Associate Professor, Department of Family and Community Medicine, Michigan State University College of Osteopathic Medicine.

Owner, All Things Male, Lansing, MI

The current traditional medical paradigm for the prevention and treatment of breast cancer is directed toward inhibition of a specific biologic pathway at the somatic or cellular level. Failure of this model justifies the need for a new approach addressing chronic inflammatory processes which originate within the glue-like matrix surrounding every breast cell. A “Breast Matrix Stabilization” protocol will be outlined along with the results of appropriate studies conducted at FDA-approved animal laboratories.

Seventy percent of the population is now overweight or obese with the majority of this population falling into the obese category. One in five American children are now obese. Of the remaining population roughly 50% are thin outside, fat inside (TOFI). The recidivism rate of dieting exceeds 50%. It is well documented that genetics accounts for 40-70% of a person’s predisposition to obesity.  Recent research conducted at Stanford University showed that when subjects were put on a diet identified as appropriate to their genotype, they lost an average of over 2.5 times more weight than individuals on diets that were not appropriate. Clearly the outdated “one sizes fits all” weight loss model based on caloric restriction and aerobic exercise is not working and may in fact be exacerbating the crisis by damaging both metabolism and psyche further. The current weight loss model fails because it doesn’t look for the cause of the problem and assumes that it is simply one of overconsumption and low energy output, without taking into account genetic and hormonal factors that could shift the metabolic requirements and impair the body’s ability to burn off fat weight while holding onto or increasing lean mass. Over the past two decades I have identified seven different modifiable factors that can slow down or stop fat loss despite the patient’s best efforts of eating healthy balanced meals, repleting core nutrient deficiencies and doing cross training exercise consistently. These factors include chronic stress, poor sleep, gastrointestinal disturbances (impaired digestion, IgG food sensitivities and gut bacterial/yeast overgrowth), elevated toxic burden, sex hormone imbalances, thyroid fatigue and insulin resistance. There are also genetic factors at play including heritable risk of obesity, increased ability to regain lost weight, decreased metabolism, taste preferences  and eating behavior traits, especially related to hunger and satiety.  Fortunately, one’s genes don’t have to dictate one’s destiny. Once genetic susceptibilities are indentified, a targeted diet and lifestyle intervention plan can be put in place to ensure a higher likelihood of weight loss and long term weight management success. 

There are many different ways of prescribing hormones for women. In addition, there are many factors that lead one to choose one type over another. Personal history, family history, patient choice, and physician choice can all factor into the decision-making process. A firm understanding of the medical literature (evidence based medicine) is necessary to have the ability to determine which hormone and which delivery method to utilize. This literature review will enable the practitioner to understand the health benefits of the hormones and therefore the importance of maintaining certain levels of hormones in order to assure these hormones’ benefits. Although the general recommendation from ACOG and NAMS is to prescribe hormones in the smallest dose for the shortest period of time, hormone deprivation caused by stopping hormones, or not providing adequate levels by optimizing HRT, will prevent the patient from reaping the tremendous benefits of menopausal hormone replacement.

Non-CME symposium sponsored by Cenegenics Medical Institute

The Use of Testosterone in Women’ is an evidence based lecture that will include the following; Brief discussion of aging and disease, Endogenous testosterone levels in women, Functions of testosterone, Androgen receptors, Major source of estrogen, Age decline of testosterone, Relative androgen deficiency including Symptoms and Diagnosis, Testosterone affect of breast tissue and breast cancer, Salivary hormone levels in newly diagnosed breast cancer (Original data). Testosterone therapy including the Benefits and efficacy of testosterone alone delivered by pellet implant (Original data) and Efficacy of testosterone in combination with aromatase inhibitors, Breast cancer survivors (original data), Vaginal testosterone therapy (original data)

Vitamin and nutritional supplementation is a critical factor in addressing the underlying imbalances that result in chronic illness, as well as an effective means for promoting health and maintaining wellness. Women transitioning through menopause often seek supportive therapies—including nutritional supplementation—not only to obtain relief from common menopausal symptoms, but also to prevent and/or treat concerns like osteoporosis, heart disease, and other issues related to healthy aging. Over the past 30 years there has been an exponential increase in the utilization of nutritional supplements, though the development of empiric tools to quantitate the need for these supplemental nutrients has not been well characterized. Through the deepening understanding of nutritional biochemistry and biochemical individuality, tools are now available to functionally assess nutritional deficiencies in B-vitamins, antioxidants, amino acids, nutritional co-factors, essential minerals, and essential fatty acids. The proper application of essential minerals, B-vitamins, antioxidants, amino acids, and essential fats supports the body in correcting underlying nutritional imbalances that lead to a broad spectrum of health concerns, including menopausal symptoms. Nutritional diagnostic testing now provides practitioners with tools to personalize supplement recommendations. 

A finely tuned symphony requires that each section be tuned within themselves and tuned to each other. I plot the sex hormones, insulin/glucose, thyroid and vitamin D as the sections of the hormone symphony and the adrenal glands as the conductor of the symphony. I have prescribed bio-identical hormones for over 15 years. Two years ago I made up this model to explain to patients how I viewed the hormone symphony and have used it successfully in my practice. I find it increases comprehension and therefore compliance. With potentially complex treatment plans in age management medicine, this model seems to simplify the goals for intervention for the initial treatment plan, and clarifies goals for the follow-up visit. This presentation outlines the model and shows through actual case presentation how it is readily applied in a clinical setting. 

This lecture will address the most common complications in using hormone replacement therapy in women. The side effects of using synthetic hormones will be discussed. Also the side effects of the use of progesterone, estrogen, testosterone and DHEA will be reviewed. Some other concepts that will be addressed will be down regulation of the receptor sites or the issue when one starts hormonal therapy and feels better but then later feels back to the beginning. The importance of detoxification of the liver will be addressed and also the issues of weight gain with hormonal replacement will be covered.  

Faculty will present clinical cases and engage attendees in an interactive discussion regarding patient evaluation and appropriate clinical treatment options as well as participate in questions and answers on topics involving women’s health.

Non-CME breakfast symposium sponsored by PhysioAge Medical Group

The lecture will focus on non-invasive and invasive imaging in order to prematurely detect the vulnerable atherosclerotic plaque and therefore the vulnerable patient. There is a glimpse of a future when about 30 or 40 years before a patient presents with heart disease, maybe we can diagnose, at least, a premature susceptibility, and using advanced imaging modalities that day is coming closer and closer all the time. I will discuss potential modalities both pharmacologic and then other invasive interventional treatments that may be able to passivate the unstable or vulnerable plaque and be able to prevent its rupture before the patient presents with an acute coronary syndrome or sudden cardiac death. If time permits, I will also like to discuss the reversibility of the high risk atherosclerotic plaque. 

The heart is a muscle that requires a steady infusion of nutrients in order to function optimally. As we age the nutrient status of the heart diminishes and very few physicians pay attention to this critical issue. The aging process along with the nutrients that are depleted from the use and abuse of prescription medications can send the heart into "life support" if this situation is not corrected. During the course of this lecture the cardiac nutrients along with the correction of nutrient depletion states from a cardiac point of view will be discussed. Inotropic along with chronotropic nutrients will be reviewed and discussed in a clinical setting.

Obstructive sleep apnea is estimated to occur in between 5% and 10% of the United States population. It goes undiagnosed and untreated in the vast majority who are afflicted. It carries serious cardiovascular consequences including hypertension, pulmonary hypertension, accelerated atherosclerosis leading to MIs and strokes, cardiac arrhythmias and CHF. In addition, it has various psychosocial ramifications. The economic impact is difficult to quantify but is clearly profound. The epidemiology, etiology, complications, diagnosis, treatment, and controversies surrounding sleep apnea will be discussed. 

This lecture will provide an overview of current published evidence and controversies on hormone substitution therapy with regard to cardiovascular safety as well as the effects of hormone therapy on cardiac function in healthy and diseased cardiac conditions. Data from the recent literature as well as our own research data will be presented. The audience will gain a deeper knowledge of published study data on the use of growth hormone in patients with heart failure as well as more recently published data on testosterone therapy in men and women with heart failure. The lecture will include and discuss off-label use of hormone therapy.

Since the work of Dean Ornish, M.D. at the University of California in San Francisco showing reversal of coronary artery disease through lifestyle modification, there have been many questions as to the benefits of stress reduction in reducing risk for cardiovascular disease. While it is widely accepted that increasing physical activity will and does reduce the risk of sudden death in existing patients with cardiovascular disease, and also reduces the risk of new events in individuals with preexisting risk for coronary disease, the idea that mind-body medicine may have an impact on cardiovascular disease has still not pervaded mainstream medicine. There are numerous studies by Benson on the value of the relaxation response, along with meditation—especially transcendental meditation—which shows reduction in blood pressure along with reduction in cardiovascular risks in general. This presentation will include various approaches to mind-body medicine along with some statistical analysis on the reduction in risk factors for cardiovascular disease, both as a proactive health maintenance program along with reducing the risk of future cardiovascular events in individuals who have already had a cardiac event.

Heart attacks and strokes (cardiovascular disease) kill 50% of all Americans. For roughly half of these victims, their first symptom of disease is sudden death. We hear the word “prevention” a lot these days. Everyone seems to agree that it is the key to solving our nation’s health crisis, but no one seems to be doing much about it. Heart attack and stroke prevention may very well be the most tragically misunderstood topic in medicine today. The fact is when it comes to preventing these lethal events, current standards of care can kill you. With the recent developments in science and technology, heart attacks and ischemic strokes are absolutely preventable. This presentation discusses the approaches available today that can be used to prevent heart attacks and strokes.

 

Over the past few years, the field of Age Management Medicine has been rapidly evolving, including new advances in diagnoses and therapies. This is particularly relevant in the detection of cardiovascular disease (CVD), which is the cause of death in close to a million men and women every year in the US. In fact, cardiovascular disease outranks all cancers, combined, as a cause of mortality. The diagnosis of CVD, hyperlipidemia and other risk factors that may present, offers an ideal opportunity for the Age Management Medicine physician’s intervention. The evaluation incorporates an in-depth analysis of our patients, followed by our proactive approach utilizing lifestyle and nutrition in conjunction with medications (such as statins), supplements (such as aspirin and fish oil), hormonal and metabolic optimization. Utilizing data gleaned from a broad population base in her Manhattan-based practice, Dr. Comite will review the evaluation of patients who present with an abnormal lipid profile, elevated homocysteine and/or markers of inflammation, such as cardiac-CRP. Individuals with hyperlipidemia are largely asymptomatic, though some may present on medications; it would be unlikely that more proactive interventions have been formally explored or implemented. Cardiologists commonly manage patients who have significant, symptomatic disease. In contrast, the Age Management Medicine practitioner is ideally positioned to have a major positive impact on the reversal and prevention of disease, with the identification of risk stratification and customized strategies to aggressively prevent, reverse, and delay the emergence of cardiovascular disease.

The audience will learn about the use of stem cell therapy for the treatment of heart failure and heart attacks with an overview of currently performed clinical trials in patients with heart failure, with special attention to cardiac derived stem cells and cardiospheres. The CADUCEUS study (cardiosphere-derived autologous stem cells to reverse ventricular dysfunction)—a Phase 1 randomized, dose escalation study of the safety and efficacy of intracoronary delivery of cardiosphere-derived stem cells in patients with ischemic left ventricular dysfunction and a recent myocardial infarction—will be presented and discussed. 

I will review the major in vivo studies that demonstrate the marked age-associated changes in the composition and number of circulating leukocytes and then discuss how to evaluate a patient’s immune system aging with clinically available tests. I will then discuss the causes and consequences of immunosenescence, including micronutrient deficiencies, oxidative stress, inflammation, and telomere shortening, with an emphasis on the role of latent infection with cytomegalovirus in all these processes. Finally, I will discuss which therapies are currently available to improve immune system aging such as telomerase activation, stress reduction, and hormone replacement.

Lecture will address the current theories of aging, including telomere theory, and their mutual interaction in relationship to Age Management Medicine.

The mechanisms and clinical uses of neuroprotective agents will be discussed. The first hour will cover 5 categories of neuroprotective agents: 

    1. Cholinergic - Huperzine, Galantamine, Centrophenoxine, Alcar, CDP-choline

    2. Nutrients - S-adenosylmethionine (SAMe), Picamilon, Bio-strath, Fish oils

    3. Herbs - Rhodiola rosea, Ginseng, Gingko, Sage, Saffron, Vinpocetine

    4. Nootropics - Selegiline, Racetams

    5. Mind-Body Practices - Biofeedback, Breathing, Movement, Meditation

The second hour will be an experiential program of Movement, Breath Techniques, and Meditation in a sequence designed to raise, circulate, and store vital energy, to enhance autonomic nervous system balance, to improve brain function, and to reduce inflammation.

This presentation explores interconnectedness of the trio, Aging, Arthritis and Algos (pain). The development of chronic pain syndrome causes immobility and immobility causes weight gain, with weight gain causing more immobility and pain in vicious cycles. This leads to a severe downward spiral of metabolic syndrome and endless co-morbidities. The present model of fragmented health care delivery of chronic pain management is not able to deliver the sustainable pain relief to break out of the negative cycle, except for brief symptom management. The unique integrative model called Tandem Integrative Pain Therapy Solutions (TIPS) can be the paradigm shift in the quest for proactive, preventive and health promotion management. It not only relieves chronic pain in the aging population of America but also prevents further escalation of illness and disease while improving the quality of life.

With the passing of Sra. Maria Gomes Valentim in Carangola, Minas Gerais, Brazil—whom the Gerontology Research Group recently validated for the Guinness Book of World Records as the oldest person in the world— at the age of 114, the recalculated mortality rate for supercentenarians at age [113-114] now increases to 71.05 percent, having started at 49.92 percent at age 110 years. This in turn strengthens our overall hypothesis that the "Calment Limit" is an inherent upper limit to human lifespan. (Madam Jeanne-Louise Calment of France died in 1997 at the extraordinary age of 122, and no one has come even close to breaking her all-time record in the last 14 years.) Thus, there is no evidence for an alleged flattening of the mortality rate with advanced age as suggested by Prof. Michael R. Rose of UC Irvine in his new book, Does Aging Stop? The reason for this ambiguity among demographers is that when the numbers of supercentenarians beyond a certain age gets to be so small that only a few outliers are left, no statistically significant inferences can be drawn from the data.