Dipping into the fountain of youth, AMNews

Dipping into the fountain of youth.
The promise of eternal life and endless youth appeals to patients and doctors alike. But is anti-aging medicine offering elixir or poison?
By Deborah L. Shelton, AMNews staff. Dec. 4, 2000.

Some doctors say science has discovered what Spanish explorer Juan Ponce de León never could: the fountain of youth. And for people who want to take a sip -- or in some cases, to dive right in -- there are now plenty of places to seek eternal youth without having to embark on an exhaustive search. In recent years, hundreds of anti-aging clinics have sprouted up across the country with the tantalizing promise of enabling people to live decades longer and healthier.

The concept appeals to many doctors. About 2,500 physicians nationwide have established specialty practices in longevity medicine over the past 10 years, according to the American Academy of Anti-Aging Medicine, a Chicago-based organization of 10,000 physicians and scientists. Broadly defined, anti-aging medicine involves the use of any technique, technology, medication or intervention for early detection, prevention, treatment or reversal of age-related disease. "The demographic is the largest in medicine," says academy president and founder Ronald O. Klatz, MD, DO. "We offer something for everyone age 45 and older. Once you start the process of aging, anti-aging medicine has something for you."

Some doctors have turned to anti-aging medicine as patients. "The results are remarkable," says Donald Kozil, MD, a 68-year-old suburban Chicago ophthalmologist, who has been taking human growth hormone and vitamin supplements as part of an anti-aging program since August 1999. "I'm not saying I'll live one day longer than the good Lord intended, but I want to be as healthy as I can for the time I'm here," he said.

Anti-aging physicians fall into one of two camps: those working to extend life span -- particularly "health span," or years of healthy living -- and those who believe that people can achieve immortality.

"Immortality is within our grasp," proclaims a recent news release from the academy, the only medical society dedicated to the science and practice of longevity medicine.

One of the goals of the anti-aging organization is to refute the view that aging is natural. "Our motto is: 'Aging is not inevitable,' " Dr. Klatz said. "There are effective treatments and interventions for memory loss, visual impairment, slowed gait and speech, wrinkling of the skin, hardening of the arteries and many of the maladies we call aging."

Advances in medicine and public health dramatically increased life expectancy during the 20th century. Vaccinations, antibiotics, improvements in sanitation and nutrition, and treatments for heart disease and cancer, among other things, have all contributed to a rise in life expectancy in the United States. At the turn of the century, people lived 47 years, on average. Today, average life expectancy is 77 years, a historic high.

The once exclusive centenarian club has become increasingly crowded. An estimated 100,000 Americans are age 100 or older, a number that has tripled in the past 20 years. Many anti-aging doctors and scientists believe that living at least 100 to 120 years will soon be the norm. "We have learned so much in the past 50 to 60 years about the biology of aging that it is now possible to envision the development of interventions that could retard aging and aging-related diseases in humans," said Mark A.

Lane, PhD, chief of the nutritional and molecular physiology unit in the laboratory of neurosciences at the National Institute on Aging. However, the demography of aging -- with the over-65 age group expected to explode from 4% to 13% of the population over the next 10 years -- also opens the door to "new markets for snake oil salesmen," said Dr. Lane, who's also president of the American Aging Assn.

The science
New scientific findings are bolstering the idea that the afflictions of old age may one day be successfully treated. Earlier this year, scientists at the University of Illinois at Chicago discovered that a single gene, p21, might be responsible for conditions ranging from heart disease to Alzheimer's disease.

A team of scientists at Scripps Research Institute in La Jolla, Calif., reported last spring that genes critical to cell division could be the cause of age-related body changes, such as graying hair.

Anti-aging scientists and doctors are also looking to the Human Genome Project for discoveries that could lead to new interventions to prevent, retard or reverse aging.

"There may be 50 to 75 'gerontic' or 'youth genes' in humans that determine one's capacity to modify the factors that determine maximum life span," said Karlis Ullis, MD, an anti-aging doctor in Santa Monica, Calif. "A good example of that was shown in the studies of the Caenorhabditis elegans worm. A few genes were altered and the worm vastly outlived the nonaltered worm and looked very vigorous, even at an advanced age." There is a split in the anti-aging scientific community about what to do with some research findings. Clinicians have been eager to apply various antiaging interventions. Basic scientists have tended to think that many of those interventions haven't been sufficiently studied.

Intervening in the aging process is not a new concept. Scientists have been researching the idea since the 1930s, most notably in studying the effects of caloric restriction. Hundreds of studies with rodents have demonstrated that reducing food intake by 30% to 50% can dramatically extend life span. Work with primates over the past 10 years suggests that caloric restriction has the potential to retard aging and extend life in humans as well. "If we can ascertain the mechanisms involved, we can come up with mechanisms that work in humans," said Dr. Lane, who conducts research in this area of anti-aging.

But the science is far less clear when it comes to widespread use of herbal medicines, dietary supplements and hormone replacement therapies -- the foundation of the type of anti-aging medicine typically practiced today. "Some of it is quackery," Dr. Lane said. "That is the stigma -- and the challenge -- that anti-aging medicine faces over the next few years."

The practice
Anti-aging doctors say they perform extensive evaluations of a person's health and "biomarkers" before designing individualized treatment. Part of the workup involves determining biological age, as opposed to chronological age.

For $1,750, Alan P. Mintz, MD, puts his patients through a battery of blood tests and completes detailed histories that look at mental health, nutrition, exercise and other lifestyle issues. Patients also undergo cognitive testing, agility testing and strength testing. Some screenings create a baseline to measure progress; others are used to determine which conditions can be treated hormonally.

Blood levels are monitored quarterly, and patients -- some of whom fly in from other states or overseas -- return at least once a year for follow-up. The goal of treatment is to "stay as close to the physiology of a 30-year-old as possible," said Dr. Mintz, chief medical officer and CEO of Cenegenics, based in Las Vegas.

Replacement therapies for estrogen, testosterone and human growth hormone play a major role. Human growth hormone, produced in the pituitary gland, is responsible for a wide range of youthful attributes, such as increased muscle and bone mass, decreased body fat, strengthening of the immune system and a greater sense of well-being and energy. Testosterone can improve mood, alertness, libido, and skin and muscle tone in both men and women. For most people, hGH levels drop dramatically by age 30. Testosterone levels also decline.

"Testosterone and natural estrogen and natural progesterone, when used correctly and safely, are cornerstones of anti-aging therapies," said Dr. Ullis.

He has treated more than 500 patients with hGH but now believes "it's not the wonder drug that the public has been led to believe." Other methods can work as well, such as intense weight training, caloric restriction, moderate cardiovascular workouts, moderately high protein intake, deep sleep and positive social relationships, he said.

Some doctors have raised concerns about the widespread use of hGH because it stimulates the liver to increase production of the insulin-like growth factor, which normally declines with advancing age. Samuel S. Epstein, MD, professor of environmental medicine at the University of Illinois School of Public Health in Chicago, has warned fellow doctors of the potential dangers of widespread use, which include increased risks of colon, prostate and breast cancers.

"For these reasons, anti-aging hGH medication, compounded by failure to explicitly disclose its grave risks, constitutes medical malpractice," Dr. Epstein said in a statement in September.

Studies have found that when used to treat patients, testosterone can cause fluid retention, stimulate aggressive behavior and raise red blood cell counts.

Both hormones are indicated only for actual deficiency, said Paul S. Jellinger, MD, president of the American Assn. of Clinical Endocrinologists.

The issue gets complicated in the context of anti-aging medicine. Does natural decline usually suggest the need for treatment? "The biggest problem in this field is to separate those people with true deficiency and those with normal declines that come with aging," Dr. Jellinger said. "There is no strong evidence that everyone who has the normal decline of testosterone from aging is a candidate for replacement therapy." Nearly nine of 10 endocrinologists polled in a recent survey said they were concerned that increased availability of testosterone replacement therapies, combined with widespread publicity about potential benefits, could lead to inappropriate prescribing by doctors and serious health consequences for male patients.Questions about the safety and validity of hormone replacement underscore the uncertainties about anti-aging medicine.

"Some doctors think they can take a weekend seminar and become a specialist in anti-aging medicine," said Dr. Ullis, who has been practicing it for about 10 years. "You can't learn endocrinology and exercise physiology over a weekend. Patients are asking about supplements and hormones, and doctors have to be well-informed."

Fountains of youth
Examples of some potential anti-aging treatments include the following:
l Stem cell therapies.
l Bionic organ parts.
l Designer anti-aging diets.
l Microscopic "robots" injected into the bloodstream to detect and repair problems at the tissue and cellular levels.
l Genetic engineering using retroviral or liposomal vectors for the delivery of human artificial chromosomes.
l Delivery of medications and natural hormones, using implantable pumps.
l Experimental investigations utilizing cells from bacterial colonies, yeast, nematodes, fruit flies, rodents, bats, rabbits and monkeys.

Fighting Mother Nature and Father Time
If you build it, they will come. If you promise eternal youth, they will stampede.

Who are these people who seek out anti-aging medicine? "I like to call my patients 'health and wellness optimizers,' " said Karlis Ullis, MD, an anti-aging physician in Santa Monica, Calif. "They want the most and best out of their lives."

Patients in Dr. Ullis' practice are more likely to be men than women. The average age is 40 to 50. They tend to be successful in their careers. Dr. Ullis describes the average patient as a "well-educated, successful, strongwilled and disciplined individual." But there is a tendency to go to extremes. "I have to tell them that filling up their bodies with high-octane hormones will not automatically make their old Chevy bodies into sleek Ferrari race cars," he said.

Alan P. Mintz, MD, who operates a multioffice anti-aging practice in Las Vegas, said patients come to him for four reasons: the desire to maintain memory function; to increase energy, especially sexually; to develop a strong immune system; and for vanity.

"The goal of most people who come to me is to maintain a very high standard of life; 60% to 70% are healthy," he said. The remainder have chronic health problems such as asthma, diabetes, neurologic disorders or chronic fatigue.

"They don't want to take aging lying down," said Ronald O. Klatz, MD, DO, president of the American Academy of Anti-Aging Medicine, who has a practice in Chicago. "They believe -- and I agree -- that they can avoid Alzheimer's disease, osteoarthritis, fatal heart attack and stroke. The technology is there to accomplish all of these things. It's merely an application of existing technology, which traditional medicine has ignored." Ultimately, anti-aging medicine seeks to create "an ageless society where you can't distinguish with the naked eye between an average 65-year-old and a healthy and athletic 105-year-old, and we're seeing that right now," Dr. Klatz said. "Look at some of the older athletes and Hollywood stars. People in their 80s are fit and vital and look great."

Weblink
National Institute on Aging Research Programs page (http://www.nih.gov/nia/research/)

American Federation for Aging Research (http://www.infoaging.org/)

American Academy of Anti-Aging Medicine (http://www.worldhealth.net/)
Gerontology Research Group (http://www.grg.org/)