In this episode of The Matcha Guardians, we had the privilege of sitting down with Dr. Gary Soffer, an integrative pediatrician and allergy expert from Yale School of Medicine. Dr. Soffer’s journey into medicine was anything but typical, starting in the music industry before a personal experience with a sick relative inspired him to pursue a career in healing. Today, he’s a leading voice in integrative medicine, focusing on allergies, eczema, and asthma, and we couldn’t wait to pick his brain about the rising rates of food allergies and how parents can navigate them.
One of the biggest takeaways from our conversation was how early allergen introduction has transformed. Dr. Soffer explained how the old guidelines to wait until two years of age have shifted to introducing allergens as early as four to six months. He shared fascinating insights from research, like the discovery that Israeli children, who eat a peanut-based snack called Bamba from a young age, have significantly lower rates of peanut allergies. These findings underscore how early and sustained exposure can actually protect against allergies, dispelling the myth that delaying certain foods is safer.
We also discussed the rise in food allergies and their potential causes, from industrialized diets to over-sanitization. Dr. Soffer emphasized the importance of exposing kids to diverse foods and environments—yes, even dirt and farm animals can benefit their immune systems. For us as parents, it was reassuring to hear that mild reactions are common during early food introduction and that systemic, life-threatening reactions are exceedingly rare in young children.
Another crucial topic was the psychological impact of food allergies. Dr. Soffer cautioned against unnecessary allergy testing without a history of clinical reactions, explaining how false positives can lead to over-restrictive diets, more allergies, and even eating disorders. He shared heartwarming success stories, like a child once diagnosed with eight food allergies who, after reintroduction, now eats freely.
Finally, we explored practical parenting strategies, including introducing fermented foods, encouraging food diversity, and resisting the urge to over-medicalize parenting. Dr. Soffer reminded us to focus on service and finding joy in the little moments, which resonated deeply as moms navigating our own parenting journeys.
This episode left us feeling more informed, empowered, and ready to share these insights with you all. We hope it does the same for you!
Gary Soffer, MD on Instagram: https://www.instagram.com/garysoffermd
Here’s the full transcript without timestamps:
[Music Playing]
Voiceover:
Welcome to The Matcha Guardians Podcast, brought to you by matcha.com. Here we focus on the biggest trending health topics of our time, featuring the greatest and upcoming wellness advocates. Now here are the Matcha Guardians, licensed dietitian Diana Weil and medical journalist Elara Hadjipateras.
Diana Weil:
Hello, welcome to this week's episode.
Elara Hadjipateras:
We are so excited to have Dr. Gary Soffer with us, who is an integrative pediatrician specializing in allergy and immunology. He serves as an associate professor at Yale School of Medicine, where he also directs the integrative medicine program and acts as the associate program director for the pediatric residency program.
Soffer earned his degree in human development from Cornell University and his medical degree from Tel Aviv University. He completed his pediatrics residency in allergy and immunology at the Children's Hospital at Albert Einstein, followed by a fellowship in integrative medicine at the Andrew Weil Center for Integrative Medicine at the University of Arizona.
Nationally recognized for his work in integrative medicine, in allergy and immunology, Dr. Soffer focuses on conditions such as food allergies, eczema, asthma, and environmental allergies. Beyond his professional endeavors, Dr. Soffer enjoys spending quality time with his wife and three children. Welcome.
Gary Soffer:
Thank you.
Diana Weil:
Doesn't it always feel like someone's singing you happy birthday when they read you your intro?
Gary Soffer:
It's always an out-of-body experience. You're like, “Wait, this is me,” and then I want to read it to a couple of high school teachers.
Diana Weil:
Okay, Gary, so I want to just jump off with the first question because I know that it involves my dad. I'm really curious what led you into medicine, particularly pediatrics and integrative pediatrics.
Gary Soffer:
So, I mean, it was a long road and I'll try to make it really, really brief. I had no interest in going into medicine, but I'd always been interested in health and healing on a certain level. I started taking Taekwondo when I was five years old. And that developed an interest in meditation and eventually, when I was 13, I got acupuncture and then when I was 16, I picked up your dad's book and that was a really, really big influence on me.
And he was on 60 Minutes at the time, and so it was really very much in my world. I ended up having nothing to do with it for a long time. I worked in the music industry for about five years and the joke was, I couldn't even walk into a hospital.
My mom wouldn't let me see my very sick aunt in the hospital because she told me that I actually looked worse than her. So, when I told everybody I was going to medical school, there was a lot of laughter and snickers.
But I had a cousin who got really sick, and I was forced … I had left the music business at that point and not really doing much and I had been forced by his mother to sit with him in the hospital. And it was my pleasure, I love him dearly.
And it was to my horror but I realized the thing that I didn't like about hospitals was I couldn't do anything. I felt really, really powerless. And once I was able to help him and even just make him smile, walk him around, watch him heal, it was transformative. And so, that's when I really thought about going to medical school and pursuing medicine.
From there, another twist of events. I thought I was going to be a surgeon and that had really been my intention all throughout med school and I applied for surgery and didn't match. I didn't get a spot.
And so, I had this year off and it was the greatest divine gift that I could have been given, which was I had this year off to kind of figure out and reassess what I wanted to do with my life, because I'd been just so narrowly focused for four years.
So, I thought, “What brought me the most joy?” And that was volunteering with an organization called Save A Child's Heart, which exists in Tel Aviv and they bring in kids from all over the world. Fifty percent of them are Palestinian and the other half come from all over the world for cardiac care. So, whether it's surgery or interventions or something like that.
And I used to go there once a week and volunteer, and that brought me so much happiness and so much joy. And I was like, “Okay, that's what I want to do with the rest of my life.” During that year, I had the opportunity to do a residency training program at University of Arizona through the center, through the Integrative Medicine Center, a one-month residential program, and that just re-grounded me back into my passion for integrative medicine.
It had always been there throughout med school. I ran meditation classes and stuff like that, but it really allowed me to target where I wanted my career to head. I spent a couple of months in India during that year, and that also helped as well, and eventually, I kind of landed my dream job at Yale. To my very big surprise, but I got it.
Diana Weil:
That's a great journey. And Elara and I have had the pleasure of meeting you in person, and I can't think of anyone better to work with children than you.
Gary Soffer:
(Laughs) Thank you. I feel really lucky. I assume you're speaking to my lack of maturity, but …
(Laughter)
Elara Hadjipateras:
So, you said you have three children. How old are they now?
Gary Soffer:
The oldest is going to turn eight probably by the time this podcast gets released and then the next one is six, and then the maybe not so baby is 20 months now and she runs the show.
Diana Weil:
So, when I had my baby, I reached out to you on Instagram because that's what you do, you're an allergist, pediatrician, and I said, “Gary, when should I introduce allergens to my baby?” And you said, “As early as possible.”
And that recommendation has shifted because it used to be they held off until a year, right?
Gary Soffer:
Two years.
Diana Weil:
Two years, okay, so two years and now they say as, what, four months? Something like that?
Gary Soffer:
The recommendations right now are four to six months.
Diana Weil:
Okay. Why did that change?
Gary Soffer:
The first question is why did we make those recommendations in the first place? And it's a new shift. Even when I was doing my pediatric training, which wasn't that long ago, the recommendation still stood: wait two years.
So, the first shift happened because we just saw an influx in food allergy, specifically peanut allergy. And the thinking was that kids can communicate how they're feeling if they're having an allergic reaction by the age of two, so we should wait until two.
What happened was some really smart doctors in the UK were talking to some really smart doctors in Israel and said, “Why are all of our Jewish patients getting peanut allergy and none of yours are?” And this is sort of one of the more incredible stories in medicine to me, because it was just thought and brain and logic. It turned out that Israelis gave their kids a little snack called Bamba.
It was just a first food. It sort of melted on the tongue. It was easy to digest and it's covered in peanut, and so, all these kids who were eating Bamba weren't having peanut allergy. So, they did a study with what's called early introduction of peanut and they showed that there's a dramatic decrease, especially in high-risk kids.
So, kids who have severe eczema or kids who have a preexisting food allergy and high-risk kids that if they introduce early, they have a much, much, much less likelihood of developing a food allergy. And so, now all the recommendations have changed and we want to get foods in as early as possible.
Elara Hadjipateras:
As far as when you're introducing kids four to six months old to different common allergies, sometimes they end up having reactions. And one of the things my pediatrician told me is that doesn't mean you just necessarily stop giving it to them.
So, what are the signs in your opinion that are normal reactions, you should still keep introducing it and also, I guess another question on top of that is at what frequency and at what point are the symptoms that I see that say, “Stop, don't serve this anymore, possibly go to your doctor about it.”
Gary Soffer:
So, our concern is always what we call a systemic reaction, meaning that the whole immune system, the whole body is impacted by it. So, oftentimes I'll have parents come to me, and these are more common foods like tomatoes or chocolate, where kids can get kind of rashes around their faces and those are local reactions.
But when you start seeing symptoms that go beyond that, so rashes to the body or vomiting or wheezing or coughing or something like that, that's really when you should stop and treat. It's important to note a couple of things first of all, though, that reactions generally happen within like 15 to 30 minutes. So, when people get concerned that they see a rash the day after they gave it, that's not a concerning reaction to me.
The other thing to remember is because there's so much anxiety about introducing foods because there's so much out there about food allergy that scares the living daylights out of everybody. The good news is that as far as we know in the United States, no child under the age of one has died of anaphylaxis, which is always what people are thinking of.
First reactions are usually pretty mild and manageable. That doesn't mean they can't be more severe and everybody should sort of be tuned into what a reaction should look like, but it's really, really, really unlikely.
Diana Weil:
I wish that I had known that before I put peanut butter in Elio's milk for the first time because we did it and I was terrified. And then later on I saw a video on Instagram of these parents sitting in a car outside a hospital when they gave peanut butter to their child for the first time and I was like, “That's brilliant. Should we have done that?”
But no, you don't have to. I mean, there is a concern, but if you're doing early allergens, the concern is not as high as what we might think, right?
Gary Soffer:
Yeah. And I think it's also about shifting this idea that you're protecting them by avoiding the food. That you're actually protecting them by introducing the food. It is scary. Listen, I said I had a 20-month-old and my wife could attest to my own anxiety and my own fears introducing these foods into her.
And I still have some anxiety and fears every time she eats an allergen in front of me, probably because I live it every day. But I don't have to tell the two of you, I mean, we're all parents here, that being a parent causes anxiety 24/7 and this is one piece of it.
Jon Gay:
I'll jump in as actually the person on the call that does not have kids, but my wife's cousin adopted a baby, pretty much from birth. And it turns out that her daughter has, or had, a severe peanut allergy, any kind of cross-contamination, checking labels on everything, every time there was a birthday party we got the food from the special nut-free bakery, and it was really, I think, what probably new parents like Diana and Elara are afraid of when they get into something like this.
And I'm not saying this goes for everybody, but I'm sure we'll come back to it later, Gary, but the technological advances that have come a long way. The daughter is 20 now, and she was able to take a therapy, a controlled dose, and work her way up and build sort of not immunity, I guess immunity is the word I'm looking for.
I don't think she's going to go for a jar of peanut butter at this point, but she can be around it. She can be on a plane, she can be around desserts that might have cross-contamination and now at 20, she has no issue after her parents being deathly afraid of it through her teenage years.
Gary Soffer:
So, I want to highlight a couple of things you said because you said the parents were deathly afraid of it. And I think putting food allergy into context is really, really important and it's something that I really work hard to convey to families.
So, the first piece of this is how important the parents' experience is in all of this and working with parents closely on it. The second piece of this is adding that context and really understanding what the risk of food allergy is.
And there's a couple of facts that I always share with parents because I think it's important to know and important to understand. Now, I would never trivialize the risk of food allergy and so that's not my goal here, I would never minimize it. There is a real risk of having a food allergy, but it's important to understand what that risk is. So, we will have the dark morbid conversation.
So, the first piece of this is children with food allergy are more likely to die in a car accident than they are from their food allergy. They're more likely potentially to die in a house fire than they are from their food allergy.
So, again, having a food allergy definitely has a fatality risk, but we have to remember, it's not like we don't get into cars, it's not like we walk around our homes with a fire extinguisher at all times, we're safe, we're intelligent about it, we manage it.
The second piece of this and this is also really, really important. There's a lot of misinformation about how risky it is having a food allergy and what your risk of exposure is. And so, I tell everybody about two really cool studies.
The first study, they took kids with peanut allergy and they wiped peanut butter on their arms and at most those kids needed an antihistamine for a local hive, so not a systemic reaction, just a local hive. There's another study where they had kids with peanut butter allergy actually smell peanut for 10 minutes straight, not a single one of them had a reaction.
So, the point here is that you really need to ingest the food in order to have a systemic reaction. That doesn't mean if you eat peanut butter and kiss your child on the cheek, they can't develop a hive or something like that, it doesn't mean that if you kiss them on the lips, they can't accidentally ingest the food.
But I hear a lot about kids avoiding social situations, parents with immense amounts of anxieties around these situations. And I think just like we would get into a car and put on our seatbelt, use our blinkers, drive safe, we have to sort of take the same approach with food allergy, which is put that fear into context.
Jon Gay:
I'm so glad to hear you say that because, well, I don't know all the specifics of their situation. There were years where she made sure that either she or the daughter had an EpiPen on her at all times. And it's interesting to hear how the science and how we're learning different things and the science changes as it develops.
Gary Soffer:
So, that's still the recommendation. That's the seatbelt. That's the seatbelt, that we always carry EpiPen. If we have a food allergy, we always carry our EpiPen or now we have intranasal epinephrine wherever we go.
Diana Weil:
Gary, it seems like food allergies have increased, is that true? Have they increased? And if they have, why do you think that is?
Gary Soffer:
So, allergic disease overall has increased, and food allergy is definitely amongst the allergies that increased and is also continuing to increase over time. In pediatrics, it's about 8 to 9% of the population. That number's going up. So that's about two kids in every classroom. So, it's really one of the most common chronic diseases at this point. We talk a lot about other chronic diseases, but food allergy is definitely an emerging chronic disease.
Why that is, so I mean that's the million-dollar question. Ultimately, I think most of these immune disorders, whether they're autoimmune disorders or they're allergic disorders, are kind of a result of—I always use the term, the broadest term possible—industrialization.
Gary Soffer:
So, with industrialization, what's happening? So, we're moving away from a dirty lifestyle, which is good and bad. Dirt and soil are actually really good for our immune system in a lot of ways, and there's some research to support that when we compare how different groups farm, which is really, really cool and interesting studies.
We've moved, we've shifted our diets to a much more ultra-processed diet, which is certainly impacting food allergy. We're using things like antibiotics more. So, antibiotics are great for an infection, they're great. For a maybe-not infection, they're not so good and they have an impact on us.
When our immune system sees a new thing, it's called an antigen. We have allergens, we have antigens. And because of so many synthetic products on the market now, we're seeing more and more antigens. Our immune systems are seeing millions of antigens that we've never ever seen.
So, over the past 50 years to 100 years, our immune systems are seeing these antigens that are completely new to it. So, of course, they're going to respond, they haven't evolved to see these things. So, of course, they're going to respond in some sort of way.
So, I think there's lots of pieces to the puzzle. I don't think there's one single thing that you can point to and be like, “That's it.” Certainly, delayed introduction like we talked about before played a big role in increasing food allergy, but it's not the whole answer.
Elara Hadjipateras:
What about other early life factors such as breastfeeding or birth methods? So, cesarean versus a natural birth or even going through IVF to become pregnant versus spontaneous pregnancy. Does that have any impact?
Gary Soffer:
Maybe. It's not totally clear. The research is still out on it and I'm always careful about how we have these conversations, especially around breastfeeding. Because I think there's two sides to the breastfeeding conversation, which the first side is, yes, we know breastfeeding is great and has plenty of benefits, but we also know that the stress that certain mothers have to undergo to get to that point.
And I think there's also something to be said for the cortisol and the stress hormones that are probably coming through that breast milk having an impact on our immune system as well. So yeah, if you can breastfeed comfortably, that's a great option.
Whether or not it prevents some allergic diseases, it seems like it may help. It seems like it may help specifically with asthma, maybe eczema, maybe environmental allergies. And I don't see an immense amount of data supporting food allergies specifically, but—
Elara Hadjipateras:
And what about women while they're pregnant? So, I'm actually pregnant with my second right now, spoiler alert, in my second trimester. Should I be eating a lot of seafood? Should I be eating a lot of peanut butter? Does that help at all?
Gary Soffer:
Let's talk about the top nine allergens. So, we have peanuts, tree nuts, fish, shellfish, milk, egg, soy, wheat, and sesame. You can tell I've said this before.
Elara Hadjipateras:
Should make a little song.
Gary Soffer:
Specific to introducing allergens, no, it doesn't seem like that makes a difference. And there's arguments one way that maybe avoiding it would help and there's arguments, maybe introducing it would help. There's no clear-cut answer on this.
But what does help, and this is where that integrative medicine world comes in, is these anti-inflammatory diets, these Mediterranean diets. So, the less ultra-processed food that mothers are consuming, the less stress that they're experiencing. Good luck being a pregnant mom with another child and not experiencing stress. But the less stress they're experiencing, all of those pieces do tend to play a role in an outcome.
Diana Weil:
I want to come back to the birth method really quickly, mostly because this is an anxiety of mine but both Elara and I had C-sections. One of the things that I was most upset about, I don't even know if upset, but that I was sad about, about having a C-section, was the impact to his gut microbiome and how that might impact allergies and just his immune system later on.
I know that you mentioned that breastfeeding may or may not help, what do you think about having a vaginal birth versus a C-section?
Gary Soffer:
So, very similarly, there's some data that supports that having a vaginal birth is better in terms of allergic disease. But there's plenty of data that if you need a C-section, you should get a C-section. Everything in medicine is like this risk-benefit ratio, this cost-benefit ratio. And not having a C-section is a far worse outcome if you need one.
And there's interesting studies, we're using vaginal fluid to coat the baby afterwards that are starting to show up and those questions are starting to show up. I'll say this about microbiome because I think it comes up a lot in the integrative medicine conversations.
We know nothing. And there's so many people in the field who deem themselves microbiome experts. We don't even know the snowflake on the tip of the iceberg because we only talk about bacteria. There's so much more going on in the microbiome. We're only learning about mucosal immunity, there's so much going on in mucosal immunity.
So, with the information that we have right now to play the blame game or to say this is going to dramatically impact versus this won't dramatically impact is a dangerous game to play because we just don't have all of the information.
There's so much more involved, so much more going on. I'm fascinated by the microbiome, I think it's really, really interesting. But I'll admit it's way above my pay grade.
Diana Weil:
I do let my dogs lick inside Elio’s mouth.
Elara Hadjipateras:
I was about to go there, Diana. I was like, “Can we talk about like pet allergies?” And me being okay with my child, like literally—he was drinking water from my dog bowl this morning. And my dog's been licking his face since he was two weeks old, the cat sleeps in his crib, my friends think I'm crazy. Is it good? Does it help?
Diana Weil:
We try not to be too clean.
Elara Hadjipateras:
I don’t know if I try.
Gary Soffer:
There we go: the jury's really out on exposure to what we call furred animals. Certainly, if a child is on the trajectory to developing allergic disease, we don't recommend that they introduce new animals into the home.
It seems like in some instances it may be protective, in some instances it may be detrimental, we don't know. So, I tell people if you want pets, just get them before you have a kid, so you don't have to figure out later on that it's going to be a mess.
Ultimately though, get your kids dirty, get them exposed to lots of animals. We know exposure to farm animals especially really does help with some of the atopic trajectory. There have been studies where they take farmers' homes, they take the dust in their homes, and the more prevalent dust that includes things like feces and animal dust, kids have … don't leave feces around your house.
Elara Hadjipateras:
But I don't purposely leave feces around the house, but I do have a little bit of a mouse problem and we come across droppings sometimes.
Gary Soffer:
It's Connecticut, it’s fine. The whole idea is just: Get your kids dirty, get them exposed to the most natural nature-based things possible.
Elara Hadjipateras:
The other thing I'm a big fan of, and you do this too, Diana, is my son does not wear shoes. I mean, at this point, it's kind of becoming a problem because he's starting to walk and just rips socks off and shoes off at all times, and his feet are getting chafed and callused.
But yeah, I've always thought it's really good that he has exposure to all different surfaces for sensory reasons to immunization reasons. So, you agree bare feet it's a good thing?
Gary Soffer:
Bare feet are great. The thing that I hate most is hand sanitizers. Listen, it's appropriate in certain settings. Certainly, in a medical clinic it's appropriate. But these parents who walk around with like Purell (I probably shouldn't say Purell because it's a product), but who walk around with hand sanitizers all the time, cleaning off their kids' hands are doing more bad than good.
Diana Weil:
I feel really validated right now.
Elara Hadjipateras:
I cannot wait for my husband to listen to this podcast because he's a germophobe who has sprayed my son's few toys with … hand sanitizer. (We won't say the company.) And I'm like, “I don't know if that's great.”
Gary Soffer:
No, it's not. Listen, integrative medicine is all about taking the things that kept people well for thousands of years and integrating it in now. So, to suggest that dirt is a bad thing after we thrived in those environments and yeah, I mean we had higher death rates, but overall, our baseline health chronically was probably a little bit better.
Soil is great. So, I'll tell you about a really cool study. So, they took a group of Amish folks and they took a group of Hutterite folks and they compared them. Amish and Hutterite actually are very genetically similar. They both come from the same regions in Europe. They came here and they also are very insular. They marry in their own, so they haven't changed much genetically over time.
Hutterite actually practice industrial agriculture. They have huge farms. The farms are far away from their homes. They have the big machines; they have the big animal lots and everything. The Amish are sort of what we view as Amish in our mind. The farms are on their home, they're using a hand plough, the horses are next to the home, the cows are next to the home.
Amish have an incredibly low rate of allergic disease. Hutterite actually have a pretty high rate of allergic disease. And so, the question is why? So, what did they do? This is the house dust that I was talking about, that I was referring to before.
They took the house dust, they collected it, and they found in the Amish homes there was this plethora, this richness of biodiversity in the house's dust. In the Hutterite, it was much more sterile. So, that's great, that's really cool information. Then they took that house dust and they applied it to mice who are at higher risk for developing asthma.
So, they did this mouse study where they … not your mice in your home, I hope your mice don't have asthma.
Elara Hadjipateras:
No, I don't think so.
Gary Soffer:
They did it in a lab and they applied that dust to mice who are genetically predisposed to have asthma. And the Amish mice were much more protected than the Hutterite mice were. They went on to develop fewer symptoms of asthma than the Hutterite mice. So, that tells us something really important, which is getting dirty is probably helpful for us.
Elara Hadjipateras:
I wonder at what age should you be getting dirty and for how long? Do you have any kind of insight on that?
Gary Soffer:
I don't think there's a clear line, but our immune system is really developing early, so that's why we talk about early introduction of food allergens. We start seeing eczema pretty early in the first few months of life. So, I wouldn't bathe your kid in dirt immediately after they come out of the womb.
But I think exposing them, put it this way: there's a greater detriment in exposing them to immense amounts of sanitizers early on than there is a detriment to exposing them to an immense amount of soil early on. Obviously, neither needs to be immense but that's sort of the view I take.
Diana Weil:
I like this. It just makes me feel like I'm doing great so far.
Gary Soffer:
Of course, you're doing great.
Elara Hadjipateras:
You’re doing great. This is also like—this is feeding my argument to get chickens outside to my husband. So, I'm like, yeah.
Gary Soffer:
Get chickens.
Elara Hadjipateras:
Yeah, get the chicken.
Gary Soffer:
Chickens are great.
Elara Hadjipateras:
Get the Rhode Island reds to eat the ticks. So, this kind of brings up another question in my mind. So, my husband is lactose intolerant, and he wasn't so lactose intolerant when he was younger and was, I guess, eating more cheese and having more milk.
And then in his high school years and college years, he just wasn't consuming that much dairy and kind of feels like it's something that developed in his early 20s. So, lactose intolerance, is that something that when it comes to being an allergen that you can control based on exposure and can you lose it if you kind of don't have dairy for a year?
Gary Soffer:
So, lactose intolerance and food allergies are two different things. And they often get confused, so we should go over what it is. So, there's a difference between an allergy and a sensitivity or an intolerance.
So, an allergy is a very specific part of our immune system. These are the kids that can have the life-threatening reactions. These are the kids, to Jon's point earlier, that have to walk around with the EpiPens to protect themselves.
Then we have intolerances. So, these are non-life-threatening food reactions. These are things that make us uncomfortable or sensitive. And things that fall into this category are lactose intolerance, celiac disease—celiac is more of an immune process but it doesn't fall into that food allergy category—and then you can include things like gluten sensitivities and other pieces.
Lactose intolerance is—so in our gut, we have enzymes that break down food. Lactose intolerance is because the lactose sugar isn't getting broken down properly. And what that causes is gas and bloating and large bowel movements and all the other good stuff that come with lactose intolerance.
You can develop it later on in life. Oftentimes, a virus can trigger it because it can impact your microbiome. It can impact your gut, but we do see it develop later on in life. One thing that I always talk about, because this is my lived experience and this gets to the food system in general: it's not always the food.
We did really well on milk and wheat for thousands of years. These are things that were integral parts of our diets, so why now? Why is this stuff showing up? And I think a lot of it probably has to do with how we're processing our foods. And so, there's even data in the world of allergy that's starting to shine a light on this and starting to point at this.
So, what are we doing with our milk? We're not getting it directly from the cow anymore. And I'm not a proponent of raw milk, but there's a space in between raw milk and super ultra-processed milk that uses detergent to homogenize it, that uses antibiotics in the cows to break down everything.
And what I found—and this is my lived experience—is there's science emerging on it, so I want to be sensitive that it's not necessarily evidence-based medicine. But, I mean, so when my first one was born, I was—you know, some people might call it crazy, I might call it careful—but I was pretty careful about the milk he was getting, I didn't want him to get just any milk.
And we were living in the city at the time, so I went down to the Union Square Farmer's Market. To their great annoyance, I had 30-minute conversations with every dairy farmer at the Union Square Farmer's Market. And I found a milk that sort of met my criteria, that fit for us. And so, I also have lactose intolerance but I also like torturing myself sometimes.
So, I had a bowl of cereal from that milk one night, and nothing happened! And then I had a second bowl of cereal and nothing happened. And so, a couple of days later, I went back to the farmer's market to get the weekly supply of his milk.
And I said to the farmer, I was like, “I have to tell you, this is the first time I haven't had a reaction to milk.” So, the farmer started laughing at me, and I said to him, “This isn't the first time you've heard this, is it?” And he just looks at me straight in the eye and he goes, “Buddy, this isn't the first time—I heard it this morning.”
Diana Weil:
Oh my gosh.
Gary Soffer:
Daphne Miller, who's another integrative physician who I really, really love, who does a lot of work talking about soil and agriculture, talks about this in her book. It was her lived experience too. So, I think there's something to how we're processing the dairy and how we're processing the milk that may actually be contributing to the sensitivity and not the milk itself.
Diana Weil:
So, my dad's a big proponent of not introducing dairy, too. He recommended that I don't have any dairy products before Elio is two. And I'm not doing that because I think I like yogurt, I think it's good for the microbiome, I feel like cheese is a good protein source, it's also just like a really easy soft food for children, and it seems like maybe that's been debunked, that early dairy contributes to eczema and things. What's your take on that?
Gary Soffer:
You're really putting me on the spot because your dad is on my top five of humans I admire. I think he's wrong in this. I think, again, dairy has been an integral part of our diet for thousands of years. I don't think it's the dairy, I think it's how we're processing the dairy.
Diana Weil:
I won't tell him.
Gary Soffer:
You can tell him, I'm happy.
Elara Hadjipateras:
Gary, you got to tell me where you get your milk from in Connecticut. I got to know your hookup.
Jon Gay:
Diana, is your dad against the dairy just because it doesn't play well with matcha in a latte?
Elara Hadjipateras:
I think he's a little lactose intolerant, isn't he, or no?
Diana Weil:
Yeah, he does tend to say like anything that doesn't work for him, sometimes he can be—but I also think that maybe 20 years ago, the thought was that there was a big connection between dairy and eczema. And it just seems like some of the science has changed its opinion.
Gary Soffer:
So, let me go through that science because it's really important and that people who are listening understand this. So, what do we know about dairy and eczema? Kids with milk allergy and eczema are related because it's all part of the same immune system.
But a couple of really important points. First of all, no study—and there have been several—no study has ever shown that the elimination of milk improves eczema, so that's first and foremost. But what studies have shown is that with eliminating milk, you put the child at a higher risk for developing a food allergy. So, about 20% of those kids who eliminate milk will develop a food allergy.
So, I had a kid come into my clinic a few months ago who the pediatrician told two months prior—this was an eight-month-old—two months prior to eliminate dairy for eczema. And I was like, “No, we're going to reintroduce it,” and the kid reacted in my clinic. It only took two months for that real food allergy to develop.
So, there's an important understanding of how food allergy works because when you see the testing, we're only testing for one piece. So, food allergy, and allergy in general, is two pieces. You have this allergy piece and so if you've gone to an allergist, you've gotten skin prick testing or maybe they've done IgE food testing.
But then there's this huge piece of our immune system called tolerance, like our ability to eat the food, and they're constantly in balance with each other. You could send peanut butter testing, peanut IgE testing on me today, and I might have a peanut IgE of 30. Doesn't matter, I eat the food because my tolerance is functioning.
When we send—kids with eczema tend to have a higher risk of having that IgE or that testing higher, but they also have some tolerance going. What builds tolerance, and this is the other important piece of early food introduction, is not just introducing it, but sustaining it.
What builds tolerance is sustained introduction. So when we remove that, we allow that IgE and that allergy piece to win. And that's why we see these kids go on to develop allergies. It's also why early introduction is so important because we're building that tolerance even though they may have some IgE developing.
Elara Hadjipateras:
So, is there anything kids can do that are a little bit older? Let's say they're eight, they're nine years old already, they've developed an allergy to the point where it's pretty life-threatening. They've had a couple of exposures, they've experienced anaphylactic shock. What can they do?
I personally had a very severe bee allergy as a kid and I went through immunization therapy where I'd go to the hospital. Every week they'd inject me with venom, they would just have me sit there, I'd drink hot chocolate, they'd come back, they'd measure the size of the welts, and it goes over the course of what seemed like one or two years. Eventually, it went down to being very minimal. So, is that kind of the only option?
Gary Soffer:
So, immunotherapy is an approach in food allergy. So, it’s a pretty broad topic. Immunotherapy is something that we've used for a very long time to treat environmental allergies and venom allergies.
One of the big differences between immunotherapy for food versus venom and environmental allergies is you can stop the venom and you can stop the environmental allergies because you've built up that tolerance, you can see it.
With food immunotherapy, it seems—and we're very early in the research—it seems that it's a lifelong commitment. It also seems that you won't be able to freely eat the food. So, immunotherapy, the goal is to build that tolerance and push down that IgE level.
Gary Soffer:
And we have different types of immunotherapy with food allergy. The first type, and there's one FDA-approved product for peanut, is food immunotherapy. It's called oral immunotherapy.
And then the things that are being researched right now include an epicutaneous immunotherapy patch, and sublingual immunotherapy. But these are huge, huge, huge commitments from families. So, the expectation is that essentially you eat the food every day for the rest of your life.
You will not be able to consume the food freely; it will simply give you that “bite safe” protection—that if you were to accidentally consume it, you wouldn’t have that reaction. Now I don’t practice oral immunotherapy, probably because of my integrative medicine background, because I find it very, very invasive for families. It’s a huge, huge commitment.
And it’s not to say that I haven’t seen it be effective for certain families—I have—but those families, often when we were talking about the parents' experience before, and this is what the research shows, it often benefits the parents even more than it does the child or the patient.
And I think we have better ways of making parents have a different lived experience than committing to such a big medical intervention. So, the way it works with oral immunotherapy is you take a dose, an increasing dose over about a period of a year, until you get to a maintenance dose. You take that maintenance dose every day for the rest of your life.
There are side effects. So, lots of kids have allergic reactions on the immunotherapy—twice as many, in fact, as the ones who are avoiding the food. Lots of kids have gastrointestinal symptoms, so about 60% of them will develop some sort of gastrointestinal symptoms, and then some of them will even go on to develop something called eosinophilic esophagitis.
Jon Gay:
Gary, what is that condition you just described?
Gary Soffer:
Eosinophilic—sorry—
Elara Hadjipateras:
Say it three times.
Gary Soffer:
I can say it a hundred times because I have. So, eosinophilic esophagitis is another type of food allergy that is different from an IgE reaction. These cells, which are allergic cells, infiltrate the esophagus, and it can be a food-sensitive process.
It’s something we’re still learning about. It’s chronic; it’s not an acute situation like a traditional food allergy might present itself. But it is an allergic inflammation of the esophagus. It’s actually not directed by the eosinophils, if anybody actually cares, but it is another type of food allergy that we call a non-IgE mediated food allergy.
Diana Weil:
Gary, I know that you could probably talk about this for hours, and I’m slipping it in towards the end of our conversation, which I feel sad about, but I think it’s really important. Can you tell us why you don’t recommend allergy testing?
Gary Soffer:
So, I do recommend allergy testing if there’s a history of a clinical reaction.
Diana Weil:
Okay. And so, if there’s not a history of a clinical reaction, why do you not recommend it?
Elara Hadjipateras:
But what is a clinical reaction, also, first?
Gary Soffer:
Sure. So, let’s go through all of it. Let’s go through what allergy testing is, first of all. So, allergy testing can happen—we’ll talk about food allergy testing. Is that okay?
Diana Weil:
Yeah, food allergy testing.
Gary Soffer:
So, food allergy testing can happen in one of two ways. And oftentimes we use both. You can use skin pricks, which are these little pricks that sort of go right below the skin level, and we can measure how big the wheal is, how big the hive is, and that gives us an idea of how allergic somebody might be.
And then you can measure IgE—immunoglobulin E. Everybody knows what an antibody is. So, immunoglobulin and antibody are the same thing. And there are different types of antibodies; the main antibody in allergy is IgE Epsilon.
And so, you can measure both of those, and those give you some sort of idea, but they only give you an idea if there’s a history of a clinical reaction. In fact, without a history of a clinical reaction, they’re about as good as a coin flip. So, what’s a clinical reaction?
A clinical reaction is when you see objective signs of allergy. So, hives, wheezing, vomiting—all within that 15- to 30-minute onset that we talked about. That’s a clinical reaction.
Gary Soffer:
So, I have lots of kids who show up to me, and these are kids who have had positive testing, but again, we’re not measuring that tolerance thing that we talked about before.
I had one kid who showed up to me a year or two ago with eight food allergies because somebody did testing without a history of a clinical reaction. He was positive to all eight foods, but we challenged him. And challenging is the real test for food allergy.
All testing does is confirm whether or not that clinical reaction was due to a food allergy. The only way to truly confirm that somebody has a food allergy is you feed them the food.
So, we had this kid come in—eight food allergies, never had eaten any of the foods, but somebody tested him and told him he is allergic. One of my proudest patients because that kid doesn’t carry an EpiPen anymore, he’s not allergic to anything.
So, there’s a real danger in sending this testing, especially when it’s sent by people who don’t know how to interpret it, and especially when people don’t have the resources to then go do the challenge.
My goal when I send the testing—my mindset, my lens—is never to diagnose a food allergy; it’s to rule out a food allergy. Because my goal is always to bring kids back to my clinic and do food challenges.
Diana Weil:
And you’ve seen real-world consequences of people being—I mean, obviously, this kid had been avoiding all of these eight allergens and doesn’t … I remember your lecture, you were saying something about the increased rate of eating disorders because of this. Is that right?
Gary Soffer:
Yeah. I just want to make one additional point, which is, again, if you’re not sustaining that introduction, even if that kid had a tolerance when the IgE levels or the skin testing was positive, they can lose that.
So, I can’t tell you how many kids have come into my clinic who have small positives. I could have challenged those kids and they probably could have passed who now, six, seven years later, because they’ve been avoiding it, are now truly allergic. They’ve grown into their food allergy.
We don’t think about food allergy as a chronic disease, and we really, really should, because there are long-term implications. So, we know quality of life in kids with food allergy is on par or maybe even worse than kids with things like lupus or juvenile arthritis.
And if you think about Maslow’s hierarchy of needs, food allergy hits all of them, except for maybe self-actualization. Food is at the baseline of Maslow’s hierarchy of needs, but then community and feeling safe and all of those pieces.
I mean, how many kids—and I’m not a proponent of this, I don’t agree with this—but how many kids are forced to sit at peanut-free, tree nut-free tables? And so, when we force these kids to avoid foods, we do see higher rates of eating disorders because we’re changing their relationship with food early on.
And listen, it happens with kids with food allergies, with true food allergies, and we try to mitigate it by setting realistic expectations and being compassionate and kind and creating a normal life for them.
But the more foods you’re avoiding, the more food is going to become a part of your entire narrative. And so, it makes sense why we see increased food disorders like avoidant restrictive food intake disorders and stuff like that.
Diana Weil:
Yeah. I mean, it breaks my heart for the kids who didn’t have to grow up with an allergy and now have very real allergies because they were inaccurately told something.
Gary Soffer:
It’s devastating to me. All of my ancillary staff can testify to how many times I’ve raged about this when I see these kids coming in with food panels. Like, no pediatrician should ever send a food panel, period. You should never allow your pediatrician to send a food panel, you should never advocate for your pediatrician to send a food panel, it only does more harm than good.
Jon Gay:
I’ll share this podcast with everybody I know. And the eating disorder thing is a really good point too, because you think about how that will warp somebody’s perception of food, if they are avoiding something like the plague that they don’t need to avoid and they could have just lived life without that headache over them or that hanging over them.
Gary Soffer:
It’s unlike any other chronic disease because food is an essential need. It just shows up in every aspect of their day-to-day lives. And so, for somebody to tell you that it’s dangerous, it’s transformative in many ways.
Elara Hadjipateras:
So, you said you had the patient you worked with that at eight months old, came in positive for all eight allergies, your biggest success.
Gary Soffer:
No, that kid was like 10. He was 10 years old. So, he got lucky.
Elara Hadjipateras:
He was 10 years old, wow.
Gary Soffer:
He got lucky.
Elara Hadjipateras:
Because I was going to say at what age, what is that the threshold which you can maybe fix, undo what you did as a parent if you were too restrictive when they were younger?
Gary Soffer:
It’s unclear what that window is; we don’t know. The earlier, the better, that’s the short answer.
Diana Weil:
We have two questions that we always end our podcast on, but before we get there, I feel like we can't leave it on the … I'm so glad that we went over it. But I'm curious, what's your favorite food to feed to your children? Or do you have a parent hack for sneaking in textures and strong flavors and vegetables?
Gary Soffer:
I mean, my favorite food is diversity. There's no one favorite food. I like getting fermented food in their diet early because it develops a taste for them probably. But beyond that, we know more and more that the more diverse food you're eating, the better.
Let them pick, let them play with it, let them choose. Take them to the farmer's market, let them decide, and if all they want to eat is cauliflower, let them only eat cauliflower because they're eating cauliflower, and then they're going to move on to asparagus and eat tons of asparagus.
Diana Weil:
I love that. I hope that that's the case.
Elara Hadjipateras:
I hope so. Well, right now our philosophy is we just kind of give him a little bit of whatever we're eating. And I know that goes against some beliefs I've read as far as when you do food introductions, you want to do one thing at a time, you want it to be very bland, and I guess we did do that a bit when we were first feeding him four to six months.
But now at this point, my son's a year old, he's just kind of eating whatever we're eating. Of course, we're trying to avoid the things that are loaded with salt and loaded with sugar on a regular basis. But would you say that that's a good thing? I would say that he does have a good palate when it comes to spicy foods, which I'm very proud of.
Gary Soffer:
That's awesome. My kids don't. I think that's great; I think that's awesome. We want to be intentional about getting these allergens in, but we also don't want to run the risk of over-medicalizing everything, which we tend to do as parents too.
There's so much on social media about what to do and how to be the best parent that it just becomes overwhelming. And then you start creating these checklists, and what worked for people thousands of years is just eating what the family's eating.
Diana Weil:
Yeah, that makes sense. Well, Gary, I feel very lucky that I can DM you after our podcast because I still have many questions for you. But before we wrap up, we always like to end with two questions. And these we did not prep you for so if you need to take a moment to think about it, we can pause.
Gary Soffer:
It’s got to be on the fly because I got to run to this next meeting anyway, so it’s—
Diana Weil:
So, our first question is, what is something like a mantra or a quote, what's something that you are living by right now? Is there anything that is sort of fueling you or life advice that you're following?
Gary Soffer:
I think the thing that always fuels me is service, and it's what I try to instill in my kids. It's the thing that's enriched my life the most, being in service to my community, being in service to the people around me.
There's an Indian guru by the name of Neem Karoli Baba. He was the teacher of people like Ram Dass and Krishna Das and Steve Jobs, in fact. And somebody asked him how to seek enlightenment, and he said, “Feed people.”
And so, I think that certainly has parallels to food allergy as well as integrative medicine. And so, that's the thing that drives me the most and where I find the most fulfillment. It's not to say I don't have plenty of ego in all of this and have my own needs and wishes and wants, but that's always the lens that I try to live my life by.
Elara Hadjipateras:
Just something that comes to mind right now—a lesson that you've had to learn the hard way.
Gary Soffer:
All of them. I mean, the greatest things in my life have come from those lessons. When the universe decides for me—whether it was the music business, which I thought was my dream job not working out, whether it was thinking I was going to be a surgeon and that not working out. My greatest failures have always led to the best things in my life, and I'm eternally grateful for all of them. It's hard to remember that in the moment, but that's the truth of it.
Elara Hadjipateras:
Those are the transformative moments. That definitely speaks to myself and Diana right now with our young children where at times it kind of feels like you're underwater, but at the same time, I feel more alive than I have been in the last 10 years, so very grateful for it.
Gary Soffer:
Totally, totally, totally. It's crazy and overwhelming and exhausting and drowning, and then you have these moments of like, “There is so much love inside of me and I didn't know it was there,” you know?
(Laughter)
Diana Weil:
Well, Gary, this has been amazing. Thank you so much for joining us. Do you want to list anything like where people can find you, or do you want to skip that?
Gary Soffer:
I'm on Instagram, Gary Soffer MD. It’s a perpetual life of me trying to be active on social media and not wanting to.
Diana Weil:
I feel that really deeply in my soul.
(Laughter)
Gary Soffer:
But I'm there and I could always use more followers.
Diana Weil:
Well, thank you so much, and yeah, I very selfishly want to bring you back, so definitely (laughs).
Gary Soffer:
That sounds great, sounds great. Bye everybody.
Elara Hadjipateras:
Bye.
[Music Playing]
Voiceover:
Sip, savor, and live well with new episodes of The Matcha Guardians every Wednesday. Follow our show for free on Apple, Spotify, YouTube, or wherever you're listening right now. Leave your questions and comments below. Find us on Instagram at The Matcha Guardians or click on matcha.com.