Tuesday, June 12, 2012

Can We Prevent Aging? National Institute of Aging Speaks

On Sunday, I wrote that I would soon discuss reseveratrol. Resveratrol was one of the products that Dr. Oz had inappropriately touted last week as an anti-aging dietary supplement.

Here’s an excerpt from his website about resveratrol:

“You can further protect your body from the harmful effects of inflammation by taking a resveratrol supplement. Resveratrol is a compound found in plants such as the Japanese knotweed, blueberries, peanuts, red grape skins, and others. While resveratrol has been recommended for fighting the physical effects of aging, a brand new study shows it reduced inflammation of the heart in the study's participants by 26%. Taking one 500 mg capsule of resveratrol daily with food will help you maintain a strong, healthy heart.”

By the way, after an hour of searching, I can find no reference to any human “brand new study” regarding resveratrol. In fact, if you examine his words carefully, he doesn’t refer to humans. He only refers to ”participants.” How misleading is that?

After initiating my research into the facts about resveratrol, yesterday, I received a publication from the National Institute of Aging, part of the National Institutes of Health, titled ‘Can We Prevent Aging?’

This publication offers a succinct review of all the current “anti-aging regiments available to us beyond a healthy lifestyle. It’s a fairly long publication, so I’ve taken the liberty to excerpt certain key sections under headings that I think would be helpful to my patients.

The headings include:

Hormone Therapy and “'Anti-Aging' Supplements”
Hormone Replacement Therapy
Bioidentical Hormone Therapy
Dehydroepiandrosterone, or DHEA

If you read anything I’ve sent you, read this. It’s an excellent up to date summary of the science regarding a number of popular, but unproven methods to decrease or reverse aging. For those of you who don’t have the time or inclination to read it, here’s the National Institute of Aging’s summary:
Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

On Antioxidants:
Antioxidants protect the body from the harmful effects of by-products known as free radicals, made normally when the body changes oxygen and food into energy. The discovery of antioxidants raised hopes that people could slow aging simply by adding them to the diet. So far, studies of antioxidant-laden foods and supplements in humans have yielded little support for this conclusion. Further research, including large-scale epidemiological studies, might clarify whether dietary antioxidants can help people live longer, healthier lives. For now, although the effectiveness of dietary antioxidant supplementation remains controversial, there is positive evidence for the health benefits of fruits and vegetables.

On Resveratrol:
In one study, scientists compared two groups of overweight mice on a high-fat diet. One group was given a high dose of resveratrol together with the high-fat diet. The overweight mice receiving resveratrol were healthier and lived longer than the overweight mice that did not get resveratrol. In a follow-up study, researchers found that, when started at middle age, resveratrol slowed age-related deterioration and functional decline of mice on a standard diet, but did not increase longevity. A recent study in humans reported that resveratrol may have some similar health benefits to those in animals; however, it is still too early to make any definitive conclusions about how resveratrol affects human health and aging. More research is needed before scientists know if there is a proper and safe dose of resveratrol or if it has any clinical applicability in people.


On Hormone Therapy and “'Anti-Aging' Supplements”:
Higher concentrations of hormones in your body are not necessarily better. And, a decrease in hormone concentration with age is not necessarily a bad thing. The body maintains a delicate balance between how much hormone it produces and how much it needs to function properly. Natural hormone production fluctuates throughout the day. That means that the amount of hormone in your blood when you wake up may be different 2, 12, or 20 hours later.
If you take hormone supplements, especially without medical supervision, you can adversely affect this tightly controlled, regulated system. Replacement or supplemental hormones cannot replicate your body’s natural variation. Because hormonal balance is so intricate, too much of a hormone in your system may actually cause the opposite of the intended effect. For example, taking a hormone supplement can cause your own hormone regulation to stop working. Or, your body may process the supplements differently than the naturally produced hormone, causing an alternate, undesired effect. It is also possible that a supplement could amplify negative side effects of the hormone naturally produced by the body. At this point, scientists do not know all the consequences.
Some hormone-like products are sold over the counter without a prescription. Using them can be dangerous. Products that are marketed as dietary supplements are not approved or regulated by the FDA. That is, companies making dietary supplements do not need to provide any proof that their products are safe and effective before selling them. There is no guarantee that the “recommended” dosage is safe, that the same amount of active ingredients is in every bottle, or that the substance is what the company claims. What you bought over the counter may not have been thoroughly studied, and potential negative side effects may not be understood or defined. In addition, these over-the-counter products may interfere with your other medications. NIA does not recommend taking any supplement touted as an “anti-aging” remedy because there is no proof of effectiveness and the health risks of short- and long-term use are largely unknown.”

On Hormone Replacement Therapy:
Here’s what scientists know:
  • Endometrial problems—While estrogen helps some women with symptom management during and after menopause, it can raise the risk of certain problems. Estrogen may cause a thickening of the lining of the uterus (endometrium) and increase the risk of endometrial cancer. To lessen these risks, doctors now prescribe progesterone or a progestin, in combination with estrogen, to women with a uterus to protect the lining.
  • Heart disease—The role of estrogen in heart disease is complex. Early studies suggested MHT could lower postmenopausal women’s risk for heart disease—the number one killer of women in the United States. But results from the NIH Women’s Health Initiative (WHI) suggest that using estrogen with or without a progestin after menopause does not protect women from heart disease and may even increase their risk.
In 2002, WHI scientists reported that using estrogen plus progestin actually elevates some postmenopausal women’s chance of developing heart disease, stroke, blood clots, and breast cancer, but women also experienced fewer hip fractures and cases of colorectal cancer. In 2004, WHI scientists published another report, this time on postmenopausal women who used estrogen alone, which had some similar findings: women had an increased risk of stroke and blood clots, but fewer hip fractures. Then, in 2007, a closer analysis of the WHI results indicated that younger women, ages 50 to 59 at the start of the trial, who used estrogen alone, had significantly less calcified plaque in their coronary arteries than women not using estrogen. Increased plaque in coronary arteries is a risk factor for heart attacks. Scientists also noted that the risk of heart attack increased in women who started MHT more than 10 years after menopause (especially if these women had menopausal symptoms). There was no evidence of increased risk of heart attack in women who began MHT within 10 years of going through menopause.
  • Dementia—Some observational studies have suggested that estrogen may protect against Alzheimer’s disease. However, testing in clinical trials in older, postmenopausal women has challenged that view. In 2003, researchers leading the WHI Memory Study (WHIMS), a substudy of the WHI, reported that women age 65 and older who took one kind of estrogen combined with progestin were at twice the risk for developing dementia compared to women who did not take any hormones. In 2004, WHIMS scientists reported that using the same kind of estrogen alone also increased the risk of developing dementia in women age 65 and older compared to women not taking any hormones. What possibly accounts for the different findings between the observational and clinical studies? One central issue may be timing. The women in the WHIMS trial started treatment a decade or more after menopause. In observational studies that reported estrogen’s positive effects on cognition, the majority of women began treatment soon after menopause. This has led researchers to wonder if it may be advantageous to begin treatment earlier, at a time closer to menopause. Additionally, it appears that progesterone and progestins (progesterone-like compounds) differ in their impact on brain health.
Despite research thus far, there are still many unknowns about the risks and benefits of MHT. For instance, because women in their early 50’s were only a small part of the WHI, scientists do not yet know if certain risks are applicable to younger women who use estrogen to relieve their symptoms during the menopausal transition.


On Testosterone:
“The bottom line: there is no scientific proof that testosterone treatment in healthy men will help them age better. Until more scientifically rigorous studies are conducted, it is not known if the possible benefits of testosterone therapy outweigh any of its potential risks. NIA continues to conduct research to gather more evidence about the effects of testosterone treatment in aging men.”

On Bioidentical Hormone Therapy:
“Large clinical trials of these compounded hormones have not been done, and many bioidentical hormones that are available without a prescription are not regulated or approved for safety and efficacy by the FDA.”

On Dehydroepiandrosterone, or DHEA:
“[S]ome proponents claim that over-the-counter DHEA supplements can improve energy and strength and boost immunity. Claims are also made that supplements increase muscle and decrease fat. To date, there is no conclusive scientific evidence that DHEA supplements have any of these benefits.
The conversion of naturally produced DHEA into estrogen and testosterone is highly individualized. There is no way to predict who will make more or less of these hormones. Having an excess of testosterone or estrogen in your body could be risky.
Scientists do not yet know the effects of long-term (defined as over 1 year) use of DHEA supplements. Early indications are that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage.”
“Researchers are working to find more definite answers about DHEA’s effects on aging, muscles, and the immune system. In the meantime, if you are thinking about taking DHEA supplements, be aware that the effects are not fully known and might turn out to cause more harm than good.”

Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

I  hope this information has been helpful and as always, please feel free to share your comments.


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