Search for tag: "allergies"

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Troy, Mitch, have you ever seen someone in an article or an ad or on social media and they talk about inflammation? Have you ever heard of this?

Mitch: Yes. Yes, I have. On TikTok every so often there will be someone trying to tell me what I should and shouldn't be eating.

Troy: That's funny, because I'm a physician, and I've probably heard about it less than Mitch has. And I'll clarify, I'm not on TikTok.

Scot: All right. And oftentimes, after you heard about inflammation, then there's some story that follows about how somebody stopped eating bread, or using seed oils, or dairy, or red meats, or other foods, and now they feel better. Maybe they were bloated for a long time, and now they're not, or their skin has cleared up, or their migraines have gone away, or they used to be congested all the time and that went away, or they've got more energy, their mood is better.

So the question is, are these health risks and benefits overblown? I mean, is this a legitimate thing, this inflammation, and can the foods we eat really impact us in these ways? And there are a lot of ads online claiming that that's super important. There are supplements or diets that tell you, "This is a legitimate deal." But we want to find out if it's true, and we're going to dive into that topic today.

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation to men's health. I bring the BS. My name is Scot Singpiel. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: A guy who is working hard on his health and is always bringing his unique perspective, Mitch Sears.

Mitch: Hey, there.

Scot: And Thunder Jalili, who is a professor of nutrition and integrative physiology at the College of Health at University of Utah. Thunder, how are you doing today?

Thunder: Hey, I'm good. I'm happy to be back on the podcast.

Scot: Is inflammation a real thing? That stuff I talked about at the top of the show, is that what's going on? That's what we want to dive into. Let's just start with that. I mean, is it legit? Because it seems a little crazy to me that changing my diet or getting rid of some of these foods is going to clear up all these health issues that I've had.

Thunder: So to answer your first question, yeah, inflammation is definitely a real thing. It's like a normal physiological process. And it has a purpose for wound healing and immune response and things like that.

But I guess what we're talking about here is kind of a low-grade, chronic inflammation that could increase your risk of unhealthy things, like maybe increase your risk of artery disease, or make your headaches or your arthritis worse, or things like that. So that's how I kind of look at this inflammation as we're talking about it.

Scot: How is the inflammation caused by the foods we eat different than the inflammation that's caused by other causes? I twist my ankle, and that gets inflamed. How is that different?

Thunder: You're talking probably an acute stimulus for inflammation with the ankle twist versus a more low-grade, systemic inflammation that's much lower level. So it takes longer for it to have a physiological impact. That would be my take on it.

Scot: And with a twisted ankle, though, I can look at it and see it's inflamed because it's swollen or it's hot. I mean, can I tell that with food as well, or is the other symptoms that I know that maybe something might be up?

Thunder: No, you can't really . . . I mean, it's different with food. It's a low-grade, systemic type of inflammation. A little bit more cytokine activation, a little bit more oxidative stress.

In the short term, it's not going to do much. In the long term, having it exist month after month after month can exacerbate other things that are already going on. So in someone who has high LDL levels or someone who has diabetes, and now you throw on this systemic inflammation, this low-grade, systemic inflammation, it could accelerate underlying artery disease, for example.

Scot: Yeah. So digestive problems, joint pain and stiffness, skin problems, fatigue, lack of energy, headaches and migraines in some people, even mood changes, anxiety, depression, irritability, allergies, erectile dysfunction, low testosterone levels, increase the risk of certain cancer and other chronic disease. This is all true, huh?

Thunder: Yeah. In a way, it's all true. I mean, maybe not exactly the way most people think of it, like there's a direct cause and effect of these inflammatory foods in every single condition you mentioned. But I think it's more that if you have these conditions, what you eat could exacerbate it and make it more difficult to deal with.

Whether there's a direct cause of eating these foods and then developing all those conditions you said, that's debatable. But they definitely don't help if this is one of the things that you're trying to deal with.

Troy: And I think too, Thunder, you talked about some conditions like coronary artery disease. And there, we're talking about longer-term effects rather than eating something and then an hour later, I have a heart attack because of it, things like that.

I agree, there are definitely inflammatory properties of certain foods. Again, we know certain triggers for migraines from certain foods. But yeah, like you said, it seems like a lot of these you've got an underlying condition, or it's long-term effects of maybe some of the food you're eating or some of the processes that can go on chronically.

Thunder: Yeah. And if we could just pick up the example of the coronary artery disease that you just mentioned, Troy, yeah, it's long-term. It so turns out that these foods that everyone . . . and I'm doing air quotes, okay? You guys can't see the air quotes. These foods that everyone labels "inflammatory," well, they also turn out to be the same foods that may increase your LDL and maybe make you more prone to diabetes. And these are risk factors for developing atherosclerosis, right?

So, in that sense, it's kind of hard to separate out. Yeah, they're inflammatory foods, but they also increase your risk for artery disease as well.

And that's kind of how this goes. It's not like, "I'm going to eat a cookie, and then have a heart attack or develop cancer in the next 30 minutes." But if that's my eating pattern, then by definition, I'm probably eating kind of more processed, high-sugar foods, foods with less healthy fatty acids, etc., which sets me up for all these other chronic diseases over the long term.

Mitch: So if I'm understanding this right, you're saying that having these foods is not necessarily directly causing, say, maybe the inflammation or the whatever, but it is definitely exacerbating problems that you might already have?

Thunder: Yeah, or it causes a very temporary inflammatory response that goes away after the food is processed. So that brief, mild inflammatory response, is that damaging? Probably not. If it happens all the time and the foods that you're eating are more in that processed food category, then yeah, that kind of increases the risk.

And remember at the same time, if you're eating a lot of inflammatory foods, then by definition, you're probably not eating a healthy diet with vegetables and other plant-based products and whole grains and things like that. So it's not just the addition of the inflammatory foods. It's that we're making a substitution of those types of foods and not eating the healthy foods.

Scot: So let's jump in here with some of the foods that are — I'll use Thunder's air quotes here — that are "inflammatory foods." Actually, I shouldn't use air quotes because they are, right?

Refined grains, bread, cereals, white flour, refined sugar, especially that added sugar that we've talked about before on the podcast that you want to avoid, sodium, red and different processed meats. The processed meats because they tend to have a lot of salt and other types of preservatives in them that are inflammatory. Trans fats, ultra processed foods also make the list, and then finally alcoholic beverage.

Did we cover most of the foods that are considered inflammatory, Thunder?

Thunder: Did you mention refined carbohydrates and monosodium glutamate, MSG?

Scot: Talked about refined grains like breads and cereals and white flour, but not MSG.

Thunder: Yeah. So let's just add MSG to that list. That can cause a little inflammation as well.

Mitch: Wait a minute. Didn't I read a study recently that said that alcohol is anti-inflammatory, like red wine and stuff?

Thunder: It depends how you take your alcohol. Is it in the form of Everclear or red wine?

Mitch: Oh, okay. Sure. Yeah, it depends on the night, but . . .

Scot: All right. Which one is inflammatory and which one isn't then? Is red wine is inflammatory and Everclear isn't, or what?

Thunder: So one of the things that we're doing, all of us, is we're oversimplifying this.

Scot: AIt's what we like to do.

Thunder: Yeah. Here's a dose response. If you have a glass of red wine or a small alcoholic drink, that's really not a big deal. If you pound half a liter of vodka a day, or you have a bottle or two of wine a day, that's a different ballgame. So we have to be mindful to dose. So a glass of red wine is actually anti-inflammatory. A bottle of red wine, probably not so much.

Mitch: Okay. All right.

Scot: So with inflammatory foods, it sounds like dose response and time, like how consistent have you been consuming these foods, those things start to add up then to possibly some of the negative effects that we talked about.

Thunder: Yeah, and let's add one other thing to that. How much of the anti-inflammatory foods are you consuming? So, yeah, you may be having some of these inflammatory foods, but are you eating a lot of anti-inflammatory foods? Because it's not like we wake up in the morning and flip a switch and decide which way we're going to go. We're probably all having a mix of inflammatory and anti-inflammatory. It just comes down to what's predominating.

Scot: All right. I mean, it really comes back to this notion of a balanced diet then, right? Pragmatically, in real life, sometimes we want to have some of these foods that might be labeled as inflammatory, but in moderation, that's fine as long as we're not going crazy with the dosage or the time. But we also need to look at how much of the good foods we're eating. What are some of those foods that reduce inflammation?

Thunder: So pretty much anything from the plant world, any plant-based foods. Whether it's a whole grain, or a vegetable, or a fruit, or a plant oil, those will all fall into that anti-inflammatory category.

And remember, really what we're talking about is eating patterns. If somebody is used to eating healthy and is trying to avoid processed foods and going after those plant-based foods, that's kind of an eating pattern, a lifestyle.

On the other hand, you can have an individual that doesn't really cook, they're not much into food preparation, they buy a lot of packaged foods, it's convenient, it's fast. That's kind of how a lot of people eat. And yeah, they may have an apple once in a while, but the dosage of the anti-inflammatory side isn't the same. So the balance shifts towards inflammatory foods.

Troy: See, Thunder, I'm hearing all this and it really makes perfect sense in terms of the balance, and some foods may be more promoting inflammation where others are anti-inflammatory. But then I think getting to what Mitch talked about is . . . Again, he's probably read more about it on TikTok than I have.

Mitch: You don't read TikTok. You guys understand that?

Troy: He's watched more TikTok videos than I have about this. But how much truth is there to that? If someone is saying, "Hey, I eliminated this, and it eliminated my migraines, or I eliminated this, and it eliminated my fatigue," is there something of a placebo effect there? Or is there some truth to saying if you eliminate certain foods, you are going to see a physical effect from that?

Thunder: Yeah, I think we can never discount a placebo effect for sure. But there's definitely truth in there too, because these foods that we do label anti-inflammatory, there's data in cell studies, in animal studies, and even human studies when you eat more of these plant-based foods that have phytochemicals and healthy oils and fiber and things like that, and you measure indices of inflammation or oxidative stress, you see they are lower, right? So there is truth that they have a physiological effect.

Now, the placebo part kicks in, in how good you feel after you eat those foods. I mean, there is probably a role in helping migraines. Definitely if people have gut issues, there's actually a role there in improving that. But how good you feel, I think that's where the placebo part comes in.

So I don't know if you can really separate the two. There's definitely a physiological role, but their mind is a powerful thing, right? So there's definitely going to be placebo in there as well.

Scot: I also feel like maybe some of this effect could be that . . . and I don't want to diagnose people or make assumptions, but when we see these videos on TikTok or hear these stories about people that remove these things from their diet and they felt better, we don't know what life was like for them before.

It might have been really bad. They might have not been eating very well, a lot of inflammatory foods. They might have had other underlying sort of medical things going on that when they eliminated some of these things, that's why they experienced this transformation. Whereas maybe I'm experiencing some bloating or whatever and I quit doing those things, I don't really experience anything, because for the most part, I'm pretty good.

Is that fair? Is that a fair thing to say, or am I just making stuff up?

Thunder: I think that's fair. And throw in "What if people lose a little weight when they're trying to eat the anti-inflammatory foods?" That somehow plays a role, but maybe they don't talk about that. But we know that's in the background.

So, yeah, I think it's all of the above. At the end of the day, I mean, we can try to pin exactly what the reason is, but we do know the long-term effects, right? We know what the result is, and I think that's the thing to focus on.

Troy: I guess so. And that's what I've wondered, too, is if sometimes we can drive ourselves crazy trying to identify every potential piece of our diet that could be causing certain symptoms and eliminating, and adding and eliminating something else, versus just trying to have that balanced diet. I don't know.

I guess if you were to go to someone and say, "Well, whatever symptoms you may be having . . ." Whether it's headaches, fatigue, gut issues, whatever it is, where would you even start? And where would a person even start to try and assess that and eliminate things?

Thunder: I mean, ideally, you would want to have a physician that has patience and is open to dietary experimentation and has time.

Troy: So you're saying not me. No, don't go to the ER for this, please.

Thunder: I mean, our healthcare system in general is not set up for that. Doctors have that 5-minute window, 5, 10 minutes, to talk to you and throw a bunch of things on the computer and then move on. So you've got to have the right healthcare team.

And then you need the dietitian as well who is willing to give you advice, kind of keep a log how you feel after you've taken this out or added this in.

But to get back to your kind of original basic question, "Where do you start?" the easiest thing to start, in my opinion, is try to reduce added sugar as much as possible, and try to increase your intake of vegetables, fruits, whole grain, and oatmeal. Start with that. And then if it comes in a box, try to eat less of it. I mean, that kind of covers a lot of ground.

But if you can do that, you may end up cutting the foods that were giving you problems, and at the same time adding things we know are helpful. And maybe that'll help. Maybe you don't have to go through this systematic thing where you try to identify the one particular food.

I mean, if you want to, great, go for it and have some patience and experimentation. But you can probably get results from just doing that kind of basic across-the-board approach.

Scot: I was going to say I heard one time when you're eating, if you can eat stuff that has one ingredient in it . . . Like, if it does come in a box and it's rice, that's fine, because the ingredient is rice. And that's generally pretty healthy, right? So I started applying that rule.

I know dairy kind of gets a bad rap for being a really inflammatory food, and that has one ingredient. What's your take on dairy in this list?

Thunder: Yeah. I think the dairy story is a little tougher because it could be inflammatory. But when dairy is processed into yogurt, that's actually pretty good. So I think we have to decide what dairy are we talking about? Milk, probably inflammatory. Yogurt, it's actually probably good.

Scot: All right. By the way, Troy, I don't know if you noticed this, but the foods that have the best evidence of being anti-inflammatory are stuff like tomatoes, olive oil, leafy vegetables, nuts, fatty fish, fruits. What does that sound like to you, Troy?

Troy: I was going to say, as soon as Thunder said that, it sounds like the answer is the Mediterranean diet. I just come back to it again and again.

Thunder: It's the answer to everything.

Troy: It's the answer to life, the Mediterranean diet. I do like that, though. It just keeps it simple. Because like I said, that's the thing I worry and I hear people talk sometimes about this. It just seems like they are kind of going . . . it's driving them a little crazy, because they're just saying, "Well, I've got to cut this. Okay, that didn't work. Let me try this."

But it seems like if you can just try the Mediterranean diet, like you said, Thunder, you're cutting a lot of that stuff that could be potentially bad and adding the anti-inflammatory properties of all the great stuff in the Mediterranean diet.

Thunder: Yeah, very well said.

Scot: It keeps coming back to just a . . . This is feeling like a familiar conversation now, right? Try to eliminate some of the stuff that's not great for you. And I think most of us are pretty good at knowing what that is. Are we eating processed foods? Are eating fast foods? Are we eating boxed foods? Try to add in some vegetables and fruits and nuts, if we're not doing that. Try to get rid of some of the red meat, if you're doing that. I mean, this is just the familiar refrain that we hear.

And over time, you'll hopefully start to feel better. Maybe then if you're not feeling better, that's when you might want to talk to somebody to drill down a little bit deeper, because that might get 80% of the people there.

Mitch: Sure. And I guess that leads to a next question. I don't know if this is something that Troy or Thunder could answer. At what point is gassiness, bloating, these different kinds of inflammatory responses, at what point is it something you should probably go see your doctor and not just, "Oh, I had a bad meal," or, "Oh, my diet isn't super great," but you should probably go to a doctor?

Troy: Yeah, that's a tough question, Mitch. It's something I see so often in the emergency department. The most common complaint I see is abdominal pain, and it includes all those symptoms. Maybe it's constipation. Maybe it's other things that are causing it.

But I think if it's becoming a chronic issue there, and more chronic issue is we're talking three months or more, then it's probably worth seeing your doctor, the idea being that you may have underlying conditions. And particularly if you're having any bleeding. I mean, that's a big red flag. Any blood in your stool, you probably need a colonoscopy to look for underlying conditions like ulcerative colitis or Crohn's disease, things like that.

Once you get past that three-month mark, it's a good idea to really go see your doctor rather than trying to figure it out on your own.

Thunder: Yeah. And I would also maybe add to that it depends on someone's personal discomfort tolerance. If it's bad enough, maybe some people after a month, they would want to do something about it. But it can be kind of a lower grade, but lasting more than three months, and I know people who would probably just continue to try to walk it off. It all has to do with your personal tolerance for pain.

Troy: Yeah, exactly. And when I say three months, I don't want to necessarily imply you should suffer for three months with severe abdominal pain, have your appendix burst, or something.

Like Thunder said, and I think like you implied, Mitch, kind of those low-grade symptoms where it's bothersome, and maybe it's some discomfort and some gassiness, things like that, once you hit the three-month mark, it's probably worth just seeing your doctor to get some other input, if not sooner.

Scot: So inflammation caused by the foods we eat, inflammatory foods versus foods that are anti-inflammatory, that's all real.

Thunder: Yep. It's all real, and it can all be traced back to dietary patterns. If you're kind of in that dietary pattern that favors processed foods, you're going to be eating a lot of these inflammatory foods we've mentioned. If you have a dietary pattern that favors more natural plant-based foods, whether it's a Mediterranean diet or a vegetarian diet, or just even omnivore diet, but just choosing healthy stuff, I mean, that's an eating pattern.

So we've got to always remember, at the end of the day, we're coming back to an eating pattern not targeting specific foods, but more a pattern of habitual eating.

Scot: Mitch, takeaway from today's episode?

Mitch: I'm shocked. I've been quiet because I'm sitting here being like, "No, these people on TikTok can't be . . ." They stopped eating bread, and all of a sudden, their skin is better and their mood is better. It just seemed too extreme, right? And it just seemed too simplistic, too everything.

So I guess it's yes, inflammatory and anti-inflammatory food exists. But I do really like that takeaway where if it's part of a larger change in your diet, yeah, maybe you can see these sorts of things, right? But this idea that you stopped eating bread for a week, and all of a sudden, you've got perfect skin, it still feels weird to me.

Thunder: Yeah. If you have celiac disease and you stop eating bread, you'll see immediate effects. But otherwise, yeah, it's not going to happen.

Scot: Yeah. So I think, Mitch, what I take from that is, again, you just can't tell. You don't know what the backstory is there, right? You don't even know if what they're saying is true. Do they have some other sort of agenda why they're saying these things?

Mitch: They're anti-bread.

Scot: Maybe they are. Yeah, I don't know. But my takeaway is it comes back to try to eat more of the good stuff and less of the bad stuff, right? And you're going to be okay. That's where I'm at.

Troy, takeaway?

Troy: My takeaway also is just balance. I think, Thunder, you really emphasized that. And I think if you're looking for anything, try to just achieve that balance rather than focusing on very specific foods and I think you'll see improvements by doing that. Again, Mediterranean diet. If you can do that, I think you're going to see improvements.

Scot: Have you ever experienced what we're talking about eliminating some inflammatory foods and you had a sudden change in your health? Do you have a question about the food you eat? Have you found a diet claim on the internet that just seems too bizarre to be true, and you want to know what's really going on? We would love to hear from you. You can reach out to us via email at hello@thescoperadio.com.

Thunder, thanks for being on the show.

Thunder: Yeah. It was a pleasure to be on and talk with you all.

Scot: And thanks for caring about men's health.
Relevant Links:

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

Interviewer: You've tried the sprays and the pills for your seasonal allergies, but they just don't seem to work. So what are the next steps to finding allergy relief?

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's really good with allergies too. So in our previous conversation with Dr. Oakley, we talked about managing those symptoms with prescription and over-the-counter sprays and other medications. If you haven't listened to that podcast, be sure to check that out first. But Dr. Oakley, if those sprays and pills aren't working, what are the next steps that you would take with a patient?

Dr. Oakley: The main next step that we generally talk about with patients is allergy testing, and that is identifying what the patient is specifically allergic to or the things, you know, they're specifically allergic to. And the goal behind doing that allergy testing and the reason we don't necessarily do that upfront is because the main goal is kind of a step towards the immunotherapy option. And this is a treatment for allergies that can be very effective for a lot of patients who, you know, are still struggling after medical therapy. And the idea behind it is basically desensitizing your immune system to the allergies, so it's less reactive to that allergen or those allergens.

Interviewer: And it seems like most people I talked to that have allergies, they'll be like, "Oh, I need to go get my allergies tested." In their mind, it's the first thing that you do. Do you find that to be common?

Dr. Oakley: I do. Yeah. I get that question actually a lot, "Should I be allergy tested?" And it's certainly satisfies our curiosity in many cases of, you know, what we're allergic to, but it doesn't necessarily change the treatment if we haven't done those medical management steps yet, because if, you know, whether you're allergic to this specific pollen or that specific, you know, weed, or this tree, or that grass, you're still going to be using those as, you know, your earlier steps. You're still going to be using, you know, those nasal steroids sprays first or the oral antihistamines first and the antihistamine sprays first, because that has, you know, a broader effect, you know, on all of those.

So that's what we generally don't do that upfront, because it doesn't necessarily change our first couple steps and, you know, the treatment. But it does affect, you know, our later steps. If we're thinking of immunotherapy, we need to know what we're specifically treating for that to work. And so that's kind of where it comes in and the point behind the testing, you know, at that stage generally.

Interviewer: Yeah, so your patients that you take at that point to the testing stage, I'd imagine they're just not finding any sort of relief from the first steps, or their allergies are just so terrible. I mean, what kind of patient then makes it to the testing stage usually? You're able to . . . I would imagine the medical things that you do first, the sprays and the pills take care of a lot of what patients experience.

Dr. Oakley: Yeah. I would say the patients that generally get to that next stage are those that are getting either really severe or really bothersome seasonal allergies that are refractory to the medical therapy. And they just don't want to, you know, suffer every summer, all summer or every spring, all spring. Those are good candidates for immunotherapy. They're getting breakthrough symptoms despite those, you know, medical treatments.

Other patients will have year-long allergies because they may be allergic to, you know, dust mite, and it's all around them. It's in their house. And, you know, there are things they can do, like, you know, try cleaning their house really well. However, we've not seen that those things will fix the problem in a noticeable way. They'll still get their symptoms. And so, you know, those patients are suffering all year, and, you know, there are immunotherapies that can help with those perennial allergies.

An additional option, for example, would be a patient who has a cat that they're allergic to, but they're very, you know, emotionally connected to their cat. It would be distressing for them to get rid of their cat, or it's a partner's cat and, you know, they can't necessarily avoid it. It's not so easy to always get rid of a pet. So that'd be another case where immunotherapy may, you know, play a good role for that patient.

Interviewer: When you get to that point, you do some of the testing, and then after you get the results, how do you proceed to the immunotherapy and how does that work?

Dr. Oakley: So generally, we're identifying the allergies that are causing, you know, the sensitivities that the patients have based on how they respond to, for example, skin prick testing, which would be the most commonly used allergy testing upfront. It can be done, you know, in the office. Patients are tested for multiple allergies at once usually on their arm. You're using a grid system to see what skin responses are the most significant to determine what they're, you know, most allergic to. And those are the allergies that you target, you know, their worst reactions with the immunotherapy. And the idea behind the immunotherapy is giving them very small but ramping up doses of that thing that they're allergic to, to just gradually desensitize the immune system to it.

Interviewer: I remember getting those as a kid. I've had more success with the first line of defense in later life, with some of the new medications that came out, I don't know, probably 20 years ago now, but I say new. So like my experience was the immunotherapy didn't really help me. Do a lot of people experience success with it?

Dr. Oakley: It's generally considered to be 80% to 90% effective. But, you know, it's not 100% effective, as you said. So some people don't get that response. It's generally very effective, but it is a commitment. It's very much a time commitment. You know, it's a three to five-year treatment where patients are coming in anywhere from a weekly to a . . . or I should say anywhere from a twice weekly to a monthly basis for injections, you know, to get that benefit.

Interviewer: Yeah. I remember it was twice a week I'd go in and get those allergy shots. So if immunotherapy doesn't work then, then it sounds like the last option is surgery, and I didn't even know there were surgical methods for allergies. Talk about that.

Dr. Oakley: Well, I should clarify because surgery is more of an assistive option.

Interviewer: Oh, okay.

Dr. Oakley: So not so much a treatment. It doesn't specifically cure or treat allergies. It helps with the symptoms, but in and of itself would not be sufficient. It goes along with these other treatments. So surgery can address some of the more bothersome nasal obstruction symptoms. For example, well, let's just say specifically from anatomical factors, like a deviated septum or enlarged turbinates, which are, you know, shelves of tissue in the nose that warm and humidify the air but can get quite enlarged with allergies. So treating some of those anatomic, you know, factors can improve symptoms of nasal congestion, but you need to treat the trigger as well, the ongoing allergy trigger. So that's that medical management or immunotherapy as well. So the surgery helps, but it's not a treatment in and of itself.

Interviewer: If somebody is listening to this and you just would want them to take away one thing after we're done with our conversation, what would that be?

Dr. Oakley: The main thing I would say is don't suffer in silence. This is a really common problem with many options for treating it. We know from, you know, research study after research study that there is a significant improvement in quality of life when these allergies are managed appropriately in patients rather than just struggling with really bothersome and really distressing, you know, symptoms on a day-to-day or seasonal or yearly basis. You know, try some of these easier steps. Don't hesitate to come in and get some, you know, formal consultation and talk about other options that can really, really benefit you.

Interviewer: There is no cure for allergies. Really the best you can do is manage the symptoms, and the first step to doing that is to avoid the things that give you allergy symptoms, but that can be hard. A lot of times you can't do that. So then the next step are sprays, pills, and eye drops.

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's also an allergy expert, and she's going to take us through the process of trying to figure out how to manage those symptoms and then maybe help us understand when you might need to get professional help. So Dr. Oakley, let's first start with allergy sprays.

Dr. Oakley: There are a couple main nasal sprays that work really well and have great evidence behind them for the treatment of allergies. Our first-line treatment based on the literature and just how well it works in patients is nasal steroid sprays, and fortunately they're all over the counter. Some of those sprays would be, if I were to name some, Fluticasone nasal spray, Mometasone, Budesonide. Those are probably some of the three most common. There're a couple others in that, you know, similar family and those work really well.

You can use them up to twice a day, more than that is not going to help anymore, but once or twice a day use. They're very reliant on regular consistent use, and they have a bit of a slower ramping up effect, so you really want to use them for at least, you know, a few weeks on a daily basis just very regularly to get their full effect rather than, you know, here and there when your symptoms bother you.

Interviewer: If the over-the-counter stuff doesn't work, are their prescription ones that are very different from that, or is most of them over the counter nowadays?

Dr. Oakley: There's an antihistamine spray that is a prescription that can actually work great for a lot of patients too, either as their primary treatment or as a, you know, secondary, an additional treatment if the corticosteroids sprays alone don't work enough for them. That antihistamine spray is called Azelastine, and it works particularly well for those let's call them the wet allergy symptoms, which is, you know, more of those like sneezing, runny nose, itchy, watery eyes, that kind of tickle sensation that we can get with allergies. They work okay for the nasal congestion symptoms, but the steroid sprays work better for that.

Interviewer: What is it that makes it so different from person to person that perhaps maybe a steroidal spray would work for one person but not another, they'd have to use, you know, an antihistamine spray? Is it just the difference in us as humans?

Dr. Oakley: We don't always know exactly why some patients respond better to some sprays, you know, versus others. It may just be a severity of their symptoms. You know, they may get 75% better with the steroid sprays, but it may just not quite be enough. Whereas somebody else where their symptoms are maybe moderate rather than severe, they may do great, and that's all they need.

Some patients may be a little more bothered by like the runny nose and the sneeze, whereas, you know, in those cases antihistamine sprays would work better for them. So sometimes we just get different presentation of our allergies, different symptoms and different severities. But you're right that the other factor is we're all just a little bit different and we respond just a little bit different to certain treatments.

Interviewer: It can be a little frustrating as an allergy sufferer sometimes because I think sometimes as patients we think, "Well, I'm going to go in and the doctor's going to give me the cure," right? But with allergies it sounds like, you know, sometimes you have to do some experimenting on what's going to work best for that individual person.

Dr. Oakley: Exactly. There's definitely some trial and error there to try to get it just right for that patient. The third thing in terms of nasal treatments I didn't mention, that I'd be remiss if I didn't mention, is very straightforward, and it's just some saline in the nose, saline irrigations specifically. Those can work really well as an adjunct treatment. It's not going to in and of itself fix your allergies, but it can help with some of the symptoms along with some of these other treatments by mechanically washing, you know, those allergens, those irritants, those pollens out of the nose so they're not just sitting, you know, on the lining of the nose inflaming it. So it can help, you know, in some of those ways as well.

Interviewer: So do you normally go nasal spray first and then oral medication? Is that how that usually goes?

Dr. Oakley: I would say, in general, yes. I like to give people topical treatments over oral treatments if possible, just because your side effects tend to be lower. The other thought in that however, that I'll talk to patients about, is that certain oral treatments, like oral antihistamines specifically, those tend to work similarly to a nasal steroid spray, have similar effectiveness, but sometimes patients will have symptoms that are not just in the nose. They'll have, you know, maybe some dermatitis that they get with their allergies that bother them or, you know, symptoms like that that are elsewhere, and sometimes the systemic therapy, an oral therapy in that case can be a little bit more helpful than a localized therapy.

Interviewer: So oral medications, let's talk about over the counter first. What are kind of the choices there?

Dr. Oakley: I would say the main one, the front runner are those oral antihistamines. So the newer versions that tend to work better for patients with fewer side effects are those medications like Loratadine and Cetirizine and Fexofenadine. Those are the main kind of newer generation oral antihistamines. The older generation antihistamines would be, you know, what we know as Benadryl, which can work too but has, tends to have higher side effects and be more sedating for patients. So we generally recommend those newer generation, non-sedating medications. And they have great evidence behind them, they work well, and those are over the counter.

Interviewer: And then itchy eyes is another symptom that a lot of people have with allergies. I used to suffer terribly, and then I was prescribed some eye drops, which now I think I can just get over the counter because I've bought them. I think they're the same thing, which makes all the difference in the world. Can you talk about some of the eye drops you might want to look for if itchy eyes are part of your allergy symptoms?

Dr. Oakley: Yeah, eye drops can actually help a lot, and it is generally an antihistamine eye drop. There are a couple different ones. One that's popping into my mind is Olopatadine. That can actually help patients significantly because a constant itchy eye will drive you crazy.

Interviewer: And just like all the other things, the nasal sprays, the oral medications, I had to try a couple of different antihistamine eye drops before I found the one that really kind of worked for me. So you know what, I started out thinking, well, let's see if we can give people, you know, some things they can try on their own, but then you start talking about how, you know, this combination isn't proven to work as well as that combination, and it can get really complicated really fast. So I'm starting to think maybe if like the first nasal spray doesn't work, maybe go see a doctor to try to figure out what combinations of stuff because that does get complicated pretty fast, doesn't it?

Dr. Oakley: It does get complicated pretty fast. It is certainly reasonable to try a couple over-the-counter meds on your own. I personally, you know, if I were in the patient's shoes, I would start a nasal spray and give that a few weeks personally. If that didn't work, you know, I'd maybe try an oral antihistamine for a couple weeks and see how I do. But after that, I don't see a lot of sense in just suffering. I think it's worth going in and talking to your doctor about some alternative options that may help quite a bit rather than just being miserable.

Interviewer: What are the symptoms of food allergies? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Dr. Troy Madsen on The Scope. On The Scope.

Interviewer: If you're listening to this right now, you probably suspect you might have a food allergy and you're curious to know for sure if that could be the case. Probably have a lot of questions and so do I so we're going to talk to Dr. Troy Madsen. He's an emergency room physician at University of Utah Health Care. So symptoms of food allergies, how do I know if I have a food allergy? What are some of the common symptoms? And there's a difference between food allergies and food sensitivities?

Dr. Madsen: Exactly, yeah and that's often a point of confusion, but allergies are like any other kind of allergy. If you have a food allergy, it can range from mild, so maybe some itching, little bit of a rash; to more severe, where you have some throat tightness, some lip tingling, to really severe cases where you just can't breathe. So those are what we think of with allergies.

Interviewer: With food allergies. And is it possible for me to just be minding my business, I'm eating something I've eaten my whole life and now, all of a sudden, my throat's swollen, like I've reacted that quickly and that severely?

Dr. Madsen: It is possible and, surprisingly, it's not uncommon. People I've known who have had eaten shellfish for years and then sometime in adulthood, eat some lobster or some shrimp, and just suddenly develop itching and facial swelling and trouble breathing. So it's entirely possible. You could've eaten this food for years and then, later in life, develop a food allergy.

Interviewer: All right. And if you start having these symptoms, what should you do?

Dr. Madsen: If they're mild symptoms, like a rash, maybe just a little bit of itching, you're probably okay just to take some Benadryl. But if it's more severe, anything that involves the airway, any lip swelling, tongue swelling, throat tightness, trouble breathing, that's where I would even call 911. I mean, you've got to get to the ER because those things can develop really quickly and be life-threatening, just very, very severe reactions.

Interviewer: So those symptoms again, lip swelling, tongue swelling, tingling?

Dr. Madsen: Tingling, I would get to the ER and, again, if you're . . . any concerns about your airway, call 911.

Interviewer: All right. Don't mess around with that.

Dr. Madsen: Exactly.

Interviewer: I feel like we only talked for a few seconds here about this topic. Have we covered it all? Is that pretty much it?

Dr. Madsen: Well, like you mentioned, there's also the issue with food sensitivity versus allergies. So again there, we're talking about very different things, some people may have concerns about gluten or other things in foods. There, they may have some more abdominal cramping, maybe some nausea, diarrhea. That's not a true allergy. Again, the allergies are the things we think of with any sort of allergy: itching, rashes, airway issues, much more concerning in terms of getting to the ER.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: You think you or maybe your kids have pinkeye. How will you know for sure and what should you do about it? We'll talk about that next on The Scope.

Announcer: This is From the Front Lines with emergency room Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. Pinkeye. Let's talk about how you would diagnose a case of pinkeye and then what you would do about it because I hear it could be kind of difficult to diagnose like a school nurse, for example, might not be able to tell the difference from allergies or not. Is that the case?

Dr. Madsen: That is the case. And that's always what I'm thinking in my mind. So the most common thing we have is someone comes in and they say, "My eye hurts" or "My eyes hurt". I look at their eyes, they're red. So a couple of questions I ask and I say, "First of all, did this start in both eyes or did it start in one eye and spread to the other?"

If it starts in one eye, that's more likely what we would call pinkeye. And pinkeye is a bacterial infection often. Sometimes it's a viral infection but it's really tough to tease out which are bacterial and which are viral. Of course the ones we worry more about are the bacterial infections because we're going to treat those with antibiotic drops, but you figure it's not going to necessarily start in both eyes at the same time. It kind of start somewhere. It's going to start in one eye and then maybe you're rubbing that eye and then it spreads over to the other eye. So typically with pinkeye, that's the case.

Interviewer: Okay, so one eye hurts before the other generally.

Dr. Madsen: Exactly.

Interviewer: Red like bloodshot red, what's that red look like?

Dr. Madsen: So the red . . . Yes, that's tough to distinguish from allergies.

Interviewer: There's nothing really unique about it, huh?

Dr. Madsen: Not particularly. It can look a lot like allergies where just if you've ever had like allergies, just seasonal allergies, your eyes are bloodshot, they hurt, they itch, pinkeye looks very similar. With pinkeye though, we often see more discharge or more drainage from the eye. This kind of stuff that's not so much, just your eyes watering, which you have with allergies, but stuff that's kind of a little more whitish in color that looks more like you would imagine an infection looks.

So someone who says they wake up and my eyes are like matted shut. Again, allergies, we can sometimes see that but it's usually more with pinkeye. They have to pry their eye open or their kids' eye or they use like a washcloth and hold it on there to kind of loosen that up and pry it open. That's pretty typically with pinkeye and that helps me out to make that diagnosis.

Interviewer: All right. So then what does treatment look like? You said if it's a bacterial cause, then you would use antibiotic drops. It's hard to tell though, so you just . . .

Dr. Madsen: It is.

Interviewer: You just use antibiotic drops across the board or . . .?

Dr. Madsen: Typically yes, and you don't want to over-treat with antibiotics, but in practical terms, if I were to try and get a culture of the eye, send that to the lab, it takes couple days to get the result. It's not really that useful. So even though it might be viral, it's often bacterial so we treat with antibiotic drops. It means using drops several times a day or often for a week just make sure this clears up. Most people are going to have improvement in their symptoms after two or three days.

Interviewer: What if it's viral though and you're using the drops, they're not doing anything, will it just get better on it's own or . . .?

Dr. Madsen: It will.

Interviewer: Really?

Dr. Madsen: It will. Yes, with the viral it will just get better on its own and the antibiotic drops probably aren't going to do a whole lot for it but, again, it's hard to say because maybe after two or three days, you're feeling better and it could be that the virus got better on its own or maybe the drops treated the bacteria. But it's not the sort of thing, again, where a culture would be that helpful because it's going to take two or three days to get the results back. If it's bacterial, it could get significantly worse and really progressing, cause some issues wherein you can get infections around the eye or extending behind the eye as well.

Interviewer: And untreated, could it cause long term problems if you didn't go into anything about it or would it eventually just clear up regardless?

Dr. Madsen: It could clear up but the concern with the bacterial infections would be something that progresses, again, to where it spreads around the eye.

Interviewer: Infects the rest of, yes, other parts of your eye.

Dr. Madsen: Exactly. And so that's why even though in my mind I say, "Okay, this could be a viral infection," I'm also saying, "I want to treat this as likely a bacterial infection because the possibilities with the bacterial infection could be pretty significant." And I don't necessarily want to tell this person, "Wait two or three days and then come back when you have a significant infection around your eye that might require even something like IV antibiotics or hospital admission," if it got to that point and got that serious.

Interviewer: And don't need to go to an emergency room for this sort of thing. Urgent Care or a primary care provider probably would be able to take care of it.

Dr. Madsen: Absolutely.

Interviewer: And you could . . . even if you have to wait a day?

Dr. Madsen: Yes. Even if you had to wait a day, you're probably okay. I think the challenge for most parents is if their kid gets pinkeye, they're not going to let the kid come to school because it is highly contagious. You've got to make sure you're washing your hands, your kid's washing their hands. Kids get this at school, they pass it to other kids. So a parent's probably not going to want to wait a day to get in to see their primary care doctor. They'll go to an Urgent Care. If you have to come to the ER, you come to the ER. Either way, I'm guessing most parents want to get that treated and get their kid back to school and get them out of the house as soon as they can.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 2, 2018
originally published: August 19, 2016

Dr. Gellner: One of the most common reasons a parent brings their children to the pediatrician is because they're concerned their child has an ear infection. I'll talk about the symptoms to watch for and what to do if your child does have one on today's Scope. I'm Doctor Cindy Gellner.

Announcer: Health tips, medical views, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Gellner: Parents come in all the time saying their child has been pulling on their ear and they know this means they have an ear infection. Well, not so fast. Kids pull on their ears for a lot of reasons, ear infections only being one of them. Other causes are teething, ear pressure from nose congestion or allergies, and because it just plain feels good, especially when kids are tired.

There are a lot of nerve endings in the ear and that's why it's such a popular place for massage therapists and acupuncturists to work on. So other than pulling, your child has no other symptoms. Ear infection? Maybe not. But say your child also has a fever, has had a cold for a while, isn't sleeping like they normally do and are just plain cranky, then it's time to get those ears checked out.

Despite what a lot of people think, going outside in the wind or cold without a hat on won't cause an ear infection. Ear infections happen behind the eardrum, not in front of it where the cold and the wind would hit. An ear infection is caused by bacteria and it's a common complication of a viral cold. Nasal congestion and mucus block off the tube that connects to the middle ear to the back of the throat. That's the Eustachian tube. And then the ears can't drain properly if that's blocked. This makes a pool of fluid, which is a great breeding ground for bacteria and, hence, an infection is born.

Sometimes, kids have what are called serous ear infections. That means there's fluid behind but it's not all gross, and this fluid usually goes away in a few months. This type of infection does not need antibiotics.

Kids between six months and two years are most likely to get ear infections, but they're actually pretty common until age eight when the internal anatomy of the ear starts to change and they aren't as prone to infections. Most kids will have at least one ear infection and over 25% of these children will have repeated ear infections. In a small percentage of children, the pressure in the middle ear fills with puss and that causes the eardrum to rupture and drain. It's usually just a small hole, which heals over the next three months.

Now, you find out your child does indeed have an infection, you need to be sure your child takes the antibiotics prescribed by the pediatrician and finish the entire course to make sure all the bacteria is treated. Tylenol and Motrin can also help with pain.

Some people talk about putting warm oil into the ear, but that's not a good idea. If the eardrum bursts, follow up in three weeks to make sure the infection is gone and the eardrum is healing. Ear infections seem like a rite of passage for some kids. I've had parents try looking in their child's ears with a flashlight to see if they have infections. Trust your child's ear exams to the experts. As pediatricians, we get really good at looking in ears and seeing if there truly is an infection or not.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you liked what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: You might be having an allergic reaction to your birth control, but maybe you're not. Let's find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking to Dr. Kirtly Parker Jones. She's our expert on all things women. So, Dr. Jones, we've been getting a lot of emails about women who are having "allergies" with their birth control, they're just having some sort of reaction to it and they're thinking its allergies. Is it even possible to have allergies with your birth control?

Dr. Jones: Okay, well, let's talk about what an allergy is. An allergy, or an allergic reaction, is where your body recognizes a substance as foreign, makes an antibody to it, and that causes a process, an allergic reaction, that can cause itching, hives, can cause swelling of your throat, difficulty breathing, low blood pressure and passing out. Not necessarily all of those, but it could be. In reality with respect to birth control it is rare for someone to be truly allergic to birth control. The reason is, with respect to birth control hormones, is the hormones are very much like your own hormones and it's unlikely that you're going to be allergic to it.

Now, sometimes birth control pills have dye, have colors in it, so you know when you open your pack there some blue ones or pink ones, so some people are allergic to the dye, probably not so much the hormones. In birth control shots like Depo-Provera, that's a brand, the carrier or the liquid that's in there you may be allergic to that. There are women who actually have allergy to nickel, that's pretty common, but in fact there aren't any birth control methods with nickel and the copper IUD is copper and it is rare to have someone truly allergic to copper because we all need copper in our body, so we're not allergic to it.

There are people who are truly allergic to latex, as in condoms. So yes, that can cause shortness of breath and hives and itching and all those things, so some people are allergic to latex condoms and some people are allergic to that foreign substances, of which there are quite a few, in spermicides. So when you're using a foam or a gel or something which is a spermicide in conjunction with your condom some people are allergic to those. But in terms of birth control pills or birth control shots or birth control implants or IUD's, true allergies are very rare, meaning less than maybe 1 in a 1,000.

Interviewer: So then is it normal?

Dr. Jones: To be allergic? It is not normal. To have side effects? Yes. Let's go back to that normal thing. So something is not normal if it happens to less than 5% of women and side effects happen to more than 5% of women. Now, side effects happen to women because the hormones in either the pill or the hormonal IUD changes some parts of their bodies. So remember estrogens and progestins, the other hormone that is often in birth control methods, they change your body. That happens to you in your natural hormonal cycle and it may change your body when you use them in birth control. So when people say, "I have breast tenderness," or, "I have nausea," or, "I got some acne from that pill."

Interviewer: That's a side effect.

Dr. Jones: That's a side effect, and a side effect isn't an allergy. The other thing is that life happens and some people have things happen concurrently when they're starting a new birth control method. When people say, "Oh, I must be having a side effect from my IUD because I'm crying all the time." "Well, how long have you had that IUD?" "Over four years." Well, in fact, that's not your IUD. What else is happening in your life?

So when you do studies of birth control methods, you often do a placebo-controlled trial. So when you're looking at things like headache and nausea and breast tenderness, you often find that those happen in people who were given a placebo. It's clear that the real attributable number of people who have a side effect would be the number of people who had it with the real drug minus the number of people who had it with the placebo. So headaches, nausea, not feeling well, mood, those can change just because and you just happen to be on birth control at the same time.

So side effects from birth control pills are common and I consider them normal. In fact, some side effects of something like the levonorgestrel IUD, the hormonal IUD of irregular bleeding or very light periods or no periods, that's actually not a side effect. That's a direct cause and some people are annoyed by the irregular bleeding but some people really like the little light periods.

Interviewer: You're still okay.

Dr. Jones: You're still okay. Now if it turns out . . . so when you first start something like birth control pills, headache, nausea, and breast tenderness may be very common side effects, they tend to go away though. So if it's persisted over three cycles, if you can hang out with it, it actually tends to get better.

Interviewer: If you can hang out with it?

Dr. Jones: Yeah, if you can hang out with it. But remember when you say allergy you're really talking about a very specific set of symptoms which are quite rare with birth control methods except latex condoms and some spermicidal gels, but talk to your doctor about it, talk to your doctor. Hopefully they're experienced enough about it or they can call an expert.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 4, 2018
originally published: April 22, 2016