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Anti-aging Medicine: Wave of the Future, or Wrong Turn?
Anti-aging medicine is out of our general area of expertise, but it relates to one of our main interests: aging well. Hormone replacement therapy for men is nothing new. Years ago, I remember my father, a medical doctor, talking about the benefits experienced by some of his aging male patients after receiving testosterone injections. More recently, I’ve received emails from older readers telling me how much better they feel and how much better their training is going after their doctor prescribed testosterone supplementation. One particularly enthusiastic 61-year-old man told me shortly after he started taking a testosterone pill under his tongue -- his testosterone had been found to be "low normal," and he had experienced a lack of muscle tone and a tendency to shift fat to his waistline, even though he was keeping his body weight stable and training regularly with weights -- that he was experiencing "a vast increase in energy." A month later, he reported that his doctor had switched him to a testosterone patch which "provides the same level of rise and fall of the testosterone level as is normal in young men." He said he was making "phenomenal" gains in body weight and strength. "I have not experienced anything like it since I was 20 years old," he wrote.
This man understood that the long-term effects of testosterone replacement are largely unknown, but assured me that he was being carefully monitored by his doctor for negative side effects. "The physical effects are too good to do without," he added. I still receive positive reports from him from time to time. He is now almost 65 and tells me he’s still slowly getting stronger.
But it was not until doctor David Chauvin, an emergency room physician from Ohio, visited with us earlier this year that I realized that anti-aging medicine is a fast-emerging specialty. Immediately before coming to Albuquerque, Dave was in Las Vegas, Nevada, talking with the doctors at the Cenegenics Medical Institute. With close to 600 patients, Cenegenics is probably the country’s largest "age management medicine" practice. Dr. Barry Sears, who developed "The Zone Diet," is a high-profile patient, and three-time Mr. Olympia Frank Zane (58) wrote in the summer 2000 issue of his Building the Body newsletter (www.frankzane.com) that he is taking supplemental thyroid, human growth hormone and testosterone prescribed by Cenegenics’ Dr. David Leonardi.
[We received an email dated 11/19/2008, from Ann Castro, Director of Public Relations, submitting a letter from Cenegenics CEO Kristy N. Berry. The letter says Cenegenics Medical Institute is the world's largest age management medicine practice, with over 15,000 patients worldwide. In addition, Berry states that Cenegenics is not part of the anti-aging movement. "Unlike our 'anti-aging' counterparts, Cenegenics is pro-aging--regarding aging as a natural process (not a disease) that can be managed," Berry writes. "Furthermore, we do not claim to affect aging at the cellular level, claim to increase longevity or use pseudo-science." For more details, please visit their website: www.cenegenics.com ]
Dave Chauvin brought me a packet of material on anti-aging medicine. One of the things I learned was that the American Academy of Anti-Aging Medicine (A4M) now has 8500 physician members and, according to A4M president Ronald Klatz, MD, DO, the membership is doubling every year. Clearly, this is a trend worth watching.
The article which follows is an outgrowth of my discussions with Dave Chauvin. I asked Dave to give our readers an overview of anti-aging medicine, with special attention to its most controversial therapy, multi-hormone optimization. Many traditional physicians question the wisdom of restoring hormones to the levels of youth; they believe that’s too aggressive, at least until we have a better understanding of the long-term consequences. Some physicians, such as well-known alternative medicine proponent Andrew Weil, MD, don’t believe in anti-aging medicine; they believe the aging process should be accepted and adapted to with conservative and healthful tactics, not fought. In a recent issue of Modern Maturity magazine, Dr. Weil said, "Healthy aging is having the physical faculties, mental faculties, and energy to do what you want as you move through life and being comfortable with the aging process."
I have asked my friend and physician Arno Jensen, MD, who practices radiology and preventive medicine at the Cooper Clinic in Dallas, Texas, to speak to the concerns many traditional doctors have with the more aggressive branch of anti-aging medicine, represented by A4M. We plan to include his remarks in our October 1 update.
Finally, I know that many of you are wondering if I am using multi-hormone optimization. The answer is that I am not using any form of hormone replacement therapy. I rely on eating a healthy diet and a combination of weights and aerobics, as described in my books and on this page. While I don’t completely rule out using hormone therapy at sometime in the future, I have no need for it at the present time and, hopefully, will never need it. My testosterone level is in the midrange of normal for my age; I have plenty of energy; I feel fine, and my training continues to be enjoyable and productive.
Now, enjoy Dr. Chauvin’s article. I believe you’ll find it quite informative, as I did.
Anti-Aging Medicine, an Overview
I have been asked by Clarence Bass to write a brief introduction and overview of anti-aging medicine. I have been a fan of Mr. Bass for several years and have enjoyed reading his books and listening to his tapes. Last May, I was fortunate to visit Clarence and Carol at their Albuquerque, New Mexico, residence for a personal consultation. At that time, I shared my interest in anti-aging medicine with them.
A medical specialty founded in 1993, anti-aging medicine is dedicated to a new approach to aging and to preventative medicine. The purpose of anti-aging medicine is not to live longer as an "older" person, but rather to delay the onset of the aging process and give people a greater number of healthy, quality years. Anti-aging medicine believes that aging is a treatable condition which can be slowed through existing medical and scientific interventions.
During the Middle Ages in Europe, the average life span was approximately 40 years. In 1897, the most common causes of death were influenza, diarrhea and pneumonia. By 1997, the most frequent causes of death were heart disease, cancer and stroke. Since the1950s, medical science has been able to reduce deaths due to heart disease 45% and strokes by 60%. Blood screening for DNA damage and other advanced technologies will make early detection of cancer and other ailments a reality, increasing life expectancy still further .
Because of modern sanitation and medical advancements, the life span of Americans continues to increase. Today, average life span is about 85 years.
Graph: Entrepreneur, September 1999
Exercise is essential to living a high quality life. Loss of muscle mass with its associated disabilities is one of the most frequent contributing reasons for admission to a nursing home. While most traditional physicians stress the need for aerobic exercise such as walking, swimming and jogging, anti-aging physicians are more aggressive and typically recommend a combination of aerobic exercise and resistance training. Numerous studies have confirmed that resistance training increases or maintains muscle mass. At a minimum, resistance training helps to slow the rate of decline in strength and muscle mass.
Several lifestyle practices have been linked to disease processes that curtail longevity. Smoking, excessive alcohol consumption, illegal drug use, unsafe sex, reckless driving, exposure to environmental and occupational pollutants hasten the demise of many Americans who would otherwise reach an advanced age. Proper diet and nutrition are fundamental to living a long and healthy life. Processed foods containing transfatty acids, refined sugars, and saturated fat are to be avoided, while unprocessed foods such as fruits, vegetables, and lean meat are important in providing essential nutrients and antioxidants.
Excess body fat, commonly determined by the body mass index (BMI), is associated with greater mortality and morbidity. The incidence of obesity (BMI greater than 30) has rapidly increased in the last 10 years, while diseases such as diabetes, stroke and cardiac disease have grown as well. Anti-aging physicians stress the need to maintain a body weight close to the ideal.
A similar concept that interests anti-aging physicians is the practice of calorie restriction. Long advocated by UCLA School of Medicine professor Roy Walford, M.D., one of the world’s foremost experts on aging, this concept suggests that by reducing calories by 10% or more human life span can be substantially increased. Various groups around the country actually practice this concept called CRAN (Calorie Restriction with Adequate Nutrition). CRAN has been shown to dramatically extend the lives of laboratory animals. Rats, mice and hamsters experience significant life span extension from a diet containing 35% of the calories, but all of the required nutrients.
Mean life span was increased 65% and maximum life span was increased by 50%
when CRAN is begun just before puberty. The exact mechanism by which caloric
restriction has such dramatic effects is still unknown.
Probably the most controversial anti-aging therapy is called multi-hormone optimization. This practice is based on the Neuroendocrine theory of aging. Develop by Valdimir Dilman, Ph.D., this theory notes that when we are young hormone levels tend to be high and decline as we mature, usually after age thirty. Hormones are vital for repairing and regulating our bodily functions. This age-related decrease in the production of key hormones such as DHEA, melatonin, testosterone, thyroid and human growth hormone (HGH) is associated with a decline in the body's ability to repair and regulate itself. In addition, catabolic hormones such as cortisol, insulin and estrogen (in men) increase as we age. Overall, these multiple hormonal changes result in fat gain, loss of muscle mass (sarcopenia), fatigue, insulin resistance, cardiovascular disease, mental decline, poor immune response, and sense of poor health.
Anti-aging physicians call this process of hormone decline, somatopause (decrease in HGH), andropause (decrease in sex hormones), adrenalpause (decrease in DHEA) and pinealpause (decrease in melatonin). These hormonal variations correlate with symptoms such as being over fat, decline in glucose tolerance, loss of muscle mass, high cholesterol, and decreased cardiac endurance, all of which are typically associated with aging. Anti-aging physicians believe that these shifts can be slowed or even reversed with strategic hormone replacement.
The concept of physiologic hormone modulation originated with the late Dr. Daniel Rudman. Dr. Rudman published in the July 7th, 1990 issue of the New England Journal of Medicine a study of men age 61 to 81 with low human growth hormone. Dr. Rudman placed the study subjects on supplemental HGH and monitored their physiologic changes. In that trial, he showed that men who were on growth hormone over six months were able to increase their lean body mass by an average 8.8%, decrease total body fat by 14.4%, increase dermal/epidermal thickness by 7%.
In another study slated to be published at the end of this year in the New England Journal of Medicine, two National Institute of Aging physicians, Dr. Mark Blackman and Dr. Mitch Harmon have analyzed the impact of testosterone (gonadal steroids) and HGH replacement in otherwise normal but hormone deficient adults. This double blinded, randomized, placebo-controlled, multi-center study placed both men and women into four groups. One group received growth hormone plus placebo. The second group received placebo plus gonadal steroids. The third group received growth hormone plus gonadal steroids and the last group placebo plus placebo. In this yet to be published study, the authors report many positive findings especially with the group receiving both growth hormone and gonadal steroids, with few reported side effects. These National Institute of Aging physicians conclude cautiously that "new strategies to optimize the benefit/risk ratio associated with this therapy are reasonable to think about."
Although research and observational reports confirm that hormone modulation can improve the quality of life, can hormone modulation actually increase human lifespan? We will likely not know the answer to this question for several decades due to the relative long lifespan of humans. Many animal studies suggest, however, that the answer may be yes.
As you might imagine, not all physicians agree with hormone modulation. Our current understanding of anti-aging hormone replacement is very similar to treatment of menopause in the 1950s. At that time it was shown that giving estrogen to menopausal women reduced the incidence of osteoporosis and heart disease, as well as ameliorating hot flashes, sweats and other symptoms of menopause. However, long term consequences were not known. Many forward-thinking doctors used this therapy in increasing numbers over time with good results. Forty years later, postmenopausal estrogen administration is now the norm. Nevertheless, we must keep in mind that the risks of anti-aging hormone modulation are not fully understood, and shouldn’t be underestimated. These hazards include increased growth of undiagnosed cancers, cardiovascular complications, liver damage, stroke and possibly other yet-to-be-discovered complications.
Many traditional physicians believe that until the risks are more fully grasped, hormone modulation is not prudent. There is certainly wisdom in this argument. Just as we learned with female hormone replacement therapy (HRT), the true risks will likely take years, if not decades, to fully delineate. Unfortunately, many patients likely to benefit from such an approach will not be around in thirty years to profit from the results of these studies.
With the advent of anti-aging medicine , hormone replacement therapy now becomes a choice to being made jointly by the informed patient and the knowledgeable physician, one in which the potential for unknown health consequences are weighed against the known benefits. Cognizant of these uncertainties, anti-aging physicians aggressively screen, monitor and follow their patients.
Anti-aging hormone modulation is not to be confused with the super-physiologic abuses of anabolic hormones by some bodybuilders and other athletes. Unmonitored hormone supplementation and experimentation is clearly dangerous. When it was revealed that Mark McGwire was taking the hormone androsteindione, many aspiring athletes began taking andro. Later research determined this practice to be self-defeating and dangerous. Unscrupulous supplements manufacturers, physicians, drug salesman and internet promoters have jumped on the "anti-aging hormone" bandwagon, promoting their modern-day snake oil to be consumed by the naive consumer. Hormonal supplementation in the United States has a long history of marginal ethics and disregard for long-term safety and health. This unfortunate background notwithstanding, anti-aging physicians believe that the benefits of hormone modulation provided to an appropriate patient population by properly trained, ethical practitioners should not be overlooked.
The demand for anti-aging medicine will certainly increase in the next several years. According to Scientific American magazine, the centenarian population grew by 160 percent in the U.S. during the 1980s. Many demographers predict that in the year 2040 20 million to 40 million people will be aged 85 or older, and 2.2 million will be centenarians in 2050.
Graph: Popular Science, October 1999
But is it really wise to fight the normal aging process? Americans are now living well beyond the medieval life expectancy only to encounter decades of chronic pain, immobilization, mental deterioration, and prescription drug dependency. Languishing for years on sophisticated life-support systems in the critical care unit of the hospital of the future just does not constitute acceptable life extension. This clearly need not be the case. The longest documented living human in the world, Jeanne Louise Calment was born in Arles, France on 1875 and died 122 years later. She lived a rich life, riding a bicycle to the age of 100 and was mentally alert until her death in 1997. http://www.wowzone.com/calment.htm
The anti-aging movement, while embracing sophisticated high-tech innovations, aligns itself mostly with economical and pragmatic lifestyle modifications. The effectiveness of proper diet, exercise and social support cannot be overstated. Although we live in a youth-oriented culture that places a premium on beauty, fitness, hedonistic indulgence and sexuality, the anti-aging movement is about extending the quality of life with a healthy recognition of our ultimate limitations.
The American Academy of Anti-Aging Medicine (A4M), formed in 1993, is the largest organization in the United States created to promote the development of technologies, pharmaceuticals and processes that retard, reverse, or suspend the deterioration of the human body, resulting from the physiology of aging. In 1999, the A4M established a specialty board to begin certifying physicians in anti-aging medicine. According to A4M president Ronald Katz, M.D., DO, about 500 physicians have taken the first part of the exam to become certified as anti-aging physicians. (The certification is not currently recognized by the American board of medical specialties, however.) http://www.worldhealth.net.
Dr. Chauvin is an board certified emergency physician practicing in Troy, Ohio.
For more information about anti-aging medicine, contact: A4M: The American Academy of Anti-Aging Medicine, 1341 West Fullerton, Suite 111, Chicago, IL 60614, 773-528-4333, http://www.worldhealth.net
The Life Extension Foundation, 995 SW 24th Street, Fort Lauderdale, FL 33315, 877- 900- 9073, http://:www.lef.org/index-con.html/
David Chauvin, DO FACEP
New Century Physicians
Ripped Enterprises, 528 Chama, N.E., Albuquerque, New Mexico 87108, Phone (505) 266-5858, e-mail: firstname.lastname@example.org (no attachments, please), FAX (505) 266-9123, Office Hours, 8-5, M-F, Mountain time.
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