The Pastore Podcast

Dr. Pastore dives into the prevalence of lactose intolerance in celiacs, and celiac disease in those with lactose intolerance.

In this episode, he covers:

-What a lactose intolerance is and how is it different from a milk/dairy allergy or sensitivity

-68% of the adult population has a lactose intolerance, but who is most at-risk: https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics

-How lactose intolerance is traditionally diagnosed, and what celiacs should do after being diagnosed to be tested for lactose intolerance (H2-lactose breath test)

-The genetic testing for lactose intolerance (MCM6-RS4988235 - C or CC allele)

-Why you should get tested for celiac disease if you have a lactose intolerance. In a study done by Ojetti in 2005, 24% had celiac disease with lactose intolerance presenting as their ONLY symptom: https://www.karger.com/Article/Abstract/84526

- What other medical conditions may be causing "secondary lactose intolerance" - your body produces lactase, but something else isn't right in your digestive tract

- How some celiacs can recover from secondary lactose intolerance after following a gluten-free, dairy-free diet for 3-6 months to allow their small intestine villi to heal

Dr. Pastore covers key information a newly diagnosed celiac patient should know, including:

• Why a biopsy is key for confirmed diagnosis

• You cannot outgrow this disease

• Why you should see a Registered Dietician or Certified Nutrition Specialist immediately after your physician's diagnosis

• "Gluten free" foods & cross contamination

• How to tackle restaurants and family dinners

• Why you may feel sick after eating doesn't necessarily mean that you consumed gluten. It could also be a different food intolerance or even an an intestinal parasite.

• What to do if you consume gluten, and why charcoal isn't the best for recovery

• Why it's critical to see your doctor post-diagnosis at month 3 and/or 6, and definitely month 12 for follow-ups
• • Vitamin/nutrient deficiencies
  • Re-test ALL diagnostic tests at each
  • Hepatitis B vaccination
  • Pneumococcal infection vaccination

In this episode Dr. Pastore covers:

• Infertility in men and women could be caused by Celiac Disease

• If you have the HLADQ2 or HLADQ8 Celiac gene but do not have Celiac disease, your child still could be born with or develop Celiac disease

• If one of the biological parents are a gene carrier or are a diagnosed Celiac, a gluten-free diet should be followed during pregnancy

• If a biological relative (parent, sibling, grandparent) is a gene carrier or a diagnosed Celiac, studies show there is a [1 in 10] to [1 in 22] chance of your child being born with or developing Celiac disease

• The complications and risks of consuming gluten during pregnancy, including miscarriage and developing diabetes

• Many prescriptions and prenatal vitamins contain gluten

• Pregnant celiac patients have a higher chance of anemia (iron deficiency), placental abruption and miscarriage

• Infants at-risk should have no more than 5g of gluten at the age of introducing grains (roughly 6 months old)

• What to discuss with your doctor during pregnancy, how often you should see them, the tests that should be run and the follow-up required

Things all Celiac Disease patients should do:

• Celiac testing for baseline IgG antibody titers. This also applies to all newly diagnosed celiacs at 3 months, 6 months and 12 months after diagnosis

• Get tested for ALL nutrients beyond the traditional Folic Acid, B12, Iron, Magnesium, Calcium, Vitamin D, Vitamin E and Vitamin A to determine deficiencies

• Review your vaccination history - such as being a non-responder for the Hepatitis B

In this episode, Dr. Pastore discusses:

DAILY Nutrient Requirements for Pregnant Women:

1) Folate

• 1000 micrograms of L-methyl-folate per day, rather than folic acid
• MTHFR gene variance - affects folate utilization and can cause folic acid deficiency which can cause the infant to be born with spina bifida or cleft pallet

2) Iodine

• 250 micrograms per day
• High quality table salt with iodine [1/4 teaspoon = 75 micrograms] instead of/in combination wth sea salt or pink salt
• Non-mercury containing fish like cod

3) Choline

• Incredibly important for cell replication
• 450mg per day (550+ during breastfeeding)
• 1 organic egg yolk = 147mg
• 3 oz. chicken breast = 72mg
• Choline bitartrate supplement
• Power ON - NSF Certified supplement

4) EPA & DHA - Omega 3 Fatty Acid

• 300mg per day minimum DHA
• 300mg per day minimum EPA
• Deficiency can increase likelihood of postpartum depression
• EPA helps transport DHA to baby through placenta
• EPA/DHA enteric-coated supplement to help with nausea - NSF Certified to ensure no unsafe levels of mercury

5) Iron

• 30g of iron per day
• Ferronyl - form of iron supplement without constipation

Bloodwork showing slight hemoglobin (protein that transports oxygen in the blood) decreases are normal as blood volume is doubling. Unsafe below:

• 10.5g/dL 2nd trimester
• 11.0/dL 3rd trimester
• Rising hemoglobin - also a warning sign

6) Magnesium

• 400mg per day
• Leafy vegetables
• Magnesium bisglycinate or magnesium taurate supplement
• Deficiency can increase likelihood of gestational diabetes

7) Inositol

• 50mg per day
• Cantaloupe
• A type of sugar, can reduce the likelihood of developing gestational diabetes for those at-risk

8) Calcium

• 1000-1500mg per day
• High-calcium foods also include dairy products (for non-intolerant people), collard greens, kale, dark green leafy vegetables
• Calcium citrate supplement

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Preeclampsia

• A pregnancy condition involving high blood pressure and excess protein in the urine. This can keep the baby from getting enough blood and oxygen. It also can harm the mother's liver, kidneys, and brain.
• A highly processed diet & poor nutrient intake can be a cause. Studies have shown that simply increasing your fruit & vegetable intake causes a 50% reduction of risk.
• Adequate calcium intake also reduces risk

—

Monitoring for gestational diabetes

• Monitor glucose and insulin levels at every doctors appointment - elevation is warning sign of insulin resistance
• To be proactive, swap fast-digesting carbs for low-digesting whole-food carbs (choosing sweet potato over bread)

—

Morning sickness & nausea

• 50mg of standardized ginger root (5% gingerols)

—

Pregnancy / "Mommy" Brain

• Forgetful, foggy, low energy - can be due to choline deficiency

The first 1000 days of life - from conception to age two - are the most CRITICAL nutritional period to prevent health issues and diseases that may arise later in a human's life.

Dr. Pastore shares his two+ decades of experience treating pregnant women and optimizing their nutrition for a safe, healthy pregnancy.

Information discussed:

Ask your doctor to be tested for the:

• MTHFR gene variance - affects folate utilization and can cause folic acid deficiency which can cause the infant to be born with spina bifida or cleft pallet

• BCMO1 - T allele - unable to convert beta-carotene into the bioavailable from of vitamin A, which can lead to deficiency - affecting fetus growth and eye development

Blood work to be run for:

• Iron status - (anemia)
• Vitamin D level
• Magnesium
• Lipid levels
• Fasting glucose & insulin - warning sign for developing gestational diabetes

Average caloric increase required for pregnant women:

+300 cal/day, +2100/week

Healthy weight gain should be an average of 25lb total gain for pregnancy (most weight gained in the last trimester) for woman with a healthy BMI. Weight gain should be less for overweight women.

Foods to avoid while pregnant, even if you crave them:

ANY & ALL alcohol

• Artificial sweeteners, flavors and colors in foods
• Fast food & highly processed foods
• Trans fats
• Unpasteurized foods/drinks like kombucha
• Refrigerated/smoked: sea food, white fish, seafood, deli meats, hot dogs, meat spreads
• Pre-made salads
• Raw sprouts such as broccoli sprouts, bean sprouts, alfalfa sprouts
• Caffeine (ideally none, but under 200mg a day)
• Fish high in mercury & other heavy metals -
• • https://www.ewg.org/research/ewgs-good-seafood-guide/executive-summary

Food cravings:

• PICA: cravings for clay/dirt - warning sign of a nutrient/iron deficiency
• Ice cube cravings - warning sign of an iron deficiency

Dr. Pastore and Lexie are back and kicking off 2020 with a popular "New Years Resolution" health topic - calories in vs. calories out.

When it comes to weight loss, there are many factors people typically don't take into consideration when calculating both the "calories in" and "calories out" portions of the equation.

They discuss:

• What a calorie is
• Thermodynamics
• Macronutrients and their thermogenic effect
• A protein study on the thermogenic effect of pork vs other meats
• Gene variances that make it more difficult for some of the population to lose weight compared to others
• • COMT-RS4680-GG - likely to overeat/never feel satiated gene
  • SLC2A2-RS5400-TC or GT - "sweet tooth" gene
• The negative metabolic effects of yo-yo dieting
• The negative metabolic effects of losing a significant amount of weight in a short period of time
• How food intolerances affect both "calories in" and "calories out"
• Why "adrenal fatigue" is NOT recognized as an official diagnosis in the medical community

Articles mentioned:

Thermodynamics of weight loss diets

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC543577/

"A calorie is a calorie" violates the second law of thermodynamics

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-3-9

Effects of Eating Fresh Lean Pork on Cardiometabolic Health Parameters

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407990/

Biggest Loser Metabolism Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/

Harvard Magazine - Are All Calories Equal?

https://harvardmagazine.com/2016/05/are-all-calories-equal

"If you hear hoofs coming behind you, don't assume it's a zebra"

In this episode, Dr. Pastore shares one of his favorite patient cases where he was able to identify a "zebra" diagnosis when the medical community had diagnosed this patient with ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's disease) - a disease that gradually paralyzes people because the brain is no longer able to communicate with the muscles of the body.

Dr. Pastore shares his thought process, the tests he ran, what he discovered and the dietary changes he implemented that halted the ALS diagnosis in its tracks.

Links mentioned in the show:

Dr. Pastore's work on diagnosing celiac disease:

https://drrobertpastore.com/blog/2019-08-26-what-do-you-do-if-you-think-you-may-have-celiac-disease/

https://mayoclinic.pure.elsevier.com/en/publications/physician-review-of-a-celiac-disease-risk-estimation-and-decision

Aspartame and its effects on health

https://www.bmj.com/content/330/7486/309.2

This week we discuss being "punked" and what to do if you unknowingly (or willingly against all recommendations) ingest gluten as a celiac.

Dr. Pastore shares his personal experience and discusses the typical symptoms a celiac would experience, the facts and myths about what a celiac should do to recover if they have consumed gluten, the immediate steps you should take and when you need to see your medical professional.

https://drrobertpastore.com/blog

In this conversation, Dr. Pastore explains the direct scientific links between gut health and mood. He covers how the gut and brain are systematically connected, the balance of gut microbiome, and why a damaged digestive tract can lead to mood-related disorders such as depression and anxiety.

Dr. Pastore shares his history with migraines and the signs, symptoms, causes, treatments and science behind migraines.

Talking points include:

• The 4 stages of the migraine, including the "migraine hangover"
• A sub-class of migraines called allodynia - the experience of pain from stimuli that isn't normally painful (ex - pain caused by steam/water from a shower)
• What triggers migraines, including MSG, aspartame, and tyramine-containing foods such as dairy, yeast extract & fermented foods
• The prevalence of dairy being a trigger in Dr. Pastore's migraine patients & how to follow a one-month dairy elimination diet
• Why it's probably NOT the weather causing your migraine