FloridaTrend.com, the Website for Florida Business


Anti-Aging Medicine: Forever Young

Dr. Jennifer Landa
Dr. Jennifer Landa, 40, runs an anti-aging practice in Maitland and is chief medical director of BodyLogicMD. [Photo: Brian Smith]
As we sleep, the pituitary gland near the base of the brain secretes a protein consisting of 191 amino acids that flows into the bloodstream. Although the substance, Human Growth Hormone (HGH), remains in the bloodstream for only a few minutes, its impact on the body is dramatic. When HGH binds to receptors on target fat cells, it stimulates the breakdown of triglycerides and suppresses the cells’ ability to store fat. At the same time, HGH triggers the liver to produce a potent anabolic hormone called IGF-1, a messenger molecule that stimulates bone, cartilage and muscle growth.

While levels of HGH peak during the rapid-growth phase of adolescence, they drop off as we age, at a rate of about 14% to 20% per decade. By the time we reach our 60s, our HGH level can be as little as 15% to 20% of what it was during our youth.

Most doctors consider declining levels of HGH and other key hormones, like testosterone, DHEA, melatonin, thyroid hormone, progesterone and estrogen, to be a normal part of aging. But a new crop of physicians says it doesn’t have to be that way. The “anti-aging” doctors promote hormone replacement, intravenously administered vitamins and a myriad of other therapies along with dietary changes and weight management as a way to stave off the effects of aging.

“We kind of call anti-aging medicine ‘inner plastic surgery’ because it kind of works from the inside out. So if somebody is considering liposuction, I say, ‘Please let me help you optimize your hormones. Maybe if you’re over 40, even consider growth hormone, and let’s see how good it can get for you in three months,’ ” says Dr. Donald Fisher, a former emergency medicine doctor who now runs an anti-aging medical practice in south Florida, the epicenter of the anti-aging medical movement.

The Anti-Aging Medicine Chest

Bioidentical Hormone Replacement Therapy (BHRT) — Bioidentical hormones are plant-derived hormones that are frequently prescribed to treat the symptoms of menopause and andropause, the decline of testosterone in men. The custom-mixed formulas are derived from yams or soybeans and then altered to be identical in molecular structure to those produced by the body. Many advocates of BHRT tout it as a safer, more natural alternative to conventional hormone replacement therapy. The U.S. Food and Drug Administration, however, says there is no evidence that bioidenticals are any safer or more effective than traditional FDA-approved menopausal hormone therapies.

Dehydroepiandrosterone (DHEA) — This hormone is secreted by the adrenal glands and serves as a precursor to sex hormones such as estrogen and testosterone. Levels peak around age 25 and gradually decline with age. By the time a person is 70, DHEA levels are just 10% to 20% of what they were in the second decade of life. Promoters claim that restoring DHEA levels with supplements will increase muscle mass, bone growth and fat burning as well as improve memory and boost the immune system. A 2008 Mayo Clinic study concluded that there’s no proof that DHEA has any anti-aging benefits.

Antioxidants — Many scientists suspect that free radicals — the unfettered oxygen particles that are produced during normal metabolic processes and by such activities as smoking — are a primary culprit behind aging. Common antioxidants recommended to help mop up these free radicals include vitamins A, C, and E and
co-enzyme Q10. Polyphenols, which are found
in red wine, fruits such as grapes, pomegranates and berries and tea and coffee, are also effective free radical scavengers.

Fish Oil—
Omega-3 fish oil is a natural anti-inflammatory. Evidence from studies suggests it lowers triglycerides and reduces the risk of death, heart attack, dangerous abnormal heart rhythms and strokes in people with known cardiovascular disease. It also decreases blood pressure slightly.

Melatonin — This hormone is produced by the pineal gland, which is located beneath the brain, each night in response to darkness to help induce sleep. It is linked to the regulation of circadian hormonal rhythms, but levels may decrease as we age. Melatonin supplements are often prescribed to help patients sleep better.

[Photo: Tom Hagerty]


Dr. Mark Rosenberg, a former emergency room physician, sees around 500 patients at his anti-aging practice in Delray Beach. Now 49, Rosenberg could pass for 30-something. What’s his secret? For one, he doesn’t eat a lot. “The only method shown to actually slow the aging process is calorie restriction. I only eat 1,400 calories a day. That’s really slowed the aging process.” He also gives himself twice-weekly intravenous infusions of antioxidants and takes somewhere between 60 and 80 supplements a day. That’s why, he explains, his skin “looks younger than everybody else’s my age.” [Photo: Scott Wiseman]
Nationwide, the market for anti-aging medicine is estimated at more than $60 billion, with Florida the No. 1 state. According to the American Academy for Anti-Aging Medicine in Boca Raton, 9,852 of Florida’s 58,896 doctors, 17%, have incorporated some element of anti-aging medicine into their practices. California, with 9,113 anti-aging doctors, is second. “Anywhere that vanity’s important, you’ll see a lot of this,” says Dr. Mark Rosenberg, who opened an anti-aging practice in Delray Beach in 2003.

While the sector’s growth is being fueled by affluent Baby Boomers eager to recapture their youth, the field is also attractive to physicians fed up with high caseloads and the hassles of dealing with insurance companies. Because insurers won’t cover many anti-aging treatments, anti-aging physicians generally operate on a fee-for-service basis. They benefit in several ways: Treatments are lucrative, patients pay upfront in cash, and since the physicians don’t need administrative staff to process insurance claims, they can hold down their office expenses.

Malpractice insurance rates are also considerably lower. Dr. Jennifer Landa, an OB/GYN who opened an anti-aging practice in Maitland three years ago, says her medical malpractice premiums ran about $100,000 a year when she was delivering babies. As an anti-aging specialist, she pays less than $10,000 a year. Freed from the constraints of insurance reimbursement rates that dictate a high patient volume, Landa is able to devote considerably more time to her patients, most of whom come to her looking for relief from the symptoms of menopause and andropause, or male menopause. While the average physician might spend about eight minutes with a patient, an initial visit with Landa lasts about an hour, and follow-ups generally last 30 minutes.

Anti-aging treatments typically involve some combination of a customized nutrition and fitness program along with hormone replacement therapy using “bioidentical” hormones, which are derived from plant oil and altered to become identical to human hormones such as estrogen and progesterone. Anti-aging doctors believe bioidentical hormone replacement therapy (BHRT) is safer than synthetic estrogens and progesterones that have been shown to increase a woman’s risk for heart disease, stroke, blood clots and cancer.

Landa charges her female patients $495 for initial lab work that includes both blood and saliva testing. Men pay $595. Once the test results are in, an initial consult costs $495. Prescriptions for hormones like estrogen, progesterone and testosterone can average $35 or more each per month per hormone. Follow-up lab tests run about $250, and follow-up office visits are $275. Add in the costs of various “nutriceuticals” recommended by the doctor, and a typical patient taking two hormone supplements might spend upward of $3,000 annually.

With celebrities like Suzanne Somers singing the praises of BHRT, Landa and other anti-aging doctors say they’ve had no shortage of patients willing to pay big bucks to feel more like they did in their 20s or 30s.

Linda Gloria, a 56-year-old physician practice management consultant in Coral Springs, says she began seeing Fisher five years ago when she was in the throes of perimenopause, the period when a woman’s body begins to transition into menopause. “After the birth of my last child at 43, I didn’t feel quite right with the hormones. I had gone to my regular OB/GYN who said that after three kids, that’s normal?—?but a week out of the month I wanted to kill everyone.”

Fisher diagnosed Gloria with several hormone deficiencies and put her on a regimen of bioidentical progesterone, estrogen and testosterone. He also helped her fine-tune her diet and exercise routine. Gloria says the regimen has made a huge difference. Sleep comes easily now, she says, and she finds that she is calmer and able to tolerate everyday stresses better than before. Moreover, she has been able to avoid the hot flashes and other uncomfortable symptoms associated with menopause. Gloria is so pleased with the results that she encourages her friends who are in their 40s and 50s to get their hormone levels tested. “Just because you’re in your 50s, doesn’t mean you have to turn into an old lady.”

?

Dr. Ferdinand Cabrera
Dr. Ferdinand Cabrera, a 49-year-old internist who runs the Genesis Health Institute near Fort Lauderdale, has slow-release testosterone implanted under his skin. [Photo: Vim Kruger]

Some testimonials for anti-aging medicine come from the doctors themselves. Every five months, Dr. Ferdinand Cabrera, a 49-year-old internist who runs the Genesis Health Institute, an anti-aging practice outside of Fort Lauderdale, has slow-release testosterone pellets implanted under his skin. He also takes a supplement to boost his production of HGH, and he takes 20 milligrams of melatonin each night to improve his sleep. A food sensitivity test revealed that his body was reacting to 34 foods, including almonds, watermelon, cantaloupe, eggplant, rice and wheat. He eliminated the offending agents from his diet. Like many anti-aging and holistic medical practitioners, Cabrera believes that low-level inflammation at a cellular level caused by foods we eat contributes to many chronic ailments, ranging from arthritis to type 2 diabetes and many autoimmune diseases.

Of course, Cabrera can’t prove he’s actually stalled or reversed his body’s aging process, but he says he feels “fantastic” since he’s made all the changes. His skin appears to have more elasticity, his thought processes are clearer, he’s sleeping better and he’s lost 20 pounds, he says.

Not everyone in the medical community is sold on the anti-aging practices, however. Views of the new field range from skepticism to warnings that anti-aging doctors are creating a threat to public health by casually prescribing substances like HGH. Dr. Thomas Perls, attending physician in the geriatrics section at Boston Medical Center who has published a number of peer-reviewed articles on aging and anti-aging medicine, says HGH’s side effects can range from tissue swelling and joint pain to enlargement of the heart and increased pressure around the brain. Some studies have also indicated that growth hormone enhances the ability of cancer to spread, he says.

“We have an anti-aging industry and other areas of the market that do an unbelievably good job of marketing an incredible false sense of safety and an incredible false sense of tremendous benefits from these drugs — and out of that comes a huge amount of money,” Perls said in testimony before Congress last year.

The National Institutes of Health offers a slightly less alarming view of the trend. The National Institute on Aging, a division of the NIH, urges consumers to “be skeptical of claims that hormone or other supplements can solve your age-related problems.” Instead, consumers should focus on “what is known to help promote healthy aging: Healthy eating and physical activity.” Moreover, the NIA advises against taking any supplement touted as an anti-aging remedy, arguing that there is “no proof of effectiveness, and the health risks of short and long-term use are unknown.”

S. Jay Olshansky, a professor in the School of Public Health at the University of Illinois at Chicago and a research associate at the Center on Aging at the University of Chicago, points out that anti-aging medicine is not recognized by the American Medical Association as a medical specialty. That’s important, he says, because there is, in fact, “no such thing as an anti-aging medicine. If there was an anti-aging medicine that was demonstrated to work, the whole world would be on it.”

Olshansky acknowledges that some practices promoted by anti-aging doctors — eating less, eating healthier and exercising more — are good for everybody. “And that’s a good thing,” he says. But, he asks, “Are they reversing their aging? No. Are they influencing their aging in any way? No evidence for it.”

The American Academy for Anti-Aging Medicine (A4M) and co-founders Robert Goldman and Ronald Klatz, meanwhile, have been sensitive to criticism. In 2005, A4M filed a $240-million defamation suit against Perls and Olshansky, alleging that the two professors had conspired to undermine the group’s credibility and harmed the group’s business prospects. Olshansky countersued, and both sides later dropped their lawsuits and reached a confidential settlement. In August, A4M sued Wikimedia Foundation and 10 anonymous Wikimedia contributors, alleging that an A4M Wikipedia page contained false and defamatory information about the group and its founders.

The internet, meanwhile, is awash with claims and promises by anti-aging clinics. “Turn Back the Hands of Time,” the Naples Longevity Clinic proclaims on its website. “Rejuvenate your life ... be younger than your years through anti-aging medicine ... slow down the aging process.”

Reached by phone, Dr. Lee Raymond Light, who runs the Naples Longevity Clinic, has a more modest description of the services he offers. “I’m not saying this is the fountain of youth. What I’m saying here is we’re going to try to help you slow the natural aging process down to where God and nature intended it to be.

“Today the maximum life span is 120 to 124 years,” he says. “We’re not saying we’re going to get you there, but we can get you to live closer to that, with less disability, less joint problems, without the loss of libido.”

Anti-Aging-Related Businesses
South Florida is the epicenter of the anti-aging movement.

Patrick SavagePatrick Savage’s BodyLogicMD provides a turnkey business model
for doctors who want to start an anti-aging practice.
Connie Araps
Connie Araps
Kevin Garrity
Kevin Garrity
Dr. Pam Smith
Dr. Pam Smith
BodyLogicMD, Boca Raton — By his late 30s, Patrick Savage, now 47, weighed 300 pounds, had a cholesterol level above 300 and was “feeling lousy.” He sought help from his brother, an emergency room physician who had begun to dabble in anti-aging medicine. His brother put him on hormone therapy, nutritional supplements and prescribed a new diet and exercise regimen. Within a year, Patrick had shed 100 pounds and felt better than he had in his entire adult life. In 2004, Savage and his brother began building a business model that would enable other doctors to build practices in anti-aging medicine. Operating like a franchise, BodyLogicMD provides a turnkey model for opening an anti-aging practice. For a fee of between $20,000 and $50,000, the company will help doctors find the right location and provide marketing and sales expertise. BodyLogicMD’s Boca Raton-based customer care center manages doctors’ calendars and handles all follow-up appointments and coordination of patient lab results. BodyLogicMD has 36 doctors in 29 practices in 17 states, including eight physicians in Florida.

AssureImmune, Boca Raton —?The 2-year-old company is at the forefront of an increasingly popular component of age management medicine —?adult stem cell collection and storage. Connie Araps, vice president of operations and business strategy, says adults bank their own stem cells for the same reasons that they bank cord blood from their infants — to ensure access to their own stem cells should they develop a disease later on in life. AssureImmune, which also collects stem cells from newborns and older children, charges $2,495 to collect, test, process and freeze adult stem cells for one year. Maintenance of the stem cell collection ranges from $219 to $349 a year.

Age Diagnostic Laboratories, Boca Raton — The company uses urine and saliva samples to analyze hormonal activity in the body —?a method that the company claims is more economical than testing blood and also better received by patients. The company says it can also test for environmental pollutants, osteoporosis and intestinal permeability (leaky gut syndrome) this way, as well as measure levels of growth hormone, melatonin, various electrolytes and amino acids.

Cell Science Systems, Deerfield Beach — Using a blood test developed in the mid-1980s at the University of Miami, Cell Science can test for food sensitivities that cause low-level inflammation that may contribute to many of the degenerative diseases associated with aging. Prices range from $425 for a “comprehensive wellness” panel that tests 100 foods, 10 food additives and 10 food colorings to $1,099 for a “platinum panel” that tests for 200 foods, 10 food additives/10 food colorings, 10 antibiotics/10 anti-inflammatory agents, 20 pharmacoactive agents, 10 environmental chemicals and 20 molds. Kevin Garrity, chief operations officer, anticipates $11 million in sales next year.

Regenerative medicine studies, University of South Florida —?Working closely with the American Academy for Anti-Aging Medicine, the University of South Florida’s College of Medicine introduced a graduate curriculum aimed at anti-aging physicians. The master’s program in medical sciences with metabolic and nutritional medicine concentration provides advanced training in endocrinology, cardiovascular disease, intermediary metabolism, genetics, immunology, pharmacology, nutrition, physiology and biomedical aging. Dr. Pam Smith, an emergency room physician who now practices anti-aging medicine, is the director of the program.