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How I Approach Anti-Aging Therapies

Updated: Sep 2, 2020

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.

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