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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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Stem Cell Therapy

#7 Stress Reduction & Adrenal Axis

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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

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#10 Osteopathic Manipulation

Osteopathic Tenant:

With the proper tools the body has the innate ability to heal itself.

QUESTIONS