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Practical Interventions for Allergy and Atopy with Nicole Bijlsma

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Practical Interventions for Allergy and Atopy with Nicole Bijlsma

Does living in a 'westernised' country put you at greater risk for allergy and atopy?

The science and statistics are saying yes. The major drivers for allergy and atopy are multifactorial and complex but indeed, almost all circumstances relate back to modernisation and the industrial revolution. Society's obsession with sterilisation and being 'germ-free' has put us at risk.

Now, in Australia, 25% of the population can be expected to be diagnosed with allergy at some point in their life.

Today we welcome back Nicole Bijlsma, author of Healthy Homes; Healthy Families and leading environmental health expert who takes us through these varied risks and how we can intervene in practical ways to minimise the incidence of allergy and atopy in our modern lives. 

Covered in this episode

[00:35] Welcoming back Nicole Bijlsma
[01:50] Incidence and prevalence of allergies
[03:05] Why are we becoming more atopic?
[05:00] Common culprits in increasing risk of allergy and atopy
[05:45] The hygiene hypothesis
[10:20] The role of diet in allergy and atopy
[10:50] Influence of microwaving food on microbial content
[13:35] Addressing allergies in schools
[16:12] Allergenic foods early in life
[19:08] Allergens in the home environment
[24:56] Tips on purchasing mattress covers
[27:48] Choosing the right vacuum cleaner
[29:10] Water filter need, benefits and making the correct choices
[30:11] Benefits of getting dirty
[30:34] Lifestyle interventions and naturopathic support
[37:25] Increasing microbial diversity
[39:57] Heavy metal load in relation to allergic potential

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today from Melbourne is Nicole Bijlsma, a woman of passion, and her passion lies in environmental medicine. As a result of her own infertility issues — that's 10 miscarriages, my god — and noticing a strong connection between many of her patient illnesses and their home, Nicole established the Building Biology industry in Australia, and in 1999, founded the Australian College of Environmental Studies to educate people about the health hazards in the built environment. 
Nicole is an accomplished naturopath, an acupuncturist of over 15 years, and has trained over 2,000 naturopaths at various institutions. You are regularly consulted by the media to discuss electromagnetic fields, mold, toxic chemicals. Nicole, you also lecture extensively throughout Australia and abroad, educating integrative GPs and about environmental health issues. 
So, Nicole has got three young children and is currently doing her PhD on Environmental Chemical Assessment. Nicole has also just finished the chapter of a textbook "Advanced Clinical Naturopathic Medicine" in its third edition, the chapter on Environmental Medicine. You are a busy lady, Nicole. Welcome to FX Medicine. 
Nicole: Yes. Thank you so much for inviting me back. 
Andrew: Our pleasure. Now, today, we're going to be talking about the allergy epidemic. So, I think the first question is, why? What's happening with allergy? 
Nicole: That's a great question. I mean, you know, when I grew up in the 1970s, peanut-free schools were unheard of. 
Andrew: Yes. 
Nicole: Now, every parent is briefed about food allergens before their child goes to school because there will be children who will have a serious anaphylactic response to peanuts and other types of food allergy. So, the past three decades, we've seen a dramatic increase in the prevalence of allergic diseases like asthma, atopic eczema, hay fever, and food allergies in western populations with marked differences in prevalence observed in populations despite similar genetic background, suggesting that the environment is primarily involved. 
Now, if you look at the stats, we know about 241 million people suffer from asthma worldwide. Nearly a thousand people worldwide die from it. We know eczema affects up to 20% of children. And Australia is leading the allergy epidemics because 25% of our population will be diagnosed with an allergy at some point in their life. We know 20% of adults will have hay fever, 10% will have asthma, and 25% of children will have asthma, and 10% will have food allergies and eczema. So, it's enormous.  
Andrew: So, we're leading on there, obviously, from the propensity to allergy, and that is atopy. Why are we becoming more atopic? 
Nicole: Well, the increase in allergy since the '90s has coincided with an increasing childhood food allergies to cow's milk, eggs, nuts, and wheat. And we're starting to suspect that it's a mixture of different things sort of, like, an increase in caesarian births, which means that children’s gut  microbiome is skewed towards looking more like the skin from the mother rather than what comes through the vagina. We know breastfeeding is really important as a prebiotic, for the gut microbiome for the infant. We know that the use of chemical cleaners, which is far more common in western countries, is affecting the bacterial diversity within the home. 
And in fact, there was a really important study published last year, looking at why the Amish children have very low rates of asthma and allergies compared to the Hutterites, which have an identical lifestyle to the Amish. The differences between the two communities is that one has industrialised farming techniques. The Hutterites use pesticides in their farming. They have cars and other things like that. And the diversity of bacteria and the endotoxins in their homes is significantly less in Hutterites who have high levels of asthma and allergies. 
So, what they're starting to look at is the whole area of the home microbiome and its influence on allergies. And what we're seeing is that the more diverse the bacteria in the household dust and the more endotoxins these bacteria create, the lower the risk of asthma and allergies especially in the first year of life. 
Now, other things that affect it are things like having pets. If you have a pet while you're pregnant and in the first year of that child's life, the incidence of allergies and asthma is lower because the pet has its own microbiome, which its shedding when it's in the home. Now, we know humans are one of the major sources of this spectral diversity in the home. We shared between 14 and 37 million bacterial genome copies every single hour into the air. So, this explains why people who have large families and older siblings, that the children who are born into these families have a significantly low risk of asthma and allergies. 
Andrew: I wrote a story, if you like, a page, and it was something I read. I think it was either The Scientist or Scientific American about microbial clouds. And the story was basically slanted towards a potential use for even forensics, but the big message was that we are shedding these bacteria into the air and sharing them. So, if we're doing that, to me, it must obviously have something to do with the microbes from soil and animals because people in urban environments, you'd expect, would have less allergies if they're sharing all of these bacteria amongst themselves to dampen an atopic preponderance to allergy, so to dampen the atopy down a little bit. Would that be correct? Is it really this hygiene hypothesis that the — what do you call it — the old friends hypothesis, where it's these bugs that live in the soil and on the animals and in the farm that we need to be exposed to that we're just not getting exposed to nowadays. 
Nicole: This is what it's leaning towards. So, in 1989, David Strachan proposed the hygiene hypothesis, which suggested that the lack of infections early on in childhood predisposed children to allergies later in life. Now, we know the reduction in infections is attributed to improvements in public hygiene like chlorinated drinking water, which is interesting because, of course, chlorination kills bacteria, and what does it do when you drink it? Well, you know, this could be a part of it. I don't know. There's no research that I can see on this. And we know better sewage management, etc. But the use of antibacterial chemicals in the home, what a disaster. It's like antibiotics… 
Andrew: Ahh, yes, the Detol generation. 
Nicole: Yeah. So, we know the immune system, which wants to be busy all the time, turns its attention to otherwise harmless antigens because it's just not being challenged. Now, whilst the validity of the hygiene hypothesis is still being debated among scientists, it's interesting to note that the progressive shift to western lifestyle in the Middle Eastern countries and Asia also correlates to an increase and the prevalence of allergic diseases. 
The next hypothesis that has emerged in 2005 by Noverr and Huffnagle has recently emerged to explain the role of the gut microbiome in the prevention of allergic disease, because we know the gut microbiome is important to program immune responses early in life. So, we know these digestive bacteria have a really important role, and that emerging evidence suggest a really strong correlation between the composition and function of the gut microbiome, and the incidence of allergies and asthma as reduced diversity in the gut microbiome of infants is associated with an increased risk of allergy. 
Andrew: Nicole, can I just go back to the hygiene hypothesis? I understand there's still debate. You know, basically, it was this holy grail. You know, we finally understand why it's happening. And there was the work of…I can't remember his first name, but Dunstan at…I think it was Sydney Uni, 2006, was it 2003, where he teased apart the Th1 Th2. And we thought that was it. It's nice and simple. It's a swing. Forgive me. It's a seesaw. One's up, the other one's down. So, there you go. It's all done and dusted. 
But it wasn't long after that that a new machine that goes "bing" became available where they could tease out a lot more of these Th…sorry, these cytokine influencers on T helper cells. And what they found is that it's not a seesaw. It swings and roundabouts and merry-go-rounds. There's comorbidity. There's cycling, quick cycling between the two. So, that's where this sort of old friends theory became a more acceptable thing, but what I saw in some studies is that they were debating where the farming practices did have an effect on reducing allergies and atopy. I wonder whether they didn't look at the use of pesticides and things that were knocking out the bugs. 
Nicole: This is really interesting because if you look at the rise in allergies, it correlates with the changes in farming practices in the '50s and '60s because most pesticides are antibacterial. Many of these pesticides are used as preservatives in personal care products, some in food. So, you know, I really suspect this is playing a huge role in the potential development of allergies later on in life. 
Andrew: Yeah. 
Nicole: Now, we know the western diet, of course, is also implicated because high omega-6 oils, saturated fat, sugar, starches, low fiber. Fiber is critical because this is what the microbiome in the gut relies on in order to create these short-chain fatty acids. 
Andrew: Yup. 
Nicole: So, it's really important that…you know, the diet plays a very important role. Well, of course, we know probiotics and prebiotics, and pickled and fermented foods, and indigestible plant-based fibers are really important. And this is certainly why we can't just look at the external environment. We have to look at the diet as well. 
Another interesting thing that I find is that when you cook food in a microwave oven, it kills microbes because microwave oven sterilizes food. So, you know, if you look at the introduction of the microwave oven, what impact does it have when you microwave the food and kill off all the bacteria in food? Because an important Japanese study was published a couple years ago that showed that bacteria naturally found on the seaweed, in nori, transfer their genes to an individual's gut bacteria so they can produce enzymes to release beneficial nutrients. So, the bacteria in food help confer these genes to help our gut bacteria digest food. When you microwave food, and if you give microwaved bottled milk to an infant whose sole form of nutrition in the first six months is bottled infant formula or nuked breast milk, I mean, what impact does that have on the gut microbiome? 
Andrew: So, is that any different, though, from oven-cooking of food? 
Nicole: Very different. 
Andrew: Really? 
Nicole: Very different. Yes. Absolutely. 
Andrew: Ah. 
Nicole: Very different. 
Andrew: I didn't know that. 
Nicole: So, microwave cooking uses microwave or radio frequency, and they're very different because it heats moisture or the water molecules within the food. 
Andrew: So, has that been demonstrated with regards to bacterial content of food with microwave heating versus oven-cooking? 
Nicole: I haven't seen any research on this, but what I do think is interesting is that, you know, when you want to sterilise anything, you put it in a microwave oven because it kills life. I mean, we use microwaves in labs and things like that to do that. So, I think…  
Andrew: That's really interesting. 
Nicole: …it's a really important issue that needs more research. 
Andrew: You know what? I'm also interested in…you know, you mentioned enzymes and, you know, if we were comparing sources of milk for an infant, one of the key things apart from the actual living microbes which are being transferred into the infant from the mother is that the mother's breastmilk has enzymes intact, functional enzymes which are now being given to the baby, whereas they do not exist in any formula at all. And I just think, what else are we missing out on that we think “oh we're being really healthy”? I really question that, you know? 
Nicole: Absolutely. 
Andrew: And notwithstanding that there are some mothers who just simply cannot or choose not to breastfeed their infants. I'm a bit of a proponent of, "Please, can you just give the first two weeks the colostrum?" you know, some immune factors. But I get that, you know, some women just simply can't breastfeed and they shouldn't be made to feel guilty about that if they simply can't. 

So, moving on from this, I guess we need to really investigate here. What do we do? One of my issues is this. I get that allergies, serious allergies are much more of an issue in school, as you said, now, you know, in today's society than previously, even a decade ago. And I totally agree with you. Now, my wife works in a school and, you know, they're seeing in the classes that the teachers are now asking, or I should say, the school is asking, you know, can these children please not bring things like peanuts. Peanuts are one of the big things and certainly other nuts into the school because there is somebody in the class with a peanut allergy. And peanut allergy seems to be the most fulminant of all of the allergies that are experienced. 
Nicole: Yes.  
Andrew: Two things. One, Professor Mimi Tang, her work with immunotherapy. That is…I think it was one two-hundredth of a peanut desensitising. Now, obviously, that's in a controlled medical environment where if a child was struck by anaphylaxis, they could rescue them. So, that's number one. Don't do this at home. 
Number two, though, there was some very interesting work being done on lactobacillus rhamnosus. I do believe it was a Chinese strain, WS…There was some paper that said LGG. So, I'm not sure about this one which strain she used or indeed if that is the same strain. But what I'd be interested to know is, does that gain an even better risk reduction, or sorry I should say, rescue from peanut allergy, i.e. these kids are no longer anaphylactic, or is it just one or the other? You know, was it as good as immunotherapy? I haven't seen that data yet, so it would be interesting to look at. 
But my concern is, if you simply tell everybody to avoid peanuts, what's next? And indeed, is it achievable, because once somebody sometimes sneaks some peanuts in, so you think you're safe and you're really not? You know, I got real concerns about asking kids to change their dietary habits because of one person's issue, horrible as that is. I'm just wondering whether that asking other parents to therefore avoid the same food will have an impact on changing behavior. And therefore, is it a useless request? 
Nicole: Well, the Australian guidelines that came out this year indicated that we got it wrong. You shouldn't be avoiding these foods in the first 12 months of life. In fact, it's really important that the allergenic foods are introduced in the first 12 months of life, including peanut butter, cooked egg, dairy, and wheat products.
Andrew: Really? 
Nicole: Yes. 
Andrew: Wow. 
Nicole: They changed their stance on this, and they said it should be introduced in order to stimulate a healthy immune response. But avoiding it has shown to increase the risk of atopy in children who are susceptible. So, obviously, this should be done not before the age of four months, and this is their guideline saying this, and that breastfeeding should be continued as long as possible for at least six months, introducing a variety of solids, you know, one at a time at around six months or more. 
Andrew: Yeah. 
Nicole: But allergenic foods should be included in that in the first 12 months of life, and that's the Australian guideline. 
Andrew: Okay. That's really interesting. So, here's my only concern. That would be nice if you were going to avoid all antibiotics and so therefore maintain a normal microbiota. But what do you think the issues are gonna be with what happens with, you know, kids with glue ear and things like that? I know that that's even contentious, but I just hope that the willy-nilly handing out of antibiotics, particularly for things like glue ear, are avoided because of the, you know, incredible concern now about bacterial resistance. And, you know, the data with use of antibiotics in glue ear is…it's actually equivocal. It might help with pain, but does it help resolve an inner eat, sorry a middle ear infection? I don't think it actually sways the recovery from it. So, it'd just be a really interesting thing to monitor. 
Nicole: I mean, there's no doubt about it. Antibiotics in the first year of life can have devastating impact on the gut microbiome which can have long-term health implications. One thing I wanted to mention in relation to food allergies is many of the childhood vaccines contain chick egg embryo and, you know, this can be part of the reason why they're reacting because they're getting minute amounts of these potential allergens if they're genetically susceptible, which could be increasing that development of food allergies later on in life. So, you know, these are…it's coming from different sources as well, and I think we need to look at the adjuvants that are used in vaccines because they could also be potential triggers. I mean, I don't want to go into a vaccine issue here, but you know, aluminum, of course, there are some metals in there that are used particularly to trigger the innate immune response. 
Andrew: Right. 
Nicole: So, I think a big part of this is looking at what children are actually receiving in the first 12 months of life and where the triggers could actually be. 
But in the house, there are many things in the house that can trigger allergies that you can significantly reduce people's exposure to, that we know people are going to react to. One of the most common allergies in the world is to house dust mites. It affects almost 22% of the world's population as opposed to grass pollens, which is about 17%, and pet dander about 9%. 
So, most of these allergens that we know trigger asthma, and hay fever, and skin related issues like eczema, you know, are things that are directly in the home. 
Andrew: I remember years ago, I used to travel from Sydney up at the Northern Rivers. And each country town would profess that they have the highest dust mite concentration, basically. It was clearly quite funny that when I looked at the National Asthma Campaign, that was years ago, decades ago, it was Grafton that had one of the highest concentrations. And the proposed theory was because it got really cold in winter, so people would heat their houses. Wasn't such an issue the further north you got because they had a warmer climate. So, I'm worried about things like Melbourne. You know, like, I don't know of any data down there. I'm not sure now. But it's a real… Is this still a real issue, like as in a huge issue? 
Nicole: Absolutely. And, you know, I'm shocked looking at all the allergens in the home and go, "Why didn't I learn this as a naturopath?" Like, we know… For example, house dust mites. The humidity is critical to the, you know, house dust mites proliferating because, you know, they are dependent because they can't drink. They don't have eyes and they can't drink. So, they are relying on absorbing moisture from the air. So, when that humidity exceeds 60% relative humidity and the warmth is there, they're just going to be prolific. 
Andrew: Ah. 
Nicole: That's the key. It's the humidity that's the issue, and the warmth because that's what they need. Now, of course, wherever you are, you provide warmth, you provide moisture, and that's why the bedding is really the area where you're gonna have the highest levels compared to any other part or furnishing within the home. So, these things, these dust mites are…you know, you can have up to 500 house dust mites per gram of dust in your home. It could be even more in higher areas. Australia does have one of the highest rates of house dust mites in the world because of our microclimate, and they peak around mid-summer. But we know it's the faecal pellets or the poo that they create, the protein DLP1 in the house dust mite that are causing the allergic reactions in susceptible people. 
So, you know, many of them produce 40 trillion fecal pellets in your mattress every three months, which is why it's so important…good housekeeping like airing your mattress in full sun, you know, at least every season, more if you've got a house dust mite allergy, is really important. Keeping the humidity below 60%. So, in areas in the Central Coast where it's prolific, whole house dehumidifiers can be very good at not just reducing mold because, of course, mold proliferates when you hit 70% or more, but also the house dust mites. So, that's the interesting thing. 
Andrew: That's the interesting… That's really interesting. 
Nicole: Dust mite, mould are really synonymous. And, of course, then you get termites and other pests involved as well, and bacteria and fungi proliferate. 
So, in this environment, you've got multiple allergens, which is why we find between 45% and 55% relative humidity, most allergens would not exist. Most people would not have an allergic response if they were within an environment between 45% and 55% humidity, which is why a whole house dehumidifier for people with allergens living in climates, you know, Central Coast, Northern Queensland, for example, would probably have more benefit doing that than most medications or herbs we could prescribe.

Andrew: Do you know of any data that might be looking at humidity versus arid areas of allergy incidence or prevalence? 
Nicole: Not that come to mind that I've come across, I would suspect that they would…might be available. That's a good question. 
Andrew: I think you'd have to probably, you know, garner it from each area and then put it together on a map. I didn't know that about the humidity issue. 
Nicole: Yeah. 
Andrew: That's really interesting. So, you would expect people in the Northern Rivers to be much higher prevalence of atopy from dust mite than people, say, from Melbourne, where it's a lower…well, does it get humid there? It doesn't really get humid down there. Well, let's say inland. 
Nicole: Yeah. The humidity can be generated from manmade sources, you know. 
Andrew: And closing it, yeah. 
Nicole: Poor ventilation. 
Andrew: Yeah. That's right. 
Nicole: Winter time, you're airing your clothes inside, huge amounts of moisture, liters of moisture. Five liters of moisture comes out from, you know, just one clotheshorse full of wet clothes in a day. So, you know, you want good ventilation. So, of course, you can get artificial forms of humidity generated from manmade activities or poor ventilation or buildings that are not waterproofed or have flood or water damage of some sort. 
Andrew: Yeah. 
Nicole: So, yes, that can be an issue, but definitely, as you go up north, as the humidity increases, especially beyond 60%, you're gonna have a proliferation of these house dust mites, which is why it's critical to address it. So, symptoms of house dust mite allergies are itching watery eyes, sneezing, itching runny, blocked nose, dry persistent cough, wheezing, and dermatitis. The symptoms are worse at night, and upon waking and improved when the sufferers are away from the source.  
Andrew: Yeah. 
Nicole: So, these are generally long-term allergies as opposed to pollen allergies which are generally seasonal. 
Andrew: So, with regards to things like mattress covers, pillow covers, I know you can get them quite readily now. They're a lot cheaper than what they used to be back in my day. Are they worthwhile? or do you find that they just…the dust mites just live now on the outside of that cover? You know, they repopulate the outside. 
Nicole: Yes. Look. Overall, I mean, there is some contention how effective are these dust mite covers. It's all got to do with the micron size and the thread of the cover. So, yes, most people I know who have house dust mite allergies do improve, but the reality is the newer the mattress is, the less house dust mites that are in it. 
Andrew: Yeah. 
Nicole: And that's the reality of it. So, how old the mattress is and how well it is maintained and aired in the sun is critical to the amount of dust mite you're likely be exposed to. And that, I think, also includes pillows and mattresses and doona covers and encasements, which should be made from natural fibers. Silk, being the best because of its thread size… 
Andrew: Silk, huh? 
Nicole: …is core for people with allergies. So, silk is the best material for pillows and for sheets for anyone with allergies, especially asthma and eczema. 
Andrew: Yeah. I guess, from a pragmatic level, particularly things like mattress covers would be worthwhile because, like, you know, let's say somebody who's not necessarily athletic in their prowess, you know, it's quite hard to get a queen-sized bed mattress outside. You know, you can wrangle it, I guess, but for a lot of people, maybe a dust mite cover might be a pragmatic way to at least reduce the count, the exposure to the dust mites because you can easily take that off and wash that and take that outside. 
What about things like vacuum cleaners, though? 
Nicole: Vacuum cleaners are important. Before I move on, the mattress, if you are in a multi-story building or you can't shift the mattress, what I suggest you do is simply get it off the bed and lean it towards the window where the most amount of sun is coming in so it gets sun exposure. 
Andrew: Ah, gotcha. 
Nicole: And that in itself will help to air it. A big part of it is making sure you have slats under the bed that it's not solid under your mattress because your mattress must breathe from underneath, and there's no clutter under the bed as well is important. That mattress needs to breathe. I've had many clients with severe asthma and eczema that eventually came down to an old hand-me-down mattress that had been sitting in their garage for years, contaminated with mold, contaminated with high level of house dust mite, and that was it. And these kids were on antibiotics, you know, six or eight courses a year for eight years, and it came down to their mattress. 
Andrew: Yeah. I've got to say, you know, due to our atopic potential in our household, we made the decision where all carpet is gone. We don't have carpet at all. We tiled. 

Nicole: Then there's no doubt about it. Moving carpet significantly reduces the amount of house dust mites in the home. 
Andrew: Yeah. 
Nicole: Vacuum cleaners, you mentioned, must be fitted with a HEPA filter. And it's the most expensive thing I recommend in my whole book, but the people with allergies, a good vacuum cleaner fitted with a HEPA filter, which will filter all of the allergens because it filters down to 0.3 microns, is absolutely critical. Because if you use a normal vacuum cleaner that's not fitted with a HEPA filter, you will make most of those allergens in the floor became airborne where they're going to expose people to it in their breathing zone. 
Andrew: Yeah. 
Nicole: So, vacuum cleaning is absolutely critical. 
Andrew: Now, here's one of my practical things that I…it's one of my bug-bears about vacuum cleaner design. What about emptying the vacuum cleaner? You've got to sometimes… 
Nicole: Yes. This is… 
Andrew: Do you wear a mask then? Do you advocate the use of masks? 
Nicole: Well, if you’ve got the allergy, you shouldn't be the one emptying the vacuum cleaner. So, it should be done outside. And this is why I only recommend vacuum cleaners that are fitted with a replaceable bag. 
Andrew: Yeah. 
Nicole: Do not use vacuum cleaners that have an open barrel where you have to shake it out and the HEPA filter gets contaminated and you can't really clean it. So, I always suggest…  
Andrew: Very good. 
Nicole: …three things to a vacuum cleaner: HEPA filter, a motorised head if you've got rugs or carpets, and of course, disposable bags. 
Andrew: Yeah. 
Nicole: Absolutely critical. 
Andrew: That's really interesting. That's really good advice. Thank you for that. So, what other things? What about things like, you know, well, dietary. Dietary modification. Can we do anything to reasonably look at controlling allergies? 
Nicole: Well, this is only my hypothesis, but you know, chlorinating the water might be great to prevent the water borne epidemics but what impact does it have on the gut microbiome? So, to me, I think a water filter is really important even if it's just a cheap carbon filter, and I'm not talking about the granular stuff you get from the Kmart and the jug filters because they're next to useless. 
Andrew: Yeah. 
Nicole: You want a solid block carbon filter, the smaller the micron size, the better, to get rid of the chlorine and pesticides because chlorine and pesticides are really strong antibacterials. So, to me, that would be the first thing you would look at in your diet to give your gut microbiome an opportunity to be as healthy as it can be. 
Andrew: And what about Dr Maya Shetreat-Klein's advice? Get dirty. 
Nicole: Yes. Get the kids out in the dirt. Absolutely so important. This is why these farm children have much lower rates of asthma and allergies because they're exposed to a greater diversity. But the research is showing that it has to happen in the first year of life. That's when it seems to be the critical window of development, because after that, once they develop an allergy to pollens or pets, which by the way, can't happen before the age of one because they have to be exposed to these aero allergens and then upon subsequent exposure, that's when they're likely to develop these allergies. 
So, food allergies tend to precede the aero-allergens like house dust mite allergies, pet dander allergies, pollen allergies, etc. So, that's an important and interesting progression, what we call the 'atopic march'.  
Andrew: So, can you reiterate that for me please, Nicole? That's a really important clinical point. 
Nicole: Yes. So, aero-allergens are things that you breathe in — pollens, pet dander, house dust mite, etc. They generally occur from the second or third year of life onwards, and a lot of the time that is preceded by food allergies in children. Not always, but generally, children who have food allergies are likely to, more likely to develop aero-allergen allergy later on in life. 
Ironically, people with allergies are 15 times more susceptible to developing chemical sensitivities as well. So, this is something we need to look at. This is a trigger and for electromagnetic field sensitivities and chemical sensitivities because their immune system's overreacting to toxins in the environment. 
But other things like pet allergens are really important. Ironically, the data's saying that children should be exposed to furry pets in the first 12 months of life to reduce their exposures. But if after that time, they are allergic to cat or dog, then they shouldn't have a cat or dog.  
Andrew: And do you find any type of animal as a worse culprit, if you like, for allergens. Like, for instance, cats are constantly preening themselves. Dogs are more likely to lick you. You know, is there any difference in the allergenic potential of animal danders? You know, cat dander versus dog dander, or is it just luck? 
Nicole: No. Cat dander is more than double the rate of allergies compared to dogs. 
Andrew: Wow. 
Nicole: They produce a protein called Fel d 1 in their sweat glands, which they spread when they lick themselves. The problem with cat fur is that you could find it in almost every school because if someone owns a cat that goes to that institution or building, it will literally contaminate the entire building with the proteins. So, we know cat hair is almost in most homes that have ever been tested it's found there because you only need to have someone who owns a cat, has a bit of fur on their clothes, and then they transfer that protein into the environment that they walk into. 
So, non-pet owners often you'll find cat dander in their homes, classrooms, clothing at work if you don't have pets, all of those things. It's incredibly ubiquitous. 
Andrew: Okay. 
Nicole: Which makes it difficult if you're sensitive to cat allergies because it's… 
Andrew: Absolutely. God. 
Nicole: …everywhere. 
Andrew: Okay. So, treatment. Other sorts of treatment. Like, if you're thinking about active intervention, are there any dietary modifications that you can look at? Are there any nutrients or herbs that you use that are worthwhile? 
Nicole: Well, before I go on to that, I just want to say, there's no such thing as an allergy-free dog or cat. 
Andrew: No. 
Nicole: So, we know that, you know, labradoodles, all that sort of stuff with the shorter hair, it's not the hair. It's the dander. 
Andrew: Yeah. 
Nicole: And the protein on their skin and hair that's causing issue. In terms of what they can do, you know what? The most important thing I learned over years of working as a natural therapist was treat the patient. Look at their symptoms, ask lots of questions to see where the triggering factors are, and support their immune response, support their detoxification pathways, reduce their stress, and build resilience. You know, really, for diet, it comes back to basics. Again, clean water, good food that's preferably low in chemicals, that's not packaged, that's made from scratch from the ground up, that's sourced from local, preferably organic, pesticide-free, or at least, you know, the sort of apples and things that have high pesticide content, is really important and lots of fiber, providing they don't have any, you know, irritable bowel, etc. in order to provide the short-chain fatty acids that the bacteria need to do their job. 
Look at each patient individually, ask lots of questions to see how the environment could be contributing, and you know, go back to basics, because I think the thing that really…if I look back at my training, it was, like, so complicated in terms of pathology, in terms of diagnosis. Everything was focused on diagnosis. And in the end, I just dropped everything. I said, "You know what? I'm going to go back to basics. I'm going to listen to the patient. I'm going to”…and I noticed, wow, visible mould. Every time someone came in with chronic fatigue, it was either pesticide exposure that stimulated the event or visible mould. And I'll go back to clean air, clean water, regular exercise, change in job if you're not passionate about it. Here's some strategies to deal with stress and long and behold it'll be just a better society. 
Andrew: I'm so thankful you mentioned these basic sort of foundational treatments, if you like, rather than going on supplements that are…you know, let's admit that if you don't take the load off, take the allergenic load off that human who is experiencing this condition, you are merely symptom relieving just like an antihistamine would. You're not doing anything to actually change their response. So, you've got to do this foundational stuff, and then potentially add some certain, you know, judicial choices in. 
After all has been said and done, I'm so glad you included in there detox as well. I remember a lady would come in. She'd treat her family, and she saw an integrative doctor. This is, gosh, two decades ago. She used to see an integrative doctor once a year, the same integrative doctor. And they would do their spring cleanse. And the whole family was atopic, and she would come in and do this comprehensive proper detox, not a 15-day cleanse. She would do a comprehensive, well-marked, well, let's say, objectified, well-measured detox. And the whole family would do it, and they'd do it once. And they'd only have to do it once or twice a year. The whole family would then remain, basically, allergenic-free until she'd see symptoms creeping back in her sons. So, they'd do another detox. Twice a year max. 
Nicole: And isn't it interesting? So many religions have fasting as part of their protocol. 
Andrew: Isn't that interesting? 
Nicole: Exactly. 
Andrew: Yeah. So, what else? What about things like…for those of us who don't farm, what can we do to increase microbial diversity? Or is it just once that first year is done, your microbial array is set? 
Nicole: Well, that's a good question that I don't think anyone can answer. But we certainly know…you know, to me, when I look at the Human Microbiome Project and I look at the Sloan Foundation and what they're doing, putting millions into their house microbiome, I go, "Where do we end and our homes begin in the environment?" It's such a gray area now between who we are if we're 90% bacteria and, you know, our food has this interplay exchanging bacteria with us and the environment in which we live. I mean, it's such a gray area now, isn't it? I think we need to…the first thing we need to do is go preservatives, antibiotics, what a disaster that's been for human health. 
Andrew: Yeah. 
Nicole: Because anything that is focused on killing the bacteria, is killing life. So, this is why we need to…simple things like I said. Get rid of the chlorinated water, reduce your pesticide load. Stop putting crap on your skin loaded with preservatives that is killing off the microbiome on the skin. Which by the way, is showing, like, Micrococcus, Pseudomonas and Staphylococcus contain mute and changed chemicals that land on the skin. So, now we're starting to realise these microbiomes can actually, probably be more effective than the liver at detoxifying chemicals. 
Andrew: Right. That's really interesting. 
Nicole: Yeah. So, anything that says “preservative” is designed to kill bacteria. It's designed to kill life. And so, chlorine, again, heavy metals, many of the heavy metals. This is why I find people who have high heavy metals, more chemical sensitivities, more chronic fatigue, more allergy risk. Why? Heavy metals are generally antibacterials.  
Andrew: Okay. So, I have to ask, though. Are we speaking about causation here or correlation? 
Nicole: Well, as a researcher, I'd always say correlation because I'm not allowed to say causation. And I have to say, it drives me up the wall every time I read a study, which is all the time, that you have to say, "Oh, but this…more research is needed," blah, blah, blah. You know what? Let's focus on the precaution and principle and go “there's enough evidence to say these issues are likely to play a role. So, let's use common sense.”
Andrew: Mm-hmm. So, what about reduction of heavy metals? Do you find a reduction in allergic symptoms? 
Nicole: I have not seen research on this. This is my own hypothesis. I'm just observing, looking at hair mineral analysis in these patients with these chronic multi-morbid conditions like chronic fatigue, electrical sensitivity, mould illness. All of these patients have similar phenotypes, similar signs and symptoms, similar levels of heavy metals, gut microbiome issues. I mean, really, the focus…to me, if I was to rewrite naturopathy, I'd move away from diagnosis and I'd be focusing more on the causes of the illness and going back to basics and looking at its impact.

In the end, the research is saying the gut microbiome, the house microbiome, bacteria, which is what we are, how does that interact with food? How does that interact with chemicals? How does that interact with EMF? That's what we really need to be asking. 
Andrew: Now, I've got to ask a question on, obviously, one of your major loves, which is mould. You've mentioned it before. Do you find treating mould in a house situation will affect not just the allergenic or the potential load, but the symptomatology of a family or an individual within that house. Given that even with the same load, different individuals within the house can react differently? Correct?  
Nicole: I think mould is one of the greatest cause of allergies that we know of, and the reason is because we know one in three homes have been water damaged in Australia, and one in four people can't create antibodies to mould. So, I think asthma, hay fever and eczema can all be triggered by mould, and it's something that's ignored by most practitioners. And it's the hidden…what's the word for it? You know, it's Pandora's box. 
Andrew: Yeah. But do you find effect? Do you find when it can be effectively reduced, when particles can be effectively reduced and you see a disappearance — dare I say that word, 'disappearance' — of the mould or an eradication of the load, do you find that symptoms improve in patients with… 
Nicole: Absolutely. 
Andrew: …atopies and allergies? I just think… 
Nicole: Absolutely. 
Andrew: Yeah. Wow. 
Nicole: Huge. And often, it's just a matter of…when I go on holidays, my symptoms disappear. 
Andrew: Right. 
Nicole: That's when we start going, "Okay, you've tried everything." Because most that really come to see us a building biologist have seen lots of practitioners. They've noticed that it got worse when they had the flood or they moved into that home and they notice significant improvements away from the site, so they're going, "Something's in my house that's making me sick." And when it comes to asthma and allergies, the first thing a building biologists will do is look at mould and house dust mite. And it'll all comes back to moisture. What's the microclimate? Does it hit 7% relative humidity in this area? What's the history of flood-related issues or water damage. You know, what of the gutters, the drainage, all of those sort of things? 
And, you know, many times, people, if they did the research before they moved into the home, especially with allergies, they could save them a fortune in drugs and misery simply by asking, you know, the neighbours about the history of the home. 
I'll give you a good example. I had a client who had severe…her and her daughter had severe eczema, hay fever, and asthma after they moved into this beautiful home in Melbourne. And it came down to…I went there twice, did all the testing, etc. And in the end, it came down to the fact that the previous occupant had 15 cats that had lived in the house and all that water damage was actually urine, cat urine, which they were allergic to! 
Andrew: Ah, you're kidding. 
Nicole: You know, she spent 1.2 on this house and I said to her, "I can't. It's not mould. I need you to talk to the neighbours and find out the history of this building. Because something's in it that's triggering it. I cannot find it." And she rang me back and she said, "Oh, my god. The previous owner had 15 cats that lived in the house and urinated everywhere, and we're allergic to cats." 
Andrew: Oh, yuck. And go through a ton of eucalyptus oil each year.
Nicole: And I think this is an interesting one. If you've got allergies, the tips I'd give you as a building biologist before you rent or build is to ask about the previous occupants, ask about previous water damage. Once you move into the house, if you can get rid of the carpets, it's very important. Because the carpets are the archaeological dig sites. They have all the DNA of all of the previous occupants. Anyone who's visited the house, the pets, the pests like cockroaches and rodents, is all sitting in the carpet. So get rid of it.

And more importantly, with the ducted…especially in Melbourne we use ducted floor heating, get rid of the flexible dust because as soon as you turn the heating on, all that dust and the DNA from all the previous occupants, they're just going to be spread through the house. Get rid of it and replace the ducts. That will be worth doing that financially than spending, you know, the rest of your life in that home miserable and, you know, having to take medication to deal with your allergies. 
Andrew: Nicole, I've got to say, I know that it's these new research papers that are coming out almost daily that are preventing you from finishing your book. But you need to get that last edition out, the most recent edition out, "Healthy Home, Healthy Family." Because people are gonna get such benefit in reading it…not just reading about it, but actually instituting these practical tips that you've developed so that they can reduce their allergen load, so that they can reduce their symptomatology, not just in allergy, but in many other conditions as well. 
So, thank you for joining us on FX Medicine today. 
Nicole: Thanks so much, Andrew. 
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Additional Resources

Nicole Bijlsma
Building Biology
Book: Healthy Home, Healthy Family
Australian College of Environmental Studies

Other podcasts with Nicole include:


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