Anti-Aging Medicine / Age Management Medicine. What is it? Is it real? Are there real controversies here? In a word, yes. Can it be fulfilled in today’s guideline, task force, economic environment?
We are poised at a very important juncture. Anti-aging medicine offers promise of a goal oriented path to optimal health and well being. Or we can pursue restrictive policy driven, algorithms of cookbook medicine.
What needs to change? What gives it the stamp of approval? Is it science or politics? As the great philosopher Schopenhauer said:
“All truth passes through three stages. First it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
There is a plethora of terms that have been spun off to better describe this new field. Longevity Medicine, Age Management Medicine, functional medicine, integrative medicine. These are all descriptions in pursuit of a new paradigm.
All medicine has from the beginning, most notably Hippocrates, been an effort to mitigate illness and suffering with the implicit goal of increasing life span. One yardstick could simply be life span or longevity. But we are more interested in quality of life. And here is the key. Increasing HealthSpan. It is about “squaring the curve” — living longer in a healthy, vibrant, vigorous, independent, and happy state of health and well being.
The paradigm shift is tectonic. We don’t have a health care system. We have a disease management system. All ICD-9 (now ICD-10) codes are a codification of disease. If you feel weak, fatigued or just “not right” you may not be suffering from a disease. You can have a battery of tests and nothing will “show positive” for a disease. You have a dysfunction. Pre-menopause is not really a disease. Yet it lasts for upwards of 4-5 years and can be seriously disabling. A dysfunction. Andropause is not even widely recognized as such. It is also a dysfunction that men suffer later than menopause. There is no formal ICD-10 code for andropause — just hypogonadism.
The wonderful medicine of the last 50 years has been disease-based , pathology-oriented with the goal of finding the right drug to cure or mitigate your disease. But there is a rapidly growing residua of conditions and patients who are not right, dysfunctional, that do not respond to the conventional or traditional approach. …
Exercising. Is there anything new we can say about the benefits of exercising? You have seemingly heard it all from the exhortations to buy the latest exercise tape to the knowledge that this is a nation of larger and larger people – fat. There was a tiny note in the news many years ago that the seats at Wimbledon were being increased by 2” – too many “strawberries and cream.”
So tell me something new.
It seems that too many of us are not exercising at all. We know that. But the flipside is that too many of us may actually be over-exercising. The most illustrative example is extreme sports. There is a terrific toll being taken on those pursing the really extreme sports – Iron Man competition and similar events.
As we age, we know that our physiology and “internal furnace” or thermostat changes. What we could eat indiscriminately as a teenager is no longer tolerated. We could eat all the root beer floats, cheese burgers, and fries and never gain significant amounts of weight. But advancing age and various internal hormonal and biochemical shifts no longer afford us this indiscreet behavior.
My good friend, Dr. Frank Shallenberger in Reno, Nevada has developed a highly unique and innovative system of measuring the quality and efficiency of your exercise routines. It is a variation of VO2Max determination (maximal oxygen uptake efficiency). He has determined that as we age we shift from fat-burning, a more powerful source of energy at 9 kcal/gram, to carbohydrate-burning, a less efficient source of energy at 4.5 kcal per gram. The quite obvious conclusion is that we lose the ability to burn extra fat as a source. It accumulates in all those unsightly areas. Meanwhile, we pursue a less efficient source of energy which leads to glucose and insulin intolerance and ultimately … diabetes.
Menopause / Andropause is the result of age related waning sex steroid levels.
Think steroids. What’s the first thing that comes to mind? What’s the first image? Bulked up Olympic Athletes? Baseball players testifying before congress? Or something else? Sex hormones — it’s what keeps us youthful, vital and playful.
We live in a world loaded with images and mis-perceived words. Menopause has become so much more”acceptable” to talk about. You could go to a local bookstore and find maybe 5 or 6 books on this subject 25-30 years ago. Now you can find an entire section. But andropause was less well known or even accepted until more recently popularized by marketing mad men as the “low-T-syndrome.”
There is one recurring theme where the sexes change roles. Women take charge and solve problems when not feeling well. When “off” men just keep working harder trying to ignore the fact that something may be “not quite right.” So men tend to become overwhelmed and find themselves about 25 years behind women in this final “passage.”
It has been said that we should stop worrying so much about Menopausal symptoms. Just let it unfold. Live with it and it will all pass. Surely this is the way of nature. Grow old gracefully.
But the truth is that we are living in exceptional times.
At the dawn of the 20th century, as consistently difficult as it is to believe, life expectancy was 47 years. By 1936 it had increased to 65 years. Today life expectancy is about 78 years. A dramatic increase, as illustrated by the very fact that for most of human existence, most women never lived long enough to “suffer” the pangs of menopause.
It is a recurring theme, the baby boomers lead once again. Why? There are 76 million of us turning 50 at the rate of 1 every 18 seconds for the next 20 years. It remains a potent force as it has for the last 5 decades. You can’t ignore us because the population bulge in the modern world continues to favor the baby boom population. We are an aging society. The World Health Organization and large annuity companies are only too aware of this developing fact. The fastest growing segment of our population is … 85 and above.
A new field and discipline is emerging in Medicine. It has various appellations — Anti-Aging Medicine, Rejuvenation Medicine, Longevity Medicine, or Age Management. But its common theme is applying well researched phenomenon of the aging process to a focus on a new paradigm. This is the essence of functional medicine. It is the application of medicine to improve and optimize function as opposed to the late stage intervention and treating of disease states. It is forward thinking and is the solution to the dilemma facing modern medicine — treating larger numbers of people with diminishing national economic resources.
So what does this mean to you? In the Silicon Valley, as in so many large metropolitan areas around the country and even around the world, we are faced with the business dilemma of retaining an aging workforce. Until recently the simple solution has been the hiring of younger workers at less expensive salaries or, worse, off-shoring. But we lose an entire generation of expertise, savvy and know-how. It is a temporary fix. Long term, more and more post-50 workers will stay in the work force — of necessity. How? This is even more critical for physicians who are retiring en masse after the age of 60 because of a crush of regulations.
The most successful application of Anti-Aging Programs is a coordinated and structured approach that begins with solid and time tested principles of good nutrition, exercise and supplementation. There is a level of hormonal modulation and balance but it is followed by “cognitive enhancement.” This means staying smart and retaining memory. Brain Longevity, as it was called by Dharma Singh Khalsa in his epic volume. We all experience a loss of memory for names and small details past the age of 50 (actually past 38). So that a structured approach to reviving this memory gap remains vital. Our memory storage and recall are our little internal hard discs. We resort to the use of external devices such as PDAs and Google searches. …
Osteoporosis. Now you thought this was a problem of 70 and 80 year olds. What was once heard described by a patient quoting her physician, “well, Mabel it seems you have moldy bones.” But some of the largest and well known HMOs won’t even begin testing for this until after 60 — until it may be quite late in the game. So why be concerned?
Osteoporosis by definition is a lack of bone strength — leading to a fragile structure usually characterized by a lack of calcium. It
is technically a decrease in bone mineral density which is best diagnosed by a DEXA (dual energy x-ray absorption) scan. But calcium (or milk and dairy products) alone, contrary to such popular belief is not enough. By way of example, a piece of chalk is loaded with calcium carbonate and we all know how strong simple chalk can be — not very. Why suggest that both men and women start checking for this in their early 40’s rather than waiting until much later? Maybe it has to do with current eating patterns. Maybe … it has to do with …prevention.
It is a painful sight to this physician and writer to see patients shuffling past an office window, stooped over a haltingly advancing walker. It is all so preventable. Hopefully, you are whispering — not for me.
At variable rates of aging or even extreme athletic competition is a subtle and then progressive outflow of calcium from bones. We are withdrawing calcium from “the bank” Our bones, seen as the skeletal support that keeps us upright, remains our main reservoir and “bank” for total body calcium. The outflow eventually moves into the blood vessels, heart valves and tissues. High performance athletes actually accelerate this shift much earlier.
What controls this process? It is a complex set of hormones, including testosterone, estrogen, progesterone and parathyroid hormone; minerals including calcium, magnesium, strontium, boron; and the vital regulatory Vitamins D3 and K. But there is a greater culprit lurking.
Carbonated Soft drinks.
These ubiquitous little companions have high concentrations of phosphoric acid which gives it the fizz. But phosphoric acid is a superb calcium chelator, meaning it sucks calcium out of the bones with vigor. So to an entire generation that is waking up to carbonated soft drinks, diet or otherwise, we are filing up the tank with powerful calcium thieves. And this is why the “epidemic” could reach such alarming levels in the next decade or two. Osteoporosis, the “disease” of the “elderly” is going to be more commonly diagnosed in mid forty year old women and, who knows, younger.
The good news — osteoporosis is preventable.
This is where Anti-Aging Medicine can begin to realize the promise of a new paradigm. If we can begin to see that some gentle shifts in eating habits, and modest exercise, and the proper consumption of true “bone builders” loaded with a healthy balance of calcium, magnesium and more, then the answer is upon us.
The iconic images of Sophia Loren, John Glenn, Jack LaLaine and Clint Eastwood give us positive pause. Vigorous, fit, mobile and youthful members entering seventh, eight and even ninth decades. We all have a choice.
There is the offer of various drugs such as Fosamax and Evista and others to reverse this process. This caters to the old model of drive-through medicine — fix me up now that the process has resulted in a fracture of the hip or the backbone (lumbar vertebrae). But those of us in the baby boom population have a different answer. Active and progressive prevention.
And you have another advantage — the sun. Recently vilified as causing wrinkly skin and skin cancers, the Sun is your most important source of Vitamin D. This is the up and coming micronutrient that is essentially free and widely available in Florida. Modest and brief “unprotected” exposure to sunlight can produce as much as 10,000 units of Vitamin D daily. This is one of the crucial regulators. Healthy vitamin D that is at low levels in more Northern climates. Vitamin K2 remains the other vital nutrient available in foliage vegetables and as a supplement from select companies.
Take these healthy precautions, and ask for DEXA scanning in your 40s and a brisk upright, confident walk and stance remain in your future.
As we say, it’s up to you and it’s about time …
Philip Lee Miller, MD
Founder, California Age Management Institute [formerly Los Gatos Longevity Institute]
Author, the Life Extension Revolution
March 2, 2006
Originally published in the Affluent newspaper
California Age Management Institute
Monterey, CA, USA
(408) 358-8855 tel
(408) 358-8855 fax
“I’m so stressed I can’t even think straight.” Sound familiar? Is stress always bad? Can it even be motivating? Are we suffering too much stress today? What is the link between stress and memory and mood?
Strangely there is a link. Stress physiology has come of age. It all started in the late 1950’s with the pioneer work of Hans Selye at McGill University in Canada. He developed the general adaptation theory. The modern leading researcher in stress is Robert Sapolsky author of the delightful and whimsical book Why Zebras Don’t Get Ulcers. He is professor of biology and neurology at Stanford University and a research associate with the Institute of Primate Research, National Museum of Kenya.
But let’s start with Selye and the short unknown volume he wrote in 1975 entitled Stress with out Distress. Turns out stress is actually motivating. It gives us our edge. It is what keeps us moving. It is distress that causes dis-ease. So the notion we call stress is really distress, a pathologic condition that leads to ill-at-ease, disease and a general assault on our immune system. This has given rise to a most compelling but quite daunting term — psycho-neuro-immunology. It is the science of how our emotions and perceptions (brain) control our immune system and thereby affect our susceptibility to disease and pathology like cancer and chronic illnesses. …
In the whimsical and delightful adaptation of the classic Peter Pan — Hook — Toodles is heard to say, “I’ve lost my marbles.” At the very end there is resolution. Memory until quite recently was thought to be irretrievable. You lose it forever. A senior moment. “Now, why did I come into this room?” “Where are my eyeglasses?” How many times have you tried to recall a familiar name, an actor or actress, an old friend, only to recall it minutes, hours or even days later? It was not gone — just temporarily beyond reach.
What is memory? An ancient question that still has no definitive answer. We do know these facts. Memory traces start fading at the age of about 38 according the most astute practitioners of psychometric testing. But these are fleeting moments. At age 50 these become a bit more disconcerting. Certainly by 60 these become more frequent lapses and beyond. But this is not inviolate.
One of the most daunting interviews this reporter remembers from the last 10 years was an interview with George Burns at the age of 92. He was witty and “on.” He had total recall of so many of the old jokes. Like a catalogue. Maybe as anyone would ride a bicycle, or golf, or bowl, you don’t forget these things. But it underscores the point that age had not diminished his most cherished bag of tricks.
Short term memory is stored in the more primitive part of the brain also reserved for emotions and sexual arousal — the limbic system. Longer term memory is stored in the left temporal lobe. We also know that as we age the fine neural network connections between neural cells — the dendritic arborizations — thin out. The network is not as rich. As if the internet highway between San Francisco and New York have less possible routings. …