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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.]
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
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.
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.
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.
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.
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.
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
Other inflammatory markers such as NF Kappa Beta, inflammatory cytokines,
acute phase proteins, eicosanoids, as well as PPAR Gamma are active subjects of
These inflammatory markers are elevated with obesity, infection, high
glucose, high insulin, hormone decline, lack of exercise, stress and age
Of special note is elevated blood sugar which frequently results in advanced
glycation end products (AGE).
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.
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
Statins, aspirin and NSAIDs
are also showing promise in decreasing inflammation.
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
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.
Insulin sensitivity appears to be the key
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
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
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
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.
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
Correction of vitamin D deficiencies minimizes breast and prostate cancer risk
as well as improves hypertension.
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.
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.
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
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)
 No Truth to the Fountain of Youth Scientific American. June 2002 page 92-95
 Guest Viewpoint: Why I Prefer “Age Management” to “Anti-Aging” Medicine By Alan Mintz, M.D., CEO, CMO, Cenegenics Medical Institute, Las Vegas, Nevada
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 Inflammation, Hypertension and the Metabolic Syndrome. J Am Med Assoc 2003; 240: 3000-01.
 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.
 Body Mass Index, Diabetes, and C-Reactive Protein Among U.S. Adults. Diabetes Care. 22:1971-1977 (1999)
 Dietary AGE Intake and Reduced Insulin Sensitivity. Diabetes 2002;51:2082-9.
 Advanced glycation end products contribute to amyloidosis in Alzheimer disease. Proc Natl Acad Sci USA, May, 1994; Vol.91, pp. 476604770.
Effect of Diet and Exercise on Inflammatory and Adhesion Molecules. Metabolism 2004;53:377-81.
 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.
 Risk of Alzheimer’s disease and duration of NSAID use. Neurology, 1997;48:626-632.
 Caloric Restriction and Aging. Scientific American 1996 January;46-50
 Insulin Exposure and Aging Theory, Gerontology 1997;43;182-200.
 Effects of Glucose/Insulin Perturbations on Aging and Chronic Disorders of Aging: The Evidence. J Am Coll Nutr 1997;16:397
and evolution of the Western diet: health implications for the 21st century.
Am J Clin Nutr. 2005 Feb;81(2):341-54
 Obesity in the Pima Indians” its magnitude and relationship with diabetes. Am J Clin Nutr 1991; 53:1543S-1551S..
 Antioxidants and Zinc to Prevent Progression of Age-Related Macular Degeneration. Arch Ophthalmol. 2001;119:1417-1436.
 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
 Hormone Replacement Therapy and Heart Disease: Replacing Dogma With Data. Circulation, January 7, 2003; 107(1): 2 - 4
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