What does a specialist in Anti-Aging and Regenerative Medicine focus on?
My approach is individualized and focuses on mitigating conditions which could negatively impact health-span or lifespan. This requires understanding your health status, risk factors, relevant labs, and family history. This also involves offering hormone normalization for life in eligible patients.
This blog is meant to stimulate thought and give patients an outline that guides how longevity might best be approached and addressed.
There are clever and cutting edge treatments that we offer; however, the foundation of anti-aging and longevity is to manage the statistically likely causes of death and disability. These are infrequently optimized by primary care physicians. The “we’ll watch this,” while not optimizing, is a common approach, which is the slippery slope to poor health outcomes.
#1/#3 Cause of Death and Disability, respectively relate to vascular disease - that being Coronary Artery Disease and Stroke (peripheral arterial disease also).
So optimization of:
ApoB to 70’s if Lp(a) negative and 50’s if Lp(a) positive
HbA1C goal 4.7%
Systolic Blood Pressure Goal 115-120 mmHg
No Tobacco or smoked THC
Limit Alcohol
Reasonable exercise goals (150 min/week Zone 2 aerobic and 2-3 sessions of weight training weekly)
Diverse, mostly plant based diet with minimum 40 grams/day of dietary fiber, and at least 30 different veges/fruits/seeds/grains/nuts weekly (if not daily)
#2 Cause of Death/Disability - Malignancy
This is trickier and individualized - but pretty much do the items above and you’ll be optimized -there are screening interventions and individual variations that need to be addressed.
#4 Cause of Death/Disability - Constellation of Cognitive Decline/Trauma/Sarcopenia/Osteoporosis
The last two items relate to exercise, maintaining muscle mass, and a careful mix of impact, aerobic, and weight lifting types of exercise. Creatine can be helpful, as can optimization of Vitamin D and K2 MK7, Omega 3 index, Vitamin B12,Homocysteine and diet.
#5 Infectious diseases
Stay as physically fit, mostly with the items above, and pay attention when symptoms occur. Early treatment before becoming very unwell is critical. Stay immunized, specifically for high level evidence based immunizations. Work on maximizing T cell immunity.
The sections below are just a tiny subset of the types of treatment, and a selected evidence base, we offer appropriate patients. The logic is fairly consistent when we deal with patients who have, or are at risk of progressive conditions. There is an assessment of the risk of treatment versus the likelihood of benefit. For many patients, we jointly make the decision to utilize treatments that have low risk of harm, and likely evidence of benefit.
Do you have one or two copies of ApoE4? This predicts high risk for early Alzheimer’s Disease. Quest also has a panel called AD Detect which is interesting as an add-on if money isn’t too tight. Agents like Rapamycin, and all the items listed below for Parkinson’s Disease can be considered.
This is an interesting space as we are seeing a range of evidence for drugs such as Rapamycin, SGLT2 Inhibitors (drugs like canaglifozin, dapagliflozin, empagliflozin), PDE5 Inhibitors (drugs like sildenafil, vardenafil, tadalafil), GLP-1 agonists (drugs like tirzepatide, exenatide, semaglutide), agents with mounting evidence for decreasing risk, and possibly reversing disease to some extent in some patients.
- An Overview of Top Longevity Medications:
Anti-lipid and Blood Pressure Medications, as well as rapamycin, dasatinib, and especially newer medications for Type 2 diabetes are at the forefront. I’m deliberately not including metformin (except this article: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.718942/full ), as I’m favoring other agents over it; but it likely has substantial benefits.
- Some interesting articles on SGLT2-inhibitors:
There are a lot more … whether longevity, cerebrovascular/cardiac disease, Parkinson’s or Alzheimer’s Disease - not to mention better HbA1C.
- Some interesting articles on GLP-1 Agonists:
Some interesting articles on Acarbose:
Some interesting articles on Telmisartan (my first choice agent for hypertension in most patients):
Some interesting articles on PDE5 Inhibitors (Like Cialis/Viagra)
A recent article on Rapamycin is here:
For a deep dive into Rapamycin, consider joining (it’s free) one of the best healthcare consumer communities who are focused on longevity. There are interesting conversations and a review of lots of literature, vigorous debates and more. Visit: https://www.rapamycin.news/about
Omega 3 Fatty Acids
Again, none of this is medical advice - but simply a glimpse into how I think about this topic and a sharing of a tiny subset of the literature I review daily in order to approach longevity and healthspan in a systematic, evidence based manner.
