Chapter 1

A New Role for Medicine

Every man desires to live long, but no man would be old.

—Jonathan Swift

Brian became a patient of mine about three years ago. He was 47 years old. He came to see me not because he was sick but because he wanted to feel better. Brian had built a successful software consulting firm and had worked hard to keep his business going while the high-tech industry went through difficult times. Now he was looking forward to enjoying the fruits of his labors. “I feel like the next twenty years should be the best of my entire life,” he told me, “and I want to be in good health. No, in the best health possible.”

By all conventional measures, Brian was in fairly good health already. Nonetheless, he felt that he was slowing down. He wasn’t planning to retire for another ten years or so, but he was finding it harder and harder to stay focused and motivated at work. His sex life with his wife had tapered off. To add insult to injury, he noticed that his hair was getting thinner at about the same rate that his waistline was getting thicker. In short, Brian was experiencing physical and mental changes typical for someone his age.

Tina first consulted me at age 66, a little over a year ago. Like Brian, she wasn’t sick but was sure she could feel better than she did. Tina is a gregarious, widely traveled woman who has always loved meeting new people and new challenges. She’d been looking forward to her retirement as a time when she’d be free for travel and adventure. But she’d noticed that she had begun to have trouble remembering details and names and felt more easily fatigued. “I hate feeling like a befuddled old woman,” she said. “It’s just not who I am!”

Widowed eight years before, Tina was still a warm and vibrant woman with a lot to offer. She was open to the possibility of meeting someone to enjoy her later years with. But she was becoming less confident about her appearance. She felt that she looked older than she was—and certainly older than she felt. Although everything Tina described was fairly normal for a 66-year-old, she was frustrated and upset by the changes she was noticing.

Both Brian and Tina wanted to know what anti-aging medicine could offer.

THE PROMISE OF ANTI-AGING MEDICINE

Twenty-five years ago, it probably wouldn’t have occurred to someone in Brian or Tina’s situation to seek help from a doctor. It would have been even harder to find a doctor who would have known what to do for them. Neither one of them was significantly overweight; neither smoked or drank to excess. Because they took reasonably good care of themselves, neither was suffering (yet) from heart disease, diabetes, or other conditions that might require treatment. By conventional standards, there was nothing wrong with them. They were in acceptable health . . . for their age.

By those standards, people such as Tina and Brian could do little besides wait for the aging process to unfold, and hope for the best. Along the way, doctors would assure them that aches and pains, failing body parts, and increasing weakness and frailty were simply a normal part of the aging process. As the diseases of aging (heart disease, arthritis, osteoporosis, diabetes, Alzheimer’s disease, prostate cancer, etc.) set in, drugs would be prescribed to manage them.

Most people are accustomed to this style of medicine—and this rather hopeless view of the aging process. Anti-aging medicine, on the other hand, takes an entirely different approach. Whereas the focus of conventional medicine is on the diagnosis and treatment of disease, the goal of anti-aging medicine is to promote optimal health and wellness throughout every phase of the human life span. This visionary approach is built on four basic but radical principles:

Anti-aging medicine is functional. By this, I mean that we are not just concerned with what might be going wrong in your body. Instead, we aim to improve and rejuvenate every function of the body—making the body stronger, healthier, and more youthful.

Anti-aging medicine is preventive. Once full-blown disease has taken hold, even the best drugs and therapies sometimes offer only limited hope. Therefore, we take aggressive action to prevent the diseases of aging with nutritional and metabolic therapies.

Anti-aging medicine is holistic. Too often, the conventional medical system sees patients as a collection of parts to be fixed by various specialists. As a result, many people continue to feel lousy despite the fact that they have an entire team of doctors working on them. By contrast, anti-aging medicine takes a holistic view of the body and of each person. Each aspect of your health is considered and treated in view of the whole person.

Anti-aging medicine is integrative. Unfortunately, our medical community has been fractured into highly politicized camps, with a great deal of mistrust and even hostility between the conventional and alternative movements. There are some conventional doctors who insist that all herbal and nutritional remedies are snake oil, just as there are some alternative physicians who consider all pharmaceutical drugs to be poison. Of course, neither of these extreme statements is true, and this sort of dogmatic rigidity gets in the way of progress. Anti-aging medicine offers the distinct advantage of being truly integrative medicine. By remaining open-minded but science-based, we can combine the best and most effective therapies from conventional and alternative approaches.

It may indeed be normal for people to get weaker, slower, sicker, or more forgetful as they get older. But I want something better for my patients, and for you. No matter what your age or health status right now, my goal is for you to experience a state of exceptional wellness, and to maintain that healthier, more youthful state as you get older. That, in a nutshell, is the goal—and the promise—of anti-aging medicine.

DELIVERING ON THE PROMISE

With both Tina and Brian, I went through the same steps that you will be going through in this book, building a comprehensive anti-aging program that was personalized for their individual needs. First, we analyzed every aspect of their health, including hormone levels, nutrient status, organ function, body composition, stress levels, disease risk factors, mood, performance, and cognitive function. All of these factors are biomarkers of aging. They indicate the functional status of your cells and organs and reveal how quickly or slowly you are aging.

Based on this information, I developed programs for each of them. First, I coached them on diet and nutrition, exercise, stress reduction, and other lifestyle factors that are the foundation of an anti-aging program. (You’ll find these discussed in detail in Part III.) Gradually, each of them implemented a customized program of anti-aging nutrients and hormonal supplements, based on the science and principles that we will be discussing in the next chapters. Over the course of weeks and months, as their cells, organs, and glands began to function better and better, both Brian and Tina began to notice big changes.

Six weeks after beginning his anti-aging program, Brian was already feeling on top of the world. He was fired up at work, instead of fighting off the Monday (and often Tuesday and Wednesday) blues. He’d lost about 8 pounds, although he had not been eating any less, and reported that things in the bedroom had taken off. “I feel like I did when I was a freshman in college,” he said. Brian couldn’t wait to continue with the next levels of the program. Three years later, he has met and exceeded every goal he set for himself.

If you met Brian today, you’d probably guess he was at least ten years younger than he is. Although his chronological age is now 50, I would judge his biological age, as measured by his hormone profiles, neurological function, heart health, immune status, organ function, and body composition, to be somewhere between 38 and 43, and holding. Seeing a patient experience this sort of metamorphosis is the reason I love practicing anti-aging medicine.

Tina also felt a huge surge in energy during the first few weeks of her anti-aging program. Over the next three months, she noted steady improvement in her memory and recall and general mental clarity. Instead of feeling her horizons narrowing, Tina felt that the world was once again her playground.

Not only did she feel better, but Tina also looked younger as a result of the anti-aging therapies she implemented. You could see the difference in her skin, the way she moved, and her attitude. Coming back from a trip, she told me that a man in the group who was ten years younger than she was had asked her for a date! “I never thought I’d see those days again,” she said. A year later, Tina says she hates to think what her life would look like today if she hadn’t taken action against aging.

Throughout this book you will meet more people like Tina and Brian, who not only feel and look years younger as a result of anti-aging therapies but have also pulled themselves back from the brink of serious disease, resolved lifelong health issues, and reduced or discontinued unnecessary or harmful medications.

No matter what your age or current health, anti-aging medicine offers you the same opportunity. With the program outlined in this book and the help of a qualified anti-aging medical professional, you can rejuvenate your body inside and out. You can vastly reduce your chances of disease and disability. You can enjoy the most vibrant health of your lifetime.

HOW AND WHY DO WE AGE?

The key to controlling the aging process lies in a better understanding of how and why we age the way we do. Only then can we take steps to slow or reverse that process. In just the past few years, we have gathered an enormous amount of new information about how our bodies age. This insight has already led to dramatic advances in effective anti-aging therapies, with the promise of more to come in the very near future.

Aging, we have learned, is not just a matter of mechanical wear and tear, cellular exhaustion, environmental toxins, or genetic programming. It is not simply hormonal, nor is it caused entirely by free radical damage, pathogens, or structural changes. And yet, all of these things play a role.

Cellular “programming.” To a certain extent, the decline in function and wellness we experience as we age is programmed by nature. The cells in your body are continually reproducing, replacing old and damaged cells with new ones. But every cell, even the ones that are newly formed, has an internal clock that remembers how old you are. That clock determines how that cell behaves, affecting how quickly the cell responds to messages from other cells and what quantities of hormones, enzymes, and other cellular chemicals are produced.

Biochemistry. As cellular behavior changes with age, the result- ing changes in biochemistry and hormone profiles have a sort of domino effect throughout the body. Your metabolism slows, and more fat is stored under the skin and around organs. The body breaks down muscle and connective tissue more quickly, while its rebuilding capacities slow down. The digestive system becomes less efficient at extracting nutrients from food. Cells and organs become less effective at detoxification functions. Nerve cells in the brain shrink and stiffen. The immune system becomes less vigilant against invading microbes or mutated cells.

Environmental influences. The effects of changing biochemistry on your organs and tissues are compounded by factors from the external environment. Every day, our bodies are bombarded by ultraviolet radiation, assaulted by free radical molecules, and exposed to a multitude of bugs and germs as well as natural and man-made toxins. All of these interact with our genetic “program” to speed (or slow) the aging process.

Heredity. In addition to the changes that are programmed to occur as we get older, we each also have a unique set of inherited genetic influences that affect how quickly or slowly we age, and may predispose us to certain diseases or conditions.

Lifestyle factors. Our daily lifestyle habits, such as how much sleep we get, how much stress we are under, and what we eat or don’t eat, also play a huge role in how our bodies cope with the internal and external factors that drive the aging process.

We’ll be discussing all of these aspects in greater detail in the coming chapters. But even this brief outline shows that aging is a very complex process involving many factors. Figure 1.1 on the following page shows how these various factors interact with one another and flow down through multiple, overlapping layers of cause and effect. Notice that the typical symptoms and diseases of aging, seen at the very bottom of the diagram, are actually the culmination of a very long process that begins much earlier, long before we are old or even middle-aged.

THE AGING YOU CAN SEE IN THE MIRROR

Let’s make this abstract discussion a bit more concrete by looking at a specific example of the aging process—one you can observe in the mirror. As we get older, the smooth, firm, and unlined skin we all have when we are young gradually becomes looser, less firm, and increasingly creased and wrinkled.

Like all aging, skin aging is the result of a combination of genetic and environmental factors. As we get older, changes in cellular behavior lead to changes in hormone levels that cause the skin to become thinner. The barrier function of the skin, which attracts and retains moisture in the skin, also becomes less effective, making the skin drier as well.

Underneath the skin is a flexible support structure made up of collagen fibers. But aging skin cells produce more collagenase, an enzyme that breaks down collagen. At the same time, the cells become less responsive to signals that tell them to increase production of fresh collagen. Because the skin is breaking down collagen faster than it is replacing it, the collagen layer underneath the skin begins to shrink and collapse. On the surface, the skin becomes loose and spongy and begins to fold in on itself, forming lines and wrinkles.

All of this is part of the genetic program for aging. The speed and timing of your particular aging program will be determined in part by heredity. But environmental factors greatly compound these genetically triggered changes in skin function. Ultraviolet radiation from the sun further stimulates the production of collagenase, the enzyme that breaks down collagen. It also creates enormous numbers of free radicals in the skin. That’s where lifestyle issues (diet and nutrition) come into play. If there are sufficient antioxidant reserves in the body, excessive free radicals are largely neutralized. But if nutrition is poor and antioxidant levels are low, the free radicals can damage skin cell membranes, causing changes in pigmentation that show up as age spots or darkened patches of skin on the hands and face.

Of course, aging affects more than just the cosmetic appearance of skin. It also affects its health and function. Many people, for example, spend a lot of time outdoors in the sun when they are young. And yet skin cancer is relatively rare in younger people. But as we get older, skin cancer becomes more and more common. Why?

At any age, ultraviolet rays and free radicals can damage the DNA in skin cells, causing them to mutate and begin abnormal replication. This is the first step toward developing skin cancer. But in a youthful, healthy body, these mutated cells are destroyed by the immune system before they can cause a problem. As we get older, hormonal and cellular changes render the immune system less vigilant. As a result, mutated and malignant cells are more likely to survive and continue dividing, eventually forming cancerous growths.

Do you see how genetic, biochemical, environmental, and lifestyle factors interact to cause the changes in structure and function that we can observe in aging skin? These same factors are affecting every system, organ, and tissue of your body. Together, they produce the effect that we know as aging.

WHAT CAN BE DONE TO SLOW AGING?

The good news is that we can do a lot to reduce, correct, or compensate for the many biochemical and metabolic changes that occur as our bod-

ies get older. At the genetic level, we are getting very close to isolating and identifying the precise parts of the genetic code that cause our cells to function differently as we age. This may eventually allow us to halt or reverse the genetically programmed changes that contribute to aging.

In the meantime, we can compensate for age-related hormonal declines with bioidentical hormone replacement protocols. This can help to prevent the changes in biochemistry, metabolism, and cell function that lead to poor health as we age.

Nutrient protocols can enhance immune surveillance, support organ function, improve detoxification, and improve cellular repair. Dietary and lifestyle changes support metabolism, detoxification, and disease resistance. On the environmental front, we can reduce our exposure to radiation, toxins, and pathogens. Each of these approaches is described in detail in the chapters that follow.

Any one of these steps will lead to a remarkable improvement in your health. In fact, you will come across many nutrients and therapies in the following pages that at one time or another were heralded as the silver bullet that would prevent all aging. As the field of anti-aging medicine has matured, we now know that as powerful and important as these discoveries have been, no one hormone or vitamin can prevent aging.

Just as there is a cascade effect in aging, with changes triggering further changes and effects compounded by other effects, anti-aging therapies likewise have cascading and compounding effects. The true power of anti-aging medicine is the integration of all of these tools into a comprehensive approach.

THE FUTURE HAS ARRIVED

Anti-aging medicine is now the fastest-growing medical specialty in the United States. This reflects more than merely a change in attitude and philosophy. It reflects the enormous scientific advances that have been made in our understanding of the causes and treatments for aging.

It also recognizes the economic and social imperative we face as senior citizens become the largest sector of our society. With dwindling government resources and a crippled medical safety net, the pursuit of anti-aging therapies is a matter not of vanity but of survival.

It’s no longer acceptable or responsible for doctors to dismiss a gradual deterioriation of function and wellness as “what happens when you get older.” It’s also not good enough to medicate symptoms as they arise, using pain relievers, antacids, arthritis drugs, and cholesterol medications. We must find a way to remain healthy, vital, and productive as we enjoy the longer life span that modernity has made possible.

The program you are about to embark upon will allow you to grow older without becoming aged. It will maximize your chances of not only a long life but a long and healthy life. Anti-aging medicine is more than just a medical specialty. It is the future of medicine and the future of humankind.