Anti-aging

George Burns once said ”You can’t help getting older, but you don’t have to get old.(emphasis added)” Oscar Wilde was quoted lamenting that “youth is wasted on the young.” In my practice, we often talk about getting younger. We don’t have to resign ourselves to declining as the years progress. I will be the first to acknowledge, staying young takes more effort at 75 than it did at 30, but getting better and feeling well is within everyone’s reach.

I love Dan Buettner’s scientific journalism in his book The Blue Zones, in which he describes the characteristic lifestyles of the longest living populations. Of course, the foundation for preventing age-related decline is positive attitude, spirit, and passion. Good diet, physical activity, and community matter too. And lots of anti-oxidants 😉

Yet, when new science emerges with therapies that may give a leg up on the effort of staying young, I’m always open. Many have been proffered; stem cells, ozone, low-fat diets – none of these have had sufficient scientific backing to make it into my toolbox. Others – NAD, vitamin C, plant-based antioxidants including CBD, time in nature – have solid science and become the basis of the programs I put together for my clients. I’m excited to share with you the newest scientific innovation: exosomes.

Exosomes are nanoparticles that come from cells and carry cell-to-cell (paracrine) messages to regulate regenerative processes such as DNA and tissue repair. They may be the holy grail of anti-aging and restorative therapeutics, as well as the basis for future biologic pharmaceuticals. Exosomes are being studied for applications ranging from cancer detection to hair restoration. What excites me most about exosomes is the use of exosomes in preventing age-related cognitive and fitness decline.

Over the next few weeks you will notice some changes coming to my practice that involve using the newest anti aging and wellness therapies, including exosomes. This space with be chock full of new information and ideas to help you feel vibrant and well. Please join me on this journey!

Please read about my availability through TeleHealth here: https://www.drericaoberg.com/post/have-a-question-tele-medicine-and-tele-health-may-have-an-answer

As people become increasingly comfortable with using secure telehealth platforms, my ability to

consult with clients beyond La Jolla has expanded. This blog post originates from a consultation I

did the other week with a 69-year-old Northern California CEO who was referred to me by

Pinnacle, a national concierge platform that specializes in connecting their members to the

world’s health and medicine experts. This client, like so many I work with, was curious about the

promise of regenerative treatments. He wanted to continue to experience vitality and a level of

both physical and cognitive performance that he had felt in earlier decades. We talked about a number of therapies and options and I thought it would be useful to summarize my approach in a blog post.

Before discussing the pros and cons of different therapies, I began with educating him about

some of the biomarkers of aging that I measure for the purposes of targeting and tracking anti-

aging treatment results. This resonated with his CEO mindset and he added his business adage

“that which gets measured, gets done.” In the case of selecting and using new therapies, targeted

testing ensures we select the right therapy for the right underlying issue. Repeat testing

quantifies outcomes, validating that treatment is on the right path, or signaling the need for a new

protocol that will yield better results.

Some of my favorite biomarkers of oxidative stress include f2-isoprostanes, GGT, SAM-SAH,

IGF-1, insulin & HOMA score, myeloperoxidase, endothelial function testing, telomere

measurement, and others. Oxidative stress tests fine-tune more general measures of

inflammation such as hsCRP. Some of these can be run through standard labs and some require

a specialty lab.  

Oxidative stress is just one pathway of premature senescence or aging. Other relevant pathways

through which we lose functional capacity include Mitochondrial dysfunction,

Metabolic/Nutritional deficiencies or excesses, Chronic infectious conditions, and

Hormone decline – menopause and andropause. These are the major categories I think about,

test for, and then ultimately recommend targeted lifestyle changes and therapies that will address

the epicenter of a given individual’s aging process. Since there are different ways in which we

decline, the choice of anti-aging therapy should be equally targeted to address the relevant

personalized underlying causes.

Mitochondrial dysfunction responds very well to therapies such as NAD infusions and exosomes.

These are highly relevant for someone like the 69-year-old CEO and athlete seeking consultation.

Not only has he accumulated mitochondrial stress over the years, his 6-days-a-week fitness

program creates its own stress through normal wear and tear. Regenerative strategies that boost

mitochondrial function generally lead to increased energy, mental clarity, and physical tissue

repair and regeneration.

Hormone replacement therapy is relevant because hormones inevitably decline over time.

Generally, this is first noticeable in the early 50s, but it can occur earlier or later. A lot of people

have questions about the safety of hormones, and it is a valid concern (and worthy of an entire

blog post of its own). When prescribed and monitored correctly, bioidentical hormone

replacement therapy is quite safe. When I discuss the option with people, I educate about the

differences between bioidentical hormones and synthetic hormone-mimicking pharmaceuticals. I

also carefully screen family history and past medical history for red flags that would skew my

recommendations toward strategies other than bioidentical hormones. Of course, doses, routes of

administration, and lifestyle strategies are all part of the conversation.

Did you know that good sleep is one of the most important contributions to healthy hormones?

When we sleep, we release growth hormone, which promotes subsequent production of estradiol

and testosterone. Some clinics offer peptide therapy such as ipamorelin to stimulate growth

hormone, but it is cumbersome (requiring home injections, sometimes multiple times per day) and

critical to confirm a quality, reputable source. Source is of highest importance as peptides are

available in the black market/doping world, as well as through FDA-approved products, but an

uneducated consumer might not know how to tell the difference.

Infectious contributions to aging include chronic infections like EBV, Lyme, Small Intestinal

Bacterial Overgrowth (SIBO), gingivitis and cavitations. When present, of course the infection

must be treated before regenerative therapies will have much impact. However, I find this is a

less common root cause.

Deficiencies and under-nutrition, on the other hand, are extremely common. And correcting these

deficiencies with simple repletion is a fast, reliable way to help almost everyone feel better.

General nutritional IV infusions are always beneficial, in my opinion, and even better when

combined with micronutrient testing to customize a repletion formula to target specific missing

nutrients in the diet or increased metabolic need for specific nutrients. I’ve written other blog

posts on IV therapy – read more here. https://www.drericaoberg.com/post/why-iv-therapy

I sometimes refer to exosomes as next level stem cells because they are the isolated “active ingredient” responsible for the regenerative benefits of stem cells, plus better safety parameters and efficacy. Mesenchymal exosomes are the information packets (vesicles of mRNA) that tell surrounding cells to activate repair and regeneration protocols consistent with the generative activity that happens before we are born.

What do they do? I’ll share a few exciting cases from the past year that demonstrate what exosomes do. Most profoundly, they are neuro regenerative.

Case 1 – 60+ female, former equestrian, who is quadriplegic following an accident 4 years ago. C4/5 spinal cord injury plus subsequent stroke and coma secondary to poor hospital care. She presented, frail and barely able to speak, in her power wheelchair, with her husband, about 9 months ago. They were both frustrated with the options conventional medicine had, although she was beginning exceptional PT at VIP Neurorehabilitation. 9 months ago, with exhaustive effort, she could elicit a tiny motion in her foot – not visible, but palpable if you were touching her achilles tendon. Now, she can fully dorsiflex (she says “I’m close to ready to push the gas pedal!) Additionally, she can fully extend her arm, speaks with almost normal volume and control, and has no issues with bowel or bladder (which were continually returning her to the hospital 9 months ago). She has not been hospitalized a single time in our 9 months of treatment.

Case 2 – just turned 60 lifelong boat captain presented with a 3 year history of a non-healing abdominal wound following repeatedly botched abdominal surgery (that’s medical short-hand for a long list of failed surgeries, skin grafts, meshes, infections, opioid over-prescribing etc.). This wound was no joke – 8”x10”, protruding 4” like a tumor; you could smell this wound as he walk into the room. Non-healing wounds are outside my day-to-day so I called the senior wound specialist in San Diego for a second opinion. He and his office worked on this patient with debridement, topicals, and systemic antimicrobials for about two months before he called me back and said it was hopeless. Well, six months later, after extensive exosome and nutritional IVs, and a rigorous weight loss program (85lb!) he had no local infection, healthy regenerative tissue across the whole area, and the team of 3 surgeons were willing to take a chance on the complicated surgery to repair the underlying hernia that caused the original problem. 6 months post-surgery, he’s happy, healthy, and probably the most eligible bachelor in the marina!

Case 3&4 – exosomes are not always heroic. Case in point: hair restoration. While it is trivial to some, it is instrumental to self-confidence and allowing the exterior appearance to exist in congruity with the youthful inner experience many of my clients experience through their intergrative health and wellness protocols. Case in point – the husband of Case 1 asked if he could try exosomes for his male-pattern hair loss. Using a combination of both intravenous and microneedling with topical exosomes, after 6 months, he has noticeably increased thickness in his grey ponytail and his hairline has advanced about 1” towards his forehead. Similarly, 70 yo female with a longstanding commitment to Rogaine for her thinning hair, agreed to stop that treatment and switch to intravenous exosomes. The attached before and 3-months later photos summarize the case.

Case 5 – orthopedics and lean body mass. This is perhaps the most common response to exosomes. 50 year old male with chronic orthopedic complaints in most joints from a lifetime of high intensity sports including semi-pro surfing, off road motorcycling, and keeping up with late-parenthood elementary school children. Not unrelated, experiencing 30lbs above optimal weight and severely limited in increasing physical activity due to injuries and pain. We started with a comprehensive oral anti-inflammatory supplement regimen, diet & lifestyle changes within his current limitations, and augmented this with exosome infusions every 6 weeks. At first, he reported skepticism of the treatment, as he had increased joint pain and inflammation a few days after each treatment. I educated him that this is consistent with the literature that demonstrate that exosomes, because of their ability to hone in on signals of inflammation, do preferentially travel to sites of injury. The initial repair response often involves transient increases in immune activity (i.e inflammation) and this passes, followed by the enhanced tissue repair and reduced overall inflammation. Despite the temporarily worse joint pain, he was thrilled to discover that he leaned up about 5 lb and a few percent body fat with every infusion. Over 6 months, the joint healing and improved body mass index translated into a renewed ability to be physically active and he is now at the level of performance he was at age 40.

Cases 6-12ish – I’m somewhat reluctant to report that the most popular effects of exosome treatment relate to skin rejuvenation. While I will always encourage self-love and acceptance at every age, I personally appreciate the challenges of being a middle aged female in Southern California who simultaneously wants to look as good as I feel, without synthetic injections or plastic surgery. Skin rejuvenation is low hanging fruit for exosome therapy. When used both systemically, or topically as part of a microneedling protocol, exosomes stimulate cellular repair and regeneration resulting in data-documented improvements in fine lines, skin texture, tone, and sun damage. Truly, a therapy to make skin more youthful.

These are just a few of the cases I have seen benefit with exosome therapy. In the literature, there are also cases of ICU-respirator Covid cases who have made 24 hr recoveries following a single exosome infusion. This is due to the ability to interrupt the cytokine storm. Not small outcomes!

How can one treatment have such widespread benefits?

The benefits are related to the mechanism of action. Exosomes stimulate repair and regeneration across all tissue types because they deliver instructions to cells to initiate the DNA replication protocols we have prenatally. These protocols, by definition, are designed to create rapid tissue (re)generation and growth and to be hypervigilant for errors or mutations. As such, following an exosome treatment, the cells behave like babies again and the subsequent tissue regeneration has the youthful properties we seen in babies.

How do I try it?

I recommend starting your exosome journey with photos of what you are trying to address. Ensure good light, no make up. Get someone to help you get a good angle if an inflamed joint or the back of your hair is your target. Exosomes are delivered as an IV infusion or microneedled into the skin. This is done once every 4-6 weeks, using 2-5 units of exosomes. In general, one should allow 3 months for full effects, although many people find benefits begin immediately.

Do you have more questions? Schedule a consultation and I will answer specific questions and make alternative recommendations if exosomes are not for you.