Episode 45: Food Allergy or Intolerance? Sorting Out the Confusion with Dr. Shaunah Ritter

Ever feel bloated, itchy, or just “off” after eating certain foods—and wonder if it’s an allergy? In this episode, allergist Dr. Shaunah Ritter helps us sort fact from confusion when it comes to food reactions. We dig into the difference between milk allergy and lactose intolerance (they’re not the same!), why food diaries matter, and how to use them to figure out what’s really bothering you.

We also talk about the pros and cons of at-home allergy tests, how skin testing works in the office, and why cutting out too many foods can actually hurt your gut health. Plus, Dr. Ritter explains celiac disease, wheat allergy, gluten sensitivity, and what you need to know about peanut exposure in kids. 

If you’ve ever wondered whether your symptoms are from an allergy, intolerance, or something else entirely—this episode will give you clarity and practical steps forward.

For more information on food allergies:

FARE: Food Allergy Research and Education

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Food Allergy or Intolerance? Sorting Out the Confusion with Dr. Shaunah Ritter 

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship and is not a substitute for professional medical advice. Diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. We're wrapping up our episodes on gut health and we're gonna spend time today talking about food allergies. I feel like you can't go anywhere without encountering something about this. There's always a label that says, this has been made in a peanut facility, or it says something about soy, or you're getting a gluten-free menu.

The food allergies, I feel like have just exploded and. I am so curious to hear why. 

So today we brought on an expert and we have Dr. Shauna Ritter, joining us today. She's a board certified allergist and assistant professor at the University of Kentucky. She also is one of my first residents when I was an attending.

And so I am just thrilled to have [00:02:00] her today because I know there's been so many times I've asked her questions about food allergies and she's been able to educate me to help me understand So before we get talking about food allergies, Dr. Ritter, can you just tell our listeners what made you wanna go into allergy to begin with?

So I 

had a lot of environmental allergies growing up, just like most people in Kentucky do. And when I was a pre-med, I ended up going to an allergist for the first time myself and I was like, Hey. This looks like a cool field. And so then I just started shadowing them and then working with them kind of in electives in med school and doing it as much as I could.

And I was like, yeah, this is what I wanna do. So it was pretty early on that I knew. 

And how would you say that food allergies impact an allergist on a daily basis in their practice? Is this something that you're seeing all the time? Oh yeah. Every day 

I would say that is probably even more common than the allergic rhinitis that I see.

There's more than those runny noses. [00:03:00] Yes, I would say it's probably just a little bit more. 

And is it because it's becoming more common or people are just aware of it more than we used to be? Or is it actually food allergies are becoming more common? 

I 

think it's 

both The prevalence has increased over the last few years, so have reaction rates, but I also think we're just better at recognizing it and like more people are getting tested, that kind of thing.

So it's a little bit of both and 

I know there's lots of philosophies on why this is. Yeah. Can you just give our listeners, and I know it's not concrete Yeah. On why, but can you just give our listeners some of the hypothesis that are out there why this might be increasing? 

when I've looked into this, there's no firm answer that.

 Yes, a hundred percent certain environmental things will cause it to happen. But we do know that there are things that maybe increase that risk or some genetics that may like family history of allergies can be passed [00:04:00] down. Is there one single gene? No. Not that they've at least found yet.

And then I would say things that are gonna make you higher risk for food allergy is like eczema. we know kids with eczema are at higher risk for food allergy. Kids with allergy and asthma are at a higher risk of food allergy. It's what you hear when someone says this person is an atopic individual.

They go with all of that. There's some thought that is declining breastfeeding rates causing it. Is c-section rates causing it? Is it processed foods? And there's not a whole lot of great studies to seal that. In it's all stuff that's been looked at. It's all stuff that may or may not contribute.

But none of it's a hundred percent. 

And I guess could be a little bit of all of those 

things, right? That's it's could it be, could it not be, people talk about like the hygiene hypothesis. Are we not getting introduced to certain bacterias and things like that early enough in life?

Or is it all the antibiotics we're doing? There's a lot of studies [00:05:00] going on , but none of it has been concrete enough to. Say a hundred percent that's what this is. And a 

lot of times that ends up being, because it's multiple things. Yeah. Yeah. 

There's so many things that contribute to that happening.

Now when we talk about food allergies, what are the most common ones? I, the one that comes to everyone's mind is always peanuts and nut allergies, just because I feel like that's the one that's was the highest for so long. But there's lots of other ones that are increasing as well. Can you just tell our listeners what those top food allergies are?

Top food allergies are cow's, milk, egg, wheat, soy, peanut, tree nut, fish, shellfish, and then sesame snuck its way in there as well. also different ethnicities and cultures based on some of the foods they'll eat can also have. Other foods that are in there too. Peanut is the one that gets the bad rep, but to be honest, most kids it's [00:06:00] milk allergy and most adults it's shellfish.

And so peanut is just the one that gets the bad rep though. 

Is that because the allergy is more severe, so we're just more careful about it, or not really? 

No, not really. I think it's just, especially in that first year of life, there's so much transition over to milk and so that makes it seem like it's probably, 'cause that's the more common thing they're seeing.

You don't have a 1-year-old eating whole nuts 'cause of the choking hazard. So most of them end up that first food being like milk or egg, that they have a reaction to. Peanut and tree nuts can have more severe reactions, but I've seen severe reactions from milk too.

I don't even think about that as something that causes a severe reaction. I tend to think of people that have a milk allergy, just having a mild upset stomach. What do most people experience with a milk allergy? Yeah, I, 'cause 

I, and I think this would be great to distinguish, we hear about lactose intolerance [00:07:00] a lot.

So what is the difference between someone being lactose intolerant versus having that milk allergy that you're seeing in these young kids? 

How I explain it is, so food allergy is an actual immune process. So if you go to an allergist, they should be saying to you, food allergy is what we call an IgE E mediated response, meaning your body has made this allergic antibody to this food.

So when you ingest it, this complicated immune process happens that causes your symptoms. So with food allergy, you're normally gonna see most commonly hives. Itching, flushing, maybe some swelling. And little kids you'll actually see like vomiting. I mean you can see that in adults too, but kids tend to do a lot more of the vomiting and have hives and a combination of those symptoms.

So that kind of reaction can be life-threatening the first time it happens. A lot of the times it's not. So a lot of people are like, oh, the first time we eat [00:08:00] this food we're scared. But most of the time when I see it, anaphylaxis isn't the first thing that happens, right?

Like they'll have symptoms of a food allergy, but it's normally not to the severity of full on anaphylaxis, right? But it's enough that you're like, oh something happened with that food. And that's what allergy testing when you go to an allergist is good for, 'cause we are testing the IgE antibody to that food.

So that's what we're looking at on skin testing. Whereas . Intolerance as a very broad definition. Sometimes there's something you can look for and sometimes there's not. So lactose intolerance is that your body is missing the enzyme to break down lactose, okay? skin testing for allergy isn't testing for enzyme, right?

That's not it. That testing is GI breath test most of the time from that is where you're getting the bloating, the belly pain, the vomiting, the diarrhea. I don't feel good. But then you're not getting the hives, the flushing, the coughing, [00:09:00] the wheezing.

You're not getting those other symptoms with it. And lactose intolerance is certainly not fun and is uncomfortable, but it's not gonna be life threatening, 

that is a great clarification there. I think it's really important. To understand when you say this, IgE mediated reaction is when you go to see an allergist, you're getting these skin tests, right?

But there's tons of blood tests out there. So what is that difference and why are you poking people under the skin There's skin, are they poking people instead of taking their blood? Like why is that? Can you explain that? 'cause I think that's, is confusing to many people and they're like, this just seems like a more, difficult thing to do than doing that blood test.

But it has a reason. Yes, 

it does have a reason. Nobody wants to have to poke you when you come to the allergist, but we do it because it's, I would say the best test we can do in a short amount of time, and I'll explain that a little bit more in a minute, but you can do skin testing for IgE mediated [00:10:00] allergies.

So when you test, you're actually the little mast cells that live underneath your skin. When you poke 'em with that food that you've already had allergy antibody made to, that's what causes a mast cell to pop open causes the little mosquito bite looking like itchy place on the testing site. So that's why we're doing that. And it tends to be better at ruling out allergies. It is not good though, at telling me a hundred percent. Do you have it? So when a skin test is negative, specifically for like egg milk, peanut tree nut, I tell people it's 95%. It's truly negative. But sometimes there are barriers to being skin tested, right?

So sometimes like people have needle phobia, they don't wanna be skin tested. Sometimes they forget to stop their Zyrtec or their Benadryl or their Claritin. That blocks our testing. So we can't test you if you're still taking [00:11:00] those medicines. So then you get false negatives. So a lot of times we'll do blood testing in those situations since you're already at the appointment, we can get an idea based off that.

But if you're asking which one is better, skin test is better at ruling things out. But to be honest, neither one of them are good at ruling things in. You get really high false positive rate, meaning 50% of the time you get a false 

positive. And that is really important when it's comes to the history that a patient brings you when they show up.

So can you explain why someone would come in and you're asking so many questions before they even have the skin testing, instead of just saying, oh, just get the skin test, it's gonna tell me whether or not I had this food allergy. 

Yes. And the thing I explained to patients is what you were alluding at is.

The most important thing to me for food allergy is your history. If you tell me I ate an egg and [00:12:00] within 20 minutes I was head to toe covered the hives I threw up, I was coughing. I didn't feel well. I did go to the er, right? If you come in and tell me that, I'm like, Ooh, I'm really concerned about food allergy.

'cause food allergy happens pretty fast. Normally within minutes to maybe an hour you should be reacting. There's a standout that is different from that, but that has a whole nother podcast on its own as far as alpha gout goes. But most food allergy is immediate. It happens very quickly. And so when we do skin testing, it's that skin test with that history that.

Increases the likelihood of this being a true IgE mediated food allergy. So if I test you to egg and your egg test is positive with that history, I'm like, yes, this is an egg allergy. Whereas in, even if someone comes in with lactose intolerance, That's a completely different immune process.

The treatment and management of those things are completely different. So if I tested you [00:13:00] to milk for a lactose intolerance and it's negative, that doesn't tell me that those symptoms still aren't real, It just tells me that this isn't a food allergy. So that's where you're teasing out the history with the testing.

'cause again, you get false positive, so you can have someone pop up positive to a ton of different foods, but that may not be explaining all your symptoms. 

 And you mentioned earlier about anaphylaxis, which is the life threatening. Reaction that can happen for some people and that doesn't happen the first time.

Obviously that's something everyone would want to avoid. Is there any way to know, or how many times does it usually take to be exposed to something before you would have that big life-threatening reaction? 

Yeah, so you normally need to see something to become what we call sensitized to it, and then whether or not you're sensitized to it can cause it to actually become an issue, right?

Like whether or not it's actually an allergic response or you're just sensitized. And having no symptoms. But, there's [00:14:00] not like a magic number to say it's gonna happen on the second time or the third time. For example, like kiddos with eczema, it may be like the first or second time they eat peanut, but the whole issue with kids with eczema is their skin barrier, 

they've got like that dry cracked, itchy red skin, and that could be a portal of entry of food allergen is happening through the skin. They're getting sensitized, and that's how their allergy is already developed, even if they technically haven't eaten it yet, Because they've been sensitized through their skin.

So there's different ways it can happen. And again, that's why the history is so important. But most of the time when we see people coming in with food allergy, especially young kids, it tends to be like they got a few hives on their face. Maybe they spit up a little bit, and it's happened again when they tried it again.

Like those are the ones that I'd tell myself like, Hey, we need to look into this. Especially if it's repeatedly happening. But majority of the time, the first time something happens, it tends to just be skin stuff or maybe like a little spit up and you're watching 'em and you're like that [00:15:00] worries me.

But it's not a bad thing to have the allergist test them to that specific food if you're worried because we can kinda work through that murky water if we need to. 

And what about things just, you've got me thinking about kids and things I experienced with mine, but my son, when we first did strawberries, he would get like a skin rash around his mouth.

But then we just stopped for a little bit and then tried again and kept doing that over time and then it just seemed to go away. 

Yeah. Kids, especially kids with really sensitive skin, will get what we call an irritant contact dermatitis around the mouth with foods like strawberry, barbecue sauce, spaghetti sauce, pizza, things that are really acidic.

And it tends to be just more of a irritation from the acidity onto their skin. And so that when I hear that, I'm reassured in the room. I'm like, oh, perfect. If it's just around the mouth, no other symptoms, I'm like, oh, thank goodness [00:16:00] this is just contact irritant from whatever acidic foods they're eating.

I tell 'em there's no need for us to do any testing and I say smother some Vaseline on the mouth and feed it to 'em. Because that barrier will keep it from getting irritated the next time. 

So that, I think that's a good thing for our listeners to hear is Hey, if you're concerned about something, look all over.

Yeah. And see what's going on. And every doctor will always say A picture is worth a lot. To us when it comes to the skin. All the pictures. Especially something that can be transient like hives is if you can grab a photo when something happens.

So when you make it to the doctor's office, you say, this is what it looks like. The advantage of having phones by side, it's Yeah. Now is to be able to capture some of that. 'Cause it really can help your physician make better clinical decisions by having that info. Now we've talked about the history being so important and I think.

That is why some people get so confused because , they do a lot of this at home allergy testing that exists out there. What are some of your concerns with [00:17:00] those home tests that people can send in? 

Yeah. Oh, that is, 

we won't say specific names, but just in general, we'll say specific names. 

We all know what, when we're talking about, I get ads on it all the time on my page and I'm like, oh my gosh, this is just a money grab.

They're not covered by insurance. You're paying two or 300 bucks out of pocket for that. And to be honest, and I can think of a lot of things I'd rather spend two or $300 on, and I tell patients that when they ask me about it. So those over the counter allergy tests are looking at IgG antibodies, number one.

So like we alluded on the first half of this podcast, food allergy is e So those. Tests are not even looking at food allergy. So then they sell it as, oh, we're looking at food sensitivity. So your body's job is to make antibodies. So when you're eating and your gut is processing that, it's processing it in a way that you are going to [00:18:00] make antibodies to something, right?

So at least in the allergy world, IgG antibodies mean nothing to me. If someone brings that in and hands it to me, I'm like thank goodness that this isn't IgE testing. 'cause then we would be in a really bad spot with all these positives. But the thought is there's actually some levels of IgG that we measure in allergy world to indicate tolerance.

So that goes into question. ' cause there is no data behind these at home sensitivity test of is this causing my symptoms or not? No one knows what to do with IgG testing because there's no clinical driven data behind it to say, Hey. This high level equals these types of symptoms that doesn't exist. And then there's also further thought that some of the IgG could actually indicate tolerance, not intolerance.

And so what I have seen at least is people bring it in and they're like, these are the foods I was eating the most of. And those levels are the highest you, we were probably tolerating it like, [00:19:00] the best thing for symptoms or concern for food is what happens when you eat it, right? So if you are eating something and you say, Hey, like my stomach hurts, it gives me a headache.

I don't feel good after I eat it. There's no test to tell me that. But what you as a patient experience, when you eat it, if you take it out and those symptoms quit happening and never happen again, then yeah, it was probably the food. But I don't have a test to tell me that. The test was what you're telling me, the symptoms.

Yeah. And I 

always. Tell people a food diary is a very powerful tool when you're trying to figure out food intolerances, not food allergies necessarily. As we're trying to distinguish that or food sensitivities that those tests are trying to tell you. You have is your best tool is actually keeping a diary of your symptoms, what you eat, and then trying to tease it out yourself.

And you can learn a ton of information by doing that. And it also helps you not have to do a [00:20:00] very strict elimination diet for a long period of time as well. The more you're able to be in touch with your own body and symptoms and monitoring that and you can quickly figure out maybe it is food. 

Yeah.

Because if there's something bothering you and you're eating it, even if my testing is negative and it still happens when you're eating it, that's the best test you can do is Oh, where your testing is negative. But I know what bothers me. Then we don't need to eat it, and if those symptoms go away, great. it, it stinks. You have to avoid that food. But at least you've done your food journal, you've figured out, it's narrowed down to this. We take it out. Symptoms resolve. But where you get into issues and people who are doing sensitivity testing that no one knows what it means.

And or someone's doing a broad panel food allergy test and again, that's not even gonna explain those symptoms. Then you may actually be ignoring something that could be more serious going on. 

That's an interesting thought. So I had a [00:21:00] friend actually who had a lot of GI issues and they did one of those.

Tests that you are referring to after going through a full workup with a gastroenterologist and having a scope and being tested for celiac and all those things, which we will touch on a little bit later. But so they did one of those tests and it showed the IgG to a lot of different things. And now that I'm hearing you say what you're saying, it was a lot of things that they were eating, wheat was one of them, and they ate a lot of wheat bread and crackers and that type of thing.

Yeah. And so it makes sense. , But because of that test, they took it out of their diet and they felt better. So then you think you can't eat wheat because of that, but can they. Yes. Is it just because they were eating so much or a refined version of that? Or how should someone that maybe has done this, because I think so many people have already done these tests Oh, yeah.

And have restricted themselves so much. [00:22:00] What should that person do? 

And see, here's where you get into a bad spot because if you take food out too long, 

Completely eliminate, not reduce. Not reduce it. Okay. Completely take it out based on one of those tests, and it's been six months.

Okay. If you actually had started developing IgE antibodies to that, and you took it out and you lost that sensitization or that tolerance, you could actually give yourself a food allergy. One that does need a, an EpiPen could be life threatening and so that's why, , if you're taking foods out and putting them back in, I tell people , no more than four to six weeks of doing that because you run this risk of if you go to take stuff out that you actually can cause a food allergy by avoiding it and not being used to eating it.

And so that's another bad part of all this over the counter testing is [00:23:00] it may say, okay, these are high, try taking it out, but then you go to put it back in and your symptoms return. Like, That's just as good as you wouldn't have taken the test and just tried that in the first place anyway.

Yes, I guess it, it's almost more like it just gives you your food diary. 

Yeah. 

When you could have just done the food diary. I think the only, if I'm playing devil's advocate here the only way I could think that maybe it would help would be if you're not realizing what's in your food. Because so many things have things that you don't know.

Like soy is in it and maybe you had no idea that it was a soy product. You just think it's something else. And then you don't put together that it's multiple things that have soy as an ingredient. Yeah. As the correct common denominator. 

Yeah. Because that one is a sneaky one. 'cause it is in so many things.

I would just say the how would we for sure know that it was, you were eating a lot of it, or just for some reason your body just made more of that antibody. Like I don't think that there's enough data with. That kind of [00:24:00] testing yet to say, oh, if you eat a lot, this level should be in this range or this level and this range is unhealthy and probably causing symptoms.

Versus this is a normal level to have. Did your body just make more of a response to soy and wheat than it does some of these other foods? And that's why the number is higher because of the way your immune system processed it. And that's the thing is nobody, we just don't know. Nobody knows. 

I think that is great.

So I'm gonna reiterate, I'm pro food diary and it's cheaper. And it's cheaper. It is cheaper and it's cheaper. And I just think people's mindsets, it's really that understanding of am I looking for an allergy or am I looking for an intolerance? And that's just one big message that I wanted to get out there.

Today on this show, because you have to look at food allergies as a life-threatening situation versus an intolerance might cause some discomfort, but it's not life-threatening. And so those are just critical to be able to distinguish between those [00:25:00] two. And I don't think that all users of some of these tests understand those differences.

Correct. 

And I think as a medical society, we are all in the point of we want to find patients' answers. Like we are all problem solver, critical thinkers. when you have someone like your friend, right? They went to gi, everything was fine. They're like, we don't know, maybe look at food testing.

And we get these referrals from GI doctors, from primary care doctors from Facebook groups, oh, I need to go do food allergy testing. As we've talked about this whole first half, like food allergy testing isn't gonna help those types of symptoms. Food allergy type symptoms? Yes. Food sensitivity and tolerance type symptoms.

No, and so again, you will find people who will broadly put on this big old panel of foods and you'll get all these positives, and then patients become confused. They're like I eat it and I don't know any problems with that food, but the food I was worried about was negative and that one's still causing me problems, [00:26:00] but now I can't eat 20 foods.

Then their grocery trips become more expensive because they're having to eliminate so much. Their diet becomes more narrow. Then you're maybe overlooking the possible issue of something else that. They think is 20 foods that probably aren't their problem. 

Yeah. And as we always preach here, we wanna keep that diversity of lots of foods so we, there's no, but you don't have to have a restriction on many of these healthy foods then, let's not have it 

correct.

When it comes to that made may think about something with milk in particular a minute ago when you said taking it away and then bringing it back. So for somebody that notices they have issues with milk and it's more that upset stomach, which would, now we know from you telling us it's not hives and flushing and vomiting, it's upset stomach, which makes us think maybe this is an intolerance or lactose problem and they take it away.

Are they then, because it wasn't an allergy, so are then they gonna have a problem or should they [00:27:00] try something else to figure it out? 

So I tell people to go with lactose free dairy, so like fair life lactate. So I'll have people, and this is also one of my favorites, like the rash on the mouth.

They're like, oh, I'm concerned. I have a milk allergy. And so I have taken milk outta my diet. I'm like, okay, how long and what are you doing? Oh, I drink fairlife every day. And I'm like, oh, good. So fairlife and lactate are still milk protein. They just have, they're missing the lactose in there that's giving people the belly problem.

So 

it's like a perfect test for 

you. Yeah, so for me, because, so for me, I'm just like, oh, perfect. If we think this is just lactose intolerance, I say well try buying dairy that is lactose free. So fair life is a good one. Lactaid is a good one. Or you can do non milk based ones if you want to if you don't have a tree nut allergy, you can do almond based or soy based or another one.

But if you're wanting to keep, like the milk protein in [00:28:00] fairlife and lactate are really good. They have I think like cottage cheeses, ice creams, cheese plus your milk. And and then that keeps the milk protein in the diet. 

Great. That was great. Yeah. So another one that I think is common that you probably get a lot of is talking about gluten and do I have a gluten allergy?

Do I have celiac? Tell our listeners about these two, because I know this is, has to be a question you get all the time. 

All the time. And then again, as a provider, you have someone coming in looking for an answer and they're like I've been told I'm gonna get food tested for my celiacs.

And I'm like, Ooh, that's not how this works. So again, we've talked about allergy, that's IgE mediated. That is what an allergist test is good for looking at, especially if your symptoms align with that. Celiac's disease is a different immune process that has happened where your body , when you eat gluten, has made an antibody to the gluten.

But it's not IgE [00:29:00] mediated, so the symptoms are different. So if you had gluten allergy, then you would say, anytime I eat gluten, within minutes, I hive up, I'm coughing, I'm wheezing, I'm vomiting, I have to use my EpiPen, I'm going to the hospital. If you're having that kind of symptom and I test you to gluten containing things and it's positive, that's gluten allergy, If you have celiac's disease, celiac disease again, is not an IgE mediated antibody. It's a different type of antibody to gluten. Those symptoms tend to be more diarrhea, bloating, belly pain, malabsorption weight loss. Then sometimes they'll get like an itchy non hive looking rash, That testing is not skin testing.

That testing is blood testing. Looking at IGA antibodies in the blood or getting an EGD with a biopsy. So different immune process, different immune antibody, different diagnosis, different management. 

And then I'm gonna put a third one in there. Oh boy. [00:30:00] Is just gluten intolerance because there are people that don't have the allergy.

Yep. They don't have celiac disease. Yep. But they still don't feel well when they eat a lot of gluten. I think it's important for people to distinguish that. Yeah. And it's okay to eat less of it 'cause you feel better. 

Correct. And that's what I tell people you know yourself more than I do.

I'm meeting you for the first or second time when you've got this testing done. I'm not going to downplay the symptoms you're having with your food, but I can't offer you a test that doesn't exist. So the answer is, if. You've rolled out food allergy, like you're not having those types of symptoms, then I don't need to put that test on you.

And then you've gone to gi, you've had the blood work, you've had the biopsy, but you're like, I just don't feel good when I eat gluten. There's no test, just don't eat it. And that's frustrating 'cause I wish there was something we could do to say that. There are things that don't agree with people and at that point, I tell [00:31:00] 'em, take it out for a month.

If you feel better and everything is gone, put it back in. If, when you put it back in those symptoms return, that's the best test you can do. And then if it comes back and your symptoms are bothersome again when you put it back in, that's also your answer. And I'm like, just don't eat it or see if eating it in moderation helps.

Yeah. Maybe something where, eating a bunch of bread would cause issues, but if you ate something that was breaded and there's not that much gluten that you might tolerate it. So those doses are. I think people probably don't think about it. They try to eliminate it all the way.

Yeah. Yeah. And we talked about how to do those elimination things properly as well. When we had Emily McGlone on here, she is a dietician that works on gut health. So if this is something that interests you as well, be sure to go back and listen to her episode. 'cause she talks about the importance, just like Dr.

Ritter mentioned, is when you eliminate, then you bring it back and assess your symptoms. 'Cause you don't wanna eliminate too much [00:32:00] stuff 'cause we don't wanna lose the diversity of the things we're able to eat. 

Can we talk about peanuts? 

Yes. 

Okay. 

And I'll say this when I have my children, I pretty sure I, was messaging Shauna immediately as okay, what do I do with peanuts?

 when can my kid have it? I don't want him to have an allergy. I'm so confused. This evidence has been all over the place. Tell 'em what you told me. Let 'em eat 

the peanut. Say it louder. Eat the peanut.

Yes. Over the years, I think, and that's even happened, I feel like from when I went from medical school almost a decade ago to now being even in practice in that timeframe, it shifted a lot. So it was thought at first if we avoid it, especially in kids who are high risk, so we were talking earlier about kids with eczema are at higher risk for food allergy.

That doesn't mean that every kid with eczema will have, it just means they are higher risk. That there is a population of [00:33:00] patients that will, should we delay it? Should we wait till they are one? Should we wait till they're a little bit older before we put it into their diet? Try to avoid it as long as we can.

We found. We created more food allergy that way. So that's where the LEAP study came in that they found, especially in kids who are high risk for food allergy, so kids with moderate to severe eczema and kids who maybe already had egg allergy. Those were the two that were deemed high risk. They found that significantly, those kids needed to get peanut in between four to six months of 

age.

 how do I feed my kid peanuts? Yes. How do you get peanut in at such a young age? 

what is that answer? So what I recommend is you can either do smooth peanut butter, like little bit into breast milk, or you can do PB two powder into apple sauce.

Or PB two powder into milk that they can drink it. Once they get to six, seven months, they can do [00:34:00] those bombas that are like the peanut puff sticks or the pouches. There are little pouches that have like banana and peanut in 'em. And then the most other important thing is once a food is in, leave it in , so if I have a kiddo who has bad eczema and they're like, we let 'em try peanut, they loved it, they're doing it.

And I'm like, great. Leave it in their diet at least three days a week. Because like we were talking about, where you get into problems is when you're eating it, taking it out for long periods of time and then go to eat it again. That's where you can take that tolerance enough away that you could shift into this more food allergy state.

And that's what, especially in kids who are high risk, you want to avoid. So get it in early. So don't, and don't take it back out.

This would be me as well, and I didn't do it 'cause I asked you, but I could see myself being like, oh, I got it in them. I can breathe. And then just forget about it.

Yeah. Not doing, yeah, you can't do that. That box is checked. We did good. So I think that's really good [00:35:00] advice. 'cause that is totally something that I would just be like, oh, made it through that and then just, yeah, forget about it. So 

for my kids that are young, that, obviously it's more of like a choking hazard, eating a whole nut.

Peanut butter PB two powder, which is pure powder, can be mixed in. You can even mix like a little bit of the smooth into something. I 

love that stuff. It's has clean ingredients. Yes, it's a great option. Yep. And then 

tree nut butters. There's a lot of tree nut butters out there too for the tree nut scenario.

Oh, that's 

a good point. Question about tree nuts. And peanuts too, I was on a flight recently and there's no good snacks on a flight, so I brought some almonds in a Ziploc bag and I took them out and then I was like, oh wait, what if they're someone around me with a nut allergy?

Should I not eat these almonds? And I put 'em back in my bag? Could I have eaten them? Yes. Because 

I used to give nuts. Yes you can. So what I tell people with food.

You put them in your almonds. [00:36:00] I'm sorry. Okay. I'm composing myself. 

Okay. So I think one of the other common misconceptions, so that's a great question actually. Food allergy is most of the time, when I say most of the time all the time, it's ingestion. You have to eat it. Okay? One scenario that could be aroma and that's fish where people are frying fish.

With fish allergy, there was a case of someone dying from that with fish allergy, but the question is, was it actually anaphylaxis or did they have bad asthma? Went into a bronchospasm that was fatal from asthma, not necessarily anaphylaxis, and I don't think that picture was ever clear. So I tell my fish people like, don't be somewhere where they're frying fish.

Just out of an abundance of caution. But other than that, most of the foods have to come from. Ingestion now, if you are a food allergic and you handle it, or it touches your skin, wipe it off. You may hive, but you shouldn't [00:37:00] anaphylax. But where you get into scenarios like traveling is, accidents happen.

Especially with little kids, you drop an almond in the seat, you don't know it, kid eats the almond I don't know if on planes they're doing, they're, they like, make that announcement sometimes. Oh, someone on here has peanut allergy don't be eating peanuts.

I don't know if it's more from just like the accident, total exposure of that, but just being on a plane, someone opens a bag of nuts and you smell it like that shouldn't cause a reaction. Now, if they accidentally got ahold of it and ate it, or appeared in some kind of other food that they didn't know.

That would do it. But there's a lot of anxiety with food allergy, 

Yeah. And I think that peanut's, like the peanuts at school. And I remember one day I accidentally sent a peanut butter sandwich with one of my children to school instead of using the sun butter. And then I was like, oh my gosh, what if I made someone have an allergy?

But I guess it's not the reason they may [00:38:00] say nut free in the classroom or something is because of the accident. Not because if my kid was sitting down the table from them and ate a peanut butter sandwich that it would make the other kid have an allergy. Correct. 

Okay. If you're on one end of if like we're sitting side by side, people can't see that.

But if I was eating peanut and you're peanut allergic, you shouldn't react. Like the smell alone isn't gonna do it.

Now if you have really bad anxiety about it, the smell could trigger, fast heart rate, vocal cord dysfunction that makes you feel short of breath. Like there is a, there's, there is a mind component to it sometimes too, right? Like it's a big anxiety but I think especially in kids or even in teenagers, 'cause that can be a thing of, oh, I dare you to eat it, That's a concerning part as a parent. So I think they do it probably more from that perspective of it. 

And what if someone touched their peanut? They didn't actually eat it, but they like grabbed it or touched it, or they, having risk [00:39:00] of having, some of that on their hands and not washing them and then eating something else that could, yeah.

Yeah. But

That could be enough to set them off. 

Yeah. 

Yeah. Okay. 

If it's on the hand, you don't know what's on the hand, you stick it in your mouth. It's in there. You could have done it. Yeah. That's why 

we don't share lunches at school. 

Yeah. Yes. But it just touching your skin.

Like if this happened in class, like not in class, but if this happened in my clinic somehow , I would just wipe it off, give them a little Zyrtec and watch 'em, if it was just on their skin.

But yeah, if it goes in the mouth, 

that's enough to do it. So not aromas, but contact and gets in ingested by accident is the issue that we're trying to avoid. And I hate it because, this is such an anxiety provoking diagnosis. Yeah. 'Cause it's so serious. 

Yeah. Like I said, anaphylaxis is life threatening.

So the thing that I preach the most again, 'cause when you have a food allergy, and I think that's where. People get confused. They're like, oh, based on my testing, the [00:40:00] test was this big, or the number was this large, testing the size or the high of a number like that doesn't tell me your severity of reaction.

That's a common misconception I think that people make in clinics is oh, this test was the biggest. That's what I'm most allergic to. That's not the case. It just tells me the bigger the test is, the more likely it is. You're gonna have some kind of symptoms, but I can't tell you what it is.

With your history, again, the history matters. And if you're reaction was hives and vomiting the first time, that doesn't mean that it's always gonna be hives and vomiting. The second time it could be hives, vomiting, coughing, wheezing, blood pressure, drop the second time. I think that's where people get into trouble is oh, my food allergies just hives and swelling and I cough a little bit, but I could still breathe, so I don't need an epi.

That is incorrect. Every person who has a food allergy diagnosis needs to avoid it and have an EpiPen. 

Lemme give you another scenario. [00:41:00] Okay. Let's say someone ate they've been perfectly fine their whole life. Let's say they're an adult. And they went to some seafood gathering and ate like a ton of shellfish, let's say.

Like they just ate a ton of shrimp at this seafood gathering. They'd always tolerated shrimp in the past. Okay. And then they had hives and swelling. Should they never eat shrimp again or was it like they ate? All of this shrimp and now that was a problem. Should they go to an allergist and eat a shrimp in front of an allergist?

If you saw 

me in clinic? 'cause you should see an allergist. You should see an allergist for that. I would say don't eat it. Try to get in to see an allergist within a month. If it were me, I would do testing and then I would challenge them in the office depending on what it was like if their skin test came back and their shellfish size.

You'll, if you've ever been to an allergist you'll hear 'em [00:42:00] calling numbers out when they're reading your back. We're measuring it. If, and again, how high a number is, tells me how more likely it is. So there's like kind of a range of numbers. So if you're, I like, look at your shellfish and it's a 20 millimeter.

Hive. I'm like, Ooh, the likelihood of that's probably like 90% that is, that was an allergy. But the gold standard is to challenge 'em in clinic to that. So if there's ever a question, I will have someone after I've met with them, done the appropriate testing. I will say, if you never, ever wanna eat it again, then we will avoid it and we will have an EpiPen.

If we are really not sure, and I'm not convinced about testing or the history, then I, I have people bring it in. 'cause if I can get rid of it, I would rather get rid of the allergy. 

 And so sometimes they 

eat it and they're, you make 'em wait for what? Like an hour? It's a little more nuanced than that.

Typically, like a standard food challenge, each food based on your [00:43:00] age has a goal amount you would need to eat. So for shrimp, if you're eating, kinda I think it's four to six ounces off the top of my head. You'd have to eat four to six ounces or eight to 10 ish medium shrimp. And so I would half it five times.

So I'd take like the eight and half it to four, then to two, then to one, then to half. And then you give 'em a little bit, wait 10, 15 minutes, no symptoms, give 'em the next amount, 10, 15 minutes, give 'em the next amount, 10, 15 minutes. And you do that till they eat all of it. And then I normally watch 'em probably an hour and a half, two hours after.

And then if they make it through that and through the rest of the day with nothing else, then you're good. 

That's not something I ever got to witness in medical school. I didn't in medical school. You like go around and see what all the different specialties do, but but that would be a fun one to get to see.

Yeah, 

That's, I think that's something that's, it's not in a lot of medical school curriculums. Like it wasn't in mine except for the fact I knew I wanted to do it and I went and did an elective for a month. [00:44:00] It wasn't mandatory. And even in residency I don't think it's mandatory to do an allergy rotation, but I feel like we're getting more learners in the last couple of years.

And this is off topic, , but is it the same method for someone that is an adult and is not sure if they have a penicillin allergy? Yeah. 

we do penicillin testing as well. 'cause a lot of that is misdiagnosed. I think it's 80% of people are like, misdiagnosed with that.

And so penicillin is actually the only drug that can be skin tested. So we can do skin testing to penicillin if the skin testing is negative. Or if your history's oh, when I was eight and I'm 55, my mom gave me penicillin and said I had a rash, and I don't know what happened after that. I've never taken it again.

Sometimes I'll just bring them in and give them penicillin. I normally split it though, like you'll do 10% of the dose, then 30 minutes, 90% of the dose and then clear 'em 

they pass. Yeah. That was [00:45:00] something that I felt like I didn't learn until I was an attending that you could do that. Yeah. Yeah. 

I feel like you can ch like I'll challenge just about anything. Yeah. If there's a concern, I would rather be like if we don't know, let's just like I was gonna do like a battered beer bra challenge one time that would never, that one never panned out. But I'm like, I guess we can just do a brat and some beer.

That's what the reaction is to , because if you don't know, I'm like, if we eat it again and we tolerate it, then it wasn't that I think one of the hardest things I've learned as an allergy attending is sometimes people hive. Sometimes people anaphylax and I never find out why. And it's not for lack of trying, and so sometimes you just have to be like, baby, it was a one-off,

no, that's it. It's true. Yeah. And I think this is another reason why when you're dealing with this, it's important to see an allergist because they have a lot of options to help you tease this out because I do feel like sometimes people just make the, conclusion on their own [00:46:00] and don't really get that specific advice from an allergist, which could really change their life.

Knowing and having confidence, I do have this allergy, or I don't, that way you have that freedom and can reduce that anxiety of carrying that diagnosis if you don't really need it. Yeah. 

Or even if you do have it, like you're at least, 'cause I'll see. You're all right on my brother, he has an almond allergy.

I saw him this past week and he is I've been wondering if I need to just eat almond. And I'm like, yeah, we probably shouldn't do that. But he doesn't have an EpiPen. Or if he does it's five years old, because they just say, oh, I'm allergic. I know that I avoid it. But then you let your EpiPen expire and then you don't, the primary care, that's not something you're really talking about in primary care a lot, and maybe the primary care doctor doesn't feel comfortable even managing the food allergy or EpiPen. So it's a good idea. Like the older you get, the less likely a food allergy is to go away. But you really should be talking to some kind of medical [00:47:00] professional and getting your EpiPen refilled once a year.

Checking in on your accidental exposures, if you've had any. The most important thing, I think, and I tell people with food allergy, 'cause it is like anxiety ridden, right? I mean there's this fear of death from your food allergy. That is a real thing. And so the thing I tell people is being prepared.

And so staying up to date with your provider who diagnosed or didn't diagnose your food allergy, like to have the EpiPen on hand to have a one and date, to have one refilled, to have another one available if you have to have used it. those are all things that are important to, 

to, 

Keep up on.

Now, speaking of EpiPens, are there any tips and tricks to get them to be more affordable? Because those suckers are, that's a good question. Sarah. Expensive.

They are, I think it is getting a little bit better. A lot of insurance companies will cover there is a generic EpiPen out now that's just epi.

It just is epinephrine and it's not as fancy looking of a pen as the other ones are. So I tend to lean toward that one [00:48:00] just because I'm like, the generic's probably more covered if you're into a scenario of a high deductible plan or like some of the Medicare plans, then the cheapest, you can get it with a good rx.

I think CVS is like $110. Oh, that's better than five. Which is better. Hundred five. Yeah. Which is better than 500. Yes. But still a hundred dollars for a life-threatening medicine is crazy. But yeah, especially when you have to get it every year. Yeah. And most of the time I would say if you have one that expired two months ago and you're anaphylax again, this is not medical advice. That would be better than nothing. Yeah. But you should keep an end date EpiPen. 

And when it comes to this, 'cause sometimes you're with someone that might be having one of these scenarios.

Where is the best place to inject an EpiPen on someone? Front 

outer thigh. In the beefy part of your thigh. And it will go through close, just if you're doing it through clothes, watch if you have jeans on the big seam on the side, 'cause it's [00:49:00] thick right there. It may not go through that. So if you go just in front of it and the meaty part of your thigh, that's where you wanna, because you never know.

Yeah. You never know. Yeah. You never know. Someone might need your help. Yeah. You never know. That's where it should go. With EpiPens, I always tell people, especially if they're like little. little kiddos, somebody probably wants to hold the leg pretty stable. 'cause no kid is gonna be like, yes, I want a big shot with a needle.

 That's scary. So they will move and so you want to , have someone hold the leg or stabilize the leg when you go to, to do it. And then you're going to the ER anytime you use an EpiPen. Yes. 

Do not stay at home. That doesn't mean you get to go nowhere. That's just step one and then off to the er you go.

So this month we've talked a ton about the gut microbiome and some of our previous guests have talked about how much of our immune system is in our gut. Do you have anything to say about that or can give us a little bit of more information since you are a specialist in immunology as well? Yeah, it 

is being looked at.

[00:50:00] So as far as recommendations of is there a probiotic I need to take or a prebiotic or way down the road. Fecal transplants, like those are things that are actually being studied for food allergy. There's some thought that are there certain bacteria that could be protective in the gut that could prevent against food allergy?

That if you don't have that in your system, is that a cause that's leading to it? And if we put a probiotic in there, will it make it better? That's all being looked at. There is nothing like firm in the data that says, Hey, for sure you need to be doing this every day to prevent a food allergy.

There's nothing like that in there, but I can tell you , it is certainly being studied, I've been at many a meetings that they're talking about, gut microbiome and the pathogens in there and possible interventions that could help with that. But there's no diagnosis or prevention yet 

and that, but I do think that's exciting for all those people or any of our listeners that do have food allergies as they're looking at it.

And hopefully there could be something in the future. [00:51:00] That maybe if we're able to manipulate, we can improve their symptoms and related to that. 

Yeah, I mean it seems to make sense. If you have dysbiosis , which was what Dr. Sohi was talking to us about last week, and your gut junctions are not tight and things can leak through, it seems like that would make it more likely for you to have an allergy.

But I guess we'll probably know in the next few years maybe. 

Yeah, and I think that was one thing that definitely in literature comes across as that's why we see more food allergy and infants and kids is because their immune system is so young and naive and everything isn't, it's more pliable, right?

Like it's more influenced 'cause of how young it is. But like as far as the gut goes, so much is going on in the gut for. Food allergy possibility that they think that part of that is the other intestines just aren't old enough yet. They're not making all those antibodies yet. Could that [00:52:00] influence some of it, but even a healthy functioning immune system, like I think it's still like 2% of food gets through to get 

processed.

Wow. Now we're talking about food allergies, and let's say we have someone who's been appropriately diagnosed in childhood with a food allergy. Is there a chance that they could ever grow out of it? Are there any scenarios that someone could be able to eat that food again safely? Yes. What are those scenarios 

then?

So kids with milk and egg allergy, like that tends to be one that's the most reassuring. I think it's like. Upwards to 80% or like a third are gonna grow out of that probably by the time they're like eight to 10. And even some kids I'll have some kids again don't try this at home.

, This needs to be under the care of an allergist, but they will anaphylax to milk, like drinking a glass of milk or ice cream or yogurt or with scrambled [00:53:00] egg or french toast, but they tolerate it in baked form. So like muffins, cakes, things like that. Things that are mixed in and baked and it's one egg to six counterparts of muffins, right?

The way the allergen protein is broken down and denatured by the heating temperature and the amount of time and it being mixed in and it being a ratio, like they tolerate that. But if you gave 'em a scrambled egg, they would still anaphylax again, right? So especially young kids, I like to see them.

Every six months about to test them regularly. 'cause if I can find a window where labs are looking a little bit better and I can challenge them to something, I will, that way we can get it in. But tree nuts, shellfish, like those are down to more like 20%. So once you get a little bit older, like into your teen years, the less likely it is to go away.

But I think you should still at least keep an eye on it. 'cause there's still a chance. 

Yeah, no, that, that's helpful. So the younger you [00:54:00] are, it's like continuing following up on it and see if there's that chance. Yeah. 

That's the most crucial part. Speaking of egg allergy, I had several patients that were just like what you said, they said that they couldn't tolerate eating scrambled eggs, but they could eat a cake and they could eat things that had baked eggs in them, but then they were fearful of getting a flu shot.

Yes. Should they be no debunked? 

Yes, the egg, the flu shot egg allergy thing has been debunked. If you have an egg allergy, you're still good for a flu shot, but yellow fever and rabies, you should not. Those are different. 

Thanks for 

that 

clarification. 

You're very welcome. 

.

Another condition that is impacted a lot by food that I think can get. Confused with a food allergy is eosinophilic esophagitis because a lot of people will have symptoms related to that. Can you just explain what that is and what those symptoms look like to food for our listeners?

 . Oh 

man. This could be like a [00:55:00] whole nother podcast.

Just need a teeny 

tidbit here. Okay. 

So eoe. Okay. We've talked a lot about definitions today. Yeah. We have a lot about definitions. EOE is a mixed IgE mediated allergy and a non IgE mediated allergy. So it's a, it's like a smorgasbord of allergy it is heavily influenced by foods. Okay. But that doesn't mean you take out certain and all types of foods and that's gonna cause your EOE to go into remission.

EOE to my knowledge, is not curable. It's manageable. So the old school of thought is if you get an EOE diagnosis, which has to be done by scope and a certain number of eosinophils in your esophagus, that you should go to an allergist and get tested. We have found, ' cause I can save pokes this way, and trauma from getting poked, that you are just as good to remove milk and wheat from your diet.[00:56:00] 

You can get up to 60% chance of remission by doing that versus when people used to come in and do specific food testing, meaning you test 'em and the foods they're positive to you. Take that out. That's only 50%. It's like you could either test them or you could just not test them and empirically remove and get just as good if not better remission.

Now what are these symptoms that patients have that have eosinophilic esophagitis? So it varies by age actually. So I think of eosinophilic esophagitis is like kind of asthma, but inflammation in the esophagus. So early on, you can have infants with this that are failure to thrive and then as you get up to like school aged adolescent, it becomes more vomiting, upset stomach.

And what's going on is you've got that inflammation that's causing those symptoms like the vomiting and the upset stomach, but that prolonged inflammation. What happens? Is [00:57:00] it causes the esophagus to scar and fibrosis, meaning it's not stretchy anymore. Things don't wanna move through it anymore.

So the older you get, so most of the time, like teenagers and on, and even in adults, what you'll see is I have trouble swallowing specifically meats and breads 'cause they're sticky and they don't wanna go down easily. Or you'll actually get, I'm not a GI doctor, but the ones I trained with, they'd be like, or I get called at midnight and they have a piece of steak stuck in their esophagus and we have to go in and pull it out.

So it based on the chronicity of it that's how it varies with 

symptoms. So again, another diagnosis that food has can have an impact. But again, isn't that typical food allergy we talk about but is also very critical to understand what you have going on and make sure you get the appropriate testing and having a scope and getting the biopsies to have that diagnosed and then understanding how to manage it appropriately.

'cause it's gonna again, look different than that a food [00:58:00] allergy management. Yeah. 

And that, I think that's the part that gets hard with EOE is because the difference with someone who's like milk allergic, if they eat milk and anaphylax need epi, someone with eoe, you're like, don't eat milk. 'cause it can flare, it can stimulate your eoe.

But there's not that I'm gonna have a bad reaction and I'm gonna need my EpiPen. So then what you find is, oh, I can eat this and nothing immediately is gonna happen. So they're, they start slowly putting it back into their diet and eating it. And then their symptoms start to, to come back.

And then once that inflammation happens, then you're starting to get those symptoms returning or the trouble swallowing if it's prolonged long enough, and so I think because it's not an immediate thing, people start sneaking it in a little bit more. But the, on the positive side, that also has good treatment as well.

Lots of good treatment. That is, I love to manage eoe, so I normally, I give people the option, we can do diet, but once you tell people they're taking milk and weed out in all forms, like that's a big part of your diet. So [00:59:00] then we normally start talking about medicines, so 

You have been so helpful with all of this.

Thank you so much for having me. This was fun. 

I'm gonna summarize a few things and then I want you to tell people how they could come possibly see you if this has brought up some questions that they have for themselves. So I think the big thing to note is if you have a food allergy. Then you're gonna be experiencing something like hives, itching, flushing, vomiting, and it's gonna be happening in minutes to an hour after eating it if any of this happens to you, because it may be that you've gone a while and tolerated something, but now this has happened.

You should see an allergist and be tested because the next time it could be a much more severe reaction and you need to know how to handle that. Also, if you already know you have a food allergy, please keep an UpToDate EpiPen with you at all times, and probably make sure that people that are around you [01:00:00] most know how to administer that if you were to need help with it.

And then this is very different than a food intolerance, which would just cause symptoms more like bloating, upset, stomach diarrhea, that kind of thing. And if you think you're having a food intolerance. I think I'm taking away from you. The best thing to do is just try taking it out of your diet, see what happens for a couple of weeks, eat it again, see if the symptoms come back.

If they do, you have an intolerance and you're just better off not eating it. 

Yeah. And again, I think, talking to your primary care doctor, they're available to do a lot of initial workup. 'Cause you can have random issues to food. Like food can stimulate reflux, foods can stimulate upset stomach, the lactose intolerance and the celiac disease.

So depending on what it is, there is an appropriate workup that needs to be done, but if it doesn't get better taking out certain foods and playing scientist in the food journal, then you need to be seen. 'cause you don't wanna be overlooking something [01:01:00] else. 

And then you gave us some great ideas for if you think you might have a lactose insufficiency.

So we have Fair Life and some other lactose free dairy products that you can try to help tease that out. You educated us on the importance of introducing peanuts and other potential allergens early for our children, which has been a big shift in thinking over the last 10 years and gave us some ideas on how to do that.

And then also making sure we keep exposing them to those potential allergens as well, so that hopefully they won't deal with this issue as they grow up. But I think when in doubt if you have an issue, you've done some investigating yourself, it's best to just come see an allergist. So if someone is thinking about it, how could they come see you?

So 

I am currently at the University of Kentucky at the Kentucky Clinic. So it's on the second floor, on the pediatric side, and I believe I'll be on the medicine side too. [01:02:00] Probably in about the next month you'll be able to schedule an appointment with me there. And I see all ages. 

That concludes this series, talking about our gut and talking about how much food can impact us. And we are going to head in a very different direction and do some shows related to neurology. Next week we're going to have a podcast dedicated to headache.

We had a. Neurologist, Dr. Duval, who is specialized in headaches that joined us for a podcast. It is fantastic. If you are someone that deals with headaches on a regular basis, I recommend listening to that show because she provides so much info there. following that, we're also gonna talk about stroke this month and then lead that into dementia.

So we have lots of great information, so be sure to tune in. And if you have any other ideas for shows that you would like to hear about, please click, send us a text, send us those ideas, or email us at contact at the starting gate [01:03:00] podcast.com. 

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