Anti-Aging

Anti-Aging Medicine

If you have had your cholesterol tested, taken a lipid-lowering drug, had a mammogram, or taken HRT with thyroid, testosterone, estrogen, melatonin, or DHEA, you have experienced anti-aging medicine. This form of medicine is based on the very early detection, prevention, and reversal of age-related disease. 90% of all adult illness is due to the degenerative processes of aging. This includes heart disease, most cancers, adult-onset diabetes, stroke, high blood pressure, osteoporosis, osteoarthritis, autoimmune disease, glaucoma, and Alzheimer's.

With early detection and appropriate intervention, most of these diseases can be prevented, cured, or have their downward course reversed.

Hormone Balance

The main categories of our hormones include the adrenal hormones (mainly cortisol and DHEA), the sex hormones (estrogen, testosterone and progesterone), the thyroid hormones (TSH, T3 and T4), melatonin, prolactin and growth hormone. All men and all women make these hormones, just in different amounts. For example, fatigue, poor energy or anxiety may be signs of low testosterone in both men and women.

Each person's hormones are as unique to them as their finger prints. Laboratories report a range of normal for each hormone but one size does not fit all. Rather, where within this range an individual's normal falls varies from person to person. Hormonal balance has a significant impact on health and well-being. To achieve or maintain optimum health, all hormones in the body need to work harmoniously together. If one hormone is altered, whether it is excessive or deficient, it will affect all other hormones.

Anti-aging physicians prescribe bio-identical, customized hormones which are compounded by compounding pharmacies to each individual's needs in order to balance hormones.

Compounding entails the mixing of one or more drugs to fill a physician's prescription. Millions of compounded medications are prescribed each year in the United States . All 50 US states regulate compounding under pharmacy laws. In fact, states require that the core curriculum at pharmacy schools teaches compounding to all pharmacy students.

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Coronary Artery Disease

To optimize heart health, anti-aging physicians evaluate lifestyle, dietary and hormonal factors. The former two impact the latter. All of them have shown effects on cardiovascular health.

There is a gender-based disparity in cardiovascular disease (CVD) in this country. Almost all large research studies on CVD have focused on men, despite the fact that each year CVD kills 43,000 more women than men. Women have different symptoms of CVD and different test results for CVD. They interpret their symptoms and report their symptoms differently than men. Coronary angiography is the gold standard for demonstrating coronary artery disease in men. This test does not prove coronary artery disease in women as their diseased cardiac vessels are predominantly at the capillary level. Gadolinium MRI will possibly become the gold standard for diagnosing coronary artery disease in women. Sadly, to date, no scientific study has been done to establish such standard for women.

Synthetic estrogen and synthetic progesterone have been shown to increase clotting and inflammatory factors in postmenopausal women. This makes sense since the Women's Health Initiative (WHI) Study showed an increased incidence in stroke and heart attacks with synthetic Hormone Replacement Therapy. Meanwhile, transdermal bio-identical estradiol and progesterone have been shown to improve markers of cardiovascular disease in perimenopausal and postmenopausal women. In fact, natural progesterone opens the heart vessels whereas progestins (synthetic progesterone) are coronary vasoconstrictors.
Estrogen helps maintain the elasticity of the arteries. It dilates small arteries, inhibits platelet stickiness, decreases arterial plaque formation, decreases blood pressure, decreases the bad cholesterol LDL, lipoprotein(a)and homocysteine (all risk factors for CVD ), and increases the good cholesterol HDL .

In men, natural testosterone has been found to dilate coronary, aortic and brachial arteries. It is noteworthy that men's progesterone levels decrease after age 60. This is significant because progesterone helps increase testosterone levels.

Cognitive Decline

Low testosterone and low estrogen levels in women and low testosterone levels in men are associated with cognitive decline. Appropriate bio-identical hormone replacement has been shown to improve or reverse memory loss. Treatment with testosterone has improved symptoms in Parkinson's disease and Alzheimer's disease.
In addition, detoxification and supplementation with nutrients, vitamins and herbs play an important role in preventing and treating cognitive decline.

Thyroid

The thyroid gland has been called the body's gas pedal. It influences energy, metabolism, tissue repair, digestion, fertility and sexual function to name a few. The thyroid can malfunction at any age. We have a thyroid epidemic of thousands with undiagnosed hypothyroidism and an increasing number of people with thyroid anti-bodies. This is an autoimmune phenomenon which can cause both high and low thyroid function. Even subclinical hypothyroidism, will increase one's risk of death from heart attack as shown by a recent Scandinavian study. One of the problems contributing to the vast number of undiagnosed hypothyroidism is the fact that, even though the American College of Clinical Endocrinologists recommended in 2002 to set the upper limit of normal for TSH at 3.0, many laboratories still use 5.0 as the cutoff point.

There are several kinds of thyroid hormones. The thyroid gland makes mostly T4 and some T3. T4 is the inactive form of thyroid hormone and needs to be converted to the active form T3 in the liver or kidneys. T4 can also be converted to an inactive form of T3, reverse T3.

Thyroid problems can arise from a number of situations. There may be inadequate production of T4, inadequate conversion of T4 to T3, problems with the thyroid receptor, problems with the cell's ability to take up T3 or problems with intracellular transport. Nutritional deficiencies, medications, diet, exposure to heavy metals, to chlorine, to fluoride and to environmental chemicals, stress and chronic illness can all adversely affect thyroid function. Evaluation of the thyroid should include measurement of the hormones TSH , free T4, free T3, thyroid antibodies and reverse T3.

If you have hypothyroidism and it is treated only with T4 (Synthroid or levothyroxine), you may still experience symptoms of hypothyroidism, if, for example, there is a problem with the conversion of T4 into T3. Simultaneous T3 and T4 replacement is more effective than only replacing T4. One option is to add Cytomel (T3) to Synthroid (T4). Another option is to switch to Armour Thyroid which contains both T3 and T4 in a 1:4 ratio. The physiologic ratio in the body is 1:3. If Armour Thyroid is not optimal for you, thyroid replacement can be customized for you by compounding.

Supplements

There are hundreds of peer-reviewed medical and scientific research studies that support the use of supplements to optimize health and to treat disease.
Supplements are important in substituting for dietary deficiencies and in the prevention and treatment of age-related decline.
The Standard American Diet is truly sad as we consume 140 pounds of sugar and about 18% of our total calories per year from white flour . These are not only nutritionally deficient in themselves but use up valuable nutrients as the body digests and assimilates them. The recommended daily allowances (RDAs) published by the Food and Nutrition Board of the National Academy of Science do not take into account individual variability in the requirements for vitamins, minerals and other nutrients to obtain optimal health. Our soils are depleted of nutrients, which if present, would have been taken up by the plants we eat. Produce is treated with pesticides to increase crops. Animals are treated with hormones and antibiotics to increase yields. There are 80,000 synthetic chemicals in our environment. The EPA estimates that more than 4 billion pounds of chemicals were released into the ground in the year 2000 alone. We drink chlorinated water, which the body converts to carcinogenic metabolites. Our drinking water is contaminated with pesticides and antibiotics. The average American eats over 100 pounds of additives per year. We prefer to drink ice cold drinks and often eat foods out of the fridge. Cold temperatures, however, inhibit digestive enzymes naturally present in produce, therefore impeding proper digestion. Improperly digested food cannot be absorbed in the GI tract.
Nutrients listed on a food label may be poorly absorbed or may not be bioavailable, which means the body cannot utilize them. A nutrition label will not tell you if a specific nutrient is biologically available. All these are reasons why our diets are nutritionally inadequate.

There are many reasons why both the men and women in today's society have hormonal imbalances. Stress is one factor. This may be emotional and physical stress due to our 24/7 lifestyle, stress from disrupted sleep or from food allergies. Stress, regardless of its source, affects adrenal hormones, which in turn impact sex hormones and thyroid hormones.
Another reason for hormonal imbalances is our exposure to xeno-estrogens. Xeno-estrogens are estrogens that are not native to our bodies. They are estrogens that our body does not make. Examples of xeno-estrogens are birth control pills, synthetic hormone replacement such as Prempro, xeno-estrogens in meat, eggs and dairy, and xeno-estrogens in plastics and cosmetics. Xeno-estrogens create havoc in our bodies because they attach to estrogen receptors in both men and women and disturb the function of our innate hormones. In fact, many anti-aging physicians are concerned that our ubiquitous exposure to xeno-estrogens is to be blamed for the increasingly earlier menarche young girls experience in our culture.
In addition to environmental estrogens, other causes of estrogen imbalances in the body include lack of exercise, lack of fiber and grains in the diet, impaired elimination of estrogen and elevation of a toxic estrogen metabolite, namely 16-OH estrone.

Like most anti-aging physicians, Dr. Worwag prefers the term bio-identical hormones over the term natural hormones because the latter can be confusing. Bio-identical hormones are naturally-derived hormones of a chemical structure that are identical to that made by the body. Bio-identical hormones are derived from yams or soy. Synthetic hormones are derived from “natural” sources as well, such as yams or horse urine (hence the name premarin which means pregnant mares' urine). Synthetic hormones are NOT natural to our bodies because they are not identical to the hormones the human body makes. While synthetic hormones fit in human hormone receptors, they do not have the same action as bio-identical hormones because they are chemically different from the hormones which the body makes. One example would be synthetic progesterone in morning-after pills which cause abortions, as opposed to bio-identical progesterone which prevents miscarriages. Synthetic hormones, because they are foreign to the body can take six months to be eliminated.
It is the synthetic estrogens and progestins (synthetic progesterones are called progestins) that were found to have significant adverse health effects in the Women's Health Initiative (WHI) study. In fact, this randomized, controlled clinical trial was prematurely ended in 2002 because postmenopausal hormone replacement therapy (HRT) was associated with a 29% increase in heart attacks, a 22% increase in total cardiovascular disease, a doubling of blood clots, a 41% increase in strokes and a 26% increase in breast cancer. While this study was of tremendous importance in showing the adverse effects of synthetic hormone replacement therapy, one unfortunate effect is that many women are shying away from bio-identical hormone replacement therapy (BHRT) because of fears of adverse cardiovascular side effects or breast cancer.

Bio-identical hormones have been successfully used in Europe and the United States for over 60 years. Bio-identical hormones cannot be patented. Therefore, pharmaceutical companies have no commercial interest in them, and may actually perceive them as a threat to their profits [as evidenced by one pharmaceutical company's recent complaint to the FDA about estriol, also called E3. Estriol is one of the body's three naturally produced estrogens. It is particularly prominent during pregnancy. The fetus is essentially bathed in E3 for 9 months. Estriol is sold in Europe over-the-counter as a vaginal cream where it is produced by an international pharmaceutical company that is also present in the United States.

Bio-identical hormones have been shown in dozens of studies to be effective and safer than synthetic hormones. Dr. Worwag prefers labeling bio-identical hormones as safer rather than safe because, when used inappropriately, such as the wrong dose or delivery route, bio-identical hormones can have detrimental effects. One example would be a prescription of oral bio-identical estrogens for someone with a history of blood clots. Oral delivery of estrogen, whether bio-identical or synthetic, increases the risk of blood clots. Another example would be the use of unopposed estrogens. This is the use of estrogens without concomitant use of progesterone. Oral and topical estrogens alone increase the risk of breast cancer. Estriol, however, when vaginally delivered, decreases the risk of breast cancer in comparison to not using hormones at all. Furthermore, vaginal estriol is not associated with an increase in breast cancer even if a woman had breast cancer in the past. In other words, vaginal estriol does not increase the breast cancer recurrence rate in a woman with a past history of breast cancer. Even better, there is significant evidence for estriol's protective effects against breast cancer.
Progestins (synthetic progesterone) doubled the risk of breast cancer in a large British study called the Million Women Study. Bio-identical progesterone was not used in this British study. The finding that oral and topical estrogens slightly increase the risk of breast cancer was confirmed in a French cohort study of 80,000 women. This study also confirmed that progestins (synthetic progesterones) increase the risk of breast cancer while bio-identical progesterone decreases the risk of breast cancer . Again, vaginally delivered estriol did not increase the risk of breast cancer in the French study.

A detailed understanding of the complex interactions of all of the body's hormones is key to their safe and effective use. In the body, for example, DHEA, an adrenal hormone, is converted to the sex hormone testosterone which in turn is converted to estrogen, another sex hormone. Women with low DHEA levels need lower DHEA supplementation than men because they can develop acne and facial hair growth. Another example would be that high production of the adrenal hormone cortisol will suppress sex and thyroid hormone production.

It is not only the amount of each hormone but the ratio of one to another that is important. For, example, a relative excess of progesterone in relation to estradiol (one of the body's three estrogens) can cause increases in total cholesterol, in the bad cholesterol LDL, in triglycerides and a lowering in the good cholesterol HDL .

Diet, lifestyle and aging affect hormone levels, as do many medications including some blood pressure medications and some cholesterol-lowering drugs. Supplements also affect hormonal balance. Just as medications, diet and lifestyle are factors that can cause hormonal imbalances, one can use these same factors to help re-establish hormonal balance.

A significant change in hormonal function happens at menopause and andropause. (Men go through menopause as well. Their menopause is called andropause). Women's menopause is known for its decline in estrogen and progesterone. Men's menopause is called andropause and is characterized by a decline in testosterone and DHEA and an increase in estrogen.
Women go through menopause between ages 35 to 55. A woman's hormones begin to decrease in the 12 years preceding menopause. Only 40% of them experience hot flashes. Other symptoms of menopause include palpitations, night sweats, insomnia, snoring, decreased libido, vaginal dryness and itching, painful intercourse, frequent urination, urinary leakage and urinary tract infections, bloating, indigestion and flatulence, mood swings, irritability, anxiety, depression, panic attacks, hair loss, facial hair growth, migraine headaches, memory problems and weight gain. The average weight gain during menopause is 20 pounds.
The male equivalent of menopause is andropause. A man's testosterone level decreases by 1% to 1.5% per year between ages 40 and 70. A man's hormonal decline is more gradual than that of a woman. While men typically experience andropause-related symptoms between ages 45 to 55, the effects of low testosterone can be seen as early as age 35. Men may experience hot flashes. Other symptoms include increased sweating, increased blood sugar, erectile dysfunction, decreased libido, incontinence, fatigue, emotional lability, depression, memory loss, loss of concentration, sleep disturbance, lack of motivation and poor sense of well-being. Men may feel they have lost their edge or their drive.

Anti-aging medicine employs hormonal assessment and balancing as an integral part of prevention, diagnosing and treatment of disease at any age. Many conditions associated with age-related decline, such as heart disease, osteoporosis and memory loss can be prevented or treated with bio-identical hormone replacement.

Ivy Pain and Rehabilitation, PLLC