Age Management

There is an ever-broadening concept in medicine that we need to look at aging as a process in need of management. Let’s be clear, there are no anti-aging treatments, no fountain of youth and no magic solutions.

Certain behaviors, treatments and approaches can better manage the process, squeezing out every last possible good moment your genetics provide. Much like the management of wild places, some of it is simple, requiring little time or treasure – and other parts more complex.

Prevention is the underpinning of all aspects of age management. Too often we think of prevention more in terms of public health and less in terms of our own individual health. Insurance payment for preventative services is still much more lip service than practice and the average person can be as paralyzed as their physician as to what to do next.

Over the past several years, we have stressed many aspects of prevention. That has ranged from not catching something awful from drinking untreated water to a comprehensive approach to early diagnosis and treatment of cardiovascular disease. It is our belief that a comprehensive approach to age management is more important than the individual pieces we discuss. The sum greatly exceeds the parts.

To start any age management process, you as an individual must be willing to change. Do you use still smoke? Really – no seriously – do you still smoke?

Aside from the wrinkles that smoking causes, how does smoking impact aging? First the “good news” – you are way more likely to die young from cardiovascular disease, lung diseases and cancer, so age management may not be your problem.

However, if smoking won’t kill you, then what else might it do? Osteoporosis, hormone imbalance, and dementia are predictable outcomes from continued smoking. There are so many effective ways to stop and you know them all. Pick one and do it. PS: Do not include “dipping” on that list.

Being overweight is a significant age management issue. New research has found that the duration of the obesity is very important. The longer you are overweight the more likely you are to have a bad outcome – that is, to age poorly. Dementia is more prevalent and occurs earlier in the obese than the general public. Diabetes as well as the usual and expected complications is very real.

What is your plan? Simply being told to eat right by your doctor, although it’s well intended, doesn’t appear to be much help. A real plan, based on an individual assessment that includes culture, region, and ethnicity is necessary. Exercise, obviously, but how much, how gradual and what is the yardstick to determine whether goals are being met? If we can have yardsticks for whitetail management, then we can do that for ourselves if given proper advice.

Hormone balance can’t be stressed enough. A while back, we discussed at length the concept of andropause. It is very real and more prevalent than previously thought. The focus may initially be on sex drive, but the reality is that low testosterone is associated with earlier onset of dementia, depression, obesity, cardiovascular disease and osteoporosis to name a few biggies.

Remember that the range of “normal” testosterone is very large – say from 250 to 800. Don’t be a lab test when you talk to your doctor. By that we mean symptoms need to be treated, not numbers. A guy with a level of 400 may feel awful if he spent most of his life closer to 800, whereas the next guy feels normal with the same level because his baseline was lower. As a reminder, free testosterone levels are more useful than total testosterone levels.

Thyroid hormone is another hormone that is very important for normal function. Too much is like turning up the body’s thermostat and too little is turning it down. Like other hormones, thyroid hormone levels naturally decline over time. The range of “normal” is very large, and many doctors don’t order the most useful tests. A decline in free T3 is associated with weight gain, decreased energy, diminished cognitive function as well as depression.

Replacement is very simple and safe. Yet, very few doctors would supplement a patient whose level has fallen from 3.9 to 2.5 (-30 percent) as it is still “normal.” Are there any data arguing against bringing the thyroid hormone level back up to more youthful levels? Not that we could find.

Human Growth Hormone (HGH) is very controversial. There are outrageous claims made on both sides of the issue. HGH levels decline with age and there is some merit to the idea of restoring levels to previous baselines. Excluding muscle building contestants, increased HGH is associated with less dementia, less body fat and enhanced cardiovascular fitness. There are several drawbacks and they include increased risk of diabetes, cost, and daily injections. Alternative methods to increase the body’s own HGH levels are available and are less costly.

Some argue that it is natural for the various hormone levels to decline and therefore “unnatural” to restore them to more youthful levels if the lab values are “within normal limits for your age.”

What if dentists took the “normal for your age” approach? Could you imagine going to your dentist and hearing “most folks your age have eight fewer teeth, you have only lost five, so you’re actually completely well.” After all, it is natural to lose teeth with age is it not? Modern dentistry represents an approach to age management that everyone accepts without a second thought.

So how come teeth and hormones are treated so differently? The honest answer is age management is simply a new field, and most doctors don’t have the training. Add insurance companies to the mix and it gets real clear, real fast.

If you are serious about maximizing your genetic potential, then you really should consider seeing an age management specialist. They are not replacements for your primary care doctor, and there will be overlap. But considering what some of us pay for a rifle, or a hunt – or jewelry to pacify others when we hunt – it is a very prudent investment.

As always be safe and enjoy the outdoors. –The Hunt Doctors, Stephen I. Merlin, MD  and Paul AJ Plante, MD

 

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