Anti-aging medicine, although as old as Methuselah, is the new frontier of healthcare in the United States “This is a clinic for preventative medicine, but if we don't say ‘anti-aging’ no one's interested,'' says gynecologist Dr Richard Reid, a pioneer of the new field of anti-aging medicine. Six months ago Reid opened his anti-aging clinic.

For those who can afford it, Reid and his colleague, specialist physician Dr Julie Epstein, will “soften the hard edge of time”, probably with diet, exercise and hormone replacement. He says: “The effects of aging can be greatly diminished right across the board.” Others go further. “It's been scientifically proven the human body can -- or should -- live to 120,'' says marketing man Brian Sher, 38, a partner in the Redwood anti-aging clinic. People don't die of old age, they die from diseases, says Sher, making an astonishing promise: “However long you're going to live, we're going to keep you disease-free -- so you won't get Alzheimer's or Parkinson's disease or osteoporosis.''

How would he stop me getting Alzheimer's, I ask, fascinated, and Sher hastily amends his promise. “We reduce your chances of getting the disease,” he says He is a marketing man whose mouth can run away with him. But his tendency to make large claims is understandable. Redwood is a template of a renowned anti-aging clinic in New York State. In fact, anti-aging medicine is taking off so rapidly in the US that the American Academy of Anti-Aging Medicine, begun in 1993 with a dozen doctors, now has more than 8000 members. “This is the fastest growing society on the planet. We dwarf sports medicine, we dwarf emergency medicine,” says its chairman, Dr Ronald Klatz. On the phone from his office in Chicago, Klatz gravitates between unabashed salesmanship and evangelical fervor. “This is the way all medicine will be going. This is the new frontier of healthcare.

“You take someone of 71 who's not ill, but not well, you make sure they're properly hydrated, get some exercise, optimal diet, you throw some hormones on top of it, you get miraculous results. “It is quite common for anti-aging doctors to reverse signs of aging by 10 years -- and for some lucky individuals, up to 20 years.” Forget the specter of diet and exercise (the fundamentals of any serious anti-aging program). The man is talking about our real millennial miracle -- products that repair the ravages of time. Who could resist?

Anti-aging medicine is based on the general idea that age-related degeneration of bone, muscle, skin, nerves and cells can be slowed by regulating the endocrine system with supplements that replace falling hormone levels. It expands the widely accepted practice of treating menopausal women with estrogen and progesterone -- hormone replacement therapy. Nowadays patients may be given estrogen or progesterone in combination with other hormones, such as DHEA, melatonin or human growth hormone, or with compounds called secretagogues, which stimulate the body's production of these hormones.

The least common but most contentious anti-aging treatment involves giving people some form of human growth hormone (which regulates metabolism and promotes growth). Once only prescribed for diseases such as dwarfism caused by a malfunctioning pituitary, growth hormone is now given to some people who, for medical reasons or reasons of vanity, want to gain muscle and lose fat. And don't we all?

The first thing to be said about anti-aging medicine is that it is very expensive. Doctors can spend from two to five hours with the patient to draw up a profile of biological markers, from waist measurements to hormone levels. Though he won't say that the treatment that follows can reverse aging, Reid is convinced that it can slow the process. “About 15 per cent of aging is caused by time alone and we can't change that. But the other 85 per cent is largely controllable.”

Practitioners of anti-aging medicine regard it as axiomatic that in our society “adverse aging” is driven by too much food (stuffed with protein and fat, not fiber) and too little exercise.In Western society, says Reid, aging could be called “an exercise deficiency syndrome” that reflects our sedentary lifestyle. The lack of exercise amplifies the declining hormone levels that are a corollary of aging.

“Beginning in the early 30s, the levels of five of our hormone systems -- the adrenal, the pituitary, the ovary, the thyroid and the testes -- start to fall by about 14 per cent per decade,” he says. “And as they decrease they make it harder for the body to conserve muscle and bone, and easier for the body to store fat. The process of replacing lean tissue with fat can be dramatically accentuated by any disease that increases the rate of tissue destruction.”

The breakdown of tissues is accelerated by central obesity (which affects the body's insulin resistance -- that is, its critical ability to burn sugar). Reid contends that treating central obesity with growth hormone will mean people not only lose weight and gain muscle, but will be less likely to die from heart disease or stroke. Overweight himself, Reid takes growth hormone and DHEA (and has had a steady weight loss over two years). He says such treatment is “becoming an orthodox strategy”. But he would get an argument from many scientists who are worried that little is known about the long-term effects of, say, giving growth hormone to help obese people lose weight. Apart from estrogen and (in some cases) testosterone, the evidence that the other hormones stop, slow or reverse aging is “negative'', says Dr Maria Fiatarone Singh, professor at the school of exercise, sports and science in Sydney University's medical faculty. Instead, she says older people should be exercising -- most particularly, pumping iron. “Resistance training can prevent much of the muscle loss that occurs with aging. It's the only form of exercise shown to do that. The muscle is forced to contract, synthesizes more protein in response and lays down new muscle tissue,” says Fiatarone Singh (whose paper on resistance training given at a Sydney conference in November convinced me to join a gym to start lifting weights).

Professor Steven Boyages, the director of diabetes and endocrinology at Sydney's Westmead Hospital, echoes the prescription. “You produce your own growth hormone by exercising on a regular basis. The effect is greater than that you'd get by administering growth hormone (by injection), which is expensive, intrusive and potentially dangerous when given in later life,'' he says. “Every tissue is exposed to the excesses of growth hormone. Will these compounds increase the risk of cancer? We don't know.''

Those on the other side of the argument claim that Western society doesn't have time to find out. “We can't wait for evidence-based medicine to stop the carnage aging is wreaking,'' says Reid Indeed, the evidence more likely to concern many who have reached middle age is the evidence they see before them in the mirror. “You start to notice a few things dropping,'' says Linda Gray, a slender, fortysomething Sydney woman who works in advertising. No sooner had she noticed, in fact, than she started running. “I don't want to look like an old hag at 50.”

These days Gray runs in marathons, works out with a personal trainer and practices yoga. She also uses Cellex-C (a costly derivative of vitamin C said to rejuvenate the skin), and is on hormone replacement therapy. The high dose of estrogen has made her feel much calmer, says Gray, who is considering adding DHEA to her daily regime. DHEA is reported to enhance energy, mood and memory, restore libido, facilitate muscle building and weight loss, and improve immunity.

Critics such as Fiatarone Singh would say the claims made for DHEA have not yet been tested in randomized trials. What is known is that even 25 mg a day can cause side effects such as an acne-like skin rash and a slight lowering of “good'' cholesterol. (This information is lost on young athletes who misuse DHEA, taking large doses, like the body builders who misuse testosterone) But increasing numbers of doctors seem to agree with Reid that replacement doses of DHEA increase physical and psychological well-being.

One result is that gynecologists in affluent areas are giving male and female patients scripts for cocktails of DHEA and melatonin, a hormone that affects the body's sleeping and waking cycles. Popularly believed to prevent jet lag, melatonin, an anti-oxidant (which protects the body against “free radicals'”) can have some side-effects. In a field that seems as much driven by patient demand as manipulation by the drug companies (if that isn't a false distinction), compounding chemist Richard Stenlake has created a market in Australia that didn't exist before he came along. Only nine years ago, Stenlake, 56, was an ordinary pharmacist with a shop in the Sydney suburb of Bondi Junction. Then he started making preparations of “natural'', or what he sometimes refers to as “bio-identical” hormones from the pharmaceuticals he imports from the US. Now he has 17 people working for him in the lab above his old shop. Many of his customers are women on “natural hormone replacement'' -- tailor-made combinations of estrogen, progesterone, testosterone and DHEA that have fewer side-effects than the standard HRT formulations from large drug companies, he says. Orders for Stenlake's capsules and lozenge-like troches are doubling each year, despite the cost.

Sydney woman Monica Graham consulted a series of doctors after failing to recover fully from an illness contracted on a business trip to Vietnam. She finally saw Reid, who convinced her that no harm could come from taking “natural” hormones. Graham has only just begun the treatment. Another of Reid's patients, a 53-year-old woman, has taken growth hormone and DHEA -- and Prozac -- for the past two years. She says she feels better now than 10 years ago. “I was more frightened of feeling old than looking old. The first time we talked, I said I will do anything to slow down the process. He convinced me the risks of taking growth hormone were negligible. I'm a gambler.'

'For those who want information you can now go online to find Klatz's Web site (www.worldhealth.net) with everything from advice about eating prunes, which are high in anti-oxidants, to a price list for products from the Cenegenics Medical Life Enrichment Company in Las Vegas. Its miracle cures (called “customized complete endocrine optimization programs'”) include human growth hormone programs starting at $1150 a month.

A related Web site gets straight down to business with the offer of a seminar on “investing in the ... rapidly expanding universe of the anti-aging marketplace.” The same note of optimism booms down the line from Michigan when I telephone Dr Edward Lichten, a member of the board. Lichten believes there are countless uses for hormones. He treats heart patients with growth hormone and testosterone. He takes diabetics off insulin and gives them testosterone. He finds testosterone “works great for depression” and, come to that, he gives testosterone to women with osteoporosis. He, too, went on hormones and started bodybuilding, and now Lichten, at 52, regards himself as his own best advertisement.

Five minutes into our conversation he tells me to look at the picture of him on his Web site (www.usdoctor.com). Pictured in his gym shorts and holding a weight, he looks as if he can barely contain his excitement, which is pretty much how he sounds on the phone. “The philosophy is, why should we waste young hormones on young people?” he says.

He and his colleagues from the A4M emphasize the growing respectability of anti-aging medicine. “Five years ago I was a wacko science-fiction mongering goofball,” says Klatz. “Today we've got to stretch really hard to get anyone to raise an eyebrow.” But call the National Institute on Aging to ask about growth hormones and DHEA as an anti-aging remedy and the response is swift and defensive. “All these things have no proven clinical benefit,” snaps Dr Stanley Slater, the institute's deputy associate director, who sounds as if he needs a bit of whatever Lichten's on. But Slater doesn't believe in it. “We don't know yet whether these changes, like less fat and more muscle, are the same as increased health.”

But handouts from the NIA about research it has funded are more positive. They reveal “that giving human growth hormone and sex steroids favorably alter measures of body composition, particularly in men ... In women, body fat was reduced, too, although to a lesser extent ... Importantly, in both men and women, the lean body mass increased significantly.”

Since 1992, Slater's department has supported nine big studies of anti-aging medicine -- the randomized clinical trials lacking until now. The results of the first, carried out at Johns Hopkins University in Baltimore by medical professor Dr Marc Blackman, are to be published in the New England Journal of Medicine later this year. The advocates of anti-aging medicine are jubilant, saying the Baltimore study confirms an earlier study (by the late Daniel Rudman) which suggested that human growth hormone increased muscle mass and decreased body fat. Rudman said one year of growth hormone replacement reversed the effects of 14 years of aging.

His work was based on a fairly small group of men. The latest study, which involved 125 men and women, again found that growth hormone, testosterone and estrogen replacement, alone or in combination, increased lean body mass and exercise capacity. Reid regards the study as a vindication of his own work. “When the results of the study appear in the New England Journal of Medicine it will further fuel strong grassroots interest in the issue of whether science can slow the aging process. And I think it can.”

Source: The Weekend Australian, Formatted and edited & supplemented by The Palm Beach Times