Antiaging (or regenerative) medicine is not "alternative" medicine. It is the ultimate in preventative medicine. We aim to prevent disease, detect early disease, and treat established disease with cutting-edge, evidence-based medical therapies. It is medicine that doesn’t wait for the old paradigms to give way before forging ahead and treating patients based on the most recent medical literature. It really is the future of optimal medical care.

The field of antiaging medicine is currently the fastest-growing medical specialty, and patients are seeking out this type of care like never before. The aging Baby Boomer population—combined with the public’s increased interest in maximizing quality of life and longevity—are big contributors to the growth in the antiaging medicine field.

In case one needs a further indicator, according to a February 2009 report by Global Industry Analysts the global antiaging products market would climb to $291.9 billion; and the United States market for same would hit $5 billion by 2015.1

DEFINING REGENERATIVE MEDICINE

This is a specialty and field of research aimed at the early detection, treatment, and reversal of age-related decline. It is well documented by peer-reviewed medical and scientific journals, and it employs evidence-based methodologies to conduct patient assessments. Regenerative medicine optimizes the body’s endogenous mechanisms of self-repair and adds proven and near-future exogenous treatments and technologies.2

The American Academy of Anti-Aging and Regenerative Medicine (A4M) was established in 1997 as a professional physician certification and review board. The A4M offers a fellowship training program as well as physician board certification. Additionally, in conjunction with the A4M, there is now a master’s degree in medical sciences with a concentration in metabolic and nutritional medicine offered at the University of South Florida School of Medicine, which is the first of its kind in the United States.

Because antiaging medicine is such a fast-growing medical specialty, now is an opportune time to consider incorporating it into your practice. This is especially relevant for cosmetic surgeons and dermatologists, given the similarities to antiaging medicine in patient demographics, office settings, and fee-for-service practices.

You can also pursue training in antiaging medicine. However, I do not recommend "dabbling" in this specialty unless you really commit to understanding its nuances and to obtaining the appropriate education in this complex field. I suggest that you align yourself with an antiaging specialist and work in concert. This arrangement can take several forms, including the following:

  1. Have the antiaging practitioner utilize your office space on your operative days or days off;
  2. Incorporate the antiaging physician as a part of your practice on a full- or part-time basis; or,
  3. Rent office space for the antiaging practice in your medical spa, wellness center, or medical building.

However, it is important to find an anti-aging practitioner board-certified in antiaging and regenerative medicine who has done a 2-year fellowship in the specialty.

WHAT’S HOT?

Without a doubt, the biggest part of my practice in antiaging medicine is natural hormone-replacement therapy (HRT). Thanks to Suzanne Somers and Oprah Winfrey, the word is getting out on natural (bio-identical) HRT. With 3,500 women entering menopause every day in the United States, this is a major women’s health issue.3 Combine this with the unfavorable consequences (increased risk of breast cancer, blood clots, strokes, and heart disease) of synthetic hormones as reported in the Women’s Health Initiative Trial4, there are a lot of women seeking safe alternatives for HRT.

Bio-identical HRT is used to treat the symptoms of perimenopause and menopause, including hot flashes, night sweats, mood swings, irritability, decreased libido, osteoporosis, hair loss, migraines, and memory changes.

However, the use of natural HRT extends far beyond just symptom relief. Natural HRT provides many antiaging and health benefits as well. For example, women with low estrogen levels have thinner skin, more wrinkles and aged skin, decreased breast size, decreased sex drive, and increased cholesterol.3 So, by replacing estrogen we can reverse and ideally prevent these problems.

It is critical to balance estrogen with progesterone for optimal health in women. Symptoms of decreased progesterone include anxiety, depression, irritability, mood swings, insomnia, pain and inflammation, osteoporosis, low HDL (good) cholesterol, and excessive menstruation. Therefore, progesterone and estrogen should almost always both be replaced whether or not the woman has had a hysterectomy.

When prescribing natural HRT, you should aim for an ideal ratio of progesterone to estrogen. First, always test a woman’s hormone levels via saliva testing, which is an extremely accurate method of testing—especially for monitoring treatment. Following this, the physician prescribes a customized dose of the needed hormones. Every woman is different, and "one size fits all" dosing is an outdated concept. The individualized dosing of natural hormones is typically then made by a compounding pharmacy, in which each prescription is individually made specifically for the patient.

By achieving the ideal balance of progesterone and estrogen, and by optimizing testosterone, dehydroepiandrosterone (DHEA), and Cortisol, we can help restore a woman’s hormonal balance to maximize quality of life, vitality, energy, and beauty. A hormonally sound woman is a woman at the top of her game at menopause and beyond.

Likewise, men also experience a decrease in hormone levels with age (termed male menopause or andropause). Andropause is more gradual in onset than female menopause, but the long-term consequences are just as severe. This is primarily due to a loss of testosterone. Symptoms of male menopause include loss of drive and competitive edge, muscle and joint stiffness, decreased fitness, decreased effectiveness of workouts (less muscle/more fat), osteoporosis, fatigue, mood changes, irritability, and decreased libido and potency.

Half of healthy men between the ages of 50 and 70 will have a bioavailable testosterone level below the lowest level seen in healthy men who are 20 to 40 years old.5 Andropause is serious business. It can lead to increased mortality due to an increased risk of diabetes, metabolic syndrome, cardiovascular disease, and Alzheimer’s disease.5

In order to treat andropausal men, you must measure their bioavailable testosterone levels (preferably via saliva testing) and treat them with physiologic doses of natural (bio-identical) testosterone replacement by a knowledgeable antiaging physician.

WHAT THE FUTURE HOLDS

One of the most exciting developments in regenerative medicine that has yet to become widely utilized may be adult autologous stem cell therapy. This is truly the cornerstone of regenerative medicine.6 Adult stem cells are not controversial, unlike embryonic stem cells, as they are autologous (self) and are collected from the same patient who will use them via apheresis and are stored via cryopreservation.6

Adult stem cells are capable of dividing and replacing damaged tissue. These cells are unique in that they have the capability to remain immature and nonspecialized. Clinical trials of adult stem cells have shown their promise in treating many medical conditions, including lupus, multiple sclerosis, scleroderma, diabetes (both Type I and II), orthopedic issues, peripheral vascular disease, and cardiovascular diseases.6

Today, a few centers exist that will collect your stem cells via apheresis and store them for future use. These cells can then be reinfused to treat a future disease. For example, studies have shown successful cardiac reperfusion following intracoronary administration of autologous stem cells in patients after an acute heart attack.7 Additionally, we may be able to "optimize" our stem cells through nutraceuticals such as blueberries, green tea, vitamin D3, and carnosine.8 These nutraceuticals can stimulate endogenous stem cells to promote healing and tissue regeneration.6

On The Web!

See also "Welcome to the New Cosmeceutical World" by Wendy Lewis, in the November 2009 issue of PSP.

CONCLUSION

As physicians, we are on the precipice of a major shift in the way we not only deliver health care but in the type of health care we deliver.

It is our responsibility and opportunity to provide patients (and ourselves) the best that medicine has to offer. This is going to occur as we implement a fundamental change in that we will investigate the causation of disease rather than just label it with a diagnosis. Other aspects to consider include exploring the role of nutrition, nutraceuticals, and natural HRT in optimizing patient health; as well as by staying open-minded to the future possibilities we have yet to discover that will not only increase longevity but also maximize our health and vitality for the rest of our lives and the lives of our patients.

Allison T. Pontius, MD, is board certified by the American Board of Antiaging and Regenerative Medicine, the American Board of Facial Plastic and Reconstructive Surgery, and the American Board of Otolaryngology—Head and Neck Surgery. After practicing cosmetic facial plastic surgery in New York City, she completed a 2-year fellowship in the area of antiaging and regenerative medicine, and is also pursuing a master’s degree in medical sciences with a concentration in metabolic and nutritional medicine. In private practice in Latham, NY, Pontius now specializes solely in antiaging medicine.

REFERENCES

  1. Global Industry Analysts, Inc. Antiaging Products: A Global Market Report. Available at www.strategyr.com/Anti_Aging_Products_Market_Report.asp. Accessed April 7, 2010.
  2. The American Academy of Antiaging Medicine: What is Antiaging Medicine? Available at www worldhealth.net. Accessed August 2, 2009.
  3. Smith PW. HRT: The Answers. A Concise Guide for Solving the Hormone Replacement Puzzle. Traverse City: Healthy Living Books; 2003.
  4. Writing group for the Women’s Health Initiative Investigators. Risk and benefits of estrogen plus progestin in healthy post-menopausal women. JAMA. 2002;288:321-333..
  5. Rothenberg R. Testosterone replacement therapy. Paper presented at: The Fellowship in Anti-Aging, Regenerative and Functional Medicine; July 18, 2008; Washington, DC.
  6. Rothenberg R. Stem cells and regenerative medicine. Paper presented at: The Fellowship in Anti-Aging, Regenerative and Functional Medicine; July 18, 2008; Washington, DC.
  7. Schachinger V, Erbs S, Elsasser A, et al. Improved clinical outcome after intracoronary administration of bone-marrow derived progenitor cells in acute myocardial infarction: final 1-year results of the REPAIR-AMI trial. Eur Heart J. 2006; 27(23):2775-2783.
  8. Bickford PC, Tan J, Shytle RD, Sanberg CD, El-Badri N, Sanberg PR. Nutriceuticals synergistically promote proliferation of human stem cells. Stem Cell Dev. 2006;15(1):118-123.