The exposome is defined as the set of non-genetic factors to which we are exposed throughout our lives and which condition our state of health and disease.

The WHO estimates that approximately 25% of diseases are related to these non-genetic factors, which could be avoided. Therefore, it provides extremely valuable information in the design of preventive, diagnostic, and therapeutic strategies in the medicine of the future.

Dr. Débora Nuevo – Neolife Medical Team

What is the EXPOSOME?

The set of traits presented by each individual is what we call phenotype, which is the product of each person’s gene combination (called a genotype) within a given environment.

What we understand as an exposome, a term coined by C. Wild in 2005, is the set of environmental (non-genetic) factors to which each individual is exposed from the moment of conception and which may condition the state of health or disease.

This name encompasses multiple factors, which also vary over time, and which we may group into 3 categories or domains:

• The General External domain includes social, economic, and psychological factors, such as education, climate, psychological stress, and the social or financial situation.
• The Specific External domain includes the influence of infectious agents, chemical and environmental contaminants, radiation, alcohol and tobacco use, profession or occupation and medical treatments.
• The Internal domain refers to metabolism, circulating hormones, microbiota, inflammation, lipid peroxidation, oxidative stress, and aging.

Variability and susceptibility windows of the exposome

In order for non-genetic factors to impact our health, they need to be able to alter biology at different levels (altering the microbiota, interacting in metabolic processes, decompensated the usual cellular pathways…).

That’s why the exposome is especially difficult to cover. Not only because of the variability of its nature but also because it is modified over time, that is, it is dynamic.

Its effect depends on the dose or the level of exposure, as well as the moment in which it occurs, so we are talking about intrapersonal variability.

And this effect does not turn out to be the same in all individuals, with population groups that are more susceptible than others, also leading to interpersonal variability.

On the other hand, it is worth mentioning the existence of windows of susceptibility, which are the specific periods throughout an individual’s life in which they are especially sensitive to certain exposures. An example is the special susceptibility to many factors at early stages of life, which may condition important events in later stages.

How do we study the exposome?

Due to the complexity of the term exposome, the approach must be multidisciplinary and comprehensive.

To obtain the data for the study of the exposome, biomonitoring is the most widely used strategy. There are two types of biomonitoring, which in turn complement each other by providing a more complete picture:

• Human biomonitoring: It consists of collecting biological samples, usually blood or urine. Concentrations of toxics or pollutants and their metabolites are analyzed. Other parameters that are compared to reference values are also measured.
• Environmental biomonitoring: It collects environmental samples that may include food, water, or air, and so their presence and the level of exposure are linked to the environment of the different population groups.

The biomarkers in turn may indicate:

• Exposure, indicating only the presence of a substance,
• Effect, the evidence of biochemical, physiological, or behavioral alterations that are associated with diseases,
• Susceptibility, in relation to the ability to respond to the exposure of a non-genetic factor.

The exposome in health and disease

According to the WHO, among the top 10 causes of death linked to a person’s life environment we find cardiovascular disease, cancer, and respiratory diseases.

Cardiovascular diseases

The role of an individual’s diet on the cardiovascular system is well known. For instance, a diet rich in salt or fat may lead to high blood pressure or dyslipidemia, which in turn are risk factors for atherosclerosis, myocardial infarction, or stroke.

The microbiota is also widely related to the risk of cardiovascular disease. Certain foods and components of the gut flora have been linked to a higher risk of atherosclerosis. An example is L-Carnitine, which is found in meats or dairy products and is metabolized by the gut microbiota generating, among other compounds, N-trimethylamine oxide, which promotes cardiovascular inflammatory processes.

Pollution, noise, or lifestyle habits are also factors that may be avoided and help lower the incidence of cardiovascular disease.

Early identification of these exposure factors and their elimination are key strategies in the development of preventive plans based on each individual’s exposome.

Cancer

Cancer is a multifactorial disease, and a large number of the factors involved are still unknown. However, it seems clear that some non-genetic factors are linked to the development of cancer,

One factor typically linked to skin cancer is exposure to the sun. UV radiation is known to cause mutations in skin cell DNA.

Additionally, some substances, like pesticides, some air pollutants, toxic substances that are present in certain foods or water (e.g. arsenic), as well as others like physical activity or circadian rhythm are also closely linked to skin cancer.

Breast cancer is also influenced by the exposome. Exposure to certain substances, like dichlorodiphenyltrichloroethane (DDT), polycyclic aromatic hydrocarbons (PAH), and heavy metals during certain susceptibility windows (such as the prenatal stage, gestation, or menopause) are strongly linked to the development of this pathology.

Lung cancer has smoking as its main non-genetic risk factor. Between 80 and 90% of lung cancers occur in smokers or former smokers.

Respiratory diseases

Once again, smoking is responsible for chronic respiratory pathologies such as COPD or asthma. Moreover, exposure to cigarette smoke during the prenatal phase also increases the risk of alterations in the fetus’ lung function and the development of diseases.

Allergies and asthma are closely linked to environmental pollutants. Climate change, urban pollution, and biodiversity loss are key to the development of allergies.

Endocrine diseases

The exposome also plays an important part in the development of endocrine pathologies. Some compounds have recently been shown to act as endocrine disruptors by altering hormonal pathways. These molecular compounds have structures that are very similar to some hormones, and through these, they can impersonate them at different steps in the operating pathway.

One example of these endocrine disruptors are the phthalates used as plastics, which are found in PVC, cosmetics, or hygiene and personal care products. These high lipid compounds, once in the bloodstream, may advance to any part of the body. In testes or ovaries, they are able to alter the secretion of hormones and cause fertility problems.

Additionally, an unhealthy diet, a sedentary lifestyle, or specific environmental components may play a key role in the development of DM II.

The exposome and the aging process

Aging is a natural and physiological process,

At the molecular level, it results in genomic instability, wear and shortening of telomeres, and a series of epigenetic changes that lead to an alteration in mitochondrial function and cellular senescence.

However, we don’t all age the same way. Aging is a biologically complex process, involving genetic and environmental factors. It is the exposome that is responsible for making a difference towards healthy aging with a similar genetic component. Some non-genetic factors have been associated with the maintenance of telomeres which is a great measure in the assessment of aging.

Pollution, smoking, obesity, and poor sleep quality are known to have a negative effect on the telomere length,

And so, the study of the influence of the exposome on cellular aging may be the key to the medicine of the future and to achieving a healthy aging process.

BIBLIOGRAFÍA

(1) Rappaport SM, Barupal DK, Wishart D, Vineis P, Scalbert A. The blood exposome and its role in discovering causes of disease. Environ Health Perspect. 2014;122(8):769-774. doi:10.1289/ ehp.1308015

(2) Wild CP. The exposome: From concept to utility. Int J Epidemiol. 2012;41(1):24-32. doi:10.1093/ije/ dyr236

(3) Olea N, Casas M, Castaño A, Mendiola J, Vrijheid M. Informe Anticipando. Exposoma. Fundación Instituto Roche. 2020. institutoroche.es

(4) https://www.vidasostenible.org/que-es-el-exposoma/

La entrada The Exposome and the Medicine of the Future se publicó primero en Neolife.

Aging is characterized by a decrease in certain hormones during perimenopause, which intensifies during menopause, and drastically drops after menopause.

This decrease in estrogen, testosterone, and progesterone is compounded by the physical and psychological changes, which to a greater or lesser extent accompany aging. All these changes, which start from the age of 30, and also depend on other factors, can be prevented and treated with a protocol that addresses the causes and consequences of aging, through regenerative aesthetic medicine and anti-aging preventive medicine.

Dr. Ruth García Moro – Neolife Medical Team

Stages in a woman’s aging process and how to prevent it

In general, it is varies a great deal, but we could say that between the ages of 30 and 40 the first signs of aging begin.

Hormone levels begin to drop, mainly leading to the loss of collagen and elastin in the skin and decreasing their antioxidant function. This causes the onset of loss of firmness, luminosity, and elasticity, and the appearance of the first wrinkles resulting from muscle movement and the beginning of alterations in the skin.

These alterations continue to evolve, becoming more evident between the ages of 40 and 50, as, in addition to other changes in the tissues due to the causes already described, there’s a bigger drop in the hormonal level, which at 50 years of age is usually below 50% of the levels present in youth. These alterations take place throughout all body tissues: the skin continues to lose its youthful appearance.

There is a displacement and rupture in the subcutaneous fatty layer, associated with hyper or hypotrophy. Ligaments and muscles suffer from hyperlaxity and atrophy. Deep fatty compartments move and increase or decrease. There is bone loss, and since it’s the support of other structures, this exacerbates the visible signs of aging.

After menopause all these changes that come with aging are aggravated by a drastic decrease in hormonal levels, which means the progression of the aging process will be much more visible.

Action and treatment protocol

After almost 20 years of experience in aesthetic medicine, I have developed a regenerative aesthetic medical protocol, which together with the anti-aging medicine experts at Neolife, achieves results with a high degree of satisfaction. In short, the 5R Technique consists of:

1R (Multilayer Renew), a technique that combines in a single session the treatment of the different layers of the skin, after a personalized preparation of the skin at home. It includes different techniques that boost the skin’s self-regeneration through peelings, mesotherapy of the patient’s own growth factors, vitamins, minerals, hyaluronic acid, and photodynamic therapy. With it, we manage to improve luminosity, remove stains, combat the loss of suppleness, as well as prevent skin cancer. This technique allows the patient to go on with her normal life, without the need for any recovery time.

2R redensification, through a personalized, immediate, and painless technique that uses stimulators of type 1 collagen (the type that is lost in the aging process), we manage to redensify the skin and subcutaneous cell tissue, helping to redefine and revitalize these skin layers.

3R repositioning of displaced surface fat and treatment of sagging, through the use of different tension systems that generate collagen bridges.

4R refill, we fill the different compartments or volumes lost in areas that suffered an important loss of fat, bone resorption, or any special areas that may need it.

5R restitution, the program will obtain optimal results if hormonal replacement is carried out in conjunction with a comprehensive preventive medicine program, together with a nutrition plan adapted to each individual’s needs and a healthy habits plan (exercise, rest, quitting smoking). This program is intended for people who want to obtain natural prevention and rejuvenation as the result.

Its application is determined by each patient’s personalized study, which results in customized management, based on their needs after a prior medical assessment.

From the age of 30, we start the preventive work, and depending on the age of the patient arriving for the first time, we offer a treatment that includes all, or maybe only part of the steps, based on their needs, requirements, and expectations.

La entrada Regenerative Aesthetic Medicine and Its Importance for Mature Women se publicó primero en Neolife.

The medicine of the future will be Preventive, Predictive, Proactive and Personalized. And furthermore, to ensure continuity in patient care, treatment must be Pleasant.

In terms of Prediction (Predictive Medicine) we are currently experiencing an era of genetic testing and ultra-accurate imaging. Prevention is taking place across society as good health and awareness permeates wider society and becomes one of the pillars of becoming health conscience. Proactivity will be essential in the future as the patient must be a willing participant in their maintaining their health. And Personalization will develop into individualized check-ups and treatment prescriptions for all.

Dr. Francisco Martínez Peñalver – Neolife Medical Team

Neolife, pioneer in the application of the Medicine of the 4Ps in Spain – the new Medicine of the 21st Century.

For many years, the great theorists behind Anti-ageing Medicine have been proclaiming that the medicine of this century, which is rapidly advancing towards its first quarter, must follow the concept that is widely known as “The Medicine of the 4Ps”. The “Ps” correspond to the founding concepts Prediction, Prevention, Proactivity and Personalization.

To achieve these objectives, it is necessary to better understand where each concept will be in the next few years and to set achievable objectives. For this reason we think it’s helpful to cover them one at a time.

Regarding the Prediction element of the medicine, we are currently experiencing an era of genetic testing, of ultra-accurate imaging and a reduction in the amount of radiation used for such tests, thanks to the knowledge -not cellular, but at a molecular level- of how the human body works…but there are times that in our rush to utilize these ultra-modern tests the amount of physical contact with the patient, which is so often key to the diagnostic process deteriorates to an unacceptable level. The predictive genetic tests (not the diagnostic tests) experienced a great advancement at the beginning of the century: supposedly allowing us to predict everything, but little by little doctors realized that these were not absolute and that in the majority of cases they only accurately indicated a percentage based on the probability that the individual may suffer the disease in question. As for the “ultra-accurate” imaging tests, the doctor’s desire to diagnose and the will of the patient to be diagnosed early, have ensured that CAT scanners and Magnetic Resonance Imaging (MRI) have reached a level of accuracy that was unthinkable only 40 years ago not to mention the tests are now used for preventive purposes (i.e., not to confirm a diagnosis, but to detect a disease during the subclinical stages). In fact, such tests no longer only provide “photos”, but they have begun to offer us “movies” of how our internal organs operate. Such imaging tests have also successfully reduced the amount of radiation transmitted to the patient, which had previously been a cause for concern amongst some patients who sought alternative measures. In addition to all of the above, we are now able to predict with a greater level of reliability how the human body will behave, focusing on the smallest unit, the cell, and observe the membrane, the mitochondria, the DNA etc. In summary: we now understand enough elements (although I am sure that in the future we will know even more) to be able to prepare a predictive map relating to the pathologies that could affect each individual in the future.

In terms of Prevention, it is perhaps what has transformed the Health Paradigm the most in the last 100 years. Prevention and the associated message has been permeating all levels of society and is one of the pillars of becoming health conscience. The percentage of people who brush their teeth, wash their hands, try to eat healthily, take probiotics when they are prescribed antibiotics, take measures to prevent sexually transmitted diseases, and take preventive actions are increasing with each day that passes. In fact, we have become so preoccupied with prevention that we are influencing the development of our children’s immune system by forbidding them from coming into contact with outside agents. When we started to educate the population in Health Prevention, small actions could be used to achieve great objectives; but today, we need wide-scale prevention campaigns at a national level to achieve small objectives. It is worth noting at this point that the internet age has posed an obstacle to the development of preventive medicine given the large number of hoaxes which circle online about preventive measures that were or could be harmful to patients, whilst encouraging many other patients to abandon measures that were in reality beneficial to them.

The third point corresponds to Proactivity. The doctor-patient relationship, in which the doctor applied or recommended medicine and the patient “patiently” waited for the treatment to take effect whilst resting, is over. The patient now takes control of their health; they are responsible for deciding the direction their treatment takes and how alternative treatments may affect their lifestyle etc. The doctor is responsible for planning appropriate actions, but the patient is responsible for carrying out the planned action. The fact that the patient now actively participates in maintaining their health helps to ensure that the patient remains motivated during treatment and achieves objectives set that they would have previously considered unrealistic.

The last aspect to be discussed is Personalization. We are used to healthcare systems that accommodate an entire population, where the range for normal for each biomarker is extensive (because the marker has to encompass at least 90% of said population) and where we try as professionals to “automate” diagnoses and prescriptions. The Medicine of the 21st Century attempts the opposite, that is to say, each decision that is taken in respect of each individual is singular and unique to the moment and the characteristics of the patient concerned. It is not only that each patient is different, but that each patient may have different needs according to their age and lifestyle for example. This personalization will lead to individual checkups and treatment prescriptions that correspond to the needs of the patient concerned. Such Personalization ensures that this type of Medicine retains a quality that distinguishes it from other health approaches.

Alongside the preceding 4 “Ps”, there is a fifth “P”, one without which this Medicine does not make sense. It is the “P” of Pleasant treatment. It is very difficult for a patient to undergo any form of Predictive testing, carry out preventive measures, remain proactive with their treatment plan and maintain a healthy lifestyle and/or follow their Personalized Medicine plan if the effects do not appear quickly and clearly. Patients who can observe how their changes have made an impact on the different aspects of their life such as vitality, mental agility, capacity for physical activity, their sex life become hooked on the new medicine of the 21st century. And most importantly, little by little these individuals are making their experiences known to their friends and family, so the health conscience spreads and permeates further – the Medicine of the 4Ps – will end up as the only real way to treat health problems in the future.

Neolife is the only Clinic in Spain that undertakes this new Medicine of the 21st Century. In our Centers we carry out the most avant-garde diagnostic techniques to help us predict or detect diseases before they develop further. We teach patients preventive measures that they should take, we motivate our patients to be proactive and we deliver all of our services in a personalized manner to ensure you can achieve a long and pleasant life. All the therapeutic tips we offer are based upon the latest scientific evidence and are applied by our team of internists -trained in the USA-. Therefore, there are no excuses as to why we do not immediately start our Age Management plan, or indeed our 5Ps Plan.

La entrada The medicine of the 4Ps that we must promote for the 21st century se publicó primero en Neolife.

There are studies underway that focus on anti-ageing drugs -such as metformin and nicotinamide adenine (NAD+)- as well as the molecules that elongate telomeres -such as TA-65-.

That is to say, drugs are already arriving on the market: anti-ageing drugs are no longer science fiction. The latest scientific advances have opened a way for us to fight against the effects of time on our bodies. In this post we will discuss the concept of anti-ageing medicine or Age Management Medicine and what we know about the ageing process and how we can better manage how we age.

Dr. Iván Moreno – Neolife Medical Team

“Gerontology”, “Age Management Medicine” and “Rejuvenation Medicine”, the new medical subspecialties that are on the frontline in the fight to slow ageing.

The concept of anti-ageing medicine in the 90s was based fundamentally on the advances being made in terms of the aesthetic treatment. The promise to rejuvenate the patient, to provide external beautification, which is something some people would consider worthy in itself, but the external aesthetic improvement did not avoid the harsh reality: we age at a speed akin to 60 minutes per hour. We may have had a more beautiful smile, a smoother and brighter looking skin and shinier hair, but we were weakened all the same by the same lack of energy and loss of muscle mass, the same joint pains and memory problems. The multiple diseases that deteriorate our quality of life continued to appear throughout the 90s.

The initial conception of anti-ageing medicine tarnished the concept itself, so that for years preventive medicine developed yet anti-ageing medicine was treated with much skepticism. So much so that those that have continued to work in this field have changed their focus to subspecialties such as:

• “Gerontology”, which is the science of studying ageing from the perspective of geriatrics (healthcare for the elderly). At a more fundamental research level (cells and laboratory animals) they are called Bio-gerontologists. Some well known gerontologists such as Aubrey de Gray, Leonard Hayflick or in our country Dr. María Blasco (in one of her numerous fields of research).
• “Age Management Medicine”, which applies to today’s discovery can be applied to real clinical practice and is intended to highlight the concept of “piloting or directing ageing to ensure that we can all life out our later years to our full potential”. Although in Spain Neolife remains the pioneer in this research, there are several American institutes and medical associations such as the AMMG ¹ or the A4M ² that for years have been providing and perfecting this type of assistance.
• “Rejuvenation Medicine”, refers to an experimental concept that directly seeks to turn the clock back on our skin and the tissues behind that -although it is often in newspaper headlines and will be a revolution in a few years time- at the moment it does not seem to have a practical or powerful application.  There are companies like Calico ³, the chair of Exponential Medicine at Singularity University ⁴ (participated in by Google, Deloitte and NASA) and the SENS foundation ⁵, amongst many others.

Beyond the name changes, the genuinely revolutionary thing that has taken place in recent years is the shift in focus: understanding that ageing is a disease in itself, and that many of what we now know as “diseases” (atherosclerosis, dementia, osteoarthritis, sarcopenia etc.) are only the consequences of ageing. In the past when medicine has been adopted to this approach and focused on other problems – solutions have been discovered.

The first step was to better understand the mechanisms that make our body age, and that, paradoxically as it may seem, has not been studied at all until these last 30-50 years. The reason is that it is widely understood as a normal part of ageing. The expected changes we are all aware of … but resignedly so.

The fundamental mechanisms through which ageing takes place are very well illustrated in a great article ⁶ by a team of Spanish researchers that marked a milestone in bio-gerontology. Specifically, there are 9 mechanisms:

1. Genetic instability: DNA deterioration impacts on cellular and mitochondrial functioning. There is evidence that up-regulation of repair mechanisms prolongs survival chances.
2. Telomeric shortening: ageing causes the ends of chromosomes to shorten, producing an increasingly “aged” behavior on a cellular level; fewer cell divisions take place and tissue regeneration occurs less often and consequently disease is more prevalent.
3. Epigenetic alterations: the “assembly instructions” that are present in our genome do not determine our entire health. There are many mechanisms that allow us to interpret our score for better or worse and these can be used to determine whether such mechanisms will facilitate or hinder the onset of diseases to which we are predisposed.
4. Loss of proteostasis: the proteins of our body are in a constant cycle of creation, deterioration and disposal. The loss of such balance can produce an accumulation of protein waste in numerous organs and damage internal functions. In the brain this can lead to diseases such as Alzheimer’s and Parkinson’s.
5. Deregulation of sensitivity to nutrients: over the years our body has progressively worse reactions to nutrients, becoming resistant to insulin and other hormonal factors. Caloric restriction or the simulation of the same through the use of drugs has been shown to increase longevity; also hormonal replacement has been shown to fight the effects of ageing on select tissues.
6. Mitochondrial dysfunction: mitochondria are the “furnaces” of cells where the nutrients are oxidized (burnt). Dysfunction in this regard causes oxidative stress to become de-regulated and can accelerate the ageing process.
7. Cellular senescence: in healthy tissue, when a cell is damaged the programmed cell death (apoptosis) is activated so that the cell is replaced by a new one. However, when this mechanism is altered, the tissues can accumulate a large number of ageing cells which are inefficient and in the long term can cause the tissue / organ itself to stop working properly.
8. Exhaustion of stem cells: the repairing of damaged cells and the maintenance of our body in perfect condition is dependent upon stem cells. These include mechanisms that ensure a greater chance of survival and prolonged reproductive capacity. The exhaustion of such cells means that we are unable to regenerate properly after a certain age.
9. Alteration to intercellular communication: the alteration which takes place within the hormonal systems, inflammation and the loss of blood stimulating factors mean that the effects of ageing go beyond a specific cell and can be transmitted to another.

Once such mechanisms are understood, we will be able to identify numerous therapeutic targets for which drugs and other such interventions can then be used (many of which are undergoing trials and research now). This will ultimately allow us to slow down, stop or even reverse the ageing process. In the last 20 years great advances have been made in our knowledge and a multitude of medical interventions have already been outlined that have allowed us to increase the longevity or healthy life expectancy of laboratory animals and, even tentatively, in humans.

The last stage is for society to carry out a number of studies to demonstrate the efficacy of such interventions on humans, that is to say, to demonstrate real, resounding results without serious side effects that would otherwise limit their use. There are already ongoing studies in this regard -such as the TAME ⁸ (Targeting Aging with Metformin)-, as well as the preliminary results of studies recently completed -including nicotinamide adenine (NAD+) ⁹ and the use of molecules that lengthen telomeres (such as TA-65^10,11)-. This is no longer science fiction: these drugs are coming.

Perhaps this whole process may seem like a very long road which will ultimately lead us to a situation where – with luck – our grandchildren can benefit from our advances, but the truth is that there is an exponential growth in scientific institutions and companies that are dedicating themselves to tackle what will be the greatest health challenge of our time: how to achieve greater health and autonomy in the last third of our lives and how to live even longer.

There is a revolution coming that is not purely scientific (which has long since been and gone), but clinical, which will change the relationship between doctors and patients forever. It will change the prism of how we operate from a focus on health to one involving the optimization of health and away from the disease towards the remedy.

Whilst we wait on the great advances in anti-ageing to materialize, we must take action now to enhance hormone replacement therapy, advanced supplementation, exercise programs, weight loss and caloric restriction…

And what can we do in the meantime? Admittedly, we could wait impatiently with our arms crossed, but we WON’T.

There are many measures that have already demonstrated a beneficial effect on all mechanisms of ageing we have outlined. At Neolife we believe in using a comprehensive approach that, following an individualized assessment, allows us to adapt all of our resources to helping our patients. Caloric restriction, weight loss, exercise programs, improvements to oxidative metabolism, hormonal replacement therapy to maintain optimal levels, advanced supplementation…all have, of course, an important role to play in slowing down our long-term deterioration and achieving optimal health.

In summary: there is a fascinating path ahead of us in terms of anti-ageing, with avant-garde treatments that can be applied now and a future full of new treatments to look forward to once they have been thoroughly tested.

At Neolife we strive to be on the cutting edge of medical science in the fight to delay or stop the ageing process. We follow a bold but critical approach when evaluating developments and we always apply pragmatic clinical perspective.

New discoveries are intellectually fascinating but sometimes they can also appear ethereal and distant and leave us just as alone and unable to stop our deterioration as we were before the discovery. Our vocation is to turn scientific advances into a modern assessment of health that can be utilized to provide specific and individualized treatment programs to each individual. We want to ensure that this revolution has a rigorous, practical and, above all, human character.

If bio-gerontologists are the scientists behind this revolution, we shall endeavor to be the clinicians who interpret the medicine with rigor and ensure that we apply the principles to the individual concerned. We shall continue to humanize this discipline and sublimate it into what is already a new medical art: the personalized preventive medicine, the optimization of medicine, the Age Management Medicine.

BIBLIOGRAPHY

(1) https://www.agemed.org/

(2) https://www.a4m.com/

(3) https://www.calicolabs.com/

(4) https://exponential.singularityu.org/medicine/

(5) https://www.sens.org/

(6) López-Otín, C., Blasco, M. A., Partridge, L., Cell, M. S., 2013. (2013). The hallmarks of aging. Elsevier, 153(6), 1194–1217. https://doi.org/10.1016/j.cell.2013.05.039.

(7) Image in open access, courtesy of Cell journal. Downloaded from https://www.cell.com/cms/attachment/2038216256/2052455734/gr1_lrg.jpg.

(8) https://clinicaltrials.gov/ct2/show/NCT02432287

(9) Dellinger, R. W., Santos, S. R., Morris, M., and, M. E. N. A. (2017). Repeat dose NRPT (nicotinamide riboside and pterostilbene) increases NAD+ levels in humans safely and sustainably: a randomized, double-blind, placebo-controlled study. Npj Aging and Mechanisms of Disease, 3(1), 1–9. https://doi.org/10.1038/s41514-017-0016-9

(10) De Jesus, B. B., Schneeberger, K., Vera, E., Tejera, A., Harley, C. B., & Blasco, M. A. (2011). The telomerase activator TA-65 elongates short telomeres and increases health span of adult/old mice without increasing cancer incidence. Aging Cell, 10(4), 604–621. https://doi.org/10.1111/j.1474-9726.2011.00700.x

(11) Salvador, L., Singaravelu, G., Harley, C. B., Flom, P., Suram, A., & Raffaele, J. M. (2016). A Natural Product Telomerase Activator Lengthens Telomeres in Humans: A Randomized, Double Blind, and Placebo Controlled Study. Rejuvenation Re-search, 19(6), 478–484. https://doi.org/10.1089/rej.2015.1793

(12) Image in open access, courtesy of Longevity International. Downloaded from Longevity International – https://daks2k3a4ib2z.cloudfront.net/581ba14cc9b0d76c5dcededf/5a01c612ba3798000177aa14_Science%20of%20Longevity%20MindMap.pdf

(13) Free access in PubMed Central – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340807/figure/f1/

(14) Garatachea, N., Pareja-Galeano, H., Sanchis-Gomar, F., Santos-Lozano, A., Fiuza-Luces, C., Morán, M., et al. (2015). Exercise Attenuates the Major Hallmarks of Aging. Rejuvenation Research, 18(1), 57–89. https://doi.org/10.1089/rej.2014.1623

(15) Jacob ME, Yee LM, Diehr PH, et al. Can a Healthy Lifestyle Compress the Disabled Period in Older Adults? Journal of the American Geriatrics Society. 2016;64(10):1952-1961. doi:10.1111/jgs.14314

La entrada What do we know about ageing? se publicó primero en Neolife.

A recent study has demonstrated that Sildenafil (Viagra) may prevent coronary stents which have been implanted following ischemic heart disease from becoming obstructed.

In the studies involving mice, Sildenafil showed four promising effects: it reduced the platelet aggregation induced by substances such as thrombin and ADP; activated a protein called Protein kinase G that reduces the thickening of arteries and repairs possible damage that may have occurred in the artery walls; stops the initial changes in the arterial wall that result in the formation of atheromatous plaque; and the last effect is re-epithelialisation, which is something akin to upholstering the surface of the vessel where the stent was placed, which prevents future obstruction.

Dr. Francisco Martínez Peñalver – Neolife Medical Team

Sildenafil (Viagra) may be a promising option as an adjunct to drug-eluting stents (DES) as a means to prevent thrombosis.

We are about to reach the 20th birthday of a pill that revolutionised the lives of people and that has been the best-selling treatment in the Western world for many years. We are talking about Sildenafil, better known by its commercial name Viagra. Pfizer, the laboratory that brought the drug to market, was originally searching for a drug that would improve the prognosis for angina pectoris, and during clinical trials noted that there was no significant difference between Viagra and the products that already existed on the market and so decided to sideline plans to market the drug. At the time the clinical trials ended many of the participants refused to stop treatment because they reported an absolute improvement in their sex life. It was in this way that one of the most successful launches of the pharmaceutical industry of the last 30 years took place. But do not forget the humble origins of the drug; the drug was conceived as a molecule that could improve coronary circulation, so researchers have continued to investigate how and where this drug could be beneficial once more. According to recent findings from the University of Seoul, Sildenafil (Viagra) can be converted in the near future into a drug that helps solve one of the main problems encountered by cardiologists: mainly that coronary stents implanted following ischemic heart disease become obstructed (1).

Will we soon take Viagra in the heart?alt In the mice-based studies, Sildenafil reduced platelet aggregation induced by substances such as thrombin and ADP, which is one of the main culprits that cause obstruction of thestents tested, more effectively than the solvents currently used by cardiologists. In addition, the drug activates a protein called Protein kinase G which reduces the thickening of arteries and repairs possible damage that may have occurred in the artery walls (2). A third beneficial effect seems to be the fact that the initial changes to the arterial wall that typically culminate in the formation of atheromatous plaque are completely stopped thanks to this drug. The fourth and last effect includes re-epithelialisation, which is a process akin to upholstering the surface of the vessel where the stent was placed, which helps prevent future obstruction.

In general terms all of these findings suggest that perhaps Sildenafil is the option with the most promise as a companion for drug-eluting stents (DES) to prevent thrombosis, or even as an option to be taken orally after implantation of said stent. Of course we should proceed with caution as these effects have only been demonstrated in animal trials; but given the importance of these findings we consider future studies will be conducted which show the effects on humans in the future.

Neolife is a Clinic of Preventive Medicine where we anticipate the onset of a disease by attacking the vascular risk factors before atherosclerotic plaques appear. The refinement of patient lifestyles together with the replacement of the endocrine-metabolic axis are an essential part of prevention. Where a disease appears and is established, our treatments share the spirit of the research outlined above, that is to say, we will try to repair the injury or at least minimise any and all immediate risks to health.

Newsletter based on paper N^o. 62 from the last American Heart Association’s Basic Cardiovascular Sciences 2017 meeting held in San Antonio, Texas, August ‘17.

BIBLIOGRAPHY

(1) Study protocol for a randomised controlled trial: harmonising optimal strategy for treatment of coronary artery stenosis – coronary intervention with next-generation drug-eluting stent platforms and abbreviated dual antiplatelet therapy (HOST-IDEA) trial.Kim CH1, Han JK1, Yang HM1BMJ Open.

2017 Oct 11;7 (10). (2) Activation of Protein Kinase G (PKG) Reduces Neointimal Hyperplasia, Inhibits Platelet Aggregation, and Facilitates Re-endothelialization.Kim JY, Yang HM. Sci Rep. 2016 Nov 11;6:36979.

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This is based on the concept that precision medicine can be applied to improve individual well-being. The concept combines the study of the genome with a diverse range of biochemical and microbiological data.

The ability to integrate the information that our biomarkers provide us with our genetic information can be crucial in initiating a specific preventative treatment or attempts to improve our health. For example, this concept would be essential to a program which sought to improve the glycemic profile in cases where our genes show that a specific type of individual or group have a propensity to suffer from diabetes.

Dr. Moisés de Vicente – Medical Director Neolife Madrid

A study published in the Nature Biotechnology journal suggests that the continuous collection of personal biological data can improve our understanding of health and diseases.

Each person is unique and in essence is unrepeatable. Not only on an intellectual level but also on a sentimental and ‘way of being’ level. Each individual contains an immense amount of biological data that make us different from each other. This data set includes our genomic information, metabolites, proteins, microbiome composition, etc. The interaction of all these systems that coexist in our body, and how they react to external or internal aggression, is what will determine our disease state (human condition). In this way, if we could understand the data in greater detail, as well as the intrinsic relationships which exist between them then we could obtain some crucial information to allow us to preserve our health. This concept is the basis for the 100 Wellness Project, whose preliminary results have recently been published in the Nature Biotechnology journal and suggest that the continuous collection of personal biological data can improve our understanding of health and diseases. The researchers collected all types of data (genomic, biochemical and personal) from 108 patients over a period of 3 months. Also, through the use of digital instruments they collected and quantified details from their daily activities. The results obtained focused on four types of diseases that are related to aging: cardiovascular risk, malnutrition, diabetes and inflammation. They used powerful analytical tools which allowed them to integrate all the information together. This process is known as “Scientific well-being” which is a new concept that precision medicine can be applied to improve individual well-being. The concept combines the study of the genome with a diverse range of biochemical and microbiological data. Such a process enables us to integrate the information that our biomarkers provide us with our genetic information that can be crucial to, for example, initiating a specific treatment or program in order to improve our glycemic profile in cases where our genes show that there is a propensity for the patient in question to suffer from diabetes and our markers do not yet meet the criteria established by the different societies to provide a definitive diagnosis. At Neolife we use a significant amount of biomarkers which allows us to establish the health status of our patients. In addition to this, we conduct genetic studies that allow us to establish the likelihood that a chosen person may suffer a disease. Then using this knowledge we carry out preventive medicine programs that allow us to optimize our parameters in the most efficient way in order to avoid the occurrence of subclinical injury, or, if this is already present, to delay the progression to the greatest extent possible.

BIBLIOGRAPHY

(1) Price ND, et al. A wellness study of 108 individuals using personal, dense, dynamic data clouds. Nat Biotechnol. 2017 Jul 17. doi: https://dx.doi.org/10.1038/nbt.3870 (2) Institute for Systems Biology and Arivale “Pioneer 100 Study” Establishes Foundation for New Industry of Scientific Wellness. https://www.systemsbiology.org/news/2017/07/17/pioneer-100-study/ (3) Cross R. Scientific wellness’ study—and a famed biologist’s spinoff company—divide researchers. 2017. Doi: https://dx.doi.org/10.1126/science.aan7123

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At present, medicine is based upon the control of thyroid function of the known TSH, but that is not quite accurate.

The recent scientific evidence suggests that conventional medicine is unable to efficiently manage the thyroid and that treatment should not only lower the TSH but also maintain stable levels and a high level of excellence in T4 and T3, which is often forgotten.

Dr. Francisco Martínez Peñalver – Medical Director Neolife Marbella

Preventive medicine included within the comprehensive approach in hormone replacement provides control of thyroid function with a mixture of T4/T3.

Historically, physicians have inherited a wide range of knowledge from their teachers as a basis upon which they then build their clinical practice. One of these pillars is the management of thyroid pathology, which is more and more present in our modern-day environment. 95% of thyroid disorders in adults occur in women, so there are many who believe that disorders in the menstrual cycle can, in some way, contribute to the thyroid losing functionality in a progressive way.

The knowledge traditionally passed on by our teachers advocates that the hormone level is controlled in the anterior of the brain, in a small stem called the pituitary. This hormone is known as TSH, and is a mechanism to control the thyroid, since at lower circulating levels of T3 and T4 the level of TSH secretion is higher, which is the hormone that stimulates the thyroid to produce more of the hormone. Traditionally the control of TSH was assumed to have been conducted through the thyroid.

However, the pituitary-thyroid axis a crucial element has been disregarded considering the transformation in the peripheral tissues from T4 to T3, something that is fundamental for the hormone to work.

In recent years the concept that the transformation which takes place in peripheral tissues to active hormones may be even more important than the control that TSH exerts on the thyroid gland is gradually being formed. Numerous articles, as far back as 2010 have stated this position. From the “Clinical Endocrinology of Oxford” about the effectiveness of adding T3 in those patients with a controlled thyroid function as a means to increase their cognitive capacity; to the latest article last April in the “Innovations in Clinical Neuroscience” journal which speaks openly about how controlling T3 levels is crucial for some symptoms associated with low thyroid function, such as depression and weight gain.

In summary, the recent scientific evidence suggests that conventional medicine is unable to efficiently manage the thyroid and that treatment should not only lower the TSH but also maintain stable levels and a high level of excellence in T4 and T3, which is often forgotten. This may be the answer to many patients who suffer the symptoms of poor thyroid control, but who are labelled as “free-from thyroid disease” because the usual clinical practice only addresses TSH levels.

The Neolife preventive medicine clinic with our comprehensive approach to hormone replacement using bioidentical hormones aims to provide the ideal hormonal profile for every patient thanks to the hormones that have been used for years to control thyroid function along with the T4/T3 mixture.

BIBLIOGRAPHY

(1)

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An article published in El Confidencial erroneously warns readers of the risks of testosterone.

The article, entitled “Low testosterone clinics come to Spain: the remedy could be worse than the problem”, reignites a debate that has been taking place in the United States for 10 years.  Despite opposition and general reluctance from the National Health System to introduce proactive measures for the improvement of health, there are more and more well-trained and informed doctors who are in favour of such treatments. Meanwhile there are patients who receive treatment, men and women, who are known to feel better and are less likely to suffer diseases.

Neolife medical management

Despite opposition from the FDA and other institutions, there has been an exponential increase in the use of testosterone thanks to the improvement in the quality of life perceived by patients.

In recent weeks there has been news relating to treatment with testosterone that deserves further discussion. Specifically, on 7th January, the digital newspaper El Confidencial published an article entitled “Low testosterone clinics come to Spain: the remedy could be worse than the problem.” Some of our patients were interested to hear from our medical director, so we felt it appropriate to publish this article and share our perspective on this issue.

In the article published in El Confidencial, reference is made to the arrival of a successful chain of clinics called “Doctor T” in Spain, which has been operating in the US and Australia for a number of years and is dedicated to the treatment of androgenic deficiency in adult men or low testosterone syndrome and the associated symptoms. The article also warns of the risks associated with this type of treatment by reference to 4 physicians (two family doctors and two urologists are interviewed) who are against treatment and a doctor who is in favour, the director of the Spanish clinic.

The same debate about testosterone and these clinics, called “Low-T clinics” has existed in the USA for a number of years. It seems that the article in El Confidencial was inspired by many similar articles that have appeared in the United States in the last 5 years. This debate is normal and logical and we are certain that there will be much more debate in Spain in the near future. In general terms we are about 5-10 years behind what happens in the US.

Despite opposition from the FDA and other health institutions regarding the use of testosterone to prevent disease and improve quality of life there has been an exponential increase in the use of testosterone. The reason is simple: the patients who receive treatment, men and women, feel better and there are more and more well-trained and informed doctors who do not believe what the institutions have stated. This has remained the reality and the use of testosterone has continued to increase during the last 15 years, despite all the negative news that appears in the press from time to time. There are many scientific studies on the positive effects of testosterone but these studies rarely come to light.

It is not true that there is not “enough” scientific literature to endorse the use of testosterone as a means to prevent disease and improve the quality of life. The argument that “there is not enough scientific evidence” is always used when a person or persons wish to move against a treatment or clinical method. However, there is much more scientific evidence in favour of testosterone based treatment than there is for dozens and dozens of interventions that are made each day as part of normal clinical practice within the National Health System. From surgical interventions to inefficient antihypertensive treatments, including the administering of certain psychotropic drugs…

So why is the profession against such preventive use of testosterone and an improvement in the quality of life? In our opinion it is because most of the health institutions and doctors are anchored in the curative and reactive medicine which was the norm in the 20th century. This is what is known as an anchor bias or anchoring bias, which is nothing more than a human tendency to resist innovation and changes in opinion. If there is no disease present, you should not intervene. The Medical Paradigm of the XXI Century, preventive, proactive, personalised… This new paradigm will take a few decades to disseminate fully across all medical faculties and consequently, into clinical practice. Curative medicine argues that you should “take no action unless it is necessary and the cure is achievable”, whilst preventive medicine states “continue the action if the measure is likely to prevent the condition worsening or improve the patient’s quality of life”. The first group argues in favour of medicalisation of the healthy, whilst the second group, which we support, argue deference should be shown and complacency of the former. The future lies in the prevention of diseases during their subclinical phase. Also, is it really wrong to attempt to make people better? It is a debate similar to on going debates in other areas of medicine (blood transfusions, for example). In our opinion, to hold the contrary position is prudish, alarmist, conservative and self-serving.

The controlled and correctly prescribed use of testosterone is very safe, with a very low percentage of side effects and the number of patients adversely affected is equally low.

In the article published in El Confidencial, it is argued that “ageing is a normal physiological process and can never be classified as a disease”. Obviously it is a natural physiological process, but it is not desirable. Furthermore, the latest scientific advances show that it is the main cause of non-communicable diseases (cardiovascular, cancer, neurodegenerative, metabolic and osteoarticular) and some well-known researchers have begun to discuss ageing in terms of a disease. What is wrong with fighting the symptoms and diseases of ageing? Why subject ourselves to ageing if we can age slower?

As for the argument that alludes to doping in an attempt to demonise testosterone – this is as simple as attempting to demonise sex by referring to prostitution or referring to money when we talk about corruption. Furthermore, many common medications, such as Couldina or Frenadol are also doping substances…

Curiously, there is a struggle between doctors of different specialities who are seeking to monopolise the therapeutic use of testosterone. In general, urologists are the most demanding in this regard and argue that management of the treatment is complicated and difficult, as well as arguing that the male hormone is essential in this regard. But testosterone has beneficial effects on a number of different organs and systems. This is why psychiatrists, endocrinologists, cardiologists, gynaecologists, oncologists use testosterone in the US… and this is what will happen here in the near future, as the latest advances and publications on the beneficial effects and clinical management of the hormone will be known by the medical collective in Spain.

Risks associated with testosterone? The controlled and correctly prescribed use of testosterone is very safe, with a very low percentage of side effects and the number of patients adversely affected is equally low. Certain commentators have attempted to attribute numerous serious side effects to the use of testosterone but one by one these have been proven to be inaccurate or brought into question by later publications (below we have included some articles which review this topic in greater detail). However, it should be noted that testosterone should only be administered and monitored by an experienced physician.

In conclusion, the use of testosterone in cases where it is not used as part of an ongoing treatment for a disease, but to improve the quality of life and prevent diseases is an excellent option that should be proposed to patients along with sufficient information to ensure they can make an informed decision.

Blog articles on testosterone in men:

• Controversies and advances in testosterone treatment, a 40-year perspective
• Andropause, quality of life and diseases related to ageing
• Hormone replacement in men
• Literature review: impact on the duration of treatment with testosterone

Blog articles on testosterone in women:

• Benefits of testosterone treatment in women
• 10th European Congress on Menopause and Andropause
• Female sexuality | Realities with a solution

La entrada A round with testosterone se publicó primero en Neolife.

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.

Neolife medical management

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.

Far from appreciating it as a negative phase in our life, the menopause should be considered as a great opportunity to address our health and our future general welfare.

It is an ideal time to broaden your expectations regarding health and well-being and the prevention of diseases related to the ageing process and how best to improve your general welfare. Ideally, one should begin a comprehensive Age Management program which utilizes hormone therapy alongside exercise, balanced nutrition, nutritional supplements, relaxation techniques, treatments designed to improve the quality of sleep of the patient and longitudinal follow-up consultations concerning your biomarkers…

Neolife medical management

The message for menopausal women should be one of optimism not negativity: most symptoms of the menopause can be treated and eliminated.

The advent of the menopause was considered to be something unavoidable. In general terms it was something that was adverse, undesirable and often associated with a decline in your health and well-being that manifested with seven classic symptoms:

1. Hot flushes and night sweats.
2. Vaginal dryness.
3. Weight gain, especially in the abdominal region.
4. Sleep disturbances.
5. Altered moods (mood swings).
6. Irregular periods or disappearance of periods.
7. Decreased libido.

But not all women experience the transition to menopause in the same way. What for some is negative, is not so negative for others. What is clear is that for all women it is a magnificent opportunity to address health issues and help prevent future health issues.

The spectacular increase in longevity over the last 100 years has meant that women now live longer going through their menopause than their childbearing years. Therefore, there is a lot of life to experience beyond the ages of 47-53, which is the age at which menopause normally occurs. The menopausal transition is a milestone in the health and well-being of women that marks a before and after yet takes place over only a few months. The appearance of the seven classic symptoms are the beginning of a progressive decline typically associated with the ageing process.

But fortunately, not everything is lost. On the one hand, all of these symptoms, except the disappearance of menstruation, can now be treated and eliminated. And, on the other hand, this same treatment may be the beginning of a reversal, that is to say, an improvement in the general health and well-being of the patient that may be sustained for many years: increased insulin resistance, elevated cholesterol and triglycerides, loss of bone mineral density, increased cardiovascular risk, sleep disorders… All of these medical conditions can be prevented with the adoption of a healthy lifestyle and bioidentical hormone replacement therapy.

Age Management Medicine and bioidentical hormone replacement therapy are the best ways to approach menopause.

The menopausal transition is a time when a woman returns to the doctor after several decades and requires treatment for the symptoms of the menopause which is a unique opportunity to take positive steps to prevent chronic diseases often associated with ageing.

Therefore, the approach to the menopause should not be limited to the treatment of the symptoms in isolation. The approach must go much further and motivate women to achieve much more than they have before in terms of their long-term health. It is a great moment to change and improve your lifestyle – whether this is through exercise, nutrition, quitting smoking, rest-relaxation or simply to adopt a new attitude towards life full of optimism. Some of the most avant-garde gynecologists have advised women that this is a great opportunity and have begun to incorporate Age Management Medicine protocols into their consultations and go beyond the basic treatment of the symptoms which manifest during the menopause. This is not surprising given the recent shift towards XXI Century Healthcare Paradigm; this includes Preventive, Proactive, Predictive and Personalized Medicine, that also occurs in other specialties such as urology (in relation to the andropause), cardiology (in those cases which relate to cardiovascular prevention), oncology (in relation to cancer prevention and improving the quality of life of cancer patients) and as such the approach has infiltrated almost all specialties within medicine. These are gynecologists who treat issues concerning cholesterol, quality of sleep, weight gain (overweight) or the sex life of their patients.

Most women are concerned about improving the symptoms they suffer during the menopause and are not so focused on preventing future health issues, but regardless of whether or not they are interested in staying thin, sexually active and physically fit, it is a great time to begin a healthy ageing program.

Unlike some of the other larger Age Management clinics in the US where the majority of patients are men, at Neolife nearly 50% of our patients are female. Many of them approach us at a time when they are transitioning towards the menopause so that we can treat the symptoms where they have not had much success with their usual gynecologist. As we have already stated, it is an ideal time to broaden your expectations regarding health and well-being and the prevention of diseases related to the ageing process and how best to improve your general welfare. Almost all opt for a comprehensive Age Management program which utilizes hormone therapy alongside a regimen of exercise, balanced nutrition, prescribed nutritional supplements, relaxation techniques, treatments designed to improve the quality of sleep of the patient and, what is more important, a follow-up on how treatment has managed the symptoms and the biomarkers for health and longevity. A program to continue doing it for the rest of your life.

Recommended reading: “I Want to Age like That! Healthy Aging through Midlife and Menopause”, Diana L. Bitner, MD, NCMP.

La entrada Menopause, an opportunity to improve se publicó primero en Neolife.