LIFE EXTENSION and the WELLNESS REVOLUTION - What It's All About!
Observing the approach of middle age, the boomers’ cry went out… resist!
As the millennium dawned, America’s largest, most affluent generation quietly began swelling the ranks of the “middle aged” ... and most weren’t thrilled with the idea. As a result, many are joining the new “resistance,” adopting such “revolutionary slogans” as: we may be aging, but we shouldn’t have to feel or act ‘old!’ Boomers, after all, have earned a reputation for embracing change. Why stop now?
Fortunately, physicians, scientists and medical researchers have been studying the processes and problems of aging for decades, with frequent, and significant progress.
In the long-term, genetics research may hold the greatest promise for finding the means to actually arrest the aging process. In the meantime, significant developments in biotechnology, endocrinology, neurology, gerontology, nutrition and other fields have given anti-aging physicians an array of solutions that work today - to help us look and feel youthful - as we grow older.
Life-Extension medicine is now the fastest growing medical specialty in the US - not merely because Americans want to live forever - but because they want to extend their productive years, and enjoy them to the fullest. The fact is, Americans are living longer - much longer. The average life span at the turn of the 20th century was about 47 years. Today it’s more than 77 - a 75% increase - and analysts predict the trend will continue - especially as society deals with life-span-limiting problems, such as obesity.
EXTENDING YOUR HEALTHSPAN
From 47 years to 77 years! A thirty year (63%) increase in life span can only be considered amazing - unless - the “extra” years are compromised by illness, or disability. Unfortunately this is too-often the case, as many people in the final one-third of their lives succumb to the degenerative diseases and disorders of aging: diabetes, arthritis, digestive, auto-immune and a wide range of others.
Meanwhile, a significant number of people do find their last 30 years of life to be nearly as active, and every bit as enjoyable as the first 47. What makes the difference for these people? While genetics do play a role, the more significant factors are education, lifestyle, and nutrition. When patients learn about their bodies and the aging process, and follow a program of enhanced nutrition and lifestyle; many will themselves once again feeling and doing things they had believed gone forever.
While medicine in general continues to increase our life span, Life Extension is more concerned with the quality of your remaining years. Extending your Healthspan means ensuring that your 2nd half at least as enjoyable and rewarding as the first. This fastest-growing new branch of medicine feeds into a worldwide database of observational data. What works for someone on the other side of the world is no longer obscured by time, distance and culture. Every day new tools and methodologies are added to the arsenal ... and practitioners and patients reap the benefits.
While we cannot turn back the clock - we can in a sense “slow it down” by eliminating sources of toxins, poor nutrition, hormonal imbalances and the degenerative diseases of aging. As they begin realizing enhanced Healthspan benefits, patients often report feeling as if the clock were running backwards.
Nu-Living Anti-Aging Concepts
One - Optimum Levels: Life extension embraces the functional medicine concept of optimal wellness. “Normal” test ranges are no longer “ends” but become the starting points, from which we define your optimal levels for peak performance of hormones, blood chemistry, and organ functioning.
Two - Comprehensive Assessment: This in-depth evaluation includes physical and lab tests, questionnaires and one-on-one interviews. The resulting data enables doctor Terlinsky to design the patient’s individualized program: a complete range of optimal wellness goals, and the nutritional, environmental and lifestyle guidelines to achieve them.
Three - Patient-Physician Partnership: Dr. Terlinsky engages in a one-on-one partnership with the patient, based on honesty, trust, and communication. This interaction supports the patient’s efforts to reach his or her program’s educational, nutritional and behavioral goals, and to realize the long-term benefits of wellness, productivity, and enjoyment of living, well into the golden years.
In the end, Wellness Optimization and Anti-Aging Medicine are really two sides of the same coin. Both seek to reduce stress, inflammation, oxidation, and toxic levels, while promoting nutrition, exercise, and positive lifestyles. Anti-aging goes a step further, prescribing hormones and other supplements achieve a more youthful body “chemistry.” Taking these steps are a personal choice, however they are by no means mandatory - great results can and are often achieved simply through diet and nutrition, education, exercise and lifestyle.
CHRONIC DISORDERS - Tired of falling through the cracks of managed care?
Functional Medicine diagnostics and treatment brings new hope to suffers of the most perplexing disorders.
Tired of feeling tired ... stiff ... achy? Perhaps you’re plagued by insomnia, allergies, bloating, diarrhea, or other stressful conditions ... Chronic disorders can produce a maze of symptoms that mimic a known diseases yet defy conventional treatment - leading to misdiagnosis and frustration. Functional Medicine addresses these “difficult,” chronic disorders by correctly identifying (and treating) their root causes.
More and more Americans are “slipping through the cracks” - of the U.S. health care system - and falling victim to a growing number of debilitating “disorders.” “Fibromyalgia, Chronic Fatigue, CHS/FHS, GERD, Irritable Bowel, PCOS, and other new terms are rapidly entering the lexicon of American medical distress.
What do these disorders have in common?
* Wide ranging, misleading symptoms - lead to misdiagnosis
* Hidden, systemic causes - often due to subtle toxicities, and years of abuse and/or neglect.
* Exacerbated (or even brought on) by aging process - in younger years, the body’s’s natural resilience managed the imbalances
* Require functional medicine physician, for successful diagnosis and treatment
* Require substantial and varying amounts of physician’s time to treat, depending on patient age, history, health, type of disorder and other variables
Finally, the Widening “Cracks” in the System…
These modern disorders exhibit a natural resistance to the basic (allopathic) disease-treatment paradigm: a philosophy near-universally embraced by the insurance-based health care system that categorizing health care options according to quantifiable diseases, and treatments. The insurers prefer to pay for only for justifiable treatments (that prevent or cure disease, alleviate suffering, and pain) - which must be quantifiable, with a defined beginning, frequency and end.
Modern disorders, however, break the rules, by masking themselves behind a somewhat confusing array of symptoms, which may resemble a number of other diseases or disorders. As a result, patients usually take part in a medical wild goose chase as they bounce from specialist to specialist, only to find that their disease is either pronounced untreatable (by that specialty) or incurable, or simply doesn’t exist. Unfortunately it usually does. These disorders are very real.
At the “end of the specialist trail” the patient eventually reaches the (previously mentioned) “crack”, and which point the patient drops through the crack - and the referrals stop. The final one often being the name of a psychiatrist or other mental health care professional. This can actually be a good thing, because it drives the patient to break the cycle and try something new - i.e. to search outside normal medical channels for help. When this happens, the patient often picks up the trail to real help: which is usually in the form of a functional practitioner.
Functional Medicine has been growing in the US for over a decade, with a national practitioner base numbering in the thousands. Practitioners come in many flavors, specializing in areas such as CFS/FMS, Women’s Issues, Intestinal, and Allergenic disorders. Doctor Terlinsky also specializes in Women’s issues, and weight control. (bariatrics)
BIO-IDENTICAL HORMONE REPLACEMENT - A Saner Alternative
There is a Safer, Saner Approach to HRT, and its name is “Bio-identical.”
After the release of the landmark WHI findings in 2002, millions of American women found themselves in an ocean of hormone-replacement doubt and confusion. Soon afterward, Suzanne Somers’s best-selling The Sexy Years made another splash, as a much-needed life preserver, bringing new perspectives, solutions and above all hope to women, who must continue coping with the “curse” of menopause. This inspirational book helps untangle the confusion surrounding hormone replacement therapy, and reassures women about their bodies, and their options for not merely “surviving” menopause - but transforming it into the richest period of their lives. For Ms. Somers, this transformation turns on the use of bio-identical hormone replacement therapy - a subject on which we are answering more and more inquiries. In light of the recent WHI (Woman’s Health Initiative) findings on HRT health risk: women today want facts about bio-identical HRT. This article will provide you with the basics.
What Are “Bio-Identical Hormones?”
Bio-identical hormones are precise duplications of the estrogens and progesterone produced by the human female reproductive system.
This term “bio-identical” is sometimes confused with the term “natural” - which means something else entirely. Substances that are produced in a biological organism are considered to be “natural” or “organic” - as opposed to “synthetic” or synthesized in a laboratory. However a natural substance is not necessarily bio-identical. For example, insulin was originally derived from pigs, until researchers learned to synthesize it in the lab, and then the practice was dropped. Why? Because while the pig-insulin may have been natural, it wasn’t bio-identical: it wasn’t an exact match to insulin made in humans. The synthetic insulin was a perfect match, and this rendered the pig-based “organic” product obsolete.
A similar situation exists with women’s reproductive hormones. Women have for several decades been prescribed an estrogen product derived from the urine of pregnant mares (horses) called Premarin. (PREgnant-MARe-urINe) While this substance may be “natural” it is also very different from the hormones produced in human ovaries. It’s active ingredient, “eqiillin” (from the latin for horse, “equs") is known for its powerful impact and persistence on the human uterus. The main hormone produced in the female (human) ovary is Estradiol. Premarin does not match the human hormones it replaces, it is a substitution. We were not surprised to learn that Premarin was the only estrogen replacement substance used by the participants of the WHI studies.
The second hormone substitute in non-bio-identical HHT is the chemical Medroxyprogesterone Acetate, (sold as “Provera") which is purely synthesized in the lab, and does not match the naturally occurring progesterone that it replaces. This powerful chemical has been linked to several health risks, including significant bone mineral density loss, breast cancer, and side effects including headache, nervousness, abdominal pain, dizziness, weakness, or fatigue. We were not surprised to learn that Prevara was the only progesterone replacement substance used by the participants of the WHI studies.
Again, bio-identical hormone replacement provides an exact duplication of the hormones that naturally occur in the body. In menopause, therefore, we replenish the primary estrogen “Estradiol” with bio-identical Estradiol, and we replenish diminished Progesterone with bio-identical Progesterone. The concept is straightforward: we replenish the body’s missing hormones with bio-identical ones. We don’t replace a hormone that isn’t missing.
HUMAN HORMONE SUBSTITUTE BIO-IDENTICAL REPLACEMENT
Estradiol Permarin Estradiol
Progesterone Provera Progesterone
Again, one the cardinal rules or bio-identical HRT is to mimic the body’s natural physiology as much as possible. The old method of “continuous combined therapy” violates this rule completely by “tricking” the body into believing it is pregnant - perpetually. In bioHRT we cycle the replacement estradiol and progesterone in a natural manner. Ideally during the first half of the cycle the estrogens dominate, and in the second part there will be more progesterone - thus fully restoring the woman’s natural, youthful hormone cycle. Normally this will reinstate the patient’s menses. If this is not desireable, we can adjust the therapy accordingly.
Bio-identical estrogens not only duplicate the naturally-occurring (human) estrogens, they also duplicate the effects of these estrogens. Through careful testing and monitoring we can reinstate and maintain a woman’s unique, naturally youthful hormone levels, providing natural relief from the distresses of menopause and related conditions - while minimizing potential adverse health risks.
Are Bio-Identical Hormones Safer?
While this question cannot be fully answered until appropriately-designed studies have been completed, many physicians and researchers currently believe that bio-identical hormones may be safer than synthetic HRT, for numerous reasons, including the following:
The studies linking HRT to long term health risks do not quantify bio-identical hormone use in their questionnaires or methodology.
The estrogens used in Natural HRT products are known to have weaker cancer risk associations than those used by the WHI participants.
The studies make no provisions for the type of estrogens or progestins used, but should, since studies have found that women using 17-beta estradiol transdermal patches had no increase in blood clots, while those using oral estrogens, such as Premarin, did have an increase.
Using hormones that are identical to those made by the body is a logical choice, especially when cancers are increasingly linked to environmental toxins and synthetic substances.
The Big Picture: Commercial Viability
After the WHI and other studies proved the existence of major health risks associated with conventional HRT, the major manufacturer responded by simply reducing the recommended dose. Then they went ahead promoting and marketing their product as the “gold standard” in hormone therapy ... Why physicians would continue to prescribe non-human estrogens - the very products used in the studies - mystifies a growing number of physicians - including ourselves.
However some do. We cannot understate the influence Drug companies continue to exert upon many physicians and their treatment choices. After all, their research and products have for decades been the powerful “silent partners” standing behind the physician’s results. Without the powerful solutions provided by the pharmaceutical industry drugs, how would doctors manage? (The real answer may surprise you)
Upon further observation, it is obvious that the benefits of bio-identical HRT run counter to the profit needs of the large drug manufacturers. Points in fact:
Bio-identical hormone protocols are tailored according to each patient’s unique physiology and needs, and the prescription is then formulated by a compounding pharmacy. When effects are known, the formulation can be fine-tuned or adjusted until the patient attained optimal relief levels.
Drug manufacturers prefer products that can be mass-produced and distributed to economies of scale. For example, Wyeth maintains 700-800 horse-breeding farms in Canada where thousands of mares are kept pregnant in narrow stalls, year round, for the purpose of collecting their urine. (They are kept in perpetual thirst to concentrate their urine, and rarely allowed to run since that disturbs the collection tubes.) This super-concentrated equiillin-rich urine seasonal “crop” yields billions of doses of the patented drug Premarin, which is distributed world-wide at arbitrary pricing. ("whatever the market will bear")
When a product’s attributes suggest major profit potential (patentable, mass-production, large market) then a manufacturer can justify the major expense of long-term clinical trials to document that product’s safety and efficacy.
Because they occur naturally in the human body, bio-identical hormones are not patentable. Hence the large drug manufacturer have no reason to invest money in research trials to prove their safety. In fact, just the opposite may be true. Yet smaller, short-term studies on bio-identical hormones have reported good results and more importantly; no adverse effects.
Individual clinicians must rely on observational data, and we have never encountered adverse risks arising out of bio-identical HRT, nor are we aware of any other practitioner having reported the appearance of real or apparent adverse results.
The Informed Decision
Whether or not to use bio-identical HRT (or any form of HRT) is ultimately your decision to make. Before you make it, you should familiarize yourself with the risks of HRT. There are known risks - and even bio-identicals have not yet been proven completely safe. However we believe your risks can be reduced by using bio-identical hormones and a natural therapeutic approach.
Here are some sources to read what other patients say about their experiences with bio-identical hormones, in comparison to years of conventional HRT dosing.
The next step is talking with your doctor about any additional risks you may have, based on your family history, current health, lifestyle, work and other factors that may influence your risk.
Risks must be evaluated in relation to what can be gained. For example, there are risks associated with chemotherapy, yet cancer patients willingly assume those risks because they stand to gain much more by defeating a life-threatening disease.
Only you can decide whether the symptom relief you can gain is worth the risks of hormone replacement therapy. What level of risk is justifiable, if the payoff is feeling good .. all month long?
Your doctor should be your partner, strategist and ally, sharing your goals and committed to using every means at his or her disposal to help you achieve maximum relief and quality of life - while protecting your long term health.
A QUESTION OF BALANCE - Adequate levels of balanced hormones are three-quarters of the battle.
Diana Schwarzbein and other leading researchers show us how balance plays a powerful role in womens’ wellness and disease prevention.
Dr. Terlinsky is a Shwarzbein-certified (SRP) Level-1 Practitioner.
The “Schwartzbein Principle” rests on a basic premise: the body is a system of systems; and when one system becomes out of balance, the others are affected. While all degenerative diseases (including aging) can lead to great imbalances, even slight ones can impact a woman’s general feeling of wellness - and her functionality. Woman is unique in that her hormonal levels are shifting from puberty on. Her systems are fine-tuned, so that common factors (diet, toxins, stress, etc.) can magnify these shifts, and place her in distress.
Doctor Schwarzbein gives us 4 categories of testing to monitor virtually every aspect of your physiology: metabolic, reproductive hormones (menopause), thyroid, and physiologic. Through testing in these areas we develop your comprehensive, individualized assessment; a detailed physiological mapping that helps us develop your personalized treatment plan. There are other factors as well, including test, questionnaires, and relaxed one-on-one sessions with Dr. Terlinsky. What you have to say is important to us, because no test can adequately explain what a woman is feeling!
Metabolic Testing: analyzes your insulin resistance and adrenal (gland) functions. While often compromised by age and/or lifestyle, these are usually restorable, through changes in diet, and/or lifestyle.
Menopause
Menopause is what happens when the ovaries shut down and production of sex hormones drops drastically. (altho a few estrogens may continue production within fat cells) Menopause generally occurs between the ages of 35 and 45, or, approximately the same age as your mother. Early onset (1-2 yrs) may occur in tobacco smokers, women who live in high altitudes, and women who have never been pregnant.
Whenever it does arrive, menopause signals serious changes in a woman’s life, including general decline of energy and vitality, sexual libido, body composition, mood; and a host of other symptoms from hot flashes, to anxiety attacks, to memory loss. While men go through their own “mid-life crises,” they are spared these levels of physical and emotional distress.
We are highly sympathetic to our patient’s needs (some of us are women too!) and our objectives are to alleviate your suffering while minimizing the risk of long-term (or short-term) side effects.
Most of us are familiar with the benefits of hormone replacement therapy (HRT) and hopefully with the risks involved as well. In the end, each woman has to make the choice for herself whether to use HRT, based on her level of distress, her physical condition, family history, and so on. Our goal is to help you understand and weigh the risks, by providing balanced facts and opinions from both sides of the HRT issue - so that you can make an educated choice. (See “BIO-IDENTICAL HRT” in the next article.)
Based on our (Schwarzbein and other) training, we adhere to the following concepts and guidelines concerning Hormone Replacement Therapy:
Use only hormones that are bio-identical to those produced in the body. These are naturally occurring estradiol and progesterone - both of which are widely available in a pure, bio-identical form.
Use them judiciously, only when deficient or absent. Experiment with dosing until normal levels can be reliably duplicated
Approximate normal physiology by re-establishing cycle (and menses). This is accomplished by cycling the hormones, just as the body does.
Monitor the hormone levels and their effects. We analyze blood - not saliva - to track the effects of HRT and adjust dosages as needed to maintain a natural balance.
You may be aware that most gynecologists prescribed HRT (prior to WHI) according to a practice called “continuous combined therapy” (which essentially mimics pregnancy). The therapy featured the heavily marketed PREMPRO (TM Wyeth) product made of potent Premarin (conjugated pregnant horse urines) and Provera (medroxyprogesterone acetate) - the same combination used by the vast majority of Women in the WHI studies.
If you wonder why thousands of physicians never bothered to mimic female body’s natural cycles, the answer is simple: they did! Cycling was the standard for years. The move to continuous combined therapy was a gauged response to persistent complaints and patients’ unhappiness with restored periods - plus bloating and irritability to boot. However, instead of trying the bio-identical approach, physicians and researchers experimented with Premarin/Provera combinations until they hit upon the “continuous” tactic: in essence rendering women pregnant for years, on a cocktail of powerful equine urines and other chemicals. Somehow, the (WHI) long-term health risk findings did not come as a surprise.
Perimenopause
This is where it begins: the earliest rumblings of menopause; call them harbingers, or premonitions. The onset and intensity varies from woman to women. Some women sail through a gentle puberty to settle into an equally benign monthly cycle, continue thusly until their 45th year, at which time everything comes to a screeching halt. Others may begin to decline ten years earlier, but proceed at a slow, halting pace: normal one month, erratic the next. Most fall somewhere in between. There is broad spectrum of possibilities for perimenopause-menopause, and where you fit in is determined partially by genetics, partly by your environment, partly by your behavior, and the rest by chance.
Perimenopause is also manageable. Some women receive excellent symptom relief using low-dose birth control pills, with an estrogen content of about 20 mcg. In addition to birth-control, it corrects irregular bleeding and helps with hot flashes and night sweats - also reducing the risk of ovarian and uterine cancer. Low dose BC can also aid the transition to hormone replacement therapy after menopause.
It follows that some women barely notice perimenopause - if they happen to be using contraceptives when it occurs. This is because contraceptives release estrogen and progestin. (to “fool” the body into “thinking” it’s pregnant, thereby preventing ovulation).
You are Unique - So is Your Program
Hormone replacement therapy is a serious step, and it mustn’t be taken lightly. You can’t “play it by ear” and rub in some cream, then see how you feel. Our initial evaluation provides a safe starting “window” from which we proceed to “fine tune” your hormone levels. We track your blood hormone levels periodically along with other blood chemistry, bone, lipids, blood pressure and the condition of your uterus to make sure you are receiving optimum levels of hormones at the proper times. In other words, your program is personalized to your needs alone, and no other person’s dosages (with the possible exception of an identical twin sister!) will apply to you.
Thyroid Highs and Lows
The thyroid is a small gland with a big role in the control of your metabolism. Hormones secreted by the thyroid (T3 and T4) are called the “building hormones” because they control the production of key proteins in your body (e.g. neurotransmitters, enzymes, hormones, cells, muscles and bones).
An insufficient level of thyroid hormone is called hypothyroidism - which may result in symptoms like fatigue, depression, weight gain, irregular period, constipation, aches and pains ... because of insufficient thyroid hormones you cannot rebuild or use sugars and fats efficiently, also negatively impacting your other hormones. Fortunately, the condition is quite treatable, once diagnosed.
HYPERthyroidism - the overproduction of thyroid hormone - is a bit more complicated. Common symptoms include sweating, anxiousness, heat intolerance and unexplained weight loss. The condition has a variety of causes, some very serious. Treatment should be prompt, and must be individualized, as it may require radiological and/or surgical intervention.
Thyroid testing may be included in our programs when conflicting symptoms necessitate ruling-out thyroid - to continue diagnostics of other hormonal or metabolic issues.
Meet the Women's Health Doc!
by Alan Terlinsky, MD PC FACP
As women face ever increasing responsibilities in today’s society, including executive careers coupled with child-bearing and family responsibilities: along with the “liberation” comes increased stress, stress-related disorders, and a greater incidence of a wide range of conditions unique to women. Doctor Terlinsky specializes in preventative health and wellness optimization for women of all ages, with programs designed to treat disorders arising from hormonal imbalances, as well as the complete range of diet-lifestyle-and-stress-related chronic conditions.
WomensHealthDoc will provide you with insight and information on a wide range of common and not-so-common womens’ health issues, ranging from Alopecia, PCOS, and PMS, to Sleep Disorders, and many others. You’ll also find complete information on our treatment modalities, specific programs, and a step-by-step enrollment process that starts right here!
We hope you will find this compilation helpful, and decide to take additional steps toward individualized wellness, and the long-term enjoyment of a fully-enhanced healthspan.
Sincerely
Alan Terlinsky, MD PC FACP
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