The suggestive title of the XXXV Memorial Lesson of the Fernández-Cruz Foundation refers to the proactivity of the so-called 4Ps Medicine or MP4.

The conclusions of eminent physicians such as Dr. López-Otín or Dr. Gabriel included, amongst others, caloric restriction, metformin, resveratrol, maintenance of a systolic blood pressure below 120 mmHg and an LDL cholesterol below 100 mg/dL, carbohydrate metabolism biomarkers which reflect levels of excellence and addressing diseases during the subclinical phase…that is to say, the measures we at Neolife practice everyday, assisted by the most avant-garde advances in science.

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The XXXV Memorial Lesson of the Fernández-Cruz Foundation presented 8 objectives closely related to Preventive, Proactive, Predictive and Personalized Medicine (MP4).

Once again the prestigious Memorial Lesson of the Fernández-Cruz Foundation was held in the auditorium at the San Carlos Clinical Hospital and once again the theme was wholly aligned to the spirit of Preventive, Proactive, Predictive and Personalized Medicine (MP4) that we carry out at Neolife.

The title, “The fight against ageing and death begins with you”, is a clear reference to the proactivity of medicine and the list of objectives for the event was similarly a declaration of intent to unite behind MP4:

1. Determine the level of excitement produced by the lengthening of our life expectancy.
2. The latest scientific advances have shown that most diseases are curable. Dyslipidemia, diabetes-obesity, hypertension, cognitive impairment, Alzheimer’s and cancer which affected the associated morbidity. Prevention is the tool of choice in chronic diseases typically associated with ageing.
3. Cut figures to be treated for hypertension based on evidence-based medicine. Cut figures to be treated for hypercholesterolemia based on scientific evidence, new measures and therapeutic strategies. The challenge of diabetes: consolidation of the therapeutic strategy.
4. Connection to creative ideas to ensure people can live longer. The power of the technological revolution is a reality that should be applied to our clinical practice, which defines new scenarios to us. “My Health file in the Community of Madrid”. Early diagnosis and personalized treatment are the new identity cards.
5. Health-wellness is the great challenge. The search for well-being and happiness can be obtained through optimal health and therefore it is important to ensure we establish suitable habits such as diet, physical exercise, mental health (through the proper management of stress-anxiety) and appropriate follow-ups. The clinical guidelines of the National Health System allow for the early detection of the diseases associated with ageing.
6. Empowerment to acquire effective and proactive attitudes. Health education should be emphasized and prioritized due to the benefits evidenced to date in the management of chronic diseases.
7. The opinion of the leaders in the revolution against ageing. Genes, editing and telomeres. Where we are?
8. Does the dream of immortality call for realizable dreams? The ability to edit genes opens up our ambition to transcend the biological limits of the human form, to end illness, suffering, risks associated with natural birth, ageing and death.

Dr. López Otín highlights the importance of caloric restriction, metagenome optimization, as well as drug and metabolic reprogramming as potential anti-ageing measures.

Dr. Carlos López-Otín (one of the best molecular biologists in the world) re-stated in his lecture entitled “Strategies for longevity in the genomic era”, his conclusion from one of his last publications in the Cell journal titled “Metabolic Control of Longevity”.

Over the years the metabolic functions of our body are altered, which results in decreased functional abilities. You could say that there is a “metabolic clock” which has a spent battery. Each of the 9 causes of cellular ageing described by the same author in 2013 are affected by metabolic disorders on which it is possible for us to act, since we know that certain genes are related to extended longevity, as well as certain congenital defects that can trigger premature ageing. It is well known that modern lifestyles, including hypercaloric diets and the sedentary lifestyle are the source for many of these metabolic disorders, in addition there is scientific evidence that demonstrates we can take certain measures that could counteract the metabolic disorders responsible for triggering the ageing process. Among said actions, Dr. López-Otín pointed out the following:

• Caloric restriction: difficult and possibly harmful to implement, which the author considers wholly unacceptable.
• Metagenome optimization: the genes of bacteria living in symbiosis with us, especially those in the digestive tract. Such optimization through the consumption of probiotics and prebiotics, as well as future beneficial bacteria is intended to avoid intestinal dysbiosis and shall provide protection against some metabolic disorders within the body.
• Drugs. Rapamycin, resveratrol, sirtuin derivatives, metformin. We have already attempted several times in this blog and we will continue to do so in the coming years to find a drug with a clear and defined anti-ageing effect.
• Metabolic reprogramming: in the future, metabolic pathways can be reprogrammed to normal.

Dr. Gabriel states that several small risk factors produce much more damage than a single major risk factor. From this we can determine that it is important to act during the subclinical phase of all diseases.

Dr. Rafael Gabriel, director of the Research Methodology Unit at La Paz Hospital, presented his lecture titled “Hypertensive diseases on the increase during the last 10 years. The SPRINT and HOPE-3 studies”. In this paper the following question was raised: What is the target level for blood pressure that we should reach? It is an approach wholly aligned with the concept of “values ​​of excellence” that we always look for in the MP4 approach. The conclusions of the SPRINT and HOPE-3 studies have been analyzed. The SPRINT study, published a year ago in the New England Journal of Medicine, observed that the morbidity and mortality in high cardiovascular risk patients who were treated aggressively in an attempt to lower their systolic blood pressure (SBP) below 120 mmHg was much lower than in those who were treated to lower their SBP below 140 mmHg. On the other hand, the HOPE-3 study did not reveal that there was any benefit to be gained from taking polypill (a combination of a low dose of rosuvastatin with an antihypertensive agent) versus conventional monotherapy using statins or antihypertensive agents separately. It is likely that the lack of efficacy demonstrated by polypill in the study was due to the fact that the goal of reducing an individual’s SBP in the HOPE-3 study was not as ambitious as in the SPRINT study.

Dr. Gabriel concluded his work with an interesting comment: several small risk factors produce much greater damage than a single major risk factor and acting on these small risk factors is much more efficient than waiting for them to become a single large risk factor. For example, pressure slightly high, glucose slightly high, cholesterol slightly high…all together are more dangerous than one of them being significantly elevated. Therefore, we must act during the subclinical phase of the disease and not demonize such behavior considering that it is a medicalization of the healthy patient promoted by the pharma industry (“You are not healthy, you are pre-sick”).

“New perspectives in the treatment of hypercholesterolemia in cardiovascular prevention and ageing” was the title of the conference held by Prof. Jesús Egido, professor of medicine and head of the Nephrology Department at the Jiménez Díaz Foundation. Despite a significant “anti-statins” movement, in the opinion of Prof. Egido, there should be a monument “to the Statins” in all hospitals for the amount of lives they have saved. However, currently statins are not the only alternative for those requiring a cholesterol-lowering treatment. Ezetimibe and the recent PCSK-9 inhibitors are very effective drugs used in combination with or as an alternative to statins. As is the case for blood pressure, the recent criteria which focuses on target figures for LDL-cholesterol (bad cholesterol) is “The lower is better” – “the lower, the better” – as presented in a recent editorial in the New England Journal of Medicine.

Dr. Hoslst, professor of biochemistry at the University of Copenhagen, presented his paper on the latest advances in the treatment of type 2 diabetes using incretins, molecule (hormone) regulators of gastrointestinal origin that are released into the bloodstream after ingestion of food and that stimulate pancreatic cells to release insulin and glucagon.

Caloric restriction, metformin, resveratrol, maintenance of a systolic blood pressure below 120 mmHg and an LDL cholesterol below 100 mg/dL, carbohydrate metabolism biomarkers which reflect levels of excellence and addressing diseases during the subclinical phase, are all actions that we at Neolife practice everyday thanks to the most avant-garde advances in science.

La entrada “The fight against ageing and death starts with you” se publicó primero en Neolife.

A study has demonstrated that the levels of omega-3 EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are low or very low in most parts of the world.

The study authors have made suggestions that health and consumer authorities should review recommendations concerning omega-3 intake and if necessary, supplement diets with foods enriched with omega-3 or even consume tablets containing these fatty acids. These low levels could be explained, according to some experts, by the increase in processed foods that change the omega 6 (proinflammatory) / omega 3 (anti-inflammatory) ratio in our diet.

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The study, which shows that most of the population has low levels of omega 3, reopens the debate on whether a “healthy and balanced” diet is sufficient.

One of the eternal debates of Preventive, Proactive, Predictive and Personalized Medicine (MP4) is whether a “healthy and balanced” diet is sufficient to maintain optimal health. We often read messages that corroborate this, but the reality is that it is very difficult to know if we are feeding ourselves in a “healthy and balanced” way. The pace of modern life has meant that we do not have much time to think about what food we are going to buy, what quality of food we should buy, how we are going to cook the food or at what time we are going to eat said meal. Instead, we eat when we have a small window of time, what we have at hand, often precooked meals and highly processed foodstuffs, whose macro and micronutrients we do not know.

One of the pillars of MP4 is the targeted use of nutritional supplementation with the micronutrients which we are missing from our diet, irrespective of how healthy and balanced our diet seems to us. This line of reasoning is further underlined by a recent study (1) published in the Progress in Lipid Research journal which shows a world map of omega-3 levels in the population around the world. The map was prepared using data provided from 298 published scientific studies and shows that the levels of omega-3 EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are low or very low in most parts of the world.

To stratify the different levels of omega-3, a percentage value that corresponds to the IO3 ( Omega 3 Index) was used, which indicates the percentage of omega-3 fatty acids in the red blood cell membrane or erythrocyte. When the IO3 was above 8% then the value was considered to be adequate, if the value was between 6 and 8% then the value was moderate, the value was considered to be low if the percentage was between 4 and 6%, and very low when the value fell below 4%.

It is widely understood that an omega-3 deficiency in the diet is typically associated with an increased cardiovascular risk, cancer, diabetes, neurocognitive impairment and loss of vision. In order to reach adequate levels of omega-3 it is necessary to eat oily fish -such as salmon, sardines, tuna or cod- several times a week. But as we said in the beginning it is often difficult to implement a diet that is rich in these and other oily fish, particularly in modern Western societies.

As you can see on the map, only some countries such as Norway, Japan, the state of Alaska, Greenland, Nigeria and some depopulated areas in the northern hemisphere are able to maintain the appropriate omega-3 value. Northern Canada, Iceland, Sweden, Chile and Mongolia have moderate omega-3 levels. These areas with adequate and moderate levels of omega-3 correspond to regions with a tradition of fishing, hunting and gathering. Spain, together with most of the countries around continental Europe, Australia, South Africa, Russia and China all achieve low omega-3 values whilst the United States, United Kingdom, Ireland, Italy, Greece, India and Brazil currently have very low values.

Age Management Medicine is used in support of omega-3 supplementation in those cases in which the diet does not reach the values of excellence required.

In view of the results shown on the map, the authors of the study suggested to health and consumer authorities that they should review the recommendations concerning omega-3 intake and, if necessary, supplement diets with foods enriched with omega-3 or even consume tablets containing these fatty acids. These low levels could be explained, according to some experts, by the increase in processed foods that change the omega 6 (proinflammatory) / omega 3 (anti-inflammatory) ratio in our diet.

One of the many biomarkers we measure as part of the Neolife checks is the IO3 (Omega 3 Index). The objective is to ensure that this is above 8% as the optimal value. Due to our experience accumulated in the clinic, it is exceptionally rare to find a patient whose IO3 values are adequate without taking omega-3 supplements. It is most likely to present in patients living on the coast or those who consume a diet rich in fish. The prescription of omega-3 is usually between 0.5 and 1g of DHA and between 0.75 and 1.5g of EPA. These doses are without a doubt the optimal values required to prevent cardiovascular disease, neurodegenerative disorders, cancer and diabetes.

BIBLIOGRAPHY

(1) Stark et al. “Global Survey of omega-3 fatty acids, docosahexanoic acid and eicosapentanoic acid in the blood stream of healthy adults”. Progress in Lipid Research, 20 May 2016. doi: 10.1016/j.plipress.2016.05.001.

La entrada Do we take enough Omega-3? se publicó primero en Neolife.

A recent study has stated that people with subclinical hypothyroidism are almost twice as likely to have diabetes.

The study analyzed patients and noted that those with a TSH of 4 mIU/L had a 35% greater chance of developing diabetes than those with a TSH of 0.4 mIU/L (who had only a 19% chance). Although the authors are not fully aware of the intimate mechanism or reason for this association, the hypofunction of thyroid hormones would appear to have a direct impact on the development of prediabetes and diabetes.

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Subclinical disease, a key phase in the prevention of diseases such as hypertension, diabetes or hypothyroidism.

The approach taken in relation to the disease during the subclinical phase is one of the principal objectives of the MP4 (Preventive, Proactive, Predictive and Personalized Medicine) or Age Management Medicine approach. The subclinical phase is the phase in which the disease has not yet developed into symptoms or signs that may help us classify the disease as such; it is a grey area where you have a disease but do not have any symptoms. But we all know, using simple logic and common sense, that many diseases can not be defined by an arbitrary red line drawn by a human. For example, the definition of hypertensive is when the systolic blood pressure exceeds 140 mmHg and/or the diastolic pressure exceeds 90 mmHg; so if my blood pressure is 135/85 mmHg, I am not hypertensive. You are diabetic if your fasting glucose is more than 126 mg/dL; so if I have a fasting glucose of 120 mg/dL, I am not diabetic. You have a hypothyroid if your TSH (thyroid stimulating hormone) is above 10 mIU/L; so if my TSH is 3.7 mUI/L, I do not have a hypothyroid. But the reality is that in the three examples above I could be pre-hypertensive, pre-diabetic and have a sub-clinical hypothyroid. And here is the key to MP4: take action at this crucial phase in the disease, before it is too late.

Thyroid function tests consist of a group of key biomarkers in our protocols. These biomarkers are TSH (thyrotropin: thyroid-stimulating hormone), free T4 (thyroxine) and free T3 (triiodothyronine). According to the ATA (American Thyroid Association), the possible causes of hypothyroidism include: congenital defects or autoimmune diseases, total or partial surgical resection of the thyroid gland, radioactive treatment, inflammation (thyroiditis), iodine deficiency or excess iodine in the diet, a side effect of some medication or damage to the brain localized in the pituitary gland. However, there is another cause: our own ageing.

A recent study has confirmed that there is a correlation between subclinical hypothyroidism and an increased likelihood of developing prediabetes and diabetes.

The endocrine function of most of our glands deteriorates with the passage of time: this is part of the programmed senescence (aging). Like testosterone plasma levels, the growth hormone or estradiol decline with age (and time) and the same takes place with the thyroid hormones, although to a lesser extent. The reality remains that as we age our thyroid function lowers in the thyroid gland (especially in women) which could be defined as evidence of sub-clinical hypothyroidism. This is particularly true when combined with slightly elevated TSH values, but normal free T4 and free T3 values, as well as non-specific symptoms including fatigue, weight gain, coldness, capillary fragility, dry skin, etc.

A recent study presented a month ago at the annual Endocrine Society Conference (ENDO 2016) held in the Netherlands (1) has confirmed the correlation between subclinical hypothyroidism and an increased likelihood of developing prediabetes and diabetes. The study assessed 8,452 people over 45 who lived in Rotterdam. Over the course of approximately 8 years, 1,100 of them developed prediabetes and 798 developed diabetes. When their TSH values were analyzed it was found that those with a TSH level of 4 mIU/L had a 35% chance of developing diabetes compared to those with a TSH level of 0.4 mIU/L who had only a 19% chance of developing the condition. The authors do not fully understand the intimate mechanism or reasons behind this association, but have stressed that given that thyroid hormones are important as part of the normal energy metabolism and for proper weight control, their hypofunction could have a direct impact on the development of prediabetes and diabetes.

Hormonal and metabolic optimization is one of the pillars of the Neolife anti-ageing medical programs. What nature denies us through programmed senescence (aging), we can safely restore thanks to hormone replacement therapy with bioidentical hormones. An optimization of thyroid function will not only improve symptoms such as tiredness, weight gain, dry skin and brittle hair but also help protect us from diabetes and cardiovascular disease.

BIBLIOGRAPHY

(1) “Thyroid Function and Type 2 Diabetes Risk: A Population-Based Prospective Cohort Study”. ENDO 2016; April 3, 2016; Boston, Massachusetts. Abstract OR33-2.

https://endo.confex.com/endo/2016endo/webprogram/Paper24901.html

La entrada Subclinical hypothyroidism may encourage type 2 diabetes se publicó primero en Neolife.

The general recommendations on public health (in terms of nutrition, exercise etc.) are, in most cases, not sufficient.

Preventive and personalized medicine goes further: preventive checks, measurement of PSA, including measurement of the homocysteine, hormone levels, fat percentage, vitamin D levels, bone mineral density in men, hormone replacement therapy for those going through the menopause, approaching the subclinical phase of the diseaseetc.

Neolife medical management

Public healthcare is subject to many conditions (mainly economic restraints), which often prevent the application of personalized medicine to an entire population.

We often have to explain to our clients the contradictions which exist between the protocols in place within public healthcare and personalized medicine. It is not that there are two different types of medicine but when a protocol is designed to reach 100% of the population, there are many conditions that must be factored in to ensure the implementation is a success.

The medicine we develop at Neolife, the MP4 (Preventive, Proactive, Preventive and Personalized) Medicine, is a medicine that, based on scientific evidence, is personalized to the greatest extent possible, without taking into account the general conditions and restraints of public healthcare. This debate is already taking place in the US and there are numerous publications that have analyzed the pros and cons of public healthcare versus personalized medicine, also known as precision medicine.

When public health institutions define their health recommendations and their clinical protocols that they intend to apply, they take into account that they will reach 100% of the population, or else they would have a problem on a political level. There are numerous conditions beyond merely the scientific evidence that must be considered before such recommendations and protocols can be implemented effectively for the entire population. Most of them are economic in nature, but also political and religious. Like everything in life, medicine is not immune to such conditions. Euthanasia, contraception, dental health, refractory defects in the eyes, plastic surgery etc. all of them are health problems that for one reason or another are affected by economic, political or religious conditions.

But let us consider the MP4. The positioning of public healthcare when addressing issues such as hormone replacement therapy for those going through the menopause, the prevention of osteoporosis in men, maintenance of optimal vitamin D plasma levels, the prevention of sarcopenia, colon cancer or defining how best to approach a disease in its subclinical phase, amongst attempts to include other factors mean that the outcome is less than ideal in terms of performance. And it must be understood; there are not enough resources to fund everything and priority must be given to only a few select public concerns. Another issue is how best to optimize these resources because we all know that a return on investment in terms of prevention measures far exceeds the amount necessary to spend on “curative” medicine if one talks in terms of pure cost savings.

But this is something that short-term politicians (those who do not see beyond one or two terms) do not value and which is also barely recognized by the health industry itself, since this approach could substantially reduce their income.

Public healthcare determines general recommendations, not personalized plans. These are often insufficient and can reduce the effectiveness of personalized health programs.

A clear example of what we are referring to here is the lack of success in public weight loss programs initiated as part of public healthcare, such as Let’s Move! in the US, MangerBouger in France or Change4Life in the United Kingdom, according to a recent document published by Dr. Adams, from the University of Cambridge (1). Dr. Adams proposes in his document that such information programs be complemented by actions such as increasing taxes on sugary drinks, restricting unhealthy food advertisements which are broadcast at 21:00 (chocolates, snacks, precooked food etc) or limiting the number offers for unhealthy foods in supermarkets. Only by taking such actions could we improve the effectiveness of these programs. However, other experts believe that obesity cannot simply be resolved by eating less and moving more: the causes of obesity are complex and may involve circumstances such as sleep rhythm disturbance, intestinal flora or stress factors.

Another example is the recommended minimum exercise amount that must be carried out. The general recommendation is 30 minutes a day of brisk walking five days a week. However, this recommendation is clearly insufficient for most of us. The achievement of the recommendation does not always equate to optimal health.

But there are many more situations in which the recommendations and protocols of public healthcare may not be sufficient: preventive checks, measurement of PSA, including measurement of the homocysteine, hormone levels, fat percentage, vitamin D levels, bone mineral density in men, hormone replacement therapy for those going through the menopause, approaching the subclinical phase of the disease etc.

Therefore, at the Neolife clinic for anti-ageing medicine we take the fourth P of MP4 very seriously, personalization. We go beyond the general recommendations, which are applicable to 95% of the population by measuring biomarkers for health and longevity that are not included in the protocols issued by public healthcare institutions and we also customize how we prescribe exercise regimes, nutritional supplements and bioidentical hormones so that each of our patients receive the best possible care.

And what is more important, we try to understand, empathize, take care of and help our clients to improve their life styles and quality of life.

“If you treat the disease, you can win (cure it) or lose. If you treat the person you will always win, no matter the outcome of the disease” (Hunter Doherty” Patch “Adams).

BIBLIOGRAPHY

(1) Jean Adams, Oliver Mytton, Martin White, Pablo Monsivais. “Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency”. Published: April 5, 2016.

https://dx.doi.org/10.1371/journal.pmed.1001990

La entrada What is good for everyone, may not be suitable for you se publicó primero en Neolife.

A recent document by Dr. JoAnn Manson has suggested that vitamin D should be supplemented using high doses which is contrary to other current movements that have questioned the usefulness of measuring the level of vitamin D.

Although some studies on nutritional supplementation using vitamin D have not revealed any obvious health benefits (probably due to errors, such as prescribing treatments with low doses of vitamin D), there are numerous studies that have shown that low levels of vitamin D is related to a multitude of diseases and the ageing process itself (cancer, diabetes, osteoporosis, cardiovascular disease etc.).

Neolife medical management

Age Management Medicine debate: nutritional supplementation with vitamin D, yes or no?

Every day that passes we receive a large amount of medical and scientific information concerning many of the actions we carry out daily as part of our Age Management Medicine. This is a avant-garde (state of the art) medicine and we base our treatments on the most recent scientific literature and therefore our position is somewhat different from the approach of other clinics that elect to adopt classical, official medicine. This is normal. The MP4 (4Ps), Preventive, Proactive, Predictive and Personalized Medicine, is not a medicine that can be applied to the entire population: as the name suggests the medicine is personalized. Consequently, many of the diagnostic tests and treatments that we prescribe are not regularly used in curative medicine. However, there is an increasing amount of information being prepared by clinical medicine that is orientated towards the approach we have been implementing as part of our Medicine of the 4Ps for a number of years.

The debate over vitamin D is a clear example. A recent document by Dr. JoAnn Manson (professor at Harvard Medical School) published in Medscape (1), has highlighted the future of vitamin D monitoring and supplementation. The question is whether or not the level of vitamin D should be measured routinely (25 OH Colecalciferol) and if so whether the levels should be supplemented using high doses. The article in Medscape has generated more than 220 comments from the health community, which reflects the intense interest shown in this topic by academics and medical professionals alike.

There are dozens, if not hundreds, of observational studies that correlate low vitamin D levels with cancer, diabetes, osteoporosis, cardiovascular disease, hypertension, depression, dementia and other age-related diseases; however, the double-blind, randomized, controlled and cross-over studies that have been conducted do not seem to shed any light on the question of whether or not we need to supplement our diets with vitamin D to prevent these diseases in the future (2). As a result, the health authorities have refused to recommend that people attend appointments for routine vitamin D monitoring and continue to limit supplementation doses to very low levels. We have already discussed in a previous article on the Neolife blog (3) that the reason for such low doses is nothing more than a mathematical calculation error; however, the health authorities appear reluctant to recognize their own mistakes and change their position accordingly. Many of us have stressed that these double blind, randomized and controlled studies do not observe the benefits of vitamin D simply because they are poorly planned and executed: they use very low doses of vitamin D over an intensely short period of time focusing on specific population groups and/or patients. As a result it is difficult to argue that significant changes would be expected during these studies.

Despite the doubts surrounding treatment of the general population – it is clear that vitamin D is an essential element in personalized Anti-ageing Medicine programs.

In her writing, Dr. Manson emphasizes the differences between applying recommendations to the general population and the attitude of the doctor in a private consultation with a patient taking into account their personal characteristics where one could argue treatment with high doses of vitamin D is necessary. There are two interesting expressions: “A good doctor must prevent disease” and “many patients suffer the consequences of complacent doctors”. We should not be satisfied to simply apply general recommendations from the health authorities and refuse to measure vitamin D levels, particularly when you consider the financial restrictions placed upon health authorities.

Surely in the not too distant future we will see how the results of large double-blind, randomized and controlled studies with high doses of vitamin D reflect what observational studies have been saying for many years.

At the Neolife anti-ageing medicine clinic we measure vitamin D levels and where appropriate supplement these levels with high doses (4) to ensure the values of excellence are maintained. Once these levels have been reached, we then readjust the doses downwards and continue to monitor the patient’s plasma level over time.

BIBLIOGRAPHY

(1) https://www.medscape.com/viewarticle/853373

(2) Hansen, K., Johnson, E., Chamber, K et al. “Vitamin D Insufficiency in Postmenopausal Women, a Randomized Clinical Trial”. JAMA Intern Med. 2015;175(10):1612-1621. doi:10.1001/jamainternmed.2015.3874.

(3) https://www.neolifesalud.com/blog/por-que-hay-que-tomar-altas-dosis-de-vitamina-d/

(4) https://www.neolifesalud.com/blog/vitamina-d-y-alzheimer/

La entrada The vitamin D debate se publicó primero en Neolife.

The poor lifestyle habits of the medical profession, the contradictory results of certain studies, the difficulties we face adopting healthy lifestyles…

…and that scientific studies on the beneficial effects of healthy lifestyles have increased only recently (less than 20 years ago), are just a few of the reasons why we do not prescribe a healthy lifestyle with greater emphasis, despite being the best medicine for the prevention of diseases related to the ageing process.

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The objective of the 4Ps of Medicine is to promote healthy lifestyle habits.

We live more, much more than we did 100 years ago. The average life expectancy in developed countries has lengthened by 30 years in just a century. However, in general terms, our quality of life during these 30 years is not very good. This situation is what has driven the so-called “21st Century Healthcare Paradigm”, the “Preventive, Proactive, Predictive and Personalized Medicine” (4P Medicine), that is responsible for extending the quality of life and delaying the appearance of age-related diseases until our last moments (what is known as compression of morbidity).

The most important element in 4P Medicine (or MP4) is to instill in the population the importance of healthy lifestyles in relation to exercise, nutrition, rest, inner harmony and how best to avoid toxic habits. Each of these can be complemented with bioidentical hormone replacement therapy (BHRT), personalized nutritional supplementation and longitudinal monitoring of biomarkers which combined form the pillars of our Age Management Medicine approach. 4P Medicine is applied to people older than 35.

This is not a new concept. Hippocrates is known to have stated the same beliefs (460-377 BC) 2500 years ago: “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” So what has changed? The North American writer Ralph Waldo Emerson (1803-1882) said: “Society is constantly taken by surprise at any new example of common sense.” The truth is that now we are surprised to learn that exercise and eating well is healthy. What has happened is because the scientific evidence for this statement did not exist until recently. Most of the scientific studies on the beneficial effects of exercise are from less than 20 years ago, and the same applies to nutrition, rest and exposure to toxic substances. Now we can scientifically confirm what Hippocrates said was true. But ultimately this is part of the arrogance of modern science…

In the same vein, the AHA (American Heart Association – American Heart Association) proposed in 2010 seven national objectives in relation to cardiovascular health and disease prevention to be met by 2012 ⁽¹⁾:

1. Do not smoke.
2. Possess a normal BMI (body mass index).
3. Participate in regular physical activity.
4. Maintain a healthy diet.
5. Normal cholesterol.
6. Normal blood pressure.
7. Normal glucose.

If only the first four objectives are met this will effectively reduce your risk of any cause of mortality in the next 7.5 years by 81%.

The INTERHEART study, conducted in 52 countries ⁽²⁾ has estimated that more than 90% of cardiac risk factors are modifiable through healthy lifestyle choices.

Despite the ever growing interest in 4P Medicine and the recommendations put forward by the AHA, healthy lifestyles are still not openly encouraged.

There is no drug capable of achieving the same results as a health lifestyle can – a healthy lifestyle ensures prevention and management of the chronic diseases commonly associated with ageing. So why is it that we do not prescribe such changes with more emphasis?

There are a number of reasons:

– There are still numerous doctors, even more than in other professions who possess very poor lifestyle habits: they smoke, lead a sedentary lifestyle, they are overweight or eat a poor nutritional balance due to poor habits… You can not preach and you can only lead by example. Many doctors do not believe in the effectiveness of changing their lifestyle and, as a result, these reluctant doctors will continue to prescribe tests and drugs to solve problems that could be managed using healthy lifestyle habits.

– Science often provides conflicting results within the same area and this can confuse the clinician, who needs to digest only clear ideas and not scientific debates. For example, the Look AHEAD study ⁽³⁾ did not yield any positive results relating to lifestyle interventions in the reduction of cardiovascular risk in 5,000 obese diabetics; however, the STENO-2 ⁽⁴⁾ and WHEL ⁽⁵⁾ studies did demonstrate that such changes could result in significant benefits for the patient. Doctors also subconsciously promote concepts that closely resemble their beliefs or viewpoints: if a doctor with a sedentary lifestyle reads a scientific study in which no value is attributed to exercise then he/she will continue to cling to the article and argue that his/her unwillingness to exercise is justified no matter how many other articles say otherwise.

– Changing lifestyle habits is very difficult. It is widely understood that it is easier to change your religion or your partner than your lifestyle. This probably does not surprise anyone reading this article. Numerous scientific studies have provided promising results whilst the study subjects are under supervision. Once the study is finished the participants progression is reviewed. Currently the trend is for the majority of the participants to return to their previous lifestyles and undermine what they once improved. Studies of all kinds have been carried out, even paying participants as an incentive to achieve health related objectives; however, once the money has been claimed, the previous habits return. The motivation to achieve compliance and persevere towards a healthy lifestyle is incredibly varied, personal and fluid. A wedding, bikini season, a sporting event, a disease, are each of the most frequent motivations. Want is nothing without will: to be able to initiate change often requires professional help. What is clear is that good lifestyle habits must be acquired during childhood-adolescence.

– Are we doctors and should we prescribe healthy lifestyles? A study published in 2007 ⁽⁶⁾ noted that between 1996 and 2001 medical advice concerning diet and exercise fell by 22% amongst family physicians. In medical schools, the importance of healthy lifestyles is still not taught to students. In addition, students and medical residents dedicate a significant amount of time and effort to completing their studies and internships which inevitably are incompatible with a healthy lifestyle. As a consequence, the medical profession is not exactly a paradigm of healthy living. Although advice from a doctor remains highly valued irrespective of the health issue at hand, the intervention of other professionals such as nutritionists, nurses, graduates in physical activity, psychologists etc. can be decisive when it comes to successfully transitioning to a healthy lifestyle.

At Neolife as an Anti-ageing Medicine clinic, we have formed a multi-disciplinary team that advocates by example: we exercise regularly, we follow a low glycemic index diet, we do not smoke, we take nutritional supplements and we frequently monitor our health and longevity biomarkers. We enjoy spending time with patients and we want to help you understand why you should take care of yourself, we want to illustrate to you how important even the smallest change is to your health by reviewing your biomarkers and above all else we want to motivate and maintain consistency through frequent appointments.

BIBLIOGRAPHY

(1) Lloyd-Jones DM, Hong, Y., Labarthe, D. et al; “American Herat Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association´s strategic impact goal through 2020 and beyond”. Circulation 2010; 121:586-613.

(2) Ford ES, Greenlund KJ, Hong Y. “Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States”. Circulation. 2012; 125:987-995

(3) Look AHEAD Research Group, Wing RR, Bolin P., el al. “Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes”. N Engl J of Med. 2013; 369:145-154

(4) Gaede P., Vedel P., Larsen N., et al. “Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes.”, N Engl J Med. 2003; 348: 383-393

(5) Perce JP., Natarajan L., Caan BJ, et al. “Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women´s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007; 298:289-298

(6) McAlpine DD, Wilson AR. “Trends in obesity-related counseling in primary care: 1995-2004. Med Care.  2007; 45:322-329

La entrada The best medicine is a healthy life; so, why is it not prescribed? se publicó primero en Neolife.

Aging is the biggest risk factor for developing any form of non-infectious disease, including cancer.

The “age” most related to developing cancer is between 40 and 50- years-old. It is for this reason that in the majority of cases cancer is considered to be a disease related to the aging process – if we understand its causes, we can combat the disease.

Cancer is the second most common cause of death in developed countries, behind cardiovascular disease. In Spain, cancer is responsible for the deaths of at least 100,000 people a year. And its incidence is on the rise. However, this is not to say that the fight against cancer is being lost, as this increase in incidence correlates, in part, to the increase in life expectancy (living longer means more chance of developing cancer) and to the improvement in its diagnosis (more cases of cancer are diagnosed now than two decades ago, partly thanks to improved screening measures).

In addition, the great advances made in treatments and early diagnosis have resulted in an average survival rate of 50% for all types of cancer at 5 years from initial diagnosis, with some of the more common forms, such as prostate cancer in men and breast cancer in women reaching survival rates of 75% and 80% respectively. Indeed, breast cancer, prostate cancer and lung cancer are the most frequently occurring, with figures approaching 230,000 new cases a year in Spain.

The majority of cancer cases occur in people over 45 years of age. This is why, in general, cancer can be considered to be a disease that is related to the aging process. Preventive, Proactive, Predictive and Personalized Medicine (MP4) applied to the aging process – Age Management Medicine– has the main objectives of preventing diseases related to aging (including cancer) and improving the quality of life regardless of the passage of time.

Bioidentical hormone replacement therapy (BHRT) is one of the steps involved in Age Management Medicine, together with diet, exercise, nutritional supplementation, emotional balance, rest and detoxification. Despite the significant scientific and medical advances which demonstrate the beneficial effects of BHRT in the prevention of diseases and the improvement of quality of life, bioidentical hormone replacement therapy is still considered controversial, both by the general population and certain areas of the medical profession.

Testosterone is one of the most utilized hormones in BHRT, and since prostate cancer and breast cancer are two of the most frequent cancers to occur in men and women respectively, we shall refer to two interesting recent studies related to this matter.

Breast cancer, testosterone and estrogen

In a prospective study published in the journal Maturitas in 2013 (1), an overall decrease in the incidence of breast cancer was observed over a 5-year follow-up period in pre and postmenopausal women who had been treated with subcutaneous testosterone implants (pellets) or testosterone therapy with anastrazole. The incidence of breast cancer in these women was as follows:

– 142 cases per 100,000 women per year

against a general incidence within the population of

– 293 cases per 100,000 women per year in a SEER study

– 325 cases per 100,000 women per year in a Million Women study

– 300 cases per 100,000 women per year in a WHI study

The researchers therefore conclude that breast cancer can be prevented by maintaining the balance between testosterone and estrogen in favor of the former through BHRT with testosterone or testosterone therapy with anastrazole.

Prostate cancer and testosterone.

The second of the studies is an important updated review on the relationship between testosterone and prostate cancer (2) published in June 2013 in the journal Advances in Urology. There is an increasing number of men who require HRT with testosterone to treat androgen deficiency in men and to prevent against age-related diseases and symptoms. Moreover, prostate cancer has the highest incidence within this population group and until recently it has been assumed that treatment with testosterone could cause prostate cancer or worsen an existing form of cancer. In this study, the researchers conclude that:

• High plasma testosterone levels do not have a significant effect on the development of prostate cancer. However, low levels do seem to predispose this type of cancer.
• HRT with testosterone does not increase the risk of developing prostate cancer or increase the risk of recurrence in men who have been successfully treated for prostate cancer.
• Men with treated active prostate cancer could benefit from HRT with testosterone if they meet a series of medical criteria.
• Men with untreated active prostate cancer should not carry out HRT with testosterone.

In view of the results of these two studies, and many others along the same lines, BHRT with properly prescribed and controlled testosterone is therefore not only safe to be used in the fight against breast and prostate cancer, but has also proven to have preventive effects.

BIBLIOGRAPHY

(1) Glaser RL, Dimitrakakis C. Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrazole: a prospective, observational study. Maturitas (2013), https://dx.doi.org/10.1016/j.maturitas.2013.08.002

(2) Atan A, Tuncel A, Yesil S & Balbay D. Serum Testosterone Level, Testosterone Replacement Treatment and Prostate Cancer. Advances in Urology. Vol 2013. ID 275945. https://dx.doi.org/10.1155/2013/275945

La entrada Cancer, the age-related disease se publicó primero en Neolife.