In this episode of Longevity by Design, our hosts, Dr. Gil Blander and Ashley Reaver, MS, RD, CSSD, are joined by Dr. Robert Pastore. Today’s episode is all about celiac disease—clinical manifestations, challenges in the diagnostic processes, and how this disease is especially relevant to longevity. Along with having celiac himself, Dr. Pastore holds a PhD in Biomedical Informatics and is a certified nutrition specialist—giving him a personal and unique perspective on this condition. Tune in to learn more about the latest science in the field.
Meet Longevity by Design’s podcast guest, Dr. Robert Pastore
Dr. Robert Pastore is a practitioner, consultant, and researcher in biomedicine and human nutrition. Dr. Pastore holds a PhD from Rutgers University in Biomedical Informatics, Nanomedicine, and Clinical Informatics and has an extensive background in nutrition, genetics, biochemistry, and neuroscience. He is a Certified Nutrition Specialist and has had the distinction of counseling some of the greatest professional athletes across the MLB, NFL, NHL, and endurance sports.
What is celiac disease?
Celiac disease is an autoimmune disease in which the human body starts to attack itself when exposed to gluten—a structural protein found in wheat, rye, barley, and other closely related grains. Dr. Pastore explains that, in general, celiac disease only occurs in people who have specific gene variants. The genes associated with celiac disease are called human leukocyte antigen complex (HLA) DQ2 and DQ8. Under normal conditions, the HLA complex provides instructions for making proteins that play a critical role in the immune system. Malfunction of the HLA complex leaves the immune system unable to distinguish the body's own proteins from proteins made by foreign invaders such as viruses and bacteria1. Individuals who do not have the gene variants DQ2 and DQ8 are unlikely to develop celiac disease2.
In genetically predisposed individuals, gluten consumption will cause the body to start attacking the lining of the small intestine. More specifically, this condition harms the villi—small, finger-like projections that line the small intestine and facilitate nutrient absorption. Gluten consumption causes the villi to flatten out or disappear, damaging the intestinal lining. Because celiac patients lack a properly functioning HLA complex, the immune system attacks the body's own tissues and organs. Abstaining from gluten is the currently accepted way to mitigate these effects.
Clinical implications of celiac disease
Celiac disease can manifest in many ways, the most common being gastrointestinal abnormalities. Initial symptoms include bloating, stomach pain, stomach swelling, and constipation. Dr. Pastore explains that untreated celiac can also cause complications beyond the intestine, with numerous conditions directly linked to celiac disease. Atrial fibrillation, autoimmune hepatitis, cardiovascular disease, many cancers, and multiple sclerosis are only a few conditions that celiac patients can develop over time. "You have to take it seriously every minute of the day. No matter what I do, I have to make sure I'm eating gluten-free because it's not just about having a gastrointestinal upset—I am absolutely increasing my risk of cancer," says Dr. Pastore. "This disease robs us of time and quality of life. It can truncate our lives in many ways when left undiagnosed."
One of Dr. Pastore's biggest concerns is that 83% of celiac patients are currently undiagnosed. "Celiac prevalence is estimated to be 1 out of 100 people, and for those with a first degree relative with celiac, your risk can be between 10-22%," says Dr. Pastore. He also mentions that 60-70% of celiac cases appear in women—a stark statistic currently without explanation.
How celiac disease impacts healthspan
Celiac disease interrupts many systems in the body, impacting healthspan in various ways when left unchecked. Nutrient deficiencies due to malabsorption are high on this list—Dr. Pastore mentions that when working with celiac patients, he tests their blood for over 40 nutrients. “All fat-soluble vitamins and many water-soluble vitamins can be lost, as well as minerals important to our health. So, I go deep into every single amino acid that we need, particularly the essential and conditionally essential amino acids,” he says. Iron and vitamin D deficiency are especially common for celiac patients.
In addition to nutrient deficiencies, obesity prevalence is also associated with celiac disease. Dr. Pastore explains the three known pathways in which celiac disease can lead to obesity:
- Lower carnitine levels—a nutrient that fuels the burning of fat.
- Thyroid gland abnormalities may lead to weight gain.
- The inflammasome, also described as an “immunology storm,” can disrupt the metabolism.
Moreover, many other comorbidities stem from untreated celiac disease. As previously mentioned, age-related diseases—like heart disease and diabetes—and cancers such as glioblastoma, brain cancer, breast cancer, lung cancer, lymphomas, ovarian cancer, and pancreatic cancer have higher rates amongst celiac patients. Therefore, diagnosing celiac disease is an important step to optimizing healthspan. Dr. Pastore strongly advocates seeking medical attention and getting tested for celiac if you present with symptoms like cramping, bloating, or regular abdominal discomfort.
Is a gluten-free diet healthy for everyone?
Throughout the episode, Dr. Pastore emphasizes the importance of adhering to a gluten-free diet among those with celiac disease. However, when asked about going gluten-free without celiac disease, Dr. Pastore doesn't believe it is necessary. "I believe that people should eat a healthy, whole foods diet and not change it unless they're diagnosed with a specific condition that proves they need to eliminate something from their diet. I don't believe in fad diets; I believe in excellent clinical nutrition for the individual."
The only other reason Dr. Pastore advises someone to remove gluten from their diet is if they have non-celiac gluten intolerance. He says that if you have a negative celiac test but are still presenting with symptoms, try exposing yourself to gluten in isolation on three separate occasions. If symptoms persist, seek medical attention. "Look for a doctor with a certified nutrition specialist degree or seek help from a registered dietitian. It's important to seek advice from a professional that understands food allergies, intolerances, and sensitivities. If you have symptoms that negatively impact your life on three or more occasions, try eliminating that specific for a period of time," he advises.
Learn more about food allergies, intolerances, and sensitivities here.
Advice on living a healthier longer life
To close the episode, Dr. Pastore shares top tips for improving healthspan. First, he says to keep your mind young by exercising the brain. He enjoys finding topics that are complicated to him and takes classes on them to continue learning. Dr. Pastore also recommends seeking a nutrition specialist who can help you eat for your health. And last, Dr. Pastore advises avoiding alcohol as much as possible.