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From The Desk Of Clarence Bass

Anti-aging Medicine Evolves: Age Management

  [CB: Almost five years have passed since Dr. David Chauvin’s article on anti-aging medicine appeared on our site (# 53). At that time, the American Academy of Anti-Aging Medicine (A4M) was a fast emerging organization. It now represents physicians, scientists, and health professionals from 73 countries. The field has evolved as well as grown. The emphasis has perceptibly shifted from antiaging medicine to lifestyle and age management. That seems wise, because we know lifestyle change works, while the jury is still out on life extension and hormone replacement therapy. Best to focus on what we know works, while ironing out the kinks in the medicine part. As you will see, the evolution has been impressive. Dave has done another excellent job giving us an overview of the new developments. I found it fascinating and believe our readers will enjoy it.  

For those who may be wondering, I'm still not using hormone replacement therapy of any kind.  As I said in my introduction to Dave's first article (#53), I rely on a healthy diet and a combination of weights and aerobics, as described on this site and in our books and DVDs.  I was encouraged by Dave's comments on the high priority given to sound nutrition and physical exercise.]

Anti-Aging Medicine... an Update

By David Chauvin, DO

  Clarence Bass has asked me to update my August 2000 article on his web site about Anti-Aging Medicine. When I wrote the article, anti-aging medicine was a new specialty only a few years old.

  Anti-aging medicine is alive and well and longevity science continues to advance.

A New Definition

  At the outset, anti-aging medicine struggled to define itself. Often labeled as pseudo-science, the term “anti-aging” was open to a range of definitions. Articles were published in The New York Times and Scientific American portraying anti-aging medicine as a foolish quest for the ethereal Fountain of Youth[1]. Marketers were quick to exploit the term anti-aging while legitimate physicians and scientists began to turn a skeptical eye on this new specialty.  Although life extension is certainly the desired result, longevity researchers are quick to point out that there is no definitive proven medication or specific intervention currently available that will guarantee prolongation of life in Homo Sapiens.

Rather than the term Anti-aging Medicine,  “Age Management Medicine” is a designation that has been advanced by Dr. Alan Mintz, CEO of Cenegencics in Las Vegas[2]. Age Management Medicine, in my opinion, more accurately reflects what the movement is attempting to accomplish. Although on one hand, it will likely take many years of research to definitively demonstrate that specific interventions prolong life in human beings, on the other hand it is clear that age management medicine improves the quality and vigor of life that may very well extend life. Age management medicine does not wait for a disease or degenerative biological process to “declare itself,” but is proactive to modulate the process of aging prior to the onset of degenerative aging.

A Basic Foundation

The tenants of age management medicine are really very simple. Proper diet, both aerobic and resistance exercise, as well as stress management are the core elements with the end objective of maintaining optimal health and vigor. The age management practitioner relies on the synergy of all of these elements in order to enhance vitality and quality of life.

Layered on top of this foundation is a proactive preventive medicine program. Specific biological functions are monitored which are known to change with age. In contrast to traditional medicine and before these physiologic functions begin to decay, the age management practitioner will initiate interventions. These interventions are tailored individually to the patient employing a range of modalities from dietary recommendations, exercise prescriptions, targeted vitamins and supplements, stress management advice, bioidenitical hormone replacement, and cognitive enhancing exercises. Only as a last resort will traditional prescription medications be employed.

Inflammation is the Problem

One of the major advancements in the theory of age management medicine is a more complete understanding of how the human body degenerates. One common pathway of aging is inflammation. Simply described, inflammation is the body “rusting.” This rusting process turns out to involve a complex biochemical matrix with an impressive array of chemical interactions.  Fortunately, most community laboratories can now measure many of these reactions. Highly sensitive C-reactive protein, homocysteine, serum insulin, HgAIC, triglycerides to High Density Lipoprotein (HDL) ratio, lipid acid profiles, and ferritin are just some of the markers that are now actively monitored[3] [4].  Other inflammatory markers such as NF Kappa Beta, inflammatory cytokines, acute phase proteins, eicosanoids, as well as PPAR Gamma are active subjects of current research.

These inflammatory markers are elevated with obesity, infection, high glucose, high insulin, hormone decline, lack of exercise, stress and age[5] [6]. Of special note is elevated blood sugar which frequently results in advanced glycation end products (AGE)[7]. Think of AGE as an extra layer of rust that makes cell membranes stiff. When cell membranes are stiff they do not work well.  Advanced glycation end products result in a number of chronic diseases such as heart disease, Alzheimer’s and hypertension[8]. 

Since we are now able to measure these inflammatory markers, we are beginning to understand which interventions are most effective. Not surprising, diet and exercise are most successful, along with targeted supplements such as folate, B12 and CoQ10, in decreasing these inflammatory markers[9] [10]. Statins, aspirin and NSAIDs[11] are also showing promise in decreasing inflammation.

What is the Optimal Age Management Diet?

Scientist continues to debate which foods and diet are best for optimal health. The good news is that, in my opinion, we are getting closer to the answer. Diets that eliminate or focus on a single macronutrients such as fats, carbohydrates or protein are clearly not healthy. In addition, processed foods with a high sugar content, especially those with high-fructose corn syrup, trans fatty acids or refined carbohydrates, are unhealthy and may lead to disease and obesity.

While it now appears that no one diet fits all, some generalizations can be made. Diets rich in colorful vegetables, a wide variety of fruit, lean meat low in saturated fat and trans fatty acids, and containing healthy fats such as the omega three fatty acids and monounsaturated fats appear to be best.

Avoiding excessive calories is crucial. One of the most promising life extension interventions appears to be calorie restriction. Also know as Calorie Restriction with Adequate Nutrition (CRAN), restricting calories is the one intervention that most experts agree is the most effective and intriguing[12]. Insulin sensitivity appears to be the key[13] [14]. Since the average person is unable to maintain a very low calorie intake on a long-term basis, active research in “CRAN mimics” is ongoing. Perhaps someday a pill will be created that provides the positive health benefits of CRANing.

I have been fascinated by the work by Dr Loren Cordain and his Paleolithic Diet concept.  Dr. Cordain is an anthropologist specializing in the dietary habits of our ancestors. Dr. Cordain observes that most of our modern diseases are rare or nonexistent in hunter-gatherers and other less Westernized people. He concludes that the diseases of modern society are a result of a complex interaction of multiple nutritional factors directly linked to the excessive consumption of Industrial era foods such as dairy products, refined cereals, refined sugars, refined vegetable oils, fatty meats, salt, and combinations of these foods. He concludes that the “ultimate factor underlying diseases of civilization is the collision of our ancient genome with the new conditions of life in affluent nations, including the nutritional qualities of recently introduced foods” [15].

A number of Age Management specialist have embraced the Zone diet developed by Barry Sears. Dr. Sears believes that food induces a hormonal response and by modifying the quality and quantity of the macronutrients, hormones will respond beneficially. The Zone diet is balanced between the macronutrients, and emphasizes good fats and low-glycemic unrefined carbohydrates.

Nutritional Science Grows Up

Our knowledge base for nutritional medicine continues to rapidly evolve. Historically nutritional scientists focused on advanced deficiency states caused by specific nutrition deficit states such as osteomalcia, rickets, scurvy, protein malnutrition etc. Researchers are now finding that specific nutrients can modulate gene expression even when advanced nutritional disease states are not present. Our genes are pleiomorphic, which means our DNA responds differently depending on its surrounding environment. The resulting end product of our gene expression is called our phenotype.

The classic example of gene expression modulation is the Pima Indians of Arizona. The Pima Indians are a Native American tribe with ancestral ties to the first people who crossed the Bering Land Bridge from Asia to populate North America. Their original phenotype was a lean body mass with a low rate of obesity and hypertension. Now living on reservations and eating western food, the Pima Indians have the highest reported prevalence of Type 2 diabetes in the world as well as a high rate hypertension and heart disease[16]. Interestingly, this is not observed with Pima Indians living in Mexico, who have a lifestyle similar to their ancestors.

Although the Pima Indians are an extreme case, researchers are identifying a number of nutritional deficiencies and imbalances that are amenable to correction with supplementation, proper nutrition and lifestyle change. A good example is the role of folic acid and the prevention of birth defects. In addition, B vitamin supplementation has recently been shown to improve hypertension, and help with some forms of heart disease and dementia. Antioxidants such as Vitamin C and E have been demonstrated to improve macular degeneration, and the omega-three fatty acids in fish oil lowers the risk of cardiovascular disease[17]. Correction of vitamin D deficiencies minimizes breast and prostate cancer risk as well as improves hypertension[18].  Unlike the traditional physician who receives little or no formal education in nutrition, the Age Management practitioner uses this growing body of nutritional research, tailoring their recommendations to the patient’s unique biochemical profile.

Hormone Modulation

  Bioidentical hormone replacement is one of the original tools of age management physicians. As we age, specific hormones are known to decrease or increase. For example, testosterone, human growth hormone and DHEA decrease with age, while insulin and cortisol increase. These hormonal deficiencies can be corrected with careful measurement and adjustment of bioidenitical hormones.  The picture of how safe or effective hormone replacement therapy is has been clouded by studies such as HERs[19]. HERs looked at synthetic hormones such as Premarin and progestins and demonstrated an increase in breast cancer and cardiovascular disease. However, there is a big difference between synthetic hormones and bioidentical hormones. Synthetic hormones are chemicals such as Premarin and progestins with hormone-like properties, while bioidentical hormones precisely match the chemical structure of the hormone. It will likely take another generation before we fully understand the risks and benefits of bioidentical hormone replacement. Nevertheless, there is a growing body of evidence suggesting that bioidentical hormone replacement is safe and that it can mitigate many of the degenerative changes of aging while improving the quality and vigor of life.


The future for longevity science is promising. Our knowledge regarding nutrition and prevention of chronic disease is rapidly expanding. Significantly, no current treatment, surgery or intervention is superior to diet and exercise. Our modern lifestyle is contributing to the decay of our health with obesity, hypertension and cancer at epidemic proportions. Unfortunately, given a choice between behavior modification or a pill, most Americans would chose a pill.

We cannot yet reverse the aging process. Aging is not a disease, but rather a process that we all experience. Age Management Medicine recognizes that successful aging requires a healthy lifestyle, appropriate nutrition, rational nutrient supplementation, and the absolute need for physical exercise. Regaining and maintaining metabolic and endocrine functions at the upper end of the normal range for age, through lifestyle change and perhaps bioidentical hormone replacement therapy, gives the best opportunity for a healthy and vigorous life. While we may or may not be able to increase longevity, we believe we are able to prevent premature disability and death and enhance quality of life. Our desired end point is to be disease resistant, mentally sharp, physically fit, and maintain a high self-esteem. Longevity without quality of life is not desirable. We now have the knowledge, the technology, and the expertise to at least delay the onset of degenerative disease and the signs and symptoms associated with aging.

  David Chauvin, DO, is board certified in emergency medicine and a fellow in the American College of Emergency Physicians (ACEP). He is also board certified in Antiaging Medicine (American Board of Antiaging Physicians) and in Bariatric [obesity] Medicine (American Board of Bariatric Physicians)

[1] No Truth to the Fountain of Youth Scientific American. June 2002 page 92-95

[2] Guest Viewpoint: Why I Prefer “Age Management” to “Anti-Aging” Medicine By Alan Mintz, M.D., CEO, CMO, Cenegenics Medical Institute, Las Vegas, Nevada

[3] C-Reactive Protein and the Risk of Developing Hypertension. J Am Med Assoc 2003;240:2945-50.

[4] Inflammation, Hypertension and the Metabolic Syndrome. J Am Med Assoc 2003; 240: 3000-01.

[5] Relation between a diet with a high glycemic load and plasma concentrations of high –sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 2002;74:492-4.

[6] Body Mass Index, Diabetes, and C-Reactive Protein Among U.S. Adults. Diabetes Care. 22:1971-1977 (1999)

[7] Dietary AGE Intake and Reduced Insulin Sensitivity. Diabetes 2002;51:2082-9.

[8] Advanced glycation end products contribute to amyloidosis in Alzheimer disease. Proc Natl Acad Sci USA, May, 1994; Vol.91, pp. 476604770.

[9]Effect of Diet and Exercise on Inflammatory and Adhesion Molecules. Metabolism 2004;53:377-81.

[10] Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with normal serum vitamin concentrations. The Lancet, July 8, 1995 Vol. 246, pp. 85-89.

[11] Risk of Alzheimer’s disease and duration of NSAID use. Neurology, 1997;48:626-632.

[12] Caloric Restriction and Aging. Scientific American 1996 January;46-50

[13] Insulin Exposure and Aging Theory, Gerontology 1997;43;182-200.

[14] Effects of Glucose/Insulin Perturbations on Aging and Chronic Disorders of Aging: The Evidence. J Am Coll Nutr 1997;16:397

[15] Origins and evolution of the Western diet: health implications for the 21st century.

Am J Clin Nutr. 2005 Feb;81(2):341-54

[16] Obesity in the Pima Indians” its magnitude and relationship with diabetes. Am J Clin Nutr 1991; 53:1543S-1551S..

[17] Antioxidants and Zinc to Prevent Progression of Age-Related Macular Degeneration. Arch Ophthalmol. 2001;119:1417-1436.

[18] Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. Int J Cancer. 2004 Jan 1;108(1):104-8

[19] Hormone Replacement Therapy and Heart Disease: Replacing Dogma With Data. Circulation,  January 7, 2003;  107(1):  2 - 4

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