Dr. Nancy Vance was disheartened by the U.S. medical system before she even finished her training to become a part of it.
Originally a psychology graduate, she went back to school in her 30s to study emergency medicine. She loved the first half of her training— the studies in biology and chemistry—but shuddered at the second when, she says, the focus shifted to prescriptions and the chemical management of disease. But by that point, she’d sunk too much time and money into her schooling to reverse course, and so she finished her training and began practicing.
Ten years later, she quit the “establishment” and went on a decidedly anti-establishment path—by pursuing training in anti-aging medicine. She opened Insight to Health and Wellness in Naples about a year ago, and now she gushes about preventing disease rather than treating symptoms, about restoring balance to unhealthy bodies and teaching patients to heal themselves through better nutrition, stress management, fitness and mind-body connectivity.
“It’s not a wonder we have so much disease; it’s a wonder we don’t have more,” Vance says. She sees herself as part of a wave of dissident doctors who’ve embraced what Hippocrates envisioned as the primary job of doctors—to prevent illness.
“The idea is to bring patients back to a healthy place,” Vance says. “If I addressed why (a patient) has high blood pressure, he wouldn’t have to be on pills.”
So, rather than watching patients sink into advanced age with a host of chronic conditions, doctors like Vance say they are offering a new way to grow old—turning back the clock from the inside out.
No one will dispute that the U.S. health care system needs fixing. According to the Centers for Disease Control and Prevention, heart disease accounts for one in four deaths in the U.S.; some 795,000 Americans suffer a stroke each year; approximately one in three adults have high blood pressure; an estimated 25 million had Type 2 diabetes as of 2010; arthritis affects one in five people. As of 2010, 37 percent of Americans 60 or older took five or more prescriptions monthly.
And in that respect, no one in conventional or alternative medicine is going to criticize the anti-aging industry’s emphasis on wellness and prevention.
The controversy lies in how practitioners do it.
The industry promotes the use of hormones to “restore balance” and relieve the common complaints of aging bodies: fatigue, weight gain, waning libido, moodiness and the symptoms that accompany menopause.
Traditional doctors worry that the anti-aging industry—not to mention the pharmaceutical giants peddling testosterone—is inventing ailments that don’t exist, prescribing long-term courses of hormones without safety evidence, hawking high-priced nutritional supplements
and claiming custom-mixed hormones are safer and more natural than the products coming out of FDA-regulated pharmacies. Tennessee’s attorney general, for example, last December filed suit against that state’s HRC Medical Centers for allegedly making “unsubstantiated claims” and failing to disclose the possible health risks of hormone therapy.
“Avoid anti-aging clinics like the plague,” warns geriatrician Dr. Thomas Perls, a Boston University professor of medicine and outspoken industry critic. “They are the last place you want to go to get hormones. These places are hell-bent on selling the drugs no matter what.”
The industry’s roots are growing. It has its own trade group, the 24,000-member American Academy for Anti-Aging Medicine, which offers fellowships and helped establish a new master’s degree program in metabolic and nutritional sciences at the University of South Florida. In Lee and Collier counties, nearly 20 doctors and clinics advertise “anti-aging” services or are listed in the trade group’s database.
Mainstream medicine has its own ailments (think: FDA recalls, doctor-pharmaceutical conflicts of interest, ever-shrinking appointment times, a system that financially rewards procedures, not prevention). It’s never been more critical for consumers to read, research and ask smart questions before embarking on any kind of treatment.
So let’s dig a little deeper into what anti-aging practitioners promise are the keys to restoring vitality and preventing age-related disease, the reasons medical groups caution against it, and, finally, tips on how to research and ask questions so you can make the best and safest decisions for your health.
Anti-aging beliefs: With more than a third of U.S. adults overweight or obese, both mainstream and anti-aging doctors agree the U.S. suffers tremendous dietary problems. Yet, doctors like Vance and Fort Myers internist Ivan Cvik say they received almost no information on diet and exercise when they trained. The first steps in anti-aging practices are to determine a patient’s metabolic rate through blood testing, discuss his or her lifestyle, look at the nutrients in the blood and examine hormones that contribute to the metabolic process. Nutritional and weight-loss counseling follows, and doctors say better diet and exercise choices by themselves are sometimes enough to reap major changes. Fat cells, Cvik pointed out, are converted to estrogen, skewing testosterone-estrogen ratios in men. He offers patients simple weekly meal plans for weight loss.
The counterargument: “I agree that those are laudable things to do,” Perls says of diet, exercise and lifestyle counseling. “But I don’t think you have to go to a fancy anti-aging clinic to get those things.” He is concerned that the practical lifestyle advice can lead to the pushing of nutritional supplements, unnecessary medical tests and, later, hormone therapies. “It’s all part of the pitch to sell the drugs. It’s like a car salesman bringing you in saying he’s giving you this great deal, and before you know it, you’re getting all this stuff.”
The bottom line: If you’re struggling with weight, many anti-aging doctors will offer lots of one-on-one time and counseling—Vance books two-hour appointments to examine blood work, figure out why patients struggle with weight and craft customized plans. Just as they should ask mainstream doctors why they need a prescription, diagnostic test or expensive namebrand drug, patients should ask critical questions about supplements, lab results and whether they can correct nutritional deficiencies through diet alone. They should also inquire about fees, as many anti-aging clinics do not take insurance (though some will help patients bill their insurance plans), and they should know that nutritional supplements aren’t FDA-regulated the way drugs are.
Anti-aging beliefs: Americans’ harried lifestyles are wreaking havoc on their fight-or-flight responses. Cortisol, the stress hormone, kicks in when a person is threatened. It shuts down everything else—immune system, sex hormones, metabolism— so that energy can be channeled into surviving a threat. But chronic stressmeans cortisol continues to circulate and overtake the other systems that keep us healthy and keep our bodies functioning. According to some anti-aging practitioners, the adrenal glands can burn out if they are constantly producing cortisol—kind of like the way sugar overconsumption can cause the insulin-producing pancreas to peter out. That creates a condition they call “adrenal fatigue” and a need to administer cortisol or other hormones like dehydroepiandrosterone, or DHEA, until balance is restored.
In addition to hormone replacement, anti-aging doctors say they work with patients to identify causes of stress—sometimes by monitoring stress levels throughout the day to determine when cortisol peaks—and by counseling them on nonmedical ways to manage anxiety. “You have to lower the stress for everything else to work,” says Dr. Robert Rubin, who operates Body-Logic practices in Naples and Tampa.
The counterargument: There is no question that stress affects immunity, sleep, muscle mass, blood pressure and cognition. But adrenal
“There is no such thing as adrenal fatigue,” says Dr. Margery Gass, executive director of the North American Menopause Society. Hers isn’t the only national medical organization to say the condition doesn’t exist. There are recognized adrenal conditions, such as Addison’s Disease and adrenal insufficiency, that stem from damage to the adrenal glands or a disorder of the pituitary gland.
“The adrenals don’t get stressed out to the point where they stop making hormones,” says Northwestern University professor of endocrinology Dr. Mark Molitch, a member of the national Endocrine Society, which in 2010 put out a public health alert cautioning that taking unregulated supplements containing thyroid hormones could cause longterm damage to the adrenals.
And, Molitch further cautioned, “It’s not too hard to take too much hydrocortisone,” creating risk of skewing the hormonal balance.
The bottom line: Stress poses serious health consequences and you won’t feel better until you address it. Start with nonmedical approaches like meditation, journaling, exercise, deep breathing and hobbies before you accept an anti-depressant or anti-anxiety medication from a mainstream doctor or consider tinkering with hormones in an alternative practice. Do your own research and get second opinions before acceptingany diagnosis at face value.
Anti-aging beliefs: Hormones are chemical messengers that coordinate complex processes like growthand development, metabolism, sexual function, reproduction and mood. They decline with age. Anti-aging practitioners believe that decline is what prompts people to feel worse as they get older—more tired, moremoody, more prone to weight gain,sexual problems and the developmentof chronic diseases. Restore the level of hormones, and you’ll restore a sense of well-being as well as build protections against diseases like osteoporosis, they argue. Doctors will test and prescribe sex hormones, stress hormones and thyroid hormones—and in some practices, controversial human growth hormones—to alleviate the fatigue, weight gain, mood changes, declining libido and related problems that plague their aging patients.
“In men, up until a few years ago, it (hormonal changes) was not being addressed at all,” says Cvik, who believes doctors need to stop dismissing patient complaints as the inevitability of age and start looking for ways to relieve what ails them.
The counterargument: According to the American Medical Association, consumers spend some $50 billion a year on anti-aging products. In a 2009 review of studies on hormone use, the organization concluded, “Despite the widespread promotion of hormones as anti-aging agents by for-profit websites, anti-aging clinics and compounding pharmacies, the scientific evidence to support these claims is lacking. In some cases, the evidence suggests long-term use of a particular hormone can present more risks than benefits.”
The bottom line: Do your homework. Ask practitioners to back up their hormone replacement recommendations with scientifically valid studies showing benefits and risks—some research findings on DHEA, for example, don’t show much harm, but don’t show much in the way of benefit, either. Look for data from independent researchers, not claims by the manufacturers and promoters of hormones. Molitch, the endocrinologist, offers this summary: Say “no” to human growth hormone, “no” to stress hormones if told you have adrenal fatigue or failure. As for testosterone, supplementing may offer some improvement in libido, quality of life, and possibly cognitive function and memory, though the data aren’t entirely clear. Molitch doesn’t think men face risk if they keep their testosterone within the levels are considered clinically normal, but those who inflate their levels beyond the norm could see their good cholesterol levels drop, bad cholesterol levels rise, prostates enlarge and risk of prostate cancer increase.
She Got Her Life Back
If anti-aging medicine creates such debate within the medical community, why would anyone risk it? Are consumers merely chasing some proverbial fountain of youth?
For Marisol Pagan, 49, of Miramar, the choice had nothing to do with a desire to turn back time. She was driven to it because, she says, no mainstream practitioner had figured out how to help her. Pagan started having intermittent menopause symptoms about four years ago. Then, doctors discovered that an ovarian cyst had grown into a tumor.
A year ago, she had surgery to remove the ovary. Her other one previously had been removed. Pagan said she went into a tailspin. Once social and outgoing, she found herself wrought with anxiety. Her thinking became cloudy. Menopause charged in like a bull—sweating, headache, insomnia. Her appetite disappeared and she shrank from 125 to 95 pounds. “Everything came back normal. Every single blood test,” Pagan says. Doctors told her she was going through menopause, nothing more. They encouraged her to see a psychologist or try anti-depressants as she sank into depression. She said that wasn’t what she needed.
Pagan collapsed on the beach one day while she was out walking with her son. She thinks her body had just shut itself down. She was rushed to Miramar Memorial Hospital, where Dr. Nancy Vance was staffing the emergency room. Vance, an emergency physician who also runs Insight to Health and Wellness in Naples, has trained in anti-aging practices like hormone replacement, nutrition and metabolic studies, and stress management.
Pagan said Vance suspected right away that hormones were at the root of her problem. When the typical diagnostic tests didn’t indicate anything amiss, Vance suggested she consider hormone testing and replacement therapy based on the results.
Pagan and her husband agreed. “I would say in a matter of two weeks, I was back to myself. Within three months I was better than what I used to be without the hormones. I have amazing energy and stability. I was able to function and think. There was none of this fuzziness,” says Pagan, who takes a mix of “bioidentical” estrogen and progesterone. Pagan isn’t sure how long she’ll stay on the therapy, but says Vance already has lowered her dose.
“In my case, I don’t need a whole lot to keep me going,” she says. Pagan knows there’s controversy about anti-aging
practices, but she says traditional doctors left her with no source of help.
The Changing Tides of Menopause Therapy
Anti-aging doctors report that many women seek out their services because they are unable to find relief for their menopause symptoms anywhere else. And on this point, they might be right. In 2002, a government-sponsored Women’s Health Initiative study was halted due to elevated risks of breast cancer, heart disease, stroke and blood clots. As a result, rates of hormone therapy plummeted: Among 50- to 59-year-olds, 6.7 percent get therapy compared to 38.3 percent in 1999-2000, writes Dr. Roger A. Lobo, a professor of reproductive endocrinology and infertility at Columbia University, in the May 2013 Journal of Endocrinology and Metabolism. That practice, he and other experts say, “disadvantaged a generation of women.”
Much research has been done in the last decade on hormone replacement therapy, and some of the initial assumptions of the 2002 study have been discredited or refined. Now, medical organizations like the North American Menopause Society and the Endocrine Society say that hormone replacement therapy has a role in relieving menopause symptoms.
“I think the important thing we’ve learned is there’s a difference using hormone replacement therapy as a treatment for menopause symptoms … and using them to prevent chronic diseases of aging,” Gass, of the menopause society, says. “We completely support using hormone therapy for menopause symptoms.”
In other words, use them to ease hot flashes, vaginal dryness, night sweats and the other life-disrupting symptoms of menopause, but don’t use them to ward off osteoporosis (even though there’s evidence hormones do help preserve bone health), or to prevent cardiovascular problems or other chronic diseases. Gass says women who’ve been diagnosed with or are at risk of those diseases should consider other therapies because hormone use still poses risks such as blood clots and an increase in breast cancer among those using estrogen and progestogen combinations for more than five continuous years. Her organization recommends using hormones for three to five years, or until menopause symptoms subside.
The bottom line: Talk to your doctor about hormone replacement therapy because the understanding of menopause management has changed. Seek treatment early in menopause, take the lowest doses possible and ask whether smaller-dose transdermal patches rather than pills are right for your health concerns. The question of whether “bioidentical” hormones are safer or more effective than conventional products continues to generate debate. Gass says there are no good data proving the custom-blended bioidenticals are superior to standard products, though doctors like Vance insist that they more carefully monitor and tailor products in the anti-aging clinics. Gass believes women can use the products that they are most comfortable with—as long as they use the lowest dose for the shortest amount of time. And women should keep following the research—some scientists, including Lobo, say that more studies should be done on whether hormone replacement should be considered as a preventive measure.