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Treating to Optimal HealthTOP TEN TREATMENTS TO OFFER PATIENTS TO SLOW AGEING AND PREVENT ILLNESS
ANGELA DEROSA, DO, MBA, CPE
Disclosures
Dr. DeRosa does not have any conflicts of interest for this presentation
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Learning objectives
Understand the role of hormone in the prevention of chronic illness and cancer prevention
Understand the role of Vitamin D in cancer prevention, fall risk and bone health as well as age related illnesses
Understand the role of mitochondrial damage and its role in cancer development as well as how to repair damage through supplementation
Understand the role of stem cell therapies in repair of inflammatory conditions and chronic disease treatment and prevention
Learn the importance of safe sex practices in ageing and cancer prevention Learn the importance of stress reduction and the effects on the adrenal axis Understand why red wine is a fountain of youth How Osteopathic Manipulation is a key tool in wellness and the body’s ability to heal itself
State of Medical Affairs
20th Century and Population Growth 21st Century and Ageing Life Expectancy and Health Expectancy Health Care Burden and Costs Need for preventive, holistic osteopathic strategies Complimentary and integrative medicine which includes hormonal medicine is rapidly
evolving and not all providers and associations agree on its role in the treatment of our patients
Many current guidelines diagnosis and treat to illness but do not make recommendations toward treating to optimal health
Modern scientific medicine prefers laboratory measurements rather than patient symptoms, regardless of the fact that it is the symptoms that make up syndromes
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Traditional medical dogma can no longer be accepted. This is reminiscent of Galileo’s fight against orthodoxy, to make the sun the
center of the solar system, the heliocentric view, rather than an immobile earth.
#1: Thyroid Optimization
Hypothyroidism is highly prevalent endocrine disorder with significant health consequences that is highly underdiagnosed Poor QOL Weight gain/obesity/insulin resistance/diabetes Cardiovascular disease Inflammation Indirect work ups
Current diagnosis of hypothyroidism is based on “hormone levels in the blood” and an out of reference range TSH and T4 levels which reflect the thyroid actual production of thyroxine.
New/Old concept “Sub-optimal” thyroid function Cellular hypothyroidism
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A. Vaquez, Migraine, Hypothyroidism and Fibromyalgia, Page 227 (2011)
Thyroid Optimization: Diagnosis
Many patients with “normal” TSH and T4 levels have cellular hypothyroidism and consequently physically functioning hypothyroid
More accurate definition: An adverse physiologic state caused by insufficient function of thyroid hormone at the cellular level” Purpose of the hormonal system is to create physiologic effects, not to produce an amount of
hormone that is considered “normal”
A comprehensive osteopathic approach to diagnosis and treatment much be taken Patient signs and symptoms
Full thyroid panel including TSH, Total T4, Free T3 and Reverse T3 levels
Calculation of Free T3/Reverse T3 ratios
http://www.imsociety.org/manage/images/pdf/bf895fb491ba1964375602f403fec4c3.pdf
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Thyroid Optimization: Treatment
Tailoring thyroid optimization based on the “break down” in the system
More tools in the toolbox: Synthroid
Cytomel
Armour and Nature-throid
Combinations
Monitor levels and patients symptoms
Laboratory follow-up
Informed consent
#2 Estrogen
Women aged over 45 years in the world increasing steadily and rapidly
Increased need for short term menopausal symptom control and long term health solutions
Serious QOL consequence and suffering due to estrogen deficiency
Lack of specialist in the area of menopausal medicine
Unwarranted fear by public and providers
Most societies agree that short term use of estrogen for symptoms control after discussion about risk is appropriate but………
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Estrogen: CV Risk
The baseline risk of CHD and stroke for women around menopause age varies from one women to another according to the presence of CV risk factors
HRT with estrogen alone is associated with NO or REDUCED risk of CHD. HRT with estrogen and progestogen is associate with little or no increase in
risk of CHD DM is not considered a contraindication to HRT in all affected women Estrogen decreases endothelial hardening and decrease inflammation
M.A. et al The NICE guidelines- Menopause Diagnosis and Management, 2015
Estrogen: Breast Cancer
The baseline risk of breast cancer for women around menopause varies from one women to another based on the presence of underlying risk factors
HRT with estrogen alone is associated with little or NO change in risk and some studies suggest a benefit
HRT with estrogen and progestogen can be associated with an increase in the risk of breast cancer
Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT
M.A. et al The NICE guidelines- Menopause Diagnosis and Management, 2015
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Estrogen: Anti-aging effects
Promotes cell homeostasis and DNA repair
Increased telomerase activity Anti-inflammatory Increase glycosaminoglycan's (GAGs),
such as Hyaluronic Acid, to maintain fluid balance and structural integrity
Increase collagen and endothelial elasticity
Improves insulin sensitivity
Decreases LDL and oxidation and increases HDL, decreases lipoprotein a
Improves blood flow Increased production of nerve growth
factor Reduces homocysteine Decreases beta-amyloid peptides
Estrogen Deficiency: Diagnosis and Treatment
Sign and Symptoms Estradiol and FSH levels Bio-identical Non-oral Preparations
Creams/Gels Troches
Patches Pellets
Informed consent
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#3 Testosterone
Millions of Men and Women suffer from Testosterone insufficiency/deficiency
Significant Morbidity and Mortality due to direct/indirect effects on the body
Women have 1/10th the testosterone of men but higher ration of Testosterone/Estrogen ratios
Clinical and biochemical syndrome associated with advancing age and characterized by symptoms and a deficiency in serum testosterone levels
Topic of medical debate and controversy due to gaps in understanding and physicians adhering to “outmoded” methods
Testosterone: Clinical Practice Guidelines
Consensus on common symptoms of testosterone deficiency Consensus lacking on biochemical parameters
Shortcomings in assays Variations over three orders of magnitude
Age
Gender
Co-existing disease
Adequate sensitivity, but relatively inaccurate and decidedly unsatisfactory
Confounding obstacles Timing
Bound or Free
“Range” of Normal
Optimal Levels
REFERENCES ON HANDOUT
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“When Borderline levels of testosterone levels are found, or the clinical picture and the blood levels disagree, a low or low normal free or total testosterone levels may be used to support a clinical diagnosis of androgen deficiency, but should not be used to exclude it.’
DR. ERIKA SCHWARTZ AND DR. KENT HOLTORF “HORMONES IN WELLNESS AND DISEASE STATE PREVENTION” COMMON PRACTICE, THE CURRENT STATE OF THE EVIDENCE AND QUESTIONS FOR THE FUTURE.PRIM. CARE CLINIC OFFICE PRACT. 35 (2008) 669-705
Testosterone: CV Risk
Increased Risk Nov 2013 JAMA Vigen et al. “Death by Testosterone” We think Not! J. Sex. Med 2014; Abdulmad et al.
Flawed methodology
Flawed statistical calculations
Actually showed benefit from Testosterone (21% versus 10%)
Full review of literature from 1949-2014 Mayo Proceeding Article 2015
No evidence to support increase in risk and strong beneficial relationship between normal Testosterone and CV health that has not been widely appreciated.
Morgentaler et al. Mayo Clinic Proceedings Testosterone Therapy and Cardiovascular Risk: Advances and Controversies February 2015 volume 90 issue 2 pages 224-251
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Testosterone: Prostate Cancer
Long held fear that testosterone causes prostate cancer is based on a 1941 (Huggins /Hodges) study with an N=1
Androgen Hypothesis: “Fuel for a Fire Androgen dependent tumor Higher levels confer greater risk of development or growth No evidence to suggest this is true
Considerable evidence contradicts the notion that testosterone causes prostate cancer and in fact may be protective
New evidence past 15 years resulted revolutionary shift in understanding: “Saturation Model”
Davidson et al: Testosterone Therapy and Prostate Cancer: Urol Clin N AM 43,(2016) 209-216Khera et al: A new Era of Testosterone and Prostate Cancer: Euro Urology 65 (2014) 115-123
Testosterone: Saturation Model
Davidson et al: Testosterone Therapy and Prostate Cancer: Urol Clin N AM 43,(2016) 209-216Khera et al: A new Era of Testosterone and Prostate Cancer: Euro Urology 65 (2014) 115-123
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Testosterone: Prostate Clinical Implications
Davidson et al: Testosterone Therapy and Prostate Cancer: Urol Clin N AM 43,(2016) 209-216Khera et al: A new Era of Testosterone and Prostate Cancer: Euro Urology 65 (2014) 115-123
Association between low testosterone concentrations and worrisome aspects of PCA
Men with symptomatic testosterone therapy and history of PCA Reasonable to offer testosterone in selected individuals
Healthy Men overall benefit from Normal- Optimal Testosterone levels
Testosterone: Breast Cancer in Women
Glaser et al: Reduced breast cancer incidence in women treated with testosterone, or testosterone with anatrozole. Maturitas, 2013 Testosterone therapy in women: Myths and misconceptions Rebecca Glasera,b,∗, Constantine Dimitrakakisc, Maturitas 74 (2013) 230– 234
Stimulates immune system and increases Natural killer cells.
It competes with estrogen at the breast cell levels and suppresses breast tissue growth and activity overall
No evidence to suggest increase risk in breast cancer and newer data suggest that it may in fact protective
Evidence is compelling that it reduces breast cancer reoccurrence in women with breast cancer
Testosterone improves the majority of menopausal symptoms in women
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Testosterone: Anti-Aging Effects
Decreases abdominal fat, increases lean muscle mass and improved glucose uptake into cells
Improves insulin sensitivity and glycemic control
Increases HDL and lowers LDL and small particle size
Decreases inflammation Promotes GH and lowered IGF Improves serotonin secretion
Anabolic effects on bone, muscle and connective tissue
Increased bone marrow production of Red Blood Cells
Increases Nitric oxide and promotes endothelial relaxation
Improved Sexual function Testosterone stimulate T cell production
and activity Stimulates the immune system to fight
cancer cells.
Testosterone: Diagnosis and Treatment
Signs and Symptoms ADAM questionnaire in men FSFI
Labs Total Testosterone Free Testosterone SHBG
Treatments Bio-identical Non-oral Preparations
Creams/Gels
Troches
Patches
Injection (IM& SQ)
Pellets
Informed consent
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#4 Vitamin D3
Great Masquerader Essential for bone health and calcium absorption Deficiency increases risk for common medical conditions
Cancers: Colon, breast, prostate
Diabetes Multiple sclerosis Rheumatoid arthritis
Cardiovascular disease
Sun exposure most often not enough
Vitamin D3: Anti-Aging Effects
Increases nerve growth factor
Anti-inflammatory
Increases immune function
Increases connective tissue health and muscle fibers strength
Potentiate insulin sensitivity
Inducer of endogenous Glial Derived Neurotrophic Factor which is neuroprotective
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Vitamin D3 Laboratory Range
Range considerations:
Total 25-hydroxyvitamin D Deficiency < 10 ng/mLInsufficiency 10-30 ng/mL
Normal 20-60 ng/mlOptimum 60-100 ng/mL
Toxicity > 100 ng/mL
VERY HARD TO BECOME TOXIC
Vitamin D3 Treatments
OTC
Prescription strength
Dietary
Non oral options Sublingual
Drops
Chewable
Intramuscular
Monitor blood levels
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#5 Mitochondrial Support
Mitochondria are essential for cellular energy and function
Life exposures which increase free radicals, increase damage and dysfunction of mitochondria
Mitochondrial dysfunction is a key biomarker of aging Biologic versus time
Mitochondrial Support: Anti-aging effects
Improved energy
Increased cellular metabolism
Improvements in insulin sensitivity
Decrease in free radicals and oxidative damage
Neuroprotective and Cardioprotective
Increased mitochondrial biogenesis
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Mitochondrial Support: Treatments
CoQ10 300mg q day
L-carnitine 500-2000mg
PPQ (pyrroloquinoline Quinone) 20mg q day
Combinations
#6 Stem Cell Therapy
Stem cells are undifferentiated biological cells that can differentiate into specialized cells and can divide (through mitosis) to produce more stem cells.
Three broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, umbilical perinatal stem cells which can be isolated from cord blood and adult stem cells, which are found in various tissues.
Stem cells can be guided into becoming specific cells that can be used to regenerate and repair diseased or damaged tissues in people. (Regenerative or Transplant Medicine)
People who might benefit from stem cell therapies include those with spinal cord injuries, type 1 diabetes, Parkinson's disease, Alzheimer's disease, heart disease, stroke, burns, cancer and osteoarthritis.
Promising research for cancer treatment NOT CURRENTLY FDA APPROVED
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Stem Cell Therapy
Best sources of Stem Cells Bone Marrow
50,000 ASC harvested at one time
Mostly become blood cells
Peripheral Blood 10,000 ASC harvested at one time
50% blood cells/50% tissue cells
Adipose Tissue 10-50 million ASC harvested a t one time
5% blood cells
95% stromal cells which become tissue cells
Stem Cell Therapy: Anti-aging effects
Regeneration or repair of damaged cells/tissue
Slow or repair disease processes
Ameliorate damage caused by medical treatments such as radiation and chemotherapeutics
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Adrenal Support: Anti-Aging Effects
Decreases abdominal fat, increases lean muscle mass and improved glucose uptake into cells
Improves insulin sensitivity and glycemic control
Decreases inflammation
Promotes GH and lowered IGF
Decreases NE and Epi and lowers BP
Stimulates the immune system to fight cancer cells
Promotes cellular healing
Adrenal: Diagnosis and Treatment
Signs and Symptoms
Labs DHEA/DHEAs
Cortisol and ACTH
Treatments Decrease stress
Supplements
Dietary
Treat based on base
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The Perfect Venn Diagram
#8 Safe Sex Practices
Safe sex practices reduce transmission of STIs Cancer prevention Over 50 crowd
Pregnancy versus STI’s
Benefits of Safe Sex Increase immunity
Decrease stress
Pain relief (oxytocin)
Mood (endorphins)
Aerobic exercise
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#9 Red Wine: Anti-aging effects
Resveratrol Phytonutrient and antioxidant
Protects DNA
Increase telomerase activity
Anti-oxidant
Protects mitochondria
Red Wine: Anti-aging effects
Resveratrol 200-300mg of red wine per day
1-2 glasses of 6 ounces of wine