Anti-aging medicine

[Ericslv]

Good for you. You obviously know how I feel about it. Consequently, I'm not going to prolong this conversation.

I feel the same. The difference is you bad mouthed what I do. I didn't bad mouth you. That's the problem with closed minds.

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[VA Hopeful Dr]

I feel the same. The difference is you bad mouthed what I do. I didn't bad mouth you. That's the problem with closed minds.

What, that we like evidenced based medicine?

 

[deleted87716]

I feel the same. The difference is you bad mouthed what I do. I didn't bad mouth you. That's the problem with closed minds.

 

[Ericslv]

What, that we like evidenced based medicine?

OH look it's va to the rescue. lmao. I think you too are having a secret love affair. By the way I sent you a bunch of studies. Remember that? It's you who won't look at the evidence. The world is flat.

 

[deleted87716]

OH look it's va to the rescue. lmao. I think you too are having a secret love affair. By the way I sent you a bunch of studies. Remember that? It's you who won't look at the evidence. The world is flat.

Ad hominem attacks do not improve your credibility.

 

[deleted480308]

Can you just link the peer reviewed studies?

 

[deleted87716]

Can you just link the peer reviewed studies?

"...there does not appear to be any solid scientific and/or clinical evidence that would justify the application of antiaging medicine in current medical practice."
https://www.ncbi.nlm.nih.gov/pubmed/20464088

"DHEA: Evidence for anti-aging claims is weak"
http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/dhea/art-20045605

"'Anti-aging' claims overlook scientific evidence on hormones"
http://www.healio.com/endocrinology/hormone-therapy/news/print/endocrine-today/{307d9e03-4342-4cd8-bb2c-1385d727f72d}/anti-aging-claims-overlook-scientific-evidence-on-hormones

"Testosterone: Not an Anti-Aging Panacea"
https://sciencebasedmedicine.org/testosterone-not-an-anti-aging-panacea/

"There is no acceptable evidence that 'bioidentical' hormones are safe or effective. Patients should be discouraged from taking them."
https://sciencebasedmedicine.org/bioidentical-hormones/

"Today, thousands of physicians are catering to the 78 million baby boomers who are hoping to feel younger, longer -- and willing to pay for the privilege. The anti-aging industry is expected to gross more than $291 billion worldwide by 2015."
http://www.cnn.com/2011/12/28/health/age-youth-treatment-medication/

 

[JustPlainBill]

And that turned into an elementary school, "Oh, yeah?" scenario rather quickly.

Ericslv-- I had a colleague in med school who was well established in the functional medicine circles before attending osteopathic school. To be frank, I once asked about the evidence as they spent the majority of their time poring over pub med articles and writing for various "journals". I was told something along the lines of ," I can make the evidence say what I want.".... I also noted that most of the "peer reviewed" journals were among the selfsame functional medicine crowd and not out in the big hitting journals save the BMJ and Lancet for a few articles. Naturally, I'm skeptical....seems to be a lot of talk but no action...in Texas, we call it "All hat and no cattle".

Not trying to denigrate functional medicine or anyone who practices it but I'm skeptical...just like I'm skeptical with most of the BS that makes up osteopathic theory.....and don't get me started on chiropractic....

Anyway...have fun gents...

 

[Ericslv]

And that turned into an elementary school, "Oh, yeah?" scenario rather quickly.

Ericslv-- I had a colleague in med school who was well established in the functional medicine circles before attending osteopathic school. To be frank, I once asked about the evidence as they spent the majority of their time poring over pub med articles and writing for various "journals". I was told something along the lines of ," I can make the evidence say what I want.".... I also noted that most of the "peer reviewed" journals were among the selfsame functional medicine crowd and not out in the big hitting journals save the BMJ and Lancet for a few articles. Naturally, I'm skeptical....seems to be a lot of talk but no action...in Texas, we call it "All hat and no cattle".

Not trying to denigrate functional medicine or anyone who practices it but I'm skeptical...just like I'm skeptical with most of the BS that makes up osteopathic theory.....and don't get me started on chiropractic....

Anyway...have fun gents...

www.worldlinkmedical.com go to the seminar. part 1 . see all the data and evidence from JAMA, BMJ, Endocrine, Urology etc. Yes it's there.

 

[deleted480308]

www.worldlinkmedical.com go to the seminar. part 1 . see all the data and evidence from JAMA, BMJ, Endocrine, Urology etc. Yes it's there.

You want me to sign up for cme in order to see studies? Can you just link your 3 favorites?

 

[Ericslv]

You want me to sign up for cme in order to see studies? Can you just link your 3 favorites?

Honestly, I don't really care what anyone does. I posted in here to show that not all physicians have such a negative view of BHRT and functional medicine. There are thousands of us doing this type of medicine. I don't have time to do peoples homework for them.

 

[VA Hopeful Dr]

OH look it's va to the rescue. lmao. I think you too are having a secret love affair. By the way I sent you a bunch of studies. Remember that? It's you who won't look at the evidence. The world is flat.

Actually I had forgotten about that, so that is my bad. I'll find that old thread and see what I can make of it.

 

[VA Hopeful Dr]

So to move from the other thread...

I don't have time enough to read every study you posted and review it, so I'm going to take the first 10 you listed.

Tutera G, Gambrell D. Marked reduction of breast endometrial and ovarian cancer in users of bio-identical estradiol and testosterone subcutaneous pellets. Maturitas 2009: 63(Suppl 1):S54.

That's a supplement for the journal, meaning its not peer-reviewed and anyone can get anything published if they pay for it.

Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions of hormone replacement therapy? Postgrad Med 2009; 121:1-13.

Interestingly, there was a response to this article in the same journal that countered this by showing the number of trials that show no difference between bioidentical hormones and synthetic ones.

Loeser AA. Mammary carcinoma response to implantation of male hormone and progesterone. Lancet 1941; 238:698-700.

1941, really? If that was such a big deal, I found it impossible to believe that surgeons and oncologists wouldn't be suggesting we still do this.

Schubert M, Bullman C, Minnemann, et al. Osteoporosis in male hypogonadism: responses to androgen substitution differ among men with primary and secondary hypogonadism. Hormone Res 2003; 60:21-28.

A trial with 53 patients? And no actual clinical outcomes?

Campagnoli C, Lesca L, Cantamessa C, et al. Long-term hormone replacement treatment in menopause: new choices, old apprehensions, recent findings. Maturitas 1993; 18:21-46.

Fletcher CD, Farish E, Hart Dm, et al. Long term hormone implant therapy – effects on lipoproteins and steroid levels in post-menopausal women. Acta Endocrinol 1986; 111:419-423

That one actually is kinda interesting, except a) no outcome data and b) the current evidence suggests that HDL is actually the bigger player compared to LDL.

Danforth KN, Eliassen AII, Tworoger SS, et al. The association of plasma androgen levels with breast, ovarian, and endometrial cancer risk factors among postmenopausal women. Internat J Cancer 2010; 126:199-207.

You realize that this study only reports on correlations between androgen levels in post-menopausal women with things like smoking history and whether or not they've had a hysterectomy, right?

Tan RS. Memory loss as a reported symptom of andropause. Arch Androl 2001; 47: 185-189.

Are you kidding me with this crap? Let's look at just one sentence from the abstract: A standardized questionnaire of 22 questions was administered to 302 outpatients of a medical center. Information on patient demographics, understanding of andropause, and risk factors was collected.

That's it, that's what this "study" used to try and prove that testosterone prevents memory loss. A survey to men who "think" they've undergone "andropause".

Aminorroaya A. Kelleher S, Conway AJ, et al. Adequacy of androgen replacement influences bone density response to testosterone in androgen-deficient men. Eur J Endocrinol 2005; 152:881-886.

Actually this one has potential, if you're not adequately treating hypogonadism it would make sense that you won't see the results you're hoping for. That said, the study didn't actually follow serum testosterone levels. They essentially said "we're going to implant testosterone and then follow BMP and not worry about T levels". Seems kinda pointless that way.

Glaser RL. Subcutaneous testosterone-anastrozole therapy in breast cancer survivors. ASCO Breast 2010: Abstract 221.

Now that one actually is interesting since estrogen is a bad idea in certain breast cancer patients.

What's also interesting is that those symptoms can all be treated pretty effectively in other ways as well, but I'll give this study credit for taking an interesting look at the issue.

 

[VA Hopeful Dr]

Like I said. Go get trained and see the high quality evidence for yourself. A4M has not failed to show evidence. If you had read my post you would see that I said there is volumes of evidence.

Let's give you and example of a patient. Lets see how you would treat or react to this patients.

Real Patient.
75 yo female who has been to BHRT or 5 years. At 69 years old she has a hga1c of 5.9. She was overweight and just did not feel good. She was fatigued, her joint ached, and was on thyroid medication for hypothyroidism with a TSH of 3.0, she felt sad all the time. She was told by the PCP that there was nothing that could be done for her fatigue and weight issues. She was told she was most likely depressed and was started on an SSRI. She was also on metformin and a diabetic diet was started.

Over the course of the year she continued to feel fatigued, had little energy and had gained weight. The SSRI's did their job. She gained the appropriate amount of weight despite being on metformin and eating the recommended diet.

She had a full set of labs and not other ailments were identified. She told her PCP she wanted to be active but could not and she had no libido even though she still wanted to be able to have sex. To make a long story short she was told by her PCP that there was nothing more he could do. Everything, all labs were "normal". She was just getting old.

A few months later she found a BHRT doctor. Not me.

He started her on testosterone, estradiol (not estrogen), progesterone, DHEA and T4/t3 combo. He optimized her levels. He changed her diet to a whole food diet. Cut of dairy and gave her an appropriate level of protein.

Over a period of 6months she started to feel better. She stopped the SSRI and metformin by herself. Her joints stopped aching as much and she started a functional weight lifting/HIIT program. AT 72 years old.

I saw her at 75 because she had to moved and was looking for a local doctor who practice functional medicine. When I saw her she was doing yoga a couple times a week and had lost all the weight she had gained. She was also lifting 3 x /wk and had a boyfriend with an active sex life. She said I have never felt so good.

I ran some labs as I usually do. Her T level was 400ng/dl and had been there for years. Her TSH was 0 and her free t3 was 6.0. HDL 60, LDL 90. HGA1c 5.4. She is in better shape and feels better than 95% of women her age.

She wanted me to continue her BHRT program for her so she could continue to do what she was doing. She said she sees no point in living to 100 if she can't be active have no sex and always be in pain and feel like crap.

If she walked into your office would you deny her her BHRT?

See, the bolded is part of my problem with all of this.

According to both Quest and LabCorp, the upper limit of normal for testosterone in women over age 18 is around 40-50. This, as with all lab tests, is determined by a large sampling of asymptomatic patients who have no known medical issues. Why is it then a good idea to want to raise that level to 10 times the upper limit of normal? Same issue with TSH: if you're giving someone thyroid hormone and their TSH is zero, it seems like their body is trying to tell you that you're giving them too much (assuming its not a panhypopit patient, of course). Similar thing with men. If you're giving enough testosterone that their becoming polycythemic, it seems like their bone marrow is trying to tell you to stop it not just phlebotomize them.

Let's take my 65 year old mother. She eats a fairly typical southern diet (meaning not healthy at all), her exercise is walking the dog once around the street in her neighborhood (maybe 1/2 mile). Her blood pressure last I checked was 100/70, lipid panel showed HDL of 85 and an LDL of 80. Her only medical problem is breast cancer 3 times. So all we have to do to prevent CV events in women is give them all breast cancer, right?

 

[JustPlainBill]

See, the bolded is part of my problem with all of this.

According to both Quest and LabCorp, the upper limit of normal for testosterone in women over age 18 is around 40-50. This, as with all lab tests, is determined by a large sampling of asymptomatic patients who have no known medical issues. Why is it then a good idea to want to raise that level to 10 times the upper limit of normal? Same issue with TSH: if you're giving someone thyroid hormone and their TSH is zero, it seems like their body is trying to tell you that you're giving them too much (assuming its not a panhypopit patient, of course). Similar thing with men. If you're giving enough testosterone that their becoming polycythemic, it seems like their bone marrow is trying to tell you to stop it not just phlebotomize them.

Let's take my 65 year old mother. She eats a fairly typical southern diet (meaning not healthy at all), her exercise is walking the dog once around the street in her neighborhood (maybe 1/2 mile). Her blood pressure last I checked was 100/70, lipid panel showed HDL of 85 and an LDL of 80. Her only medical problem is breast cancer 3 times. So all we have to do to prevent CV events in women is give them all breast cancer, right?

And you bring up an interesting point --- How many of us have seen people who weren't supposed to live make it out of the ICU and others who were "relatively healthy" pass? Don't know where you're at with this but there may be some truth to the saying,"When your time is up, your time is up"....

doesn't mean I won't work like heck to make the "-" as healthy and long as possible but really, some things we just can't control.

Hope my comment makes sense ---

 

[VA Hopeful Dr]

And you bring up an interesting point --- How many of us have seen people who weren't supposed to live make it out of the ICU and others who were "relatively healthy" pass? Don't know where you're at with this but there may be some truth to the saying,"When your time is up, your time is up"....

doesn't mean I won't work like heck to make the "-" as healthy and long as possible but really, some things we just can't control.

Hope my comment makes sense ---

I'm still fairly young, but I'm now convinced that 90% of a person's life is controlled by genetics. We all have the 500 pound patient with perfect BP and the 45 year old marathon runner with diabetes.

My mother's family hasn't had a women die before age 90 in 3 generations (her mother hit 90, her grandmothers hit 95 and 97).

Contrast that with my dad dying of an MI at 54 despite running 5 miles/day and lifting weights 4x/week (could still bench 250 the week before he died), granddad surviving his first MI at 53 (first year they did triple bypasses at Emory), so I went on Crestor at age 27 (the LDL of 160 didn't hurt that decision either).

 

[deleted87716]

There are thousands of us doing this type of medicine.

A4M claims 24,000 members worldwide, out of an estimated 10-15 MILLION doctors worldwide (according to the WHO). So, at best, something like 0.0024% of doctors are doing functional medicine. I presume the rest of us are actually looking at the evidence (or lack thereof).

 

[Ericslv]

A4M claims 24,000 members worldwide, out of an estimated 10-15 MILLION doctors worldwide (according to the WHO). So, at best, something like 0.0024% of doctors are doing functional medicine. I presume the rest of us are actually looking at the evidence (or lack thereof).

Like I said. keep thinking the world is flat. My patients love the way they feel and they are doing great.

 

[VA Hopeful Dr]

Like I said. keep thinking the world is flat. My patients love the way they feel and they are doing great.

So do all my Adderall patients

 

[FrustratedFamDoc]

I'm still fairly young, but I'm now convinced that 90% of a person's life is controlled by genetics. We all have the 500 pound patient with perfect BP and the 45 year old marathon runner with diabetes.

My mother's family hasn't had a women die before age 90 in 3 generations (her mother hit 90, her grandmothers hit 95 and 97).

Contrast that with my dad dying of an MI at 54 despite running 5 miles/day and lifting weights 4x/week (could still bench 250 the week before he died), granddad surviving his first MI at 53 (first year they did triple bypasses at Emory), so I went on Crestor at age 27 (the LDL of 160 didn't hurt that decision either).

I like to see it as a poker game and pass this analogy on to my patients on occasion. We're all dealt a hand in this game and like it or not, you gotta play it. Some hands are better than others. A good hand played well speaks for itself. A Good hand played poorly may still end up ok based on the fact that it's so much better than everything else at the table. A bad hand played well can do ok as long as long as everything goes right. A bad hand played poorly, well, that one can speak for itself as well.

I'm starting to subscribe to the genetic idea myself. In the past month, I've got 2 patients (40 y/o today and a 41 y/o a few weeks ago) recently diagnosed with colon cancer. 1 in great health, 1 in fair. Both showed up to the ER with severe anemia. Last year, one of my younger patients that really struggled with his diabetes, mainly compliance problems, bought something online in desperation to get his neuropathy better. Wasn't sleeping. He died in his sleep in his mid 40s. Tox report showed a cocktail of Dextromethorphan, Unisom and U-47700. Sure wish he would of run that one by me. I miss him, he was a really nice guy.

I can't lie, some aspects of functional medicine really appeal to me but I just can't stray so far from the norms and sleep comfortably at night. I don't mind going a tad strong on Synthroid on my young people who feel better, but that's about it. Defending the aggressive prostate/testicular/ovarian/breast/uterine cancer that my super therapy may have contributed to is something I hope to never have to consider.

 

[Ericslv]

So do all my Adderall patients

You really compared a stimulant that is addictive to what I do? REALLY? Go get some CME on it. learn then come back and comment and we can have a discussion on the same level.

 

[deleted480308]

You really compared a stimulant that is addictive to what I do? REALLY? Go get some CME on it. learn then come back and comment and we can have a discussion on the same level.

Do you sell the cme?

 

[Ericslv]

Do you sell the cme?

NO.

 

[VA Hopeful Dr]

You really compared a stimulant that is addictive to what I do? REALLY? Go get some CME on it. learn then come back and comment and we can have a discussion on the same level.

You mean like those 10 studies in that other thread that I tore apart earlier today?

Besides, all I'm really saying is that "patients feel better" is a terrible metric to use for evidence that stuff like this works. Exercise? Sure, that's a valid metric there. Healthier diet? Sure, them feeling better is great. Controlled substances? Nope, not kosher.

 

[Ericslv]

You mean like those 10 studies in that other thread that I tore apart earlier today?

Besides, all I'm really saying is that "patients feel better" is a terrible metric to use for evidence that stuff like this works. Exercise? Sure, that's a valid metric there. Healthier diet? Sure, them feeling better is great. Controlled substances? Nope, not kosher.

Who made it a controlled subtance and why? Who did testosterone hurt? And no you did not tear any studies apart. Your not that smart. Don't flatter yourself. LMAO.

 

[JustPlainBill]

Who made it a controlled subtance and why? Who did testosterone hurt? And no you did not tear any studies apart. Your not that smart. Don't flatter yourself. LMAO.

ahem...*You're -- contraction of "You Are"

 

[deleted87716]

Your not that smart.

LMAO, indeed.

 

[Ericslv]

LMAO, indeed.

typo.

You know you have been in here a long time. I've seen many of your past posts. Very conservative and traditional. I generally disagree with much of your info and posts. So it's no surprise people in here as well as yourself are blinded by the tons of evidence out there.

 

[deleted87716]

You know you have been in here a long time. I've seen many of your past posts. Very conservative and traditional.

Why, thank you. I take that as a compliment.

I generally disagree with much of your info and posts. So it's no surprise people in here as well as yourself are blinded by the tons of evidence out there.

None of which you've been able to provide here, oddly enough. If you're talking about that list of crap studies that you posted in another thread, all I can say is...

 

[VA Hopeful Dr]

typo.

You know you have been in here a long time. I've seen many of your past posts. Very conservative and traditional. I generally disagree with much of your info and posts. So it's no surprise people in here as well as yourself are blinded by the tons of evidence out there.

But see it's not just us. It's the AAFP, the ACP, the endocrine society, ACOG, the AMA, and so on.

Now I'm normally all about viewing the major societies with skepticism, but for clinical things when they are all saying the same thing it's usually right based on the current evidence we have.

But no you're right, hundreds of thousands of doctors are wrong and your group is right. That must be it.

 

[Ericslv]

But see it's not just us. It's the AAFP, the ACP, the endocrine society, ACOG, the AMA, and so on.

Now I'm normally all about viewing the major societies with skepticism, but for clinical things when they are all saying the same thing it's usually right based on the current evidence we have.

But no you're right, hundreds of thousands of doctors are wrong and your group is right. That must be it.

You got it. the world is flat right?

Hey I have an idea. You too should get a room. lol

 

[deleted87716]

You too should get a room. lol

LOL is right. SRSLY, I hope English is a second language in your case. It's a lot trickier to learn than HRT.

 

[Ericslv]

LOL is right. SRSLY, I hope English is a second language in your case. It's a lot trickier to learn than HRT.

Get room enjoy yourselves, let out some of that pent up frustration. LMAO.

 

[SXMMD]

this thread has been a wild ride from beginning to end, however I think we have reached the apex of this stimulating discussion

 

[deleted87716]

this thread has been a wild ride from beginning to end, however I think we have reached the apex of this stimulating discussion

Agreed.

 

[Hershalmike555]

Myself even heard about this Anti-aging medicine. But didn't use it and don't have practical experience on it. But I am confused is there any side effect for using this anti-aging medicine?

 

[wholeheartedly]

This discussion is going off the rails. Closing.