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Wednesday
Jun012005

I Prefer "Age-Management" to "Anti-Aging" Medicine

I do not like the term “Anti-Aging Medicine,” and I’ll tell you why. The term is too often associated with

* Unsubstantiated claims for longevity;

* Unsubstantiated claims for slowing down the aging process at the cellular level;

* Magic-bullet solutions for complex problems.

Today I received an e-mail that claims to be about an anti-aging product. I quote, “I am setting up distribution channels for a remarkable product. This is a fabulous opportunity to secure distribution of one of the hottest products to hit the Anti-Aging industry! Please E-mail me, and I will send additional information to recommend products to your physician and receive dollars.” It goes on to state that “...it is the only clear choice to delay and reverse the aging process. All the while consistently decreasing IGF levels.” The ad continues to make additional claims about a transdermal product that actually increases endogenous human growth hormone while consistently decreasing IGF levels.

This is a clear attempt to fool the public with a “magic bullet” product. It is a widely known and a well-established fact that if you increase growth hormone, you increase IGF. There is no evidence that if you increase growth hormone by any means whatsoever that IGF does anything but go up. Another article states: “Can we actually feel better and live a longer life? Scientific advances have allowed us to increase lifespan. ‘X’ product represents the pinnacle of these scientific achievements in not only extending life, but perhaps improving the quality of that extended life.” This is pseudo-science at its best, designed to mislead the public, and has no substantiation in the scientific literature whatsoever. The truth is, we cannot yet delay or reverse the aging process. There is absolutely no scientific evidence that this can be accomplished with the knowledge base that we have today. As long as such claims continue to be made in the name of the Anti-Aging industry, I’m inclined to shy away from the use of the term. Connotations associated with the term have created an atmosphere in which established medical organizations have very negative feelings about “Anti-Aging Medicine” and have biased the insurance industry against covering physicians practicing it. Unfortunately, there is a self-inflicted (and, I might add, well-deserved) “buyer beware” mentality associated with this term.

Some in the Anti-Aging field claim that aging is a disease and therefore can be “cured.” It is not a disease, but rather a process that we all experience. You could say that to be against aging, one would have to be against the natural order of life. The term “Anti-Aging,” therefore, is a misnomer. Qualified physicians are, on the contrary, pro-aging, i.e., proponents of attaining a higher quality of life for as long as possible. That is why I prefer the term “Age Management Medicine.” Age Management implies that a process can be managed to produce better outcomes. We manage our budget; we manage our calendars; we manage our practices and businesses, we manage our household — therefore, why not manage the process of aging? The real focus is to prevent premature disability and death and lead the highest possible quality of life for as long as we can. How about healthspan? At the present time, there is absolutely no knowledge that will allow us to extend our genetic potential for life, which is probably in the ballpark of 125 years.

My definition of Age Management Medicine is preventive medicine focused on regaining and maintaining optimal health and vigor. This medical specialty incorporates well-known and accepted markers of disease-risk into proactive patient management and uses hormone modulation for the endocrinologically “normal” by identifying hormone levels that yield superior health outcomes. For most hormones, this is simply the upper 33 percent of the normal range for a patient’s age. The exceptions are insulin and cortisol that should be modulated to the lower 33 percent of the normal range. Our focus is on optimal health. Regaining and maintaining metabolic and endocrine functions at the upper end of the normal range for your age gives you the best opportunity for a healthy and vigorous life.

Age Management Medicine recognizes that successful therapies necessitate healthy lifestyle, including optimal low glycemic index nutrition, appropriate nutrient supplementation, and the absolute need for physical exercise. We focus on the synergy of all of these elements in order to enhance vitality and extend our health span. While we may or may not be able to increase longevity, we are able to prevent premature disability and death and enhance quality of life.

What we are really striving for is to be disease resistant, mentally sharp, physically fit, and maintain high self-esteem, so that we can interact positively in our environment. It is truly not necessary to cure anything, but if we can delay the onset as long as possible and focus on quality of life issues, our goals will have been achieved. The correlate to that is that we continue to lead a high quality of life and remain healthy, as we make new strides to understand the potential for longevity through mechanisms such as stem cell therapy, teleromase research, gene replacement, and other modalities yet to be discovered. We will be able to take advantage of these opportunities so that we may increase our longevity potential in the future. Longevity, of course, without quality of life is not necessarily a desirable end point.

We have the knowledge, the technology, and the expertise to at least delay the onset of degenerative disease and the signs and symptoms associated with aging. The starting point is a comprehensive evaluation to understand each person’s metabolism, each person’s endocrine system, and of course overall physiology. Each of us has the power to improve the quality of our lives, but the answers do not lie in magic-bullet-product solutions, but rather by beginning with a comprehensive evaluation to understand all of our unique needs, deficiencies, and partial deficiencies, and then taking comprehensive corrective action to allow our bodies to function at the highest possible level.

I strongly believe that Age Management Medicine is the rational, evidence-based approach to an increased health span.

Alan Mintz, M.D., CEO, CMO, Cenegenics Medical Institute

Reader Comments (27)

Sir,
I'm a pharmacist lives in Toronto/CANADA. I also am interested to have a course or training on-line in Age Managenment Medicine.
Thank you

Bardhyl Skenduli
1137 Royal york Rd. # 202
Toronto/ON M9A 4A7
CANADA
E-mail: bmskenduli@hotmail.com

Obivously there isn't really thing out there that can able the process of aging by much. Most of the claims are nothing but marketing hype. However, yes there are products which help slow down the process of aging a little.

06.16 | Unregistered CommenterSkin Care

Well, there is a good age-management course, but not on-line, at www.Cenegenics.com. Their main center is in Las Vegas. hope that helps.

06.16 | Unregistered Commenterdermarogue

dermarouge

Have you taken the cenegenics course? What do you think about it?

They did a hell of a job keeping Dr Mintz death quiet. That is some serious PR work.

06.17 | Unregistered CommenterFlorida PA

Did he die?? I used to be a member of A4A also but just found the whole thing very commercially driven. What was his age?? I wonder if the HGH caused some of his organs "enlarged" and eventually failing!!!

06.17 | Unregistered Commenterpmdoc

pmdoc

Oh Yes, very dead. I told you it was some serious PR work keeping it quiet


http://www.lvrj.com/news/7860082.html

06.17 | Unregistered CommenterFlorida PA

LOL, "very dead!!!". Well, All I can say is for him to die at a young 69 and of "bleeding complications" from a seemingly routine biopsy seems to indicate something not good with his health. HGH is generally known to "promote" wound healing also. Uhm!!!!!!!!!His practice must have had much problems since. I often receive marketing emails from his practice the past year looking for MD's who wanted to make lot of $ in "alternative ways".I doubt if this is really true anyway.

06.18 | Unregistered Commenterpmdoc

I have been doing age management for about four years. I actually wrote many of the treatment protocols and other guidelines for a well established HRT clinic in Florida. Very medically sound in fact when the Feds busted Signature pharmacy and eight clinics in Fla we were not even a thought to them. I think cenegenics is a little much. They go into the realm of the unknown, especially with DHEA and HCG. I think this sometimes may have negative effects on the pts. If any one has some IM or HRT training we are always looking for good Docs nationwide to send pts to for a face to face visit. Pts will be good candidates with medical need. Pay is $250 for H&P with consult and of course be available for periodic f/u visits.

Word to the wise: I would not call yourself certified in anti-aging medicine or anti-aging anything. The FDA has made this a crime due to the fact there is no evidenced based medicine that anything anti ages.

06.18 | Unregistered CommenterFlorida PA

Yes< I did take the course and found it quite a valuable fund of knowledge. Did so after Dr Mintz, but it seems that any anti-aging therapy Shouldn't be expected to stop a intraoperative bleed; he looked good in the videos I saw. he seemed to live up to the mantra of "live well-longer. Without knowing how his antecedents died (what age), its hard to tell how much extra longevity he got from the program. Cenegenics does frequent labs to monitor levels (expensive, but necessary). I don't know how you can optimize hormone levels without checking labs. All their science is based on evidenced based medicine, they have no problem changing if the evidence changes. As a part of the program, they have the Docs go through the program, and in me they found a early life threatening cancer--despite apparently normal labs and exam. Their strong point is they have a system for monitoring and evaluation which people think is worth the price.

06.19 | Unregistered Commenterdermarogue

Dr Mintz was 69 and built like a brick shit house. I don't think the HRT was responsible. We also do frequent labs but not as extensive. I have seen their notes and blood work on some pts I treat. My issue with the HCG is in secondary hypogonadism with low LH I can see it, but I have seen it given to symptomatic low normal T pts. I think this just promotes end organ burnout (leydig cells), its like giving a secretagogue to Type II DM with B-cell dysfunction. Why not just give T.

DHEA

No Effect of DHEA on Exercise Training in Older Women
With DHEA or without it, exercise provided the same benefits.
Dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) are produced robustly in men and women until the third decade of life, when production begins to markedly and progressively decline with age. These observations have led to recommendations that DHEA be provided to older adults. But does DHEA improve physical performance, body composition, and metabolic parameters? So begins the great debate.
In this 12-week blinded randomized trial, 31 sedentary, healthy, postmenopausal white women received both endurance (4 days weekly) and resistance (3 days weekly) exercise training; half received daily DHEA (50 mg) and half received placebo. DHEA treatment resulted in increases in circulating DHEA-S (by a mean of 650%), total testosterone (by 100%), estradiol (by 165%), estrone (by 85%), and insulin-like growth factor-1 (by 30%). Exercise with or without DHEA resulted in similarly significant improvements in physical performance, body composition, and insulin sensitivity.
Comment: These results are consistent with findings from another recent study of DHEA supplementation in women (Journal Watch Oct 18 2006). The bottom line here is that, as is well recognized, exercise improves a number of parameters in postmenopausal women, but DHEA does not result in further improvement. Women are well advised to remember the exercise and forget the DHEA.
— Robert W. Rebar, MD
Published in Journal Watch General Medicine February 28, 2008
Lack of dehydroepiandrosterone effect on a combined endurance and resistance exercise program in postmenopausal women.

Igwebuike A, Irving BA, Bigelow ML, Short KR, McConnell JP, Nair KS.

Mayo Clinic, 200 First Street SW, Joseph 5-194, Rochester, Minnesota 55905. nair.sree@mayo.edu.

Context: Recent studies disputed the widely promoted anti-aging effect of dehydroepiandrosterone (DHEA) supplementation; however, conflicting data exist on whether physiological DHEA supplementation enhances exercise training effects on body composition, physical performance, and cardiometabolic risk in healthy postmenopausal women. Objective: The aim of this study was to determine whether 12 wk of DHEA supplementation (50 mg/d) in postmenopausal women enhances exercise-related changes in body composition, physical performance, and cardiometabolic risk. Design and Setting: This study was a 12-wk randomized double-blind, placebo-controlled trial and took place at the Mayo Clinic General Clinical Research Center (Rochester, MN). Participants: Thirty-one sedentary, postmenopausal, Caucasian women (mean +/- sem age 64.6 +/- 1.0 yr) completed the study. Intervention: Participants were randomized to one of two 12-wk interventions: 1) exercise training plus 50 mg/d of DHEA (n = 17), or 2) exercise training plus placebo (n = 14). The exercise intervention consisted of both endurance (4 d/wk) and resistance (3 d/wk) exercise components. Main Outcome Measures: The main outcomes were measures of body composition, physical performance, and measures of cardiometabolic risk. Results: DHEA treatment with exercise resulted in increases in circulating sulfated DHEA (650%), total testosterone (100%), estradiol (165%), estrone (85%), and IGF-I (30%) (all P </= 0.05, for all within and between treatment comparisons). Although exercise training alone significantly improved physical performance, body composition, and insulin sensitivity, administration of DHEA provided no additional benefits. Conclusions: Twelve weeks of combined endurance and resistance training significantly improved body composition, physical performance, insulin sensitivity, and low-density lipoprotein cholesterol particle number and size, whereas DHEA had no additional benefits.

PMID: 18029465 [PubMed - in process]

My issue with DHEA is the increase in estrogen

In post menopausal women this may promote uterine CA without progesterone

In adult men too much estrogen is not your friend: water retention, gynecomastia.....

06.19 | Unregistered CommenterFlorida PA

PA DHEA tends to load the cannon toward all hormones, so deficiency in that (once replaced) needs to be followed by hormone levels ( estrogen estrone levels etc). Sounds like what you're saying is that if you replace DHEA things increase (total T etc and thats not the case in all people) and the reason hormone levels are monitored frequently. Cenegenics tends to replace hormones or co-factors that are deficient and monitors the process as we are all different. I'm sure you'll agree that there is not a "one size fits all" solution. Cenegenics offers "customization". I'm sure you think you can do that at $250/person, but someone may slip through the cracks. Its like if someone is on fire.. do you want to put them out slowly?

06.19 | Unregistered Commenterdermarogue

Dermarouge

I think you misunderstood some of what I was trying to say. Probably my fault, sometimes it is difficult to get you point across in text with one person taking at a time. If you look at my last post from DHEA down to PMID: was a copy/paste of a recent summery and abstract . I was trying to give some validity to my opinion DHEA in the adult is not always a good idea. We also customize on an individual basis and agree there is no "one size fits all". I was just voicing a difference in clinical opinion in a few pts I have seen who were treated previously at cenegenics and brought their notes.

The $250 was the initial fee paid to one of our affiliate Physicians for an evaluation. We advertise nationwide and some times it is not feasible for the pt to fly in and see us. That is why we look for Docs to work in collaboration with us in different areas. As we both know it is a lot more then $250 for on going treatment with f/u and labs and all.

06.19 | Unregistered CommenterFlorida PA

Dermarouge

The patients have a detailed history and symptomology. The affiliate MD is sent the info to review as well as blood work. Only after this the pt gets an appt for eval and treat. We do this to weed out any secondary gainers.

Was the CA found on a screen they do, or an incidental find?

06.20 | Unregistered CommenterFlorida PA

FL-PA: I agree DHEA is not for all and most times not for women. My Ca was found based on normal (but age-matched abnormal) labs--and all is currently well. One thing, HCG mimics LH and stimulates a patients own testes to produce T (if they can) ; many people wish to produce "their own T" and perhaps maintain a greater degree of natural fertility. Wheras if someone has had a vasectomy (and not concerned about fertility) usually they just give T.

06.20 | Unregistered Commenterdermarogue

FloridaPA:
I used to be involved in HRT for about a year in 2002 dealing with a pharmacy in Phoenix, AZ.I quit b/c of "squabbling" between partners. I would be interested in knowing more of your HRT protocol.
Dermarogue:
The link from the 6/17 post by FloridaPA did mention of Dr. Mintz's parents. It sounded like his father lived longer than he did.

06.20 | Unregistered Commenterpmdoc

Cenegenics Medical Institute is a rival of the A4M.
I can understand his (the CEO=$$$$) opinion but think of his motives of posting on this site!
The A4M has members in the upper tens of thousands and more outside the U.S. They have a board and are starting to accept residencies so that the AMA will recognize the specialty (and no I'm not a member of any group).

06.21 | Unregistered CommenterErica

PM: from the article it does mention Mintz's 70 yo mother; as we know women do live longer than men. Don't know about his dad though. Erica, I'm a member of A4M and I believe Cenegenics goes and displays at their events-so it must be a cordial rivalry if at all. In theory they do the same things; Cenegenics seems to have more clearly defined systems for training and patient management. A4M is getting better at describing the fund of knowledge thats important; but some of the A4M info was "way out there" (but getting better) in my opinion. Cenegenics does a beter job of moving toward evidenced based treatments from my personal comparison.

06.21 | Unregistered Commenterdermarogue

My understanding was they used to work together, then there was some sort of rift. My opinion cenegenics is more sound medically. A4M takes anyone who pays the booth fee for the show. A4M has some info approved for AMA catI credit. The board and residency will never be accepted by the AMA as a specialty.

The HRT clinic I do some work at has the wall peppered with A4M certificates but no one has a medical degree. That's why they hire myself and some other Doctors to eval and treat patients.

06.21 | Unregistered CommenterFlorida PA

dermarogue

I have a pt with Acute Intermittent Porphyria. Testosterone is contraindicated because it will precipitate an episode. HCG has been deemed safe. As we discussed before I usually do not treat with HCG in the long term Pt 54 M has s/s of hypogonadism and T=308.

The doses for fertility Tx seem high for the long term even though you can treat up to a year for that. What doses do you use for replacement as far as units and frequency? I check T at 6wks and 3mo, is that appropriate for HCG?

F-PA: AIP appears to be associated with a high sex-hormone binding globulin (SHBG). Increasing the androgens should decrease SHBG; if you can't use injectable or implanted (pelletized) T the dose for HCG I've used is betw 2000 an 4000 units SQ 2x per week based on labs at 6-8 weeks apart.

dermarogue

Thanks for your info. Pts SHBG is also high, which can be expected with an aging male. SHBG bound to T is unbreakable, not like Albumin bound. Its funny with AIP, androgens and their analogues will precipitate an episode but HCG will not- even though end result is the same (more free T). I will give this a try. Maybe I will start a blog for age/weight management. It is very interesting to me and goes hand in hand with Aesthetics.

I think scams like these deserve jail time. I am so frustrated with businesses that try to gain wealth by manipulating the public, even if the public is gullible.

Bath and Body,

Please explain what scams you are referring to

I am of the opinion that all anti-aging products are a bunch of frauds and scams and their effectiveness cannot be proven, yet there will always be those hopeful people who buy them because the though of having a younger looking skin overpowers their doubts. As stated in the article there is no cure for aging, for aging is not a disease but rather a natural process that cannot be avoided.

This is a very good concept and I completely agree with you that this is a very effective way to look at it,

Not many people think this way and this is mainly because they are not concerned about the quality. I think they are concerned about the physical appearance. Hence they go for all these methods. I think that it is important to accept your age and act it.

09.18 | Unregistered CommenterXanGo

Age management has not got its due to the over hyped and glamorized Anti Aging Medicines

I completely agree with you that longevity is useless without quality. I think the term medicines should only be used for pills that cure a disease like you said and not for delaying a natural progression.

There is no such thing as "anti-aging" anything. It is a clever marketing phrase in many industries with no scientific basis, FDA website deems this term illegal in description or advertising for this fact.

09.18 | Unregistered CommenterFlorida PA

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