestyle based approach. I think the other thing that's really important in, and especially with working with nutrition, you know, those that have more nutrition background, [00:49:00] my dietician colleagues, you know, other folks who have, um, that nutrition education background that's more expense extensive is thinking about and making sure we're not running into any nutritional deficiencies.

Yeah. When we're, um, making these big dietary chip. And then with gluten-free, I think the other trap that we can fall into is substituting, you know, one, you know, gluten-free pasta for regular pasta. Mm-hmm. And often nutritionally. Ooh, it's not, you know, it's not that great of a swap. And so what I tend to encourage is saying, Hey, if you're really gonna try this, let's also try to switch to, you know, some options that are more nutrient dense, that have more of just vitamins and nutrients and, and other types of, uh, whole grain fiber.

Mm-hmm. Uh, non-gluten, whole grain fiber. And let's see how that goes and see if that can help kind of switch up some of the patterns that we get into with like, oh, a sandwich for lunch, pasta for dinner. [00:50:00] You know, kind of being able to, to try some other, other recipes and things on for size. Mm-hmm.

Chickpea pasta, everyone, if you're gonna go grain free Yes. Start with a small portion though, if you're not typically, uh, used to eating beans, because Yeah. 

Dr. Brighten: If you're not a fiber first, uh, kind of plate. Definitely. I know, I feel like every time I do a podcast episode where I'm talking about eating fiber and then I'm, I'm like, I'm always being like, but if you're only eating like five grams a day, then are only gonna increase by like five more.

And you're gonna do that for a week. Yeah. And why are we doing that? Because your microbiome's gonna shift. Your digestion is gonna shift. But I'm always like so cautious. 'cause I'm like, I don't want anybody to be like, now I have horrible gas, or I'm really constipated and I hate Dr. Brighten show. Like, yeah, it's, we don't want that.

Dr. Wada: You know what I think of, do you remember those infomercials with the different exercise programs that we grew up with? Mm-hmm. Like Ty Bow and like Yeah. P 90 x or whatever they were. Um, and you, you know, you like jump into [00:51:00] some hardcore routine and then you couldn't walk for like days afterwards. Yeah. I think about that with dietary shifts.

We are so much better off for the long term and for sustainable change by doing what you just said. Mm-hmm. Small changes they add up over time and frankly they're more comfortable, they're more pleasant. Yeah. It's like, you know, picking up the two pound weight, getting good with that, then moving up to three mm-hmm.

And maybe pushing it to five. Um, and, and doing that gradual step up that is gonna allow your body and your microbiome to adjust, um, and to make those shifts. 

Dr. Brighten: The commercials of the nineties, the fitness commercial you're talking about is now the sensational influencer of social media. Yes. Who's like, because that's what the algorithm will show you.

So as we sit here and we talk about nuance, like the algorithm's gonna be like, shut it down. Like we want sensational stuff of like, just change everything. I have very few patients, I would say like maybe [00:52:00] 1% of patients, like they get a treatment plan, they jump all in, they do it all, and they're like doing great.

Most of the time somebody who's like, I'm gonna jump into this diet a hundred percent after two weeks, they're like, I'm out, I'm done. Mm-hmm. I can't sustain this. And so I always talk about like. First take a week to look at it, put it on your fridge. Every time you go to the fridge and you're opening the fridge, you're looking at what's gonna change, what's gonna change.

Start wrapping your mind around what's changing. Then the next week we start to introduce things and I actually like to do like five day like thing, you know, at a time. Mm-hmm. Like little trials, like, so for like, if just five days you can eat a serving a crucis cruciferous vegetable. And what I find is, is that after five days they're like, habit, I'm doing this four more.

It's easier to adopt. There's something about five, like with only uh, a DHD people. I'm like, just, just say like, I'm just gonna do five minutes. I'll just do five minutes. And, and odds are you'll start and then you're there for 15 minutes. Fantastic. That's 

Dr. Wada: 10. Yay hyperfocused. Yeah. 

Dr. Brighten: That's 10 more than you thought you would [00:53:00] get.

Like, you know, it's things that, like when I was a group fitness instructor, I'd be like, can you just do five pushups? Like you can do anything for five. There's something about that. Mentally, I have not seen any research, but I see it works all the time of like where people are just like, I can do anything in the, in an increment of five.

Like I can, I can do that. 

Dr. Wada: I think it gets you through the work week too, which also just from that kind of. You get in that routine. Mm-hmm. And then it's easier to keep it up. Yeah. Like, oh, Monday's here again. All right. Back at it 

Dr. Brighten: with gluten and specifically autoimmune disease, what do you see in terms of it triggering autoimmunity, perpetuating autoimmunity and being part of the healing journey of removing it?

Dr. Wada: I think, you know, the evidence is still a mixed bag. Mm-hmm. Anecdotally, I certainly have, you know, a number of patients who have, who have shared with me, gosh, that was a huge game changer and really moved the dial for me in, you know, X, Y, z gut health joints feeling better, energy better. [00:54:00] Mm-hmm. I also have just as many, if not more, that have said, yep, I tried it, and frankly it didn't make a difference.

Yeah. And I think that's where this individuality comes into play. Mm-hmm. We are, you know, at our core, we have our, our genetic code, and that gets turned on and turned off by what we now understand are these epigenetic kind of signatures, the on and off switches, you know, impact us from the time that that egg is even created inside of our grandma.

Yeah. And, you know, through our lifespan, it's influenced by our microbiome, by the food we eat, by our lived experiences, and about all these things. Right. And to think that there's a one size fits all solution that's gonna work for everyone. I think it's kind of shortsighted. Mm-hmm. We even see this across, you know, hormonal shifts over the, the lifetime with, for instance, uh, there's always kind of this rule of thirds that's talked about with inflammatory conditions, this [00:55:00] asthma, lupus, sjogren's, rheumatoid arthritis, what have you, that as a woman goes through puberty or goes through pregnancy.

Mm-hmm. Um, in particular, a third of patients will stay the same, a third will get worse and a third will get better. Even if they have that same underlying diagnosis mm-hmm. Um, and are undergoing generally a similar pattern of hormonal shift during those times. And so I think that's where diet individuality plays into.

Mm-hmm. 

Dr. Brighten: Yeah. And as you're talking about this, like it's an important reminder for people to understand that your diet is never meant to be static your entire life. Mm-hmm. You meet people, it, it, like right now we've got like carnivore versus vegan, um, which is just, you know, they're each just decided the same coin of like very restrictive diets.

I know the vegans are gonna come for me, but doesn't change the fact that like it's a restrictive diet and if it's because of your belief system, I will always support you in that endeavor. And I'm not judging you. Okay. But [00:56:00] when we look at this, it's like, you know, I've had patients who get really frustrated because they have to change their diet.

I was a vegetarian for 10 years, I developed autoimmune disease. I could not manage blood sugar stability. I could not on a vegetarian diet anymore. And I, you know, was, um. I, man, the food pyramid like really messed me up. Um, it really, it really messed me up whenever people are like elimination diets cause orthorexia, ooh, all this wellness stuff.

I'm like, can we talk about the food pyramid? Because that was really messed up in the early two thousands. Like my diet, like I was eating six servings of grains, but having like inflammatory joint issues. Yeah. Like not being able to walk some days like Yeah. All this joint pain, not being able to like move my fingers, grip weights and like I still ate the six servings of grains a day even though it made me feel like trash.

Right. Because mm-hmm. One size fits all and the government gives us one size fits all. Medicine gives us one size fits all. Wellness gives this one size fits all. And so I really wanna echo your message of like, it [00:57:00] needs to be that end of one. Yeah. You need to ask what's true for you. So I wanna shift the conversation 'cause you brought up Sjogren's disease.

Yeah. How many women are affected by Sjogren's disease? 

Dr. Wada: So it is estimated that there are somewhere between one to 4 million Americans with Sjogren's disease. Mm-hmm. And somewhere around half of those individuals are not yet diagnosed of the, that that total number, 90% of those patients are women. Mm-hmm.

And you know, I think what's really profound is that Sjogren's is one of the most common autoimmune conditions. It is right behind Hashimoto's. It is right behind rheumatoid arthritis. But. Most people listening maybe have heard of it, but really don't know exactly what it is, or, you know, maybe frankly haven't heard of it.

I joke that in part it, it needs its own [00:58:00] pr. Yeah. Think, you know, it needs a, uh, it's named after the doctor who described it and frankly sounds like the name of a chair from ikea. It's hard to spell. It's hard to say. Um, and it's hard to build. Yes, yes. Um, and there's a lot of myths and misperceptions, um, that are perpetuated through, um, frankly through medical education about what it looks and feels like.

Mm-hmm. And I think that's in part what has, um, led to this, this big gap. Um, we're, we're, there's some really great data out of the Sjogren's Foundation that shows that that diagnosis gap is, is narrowing. Um, we're down to taking about three-ish years now, um, for the average patient to be diagnosed. Got endometriosis b go show.

I know, I do wonder though, when you look at some of the data with a little more nuance and you look at the survey responses of like, well, how long did you actually have those symptoms [00:59:00] going on? Ah, majority of patients are saying they had symptoms dating back to teens, childhood, early adulthood. Mm-hmm.

Um, and so I do wonder, you know, is that that three year mark from when someone. Made that self-diagnosis. Yeah, and that self recognition, and then finally had the validation. Rather than looking back. 'cause personally when I look back and see some of those breadcrumbs along the way, I see signs and symptoms that are suggestive, or at least were leading me down that path back to high school and college.

Dr. Brighten: Yeah. We see the same is true with a lot of women's health conditions, which Sjogren's, for all intents and purposes, is a women's health condition when it predominantly is affecting women. But it just like endometriosis can affect anybody. PCOS, we now see there's a male version of polycystic ovarian syndrome, bad name 'cause they don't have ovaries.

So we gotta figure that one out. That means it's a bad name for women as well. But you know, [01:00:00] we, we take, PCOS is an example. Women had symptoms. It's usually when they self-diagnose, then. Mm-hmm. It takes two to three doctors before they get believed. Mm-hmm. With endometriosis, women had the symptoms the entire time they were living with it.

And then it takes seven to 10 years of advocating. And that's the worst thing I think about being sick and then having to fight just to be heard that you are actually sick. Yeah. Let's go through the breadcrumbs though, because I think it's important for anybody listening. If you have ovaries, odds are you, you, you're gonna develop an autoimmune disease, unfortunately, is what we're seeing.

If you've got the genetics for it, you've got the family history. Like the environment that we live in currently is kind of just set up right for the development of autoimmune disease. Perfect storm. Perfect storm. And with that, if you already have an autoimmune disease, we know per the research is that when you get diagnosed with one, you actually usually already have three.

I'm someone who didn't. So my [01:01:00] breadcrumbs of having this joint pain in my, um, you know, teens, I mean, I just had a lot of like, health issues that I struggled with as a kid because of all these gut issues. That is what it started with. But I, you know, forever thought, oh, I, I like it was Hashimoto's and then it turns out mm-hmm.

Psoriatic arthritis actually is what you had and nobody caught that. Um, so wanna talk about those breadcrumbs that people should be looking out for when it comes to Sjogren's disease and then we can maybe expand it more broadly to autoimmunity. 

Dr. Wada: We look by numbers, dryness is kind of the, we call it the pathognomonic or kind of the, the test question.

Mm-hmm. Uh, symptom that is most connected with Sjogren's. And when you say dryness, dryness of the eyes. Mm-hmm. We don't talk about it as much, but the nose. Mm-hmm. And some sinus issues can go along with that because it's all interconnected. The mouth dental changes increase in those [01:02:00] cavities and things, crowns that you need at the dentist and vaginal dryness mm-hmm.

That often though is not what a woman is going to her doctor to talk about, frankly. Typically a patient with Sjogren's has bigger fish to fry, you know, or, or things that they're gonna bring up, which are fatigue and body pain. Mm-hmm. So often a, a lot of similarities and overlap with fibromyalgia. Mm-hmm.

Which is, I would put in the same bucket as IBS 

Dr. Brighten: Yes. Of like, oh, we're just gonna call it fibromyalgia. And it's like, hold up, what else is going 

Dr. Wada: on? Yeah. Yes, absolutely. There. Um, in majority of patients there are digestive issues and it can be across the board, so certainly can see bloating, gas, constipation, diarrhea, but also especially with less saliva change in the microbiome, difficulty swallowing.

There also can be some issues with motility. So the food moving from the mouth down [01:03:00] into the stomach and then through, uh, the rest of the truck when we're talking about dryness of hard skin dryness too. Itching is also another, a common symptom that will come up. The other piece that I don't think gets taught, and frankly I was.

Quite surprised to learn. Uh, I was at a, at a conference for, on dysautonomia. Mm-hmm. Or misbehaving, automatic part of your nervous system. A couple summers ago, and I'm sitting in the audience, I also, I was gonna do a talk on lifestyle as medicine, and they start talking all about Sjogren's. Mm-hmm. And I was like, wait a second.

What did I miss here? Sjogren's is the number one autoimmune cause of things like pots, so postural orthostatic tachycardia syndrome. Mm-hmm. So these conditions where primarily women, um, will notice that if they change positions, that their heart rate will skyrocket or they feel like they're gonna pass out or they do pass out, [01:04:00] um, that they have these changes or differences in how their nervous system is responding.

Sometimes you can see it as eyes dilating differently or not able to sweat. Um, interestingly enough, 

Dr. Brighten: mm-hmm. You brought up fatigue. Fatigue is such a common symptom of all autoimmune conditions. It's actually the, the top symptom of endometriosis. I actually, um, I had excision surgery and two weeks after my excision surgery for my endometriosis, like my energy was through the roof and I was like, I'm recovering from a surgery.

This doesn't make sense. But what is at the heart of this is this chronic inflammation that you're living with for women. You go to the doctor, you say, I'm fatigued. Of course you're fatigued, you're a mom. You need to sleep more. You're working too much. You are too stressed. You're just getting old. Like, there's always some reason to dismiss us.

Fatigue is something worth paying attention to. But somebody listening right now, I'm sure their [01:05:00] question is, what can I do that's gonna help with the fatigue while I'm waiting on that doctor's visit? Yeah. While I'm waiting on that lab work to help improve my energy. So. 

Dr. Wada: One thing I just wanna echo that I gaslit myself Oh yeah.

Into thinking. We're so 

Dr. Brighten: good at that. I like, this is something that I want your doctor, mom want people to understand that like doctors, it is so inherent in our training to gaslight like that we gaslight ourself, so Oh yeah. I certainly gaslit myself about things like, oh, my pain's not that bad. Oh, my energy.

So, so I was to share the story. This is the worst, um, gaslight. It's so I'm like, why I do this, I won't do this with patients, like with patients. I'm like, no, we are not gonna gaslight you. I do it to myself. Why? Why is it same with the self-compassion, right? 

Dr. Wada: It's like the same, like 

Dr. Brighten: so, uh, yeah, I was going through fertility treatments and they put me on birth control pill.

'cause they were like, oh, we gotta delay it. And within about three to five days my mood tanked. I was raging, I was so off the chain mentally, and [01:06:00] I was like, this can't be the pill. It can't affect me that quickly. Like, sure the pill can affect your mood, however, not this quickly. Like this, this gotta be a me issue.

And it was my husband being like, no, you cannot take birth control. You are not the kind of person I wanna be around. And like, and it takes that so often and I think that is what can something you see the most healing part of going to the doctor is when your doctor hears you, sees you, believes you. Yeah.

And. Ends your gas lighting for you. So sorry, you were saying yes, you gaslight yourself, but I just wanted to know that if they're doing that, you're listening to two medical experts right now who have done it to themselves too. 

Dr. Wada: Yes. And I still find myself from time to time being like, oh no, wait, you do need a day off.

So I think one of the things that can help you as you're getting ready for that appointment is one, trying to notice what, what fills your cup, what charges your batteries, and what drains you. Mm-hmm. That can be helpful information for your healthcare professional to know. I [01:07:00] think another thing to jot down and to take note of is how is it showing up in your life?

I think, you know, one of the things that I finally said to my primary care doc was, Hey, when I sit on the floor and I'm trying to play with my kids and I stand up, I feel and look like I'm 80 years old, I'm like hunched over. I'm so stiff. Um, I'm having to take a nap every day after work, even though I'm working halftime, like this isn't normal.

I think showing, you know, kind of. Showing them and telling them how that's showing up. Mm-hmm. Can be really helpful. It's also giving you some information about yourself too, because there can be certainly different drivers towards fatigue. So the one thing we're always going to wanna ask about is how is your sleep?

Is it restful? Mm-hmm. Um, if you have, um, someone who can keep an ear out, you know, while you're sleeping to listen to your breathing. Mm-hmm. Um, are you [01:08:00] snoring? Are you having pauses in breathing? Because we know if, if you're obstructing, if you have apnea, that that's gonna increase inflammation. Um, and frankly, poor sleep is going to too.

Oddly enough, sometimes a little bit of movement can be quite helpful. Mm-hmm. But listening to your body is movement and doing a little bit of movement or exercise, is that energizing you? Mm-hmm. Or are you paying for it? Day two, three, down the line where you have this, what's called post exertional malaise where you've overdone it, you've over, you know, over drained your batteries and you are just out for the count for the next few days.

That is a really critical part of that history, that lived experience. Mm-hmm. It really helps me understand what's going on. I think, you know, are there other symptoms going on, things that might point towards vitamin deficiencies, thyroid problems. Um, do you have really heavy periods where your iron might be low?

Um, those are all, you know, things that. [01:09:00] Each one individually may not be the magic, you know, solution. Mm-hmm. But certainly if someone has low iron and low vitamin D and you know, these different things, one that's gonna make me think how is their gut health and those sorts of things. But replacing those can be really beneficial.

Mm-hmm. Or if your thyroid hormone is low. You know, getting back that back into balance can be really beneficial. Are there common nutrient deficiencies you see with Sjogren's? Similar across the board with other autoimmune conditions? Mm-hmm. So not uncommon to see iron or ferritin, um, which is kind of the marker for iron storage at the body.

Vitamin D um, is another one. Vitamin B12 is another that I think of a lot, especially knowing and learning. Um, a lot of the recent science looking at Sjogren's is looking at this role of neuroinflammation. Mm-hmm. Um, and so we know that B12 deficiency, um, is another factor that can play in. [01:10:00] Um, I also often will check a B six because if someone's taking B vitamins, sometimes you can overdo it with the B six and kind of shoot me the other way.

Mm-hmm. But those are the things that I'm typically thinking and looking for. 

Dr. Brighten: Yeah. And we see that vitamin D is such an integral player in the immune system. Mm-hmm. And when vitamin D gets low, we can see autoimmune flares and we can see, I mean, we see a lot of immune dysfunction. Yeah. And you know, I hear still from other doctors who are like, well, I just tell 'em to go outside and get more sunlight.

And I'm like, I love everybody. Get outside more. I love that. Yeah. However, in these autoimmune patients who are deficient, they're not gonna be able to get enough sunlight. And we know that not everybody's synthesizing it in the same way people are wearing sunscreen. People have office jobs, some people are night workers.

Like again, it's bio 

Dr. Wada: individual. Yes. And some autoimmune conditions. Lupus, for instance, some patients with Sjogren's are sun sensitive. Mm-hmm. So sun and UV exposure itself may [01:11:00] actually precipitate a flare too. Yeah. So again, those are folks that you're going to have to rely on supplementation or, you know, significant, um, increase in dietary intake as well 

Dr. Brighten: for people who are getting their blood tests.

'cause that's the best way to guide mm-hmm. Supplementation for everybody listening. And then we always wanna have D three coupled with K two 'cause we don't need calcium in our like arteries. Not a good, not a good place to have it, but for people listening, they're gonna get their blood tested. What's the ideal reference range that you're looking for?

For autoimmune patients? 

Dr. Wada: I am typically looking for 50 and above. Mm-hmm. Um, and, and try not to get too, too close to a hundred, you know. Yeah. Trying to stay in that range. It's interesting for some folks, you really have to push the daily doses much higher than mm-hmm. I. Ever expected kind. You know, you, you read through kind of what the replacement guidelines are.

Yeah. And you kind of ing it up and you're like, oh gosh. But when you look at kind of those factors that, um, change gut permeability, vitamin D deficiency [01:12:00] increases, permeability, increases, leakiness not gonna be absorbing it as much. So sometimes you do have to kind of turn up the dial Yeah. To switch that, uh, in reverse course.

Dr. Brighten: Mm-hmm. I think that's important for people to hear that, you know, at least 50 because, you know, I made this joke to my husband that I got lab work done and my doctor was like, everything's fine. I'm like, well, I need to see it because Yep. Like with something like vitamin D, if the lab, so if, if you get to your labs drawn in the Pacific Northwest, for example, then 20 is gonna be the end cutoff.

Why? 'cause I mean, I lived in the Pacific Northwest and I do love not seeing the sun for nine months outta the year. I know it's weird, but I do love that. Um, and yet, you know, if it's something like you get your, you know, your blood drawn in California, then that reference range, the lower end might be 30.

But what I said to my husband was like, I have to see my labs because if the reference range cuts off at 20 and I'm at 21, they're gonna call it normal. They're gonna be like, that's fine. And it's like, it's not fine. And also it's really low. And [01:13:00] so for people to understand. Lab reference ranges are that data is flawed because it is elderly people and it is sick people who predominantly go get their blood drawn.

And if we're drawing someone's vitamin D, it's often because we expect it to be low. And so a lot of the lab reference ranges are actually set on the suboptimal, uh, you know, population in terms of like, I'm not saying elderly people are suboptimal, but. Fortunate reality is that in the next 40 years, my tissues are not gonna function in the way that they used to.

Like, I'm like, show me the data of that healthy 20 something. I wanna see that reference range. That's my goal. That's what I wanna go with. 

Dr. Wada: Well, I think, you know, we've been seeing an increase in that conversation on ferritin and iron too. Mm-hmm. Um, and I, I know at least the labs I've been using recently, their cutoff is somewhere around 15.

Yeah. Is considered normal. But really you're looking for somewhere 80 to a hundred at least to say, okay, your tank's full enough. Mm-hmm. Where we don't think that that's [01:14:00] necessarily contributing to your fatigue. 

Dr. Brighten: Yeah. And for women listening, when your ferritin starts to drop below 50, we will often see hair loss.

And hair loss can be a sign of multiple autoimmune deficiency. Mm-hmm. Or diseases and nutrient deficiency. So that's also something that your doctor just saying like, oh, you're just getting old. Like, if they say, yeah, you're a new mom 'cause you're four to six months postpartum. Sure. That, that, that happens.

Yeah. We expect, but like if your hair's not growing back after that Yeah. Then we've got a problem there. Yeah. We talked about Sjogren's symptoms, how prevalent it is impacting 90% of that population being women. For people who don't know what Sjogren's is, what is going on. Yeah. What's the mechanism that is driving this dryness, but also, you know, the, the pots like symptoms.

Yeah. The inflammation. 

Dr. Wada: So. For the longest time, Sjogren's was taught that it was a localized autoimmune condition that just affected the glands that create [01:15:00] secretions. So your saliva, your tears. What we've realized though, and when you look at biopsies of those salivary glands is that most often in patients, even with longstanding Sjogren's disease, that they still have viable tissue there, which is different than what you might see with, for instance, Hashimoto's.

That has kind of gone to where the whole gland often is destroyed by the, by the immune system. And so that kind of started this question of like, okay, well if the tissue's still there. Why is it not functioning? Mm-hmm. Um, and this greater, you know, discussion around Sjogren's role and its impact on the nervous system, which I think comes into this play with the, the dysautonomia, the connection with pots and so forth.

So Sjogren's is a systemic autoimmune disease. For the longest term time, it was known as Sjogren's syndrome. Mm-hmm. That has changed. We, it's now [01:16:00] considered its own disease process. For many years it was divided, kind of ar somewhat arbitrarily into primary Sjogren's and secondary, um, meaning that someone had Sjogren's on its own.

They didn't have any other known autoimmune diagnoses yet. Mm-hmm. Um, and secondary being, because it often is like many seen with lupus, Hashimoto's, celiac, you name it, um, other autoimmune conditions, um, that kind of, that terminology has gone by the wayside, but you'll see it come up from time to time. It does primarily affect those, um, those epithelial glands.

So the secreting glands that I mentioned, um, but it also does seem to impact the nervous system. And in particular, um, you can see impacts on the nervous system and from the small fiber nerves, which are the part of our, our nervous system that are helping us. Uh, sense what's going on in our body and in our environment, right?

Our [01:17:00] sensory, um, neural network all the way up to our central nervous system. And so it's not uncommon to have a history of migraine headaches mm-hmm. Or other, um, neuropathy, nerve problems, tinnitus or that ringing in your ears. Anything numbness, tingling across, across the gamut that, um, really kind of comes into play.

Although we think of it as primarily affecting those epithelial glands. For some folks, especially those who have a more neurologic, predominant kind of form of the condition, often that dryness will lag behind. So that may develop later on in the disease course. The other thing that we know is that, you know, the labs that I learned to, to pass my exams that are associated with Sjogren's, so some of those, those blood tests or serologies, autoantibodies, the ones that we think of that [01:18:00] are more, most specific for Sjogren's are called SSA, or SSB, the Sjogren's syndrome antibodies, A and B, those are positive somewhere between 60 to 70% of the time.

Mm-hmm. It's pretty good, but that also means that 30 to 40% of the time. Lab work may be totally normal. Mm-hmm. Um, and I, I think this really complicates this diagnostic process. If you have a patient who comes in, they primarily have fatigue and body pain. Their labs are pretty normal-ish, maybe low vitamin D, what have you, and you're in that rushed visit where that doc doesn't have the time or thought to say, are your eyes dry?

Is your mouth dry? How, how have your dental checkups been there? That additional, that additional workup, that additional evaluation doesn't even come up. So they, you know, get that label of fibromyalgia, vitamin D deficiency, what have you. And you [01:19:00] know, that diagnosis is pushed further and further out. I 

Dr. Brighten: think 

Dr. Wada: about 

Dr. Brighten: how you bring up the impact on oral health and how within the United States, oral health and eye health are separate entities.

Uhhuh, it's ridiculous. Right. Uhhuh as if like, these are just not part of your body. Uhhuh, these are two areas that Sjogren's can affect. Yes. And yet people may not have, you know, eye coverage or dental coverage and so they're not getting that extra check. 'cause what I'm hearing from you. Is that there's the problem with, you know, the quick visit, the lab testing.

So I thank you for hearing the diagnostic, uh, tests for Sjogren's, but the other checks that would be in place would be seeing your dentist, seeing your optometrist or ophthalmologist. 

Dr. Wada: It's critical. And that's actually, that was kind of the, the last breadcrumb or last puzzle piece that pushed me to go ask for labs.

Mm-hmm. So I went in for my dental checkup. That was due for after having my second, [01:20:00] um, child At the time I was, oh gosh, I was so fatigued again, you know? Yeah. I was like, oh, mama. Two, my second year as, you know, a, a full fledged, you know, faculty, you know, doctor, I just must be tired from that. Like, and um, in the background though, I hadn't really been able to wear contacts for years.

Every time I put on mascara, for the most part I looked like a raccoon. And, 'cause I was always touching my eyes dry eye. And the dental hygienist was like, Kara, your mouth looks really dry. Mm-hmm. Is everything okay? Are you on any new meds? Wasn't really on any medications at that point. And I was like, oh gosh.

And then, you know, knowing kind of that, the answer to the test question, right? Um, then I was like, oh, okay. The puzzle piece has kind of shifted of like, I did have some weird kind of off blood work that I couldn't quite make. You know, make sense [01:21:00] of a couple of years ago, and I never repeated and my back has always been real stiff, but it gets better when I'm pregnant.

So I always felt I was in that third that always felt amazing. I wanted to bottle up the pregnancy hormones and just stay in second trimester all the time. Progesterone, which 

Dr. Brighten: is also why I am like, you know, this whole conversation around perimenopause and menopause and like, I just get so much fla from doctors that are like, if she doesn't have a uterus, she doesn't need progesterone.

And I'm like, well, if she's ever had endometriosis, she needs progesterone. And if she's ever had immune system dysregulation, she needs progesterone. And if she ever has had trouble sleeping or anxiety, she needs pro like progesterone's, not just about our uterus. Could we just stop with that? So I'm curious as you bring that up though, what do you feel like childbirth was the triggering event that really tipped the scales on autoimmunity?

I think 

Dr. Wada: it, I. Ramped things up enough mm-hmm. To where I couldn't ignore it anymore. Yeah. But thinking back, I mean, the summer before I went to medical school, I had an [01:22:00] episode of Parotid Gland Swelling. I remember going to, I, at the time, my primary care clinic was a, a medical student kind of run clinic, um, with the university, um, medical school.

And I remember being the interesting patient that everyone kind of came and looked at, like, yeah. 'cause I had swollen glands and I didn't have mums. And no one ever wants to be the interesting 

Dr. Brighten: patient. I could say. Like in my, um, yeah. With not ideal facility Doc. Uh, there was stuff going on and he was like, you're such an interesting patient, I'm gonna bring my ants in.

And I'm like, no, nobody, I don't wanna be the interesting patient, but he is just like, yeah. Like any medication, if there's gonna be a side effect, like you're gonna have it. Yeah. I'm like, yes, I know. Yeah. Like, it's the worst. 

Dr. Wada: No, that was like when, um, another story. But, uh, I ended up, um, having a significant flare with, um, my liver becoming inflamed liver biopsy and, uh, the local academic center's, like, yeah, we actually need to send this to the NIH, um, to have them look at it.

I was like, oh, great. Super. [01:23:00] Yeah. You're like, I don't, I 

Dr. Brighten: don't wanna, I don't wanna be special No. In any way. Yeah. That's in the, no-no. So we've, um, we've talked about these different ways that Sjogren's shows up. Mm-hmm. What are the top conditions that Sjogren's gets misdiagnosed as? So you brought up IBS you brought up fibromyalgia.

Dr. Wada: I often think and often will see patients who have been diagnosed with, um, systemic yeast issues. Oh, yeah. Candida. Um, and, and it may be a true, true related situation, if you have changes in, you know, with dry tissues, having thrush and having changes in your microbiome, where there might be, you know, increase in yeast like dysbiosis or, um, cfo, small intestinal fungal overgrowth, recurrent vaginal yeast infections, it's not surprising if you have those tissues that already have changes in, in that local environment.[01:24:00] 

The other, um, the, those are. Really the common ones. Sometimes lupus will come into play too, in part because the diagnostic criteria are a little bit harder to follow. And, um, it's not uncommon for patients with Sjogren's disease to have a positive a NA. Mm-hmm. Which is considered kind of the lupus test.

Dr. Brighten: Yeah. Except a NA positive for so many 

Dr. Wada: reasons. Sometimes Yes. Cutting Hashimoto's and everything else. Yeah. Yeah. 

Dr. Brighten: Totally. Uh, and that is something that I, I, I would like to know if you agree with, but if there's a positive a NA sometimes we need to retest. Yeah. And see like, what else, you know, is it, does it stay true?

Mm-hmm. And also, you know, what else could be going on? 

Dr. Wada: Yeah. I think, you know, one of the very first lessons I remember learning in medical school is treat the patient, not the labs. Mm-hmm. It's also one of the first lessons that gets thrown out the window. I was just gonna say, so why put telepractice, [01:25:00] right.

They're like, your labs are normal, and you're like, I don't feel normal. I love that. Me, uh, I mean, I love it. Hate it. Right? The reality is you, and, and this is so very true with allergy testing especially, you need to take that lived experience and reconcile that with the data. Does the data make sense?

Mm-hmm. Is it supportive? Is it contradictory to what you would expect? And that takes some time, some thinking time. And the fortunate reality is our system is not set up to allow for that time and space to, to think through those things that don't quite follow the textbook. Mm-hmm. Um, as you were taught, 

Dr. Brighten: when it comes to exposures that make Sjogren's worse, what would be like the top three things that you would say make your best effort to avoid these?

Dr. Wada: One thing from a practical standpoint that I have found pretty darn helpful, I, I've always been very prone to, um, mouth ulcers, canker sores. Mm-hmm. [01:26:00] And for me, making a switch to a sodium oral sulfate free. Toothpaste has been really helpful. Mm-hmm. So SLS is the soap or the surfactant in toothpaste. It's a really great cleaner.

Um, it makes it all bubbly and wonderful, but for some folks, if you already have changes in that barrier, um, and that, that your armor is already a little more susceptible to having, uh, injury or, or chinks in your armor, then that may be one extra thing that could push you over the edge. Mm-hmm. Um, and so that's one simple swap that for many folks can be quite helpful, I think.

Um, the other is, is being mindful of the, the amount of vitamin D and omega threes in our diet, whether you're taking in a supplement or getting it through your food. Big study, um, several years ago called the Vitals trial that looked at autoimmune patients, all comers and didn't even test their vitamin D levels.

They just put, you know, a [01:27:00] group of patients on vitamin D supplementation, a group of patients on fish oil, and then there the placebo controls and then they look to see. Which of these groups were more likely to have an additional autoimmune diagnosis, and which were the least likely. Those that were on the Omega-3 or fish oil supplement and vitamin D were the least likely to have that additional diagnosis.

Mm-hmm. So I think if you have someone who is success susceptible or has an other, you know, has other autoimmune conditions, it's probably a low hanging fruit to think about in regards to kind of setting yourself up for success. Mm-hmm. And then last but not least, you know, keeping an eye on how, how your digestion is doing and if you are noticing shifts or changes.

Sorting that out and really working on trying to increase the plant power, you know, is, is best that you tolerate it, sorting out what you like. Variety is the spice of life. [01:28:00] Um, and we know that so much of the immune system is really in the gut and so many patients with Sjogren's are, you know, are seeing kind of those changes whether it's related to the gut barrier dysfunction or leaky gut or the motility issues.

Mm-hmm. And that's something to kind of keep an ear and an eye out. And as I think back to my own story, those are probably some of the first things that I recall, like. I couldn't tolerate eating raw broccoli anymore. Yeah. Or onions like that was just woo miserable. And, and so having an ear and an eye out for that and making adjustments, I think.

Dr. Brighten: And so you've talked about some of the nutrition, the lifestyle things to avoid. What can people expect if they get this diagnosis? What's the treatment look like for them? 

Dr. Wada: Yeah. So I think that has been another really big barrier to diagnosis because there are no FDA approved treatments as of right now as we're recording, um, for Tracker for Sjogren's disease.

That being [01:29:00] said, um, there is some data to say that, um, using hydroxychloroquine also known as Plaquenil mm-hmm. Can be helpful. That especially can help with, um, we didn't talk much, but Sjogren's also can affect the joints, also can affect any of the internal organs similar to lupus. That, that may help prevent kind of ongoing progression per some of that.

And generally speaking, it's, that is a medication that is not terribly, it's not immune suppressive, so it doesn't increase the likelihood of weird infections or, um, or other, you know, other things going on, um, in that realm as long as you tolerate it. Okay. So I think that's something to consider generally will help with energy too, for a lot of folks.

I think the other thing to know, and another reason I've really advocated for patients to be proactive about, um, exploring a diagnosis, if they're kind of reading through the symptoms and like, oh gosh, this shoe fits is there are. What appear to be effective and so far, so, you know, knock on wood, [01:30:00] um, look to be fairly safe treatments that are in phase three clinical trials.

Mm-hmm. So I think there's a lot of hope within the Sjogren's community that we're finally going to see some of the, the beneficial changes that have come, come about in psoriatic arthritis that have come about in RA and lupus, um, that we, um, that we're gonna have our turn, um, at, at some of these treatments that are a little more targeted to what's going on.

And the other reason I think pursuing a diagnosis and, and being thoughtful and proactive is something we haven't talked about, but it's really critical that having a diagnosis of Sjogren's disease increases your risk of lymphoma considerably. Mm-hmm. Somewhere upwards of 44% of like someone who doesn't have Sjogren's disease.

So there's somewhere between five to 10% of patients with Sjogren's will go on to develop a non-Hodgkin's lymphoma. And so if you have that diagnosis on your chart and you have a lymph [01:31:00] node that's staying swollen for long, you know longer than it should for a cold, well goodness, I'm gonna be a lot more aggressive at saying we need to get that biopsy ultrasound, we need to check that out because you wanna catch that right early.

It, it changes the math and how you're thinking through what you're more, you know, what those. Potential problems and, um, downstream effects. Maybe 

Dr. Brighten: do we know the reason why Sjogren's increases the risk for cancer? 

Dr. Wada: Yeah, so it increases the activity of B cells. Mm-hmm. So when we look, there are some markers you can look at with disease activity.

Those who have, um, those higher disease activity markers, those do tend to be the folks that are at higher risk for Sjogren's disease. So folks that have, um, a lot of ongoing lymphadenopathy or swollen lymph nodes, those that have vasculitis or kind of the inflamm inflammation of the blood vessels that may cause some characteristic rashes and things.

Um, those that have particular [01:32:00] lab markers. So often we'll monitor something called complement levels, something called C3 and C four. If those are lower, that's also, um, a little bit worrisome. 

Dr. Brighten: Mm-hmm. And do you ever recommend things like lymphatic drainage massage, or people doing dry skin brushing? I haven't 

Dr. Wada: routinely, um, recommended it.

Folks find it helpful and they can fit it into their routines. I don't think it's gonna be harmful by any stretch. Yeah. I enjoy it. I think the one thing to be cautious with the dry skin and skin that's a little more sensitive to begin with is just making sure the brush isn't too rough. Mm-hmm. Um, and that we're moisturizing afterwards.

Yeah. Yeah. 

Dr. Brighten: You brought up, uh, dys mm-hmm. As part of Sjogren's, but we also see it with mast cell activation syndrome. Can you explain that connection and how people can differentiate what's going 

Dr. Wada: on? I'm gonna go out on a limb because I have no scientific evidence to support this, in part 'cause no [01:33:00] one's looked at it yet.

Mm-hmm. I wanna change that. Working on it. I suspect that there also is a significant overlap between Sjogren's disease and mast cell activation. I think in part it's the patients I'm seeing, but, um, what's happening with mast cells and small fiber nerves is that they are found in the same locations in our connective tissues and they're tasked with.

Similar tasks physiologically. Mm-hmm. To help us recognize safe from not safe. They're in constant communication with one another. If you look at the surface of a mast cell, there are multiple receptors for different neuro neuroreceptors on them. If you look at the nerve receptors, there are, um, receptors there that are looking at some of the, um, things that mast cell secrete histamine.

These two structures right in the midst of our connective tissue are in constant communication, immune system, nervous system. And for so long, you know, the real, the unfortunate [01:34:00] reality as medicine has become so super specialized, so the neurologist and the immunologists are in totally different wings or buildings of different hospital systems not talking to each other, um, as much as ideal that, that has shifted, especially I think as we've come into this post pandemic, you know, era where we realize that neuroinflammation is a big deal and is affecting more people than I think we ever thought.

But when you have, you know, that breakdown in those barriers, those leaky barriers in our skin, in our gut, in our respiratory tract, our geo geo tract, those mast cells who are the border guards, along with those sensory nerve fibers are seeing more of the external environment, more opportunities for them then to say, Hey, there's a problem here.

And what we think is happening is that in some cases that, uh. Response is kind of getting stuck on autopilot. Mm-hmm. That [01:35:00] if your body feels as though it is constantly under attack, you are going to go into a state of kind of hypervigilance, right? Yeah. Your immune system is gonna wanna make sure that it is on guard to be able to protect us through whatever that insult is.

And so that's kinda some of the working thought behind what may be happening in mast cell activation and why I think patients with Sjogren's who already have a lot of barrier dysfunction mm-hmm. Maybe at an increased risk. 

Dr. Brighten: What can people do to, you know, address the histamine issues if they have mast cell activation syndrome?

Dr. Wada: Yeah, so, you know, one of the mainstays of treatment is, um, I lovingly like to say trying to keep the horses in the barn. So we will often rely on antihistamines things like, you know, the over the counter Loraine cetirizine, um, vine famotidine, which often you'll think of as a stomach acid suppressant, but kind of closes the back [01:36:00] doors and sometimes it's trial and error of figuring out which, which one or ones might be helpful.

What's diff difficult, um, is that sometimes, um, the extra ingredients that are in a tablet or in a liquid medication for that matter too, those fillers or binders, sometimes those can be perceived as a problem. And so sometimes we are thinking about trying compounded versions of those where some of those binders or other things are left out.

We're also thinking about other ways just to decrease that load, that allostatic load or what the immune system is seeing and potentially, um, deeming as, uh, a dangerous signal, right? So trying to avoid fragrance, you know, using kind of cleaner products, more simple products, trying, uh, to eat, you know. This may be a case where we may try gluten-free or you know, some dietary changes, um, to see if those are helpful.

Occasionally folks will [01:37:00] find eating less histamine helpful, though I always tried very carefully there. Um, because that diet's the worst. It's really hard and it does eliminate a lot of foods that are thought to be generally quite healthy, like fermented foods. So it's a balance. Um, but also no leftovers.

I'm 

Dr. Brighten: like, that's so hard. I don't know. There are people, it's a mixed bag there that when the histamine diet works for them, I'm like, that's fantastic. Let's try to get you off that as soon as possible. It fits. Absolutely. It's really, it's really restrictive. It's hard and it really takes the joy out of living.

And I think we also have to like look at food that way of like, it's, I just, um, I always joke like, if you're someone who's like, food is fuel and that's it, we can't be friends because food is pleasure, food is community. Like tell me you're from the United States without telling me you're from the United States.

You say that because no other culture in the world, like I grew up in a Hispanic family. Like food is about how we love food, is how we have community food is about like tending to the parasympathetic nervous system like it is doing so [01:38:00] much more and know that's a little bit of a rant there. No, you didn't mention, you didn't mention Benadryl.

No. 

Dr. Wada: Yeah, so we've shifted away from Benadryl on the whole, now I do have some patients that that is their. They're perfect antihistamine in that it works really well for them. They tolerate it. It's not making them sleepy. And so, you know, again, everything in the nuance that it's why you have longer episodes.

Um, but in general we've realized that Benadryl, one, it doesn't work any faster than those longer acting, less sedating antihistamines. Mm-hmm. It also has an increase in what we call anticholinergic side effects. So the dryness, the sleepiness, the foggy thinking people on Benadryl, they, they studied, um, it's equivalent if you're driving on Benadryl to drunk driving.

Um, so there is a big safety component there. 

Dr. Brighten: I don't think enough people have gotten that information. Yeah. You're talking about the safety component and then the [01:39:00] dryness. Like if you have a condition that's making you dry, you don't want medications that make you dry, but there's also long term implications.

Yeah. This medication. 

Dr. Wada: Yeah. So it's thought to be linked to those anticholinergic effects that that may increase our risk of memory issues as we're older. It's, it's tricky. Right. We also haven't really known about or studied the long-term impacts of mast cell activation. And so, you know, I think there's this, this push and pull, right?

There are some folks that, there are conditions, for instance, that using long-term use of. PPIs or proton pump inhibitors seem to be very beneficial and helpful. There's also a lot of data that says for vast majority of people, that's not a good idea at all, and maybe setting us up for a lot of significant health issues.

So I think it always has to be that individual conversation with your healthcare team to really kind of parse out what makes the most sense given your unique set of [01:40:00] circumstances. 

Dr. Brighten: What is known right now about the long-term impact of mast cell activation syndrome? 

Dr. Wada: I don't think we have great. Data at mm-hmm.

Mast cell activation syndrome. We have a bit more understanding of conditions like mastocytosis mm-hmm. Which are related, but different enough. Can you explain what that is for me? Yeah. So mastocytosis, uh, is more of a, a issue with the bone marrow producing mast cells in greater numbers. And also they look a little funny under the microscope.

They behave a little different. Most often they are associated with a particular mutation in something called a kit receptor, which makes it a little easier to kind of test for. In many ways, we will extrapolate to some degree, uh, treatment strategies on mast cell activation from those patients with mastocytosis because there are, are a good amount of overlaps.

But frankly, there's a lot of ongoing debate amongst docs who take care of patients with mast cell activation [01:41:00] syndrome on exactly what it is and who it is that we're treating. 

Dr. Brighten: Mm-hmm. 

Dr. Wada: So there are two kind of mean camps and they each have a set of diagnostic criteria called consensus criteria. Um, consensus criteria one, and consensus criteria two.

And the unfortunate reality is that there aren't many folks from those particular groups that communicate effectively with one another. Fantastic. I think there's some backstory. Frankly, I'm. Still somewhat young enough to not know the whole backstory. Yeah. There's some little drama there. I think so.

Which is really unfortunate because you know what we've come to find out with many conditions. Um, I think the one that's the best example in my mind is asthma when I went through medical school as opposed to diseases allergic, non-allergic. Mm-hmm. Now we realize it's over a dozen and they have some unifying characteristics.[01:42:00] 

Um, the airways constrict, there's inflammation, but the flavors of inflammation vary a little bit. The types of medications that treat that inflammation are different amongst those people. And there's generally some different characteristics on age and gender and other health conditions that go along with them that kind of group those into different, um, you know, kind of clusters.

I really suspect consensus one and consensus two, we're just kind of focusing on different clusters mm-hmm. Of folks. And we haven't really fleshed out what that whole picture looks like, but that would make the most sense to me. And so where I come from is. I listen to the patient, does it look like a duck and quack like a duck?

Do the symptoms that they're explaining sound and look like symptoms that may be related to histamine or the dozens, if not hundreds of other chemicals that these mast cells secrete? You know, many of the medications we talked about, many of the treatments [01:43:00] we think about, especially those first line treatments, they're pretty safe and they're generally fairly effective.

Mm-hmm. So while we're working on diagnostics and thinking about some blood work and checking urine for some metabolites and other things, why don't we. Try some of those. Yeah. And see how it goes. You'd be surprised at the pushback I got from some peers on that interpretation of things. But, um, 

Dr. Brighten: I'm, I'm right there with you.

I'm like, once the patient gets the blood drawn, what the, once the labs are done, why don't we start an intervention that gets them feeling better? Because Yeah. Sometimes labs takes six weeks to come back. Yes. Like, why would I make that person wait another month and a half? And like you were saying, you know, using something like, uh, so it's really, um.

Within the PMDD community, within the endometriosis community, the A DHD community, the autism community. Mm-hmm. Using H one and H two. So like Prevacid and um, like Loraine, Claritin. I'm like, what is [01:44:00] the, what is the Yeah. They're the mean that other people will recognize. Yeah. Using those in conjunction, um, has had tremendous results for people.

And so it's always something that it's like we can just try it. Also, when I have a patient that's like, I think I have histamine issues, should I do the histamine, you know, antihistamine diet. I'm like, why don't we instead work this up and let's just start you on these medications because if you feel better in three to five days, we've got the answer.

Yeah. But the histamine diet, you're gonna be on that sometimes for three months and it's still like, I don't know, because surprise, it's not just a food issue. Other things can be setting you off. Absolutely. I want it. You brought up the symptoms, you're like, I listen to my patient, I look at the symptoms.

Mm-hmm. The duck analogy, what are the symptoms Yeah. Of mast cell activation syndrome. 

Dr. Wada: So, you know, those typical allergy symptoms are the ones that I initially will ask, uh, itching, sneezing, runny nose. Mm-hmm. Watery eyes, red eyes, mouth, itching, hives, big [01:45:00] ones. Mm-hmm. Swelling. Um, hives will look like red, raised itchy bumps.

Kind of like they'll play a game of whack-a-mole across your body. Yeah. Um. The swelling or angioedema will sometimes talk about, usually it will affect the lips, the tongue, sometimes the eyes, genitals, hands and feet, similar to hives. It just looks different in those more vascular tissues. The other things that we'll talk about are digestive issues and sometimes this may kind of overlap with histamine intolerance.

Mm-hmm. And that we're still trying to understand some of those distinguishing features. You may have symptoms where you eat and then you run into the bathroom because it's kind of like a dumping syndrome. Mm-hmm. Where it's gotta go, gotta go or eat. Um, a big histamine load. And some folks will have profound flushing, feel very hot, feel very unwell, and just that sense of doom.

And then there are the neurologic symptoms, headaches, migraines, changes in concentration and things. And I think [01:46:00] that's where it gets challenging because there are a lot of things that can show up that way. Um, so it's really trying to put together this whole picture and then leaning in, you know, a bit to that intuition a bit with where your patient's coming from too, and saying, okay, with all this in mind, what do you think about maybe a trial of antihistamines for a week low risk?

Good potential for, you know, reward based on what we've talked about and deciding if that sounds like it's a good idea or not. 

Dr. Brighten: Mm-hmm. Mast cell activation syndrome versus histamine intolerance. How can people differentiate the two? 

Dr. Wada: Hmm. I think we're still trying to understand that fully. I, at least in my mind, I think of histamine intolerance in a similar vein that I think of lactose intolerance, where the body is not making sufficient enzyme, um, to break down a histamine that is in our diet or that we're producing internally and, [01:47:00] um, and trying to eliminate through our gastrointestinal tract.

Sometimes I will try, or patients will want to explore trying some supplemental enzymes, kind of like we would use lactate. Um, and I think that's very reasonable. I also will say my experience with that has been hit or miss, depending on the patient. This is, um, 

Dr. Brighten: a very hot topic, and so that's cell activation syndrome.

We're seeing a lot of people talking about it online. We're seeing a lot of doctors saying, this is just the new trendy diagnosis. It's not real. What would you say to that? 

Dr. Wada: It's really disheartening, I think back to how much has changed in my, you know, relatively short career and lifespan within, even within my field.

Um, I'm gonna go back to the condition we mentioned briefly, eosinophilic esophagitis. Mm-hmm. EOE as it's more easily said and known. Was case reportable when I was born in the 1980s. It now is so [01:48:00] common that it's no longer considered a rare disease. It's a huge change in how that disease is showing up in the population who it's showing up in our understanding of it has changed night and day over that period of time.

If we think that the only conditions that we would ever see in our career were those that we learned about in textbooks and medical school, and it's pretty shortsighted. Mm-hmm. We, as a species, we talked about we're living in this perfect storm of circumstances where our bodies are seeing more, interpreting more of our environment, have that potential for things to go haywire or misbehave.

In my mind, it would, it would make sense that we're going to continue to see different conditions or the potential of different things to pop up. First and foremost, [01:49:00] listening to our patients and their lived experiences is critical. That's how we learn. That's how we know and discover new conditions. And by just brushing something off, because, you know, it, it is a hot topic.

And, and we are, um, more engaged and wanting to, um, take ownership in our health and healing, essentially shooting ourselves in the foot. 

Dr. Brighten: Mm-hmm. And I appreciate that you said, you know, EOE that, you know, is something that's being recognized more. Mm-hmm. It doesn't necessarily mean that there's this explosion, this epidemic that far more people are having this, A lot of times it's that it's actually being recognized.

We actually have lab testing now. Yeah. We have imaging. We have enough studies to validate what the patient is saying in reality. Yeah. Is a lot how doctors come from these. And we're seeing this so much on social media where people start talking about a topic more, more [01:50:00] people start to get diagnosed. You have more doctors dismissing those people.

And then you have the general public also saying like, we must have an epidemic. We have a problem. We're seeing this with a DH, ADHD and autism in women right now. No, we don't have an epidemic. We have decades of women. We have generations of women who were ignored, dismissed, and told, suck it up. Yep, suck it up and smile and be a good girl.

And just be pretty like, that's what we're asking of you, Uhhuh. And now we've got people saying. We're seeing this huge explosion in, uh, you know, it must be an epidemic. And it's like, no, this, these are people that she'd been diagnosed 

Dr. Wada: 43 years ago. No, I, I'm laughing because 39. Yeah. Yeah. I, I took my old, my oldest to get evaluated, and my own therapist was like, you know, 

Dr. Brighten: this is my story too.

I, I had my session. I'm like, having meltdowns because the scene of your socks is not right, is normal. I don't, I don't understand. She's like. Girl, we need to talk. I'm like, what? [01:51:00] Like I, and then when I got my diagnosis, I was like, oh, my entire life makes sense now. Mm-hmm. Then we see these clusters of things.

So as we talk about these histamine issues, as we talk about autoimmune disease, we see these clusters of genes. So if you're neurodivergent more likely to have histamine issues, more likely to have autoimmune issues, more likely to have endometriosis, more likely to have PCOS and A DHD going together.

Yeah. There's these clusters, but there's also the way that our nervous system is wired, as you talked about from the beginning, that sends this danger signal when your brain, so for people who are neurotypical and you're like, what are you talking about? Neurodivergent brains don't get the same pruning that your brain got, which is like basically take in less information.

We take in far more information, more chorus, and we now live in a society where we walk around with computers in our hands. There is literal noise and overstimulation and input coming in at all times that the neurotypical [01:52:00] brain is suffering from this sympathetic overdrive, from this chronic stress. So that makes the neurodivergent brain even more susceptible for these things.

So I just wanna fit all of that together for people, for them to understand that like. If you have one autoimmune disease, we need to look for others. Yeah. If you're having trouble with histamine, we need to ask what else is going on. There's a problem in medicine where doctors will often think you got the diagnosis.

PMDD is one. You have PMDD, that is your label now this is who you are. And we look at nothing else. Check. Yeah. And yet we understand that 50% of those with A, D, H, D, and over 90% of those with autism report having PMDD, and we start missing those pieces because what's under PMDD, sometimes it's a progesterone issue, but a lot of times there's a histamine issue, there's a nervous system issue and so we have to peel back those layers.

I wanna ask you, for [01:53:00] women who are going to their doctor, they don't feel normal, but their doctor tells them, your labs are normal, there's nothing we can do. Go on your way. What would you want them to know about advocating for themselves? 

Dr. Wada: First, I just wanna say don't give up. I know it can be really hard not to.

Uh, and what frus frustrates me to no ends when this happens is we know that that leads towards a ongoing delay in diagnosis, an ongoing delay in treatment potential and intervention potential. I think this is where having your data can be helpful. Doing a bit of homework before your visits can be helpful when you have.

Seven minutes with that doctor, having kind of those key points in mind, like, these are my objectives that I, I need or would like to get out of that particular visit, can be really helpful to have thought about beforehand. I think it's also an important [01:54:00] time to say, okay, is this something where I think about seeing someone that has more time mm-hmm.

That can put together all of those pieces and, and listen to the whole story. Isn't that gonna be really powerful? I worry that things are gonna get worse before they get better. Why do you say that? Um, it's been really hard to see any type of consensus when it comes to enacting more systemic change across healthcare.

Mm-hmm. And to me, it seems like we're more divided than we ever have been. I, I don't know. We, we all lived through a pretty horrific set of years with the pandemic, with so many people dying, so many people coming out with long-term, ongoing suffering. Mm-hmm. And that wasn't enough to spark change. So it makes me wonder what, what, what will 

Dr. Brighten: be enough?

Mm-hmm. It was interesting to see in the pandemic how. [01:55:00] Quickly, many practitioners started to turn their back on nutrition lifestyle. What we knew about vitamin D, we weren't allowed to discuss about vitamin D. And I think a lot of what happened in healthcare behavior was driven by the censorship of both the political administration who was in charge, but also the social media.

And when Mark Zuckerberg came out and finally admitted that, yes, they were in fact censoring during the pandemic, I'm like, that's so problematic. I'm someone who I developed severe COVID. I spent four months on oxygen. I ended up with long haulers. Every neurological symptom that you were listing off with Sjogren's, I'm like, oh shoot.

Should I get tested for that? He goes, we can chat. After I had pots, I had trigeminal neuralgia. Like my COVID was, I couldn't oxygenate and I had all these neurological symptoms and I was trying to share my story online. And find people who were like [01:56:00] me because doctors were like, we don't know. And yet I was also censored, and they wouldn't, and I'm like, I'm just sitting here talking about the fact that I'm on oxygen, that I don't have diabetes.

Yeah. I don't have heart disease. I don't have any of that. And yet I got severe COVID. Mm-hmm. And that was something that they deemed had to be censored because it went against the CDC saying, you only get severe COVID. The World Health Organization only says you get severe COVID if there's these things.

And now, uh, you know, it was like, I kept saying like, I think it's related to my autoimmunity. I think, yeah, there's something going on with my auto immunity. And then studies came out like six months later and it was like, lo and behold, yeah, you might actually have autoimmunity triggered by COVID. Mm-hmm.

That makes it so your immune cells don't fight. And then you have dis dismia, you're having pots, you're having all of these things. And so I think we have like, it's so easy to be like. Wow. Doctors, you got it all wrong. But I think doctors being human were [01:57:00] influenced just as much Yeah. By what social media was doing, which was I, it's funny because people ask me like, do you censor your podcast?

I'm like, no, because I actually don't after what I saw happen in the pandemic. Yeah. I don't support censorship anymore. If you're saying racist things, I'm gonna kick you out. You're not, you're getting censored and I'm kicking you out because you're not allowed in my house. But good call. But you know, yeah.

It is outside of like something grossly horrific like that, it's like you can have independent ideas and thoughts. Something happened in the pandemic where clinical experience became something we stopped listening to, and then we started censoring anything that wasn't just in line with what we currently thought.

And I'm like, this is the opposite of science. And we saw these camps split. And people blame like this, you know, alt-right pipeline and all of this stuff. And I'm like, okay, censoring people pushed people that way. Like these camps split and they divided because people were like, I wanna be able to talk about what I wanna talk about.

I [01:58:00] dont wanna be censored. And then we had people that were like, everything, and everyone is a conspiracy theory. If you question pharma, if you question this, and it's like, and on this podcast I find that every single person has been in the middle where they're like, no, no, no, no. Some things are a conspiracy, but also some things were true.

Yeah. Like people needed to exercise during the pandemic and have community. And we took that away from them. But I got censored when I said that on social media. Yeah. So there's a bit of a, a, a rant there, but also to like, I think it's really easy for us to be like, ugh, like put it on the individual doctor that you can see and touch and maybe punch in the office.

Right. Like that. We, we've all been frustrated that way with doctors before, please don't punch your doctor. But it's really easy to be like, that is the problem. And not pan out and be like, we had a lot of issues and we still haven't come to terms with talking about them. 

Dr. Wada: Yeah. Well, and I think, you know, part of what's driving a lot of gaslighting is you, burnout may not be the right term for [01:59:00] it, but if you look at the healthcare system, physicians and nurses and other healthcare professionals are leaving clinical practice in droves.

Oh yeah. Because the system. Is bad as an as, as an employee, as someone like providing that care. It's not in line with what we anticipated or what we were promised healthcare was going to look like. Those healing relationships were going to look like and when you were burnt out. If you look at the description of those symptoms, one of the first things that happens is you're depersonalized.

You're unable to be empathetic. Mm-hmm. Compassionate to listen, to think cur with curiosity and creativity. That's what you need when you are a more challenging patient that doesn't read the textbook you need. Someone who is not burnt out, who is healthy. You know, like we need to work on healing our healers, I think is part of this whole, you know, [02:00:00] paradigm shift.

That's, that's really I think what's needed to help us as, you know, chronic illness patients too. 

Dr. Brighten: Yeah. We're also seeing the numbers of people going into medical professions declining. Mm-hmm. People don't wanna take out the debt, miss out on, you know, 15 years of their life and sacrifice all of that to only have that five to seven minute experience.

And I think that's, yeah. Important for patients to hear what you just said. Like, nobody goes into medicine because they want to gaslight their patients, they wanna dismiss their patients. No. They don't wanna help people. Everybody goes in wanting to help people. And there are people that will always, when I say this, they're like, no, they wanted to make money.

I'm like, if you knew how much doctors are making compared to how much debt they took out and how much of their life they've given up, you would clearly see that they would've gone into healthcare administration instead of clinical practice. Finance. Yeah, [02:01:00] finance. There we go. Trust funds. Like now go a different route.

And like, um, that just reminds me of that like, TikTok trend of like, I'm looking for the guy in finance. Um, so people who are listening to this right now. 'cause this feels like really disheartening. Yeah. One thing that I always say is that when you find a good doctor, like. Be, be their cheerleader. Tell them how great they are.

When you see a person online like yourself who's going against the grain to do better for patients, cheer them on, give them a follow of, like, share their content, leave them positive comments, because people are more inclined to leave negative comments than they are ever positive. We also, that's why Yelp is like, don't go to Yelp if you actually want the truth, because it's just usually people being mad.

So that's one thing that I say is like, cheer them on. Help them keep going because as you already said, when you, you're doing these things and it's not totally in alignment with where, and your colleagues will get there and the next 10 years and then they'll act like they discovered it. They will, I've watched this play out.

You [02:02:00] have party about it 25 years in, in, uh, healthcare. I'm like, this is always the pattern. Same pattern all the time. But what else can people be doing to elicit the change to help start making that positive change? Because as a patient, they're not completely helpless in this. 

Dr. Wada: I, first of all, I really appreciate, um, that, because I think when you're in the midst of it, those little one-off comments really, gosh, they really make a huge difference.

I had a colleague reach out last night from, we share a mutual patient. She wanted to make sure that I was someone who it would be safe to send a a. Transgender patient to come see me. Um, and so I, I messaged her back. But even that little comment of like, oh, I heard really great things from our mutual patient like that honestly made my month.

Yeah. Like, you know, like just that little comment. I really think education is power. Learning as much as you can about how the body works, how the body, uh, not, doesn't work sometimes [02:03:00] really helps put you in the driver's seat. I think the other thing that's helpful to remember, um, a, I love grew up in the Midwest, loved little sayings, but like, uh, we attract a lot more flies with honey than vinegar.

And even when we are just so fed up with the system trying to be, and to channel that frustration with a little bit of kindness with, especially with the folks on the phone, um, 'cause gosh, they are just taking it from everyone. That can be really helpful. So one tip that I love passing on, you can ask how long your visit is scheduled for.

You can ask the scheduler. You can also ask if there's any potential to be double, like, to have two sessions or to, um, ask them like, Hey, does doctor and so and so tend to spend a little extra time with that first patient or that last patient on the day? So that's another, um, great, um, little tip and then keep your ear to the ground in, uh, support [02:04:00] groups.

I think that is a really great place to find the names of those, those folks who may be a bit safer, um, and or maybe worth kind of that extra investment in time, energy, and sometimes frankly, money, um, to go see. Um, because our health really is, is one of the things that is a huge priority, right? And a. It just makes such an impact, especially just thinking about us as moms, leaders of our families.

Like if we go down, that ship goes down the whole, you know, like everything goes down. 

Dr. Brighten: Yeah. Yeah. 

Dr. Wada: And to 

Dr. Brighten: your point about, you know, you attract more flies with honey, I think it's very easy to see why a patient would yell, be angry. Absolutely. Lash out. And yet you have to remember that you are talking to a human and if you put them into fight or flight mode mm-hmm.

They go into that sympathetic drive, [02:05:00] they're, A lot of people aren't gonna actually fight you or leave the room. They're gonna go into freeze. And they're gonna shut down because they can't, because you might be like, this is the one time I'm yelling at you. Mm-hmm. But you might be the 10th person that week to yell at them.

And now their nervous system is shutting down. What's their nervous system? Their brain. And that's what you came for, is the brain. And so yeah, I am totally like, I feel like, um, there's definitely been in my own doctor's visits where I've had to go and I'm like, I feel like I'm going to war and I have to be super strategic as, as awful as I feel right now, as heartbroken as I am right now, I'm going to war.

And I don't win this war with weapons. I win it with my mind. And so. For people to understand that you can start to shift that doctor patient relationship as well. Mm-hmm. Trash humans exist everywhere. I want you to know that as well. Whether it's your plumber, your, your mechanic, uh, you know, your, you know, whatever it is.

Every single profession has them and so that doesn't mean that [02:06:00] it's, sometimes it's just not a good fit. You got breakup. Yeah. So true. Where can people find you? Where are you working with patients right now? 

Dr. Wada: Yeah, so I am based out of Columbus, Ohio. Mm-hmm. I'm licensed in about 16 different states. Wow. So you work with you virtually?

Yes. Perfect. So I have, um, primarily telehealth based practice. Mm-hmm. But do you have patients come to see me for the immunotherapy treatment? I mentioned people can find [email protected]. I also have YouTube channel at, um, car Wata, md and I look forward to connecting. Thank you so much for having me on.

Yeah. 

Dr. Brighten: We'll link to all of this in the show notes so people can find you very easily. 

Dr. Wada: Yeah. Over on my website, have a freebie if you want to kind of get inside my mind and think about how an immunologist might think so you can prepare for your next visit. I have a nice resource over there that's for free.

Dr. Brighten: Oh, perfect. We'll link to that too. Well, thank you so much for taking the time to share your expertise with us today. Thank you so much for having me. I'm, this has been a thrill. Thank you so much for joining the conversation. If you could like, subscribe or leave a review, it [02:07:00] helps me so much in getting this information out to everyone who needs it.

 

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