stephen holt md-anti aging and aesthetic medicine

8/8/2019 Stephen Holt MD-Anti Aging and Aesthetic Medicine

1/48

NUTRITIONAL SUPPORT FOR

ANTI-AGING AND AESTHETICMEDICINE

STEPHEN HOLT, MD, LLD(Hon.) ChB., PhD,

ND, FRCP(C) MRCP (UK), FACP, FACG,FACN, FACAM, OSJ


2/48

CONCEPT:INNER BEAUTY

Physical appearance is a function of

general body health.

Beauty lies within the body.

All cosmetic interventions have short

to intermediate term benefits only.

Longevity is a legacy of positive

lifestyle, resulting in youthful looks.


3/48

ANTI-AGING METHODS

Natural medicine is favored byclients in medical spas and anti-aging or recuperative clinics.

Natural medicine is combined withadvanced preventive medicinestrategies in the practice of anti-

aging or recuperative medicine. Recuperative medicine integrates

allopathic and natural approaches.


4/48

LONGEVITY

Longevity implies health retention in the

elderly. Elite age with ill health is bad.

First-line anti-aging strategies are theprevention of diseases that cause

premature disability or death.

Important public health initiatives to

promote longevity involve strategies for:Metabolic Syndrome X, obesity, diabetes

mellitus, cancer and osteoporosis etc.


5/48

LIFESTYLE MEDICINE

Several domains of lifestyle exist.

Attention to each domain is the basisof holistic healthcare.

Psycho-social wellbeing

Avoidance of substance abuse

Optimum nutrition

Exercise Sexual Health

Biorhythms (Sleep)


6/48

THE SPA OR ELDERLY CLIENT

These clients often have occult

nutritional deficiencies (e.g. fad diets).

These deficiencies impair recuperativeprocesses or healing from invasive

cosmetic treatments.

All clients may benefit frommultivitamins combined with

phytochemicals and active omega-3.


7/48

THEORIES OF AGING

Free radical

theories

Cross-linktheories

Immunologic

theories

Mutation and

Error Theories

In-built

Programs of

Tissue Aging

Stress

Theories

Repair budget

Theories

Miscellaneous


8/48

DIET SELECTIONS

The anti-aging diet should be low incalories but nutrient dense (Walford).

Reduced in simple sugars andsaturated fats, enriched with omega 3.

High in dietary fiber, >25g/day

Modest in mixed protein intake

Rich in mineral and antioxidant intake


9/48

OXIDATIVE TISSUE DAMAGE

Free radical damage is the most tenabletheory of aging OXIDATIVE STRESS.

Environmental toxins are pro-oxidants. Multifunctional antioxidants are found in

fruits, vegetables and berries.

Antioxidant support must be given withantioxidants of different REDOXpotential, with wide tissue distribution.


10/48

CUTANEOUS OXIDATIVE DAMAGE

The fundamental basis of skin aginginvolves sunlight, toxins etc.

Topical antioxidants are limited intheir value for skin rejuvenation.

Oral antioxidants in mixed formshave greater therapeutic potential for

the reversal of skin aging.

A combined approach is ideal.


11/48

SUNLIGHT

A double-edged sword, vitamin D

Protection from UVA and B radiation

Polypodium leucotomos diminisheschanges associated with photo-aging.

Reduces dermal elastosis, mast cell

infiltration and skin fold thickness (UVB). Oral photo protection: A new concept


12/48

ANTI-AGING ANTIOXIDANTS

Certain antioxidants have tissue ororgan specific effects, EXAMPLES:

Ellagic acid prevents breast cancer. Turmeric supports cognition.

Lycopene supports the prostate.

Alpha-lipoic acid (protean benefits)

Polyphenols regulate glucosemetabolism (green tea and coffee).


13/48

TISSUE GLYCATION

Undesirable cross-linking of sugar

or aldehydes with protein.

Results in AGES with loss offunctional integrity of proteins.

Carnosine and antioxidants may

inhibit tissue glycation(glycosylation).


14/48

METHYL DONATION

Methyl donation maintains structural andfunctional integrity of key compounds,e.g. DNA, HDL, serotonin.

Characterized by elevated bloodhomocysteine.

Part of body inflammation (bodyitis):

obesitis, diabetitis, Syndrome X-itis.

Curb inflammation e.g. fish oil (EPA)


15/48

THE OMEGA STORY

A widespread deficiency of omega-3

Active moieties are EPA and DHA

Omega-6 to 3 dietary ratio up to 20:1

EPA is anti-inflammatory. DHA is not.

Plant LNA precursors are not reliable

sources of EPA or DHA.

Enteric coated fish oil capsules arethe optimal way of taking fish oil.


16/48

THE VALUE OF ENTERIC COATING,

TARGETED DELIVERY FISH OIL

Better tolerated, absorbed withhigher bioavailability to meetrecognition of high dosage

therapeutic benefit. Regular fish oil capsules and liquids

are obsolete in professional

practice. Belluzzi et al, NEJMed, 24, 334,

1557-8, 1996.


17/48

VALUE OF ENTERIC COAT, NEJMed, 1996


18/48

HORMONE REPLACEMENT

The notion that hormone deficienciesexplain aging in a comprehensive

manner is quite nave. GH, Bio-HRT etc. must be monitored.

GH releasing hormones should be tried

before GH injections e.g. GHRP-2

Need for staged anti-aging strategies.


19/48

THALASSOTHERAPY

Topical for detox and dermabrasion

Oral for weight control, iodine, fucoids,

minerals, vitamins and gels.

Fucoxanthin promotes fat oxidation by

increasing Uncoupling Protein-1. Synergy

with fish oil.

Increase in transporter 4mRNA

expression of L-6 myotubes, glucose

uptake.


20/48

AESTHETIC PROCEDURES

Increase in trauma from semi-invasive

cosmetic procedures e.g. lip-puffing,

liposuction, nips and tucks etc.

Trauma and Procedure Recovery is

required in spa and anti-aging practice.

Evidence-base for homeopathic Arnica

montana, bromelain and bioflavonoids.

Start supplements on day of surgery or

intervention, continue for 5-7 days.


21/48

SKIN, HAIR AND NAILS

Skin, hair and nail beauty areparamount in aesthetic practice.

Several natural substances optimize

skin regeneration or repair andsupport sub-dermal structures.

Evidence-based ingredients can be

used in synergistic formulations:eggshell Ca, horsetail, olive leaf,antioxidants, DMAE, hyaluronate,MSM, collagen, Aloe etc.


22/48

WEIGHT MANAGEMENT

Obesity and Metabolic Syndrome Xare the number one preventablecause of premature death anddisability.

Overweight status is not a simplecosmetic issue.

Weight gain is of multi-factorial cause,requiring multi-pronged interventions.


23/48

LINKED TO OVERWEIGHT STATUS


24/48

REDEFINING SYNDROME X

Classic Definition: Obesity,Hypercholesterolemia, High

Blood Pressure, Linked by

Insulin Resistance.

Syndrome X, Y and Z.., an

expanded definitionincorporating a novel unifying

concept of common diseases


25/48

SYN X, Y, Z(Expanded Definition)


26/48

THE PUBLIC HEALTH RISK

Syndrome X increases risk

for :

Type II Diabetes MellitusCardiovascular Disease

Cardiovascular Deaths

Deaths from ALL CAUSES

Am.J.Epidemiol, 148, 958, 1998.


27/48

FACTS

Obese people die young

Obese people develop

premature disability Obese people are modern,

metabolic dinosaurs

Obese people are generallymismanaged in clinical practice.


28/48

OBESITIS Epidemiological links between obesity and

inflammation have been proposed for >40y.

Glucose and fat intake induce inflammation byoxidative stress or the activation of transcription

factors.

Reductions in macronutrient intake in obesesubjects reduces oxidative stress and theproduction of inflammatory mediators

(1000kcal/day, 4 weeks or 48 hr fast).

Managing weight control without managinginflammation may be malpractice?


29/48

: Fat tissue, normal weight mouse

:Fat tissue, from fat mouse (ob/ob)


30/48

POTENTIAL MECHANISMS OF OBESITIS


31/48

OBESITIS

Obesity is an inflammatory disorder

30% of blood cytokine IL-6 fromadipose tissue, decrease CRP and IL-

18 with weight loss

Nave Zones, but EPA valuable

Adipocytokines [leptin, adiponectin and

visfatin], adiponectin lowers TNF-alpha

Final common pathway oxidative stress


32/48

OBESITIS


33/48

DRUGS AND NUTRACEUTICALS


34/48

UNREALISTIC

WEIGHT LOSS

EXPECTATOIN


35/48

THE POT BELLY:USELESS AND

DANGEROUS ENDOCRINE ORGAN


36/48

POT-BELLIED DINOSAURS

Fat tissue stores fat soluble chemicals,synthesizes inflammatory mediators andelaborates sex hormones.

Toxicants e.g. PCBs, pesticides etc.concentrate in fat deposits and alter fatmetabolism.

This is the concept of TOXIN INDUCED

LIPOGENESIS and it provides good reasonsfor body detoxification with weight control.

Pot bellies and insulin resistance go hand inhand, especially in Syndrome X.


37/48

WHICH ARE QUICK FIX PROMISES

FORWEIGHT CONTROL?

DRUGS: Phentermine, Sibutramine,Orlisat, Phenylpropanolamine etc.

DIETARY SUPPLEMENTS: Pyruvate,Chromium, Hydroxycritic Acid,Omega-3 Fatty Acids, GLA, HoodiaGordonii, Caralluma, Fucoxanthin etc?

[SYNERGY IS IMPORTANT!]

ALL OF THE ABOVE!


38/48

COMMON CAUSES OF

OBESITY The Double Whopper Brain

Sedentary Lifestyle Genetic Tendency

Social Gluttony (Appetite) Sleeplessness


39/48

THE GLYCEMIC INDEX

Calculations of the glycemic index offood is probably a waste of time.

Understanding factors that controlgastric emptying rate can result ininference about the glycemic index.

Slowing gastric emptying slows glucoseabsorption relevance in acute dosing


40/48

GLUCOSE TOLERANCE WITH

SOLUBLE FIBER

Holt S, et al

Effect of

Gel Fiber

Lancet,

March 24th,

1979.


41/48

DIETARY PRINCIPALS

Calories Count

Watch Macronutrients CHO, Fat

Protein

Healthy Fat (EPA)

Salt Restriction Fiber Intake


42/48

DIETARY SUPPLEMENTS

FORWEIGHT CONTROL

Modern concepts use synergy informulation for weight control.

Appetite suppression (Hoodia),thermogenesis (Fucoxanthin andHydroxycitrate), sugar regulation

(Polyphenols, Cinnamon), antioxidants,soluble fiber (oat beta glucan).

Example: Clinical Fucoxanthin Complex


43/48

SYNDROME X NUTRITIONAL FACTORS

OBESITY: Hoodia, fiber, green coffee beanextract, starch blocker, chromium, fat blockers

HYPERTENSION: fiber, botanicals unpredictable

OXIDATIVE STRESS: alpha lipoic acid, AGES,

redox balanced, hydrophilic and lipophilic

HOMOCYSTEINE: B6, B12, folate, TMG

INSULIN RESISTANCE: fish oil(EPA), alpha

lipoic acid, vitamin and mineral supportBLOOD LIPID: soy, fish oil, guggul, garlic etc.

INFLAMMATION: EPA, curcumin, C etc.


44/48


A healthy blood glucose level

A healthy blood cholesterol level

A healthy blood homocysteine level

Healthy immune function

Healthy digestive function

Antioxidant functionCalorie control by induction of satiety

Inhibition of fat and sugar absorption


45/48


Soluble fiber e.g. oat beta glucan

Soy Protein 25 g/day Omega 3 fatty acids (EPA)

Chromium

Alpha lipoic acid

Vanadium Antioxidants e.g. ellagic acid, bioflavonoids

Starch blockers

Cinnamon

Maitake Green coffee bean extract

Hoodia gordonii


46/48

THE SLEEPLESS NATION

About 100 million Americans do notsleep well. Sleeping pill poppers

Sleeplessness causes obtrusive and

unobtrusive problems. Sleep deprivation promotes weight

gain and it is diabetogenic.

Restoration of the biorhythm of sleepis pivotal in beauty and anti-aging.The nation should Sleep Naturally.


47/48

ADAPTOGENS

Stress causes disease andaccelerates aging.

Adaptogens are underestimated

nutraceuticals in anti-aging medicine(concept of genomeceuticals).

Anti-aging adaptogens include:

Ginseng, Ashwagandha, Dandelion,Ganoderma, Schisandra, Rhodiola,Bacopia monnieri and Resveratrol.


48/48

CONCLUSION

Dietary supplements remain the mainstay

of natural approaches for anti-aging.

Longevity is a legacy of lifestyle.

Synergistic formulations address the

complex cascade of harmonious

biochemical events in the body.

The therapeutic use of dietarysupplements has emerged into main-line

medical practice, despite the rhetoric.

stephen holt md-anti aging and aesthetic medicine

Documents