Key Anti-Aging and Integrative Medicine Initiatives 2011
Stephen Holt, MD, PhD, DSc, LLD, DNM, ChB, FRCP (C), MRCP (UK), FACP, FACG, FACN, FACAM, KSJ, Distinguished Professor of Medicine (Emeritus), Scientific Advisor to www.naturalclinician.com.
Introduction
The Integrative Medicine physician who practices anti-aging medicine is inundated with new information on ways and means of “staying young forever”. As another year, in the field of anti-aging sciences, draws to a close, I have selected several areas of anti-aging science that form the exciting frontiers of longevity medicine. There is a modern focus on three areas of pursuits in anti-aging science that are inextricably linked with each other in what I have called the “Anti-Aging Triad” (www.antiagingtriad.com). The triad is composed of the use of calorie restriction (or calorie restriction mimetics) stem cells and telomere sciences in an attempt to increase average and maximum lifespan.
Of course, few people need a reminder about the consequences of the global obesity epidemic, but clinical approaches to this public health concern are changing and the obvious need for calorie restriction still dominates medical thoughts. A clear understanding of telomeres and their shortening with age is now appreciated as a key chronological marker of age or senescence or chronic disease evolution. Furthermore, the rapidly expanding practice of stem cell therapies has created enormous interest in all sectors of society, but it is fraught with uncertainty about its safe and effective applications.
While these three areas of science (The Anti-Aging Triad) will drive advances in anti-aging in the next few decades, several current areas of interest and importance in the clinical practice of anti-aging medicine remain.
There are advances in hormone replacement therapy, revised dietary interventions for weight control and new perspectives on nutrigenomics. The “health and beauty field” continues to explode with new technology and the HCG Diet Revolution continues to sweep the U.S. Nation. The objective of this short article is to highlight these areas of advances in anti-aging medicine (2011).
Battling the Bulge: Calorie Restriction
There is no doubt that the management of overweight status or obesity must be part of a comprehensive care program that presents global health initiatives. Any individual who promotes a “magic bullet” approach to weight control does not serve the best interests of the healthcare consumer. Arguably, the only medical intervention known to humankind that increases average and maximum lifespan is calorie restriction in the diet (at least 30-70% restriction of total calorie intake per day). With calorie restriction, a whole host of biophysiological changes occur that can promote health and wellbeing.
The problem is that changing the eating habits of any nation is a monumental task and our advanced lifestyle with frequent combinations of idleness and excess calorie intake work to tip the scales on the basic laws of thermodynamics. The notions that calories do not count are “fairy tales” that must be placed in their own absurd perspective. That said, laws of thermodynamics do not fit perfectly in our understanding of “energy balance”.
Against this background, there is frenetic interest in the use of human chorionic gonadotrophin (HCG) in weight control, when combined with a very low calorie diet (500kcal per day, Simeons approach). In my new book, (Holt on the HCG Diet Revolution 2011), I review and search for an evidence-base for the use of HCG in obesity management and I tackle this controversial subject with a strong message about the need to avoid problems by the use of “standardized clinical protocols”. A very low calorie diet (VLCD) cannot be considered to be safe for use in an unsupervised manner, especially without supplementation of vital nutrients (multimineral and multiple vitamin support with perhaps the judicial use of omega-3 fatty acids, www.naturalclinician.com).
In this calendar year, there has been ever increasing interest in the use of very low calorie diets and injections of HCG. My new book reviews 60 years of science on the use of HCG following its original description by Simeons in 1954. This book is an attempt to analyze “hard facts” about the scientific basis for the diet and address issues such as: standardized protocols for use of this diet, the necessity for supportive supplementation and the significance of treating obesity or the presence of Metabolic Syndrome X (“Holt on the HCG Diet Revolution” 2011, www.stephenholtmd.com).
There is much confusion amongst healthcare givers and patients concerning HCG diet protocols which may have been arbitrarily modified in ways in which may not be universally safe and some may be associated with questionable efficacy.
While the HCG diet has been undertaken in thousands of patients, argument prevails about the existence of a clear evidence-base for the use of adjunctive HCG. I believe that the work of Dr. ATW Simeons MD has not been fully appreciated in modern times and was certainly cast-aside prematurely, following its initial description in the 1950’s (Lancet, II, 946-7, 1957). Simeons was trying to say that the use of adjunctive injections of HCG produced a better quality of weight control, with focused loss of fat in the absence of significant loss of muscle mass. The discovery of a link between loss of muscle mass and the onset of Type II diabetes has altered our perception to some degree concerning a previous focus on “diabesity”.
Simeons postulated that there were changes in “hypothalamic controls” of appetite which permitted better compliance with a 500kcal per day diet and he described a potential long-lasting effect of reprogramming eating habits. More than 60 years following the initial descriptions of Simeons, many issues concerning the Simeon’s Diet remain unanswered despite the rhetoric. Meanwhile, the current frequency of use of the HCG Diet is increasing (on a global basis) (Holt on the HCG Diet Revolution 2011, www.stephenholtmd.com).
Scientists continue to unravel many of the favorable biological consequences of dietary calorie restriction which include: improvements in insulin sensitivity, glucose homeostasis, apoptosis regulation, reduction of oxidative stress and partial restoration of hormonal secretions that tend to fall with age… to name a few benefits! As these favorable outcomes became apparent in many studied species (including humankind), it was proposed in the late 1990’s that there are compounds (drugs or nutraceuticals) that may be able to mimic the beneficial consequences of significant calorie restriction in the diet. This resulted in the novel concept of “calorie restriction mimetics”.
Compounds with “calorie restriction mimetic” qualities are being screened in extensive laboratory experiments, and they have been utilized in humans (www.naturalclinician.com). There are many examples of calorie restriction mimetics that work by different mechanisms including apoptosis regulation (e.g. resveratrol) and improvements in glucose control (e.g. Gymnema extracts). The obvious antiaging approach is to use tolerable levels of calorie restriction with comprehensive care in obesity management, to which can be added the putative benefits of calorie restriction mimetics (Holt S, “Peel off the Weight” 2009, www.stephenholtmd.com).
Stem Cells
It is a difficult task to select the most important recent advances in stem cell sciences, but I have attempted to cover these issues in Part C of my book “The Anti-Aging Triad” (2011) (www.stephenholtmd.com).
Perhaps it is now time to raise some controversial issues. The clear promises of totipotent embryonic stem cells may never overcome widespread moral or ethical concerns about their use. The focus of current treatments has obviously moved towards the use of adult stem cells.
Promises of stem cell engraftment and growth for purposes of regenerative medicine or anti-aging must be somewhat questioned. The most critical scientific minds are indicating just how far science has to go before we will be able to master the “art” of the autologous implantation of harvested adult stem cells (from fat or bone marrow or blood).
I imagine a day when their will be no collection of adult stem cells, but there will be a way of inducing their release from their tethered niches in many body organs. These notions incorporate the use of the innate ability of stem cells to “home in” on diseased or ailing tissues (tissues that require revitalization or replacement). This is the concept of IASCR which is the Induction of Adult Stem Cell Recruitment. I believe that this approach is applicable today with a demand for further research (The Anti-Aging Triad, 2011, www.stephenholtmd.com).
A variety of drugs, nutraceuticals or external forces can mobilize stem cells effectively. Certainly, the use of biological agents, such as Granulocyte Colony Stimulating Factors are being undertaken with a view to releasing mesenchymal stem cells to ameliorate or treat many disease targets e.g. Amyotrophic Lateral Sclerosis, Parkinson’s Disease, Cardiovascular Disease etc. More appealing is the use of nutraceuticals that have synergistic effects on stem cell release e.g. blue green algae (AFA), blueberry extracts, carnosine, vitamin D3 and fucoidans.
My colleagues and I have started to research the powerful effects of hyperbaric oxygen treatment and electromagnetic forces on stem cell mobilization and some of these issues will be addressed in the evening workshop (Stephen Holt MD) at the Annual Meeting of the World Anti-Aging Society (Las Vegas, Nevada, December 8-10, 2011).
Perhaps the biggest problem facing immediate application of Adult Stem Cell treatments is continuing confusion about what is allowed and not allowed or recommended by U.S. regulatory agencies or laws. There have been mounting controversies about various clinical procedures and their safety or effectiveness, as currently practiced. The matters are growing concerns on an international basis where stem cell tourism has become very popular, but subject to a real need for “caveat empeator”.
There has been a re-emergence in the interest of live cell therapy which is not stem cell therapy. I have objected strongly to fostering of prevailing confusion between the procedures of live cell therapy and stem cell therapy, as currently understood. On the one hand, live cell therapy is the delivery of chemical messengers or cellular fragments from animal fetal cells. These animals cells (sheep origin) are mostly composed of differentiated somatic cells. The idea of live cell therapy is to “revitalize or reprogram tissues” as a disease treatment, but this clinical procedure is banned in the United States, unless it is part of an FDA-approved clinical trial protocol. However, there is increasing evidence that injected human stem cells may work to some degree by the provision of chemical messengers of cellular revitalization, rather than tissue engraftment.
In other words, not all engrafted human stem cells can be expected to survive, just as animal “live cells” do not engraft in live cell therapies. However, human stem cells provide a reservoir of “bioactive compounds” that can do many things including: act as growth factors for positive influences on cellular reprogramming. These matters require further intense research and resolution. I have addressed these issues in my book, where I have used live cell therapy as an example of the “birth of the use of biologicals in human or animal tissue transfer” (The Anti-Aging Triad, www.stephenholtmd.com), but live cell therapy continues to have a questionable base in science.
A Mixed Collection of Anti-Aging Initiatives
Bioidentical replacement hormone therapy has moved to a new level of understanding, where the strengthening “physician lobby” continues to make claims of improved clinical outcome and safety, in comparison conventional hormone replacement therapy. However, the picture is not simple and arguments prevail. Many factors operate in a balanced approach to hormone replacement therapy. Examples of the issues at stake include the pathway of metabolism of estrogen, the hormonal inter-conversions to different sex hormone end-products, the role of nutrigenomics and mounting concerns of environmental toxicity with organochemicals that have potent hormonal effects (e.g. xenoestrogens).
Bioidentical Hormone Replacement Therapy cannot be perceived in the absence of a holistic healthcare approach and a serious consideration of the overall hormonal balance of the patient (thyroid, insulin resistance, testosterone etc.). These issues relate to the “tailoring of endocrine interventions” as part of key anti-aging strategies and they “spill over” into modern concepts of testosterone replacement therapy, diabetic care and the use of Human Growth Hormone.
There are many innovations in the field of “health and beauty” which is an important component of the “surface perception of aging”. There are new thoughts about the importance about “beauty from within” and there has been much growth in the new field of nutritional cosmetic dermatology, where dietary supplements are finding expanding applications. In addition, topical cosmeceutical technology is expanding. In simplistic terms, many dermatologic interventions induce a certain amount of skin trauma and the issue of “downtime” following plastic surgery, liposuction, laser therapy etc. is a key issue in clinical practice. The use of agents to decrease this “downtime” by assisting in recovery from bruising and trauma has led to the use of Arnica formulations which are fortified with agents that support connective tissue functions (www.naturalclinician.com).
Beyond the spectrum of trauma and procedure recovery is the increasing appreciation that adequate nutritional status is a pre-requisite for skin health and beauty. There are many protomorphogens which assist in the support of the structure and function of the skin, hair and nails. While nutritional approaches and lifestyle adjustments are entering the health and beauty world, there have been major developments in techniques such as non-invasive body sculpturing and the use of new agents for tissue augmentation with fillers, fat transplantation and the appropriate use of Botox. There is a move towards the use of stem cell treatments and growth factors in skin care. These scientific domains are related to longevity medicine. More attention is being placed on the universal effects of oxidative stress, particularly in the field of photoaging (The Anti-Aging Triad 2011).
Telomeres (DNA caps on linear chromosomes) function to prevent aberration or loss of genetic information during cell division. These protective regions of DNA tend to shorten with repeated cell division in somatic cells. The enzyme telomerase (a reverse transcriptase) acts to retain telomere length. There is a general correlation of telomere length with age and attempts to sustain telomere length or prevent telomere attrition are now applied in clinical practice.
There are telomere supporting protocols which involve meticulous disease management and the application of a variety of nutrients or botanicals that sustain telomere structure and function e.g. Astragalus extracts, ginger, Vitamin D, omega 3 fatty acids, antioxidants and other botanical agents. Telomerase is an enzyme that is not normally expressed in adult somatic cells, but it is expressed in stem cells, cancer tissue and germ cells. Scientists acknowledge that a perfect compound to cause telomerase activity has not been found.
During my chairmanship at the World Anti-Aging Society meeting in Bangkok Thailand, I became introduced to many of this year’s revolutions in skin care and anti-aging applications. There is a constant quest to improve practice standards in “skin procedures” that are used as part of facial rejuvenation. Recent innovations include the use of devices that can inject cutaneous or facial fillers with control and precision. Such innovations may improve standards of care in the common practice of cutaneous (tissue) augmentation.
There is much variation in the “art” of the use of injections of Botox and fillers. This has resulted in some need to develop a consensus opinion on treatment techniques. There is an increasing use of bariatric surgery with innovative surgical procedures that leave the option of a non-invasive option to surgery (laparoscopic) and less mutilation of the digestive tract (e.g. gastric-sleeve procedures) (Taylor, TV in the HCG Diet Revolution, 2011). Our knowledge of the value of weight control itself in longevity promotion emanates from recent studies which show that long term or sustained weight control following gastric bypass surgery may enhance longevity and reduce morbidity from some common diseases. Conservative opinions about the value of bariatric surgery are being revised to a more liberal perspective as we see more evidence of safety and effectiveness of laparoscopic bariatric surgical interventions.
Conclusion
Anti-aging medicine is developing a powerful evidence base. Clearly, there are other innovations in anti-aging medicine that deserve highlight in this year (2011). While this article scratches the surface, the key initiatives of anti-aging must move more towards stem cell sciences, telomere support and the complex science of calorie restriction. These matters are contained within my aphorism “The Anti-Aging Triad”, www.stephenholtmd.com.
Biographical Sketch of the Author
Stephen Holt is a Distinguished Professor of Medicine (Emeritus) and Scientific Advisor to Natural Clinician LLC (www.naturalclinician.com). He is a best-selling author and practices medicine New York state. His new books “Holt on the HCG Diet Revolution” and “Holt on the Anti-Aging Triad” are available at www.stephenholtmd.com. Dr. Holt has a free newsletter available by email through www.vitacost.com. This newsletter is circulated to more than 1.2 million individuals. Dr. Holt has two new book titles in press (Sex: The Natural Way and Menopause and PMS: The Natural Way). Stephen Holt is an appointed member of Who’s Who in Anti-Aging Medicine.