Balancing Food Allergies and Mental Health
Kara Wada, MD: Welcome everyone to the Becoming Immune Confident Podcast. My name is Dr. Kara Wada. I'm a board certified pediatric and adult allergy immunology lifestyle medicine physician and autoimmune patient. And today, I have an esteemed colleague with me who is Tamara Hubbard. She is a licensed clinical professional counselor and trained in marriage and family therapy, and she has over 19 years of experience and in her private practice, she helps allergic and non-allergic clients, especially parents, find their just right balance between the overwhelm and quality of life.
Tamara is also the founder and CEO of the Food Allergy Counselor, Inc. An internationally known allergy mental health resource hub, which houses the Food Allergy Counselor Directory, Exploring Food Allergy Families Podcast, evidence-based allergy behavioral health content, and a growing professional network for therapy providers supporting those with allergic diseases.
An international speaker at national conferences for both patients and provider groups. Tamara is an Allied Health member of both the AAAAI, which is the American Academy of Allergy, Asthma and Immunology, and the American College of Allergy, asthma and Immunology and she holds advisory roles for multiple organizations, including the Center for Food Allergy and Asthma Research, which is called CFAAR.
She is active on social media, on Twitter and Instagram, and we connected through one of my mentors, Dr. Dave Stukus. And I am just so excited to connect again, Tamara, and to record our conversation and just share your wealth of knowledge and experience a little bit of it with our listeners today.
Thanks so much for joining me.
Tamara Hubbard, MA, LCPC: Thank you so much for inviting me. I appreciate it.
Bridging the Gap of Food Allergy
Kara Wada, MD: Can you share a little bit how did you end up in this area food allergy and in helping those of us who have dealt with it in our lives and in our family's lives?
Tamara Hubbard, MA, LCPC: I talk a lot. I have a lot of undergrad and graduate students who reach out to me and I've done high school fairs and I get that question all the time and I always say I zigzagged my way there.
So for those that are out there who are like, "Okay, I'm starting in one space, but I really wanna be over there" like there's hope you can get there. I did not start off in food allergy, so as my bio said, I am trained in marriage and family therapy, so I'm a trained marriage and family therapist by graduate school training and I actually started off in substance abuse. So I worked inpatient at a hospital, behavioral health hospital, working with substance abusing teens who were having a really tough time using heroin, all that kind of stuff. So pivoted from there and then joined a group private practice. Just being a generalist, seeing couples, families, individuals working a lot with teens.
And then I ended up having my own kids. And so my second son was born and when he was three he was diagnosed with a peanut allergy. So that's where the allergy piece came in. We don't have food allergies in our family, allergic diseases, we've been very lucky. And here he has a peanut allergy. And so I was just the allergy parent at that point. I was still a therapist doing therapy work in other niches. And then I was an allergy parent. And after I managed my own feelings about it and got to a place where I felt like I was on solid ground too, I noticed that there was a lack of reputable evidence-based resources out there focused on mental health and wellbeing of those managing food allergies and in particular the caregivers especially because if you think about the typical time when some of these diagnoses come in, these kids are younger and it's the parents who are managing a lot of that, and it's very stressful.
I just decided, I always like to say, my husband's English, I always like to say, "I didn't mind the gap, I filled the gap". And I'm gonna start something and I had no vision at the time for what this could be. I literally started a blog, the physiology counselor blog, where I wrote and shared tips as a clinician. Again, I thought it was important. There's a lot of people out there sharing their experiences, and I think that's valuable. But I also am really, try to tell people it's important to have those of us who are trained and who have clinical background sharing this information. So I wanted to do that. And then long story short, I had people reaching out all over the US saying, "Can you do therapy with me?" And unfortunately, in behavioral health, we can't practice outside of the states in which we're licensed in. It's an archaic system in mental health. But I'm only licensed in Illinois and Ohio, so I can't see anyone outside of those states. So then I thought there have to be other people doing what I'm doing working with allergic disease. And at that point I was working with allergy families. And so the rest is history. Yeah.
Kara Wada, MD: That's amazing. And really I hear and feel so many similarities in our stories of having this adversity that we faced and then realizing that there also is this clinical gap and how can we be that bridge between the lived experience and also practicing in our area of expertise as well.
Tamara Hubbard, MA, LCPC: I like to say that those of us in this niche are in food allergy counseling. It really is allergic disease counseling, quite honestly, but that's just the company name that's stuck. But we're building the plane as we're flying it because there is no training program at this point for allergic disease, mental health or allergic disease counseling. Many of us who are really far deep into this field, go to the college meeting, the AAAAI and so we have to learn and stay relevant in our field, and then we have to learn the medical side of it. And not that it's within our scope to give guidance on any of that, but it really does help that we understand the medical piece because as with any of these chronic illnesses, it's very much body-mind and so we really need to know both and there isn't any training at this point for that. So it's this zigzag way to this niche.
Kara Wada, MD: And I'm thinking just to, yesterday in clinic I saw a teenager who was diagnosed with nut allergy as a young kiddo. Now working on navigating life outside of the confines of the family home, like through college and travel and one of the questions that came up, for instance was the real question of do I need to worry about airborne exposure? And so just thinking about some of the misconceptions that may come up because this person had experienced some symptoms of like itchy throat and throat tightness when someone was eating a nut next to them.
No contact, no anything. And that really comes into this discussion of what is real reaction and then
Intersection of Anxiety, Allergy, and Immunology
Kara Wada, MD: mind-body
Tamara Hubbard, MA, LCPC: Right. So what you're talking about comes up a lot. Maybe not that particular example, but what you're talking about is the intersection of anxiety and allergy and immunology, because some of the symptoms of what we feel when we feel anxious can be similar to symptoms we might feel when we're having an asthma attack or we're potentially having a reaction.
So there's the perceived risk versus the actual risk. And not all allergists are talking to patients about that, or those conversations are, I shouldn't say they're not talking about it, but maybe those conversations aren't happening because they're not coming up. There's so much to cover in appointments, there's only so many minutes at an appointment.
But then that may leave, like you said, families or individuals they don't really know where that line is of is this a perceived reaction or is this an actual, and then of course that triggers anxious thoughts. And anxiety has both a physical and a mental component to it. We've got the racing thoughts, the rumination, but we've also got, our bodies in fight or flight instead of rest and digest.
And so our digestion changes and our breathing changes, and then we get hyper focused on all of that. So it's really cyclical. And so for that individual, that would feel very scary to think, " Gosh, is this a reaction?" and talk yourself through that.
Kara Wada, MD: And, as we have this conversation increasingly about physician-patient communication, relationships, gaslighting, if that scenario isn't talked and brought up in a nuanced way. That could very easily be perceived as being blown off too.
Tamara Hubbard, MA, LCPC: Yep. Or some people will turn it into shame, or blame, like in internalize that. I've heard from my own patients and just I do a lot of speaking in the community and such that sometimes people don't wanna bother their doctors with questions because they feel like it's a silly question or it's not important. And I always like to challenge that because I would rather somebody reach out to their doctor with what they feel is a simple question than spend hours on the internet and get led down either a rabbit hole of misinformation or some people who are offering their own insight, which is incredibly helpful. There's a place for that.
But they're really seeking specific data pertaining to them and their diagnoses. And I would rather them say, " Let's work on how you can reach out to your doctor and ask that question. Cuz that's a really important question to you."
Kara Wada, MD: Absolutely. And as we were talking about the potential for airborne reactions, the answer isn't a hundred percent straightforward.
Tamara Hubbard, MA, LCPC: No.
Kara Wada, MD: It depends on the particular allergen we're talking about. And in the context of what's going on.
The Comparison Trap
Tamara Hubbard, MA, LCPC: And that's something that I'll talk to my patients about and when I do webinars, I also share too, is there's these traps. And one of them is the "Comparison Trap", right?
Somebody who's on social media looking for somebody who, again, they're looking for common humanity, they're looking to feel less alone. And I think there's such a place for that. Absolutely agree that is important. But what can happen is that we can get into comparison traps where maybe we read about in a group, a health online health group, somebody who's managing the same things we are or has the same diagnoses, and then suddenly all of their experiences, we over generalize that, that's going to be our experiences. And what you just said is so important that, we have to remind ourselves that everybody's situation is different and unique. There's a variety of factors that make their situation different than ours. And so we have to be mindful of that if we're, connecting with others online, which is important to feel less alone, that we can't necessarily take all those experiences and say that's what's going to happen to me.
Kara Wada, MD: Yes, absolutely. And I feel like at least when I have dipped my toes into some of, for instance, the Sjogren's related support groups, you see the extremes so much more often than the reality of what I see in the office, which is a more of a mix. Like the extreme badness, more severe cases.
And then those that are like, oh, I healed myself with yoga and essential oil.
Not to discredit they have their place, but.
Tamara Hubbard, MA, LCPC: Yeah. Yeah. Think about human behavior, what brings people to online health groups to share experiences. Either they're looking for information or insights potentially, or they are sharing information or insights.
And so I talk to people about, those extremes and that's, let's do perspective taking. For instance, we may read about a lot of reactions for food allergy or anything online. But what we're not seeing is all of the people who are managing it well or who are not having allergic reactions every day.
So our perception becomes like this when we really need to take everything into context and that's an example of that. Yeah.
The Struggle with Balance
Kara Wada, MD: What other sorts of struggles do you hear from when you're talking with your clients?
Tamara Hubbard, MA, LCPC: Oh gosh. My practice primarily by choice is working with parents and more specifically moms because the other part of my practice that's not allergy is women's wellness, women's health.
It's just where my heart lies as a woman and in my forties. And I hear a lot about, balance, right? How do I be the allergy parent, taking care of my child and making sure that they're safe, but also make time for myself. So that's one, I hear the balance, trying to find the balance between anxiety and quality of life, right?
I practice acceptance and commitment therapy, or they call ACT, right? Yeah. So it's a cousin of CBT, cognitive behavioral therapy, and I'll pull that in too. But what ACT really focuses on is values alignment. And so that looks we may feel anxious about something, but what is important to us and can we do that important thing even when we're anxious?
So I do a lot of talking about finding that balance between safety and quality of life and a lot of things fall under that umbrella.
Kara Wada, MD: One thing that I have been increasingly struggling with some of my particularly moms, they may or may not be food allergy moms, but in particular I see a lot of folks who suspect food allergies, but in reality, more intolerances, sensitivities and have this increasingly restricted diet. And so that is, where I, in a perfect world, like we would have someone with your training, maybe you, since you're licensed in Ohio in helping because it really is scary sometimes to purposely expose yourself to something that you associate with.
Or bad symptoms or outcome or what have you.
Tamara Hubbard, MA, LCPC: Yeah. You're talking about something that's unfortunately a component of finding your way to, everyone talks about "I wanna be confident living with my diagnosis". And that is incredibly possible, that is possible to do. The part about it that people don't like, and I can understand it cuz I wouldn't, I've had to do the same, I've had to do the same work that I do with my patients. Oh cause I'm an allergy parent as well. But the hardest part is that you have to go through something in order to get to the other side.
For example I talk a lot about the idea of if you're gonna be, become confident managing your diagnosis, then you have to become competent. And competent means that you have to build skills and knowledge. And in order to do that, we have to practice the very things that are very scary to you.
Now, that doesn't mean: A- it's outside of my scope for me to say to anybody. Go be near your allergen or your feared food. Yeah. I would never do that. Number one, that's not within my scope. That's up to your medical team. And I might talk with them and find out about that. But what that does mean is that all those perceived things that are fearful that are probably safe. My role would be helping you figure out like what questions to ask your allergist, your healthcare team in order to figure that out. Is that a perceived fear or is that real? Let's get a really good, clear diagnosis, so let's talk about how we're gonna communicate those needs and then working through the anxiety and stress they would feel as we pursue quality of life.
Versus staying really, in this safe little bubble. Yeah, ideally, I think those of us in the health, mental healthcare fields would love to see every clinic, every practice. Yes. In our fields. Cause there's so much that we could do to help. Even at the very beginning, right? So when somebody receives a diagnosis and we talk about, mindset and skills training and anxiety management , at the onset, imagine how that would change the trajectory of many people's experiences rather than they go along and all of a sudden it's really overwhelming and now they have to talk to us and backtrack with it.
Yeah, I'm in alignment with.
Kara Wada, MD: I imagine it's not uncommon that like the house is burning essentially by the time folks sometimes come calling for help.
Tamara Hubbard, MA, LCPC: Yeah, again, it's people are busy. We have busy lives and unfortunately sometimes our mental health and wellbeing gets pushed to the side, especially as parents.
But there's a reason why they say put the oxygen mask on yourself before helping other people. Because if we can't do what we need to do to take care of ourselves so that we can. Help the people we wanna help, then it's a lot harder. So unfortunately, sometimes it takes, like something major or they can't function the way they want to on a daily basis to bring people in.
And that's a whole nother Pandora's box. But the way that the healthcare and the mental healthcare system are set up, it's very much reactionary versus being proactive. And I wish it was proactive.
Fight or Flight
Kara Wada, MD: Yeah. Similar to how unfortunately, like primary care and things end up as well in instances.
We were talking a little bit earlier about this interplay between kind of fight or flight, our stress responses, like some of those actual physical sensations that we may experience. Maybe we could talk a little bit more about how that can show up or what overlaps there are.
Tamara Hubbard, MA, LCPC: Yeah, so fight or flight, we have our central nervous system and there's the sympathetic and parasympathetic, I won't get too scientific, but essentially there's different functions with our central nervous system.
And whenever we feel we're threatened or we're near danger, and again that can be perceived or actual. The classic example is if you're in the woods and a bear comes up, of course you're going to be afraid and your body is going to say, "Okay, I need to change so I can either run or I can fight this bear, or I can lay and play dead," right? And get to safety.
So essentially that's what our body is doing. Our body is making these physical changes in order to allow it to function in a way that's going to get it back to safety and rest and digest.
Rest and Digest
Tamara Hubbard, MA, LCPC: And rest and digest is just the every other moments where we're breathing deeply, we're calm, our digestion system is working the way it's supposed to. We're not feeling as anxious and in danger as that.
Really, one of the important things that I like to teach is breath work. And so breath work, it wasn't physical therapy. We were talking about this before. And here I am a therapist who talks about mindfulness and breath work.
And I went to physical therapy and they're like, "Yeah, you're not even breathing. Your belly breathing isn't deep enough". And I was like, "What? I'm not breathing correctly?" So I really had to focus more on, because what happens is when we're sitting here, at any given moment of the day, you and I talking, we're working, we're driving, we're doing a lot of chest breathing, right?
So we're expanding our chest. We're forgetting about our diaphragm and our belly, and that's really where that calming sensation comes from, right? Our ability for our mind and our body to go, "Oh, it's not a five alarm fire?" Like we can calm down and get back to rest and digest. So that expanded belly when we breathe is really important.
So things like breathing can bring us back to rest and digest. Mindful work, mindfulness can bring us back there. Really anything that helps you get out of that cycle of anticipatory anxiety and fear and perceived fear is gonna help us get back to rest and digest.
Kara Wada, MD: Yeah, and what I am increasingly I'm gonna be curious to see where we are five or 10 years from now.
There are some newer studies that are starting to trickle out, looking at strategies of increasing through, like either little earpieces or other devices that increase vagal nerve stimulation. So kinda rest and digest nerve in its role in inflammation itself. So looking at it as a treatment potentially for rheumatoid arthritis and things.
I have said this a few times I think on other episodes, but one of the biggest disservices we've done in modern medicine is artificially separate our heads from the rest of our bodies, both oral health, but also, our mental health and our nervous system health, and realizing that we're all one human. It's all interconnected.
The Head and the Body
Tamara Hubbard, MA, LCPC: Yeah, it is. I gave a talk at the AAAAI meeting in February and it was on asthma and mental health. And as I was combing through all the research to see the latest and greatest for that talk. It was very clear. Again, it's the same in probably every diagnosis, every chronic condition.
The head and the body they communicate, right? They're, like you said, they're part of the same body. And so to really separate those two is really hard because then that leaves doctors and healthcare providers maybe not able to address that part, right?
Or have tools to address that part. And then of course, mental health care providers, it's outside of our scope. So then I agree. I think there needs to be a lot more collaborative medicine going forward because if you tell somebody they have a diagnosis, they're gonna be anxious probably.
And that's appropriate. There's part of anxiety that's useful. Yeah. Helps us to not walk into a busy intersection cuz we go, "Oh wait, hang on a minute. Maybe we should like, ooh, something feels we should stop and look". Yeah. And it's the same thing with living safely with our diagnoses or living that balanced life, but sometimes our anxiety takes over.
So that's that part where that then affects how we live physically with it. Yeah. It's all, yeah, you're preaching to the choir here, so.
Vocal Cord Dysfunction
Kara Wada, MD: I'm just thinking of how often we see increasingly, I have this I think a different perspective on, there's a condition, overlap condition that I alluded to a little earlier called vocal cord dysfunction, where essentially your vocal cords are closing, opening, and closing to the essentially the beat of their own drum.
And you think about you want your vocal cords to close so that you don't get postnasal drip or mucus dripping down there, you don't get reflux going down there. That is protective. It keeps us safe. But if you've experienced things like asthma significant asthma or food allergy reaction where you've had that sensation of throat closing before, you can see where those wires could get crossed easily or into maladaptive feedback.
Tamara Hubbard, MA, LCPC: It can get very confusing very quickly. So again, what I work with my own patients on is obviously they need to do what they need to do first to rule out whether, this is an asthma attack or it is an allergic reaction or some other flare up of their diagnosis. That's first and foremost, and again, that's guidance that their allergists and healthcare team have to help them with.
So if they need to call and reach out, they need to call and reach out to rule that out. But once they've got a sense that, it's probably not one of those things, then we start to use the strategies of calming the mind and the body. Because again, anxiety has the two components. It has a mind component, it has a physical component.
And what I'll tell people too is observe how you react to your anxiety and anxious thoughts and stress when you're sure that it's nothing to do with your diagnosis.
For example, a teen or someone who's doing a presentation that's pretty typical to feel anxious or worried before public speaking.
And probably has nothing to do with their diagnosis, right? So pay attention to what happens in your body when you feel that anxiety come up in that situation, right? And so you'll get to know what happens in your body when you're under stress or when you're feeling very anxious, and that can help you be a roadmap into discerning between is this anxiety and a stress response versus is this potentially something related to my diagnosis?
Kara Wada, MD: Huge.
Discernment and calming strategies
Tamara Hubbard, MA, LCPC: Yeah. It's not always easy to tell even. That's the hardest part, even with these strategies, right? These discernment strategies and these calming strategies, sometimes either we can't tell the difference or, it's we're so anxious we can't think clearly about whether it is anxiety or not.
Get the space to do that work, and that's okay. Then we allergists would tell you if you're unsure, use your epinephrine autoinjector. It's safe. There's time to process afterwards. Yeah, but that's the hard part. And that's the one thing too, at least in food allergy, people are looking for certainty.
And of course we are because when we're anxious, anxiety gets triggered by uncertainty, unpredictability, ambiguity, right? Hello, food allergy and some of these other conditions, right? Like everyone lives in that world.
Kara Wada, MD: Taylor Swift song, "Hello, I'm the problem. It's me".
Tamara Hubbard, MA, LCPC: Exactly. They're looking for certainty. They're looking for, it's this or that. They're looking for very straight answers. And unfortunately in with a lot of these diagnoses, it's not that clear cut. So we can give you guidelines and then, it's really in that moment learning, it's a lot of this is skills.
It's building skills to navigate those moments and get through them. And I would love to see more skill building stuff out there.
Comfortable with uncomfortable
Kara Wada, MD: Yes, getting comfortable with being uncomfortable.
Tamara Hubbard, MA, LCPC: That's basically the work that I do. You just summed up my job in private practice online. Because a lot of things in life make us uncomfortable. And sometimes it's appropriate. A lot of times it's appropriate for us to be uncomfortable about things that are new or when, even when I talk with my own kids about anxiety, I'll say, "Hey, you're feeling anxious. Of course you are.
It's the first day of school. That makes sense". So yeah, you immediately think anxiety means something bad is going to happen, and that's not always the case.
Kara Wada, MD: And I think what you just alluded to there too is understanding and realizing it's just part of that collective human experience that you aren't alone, even though your brain's gonna tell you are when in the midst of it.
Tamara Hubbard, MA, LCPC: Dr. Kristin Neff does research into compassion and self-compassion to you, you know that name?
Kara Wada, MD: Yes.
Tamara Hubbard, MA, LCPC: And she talks about there's components of compassion and it's kindness and for self-compassion too. There's kindness, there's mindfulness, and there's collective humanity.
Like the experience you're having today, the thoughts you're having today, you're not the only one who's experiencing that, even though you feel like it. And so I think there's a really important place for that work in managing any kind of chronic condition because it can feel very lonely and overwhelming and we can turn it on ourselves and we can forget to be kind to ourselves.
And so I think there's a lot of benefit to using compassion and self-compassion as a skill and a tool to help us manage these diagnoses.
Where to find Tamara Hubbarb
Kara Wada, MD: Amen. So if people want to work with you, they want to hear more of your wisdom on socials, where should they go? And we'll make sure to link to all of these over in the show notes of, you could just click on the hyperlinks.
Tamara Hubbard, MA, LCPC: Yeah
I've made more work for myself than I need to on social media. I have two separate accounts, so I don't post as often there, but @TherapistTamara is my handle on both Twitter and Instagram. I do have a private practice page on Facebook. But again, I don't post there that often.
So the food allergy counselors where I spend most of my time, and that's @foodallergycounselor. So that's what it is on Instagram and on Facebook. And then because of lack of characters on Twitter, it's @FACounselor. And so again, it's food allergy counselor pretty much everywhere but @FACounselor on Twitter.
And I'm most active on Instagram and Facebook and even LinkedIn to the professionals.
Kara Wada, MD: Awesome. Yeah, that's why my Twitter is slightly different too. It's ah,
Tamara Hubbard, MA, LCPC: I know.
Kara Wada, MD: It just, it has not been I am, I'm a little more longwinded so having conversations like these or, like you had started writing blogs like that is, yeah.
Tamara Hubbard, MA, LCPC: I blog on Instagram. Like now I find myself, I'm having my whole, the food allergy counselor website, the company website's being completely redone, so I'm not adding new blogs. Cause I don't wanna add more work for my website designer. But so now I've been micro blogging on Instagram.
Kara Wada, MD: Oh, awesome.
Tamara Hubbard, MA, LCPC: New on Twitter, right? Because kind of space. So I'm in love with Instagram at the moment. Yeah.
Kara Wada, MD: Me too. Thank you so much for taking time out of your busy schedule to join us. I am so excited to continue the conversation and hopefully we will see each other either this fall or next spring at one of the meetings.
Tamara Hubbard, MA, LCPC: I'll be there. I'm speaking at all of them, so let me know if you're there. But thank you so much for having me come and talk about something I'm passionate about.
Kara Wada, MD: Thanks. Awesome. Take care.
Tamara Hubbard, MA, LCPC: You too.
Kara Wada, MD: Hey, everyone. I am going to ask you once again to go into Apple podcasts and submit a review of the podcast for me.
But first I'm going to share a review from Dr Lex RX.
"Dr Wada's unique perspective is amazing considering she's both an auto-immune patient and physician. Her experience, expertise and insight make this podcast so valuable. Keep them coming."
One other from Amanda Katherine.
"Wow. So informative. Thank you for bringing more attention to autoimmune diseases. Each podcast is so informative and well thought out. Very impressed with all that you do."
Thank you so much, Dr Lex Rx and Amanda Katherine. I really appreciate the feedback and the review.
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