THE FUNDAMENTAL OF

ANTI-AGING MEDICINE

Wimpie Pangkahila
Center for Study of Anti-Aging
Medicine
Post Graduate Program in Anti-
Aging Medicine
Department of Andrology and
THEORIES OF AGING
Many theories of aging
Wear and tear theory:
1.DNA
2.Glycosilation
3.Free radical

Programme theory:
1.Limited cell replication
2.Immune process
3.Neuroendocrine theory
However, external factors
play
Important role in aging
process

Life style
Environmental intoxication
Habits
Social economic status
 ANTI-AGING MEDICINE IS

A medical specialty founded on

the application of advanced
scientific and medical
technologies for the early
detection, prevention, treatment,
and reversal of age-related
dysfunction, disorders, and
diseases to prolong the
healthy lifespan Anti-Aging
and Regenerative Medicine
 The fundamental and
original
definition of Anti-Aging
Medicine
was introduced by the
A4M in 1993
which shocked the
medical world
Anti-Aging Medicine
is not
A type of alternative
medicine
Cosmetic medicine
Aesthetic medicine
 The term anti-aging is
controversial
because aging is considered
as
natural process or destiny

The question:
Is anti-aging medicine
against the law
Age

Chronologic age
Physiologic (biologic) age

Chronologic age is not always

identical with physiologic
(biologic) age
Physiologic age might be older
or
younger than chronologic age
Chronologically to get
older is not
a problem, it is a must

However, physiologically it
should be prevented to
maintain the quality of life
Subclinical phase (ages 25-35)
3Hormones
phasesbeginof aging process
to decline: T,
GH, E
Free radical formation
damage cells
and DNA, begins to affect the
body
Not outwardly detectable
Look and feel normal
No signs or symptoms of aging
But many women complaint
sexual desire
 Hormone levels decrease
25%
Muscle mass is lost (1 kg /
couple of
years)
loss of strength and
energy,
increased body fat
insulin resistance
increased risk of heart
disease
Transition phase (age 35-45)
Clinical symptoms begin:
loss of elasticity and skin
pigmentation
decreased sexual desire and
arousal
start to feel and look older
free radical damage begins to
affect
gene expression
many diseases of aging (cancer,
arthritis, memory loss, CAD,
Decline of hormones
continues
Loss of the ability to fully
absorb
nutrients, vitamins and
minerals
Decrease in bone density
Accelerated muscle loss
(1 kg/ 3 years)
the inability to burn
calories and
Counseling
2 groups of people seeking
Anti-Aging management

1. With certain complaints

2. With no complaints
What is the purpose of the
counseling?

1. Find the signs and

symptoms of
aging process----Biomarkers
2 Find the presence of
comorbid of
aging process
Biomarker of aging may be one
parameters of anatomy, physio
biochemistry, or molecular tha
related to aging process

Biomarkers can be found durin

3 phases of aging process (sub
transition, clinical)
Biomarkers of aging can be
detected
by:
1.The questionnaires for
health
condition and risk factors
2. Physical examination
3. Functional capacity
4. Biochemistry tests
The questionnaires:
the history of diseases
health condition at present
the history of diseases in the
family
(genetic)
the histories of nutrition,
exercise, environment
the history of medicines and
supplement consumption
the history of psychic condition
and
Physical examination

vital signs: blood pressur

pressure, pulse rate, resp
temperature
physical composition and
the presence of diseases
examination of skin
 Presence of
visceral fat accumulation
Waist/hip ratio > 0.95
waist circumference > 102
cm
sagittal diameter > 23 cm
For Asia Pacific region:

the upper limit of

waist circumference
* 90 cm for men
* 80 cm for women
Body mass index (BMI) :
a better parameter to assess
the degree of obesity

BMI =
body weight in kilograms
divided by the square of height
in meters
For western population
BMI 20-25
BMI 25-30 overweight
30 obesity
For Asians:
> 23 overweight
> 25 obesity
 BMI-Associated Disease Risk
Classification BMI (kg/m2) Risk
Underweight <18.5 Increased

Normal 18.5-24.9 Normal

Overweight 25.0-29.9 Increased

Obese I 30.0-34.9 High

II 35.0-39.9 Very high
III 40.0 Extremely
high
Additional risks
Large waist circumference:
men > 40 inc, women > 35 inc
5 kg or more weight gain since age
18-20 years old
Poor aerobic fitness
Specific races and ethnic groups
Clinical guidelines on the identification, evaluation,
and treatment of overweight and obesity in adults.
The Evidence Report. Obes Res 1998.6 (suppl 2)
Functional capacity
Pulmonary function
Cardiovascular function
Cognitive and memory
Sensory function
Renal function
Coordination and balance
function
Grasp strength
Bone density
Reaction time
Biochemistry tests

Routine blood tests:

Complete Blood Count
Blood Type (ABO & RH)
Urinalysis (Urine Complete
Cardiovascular risks

Total Cholesterol
HDL , LDL Cholesterol
Triglycerides
Cholesterol / HDL Ratio
Glucose, HbA1c
Homocysteine
Hs-CRP (High-sensitive C
Reactive Protein)
Kidney function

BUN (blood urea nitrogen

Creatinine
Uric Acid
Liver function

ALP (Alkaline Phosphata

SGPT
SGOT
GGT
Blood Mineral

Calcium
Sodium
Potassium
Chloride
Phosphorus
 Hormone Profile
MALE FEMALE

Testosterone
Testosterone
Estradiol (E2) Estrogen
(E1,E2,E3)
DHEAS
Progesterone
T3 & T4 T3 & T4
Tumor markers

PSA: prostate
CA 125: ovary
Pap smear: cervix
Prolactin: pituitary gland
CEA: colorectal, liver,
stomach, lung, breast
OTHERS:

Genetic markers
Toxins
Products of oxidative stre
Antioxidant molecules
Intervention and treatment
All intervention and
treatment
must be scientific and
evidence base
 Aesthetic intervention

Administration of nutrients
and biological agents
Diet control and
exercise
Lifestyle changes

Early detection, non invasive

screenings and evaluations
 Intervention and treatment:

Biological agents:
1. Supplement
2. Hormonal treatment
3. Cell / stem cell therapy
In the future:
1 Therapeutic cloning
2 Nanotechnology
3 Artificial organs
4 Nerve impulse continuity
(brain/spinal cord)
Evidence-base / Clinical data:

Vitamins C and E could help t

arteries healthy
Small dose of aspirin protect
the damage caused by ischem
strokes
Evidence-base / Clinical dat
Coenzyme Q10 could slow dow
progression of Parkinsons dis

Men with the lowest exercise

are roughly 4 times more like
than the fittest participants.
Physical fitness has a bigger i
on the risk of death than all o
known heart disease risk fact
 Androgen replacement
therapy
Evidence-base / Clinical dat
improves sexual desire and
function
in young hypogonadal and
elderly men
Androgens enhance the
relaxation of
the vaginal smooth muscle
to
endogenous NANC released
 The combination of PDE5
inhibitors
Evidence-base / Clinical dat
with testosterone is
emerging as a new
treatment in ED, especially
in aging.

Testosterone has profound

effect on tissues of the
penis involved
in the mechanism of
 Evidence-base / Clinical data
Testosterone treatment stimul
growth of penis with normal e
function in hypogonadal youn

Testosterone treatment heals

venous leak in hypogonadal d
patient with ED. This indicate
changes in penile structure m
in part be reversible.
 Evidence-base / Clinical dat

GHRT results in improvements

composition and lipid profile w
causing serious side effects

GHRT in adults demonstrates

effects on lean body mass com
and cardiac function improvem
 Stem cell therapy
Evidence-base will be the
/ Clinical dat
basis
for treating diseases such as
Parkinson's disease,
diabetes, and
heart disease

Data of stem cell therapy

being
collected