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Healing the Aging Metabolism: Breakthroughs in Anti-Aging Nutrition
Dr. Robert G. Silverman DC, DACBN, MS, CNS, CCN, CSCS, CIISN, CKTP, CES, DCBCN, HKC, SASTM
“Take care of your body, it’s the
only place you have to live”.
Jim Rohn
Objective
What’s the Problem?
THE THINKER, Auguste Rodin in 1902
Obesogenic Overview
• Obesity epidemic
• 50% of US adults will be obese by 2030
• Obesity prevalence in adults in their 40’s and 50’s would be 60%
Additionally:
• 6 mil to 8.5 mil more people with diabetes
• 5.7 mil to 7.3 mil more cases of heart disease and stroke
• 490,000 to 670,000 additional cancers
• 26 to 55 mil quality–adjusted life years left
• Increase medical expenditures: 48 bil – 66 bil by 2030 (not including lost productivity estimated at 390 bil – 580 bil per year)
The Lancet 2011. 378: p.815-25
0
10
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30
40
50
60
1971-1974 1976-1980 1988-1994 1999-2000 2000-2012
Protein
Obesity & Diabetes
Carbohydrates
Fat
% o
f C
alo
ric
Inta
ke
Change in Dietary Composition in Relation to Obesity Prevalence (1971-2010)
5
10
15
20
25
30
35
Pre
vale
nce
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esit
y (%
)
Adapted from: Flegal KM, Int J Obes 1998; Hedley AA et al JAMA 2004;291(23):2847-50; Flegal KM et al, JAMA. 2012 307(5):491-7
1971-1974 1976-1980 1988-1994 1999-2000 2009-2010
No Nation Has Lowered Obesity Rate in 33 Years• The Lancet, June 2014: Study combining 3 decades of data from 188
countries
• Nearly 30% of world’s population is overweight or obese – not one country has reduced its obesity rate in 33 years
New York Times, June 3, 2014
Obesity-Related Ills May Shave Up to 8 Years Off Your Life: Study
Excess weight also shortens the time you live free of chronic diseases that lower quality of life
Published online Dec. 5, The Lancet Diabetes & Endocrinology
Obesity = Postural Compensation
Obesity as an Inflammatory Disorder
One of the more interesting discoveries of the past decade has been the recognition that the adipocyte produces inflammatory cytokines
Obesity, therefore, may be viewed as a low grade systemic inflammatory disease
A.M.A. Recognizes Obesity as a Disease
• The American Medical Association officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition
The New York Times, June 18, 2013
Lipotoxicity: the result of unhealthy lifestyle choices
Lipotoxicity• ectopic fat accumulation in various
tissues and organs leading to pathologic changes and impaired function.
Ectopic• occurring in an abnormal position or
place; displaced.
What really determines aging for most of us?
Genetics
Physiology/
Biochemistry
Environment
Lifestyle
Shift focus from calorie counting to nutritional value for heart health• It’s time to stop counting calories
• Start promoting nutritional value of foods:• Rapidly cut illness
• Death from cardiovascular disease
• Curb rising tide of obesity
BMJ Aug 26, 2015
There are too many people counting calories and
not enough people counting chemicals
“obesity and diabetes have joined the list of
adverse effects that have been associated with
developmental exposure to environmental
estrogens and other endocrine-disrupting
chemicals.”
Am J Clin Nutr. 2011 Dec;94(6 Suppl):1939S-1942S
Chemical exposure may be linked to rising rates in diabetes and obesity
• Particular concern to unborn children exposed to EDCs
• Studies demonstrated that exposure to even very small amounts of EDCs during pregnancy can trigger obesity in the child later in life
• EDCs directly target beta and alpha cells in the pancreas, fat cells, and liver cells, which can lead to insulin resistance and type-2 diabetes
Chemical exposure may be linked to rising rates in diabetesand obesity
• The Journal of Clinical Endocrinology and Metabolism, March 2015: EDC exposure will likely cost the EU $209 billion a year in actual health care expenses and lost earning potential
Is your belly turning you into a pregnant woman?
The Obesity Epidemic: It’s a Guy Thing
• The other gender gap
• 72% of men are overweight or obese; 64% for women
• Life expectancy is less for men
• CHD mortality starts at younger ages for men
• 3 main factors:• Declining testosterone
• Increasing visceral fat
• Chronic inflammation
An Estrogen Factory
• Overweight men 9x more likely to have low testosterone
• Insulin sensitivity has a strong inverse relationship with visceral fat (VF)
• VF is an estrogen factory
• VF converts testosterone to estrogen to further fat deposition
Testosterone
Insulin resistanceWeight gain
Visceral fat
Low Testosterone Linked to Obesity and Muscle Loss
Lower levels of testosterone and free testosterone linked to increased body fat, body mass index
(proportion of weight to height) and waist-to-hip ratio
Journal Clinical Endocrinology Metabolism. 98:p.2442-50, 2013
Additional Causes of Low T
• Estrogen and estrogen-like compounds in our water:• Government researchers found natural estrogens and estrogen mimickers in 80% of
the streams they tested in 30 states
• Excess estrogen in body: new consideration – beta-glucuronidase:• Protocol: Indole-3-carbinol, Probiotic
• High levels of aromatase enzymes (estrogen synthase):• Transforms androstenedione to estrone• Transforms testosterone to estradiol
• Takeaway: it converts steroid hormones to bad estrogens• Protocol: Indole-3-carbinol
Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, Environmental Science & Technology
Low “T”
• Links exposure to phthalates – to a 13% lower testosterone level in men ages 40-60
J of Clin Endocrinology & Metab, 2014 report
Declining Testosterone
• Current measure indicate that testosterone levels are declining at a rate greater than would have been expected purely from aging
Travison, T. et al. Clin Endocrinol Metab. 2007: 92(1) p.196-202
Low-T
• U.S. prescription testosterone sales – 2.4 in 2013
• Expected growth to 3.8 by 2018
• Happening without FDA approval
• Testosterone therapy approved for males who suffer from medical conditions associated with a deficient or absence of endogenous test
• U.S. prescriptions grew ten-fold from 2000 to 2011
Time Magazine, Aug. 18, 2014
Testosterone gel has modest benefits for men
NESM, Feb. 17, 2016
“Time the healer also time the destroyer”
Tips for Men: Nutritional Support for Low T
• CYCYP test – great motivation
• Detox/heavy metal/estrogen detox/avoid plastics
• Improve body composition/cut simple carbs
• Eat more monounsaturated fats – increase manufacture of testosterone
• Squat, don’t run – squats, pushups and burpees burn more fat than running
• Add vitamin D, zinc, omega-3 fatty acids, DHEA, Indole-3-carbinol, resveratrol
• Tribulus, cowage seed, flax lignans, ashwagandha root
The Endocrine Society, news release, June 25, 2012
Best Time of Day for a Testosterone Test
Before 2 PM
The Journal of Urology, July 2014
Case Study
• Patient is a 40 year-old male who is unable to lose weight. Has to take Viagra to “perform”. Has tried various diets, including Androgell
Jan. 2014 Aug. 2014
Weight 284 215
% Body Fat 33.1 15.8
Total Testosterone 176 622 QuestLab250-1100ng/dl
Free Testosterone 38 168 QuestLab46-224 pg/nl
HPQ 62 12
Inflammaging
Optimal ResolutionLow proinflammatory statusHigh efficiency of stress response
Inadequate Resolution High proinflammatory statusLow efficiency of stress response
Young Aged
Chronic Disease
Unresolved Immune Function leads to Chronic Disease
Poor DietInjuries Infection
Chronic Inflammation Leads to Many Chronic Diseases
Chronic Systemic Inflammation
Inactivity Obesity Aging
Adipocytes Immune Cells Brain CellsSystemic and local increase in cytokine concentrations
Immune Cells
Insulin ResistanceType 2 Diabetes
Atherosclerosis Alzheimer’s DiseaseHuntington’s DiseaseParkinson’s Disease
CancerArthritis
Handschin & Spiegelman. Nature. 2008;454:463-9
Health Trajectory’s Have Age Thresholds
36Time Magazine 2015
Aging is a Young Person’s Disease!
Prevalence of two or more of nine selected chronic conditions among adults aged 45 and over, by age and sex: United States, 1999–2000 and 2009–2010
Chronic Disease on the rise
CDC/NCHS, National Health Interview Survey
The primary driver of chronic disease is the interaction among genes, activities of daily living (lifestyle), and the environment
Willett WC. Balancing lifestyle and genomics research for disease prevention. Science, 2002;296:695-97Thorpe KE, Florence CS, et al. The rising prevalence of treated disease: effects on private health insurance spending. Health Affairs, web exclusive, June 27, 2005Henry RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr2003;78:912-9
Why doesn’t the old healthcare model work?
Because chronic disease is a food- and lifestyle-driven, environment- and genetics-influenced phenomenon
Major influences contributing to the epidemic of chronic disease
Chronic disease
epidemic
Nutrition(food supply, dietary habits)
Sedentary lifestyles(young and old)
Chronic stress
Poverty/Uninsured Aging population
Outdoor living ( vit D)
Fragmented families, communities
Environmental toxicity
The Institute for Functional Medicine
Core clinical imbalances – Multiple influencesOne Condition – Many Imbalances
One Imbalance – Many Conditions
Inflammation Hormones Genetics and Epigenetics Diet and Exercise Mood Disorders
Obesity
Heart Disease Depression Arthritis Cancer Diabetes
Inflammation
Study shows 70 percent of Americans take prescription drugs• CBS Atlanta: Nearly 70% of Americans on at least 1 prescription drug
• 55% take 2 prescription drugs
• 20% take 5 or more prescriptions
• Mayo Clinic: Antibiotics, antidepressants and pain killer opioids are most common
The U.S. accounts for 4.4% of the world’s population and consumes 52% of the world’s pharmaceuticals (medications)
Anti Inflammatory drugs (NSAIDS) cause leaky gut.Leaky Gut causes inflammation
Inflammation
NSAIDS cause
FDA Strengthens Stroke and Heart Attack Warnings on NSAIDs• Lancet analysis of more than
600 studies and 350,000 people: showed significant doses of these medications daily can increase risk of cardiovascular event by up to a third
NY Times, July 10, 2015
“Over 99% of us are born healthy and suffer premature death or disability only as a result of personal misbehavior and
environmental conditions”.
John Knowles 1977
The Anti-Aging Promise
Lighting
Botox
Make-up
Why your DNA isn’t your Destiny
“For decades, we have stumbled around massive Darwinian roadblocks. DNA, we thought, was an ironclad code that we and our children and their children had to live by. Now we can imagine a world in which we can tinker with DNA, bend it to our will.”
www.time.com Wednesday, Jan. 06, 2010
7. Brain health
4. Healthy blood-sugar regulation /Whole body alkalization
3. Increase telomere length
2. Body composition/protein synthesis (muscle mass)
1. Functional movement – move well, joint health
Dr. Rob’s 7 Steps to Anti-Aging Through Epigenetic Science
5. Environment/microbiome
6. Lifestyle/exercise
Epigenetics
• Food is a powerful epigenetic modulator
• It can change our DNA for better or worse
• Epigenetics refers loosely to heritable changes of gene expression (methylation, histone modification)
Methylation
Addition of (CH3) to either cytosine or guanine nucleotides
Expression of genes
Epigenetics (cont’d)
• Discoveries in epigenetics are rewriting the roles of disease, heredity, identity and aging
• Epigenetics is the phenomena whereby genetically identical cells express their genes differently, resulting in different physical traits
Adams, J. (2008) Obesity, epigenetics, and gene regulation. Nature Education 1(1):128
Transforming Youth: Turn Back the Epigenetic Aging Clock
Functional movement
Functional Medicine
=
Optimal Health
+
The NMS Detonation SequencePain DynamicTight muscle
Inhibited muscle
Strain point
PAIN
Complaint
Sherrington’s law of reciprocal
inhibition
Head = 10 lbs 1” = 2x weight
Tight muscle Inhibited muscles1. Pecs 1. Mid-lower trap2. Suboccipitals 2. Deep neck flexors3. Erector spinae 3. Abdominals4. Psoas 4. Gluteus maximus
Suboccipitals
Medial scapula stabilizers
C7 – T1TMJ
Deep neck flexorsGH jtPec major
Abs
Psoas
Hip
T/L jct
Erector spinaeL/S jct
Gluteus maximus
Strain points Symptoms1. TMJ neck & shoulder2. C7-T1 jct stiffness & pain3. GH joint4. T/L junction SI, L/S & hip5. L/S junction stiffness & pain6. Hip
1 2 34
Posture follows movement like a shadow
Sherrington - 1906
Pathogenesis of the cumulative trauma disorder
RecoveryCycle
Injury Cycle
Frequency of Insult
Am
ou
nt
of
Tiss
ue
Insu
lt
SymptomaticInjury Threshold
Pathogenesis of the cumulative trauma disorder
Injury Cycle
Frequency of Insult
Am
ou
nt
of
Tiss
ue
Insu
lt
Insufficient Tissue Recovery Between Injury Cycles
Tissue Damage Accumulates
Copyright Jerome M. True, DC
Hypertonicity
Weakness
Does posture change with age?
Dr. Rob’s Magnificent 7
• Posture/pain
Functional Movement Assessment
• Push-up
• Overhead squat
• 1-legged squat
• Trunk stability push-up
• Valgus jump test
• Upper/lower muscle firing patterns
Functional Movement Assessment
“Our response to injury is like hearing the smoke detector go off and running to pull out the battery.”
UltraPrevention by Hyman & Liponis
Kinetic Chain = Functional Anatomy
Muscles act in synergy not in
isolation” Movement, not muscles
Movement becomes habit, which becomes posture, which becomes
structure
FORM = FUNCTION =
PERFORMANCE
Correct Altered Motor Control
Age Risk-Factors:Genetic AlterationInflammationMechanical StressObesity
Transcription Factors Epigenetics Changes
Catabolism Anabolism
Dysregulation of Target Gene Expression in Various Joint-Cells
Disrupted Cellular Function
OsteoarthritisSports Health. Vol.6(1), Jan/Feb 2014
Age-Related Factors in the Maturing Adult
The Mature Adult: Aging Tendons and Ligaments
• Several published reports shown increased levels of matrix metalloproteinases (MMPS) lead to degenerative tendon disease
• MMP inhibitors associated with a decrease in tendon dysfunction
Sports Health, Jan/Feb. 2014, p.41-48
Disc Injuries
Flexion movement
Flexing the spine
Strains layers of collagen in spinal discs
MMPS, cytokines
Inflammation
Flexion moment
Flexing moment or torque
Ab muscle stiffening
No movement
Stuart McGill website
vs.
Interleukin-1β in intervertebral disk degeneration
• Interleukin-1 (IL-1) β has strong pro-inflammatory activity by stimulating the secretion of multiple pro-inflammatory mediators
• IL-1β is highly expressed in degenerative intervertebral disk (IVD) tissues and cells
• Inhibition of IL-1β found to promote extracellular matrix (ECM) repair and protect against disk degeneration
Yang W, et al. Clin Chim Acta 2015
New approach to diagnosing low back pain
• Findings determined serum levels of IL-6 significantly higher in subjects with low back pain compared with control participants
• Participants with low back pain due to spinal stenosis or degenerative disc disease also had higher levels than those with intervertebral disc herniation and controls
• Findings suggest that patients with low back pain have low-grade systemic inflammation
• Biochemical profiling or circulating cytokines can assist in diagnosing those with low back pain
North Shore-Long Island Jweish (LIJ) Health System-Jan-7-2016
Key Takeaway
• Inflammation/MMPs cause cartilage loss, not “wear-and-tear”
• This is the same process that causes disc nuclear degradation and herniation
Failed healing of rotator cuff repair
• Found that gene expression related to tissue remodeling, particularly MMP-1 and MMP-9, differs between rotator cuffs that healed and those that failed to heal after orthoscopic repair
• MMP-1 and MMP-9 are highly effective in degrading type-1 and 3 collagen
• Their expression contributes to poor cuff healing
• MMP-1 and MMP-9 expression reflect a highly degenerated tendon or diminished ability to heal
American Journal of Sports Medicine, 2012, vol. 40 (9):1993-2000
Your connective tissues are your extracellular matrix
TendonsLigaments
CartilageFascia
What is Extracellular Matrix (ECM)?
The Extracellular Matrix: the network that binds us together
“The ECM is a conglomerate of substances in which biochemicals and biophysical properties allow for the construction of a flexible network that integrates information from loading and converts it into mechanical capacities…It serves as a scaffold for adhesion of cells mediated by integrins, dystroglycan, and proteoglycans at the cell surface and of tyrosine kinase receptors. The interaction between the ECM and the adhesion molecules leads to activation of intracellular signaling pathways and cytoskeletal rearrangement.”
Kjaer, M. Physiol. Rev. 84:649-698, 2004
The extracellular matrix is composed of tissues that serve multiple purposes
A complex web that of connective tissues that
• Provide adhesion to cells
• Act as a structural scaffold
• Actively participate in intracellular signaling
• Translates mechanical loading into cellular response
EFFECTFASCIA
Key
Extracellular matrix — the fascial system is
the largest system in the body and is the only system that touches every other system
An unhealthy ECM:Torn, weak or relaxed
tendonsSoft tissue injuryRepetitive injury
Structural imbalances
A healthy ECM:healthy,
well-functioning tendons, ligaments
and cartilage
The extracellular matrix
IT’S ALL CONNECTED
• MMPs are collagen-digesting enzymes naturally produced by the chondrocyte during time of injury
• Poor diet, lifestyle, injury, tissue damage can trigger cell signals which can lead to the over-activated release of MMPs
• Excessive release of MMPs can damage healthy tendon and cartilage tissue
Litherland et al., JBC, Papers in press, March 10, 2008
Matrix metalloproteinase (MMPs) enzymes damage collagen and connective tissue
Matrix metalloproteinases digest collagen and connective tissue
Collagen Triple Helix
Chondrocyte
MMPs are released from the chondrocyte in response to injury or inflammation
MMP-9
MMP- 2
MMP-1
MMP-13
MMP-13
MMP-13
MMPs further degrade collagen tissue during injury or inflammation
Modulate expression of MMPs to support healthy remodeling of connective tissue
A comprehensive strategy to support the health and integrity of extracellular matrix tissues
• THIAA & Berberine synergistically modulate MMP-13
• Selenium to address MMP-1 & MMP-2
• Folic acid to impact MMP-9
• Niacinamide to address tissue-damaging PARS
• Zinc – to reduce cytokine release
• Biotin – to reduce NF-Kappa production
Nutrients that impact matrix metalloproteinases:
Nutrients that affect the lifespan and health of connective tissues:
Additional nutrients:
Quote
As a rule of thumb, the earlier a musculoskeletal injury is treated, the
sooner healing can begin. An untreated injury can easily slide from “acute” into
“sub-acute”, and even into “chronic”
Nutrients to Address Swelling (within the First 72 Hours)
Tricket P. Proteolytic enzymes in treatment of athletic injury. Appl Ther 1964;30:647-652
Fortschr Med. 1995;113(19):303-306
Trypsin, Chymotrypsin, Bromelain
• Proteolytic enzymes –work on protein –containing chemicals
• Enzymes showed reduction in swelling, pain and inflammation
Proteolytic Enzymes
• Proteolytic enzymes – various enzymes that digest proteins and fibrin
• Work systemically when taken orally away from food
• Without food, they are absorbed with enzymes intact in the small intestines
• Turmeric:
1) Inhibit inflammation by blocking cyclooxygenase and lipoxygenase
2) Stimulates tissue repair, mainly the regeneration of muscle tissue
3) NF-KB inhibitor
• Ginger:
• Anti-inflammatory, antioxidant
• Boswelia serrata: inhibits 5-lipoxygenase
• Quercetin, cayenne: anti-inflammatory properties
Nutrients to Address Pain and Inflammation (within the first 72 hours)
Prostagladins Leukotr Med 1986;24:195-98Int J Clin Pharmacol Ther Toxicol 1986;24(12):651-54Journal of Biological Chemistry – August 2011. “Curcumin modulates nuclear factor-KB”
Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. Am Heart J 1984;108(1):188-194.
Calcium & magnesium
• Calcium may work to relieve spasms by acting via pre-synaptic inhibition at neuromuscular junction
• Magnesium promotes muscle relaxation
• A balance of these minerals reduces spasm and cramping
Passion flower & valerian root
These herbs have been traditionally used to promote relaxation and are considered to be safe and effective
Nutrients to Address Muscle Tissue
Therapeutic Strategiesfor the UnavoidableAspects of Aging
• Osteoporosis affects over 20 million people in the United States alone
• Osteoporosis accounts for approximately 250,000 hip fractures per year
• Annual toll of 1.5 million fractures in total
Dempster DW, Lindsay R. Pathogenesis of osteoporosis. Lancet; 1993;341:797-805
Nutrition Masters Course™1988, Advanced Nutrition
Publications, Inc.. rev 1999
