Loosing the Tour de France Because of Allergies

I could not pass up the opportunity to comment on a news item that combines two of my favorite subjects: allergy and cycling.

The Tour de France – arguable the hardest endurance sporting event in the history of particularly hard sporting events – concluded this week.  “The Tour” is a three week long cycling race.  Participants ride more than 4-5 hours a day, distancing more than 100 miles, up and down mountains, in freezing rain and gale force winds, at a pace that burns a mind boggling 8000 calories each day. Most adults would consider any work-out that consumes more than 500 calories to be an exhausting challenge.   Needless to say the event includes some of the strongest athletes in the world.Untitled design (53) 2

Two men were favored to win the tour this year: Chris Froom (two-time winner and defending champion) and a young columbian rider, Nairo Quintana.  Unfortunately, although eventually taking third overall  (Chris Froom finished first), it was clear that Nairo was struggling and riding well below his -and his fan’s-expectations.

When asked about his difficulties, this is what Nairo had to say:

“It’s not fatigue that I’m feeling, but still, the body isn’t responding. It could be some sort of allergy I’ve got at the moment because my legs aren’t getting enough oxygen. “It could be some sort of allergen in the area that’s been affecting me these last few days. I hope with the rain that is coming in these next days I can keep it at bay.”

Although some may find watching a four hour bike race a bit boring, I am mesmerized by the scenery as the cyclists sale through the countryside of France and into the alps or the Pyrenees mountains bordering Spain.   Untitled design (54) (1)The dreamy state of captivated longing as the peloton winds through river valleys, past medieval castles,  across fields of sunflowers and mountain meadows, is acutely enhanced by the fact that the tour takes place in July. In July the “countryside” of Phoenix is looking a bit scorched after more than a month of  115 + degree days and 100 degree nights with very little rain.

With the record-breaking heat comes very low pollen counts – the plants have a hard enough time surviving much less reproducing – but you could image a very different story in the spring like weather in the mountains of France.  In fact, it is likely that these areas are experiencing their peak allergy season.  Which is why I think Nairo Quintana’s assessment of the source of his struggles has merit.

So how can allergies adversely affect an athlete’s performance?  Here are a few thoughts:

  • Allergy is the primary risk factor for asthma and asthma can certainly have a significant negative impact on any athlete participating in an aerobic sport.
  • Allergies can disrupt sleep and if there is anything that a Tour de France rider needs during a month long bike race is adequate sleep.
  • Energy that the body spends dealing with allergies means less energy available to ride your bike up mountains and sprint to the finish line.
  • Mouth breathing because your nose is congested from allergies means that you loose the conditioning and filtering affect of the nose.  This can lead to increased irritation of the upper and lower airways as well as the  lungs
  • Medications taken for allergy symptoms such as antihistamines and decongestants can negatively impact performance.

Possible the best treatment option for athletes who suffer from allergies (besides staying home) is allergy immunotherapy.  Immunotherapy prevents the allergic response from occurring (rather than treating symptoms after the fact) so that the risk of asthma is reduced, sleep disruption, energy loss, and mouth breathing do not occur and the need for medications is eliminated or significantly reduced.

Hopefully, Nairo Quintana will look up a good allergist when he gets home to Columbia so that he can give Chris Froom a run for his money next year.

Brian Millhollon,MD


Brown Cloud of the Apocalypse

It’s monsoon season in Arizona and this is what my phone screen has looked like for the past several days.

Dust Storm Alert












And this is what all the fuss is about.
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From an allergy perspective, monsoon season is a mixed bag.

On the positive side, monsoon moisture and rain removes the dust and pollen that tends to hang in the air forever when the air is dry.  Also, the damp ground is less likely to be picked up by a dust storm, carried across the valley and dumped in your pool (and lungs).

On the negative side, monsoon storms pick up an incredible amount of dust which is carried across the valley and dumped in your pool (and lungs).

Ozone and particulates are the primary contributors to air pollution in Phoenix and both can reach unhealthy levels in the summer.  Particles of organic and inorganic mater small enough to stay suspended in the air and also small enough to travel deep into the lungs when inhaled are the visible danger when dust storms blow through the valley.  Ozone is more insidious but a serious risk for people with heart and lung disease.

This is an excerpt from the Arizona Department of Air Quality forecast for today and yesterday showing the ozone and particulate levels and a comment:Untitled design (50) (1)

“Circling back to ozone…lack of daytime cloud cover and light winds, until outflows from the north came, gave ozone a serious boost in the afternoon hours Wednesday. Seven monitors did exceed. An Ozone High Pollution Advisory remains in effect today and will be extended through Friday” .

The air quality forecast warning suggests that “sensitive groups” (which would be most of our patients) and active children and adults (which is most everyone else) should limit time spent out of doors, particularly if your activity calls for breathing.

If you would like to learn more about air pollution and ozone in Arizona you can find it here and here.  Information about air pollution and exercise in Arizona can be found here.

Food Allergy for Beginners: Sugars

What is a Sugar?

Sugar is one those loaded words that can have a variety of  meanings.  For example sugar can mean sucrose, the white granules you put in your coffee, or it can refer to the level of glucose in your blood, as in: “I need to up my insulin because my blood sugar is sky high after putting all that sugar in my coffee”.

Sugar can also refer to carbohydrates (“carbs”), one of the three categories of chemicals, along with fats and proteins, which make up the food we eat.

Carbohydrates can be single molecules or joined together to form large chains.  Single molecules are called monosaccarides and include glucose, galactose and fructose. Any two of these simple sugars combined are called disaccharides. For example, sucrose (table sugar) is a disaccharide combing the two simple sugars glucose and fructose. Lactose is a disaccharide containing glucose and galactose. Polysaccharides are long chains of monosaccharide joined together and are used in plants and animals for structure and storage. Sugar is stored as starch in plants and as glycogen in animals.

Monosaccaride - glucose

Monosaccharide – glucose

Disaccharide Sucrose

Disaccharide Sucrose


Polysaccharide Starch

Sugars can combine with proteins to form glycoproteins and with fats to form glycolipids.

It’s All About Glucose

Glucose is our body’s primary source of energy and also the primary product of photosynthesis, the process in plants that turns sunlight into food.  Most of the carbohydrates that we eat are converted to glucose during digestion. We crave sweet things because they usually contain lots of simple sugars that require very little or no work to convert to glucose. Most of the cells in our body can run on either glucose, fats, or proteins but the brain needs glucose to work.Glucose metabolism

Can You Be Allergic to Sugar?

The short answer is no. Simple sugars and disaccharides such as sucrose and lactose are not allergens and cannot cause true allergic reactions.

However, people have become allergic to glycoproteins, sugars combined with proteins. An example of this is allergy to galactose-alpha-1,3-galactose, also know as alpha-gal.   Alpha-gal is a common glycoprotein found on all animal cells except humans and primates and those sensitized can have allergic reactions to a variety of meats including beef, pork, and lamb.   Interestingly, a large number of alpha-gal allergic patients developed symptoms after being bitten by a tick, particularly the lone star tick found in the Southern and Eastern United States. Skin testing to meat and a blood test for allergic antibodies to alpha-gal can make the diagnosis.

Lactose Intolerance

Although sugars rarely cause true allergic reactions, they are a common cause of food intolerance. Because the cells in our body can only use glucose for fuel, all complex sugars (disaccharides and polysaccharides) have to be chopped-up or digested to make the glucose available. To do this, we produce enzymes that make the process of digesting the complex sugars possible.   Many of these enzymes are specific for a particular type of sugar. For example lactase is the enzyme that facilitates the break down of cows milk sugar (lactose) to yield glucose and galactose that is then easily absorbed into circulation to be used as fuel.

Without lactase the milk sugar passes intact into the colon where it provides nutrition for colonies of fermenting bacteria. These bacteria feed on the sugar and as a by-product, produce a large amount of methane gas and fluid retention causing intestinal bloating, cramping, and gas.   Treatment is avoidance of all mammalian milk and/or taking supplemental lactase (Lactaid) whenever milk products are consumed.

In summary, true allergic reactions to carbohydrates are rare while food intolerance, such as lactose intolerance, are more common.  Other problems associated with sugar (i.e., how to say,  “No thank you” to that cheese cake) is an important topic, although – except as a fellow victim- a bit out of my area of expertise.

Brian Millhollon, MD

Food Allergy for Beginners: Fats and Oils

As discussed in the previous article (Food Allergy for Beginners: Proteins), primarily it is protein in foods that causes the majority of allergic food reactions. Our diet also contains fat (oils) carbohydrates (sugars), and minerals but these rarely cause true allergic reactions.   This is an important point because many oils, such as peanut oil, are made from very allergenic nuts or seeds.

Is peanut oil safe to eat if you have a peanut allergy?

The answer to this question depends on the type of processing used to extract the oil.

Most vegetable oils used for cooking are produced using an extensive multistep mechanical and chemical process that begins by heating and crushing the seed or nut.   The oil is then extracted using the chemical hexane. Additional steps may include adding acids and steam distillation. The final product contains so little protein that the FDA does not require oils processed this way to be listed as a potential cause of allergic reactions.

Chick-fil-a, a fast food chicken chain, uses peanut oil and posts the following information about food allergies:

     “Chick-fil-A(r) cooks in 100% refined peanut oil. According to the FDA, highly refined oils such as highly refined soybean and peanut oil are not considered major food           allergens and therefore are not listed here”

Oils may also be extracted from nuts and seeds using only mechanical press without heat or chemicals.   This method produces much smaller amounts of oil but the oil produced retains more of the natural flavor and also may contain significant amounts of protein.  For this reason, contact with cold pressed oils can cause allergic reactions if you are allergic to the nut or seed used to produce the oil.Untitled design (42) (1)Untitled design (43) (1)