By Marios Kyriazis, MD

While everybody is talking about Antiaging Medicine nowadays, very few people agree on what the term actually means. Some practitioners use the term very generally to include ‘quack’ treatments and therapies that have no scientific basis whatsoever, while others rely so much on strict scientific and academic terms that do not allow room for a common sense and practical discussion. Between these two extreme positions, true Antiaging Medical practitioners are now getting organised to stimulate a debate aimed at clarifying what their speciality is truly about.

Setting the Scene

Before discussing the exact meaning of Antiaging Medicine it is necessary to mention a brief overview of Gerontology- the science of aging. Gerontology is an academic and scientific discipline which studies every aspect of aging, not just medical matters. It is divided into three main categories. These are distinct entities but certain elements of one category may overlap with another:

• Social Gerontology. This is about social issues associated with aging, including families, relationships, pensions, financial issues, retirement, employment, education, the politics of old age, and so on.

• Biological Gerontology. It is the study of the biology and biochemistry of aging. It includes molecular and cellular research such as stem cells & cloning, immunology, animal research and other academic issues or basic and laboratory sciences.

• Clinical Gerontology. This concerns human aging medical issues. Clinical gerontology is further divided into two sub-categories:

• Geriatric medicine, a well-established branch of medicine which aims to treat existing diseases affecting older people (those over the age of 65).

• Antiaging Medicine, the new medical specialty aimed both at young and old individuals who want to delay age-related problems for as long as possible, and maintain health into old age.

The Specialty

So, you can see that Antiaging Medicine is only a small part of a much bigger umbrella which covers age-related issues. A specific definition of Antiaging Medicine is the following:

Antiaging Medicine is a branch of medical science and clinical medicine, aimed at treating some of the underlying processes of aging and at alleviating or postponing any age-related ailments, with the ultimate goal of extending the healthy lifespan of humans.

Antiaging medical practitioners aim not only at delaying and reducing the severity of age-related diseases (such as arthritis, dementia, cataract), but also at postponing and reducing the severity of ailments which are due to the natural process of aging (e.g. skin aging, loss of muscle tissue, loss of bone mass) and so maintain some of the characteristics of youth.

Strictly speaking, those who practice Antiaging Medicine should be fully qualified and registered medical practitioners, although other health practitioners, such as nutritionists, osteopaths and complementary practitioners are currently involved in this specialty.

An Antiaging medical doctor may use both conventional and alternative treatments, in an integrated approach for achieving the best possible result for the patient. Antiaging Medicine is a holistic discipline, seeing the patient as a whole and not just as an isolated disease. Perhaps one of the most important characteristics of Antiaging Medicine is that it is not so much concerned with treating existing diseases, rather with preventing or delaying future age-related health problems. This begs the following question: What is the difference between conventional preventative medicine and Antiaging Medicine?

Well, preventative medicine and general health promotion is directed at people of any age and uses general concepts of prevention, aiming to reduce the likelihood of any disease. It does not offer any treatments. Antiaging Medicine on the other hand, is more focused and specific, concerning itself only with age-related issues. For example, preventing infectious diseases or diseases in pregnancy is not within the realms of Antiaging Medicine.

In addition, preventative medicine relies only on prevention, whereas Antiaging Medicine is both about prevention and cure. Some of these cures are already used by mainstream health practitioners (such as Alendronate and hormone replacement therapy for age-related osteoporosis). Other treatments are used to cure specific age-related diseases (such as n-acetylcarnosine drops for cataract, Strontium Ranelate for osteoporosis, and Alagebrium for cardiovascular disease).

Antiaging Medicine is not necessarily against all aging as such, but only against the medical or health problems of aging. Some parts of aging can be really useful. For example, wisdom and understanding of the world increases with age, spiritual matters are better appreciated, and there are even some physical areas which improve with age, for example:

• Allergies generally become less troublesome.

• Travel sickness becomes less likely.

• Sensitivity to pain decreases.

By the same token, youth is not necessarily a good thing, but only certain aspects of it are desirable (health and appearance for example). Other aspects of youth, such as inexperience and insecurity, are definitely seen as undesirable in the eyes of many older people. Youth should not be confused with ‘a young chronological age’. What most people are trying to achieve is not to have a young chronological age but a young biological age, i.e. be healthy and biologically efficient.

Aging

To give a better idea about Antiaging medicine, it is necessary to also explain what ‘aging’ actually means. There are different ways of trying to define aging, and experts in the field have been struggling for years to come to an agreement. Generally, aging can be described as: ‘the progressive failing ability of the body’s intrinsic and genetic powers to defend, maintain and repair itself in order to keep on working efficiently’. This highlights the fact that, as we grow older, we are subjected to an increasing number of both external and internal damaging events, which are not being properly controlled, leading to illness and disability.

Another definition of aging is ‘the process of accumulated damage to the building blocks of life (proteins, DNA, carbohydrates etc), leading to malfunction of cells, tissues and organs, ultimately leading to death’. This is a more academic explanation of aging at the molecular level, but essentially implies that, if we somehow repair this damage to the building blocks of life, then we could retard or reverse aging at the clinical level.

Traditional scientists believe aging to be a natural phenomenon which is intrinsic (in our genes), deleterious (it is detrimental and has no benefits), universal (it affects every living thing), and progressive (it goes only in one direction and it ca not be turned back).

Cutting-edge thinking however, shows that this view is becoming difficult to support. Although aging is indeed written into our genes, it is not completely irreversible. The clock has been turned back in a number of pioneering experiments during the past few years, and on at least one occasion involving ground-breaking cloning techniques, it has been reset right back to zero. Also, aging is not necessarily detrimental, and there are several aspects of it that are advantageous, as already mentioned.

Aging is certainly not due to a simple lack of a hormone or nutrient. Taking a few supplements or replacing a single nutrient is not going to reverse aging. It is a much more complicated process, and there are several different mechanisms involved in it.

As mentioned above, Antiaging medicine aims to maintain some of the characteristics of youth. But what does ‘youth’ actually mean? Youth, in the context of Antiaging medicine, does not mean ‘somebody who is not old’, but somebody who has some, or all, of the characteristics of idealized youth, for example, good general health, strong muscles and bones, an efficient immune system, sharp memory, a healthy brain, and hormones working at their peak capacity.

Antiaging practitioners believe that it does not matter how old you actually are, in other words it is not a matter of chronological age, but a matter of improving biological, social, spiritual and mental age. ‘Aged’ or ‘old’ is somebody who has succumbed to the problems related to age. You may be of an advanced chronological age but still retain some of the characteristics of youth. For example, there are 90 year-olds who look healthy, are without any significant illnesses, feel energetic and enjoy life to the full. They are content and fulfilled, and enjoy the best of both worlds: health (youth) plus wisdom (age).

Other terminology

Many people, including some respectable scientists, are in a muddle about the different terms used in the Antiaging field. They use words like ‘longevity’, ‘immortality’ and ‘rejuvenation’ without making a distinction. These words may sound similar but there is, in fact, a great difference between them.

Any linguist will tell you that ‘longevity’ simply means ‘living longer’. An Antiaging physician will tell you that ‘longevity’ does not mean merely prolonging life for the sake of it, but also extending the years you can live in good health, your ‘health-span’. Those who are opposed to longevity, thinking that the aim of longevity is merely to add years to life (with all the illnesses that come with that), are simply mistaken. ‘Longevity’, in the eyes of an Antiaging practitioner, is not one, but two things: living longer and being healthier.

You will notice that ‘living longer’ is not specific and does not refer to any numbers. How much longer? Longer than what? The answer is vague: By as much as possible. Longer than others. ‘Long life’ to most people means an age of, perhaps, 90-95 years, whereas a minority may mean an age of over 100.

Other terms used in the Antiaging field are:

• ‘Rejuvenation’ means exactly ‘to become young again.’

• ‘Eternal life’ means to live forever. ‘Forever’ means different things for different people. Some take it to mean 200-300 years of age, whereas others consider it to mean thousands of years. Some people even take it literally, i.e. really forever (billions of years).

• ‘Immortality’ means never to die, which is, in a sense, similar to the above.

Notice that none of the above terms say anything about being healthy or unhealthy. These terms should be used to their exact meaning. Treatment with a certain product will not make you ‘immortal’, but may grant you a certain degree of ‘longevity’. Future treatment with genetic manipulation may give you ‘rejuvenation’ but not ‘eternal life’.

Antiaging Medical Treatments

The following treatments or therapies are currently used by Antiaging practitioners and form part of true Antiaging Medicine.

Drugs and supplements

• Hormonal therapies. These include treatment with bio-identical hormones such as DHEA, growth hormone, androgens, testosterone, and estrogens. Other hormones used are thyroxin, insulin and melatonin. On certain cases, hormones may be used to treat endocrine (hormonal) problems before these are picked up by conventional laboratory tests. Examples are diabetes, hypothyroidism, menopause and andropause.

• Antioxidant therapies, such as vitamins A, C and E, resveratrol, glutathione, co-enzyme Q10, polyphenols and many others. Although many people buy some vitamins from their health food shop, this does not guarantee any Antiaging effect, because one should take into account the strength of the preparation, its quality and purity, the reliability of the supplier, the combination these supplements are taken, and many other factors.

• Antiglycators, which are active against glycation, the damaging process whereby sugar molecules attach to proteins or DNA. Commonly used antiglycators are carnosine (including N-acetylcarnosine for cataract) and aminoguanidne. Less common but effective agents are tenisletam, pyridoxamine, and cross link-breakers such as Alagebrium (ALT 711).

• Nootropics, commonly known as ‘brain-boosters’ such as ginkgo biloba, phosphatidylserine, choline, memantine, bacopa, centrophenoxine, piracetam and hydergine, to mention just a few. The general activity of nootropics is to improve circulation of the blood to the brain, protect the neural tissues against damage (including against free radical damage) and stimulate neurotransmitters.

• Other general anti-agers are deprenyl, methylators (i.e., SAMe and TMG) and Calorie Restriction mimetics, such as metformin. Less commonly-used treatments such as heavy metal chelation, human stem cells, fetal cell therapy, and other immune therapies are also available in a clinical setting. Nanotechnology has a future potential for Antiaging medicine.

Lifestyle and appearance

• Lifestyle therapies including hormesis (beneficial stress), brain and sense exercises, physical exercise, calorie restriction, and general health education. Advice on these is available from books or from Antiaging clinics.

• Cosmetics used against aging of the skin: Botox, Isolagen, collagen, hyaluronic acid fillers, face lifts and other surgical operations used against face skin aging.

Others

Treatment for specific age-related diseases such as Alzheimer’s disease, Parkinson’s, osteoporosis etc is also part of Antiaging medicine although some aspects of this overlap with Geriatric medicine. Complementary treatments such as with plants and nutrients which protect against specific age-related illnesses are included.

It is worth remembering that certain treatments or approaches, although aimed at helping us live longer, are not entirely part of Antiaging Medicine. For example:

• Cryobiology and cryonics. This is not against the aging process, but against death.

• Sports medicine and endurance. Although helpful in improving the health of an older person, general sports medicine and activities such as body building or body sculpturing are not age-related therapies

• Treatment for unusual or incurable diseases such as Multiple Sclerosis, ALS, fibromyalgia, chronic fatigue syndrome. These are not related to the aging process.

• Beauty treatments (aimed only at improving beauty and not aging of the skin), such as artificial nails or eyebrows, treatment of excessive facial hair etc.

• Certain cosmetic procedures such as breast enlargement, liposuction, penis enlargement etc., which do not deal with any age-related changes.

Conclusion

Antiaging medicine is a new and pioneering branch of medicine. By outlining exactly what one means when using the different terms related to aging, it becomes clear that this specialty has not any mythical or unscientific connotations, but it is scientifically-based and worthy of further recognition.

No doubt, soon more treatments will become available and added onto the existing mainstream treatments offered by Antiaging practitioners, to help achieve the aim of ‘living longer and healthier’.