Ask the Doctor (2017–…): Season 1, Episode 4 - Allergies - full transcript

Dr Sandro Demaio discovers what life is like for kids living with severe food allergies and checks out a world-first trial to cure peanut allergy.

[Dr Shalin Naik] Life.

We only get one chance at it.

And to make the most of that opportunity,

it helps to know the best ways
to look after ourselves

and that's where we come in.

We're three medical professionals

on a mission to get the best and latest
health advice out there.

In this episode, we look at why
so many of us are modifying our diets

and separate the food facts
from the fads...

The kale-eating hipsters
are on to something!

...as my efforts to rule out
lactose intolerance get personal.



- I need to find a bathroom pretty quickly.
- Mmm.

And Sandro explores remarkable
new evidence

suggesting diet may help
in the battle against depression...

We have to intervene to stop this
intergenerational transmission of disease.

...with a simple food fix
that could help future generations.

You feel like you're in this big
black hole

and I sort of felt like
I was being lifted up.

[Dr Shalin] Navigating dietary advice in
our modern world can be exhausting.

So it's not just when faced with
the contents of our fridge

that many of us are left wondering,
"What should I eat?"

[sniffs] Eugh!

These days, it seems,
food intolerances are all the rage,

with many of us claiming to have
tummy troubles triggered by certain foods.

In fact, a recent study showed



that regardless of whether we have
a proper diagnosis or not,

1 in 10 of us now avoids the gluten
found in wheat, rye and barley

and a whopping 1 in 6 shuns lactose,
found in some milk products.

And I'm one of them. In fact, right now
I'm convinced I'm lactose-intolerant.

Dr Sinead Golley
is a behavioural scientist

who knows all about trends like this.

She also enjoys...

a gruesome murder mystery.

Which is why I've chosen to meet in
a busy cafe, just to be on the safe side.

- A flat white, please.
- Flat white?

I'm gonna get a soy hot chocolate, please.

Soy hot chocolate? Awesome. Thanks, guys.

Sinead has just completed a study

that showed more people are giving up
dairy than may actually need to.

Sinead, you highlighted this disconnect

between the actual number of people
who are lactose-intolerant

and the number of people
who self-diagnose.

- Mm-hm.
- What's accounting for that?

So, traditionally, you might have gone to
your GP or your doctor or a specialist...

Right.

...but now we're finding on equal par that
people are consulting media as a source,

internet and often family and friends

are actually really quite influential
in decisions like this as well.

Yeah.

So people seem to be jumping on
the food-intolerance bandwagon

without bothering with a medical opinion.

Thank you!

Which is... exactly what I've done.

So, Sinead, I have a confession to make.

- I'm guilty as charged.
- Oh, no!

I am one of those people.

I avoid lactose because...

I am, I think!

- I think I am...
- Yep.

...a lactose-intolerant individual.

- OK.
- Yeah.

- But you've not been formally tested?
- Never been formally tested.

But that's one of the big characteristics
of the behaviour

that is of concern for us, obviously.

[Shalin] Yeah.

That people are symptomatic
yet not actually going to the doctor

and getting, you know, a diagnosis

or at least getting other conditions
ruled out first.

Sinead's right - the bloating and...

digestive issues
I've been putting down to dairy

could be something more serious.

And with my scientific background,

I should know better
than to self-diagnose.

So, have you ever felt the need
to restrict your diet?

Or perhaps you're not averse
to the occasional food fad.

We took to social media to ask you
about your food choices.

[Dr Renee] Many of us diet
for health reasons

but our specimen of human averageness,
Gary,

isn't one of them.

And with little else to stimulate him,

his mealtimes have become
the highlight of the day.

Ahem! You're not seriously
about to eat that, are you?

Yeah.

Do you have any idea
how much sugar is in that?

Mm-mnn.

In terms of calories,

Gary's diet is fairly typical

and there's plenty he could do
to improve it.

In some cereals, like his,

over a third of every spoonful
is pure sugar.

That's almost as much
as you'll find in a chocolate bar.

And you wouldn't eat a chocolate bar
for breakfast.

Would you, Gary?

Ahem! Gary!

While fruit juice is delicious,

it has almost none of the healthy fibre
that whole fruit contains,

making it another sugar bomb.

[explosion]

[stomach grumbling]

Don't worry it's only a few hours
until lunchtime.

It'll pass in a...

OK. Lunch.

And what have we got here?

A burger, some chips and a soft drink.

Let's start with that burger and chips.

Sure, they taste good

but burgers, on top of a big serve
of fat and sugar,

often pack more salt in a single portion

than the suggested target
of 4 grams a day for adults

and those chips contain a large amount
of trans fat, which we know is harmful.

Moving on to that soft drink

and I only have one thing to say

nearly 10 teaspoons of sugar!

Studies have found that those who drink
one can of sugary soft drink a day

increase their risk of type 2 diabetes
by 26%

and heart attack by 20%.

And finally, it's dinner time

and Gary's convenient choices include
a chicken shop chook

with a big side of frozen vegies.

[chicken skin crackles]

Hold your horses, Gary!

While chicken itself is good for you,

store-bought birds can be
super-high in salt.

In fact, some contain 10 times the salt

of a healthy, skinless breast
you can cook yourself.

And those vegies-well, with the
nutrients frozen in soon after picking

and plenty of fibre,

they're actually pretty good

but, Gary, before you hoe in...

Only joking! Get stuck in, mate!

[Dr Shalin] As a medical researcher,

I'm embarrassed to admit I've not seen
a doctor about my tummy troubles.

All this time I've been cutting out dairy,

when my symptoms could be indicative
of something much more serious.

So I'm going to get what I think is
lactose intolerance properly tested

by an expert, not off the internet!

Dr Andrew Brett is a gastroenterologist.

[triumphal music]

But as a kid, he dreamed
of batting a century for Australia.

[applause]

So, um, you think you might be
lactose-intolerant.

- I'm pretty sure I am.
- OK.

Why do you think that is?

Well, I've had some, you know,
issues with my gut,

so I've reduced it in my diet but I...

you know, I'm not gonna avoid
the flat white in the morning.

- That's compulsory.
- OK.

So, after your flat white in the morning,
what symptoms do you get?

[laughs] When I have my flat white, uh...

So, how do I put this delicately?

It's, uh, about half an hour later,

um, I'll get a little rumbling.

A little something-something,

telling me I need to find
a bathroom pretty quickly.

- Yeah. That's generally it.
- Yeah. OK.

So, coffee's an interesting one,

because there can be two reasons
for having symptoms after coffee.

There's lactose intolerance, if you
have a lot of milk with your coffee...

Right.

...whilst some people also have an
exaggerated response to coffee itself

and coffee can exaggerate a reflex in the
stomach called the gastro-colic reflex,

that moves the bowel along.

Right, right. So could be
either one of those.

Yeah, that's right.

So, a quick way to find out is to do
what's called a breath test.

So, what's the breath test?
I haven't been drinking this morning!

So, this is a breath test not to measure
alcohol in your breath...

OK.

...but a gas, hydrogen, which,
if you don't absorb lactose,

there's a lot of hydrogen produced.

But hydrogen's flammable.

Uh, yes, it is

but we're just gonna measure it
we're not gonna burn it.

OK. We're not gonna light my burps!

Usually, lactose is absorbed
within the small intestine.

However, for people with
lactose intolerance,

it passes straight into the colon

and is fermented by the bacteria
that live there.

This produces hydrogen,

which escapes... any way it can!

I fasted eight hours for this test,

so I'm keen to get it over with.

But before I do, we need
a base-line reading

to establish how much hydrogen
is normal for me.

[gasps] That's all I've got!

- It says "1ppm".
- Yeah, so, that's good.

So, it's just gone up to 2ppm now and so
that's a normal base-line of hydrogen.

So, what's next?

OK, so, the next part is
we'll give you some lactose.

So I'll just mix it in the glass now
and bomb's away.

Oh, jeez.

"Bomb's away" could be right.

This solution has the same lactose
as half a litre of milk.

About three times as much
as my daily coffee.

Is it tasty?

You tell me.

Alright.

Hmm.

It's sweet. A little bit sweet.

'Sweet' does not mean good.

I would do anything for a coffee
right now.

Even a soy one!

Alright. Now we wait!

[Dr Andrew] No going back now.

With results sometimes
taking hours to show up,

I've now got a long wait on my hands.

And, uh, well, in case I need it,
where's the toilet?

You'll find it.

That sounds ominous...

[cows mooing]

- Morning!
- G'day, Sandro. How are you?

[Dr Sandro] According to one study,

more than a third of us
want to eat more healthy food

but not everyone's as lucky as I've been,

growing up here, on my parents' farm,
surrounded by it.

My dad's Italian, so I was raised on
a predominantly Mediterranean-style diet

and many of my relatives

have lived longer-than-average lives.

Now, as a doctor,

I've seen many studies suggest a diet
high in vegetables, seeds and olive oil

is good for our health

but new evidence suggests it might be
good for our mental health too.

In fact, there's a whole new
field of study emerging

around diet and mood.

It's called nutritional psychiatry...

which is why I'm heading to Geelong
in Victoria, Australia,

home of the first faculty in the world
dedicated to it.

I'm hoping to find out
exactly how nutritional psychiatry

suggests good food could
help make us happier.

- Professor Jacka.
- Hi. How are you?

- Sandro. Lovely to meet you.
- Lovely to meet you too.

- Do you want to come through?
- Love to.

OK. Great.

Professor Felice Jacka
is one of the scientists

behind this radical new field of research
here at Deakin's Food and Mood Centre.

And like me, she also enjoys cooking!

But the professor's passion for good food
goes well past the pot.

She believes that where it ends up,
deep in our gut, is key to our wellbeing.

The relationship between
our brains and our guts

can you tell us a little bit more
about that?

Look, it's really fascinating.

What's becoming increasingly clear

is that the gut microbiota
that live in and on us

play a very important role
in the immune system,

in metabolism, body weight

but also in mood and behaviour.

[Dr Sandro] Our microbiome is a collection
of bacteria living in our gut,

inherited from our mother
and the environment around us.

These micro-organisms
number in the millions

and are essential
to many of our bodily functions,

including our immune system,

which scientists now suspect may help
keep our mental health in check.

To do its job, a gut microbiome
needs a steady supply

of fibre-rich grains, vegetables

and legumes such as peas, beans
and other edible pods.

Now, ideally, we should be getting between
30 and 50 grams of dietary fibre a day.

Only about 5% of adults in Australia

consume the recommended intake
of vegetables and legumes.

Only about half a percent of kids.

So the gut microbiota can't do
what they're designed to do,

which of course has huge implications
for our health,

because the immune system underpins
every aspect of our health,

including our mental health.

Not all experts agree
but if Professor Jacka's right,

our fibre-deficient diets could be
affecting both our gut and our mood.

And it's not just us.

Because we pass our gut microbiome on
to our kids,

something as simple
as a few extra serves of veg a day

could be a factor in their
future wellbeing too.

Very important studies show

that after four generations
of a fibre-deficient diet,

the microbiome diversity couldn't be,
um, saved, rescued,

by introducing fibre again.

So we really need to, uh,
get back to basics

and help children to learn about food
in a way that is really joyful.

Because we have to intervene to stop this
intergenerational transmission of disease.

It's shocking to think future generations
could inherit irreversibly bad guts

ad perhaps a predisposition to depression.

But there is hope

and that's where the centre's
Mediterranean diet study comes in.

And I'm on my way to meet
one of its star participants, Sarah.

Apparently she's seen a big reduction
in her depression symptoms

since taking part in the trial

and I want to find out exactly what it is
that's made such a big difference for her.

Now, it was a small preliminary trial

but one-third of the participants
found their depression eased

after making changes to their diet,

compared to only 8% in a control group,

whose diet remained unchanged.

- Hello!
- Hi.

- How are you?
- Sarah. Sandro.

- Sandro, nice to meet you.
- Thank you so much for having me.

You're very, very welcome.
Do you want to come in?

- Yeah, love to.
- Excellent.

Um, I just thought I'd do
a smoked salmon salad.

- Yum.
- With nice Mediterranean stuff in it.

- Delicious.
- So, yeah.

- Can I do anything?
- Nope.

- OK.
- 'Cause you're in my kitchen.

- [laughs]
- It's my kitchen!

Clearly Sarah's a keen follower

of the diet she was first
introduced to on the trial,

a modified Mediterranean diet
that focuses more

on the fibre-rich veg, nuts,
legumes and seeds

and less on the carbs.

And so, can you tell me a little bit

about what your diet was like
before you started the trial?

Sure. It's, um... Well, actually,
it was non-existent.

- [chuckles]
- OK.

So, yeah, it wasn't overly... overly good.

And what were you eating?
Would it be food like this?

I mean, look, I'd always eat some
vegetables at night with the kids.

- I'd always eat a bit of protein.
- Yep.

- But I'd only be eating one meal a day.
- Right.

I wouldn't be eating,
you know, anything else.

Not eating properly, probably.

I would eat, like, probably, bread
and something quick like toast

and drink coffee and... just to get me
through, just to fill the stomach.

OK.

So many people don't understand
that when you've got depression,

it's just impossible to think about things
that are gonna make you healthy,

because quite honestly, you want to do
stuff that doesn't make you healthy,

'cause you just want to die.

You just want to die. It's horrible.

Sarah was already on medication
for her depression

but is convinced her new diet
helped her turn a corner.

Did you find that eating well
in turn increased your motivation?

Yeah! Yeah, it did.

You feel like you're in this big,
black hole and you cannot get out of it

and you feel like someone's pushing you
down, down, down, down

and so finally, when I had
some direction on my food,

I sort of felt like I was being lifted up.

The more nutrients that I was
getting into my body,

the better I felt.

- Shall we eat?
- Love to.

Excellent.

- This looks amazing.
- I hope so. I hope you like it.

One person who saw the transformation
first hand

was Sarah's mum, Barb.

Sarah was telling me about, um, the change
in her diet since she was on the trial.

The change in her was amazing,
once she started on this diet.

Well, she became brighter,

she was excited

and, um, she used to talk...
she'd talk to us about it.

And I was quite amazed.

I really hadn't realised how bad
things were with her

but like most people with depression,

she covered it up very well,
quite often, yeah.

So, Sarah, looking at the future,

will you stay with the diet, do you think,
and stick with the new way of eating?

Absolutely, yeah.

Certainly not a medication replacement

and that's one thing that I'm
very, uh, aware of.

It just... it's a complementary, um, thing

and it's helped in so many other ways,

rather than just the depression.

You know, I haven't been sick
for two years.

And it's funny, that - it's been
two years since I started on this.

So, yeah, going forward, definitely,
it's medication if you need it,

diet, exercise,

have a laugh.

And on top of that, it's also
pretty delicious.

- It is, it is.
- It's pretty good.

Sarah's ability to turn her life around
like this is inspiring

and while bigger and more controlled
research still needs to be done,

if good food and a healthy gut
is shown to ease depression,

then millions of lives could be
positively affected,

like Sarah's.

While it is still early days for the field
of nutritional psychiatry research,

there's a growing body of evidence now
connecting what we eat with how we feel.

So until we know more,
we shouldn't underestimate

the effect good diet could
have on our mental health.

And that's certainly food for thought.

[Dr Shalin] I feel more than just guilty
after an ice-cream binge,

I feel positively bloated.

I've been putting it down
to lactose intolerance

but it could be something more serious,

which is why I'm getting it checked out.

So, how are you feeling?

Uh, little bit of a rumbling but, uh,
nothing drastic just yet.

OK. Well, let's blow into the machine
and see what we've got.

Alright.

I took a huge hit of lactose
two hours ago.

I have since been doing this
every 30 minutes.

If my hydrogen levels go 20 points higher
than my base-line of 2 parts per million,

I'm definitely lactose-intolerant.

It's rising. Up she goes.
Where she stops, nobody knows.

15! Still going. 33, 34.

Ooh, 38. So, that's a...
that's a definite positive, Shalin.

Right.

So that means you've definitely
got lactose intolerance.

- Is that on the high range?
- That's a pretty mild reading.

It's definitely a positive reading

but sometimes we see people
who go up to 100 or even 200.

- So... it's relatively mild.
- I see.

Um, but what's your advice for me
from now?

So, you've only got mild
lactose intolerance, Shalin,

and so you're able to have some dairy
but probably just in limited amounts.

So you can still have a coffee
but perhaps a smaller one.

[ding!]
Whoo-hoo!

- Yeah?
- And the other important thing

is to make sure you have plenty
of calcium in your diet.

Alright. So I can still keep
having my flat whites?

Yeah but just maybe piccolo
rather than grande.

[laughs] Indeed.

- Well, thanks very much for your time.
- No worries.

- See you later.
- Bye.

Well, there you have it. I thought I was
lactose-intolerant and guess what I am.

But it's important to know

that lactose intolerance itself
is not a serious health issue,

as long as I get enough calcium.

However, avoidance of other food groups
can have more serious health consequences.

So if you feel you have an intolerance,

ask the doctor.

[Dr Renee] Now, as a health professional,

I'm already a fan of nutritious food

but what about the other stuff
we're constantly consuming?

You know, drinks!

Water is obviously the first thing
that springs to mind

and the daily recommended minimal intake
for adults is 2.1 litres per day for women

and 2.6 for men.

But just as there are fad diets,

there are also plenty of fad beverages.

So if you're into regular exercise,

then you probably know there's a whole
world out there of colourful sports drinks

that promise to maximise your performance,

energise you and rehydrate you.

The fact is these drinks, which were
once aimed at endurance athletes,

are high in sugar and salt,

two things that modern diets
are hardly lacking.

So unless you're running marathons,

there's a lot of research to say
stick with tap water,

which is just as effective

and doesn't have the hefty price tag
or the extra calories.

Now, we should have a little talk
about coconut water.

Yes, it tastes good

and yes, it is refreshing

but claims that coconut water is a more
natural or a better way to hydrate

are interesting...

Because comparative studies have shown

that unless you're doing long periods
of intense exercise in extreme heat,

water really is just as good.

[loud whirring]

You can't have a conversation
about fad drinks

without talking green smoothies,
which are all the rage.

So, the thinking goes like this.

We know fruit juice is a problem,

because it's full of sugar with no fibre.

Green smoothies, on the other hand,

retain all the fibre, pulp and skin
of fruits and greens

by blending everything at high velocity
with water.

However, there are pros and cons.

So, these smoothies, on the one hand,

are getting people to eat
healthy whole fruits and greens,

which they otherwise might not have

and that's a good thing.

But there is research that suggests

smoothies may rob you of the satisfaction
you get from eating solid food,

which could lead to more eating.

And when there's too much fruit,
it can be a problem too,

as the high sugar and acidic nature
of sweeter smoothies

can be damaging to your teeth.

And so the thing with beverage fads

is that while they can have benefits,

they seldom trump the oldest
and most popular drink of all.

[Dr Shalin] I've just been told
I'm officially lactose-intolerant.

And like everyone in my situation,

it's important I find ways
to get calcium into my body

that don't include a big, frothy coffee.

But it's not as easy as it sounds.

In Western cultures, dairy is by far
the biggest source of calcium.

- G'day, Shalin.
- Hey, Malcolm. How are you?

Thanks very much for having me today.

But what is calcium and why do we need it?

To find out, I've come
to this space-age building

to meet Dr Malcolm Riley,

a nutrition scientist and an expert
in health and diet.

He's also a keen rock climber.

Calcium, I mean, that's something
that we all hear about, growing up,

is milk has calcium and that's
important for your bone growth.

So what's the evidence there?

Yeah, so, we store calcium in our bones.

That structure keeps getting stronger
and denser and bigger

until about our mid-20s

and then it loses density
for the rest of our lives.

Right.

So the important thing is to build the
strongest bone we can in our mid-20s,

to build the highest bone density

and an adequate supply of calcium
is particularly important for that.

So it's kind of like putting deposits
in the calcium bank.

Yep, I think that's a good analogy.

[Dr Shalin] Each day,
the body uses calcium

to clot blood, make skin, nails and hair

and aid in muscle contraction.

And we also lose a bit sweating.

So it's really important
I maintain an adequate supply.

Where am I going to get my calcium from
if I reduce my dairy intake?

OK. The thing is,
even if you're lactose intolerant,

you don't have to avoid
lactose completely.

- You can have small amounts of lactose.
- Right.

Maybe the easiest way to do this
is to demonstrate some foods

and talk about their calcium contents.

- Sounds great.
- Let's go.

That could be life-changing for me.

I love dairy
and would rather not lose it altogether.

To prove his point, Dr Riley has asked me
to help him set up a table

with loads of different foods,

which have all been portioned out

to show a calcium content
comparable to one glass of milk.

So, the lactose content
of that serve of milk

is around about 15 grams, in that glass.

But the cheese the lactose is all gone.

- It's all gone?
- Yep. Yep.

So, there's less than 1 gram.

- So it's...
- So it's just fermented away?

Yeah, that's the best way to put it.

So, around about equivalent in calcium
content, we have feta cheese.

But you can see the concentration
is lower than in the cheddar cheese.

Right. So you need to eat more feta
than you do cheddar cheese

to get the same amount of calcium.

That's exactly right.

Well, feta's going to be no problem
for me, 'cause my wife's Greek, so...

- Yeah, that's, uh...
- There's plenty of that going around.

And my favourite feta is actually
an Australian feta

but I know other people favour fetas
from different places.

- The Greek one's better.
- [laughs]

Any three to four of these serves,

including the milk option,

will help me meet my
daily requirements of calcium.

So, fish with bones,

nuts, calcium-fortified tofu

and figs

are all good sources of calcium,

as are, of course, green vegetables.

Which means there's one food fad
that might actually be doing some good.

And kale, in fact, is higher in calcium

than the other vegetables bok choy
and broccoli that we have here.

- Right.
- Yeah.

So the kale-eating hipsters
are on to something?

[laughs] Well, you always
knew they were, didn't you?

If I'm honest, I could be accused
of being a bit of hipster myself.

After all, I do have a beard

and kale, a member of the cabbage family,

is something I love to put in my salad.

I've gotta say, I eat almost everything on
this table,

so I'm not too worried
about my calcium intake.

It's still quite a lot of vegetable,
though.

Yeah, it is.

I'm not gotta eat that much bok choy
in a meal.

It is but you might...

well, you might or might not eat it
across the course of a day

and maybe that depends
on your culture as well.

Yeah.

What are we going to do
with all this food now?

Well, I can put the sardines
in a bag for you.

I'm travelling.
I don't think they'll keep.

No, maybe not but you'll...
you'll make conversation on the plane!

[laughs]

[laughing]

Getting to the bottom
of my dietary sensitivities

has been a personal experience

but if you've got any concerns,
get it checked out,

if only for peace of mind.

After all, happiness is a precious thing.

[Dr Shalin] It's so exciting
to see the advances we're making

in the understanding of the gut and
the role it might play in mental health.

It's research that could change lives

not just ours but future generations' too.

I now know that there is a light
at the end of the tunnel.

I can... You know,
if I eat well and stay well,

well, then I should be OK.

And that's something
we can all get excited about.

Oh, go on, Gary.

You can have a chip.

But only one!