NUTRITIONAL SUPPORT FOR ANTI-AGING AND AESTHETICMEDICINE

Stephen Holt, MD, PhD, LLD, NDDistinguished Professor of Medicine, NYCPM, NY, President

WONMP

The following potential conflict of interest relationships are germaneto my presentation.

Stock Shareholder: Natures Benefit Inc.Consultant: Natural Clinician LLC

Compensation: The presenter is not receiving payment for hislectures

Stephen Holt attests that he presents information on naturaltherapeutics which involves information about dietary supplements.His presentations are third party literature and governed by DSHEA

(1994) which does not permit disease treatment, prevention ordiagnosis, using dietary supplements.

NUTRITIONAL SUPPORT FORANTI-AGING AND AESTHETIC

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

ND, FRCP(C) MRCP (UK), FACP, FACG,FACN, FACAM, OSJ, Scientific Advisor toNatures Benefit Inc. and Natural Clinician LLC

• President, World Organization of NaturalMedicine Practitioners, DistinguishedProfessor of Medicine and Chairman, NewYork Department of Integrative Medicine

CONCEPT:“INNER BEAUTY”

• Physical appearance is a function ofgeneral body health.

• “Beauty lies within the body”.

• All cosmetic interventions have shortto intermediate term benefits only.

• Longevity is a legacy of positivelifestyle, resulting in youthful looks.

ANTI-AGING METHODS• Natural medicine is favored by

clients 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 integratesallopathic and natural approaches.

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 causepremature disability or death.

• Important public health initiatives topromote longevity involve strategies for:Metabolic Syndrome X, obesity, diabetesmellitus, cancer and osteoporosis etc.

LIFESTYLE MEDICINE

• Several domains of lifestyle exist.• Attention to each domain is the basis

of holistic healthcare.• Psycho-social wellbeing• Avoidance of substance abuse• Optimum nutrition• Exercise• Sexual Health• Biorhythms (Sleep)

THE SPA OR ELDERLY CLIENT

• These clients often have occultnutritional deficiencies (e.g. fad diets).

• These deficiencies impair recuperativeprocesses or healing from invasivecosmetic treatments.

• All clients may benefit frommultivitamins combined withphytochemicals and active omega-3.

THEORIES OF AGING

• Free radicaltheories

• Cross-linktheories

• Immunologictheories

• Mutation andError Theories

• In-builtPrograms ofTissue Aging

• StressTheories

• Repair budgetTheories

• Miscellaneous

DIET SELECTIONS• The “anti-aging diet” should be low in

calories 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

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 with

antioxidants of different REDOXpotential, with wide tissue distribution.

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 potentialfor the reversal of skin aging.

• A combined approach is ideal.

SUNLIGHT• A double-edged sword, vitamin D• Protection from UVA and B radiation• Polypodium leucotomos diminishes

changes associated with photo-aging.• Reduces dermal elastosis, mast cell

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

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 glucose

metabolism (green tea and coffee).

TISSUE GLYCATION

• Undesirable cross-linking of sugaror aldehydes with protein.

• Results in AGES with loss offunctional integrity of proteins.

• Carnosine and antioxidants mayinhibit tissue glycation(glycosylation).

METHYL DONATION• Methyl donation maintains structural and

functional 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)

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 are

the optimal way of taking fish oil.

THE VALUE OF ENTERIC COATING,TARGETED DELIVERY FISH OIL

• Better tolerated, absorbed withhigher bioavailability to meetrecognition of high dosagetherapeutic benefit.

• Regular fish oil capsules and liquidsare obsolete in professionalpractice.

• Belluzzi et al, NEJMed, 24, 334,1557-8, 1996.

VALUE OF ENTERIC COAT, NEJMed, 1996

HORMONE REPLACEMENT

• The notion that hormone deficienciesexplain aging in a comprehensivemanner is quite naïve.

• GH, Bio-HRT etc. must be monitored.

• GH releasing hormones should be triedbefore GH injections e.g. GHRP-2

• Need for staged anti-aging strategies.

THALASSOTHERAPY• Topical for detox and dermabrasion

• Oral for weight control, iodine, fucoids,minerals, vitamins and gels.

• Fucoxanthin promotes fat oxidation byincreasing Uncoupling Protein-1.Synergy with fish oil.

• Increase in transporter 4mRNAexpression of L-6 myotubes, glucoseuptake.

AESTHETIC PROCEDURES• Increase in trauma from semi-invasive

cosmetic procedures e.g. lip-puffing,liposuction, “nips and tucks” etc.

• Trauma and Procedure Recovery isrequired in spa and anti-aging practice.

• Evidence-base for homeopathic Arnicamontana, bromelain and bioflavonoids.

• Start supplements on day of surgery orintervention, continue for 5-7 days.

SKIN, HAIR AND NAILS• Skin, hair and nail beauty are

paramount in aesthetic practice.• Several natural substances optimize

skin regeneration or repair andsupport sub-dermal structures.

• Evidence-based ingredients can beused in synergistic formulations:eggshell Ca, horsetail, olive leaf,antioxidants, DMAE, hyaluronate,MSM, collagen, Aloe etc.

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.

LINKED TO OVERWEIGHT STATUS

REDEFINING SYNDROME X• Classic Definition: Obesity,

Hypercholesterolemia, HighBlood Pressure, Linked byInsulin Resistance.

• Syndrome X, Y and Z….., anexpanded definitionincorporating a novel unifyingconcept of common diseases

SYN X, Y, Z…(Expanded Definition)

THE PUBLIC HEALTH RISK• Syndrome X increases risk

for : Type II Diabetes Mellitus Cardiovascular Disease Cardiovascular Deaths Deaths from ALL CAUSESAm.J.Epidemiol, 148, 958, 1998.

FACTS• Obese people die young• Obese people develop

premature disability• Obese people are modern,

metabolic dinosaurs• Obese people are generally

mismanaged in clinical practice.

OBESITIS• Epidemiological links between obesity and

inflammation have been proposed for >40y.

• Glucose and fat intake induce inflammation byoxidative stress or the activation of transcriptionfactors.

• 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?

: Fat tissue, normal weight mouse

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

POTENTIAL MECHANISMS OF OBESITIS

OBESITIS

• Obesity is an inflammatory disorder• 30% of blood cytokine IL-6 from

adipose tissue, decrease CRP and IL-18 with weight loss

• Naïve “Zones”, but EPA valuable• Adipocytokines [leptin, adiponectin and

visfatin], adiponectin lowers TNF-alpha• Final common pathway oxidative stress

OBESITIS

DRUGS AND NUTRACEUTICALS

UNREALISTICWEIGHT LOSSEXPECTATOIN

THE “POT BELLY”:USELESS ANDDANGEROUS ENDOCRINE ORGAN

POT-BELLIED DINOSAURS• Fat tissue stores fat soluble chemicals,

synthesizes inflammatory mediators andelaborates sex hormones.

• Toxicants e.g. PCB’s, pesticides etc.concentrate in fat deposits and alter fatmetabolism.

• This is the concept of TOXIN INDUCEDLIPOGENESIS and it provides good reasonsfor body detoxification with weight control.

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

WHICH ARE QUICK FIX PROMISESFOR WEIGHT 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!

COMMON CAUSES OFOBESITY

• The Double Whopper Brain• Sedentary Lifestyle• Genetic Tendency• Social Gluttony (Appetite)• Sleeplessness

THE GLYCEMIC INDEX• Calculations of the glycemic index of

food 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

GLUCOSE TOLERANCE WITHSOLUBLE FIBER

Holt S, et alEffect ofGel Fiber…Lancet,March 24th,1979.

DIETARY PRINCIPALS

• Calories Count• Watch Macronutrients CHO, Fat

Protein• Healthy Fat (EPA)• Salt Restriction• Fiber Intake

DIETARY SUPPLEMENTSFOR WEIGHT 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

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), alphalipoic acid, vitamin and mineral support

•BLOOD LIPID: soy, fish oil, guggul, garlic etc.

•INFLAMMATION: EPA, curcumin, C etc.

SYNDROME X NUTRITIONAL FACTORS•A healthy blood glucose level

•A healthy blood cholesterol level

•A healthy blood homocysteine level

•Healthy immune function

•Healthy digestive function

•Antioxidant function

•Calorie control by induction of satiety

•Inhibition of fat and sugar absorption

SYNDROME X NUTRITIONAL FACTORS• 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

THE SLEEPLESS NATION• About 100 million Americans do not

sleep well. “Sleeping pill poppers”• Sleeplessness causes obtrusive and

unobtrusive problems.• Sleep deprivation promotes weight

gain and it is diabetogenic.• Restoration of the biorhythm of

sleep is pivotal in beauty and anti-aging. The nation should “SleepNaturally”.

ADAPTOGENS• Stress causes disease and

accelerates 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.

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 harmoniousbiochemical events in the body.

• The therapeutic use of dietarysupplements has emerged into main-linemedical practice, despite the rhetoric.