Anti-Aging Medicine: What Works

March 8, 2008

Anti-Aging Psychologist, Dr. Michael BrickeyDr. Nicole Flora

  

  

  

  

  

  

  

Host: Anti-Aging Psychologist Dr. Michael Brickey

Expert Guest: Dr. Nicole Flora, Anti-Aging Physician

Broadcast: 2-24-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts

Medicine has focused on treating diseases. What we call healthcare has mostly been disease care. Anti-aging medicine emerged in the last ten years or so to ask what can doctors do to be proactive in preventing aging and diseases. As a new discipline, it has attracted both very dedicated physicians and frankly a few hucksters. Today’s expert is clearly one of the best anti-aging physicians, Dr. Nicole Flora. Dr. Flora was Board Certified in family medicine, obtained a Master’s degree in Public Health, and later specialized in age management and anti-aging medicine. She has been active in research and is on several policy boards. In the first part of the program, we will focus on what anti-aging medicine is and what it has to offer. In the second part of the program, we look at the pros and cons of different anti-aging treatments. Her websites are www.CincinnatiAgeManagement.com and www.Cenegenics-DrFlora.com

TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution

MB: This is Dr. Michael Brickey with Ageless Lifestyles Radio, cutting-edge thinking for being youthful at every age. On each program I interview experts on what it takes to live longer, healthier, and happier. Our program takes a holistic approach in addressing anti-aging psychology, medicine, alternative medicine, fitness, nutrition, and wellness. Our emphasis is on innovative thinking and practices that have solid data and results.
Medicine has focused on treating diseases. What we call healthcare has been mostly disease care. Anti-aging medicine has emerged in the last ten years or so to ask, what can doctors do to practice preventing aging and preventing diseases? As a new discipline, it’s attracted both dedicated physicians and, frankly, a few hucksters. Today’s expert is clearly one of the best anti-aging physicians, Dr. Nicole Flora. Dr. Flora was board-certified in family medicine, obtained a masters degree in public health, and later specialized in age management and weight management. She’s been active in research and on several policy boards. In the first part of the program, we’ll focus on what anti-aging medicine is and what it has to offer. In the second part of the program, we’ll look at the pros and cons of different anti-aging treatments. Dr. Flora, after years in medical school, what prompted you to get a masters degree in public health?NF: It was part of the career path that I had chosen. After I came out of medical school and residency, I joined a group that was providing indigent care in the southern part of the state, southern Ohio. And we really took care of about 57,000 patients that had no insurance and had no access to good healthcare. And so as part of that path, they pursued the public health arena and then took over a lot of the quality assurance and some of the government programs to help people that couldn’t get good care.MB: So working with indigent patients got you interested in chunking up to a higher level of, “How can we solve some of these problems on a policy level and get a better system?”

NF: Absolutely. We saw some of the epidemics of disease and some of the cultural ills that affected these people, and it really – while I wanted to certainly impact people’s lives on an individual basis, I felt like there needed to be a broader approach.

MB: And then what got you into age management and weight management?

NF: It was kind of an extension of that. You know, after seeing – unfortunately, in the poorer populations, obesity, diabetes, heart disease, poor nutrition and poor lifestyle choices are rampant. And that really was what I wanted to tackle. And in age management, that’s exactly what we approach are all of those things, and how do we prevent those things, and how do we get people to think proactively about their health and about their lives.

MB: So you were working with the other end of the extreme, people who are aging very fast?

NF: That’s right. I would have young people in their 30s – you know, the most extreme examples were the 10 or 11-year-olds that came in and they were already obese and had diabetes. I probably diagnosed 50 preteens with Type 2 diabetes because of poor lifestyle choices. And those kids were not going to live very long.

MB: Was there something specific that got you to go from public health to the age management, weight management?

NF: It had a little bit to do with the system. Unfortunately now, the way healthcare is structured, in order for it to be financially feasible, you have to see a huge number of patients. And I was averaging, on a lot of days, 40 patients a day. And it really became an ethical dilemma to me. I knew I could treat them well. I was treating them at the standard of care, but I knew they needed something better than that, and I wanted to be able to provide more than that. The system as it’s structured now just doesn’t allow for that. So it really kind of became an ethical dilemma – do I give them another pill and I expect to see them in about three months when they come in for the side effects from the pill I gave them last month. I just wanted to have greater contact with my patients and hopefully have a great impact long-term.

MB: So now are you working with kind of a cross-section of social classes and lifestyles?

NF: Well, unfortunately I’m not. Age management medicine, because it is relatively new and because insurances don’t cover it in most cases, right now my experience is relegated to those people that can afford to pay out of pocket, and that’s certainly fine for them but it does leave out a huge portion of the population right now.

MB: Personally, I don’t have any problem with that because it blazes the trail, and what’s the ideal standard of care now becomes the standard of care maybe ten years from now.

NF: Well, that’s absolutely right. And that’s certainly my hope, is that as we get better and better at this and as we hopefully do get rid of, as you said, some of the hucksters in the arena, that it will become standard of care and will be more acceptable to people. And that’s certainly my hope for the long term, and some of the things I do with the physician advisory board and things are to promote those type of things.

MB: And in the long run, it’s going to be cost effective by preventing a lot of health problems, and a lot of medications.

NF: Absolutely, certainly.

MB: If a 50, 60-year-old person comes into your practice, what do you do that’s different than if you were a mainstream family practitioner?

NF: First thing is that I get to know them. Instead of spending 15 minutes, and two or three of that is looking at their chart and seeing what the nurse wrote and having a brief conversation about what’s ailing them today, they’re in my office for their first visit usually between six and seven hours – between meeting with the nutritionist and meeting with any additional people in the office, and they’re usually face-to-face with me for two to three hours. And most people have never had that type of experience with a doctor. And you get to know what’s affecting them, what pressures they’re under, how they eat, how they exercise, what are their support systems, certainly what are their medical issues in the past, what really do we need to fix now and what are going to be hurdles in the future to keep them healthy. So it really is that close connection that is the biggest difference to start with. In the long run, it really is the fact that we work together so closely, maintain a very close relationship. I work with their other physicians, if they have specialists that they work with. It really is that quarterback mentality that I think primary care was originally supposed to tackle, and it ended up just being a paperwork job where you just do referrals for everybody. But it really is keeping the patients educated on everything that’s going on in their lives from a health standpoint.

MB: So right from the start it’s holistic and it’s about a relationship.

NF: Absolutely. And that’s what makes it most rewarding.

MB: I suspect some of your patients are shocked to have so much one-to-one time with the physician.

NF: Oh, that’s the first thing. They’re like, “Really? Are you serious? You need six hours of my time?”

MB: We’ve all spent six hours of our time going from one test to another, but to spend a couple of hours face-to-face with a physician is a real treat.

NF: That’s right. And instead of wasting your time, at least we’re getting educated and getting to know each other.

MB: So we’ve had this first session – then what?

NF: Well, certainly after that it varies, depending on the person and what their individual needs are, what their goals are, what we’re trying to fix and kind of what the short-term issues are, as well as long-term. But certainly, just a general overview is we want to get them eating better, we want to get them moving, we want to – if they need medications, and whatever they need. If they need specialists, if they need therapists, we’ll facilitate it.

MB: I gather that it’s not everybody needs to be at this level of hormones and this level of exercise and, you know, get with the program, but extremely individualized.

NF: Absolutely. And that’s one of the problems we’ve had with mainstream medicine is that we have over-generalized. And a lot of the things that you will see come down the pike as problems are because we took some research point that sounded good and tried to apply it across the entire population, and we abdicated the thought process, I think, in some cases. And so everybody’s very individualized. I do certainly have people on hormones. I certainly have people on blood pressure medicine. I have the whole gamut. But it really is very individualized to each person and their needs and their health and what’s the best combination for them.

MB: How many of your patients come to you and say, “Dr. Flora, can you get me some of that HGH? You know, is it legal? Is it going to make me a he-man?”

NF: Well, I have a small percentage that actually come and say that. I probably have a bigger percentage that think that in the back of their mind. Honestly, about 7 or 8% of my patients are on HGH, but a lot of people, that’s what they hear about and so that’s what they think it’s all about. And certainly HGH is a wonderful medication when used appropriately in appropriate patients with the right expectations. But unfortunately, there is a ton of misinformation regarding it. It is not the cure-all for everything. It won’t make you live forever. It won’t make you beautiful if you’re not beautiful to start with. But it has its place. And it’s a very safe medication and it is certainly appropriate in some people.

MB: So who are the 7% that benefit from it?

NF: The people I specifically prescribe it to are people who have developed a deficiency, so they have stopped producing it naturally – they have no levels. And those people are usually experiencing things like a lot of muscle loss, weakness, tiredness, and a lot of quality of life issues. Growth hormone really affects your ability to kind of appreciate life and mood. And those are the people that really end up benefiting from it the most, are the ones that have that combination. The other thing with human growth hormone is it rarely is a problem by itself. When I see human growth hormone has declined, it’s usually declined in combination with other hormones. And so a lot of times when we balance the other hormones, it will help you produce human growth hormone, and a lot of people will improve their human growth hormone that way, as well.

MB: So you rarely recommend using human growth hormone to enhance; you’re usually using it for people who have deficiencies?

NF: That’s right, yes. I do not.

MB: What about testosterone? I see all these charts about how men’s level of testosterone declines with age dramatically. Is that something that should be enhanced? Or again, are you just concerned about deficiencies relative to a person’s age?

NF: It does decline dramatically. And not only does it decline dramatically, if we look at population studies from as little as about 20 years ago, the average testosterone level of men in our society now is 17% less at any given age, and we’re not quite sure why that has occurred either.

MB: All these metro males, huh?

NF: Yeah, certainly I do recommend we replace it, and I do take men to an optimal level, not for their age.

MB: My understanding, one of the problems with replacing testosterone is that it often gets bound and can actually turn into estrogen and have the reverse effect. How do you control for that?

NF: That’s why if you’re going to deal with hormones, you need somebody that’s very well-educated on how to do it. I’ll see a lot of people come in and they’ve gotten testosterone from one source or another and it’s not being managed well. You have to – before you start that medication – you have to measure all of those things. It’ll give you a pretty good picture of how an individual man or woman will metabolize the hormone. It doesn’t always give you the whole picture, but it’ll give you a good starting point. And then you monitor those as your start therapy and continuously throughout. If men start putting out too much estrogen, then certainly we can sometimes change the route of administration of the testosterone, you can sometimes use prescription medications that block the conversion, and you can sometimes use herbal preparations to stop the conversion, as well.

MB: With women, they practically stop producing testosterone after menopause. Are you doing any testosterone supplements with them?

NF: I do. And honestly, my experience with women is I will see women drop their testosterone usually in their 30s. We always think that the hormone production stops at menopause, but truly, I will generally see women who drop their progesterone, drop their testosterone in the early 30s, up to 10 to 15 years before they actually stop producing enough estrogen to stop having cycles. I will even replace it in some women before menopause if we see that it has declined beyond a normal range.

MB: Top of your head – what percentage of women in our country would probably benefit from hormone replacement after age, say, 40?

NF: After 40? Well, if we say after menopause, I would certainly say a majority, but not – you know, it’s not 100%. There are still other risks to be considered. After 40, though, it really depends on where they’re at in the perimenopausal cycle. But I do see a lot of women in their 40s have a lot of PMS type symptoms, have a lot of weight gain around the middle, develop more fatigue, those type of things. And so – and those are the women that usually seek me out. So of the people coming through my door, it’s a huge percentage. It’s probably 90%. In the general population, I would probably guess at age 40 that it’s probably about half of the women.

MB: So is weight gain a red flag that something’s probably going wrong?

NF: Something is wrong when you start gaining weight. Unless you’re someone that walks through my door and tells me that, “I eat McDonald’s three times a day and I never exercise,” that’s generally not the case. Those people – certainly it’s a lifestyle issue, and everybody has lifestyle issues. But when we start seeing the kind of weight creep, I like to call it, where it’s just every year you’re adding a little bit and you’re adding a little bit, and then all the sudden you’ll see it, about 20 pounds in a year – that tells me that there is a metabolic issue going on. And the fact that we tell women, “You know, just eat less and exercise” – certainly that is good advice, but it is missing a whole component of the picture of what’s going on, and it really is a little patronizing to people that have had weight issues. I’ve dealt with weight issues, and until I personally fixed the metabolic issues, the hormonal issues, it was impossible. I craved food, my appetite was much higher than it is now, and I had no energy to exercise, and it became very mentally daunting when you went to the doctor and they said, “Well, just exercise.” And once all of those thing were fixed, weight for me in the last seven, eight, nine years really hasn’t been an issue.

MB: So for you personally, the weight management became a lot easier?

NF: Oh, absolutely. I wasn’t, you know, five pounds overweight. I lost about 65 pounds when we fixed the hormones. And you know, I still go out to – I ate at an Italian restaurant last night and I enjoy myself. So I’m not depriving myself, but it just became much, much easier.

MB: I keep seeing the term “estrogen dominance” in the press. Is that a useful term, and are you seeing a lot of it?

NF: I do see a lot of it, and I think it’s under-diagnosed, and especially in a 40-year-old that you asked about, estrogen dominance is a big thing. I’ll see it in men, as well, but in the younger women, in the 40-year-old women, what has happened is the ovaries have slowed down so that the progesterone and the testosterone are declining; the estrogen production is still relatively high. And therefore that’s where they end up with some of those more PMS type symptoms. They’re more moody, irritable, the weight creeps up, they tend to retain fluids – all of those type of things. With the men, they gain weight, they put weight on in the middle, they can’t maintain the muscle mass that they had. They get moody and irritable, as well.

MB: For women who are going through menopause, how many of them do you recommend some kind of hormone replacement?

NF: For the people that come to my office, it’s about 90%, because that’s kind of why they’re coming to see me. And they usually – the people that I’m seeing are well-educated, they’ve done their research in this arena, so most of the people that come to see me, I do recommend it. People that I specifically don’t recommend it for – and we can’t lump all of hormonal therapy in one bushel, either – there’s very few people that, given blood work results, that I would say, “You just aren’t somebody that I would give hormonal replacement to.” Certainly if all the blood work is normal, they don’t need hormonal replacement. Most women or men that come to see me will have one abnormality or another. Places that it is a very complicated decision for me are women with a history of breast cancer or endometrial cancer or certain ovarian cancer; women that have a very high risk, so they’ve got two people in their family that have had breast cancer; men with a history of prostate cancer or certain other melanomas and things like that are also big flags for me that, you know, we really need to proceed very, very cautiously. The breast cancer issue is the one that almost invariably comes up in women. They come to me and they say, “I’ve got all these symptoms, my quality of life has declined, but I’m afraid if I take hormones, I’m going to get breast cancer.” The fact of the matter is, at this point – there is a lot of research, and at this point it is not conclusive that hormonal therapy caused breast cancer. It actually is pretty evenly split that it’s very safe, it can lower your risk, versus it increases your risk. And the relative risk increase on the studies that have said that is extremely small. But that is related to estrogen. What women forget is they still have progesterone, they still have thyroid hormones, they still have testosterone, all of these other hormones. So we can’t lump them all in together. So if women are concerned, they’re worried about estrogen, sometimes we’ll use some of the other therapies first, see how we get them feeling – base it on their risk, base it on their blood work, and then maybe add that down the road, once we feel more comfortable and they feel more comfortable about it.

MB: For women who are having that creeping weight gain, how often is thyroid a factor in that?

NF: More often than what we’re led to believe. I’m the perfect example. I was tired, my weight was up. I went to my primary doctor, went to my OB/GYN, went to an endocrinologist – they all said, “Your thyroid is fine.” And that was all based on a screening test. Back in the 1970s, this new screening test came out. It’s called the TSH. The insurance companies pay for it; that’s the only thing that they recommend if you want to look at thyroid. And that’s what all of us doctors that went through medical school since the ‘70s had been trained on, and so that’s all we look at. But thyroid is a very complicated gland. There are multiple hormones involved. There are absorption issues that a lot of doctors just fail to look at. And we like to treat it as a disease, too, like to wait until it’s really bad before we treat it. So I don’t know. So in my case and in patients that I see, probably about 30 to 35% of women will have a thyroid issue that, when corrected, it helps them tremendously. Whereas if you look at the statistics nationally, they say between 2 and 4% of people with weight issues are thyroid-related. And we really have, again, given the whole clinical responsibility – and we like to look at that number on the paper and say, “Oh, the number on the paper is fine,” and we forget about physical examinations, our skin texture and fluid retention and basal body temperatures and examination of the thyroid. All of those things go into the diagnosis, as well.

MB: If a woman’s having weight gain and suspecting thyroid might be a problem, what kind of tests should she ask her physician to do, to make sure that he or she catches it?

NF: It’s a tough thing. Most physicians are going to order the TSH, again because that’s what the insurance companies – and they were told to do. There are multiple other tests that you can do. You can do what’s called a T3 or a T4. The thyroid gland that’s in your throat is controlled by a hormone that comes from your brain and tells it to make thyroid hormone, and that’s called TSH and that’s what the screening test is for. The thyroid gland then puts out a hormone called T4 which floats around in the bloodstream and eventually gets broken down into T3. The T3 is the active form of thyroid hormone and that’s what actually goes into the cells and makes your cells metabolize energy. There’s also, in your bloodstream, there can be antibodies, things that block that T3 or that T4 from working. So you need to look at all of those things. Additionally, you can have issues of absorption of the T3 through the cells, which we don’t really have a good test for. So the biggest thing I tell people, if they’re concerned about thyroid, is to find a doctor that knows what they’re doing with the thyroid. Honestly, most doctors don’t. There’s a couple of very good books on thyroid that I will oftentimes refer patients to, to get educated on it and allow them to help themselves a little better.

MB: And what are those books?

NF: There’s a Dr. David Brownstein who is wonderful – he’s in Michigan. And he has a book called Overcoming Thyroid. And it talks about things from a physical exam standpoint, things that you can do at home to see if thyroid is potentially an issue, see if iodine absorption, which is what makes thyroid hormone active, is an issue. And plus, it gives you symptoms to look at that might tell you if it’s an issue, as well as here’s the test that should be done. So it’s a good quick read that gets you well-educated. And in a lot of cases, my patients will read that and go to their primary doctor and they’ll know a lot more about it than their primary doctor. We can point them in the right direction if they need to.

MB: Other than anti-aging specialists, are there physicians who, because of their specialty, would be knowledgeable about thyroid?

NF: Endocrinologists are the hormonal experts in the medical field. And they are very well-educated and very well-meaning, but unfortunately they treat diseases. Their philosophy right now with thyroid and the way they’re educated and their policies that are put out by the Endocrinologic Society is for thyroid, if the screening test – the TSH test – is elevated to 10 – TSH is an inverse number, so the higher the number, the less thyroid function you have. So with over 10, you treat thyroid. But when you’re going to treat it, you’re going to treat it down to a 2. Where I see a lot of people falling into thyroid issues are between that 2 and that 10, which the Endocrine Society says, “You don’t treat those people. It’s obvious that they have a problem, but we’ll wait until the problem gets worse before we treat it.” And that’s where philosophically I differ from them. I think if you know you have a problem and you have symptoms – you’re gaining weight, you’re tired, all of those things – then we need to treat it more aggressively. If you come in to me and you have abnormal blood tests and it seems elevated but your weight’s perfect, your energy is good, you’re not losing hair, you don’t have any symptoms, then I agree, we should watch it. But our goal in age management is to be more proactive and not wait until you’re in a disease state to fix things.

MB: It sounds like medicine as a whole – and I hope anti-aging medicine takes the leadership in this – needs to define new standards of what’s healthy instead of just what’s unhealthy and disease.

NF: And that’s right. That’s where medicine has been focused for decades now is illness, and nobody knows what it means to be healthy.

MB: Are there boards that are working on that issue?

NF: Oh, absolutely. There are a lot of people that are approaching Congress, approaching like the AMA to try and push things into this direction.

MB: Good.

NF: Certainly there is resistance. Doctors are the slowest people to change their mindset on anything, of any group I’ve ever seen – which is good and bad. But so there is certainly resistance within the system to that. There are also some inherent problems with things like research. Research funding is usually focused on, you know, how do we cure a disease, or it’s coming from pharmaceutical companies which are trying to sell us patentable products. And so there are some problems with getting funding for good research from that standpoint, as well. As well as, you know, there are certain biases, especially in the nutrition field. There are certain – we’ve gone from “Fat will kill you,” to “Carbs will kill you,” and back and forth for decades. And you know, a lot of that is there have been a lot of political shenanigans that have gone into those positions, unfortunately. And it’s probably going to persist for some time, just because – and part of the reason for that is that there’s not one universal answer. We want an answer that says, “Here is what everybody in the world should eat and you will be healthy.” The fact of the matter is not that straightforward. Again, back to where we like to generalize everybody. We are individuals. We are genetically different. We are metabolically different. There is not going to be a right answer for everybody.

MB: Everything you’re talking about is talking about how it’s not easy and it’s very individualized.

NF: That’s right.

MB: Let me take a break here. You’re listening to Ageless Lifestyles Radio on Webtalkradio.net and we’re talking with anti-aging physician, Dr. Nicole Flora. She practices anti-aging medicine and age management, weight management in Cincinnati, Ohio, and she’s associated with Cenegenics Medical Institute in Las Vegas, with affiliated physicians around the country. Her website is http://www.cincinnatiagemanagement.com/, and the Cenegenics Institute site is http://www.cenegenics.com/. For information on anti-aging psychology and my books, Defy Aging and 52 Baby Steps to Grow Young and my free Defy Aging Newsletter is at http://www.drbrickey.com/  or you can just to http://www.notaging.com/  and it’ll take you to http://www.drbrickey.com/ . Dr. Flora, how much does it cost to get a good workup in anti-aging medicine?

NF: Certainly individual doctors charge different amounts. I don’t think there is a set fee. It really depends on what you’re dealing with.

MB: So for a typical person that says, “I’m feeling rundown and want you to work it up and put me on a program of nutrition and exercise and hormone replacement, if that’s needed,” are we talking a few thousand dollars, several thousand dollars?

NF: We’re talking in general, to start with, all-inclusive – between a good blood work panel, which unfortunately is the majority of the cost – probably a couple of thousand dollars. I mean, blood work – we do exercise testing, fitness testing, bone density, body fat, all of those things, plus consultations with a nutritionist – all of those types of things are included.

MB: I’m surprised that it’s not a lot more than that. Sounds like a bargain to me. I mean-

NF: Honestly, if you compare what you would go and pay if went to the hospital and got those things, you’re right. It absolutely is a good bargain.

MB: Considering what we spend on cars and stereos and plasma TVs – well, it’s the cost of a fancy television set – which is more important?

NF: Absolutely. It is an investment. It’s how much do you know about your body, which is – you know, a car is going to last you, on the outside nowadays, 10-12 years. You have to live with this body for a very long time.

MB: You’re engaged in some research. Can you tell us about that?

NF: Through the Cenegenics Foundations, we work with two medical schools, the University of Miami and the University of Nevada, and we do multiple research programs yearly. And the latest one involves weight and particularly hormone replace, specifically growth hormone and testosterone. And that came out through Cenegenics in November. It’s being submitted for publication in March.

MB: Are you allowed to share with us the gist of it, or is it under wraps?

NF: It’s been presented at the national meeting, so I’m assuming I can tell you a little bit. But that we did see, particularly in women, we saw a significant weight loss when hormones were balanced. With men, the weight loss was less significant, but the body fat content came down significantly. So they gained more muscle mass and lost more fat, where women kept their muscle mass consistent and lost fat. So their actual number on the scale, which we women like to focus on a lot unfortunately, changed more so with the women than with the men. But it was statistically significant weight loss.

MB: Well, speaking for men, we’d be happy to have it translated to muscle instead of fat. That’s okay.

NF: Exactly, exactly. So it made people happy on both fronts.

MB: Well, wonderful. I gather your approach to anti-aging medicine is fairly Western as opposed to someone who emphasizes Ayurvedic medicine, colonics and fasting and that kind of thing?

NF: That is true. You know, I am a traditional doctor. I went to traditional medical school and I trained to look at the scientific evidence. So I am more comfortable in that realm. I certainly am open to my patients using other approaches, but I won’t certainly present myself as an expert in those realms. I get, particularly with chiropractic and acupuncture, I get patients that have tremendous response. But certainly I will work with other practitioners if that’s their choice. But again, I just don’t present myself as an expert in those fields because that’s not where my training lies.

MB: It seems to me like there’s three schools: what you’re doing, which is very Western integrative; there’s the more Eastern approach; and there people who are just emphasizing the hormones and the shots and the cosmetics but not asking people to do the exercise, to take a look at their eating, and that kind of thing.

NF: I think you’re correct in that assumption. My personal opinion is that really to have the best outcomes you need a combination of all those things. People like to go to the doctor and be given pills and shots and creams or what have you because that’s what they’ve been taught to kind of expect. But it really – we cannot under-emphasize the other components. You know, the psychological components – and you’re the perfect expert to talk about that. There’s a huge impact on, you know, the diet and the nutrition. If you are going to put – if you want to know what the side effects to this pill that you’re putting into your body are, you certainly ought to think about the side effects of what the food you’re putting in your body are and how we change those. I mean, that – you eat three meals a day. You may take one pill a day. What is going to have the bigger impact on your life long-term? And people like to forget about that component. Eating is unconscious in a lot of cases. Our activity level is unconscious and it takes a lot more work. It’s easier to take a pill or a cream or a shot and not have to do that component. So my opinion is certainly it needs to be a comprehensive program. It has to address all of those things. It is hard as a practitioner to put all of that together, but that’s where the challenge lies.

MB: What do you think is going to happen in anti-aging medicine the next 10, 20, 30 years?

NF: I think we’re going to get better at it, and I think we’re going to get better at doing research at it, I think we’re going to get better politically getting people to support our position that we want to promote health and avoid disease, as opposed to just treating disease. I don’t know in the next ten years where the traditional medical community or the insurance communities are going to be on that front. In 20 years, I think they will be onboard, but it’s going to be a rocky road between now and then, unfortunately.

MB: Do you see huge changes from, say, genetic engineering and tissue engineering that’s going to get integrated into the anti-aging medicine at the practitioner level?

NF: Absolutely. Right now, genetics are – there are a lot of problems with the genetic component, from a decision-making point. But the genetics I think will be the next big mover. However, we have to remember that probably 45 to 50% of what happens to you, you are predisposed to, from your genes. The remainder is lifestyle. So we can’t expect genes to come in and cure everything. We still are responsible for our health and our environment and our psychological wellbeing. So it will never come in – and a lot of people are waiting for it – “Hey, if I get the genes right, I won’t get heart disease and I won’t get this, that, or the other.” But it’s never going to be that simple.

MB: “And I can go to the restaurant and eat everything.”

NF: Right! “And if I’ve got the right genes, my jeans get on fine.” And I actually had a gentleman that called yesterday and said, “Hey, I heard about this genetic testing. Can I get it done to find out, you know, do I need to do this?” And you know, my take to him was that right now, at least, it can sometimes give you a false sense of security. If you have a genetic test that tells you you’re at low risk for heart disease or you’re at low risk for diabetes, does that mean that you don’t need to know what is best to prevent those things? And my position is no, I’m going to treat everyone like they’re at high risk for heart disease and diabetes, because still, the vast majority of heart disease cases and probably 85% of new diabetes cases, Type 2 diabetes, occur in people with no genetic risks. So we can’t rely on a blood test to tell us we’re safe.

MB: One of my pet peeves is statins. I think they have so many nasty side effects; I hate to see so many people taking them. What kind of alternatives do you tend to get into with patients to see if they can get off the statins?

NF: I have a problem with the statins, as well. I feel the same way. Cholesterol – certainly diet is important, but diet – if we’re honest with ourselves and we look back at the medical literature for the last 30 years, diet – and I hate to say this because it will tell people they can go every fried food they see – diet has a very small impact on cholesterol levels, maybe 10% if you’re very good – which is important. Diet has other impacts, though. It affects inflammation, which the statins also decrease. So we can’t just look at the cholesterol number. But diet is important. Exercise is important. Looking at hormonal levels – I never, never treat someone’s cholesterol number unless their thyroid is optimal. Thyroids will impact your cholesterol readings, as will testosterone levels, as will estrogen levels. And so a lot of people, when we get the hormones balanced, we get them eating right, we get them exercising, they don’t need the statins. The statins, I think, are so over-prescribed. If you actually follow the American Heart Association’s recommendations now for cholesterol levels, in my personal practice, my primary care practice – if I followed that, 75% of the patients that I saw on a daily basis would be on a statin. And honestly, that is – in my mind was a big turning point. Common sense has to come into play. There’s either something wrong with our society, with our lifestyle, with how we’re eating – that didn’t come about – you know, that isn’t a genetic issue that all of the sudden 75% of people need a pharmaceutical. It’s either our position as doctors and as researchers is wrong, or there’s something going on culturally with our diet. Something has changed that has made that occur. And that’s why I think, as a doctor, you really, really have to step back and step outside of the box and not just read the recommendations, but go back and look at the individual research that has been done to date.

MB: I’m hearing that public health perspective there.

NF: Absolutely, sure.

MB: How does a person tell whether somebody is a well-qualified, competent anti-aging physician?

NF: It’s tricky. There are a lot of people out there that are dabbling, that are not well-educated on the subject, that have gone to classes that may not have been the best classes, that have gone to seminars or have been pitched products that are not well-supported by research. And so honestly, it is a tough position as a consumer. My biggest thing is that you need to find a physician that you can talk to, that you’re comfortable with on a personal level, that can give you supporting evidence to their opinion, and who is willing to have that conversation, and also who doesn’t treat you – not a cattle call at their office, and they’re not going to treat you – everybody that comes through the door gets this treatment or that treatment. That is, for me, the biggest thing. You want certainly someone who has some experience in the field. You probably need someone who has been doing it – and I hate to, you know, give time cut-offs, but multiple years, five years or more. And you need somebody that, in my opinion, does this as their primary focus. The guys that are doing it one day a week out of their office unfortunately can’t keep up with the amount of medical and other sources of information at this point. You can’t keep up with your regular practice, let alone a whole other field. You wouldn’t go to a gynecologist that did gynecology one day a week and had some other job on the side. You really need somebody that this is their primary focus.

MB: Are there any board certifications yet that would tell you that you had this kind of doctor you’re talking about? Or are we not there yet?

NF: Some doctors will promote a board certification and there is a program out there that they can go take classes and get a board certification. To date, though, that board certification has not been recognized by the AMA. So the AMA has looked at the protocols and they have not given their stamp of approval yet. They may in the future – I’m sure they are continuing to work on that. So right now, board certification is – while it does indicate that they have taken a significant amount of education, at this point we don’t know specifically what that entails.

MB: What’s the patient to do, other than interview the doctor and find out whether they’re full-time in the business?

NF: I wish I could answer that. You know, the other thing that I will tell patients to do that aren’t local to me, is I will tell them to go to a local compounding pharmacist – if they’re women. Men a lot of times will use FDA-approved medications that you get through a regular pharmacy. But honestly, the pharmacists in the area know the good doctors. They really do. If you are an age management doctor and you’re doing hormones, you have to be working closely with a good qualified compounding pharmacist, almost on a daily basis. And I have a lot of patients come to me from a local pharmacist because that’s where they’re asking questions, and I think they’re a good resource.

MB: Oh, I love that strategy. That’s cool. The Cenegenics Medical Institute that you’re associated with, are they certifying people who have comparable credentials to yourself?

NF: Well, we do – at Cenegenics they train physicians and they are actually AMA-accredited to do training. They don’t offer a board certification but they do offer a certification through Cenegenics. They train – they have to be MDs or DOs and they have to go through – they have to see patients with the doctors there and their clinical knowledge is assessed. Certainly they do testing, they do home studies, they do ongoing monthly educational seminars to maintain that certification.

MB: Do they teach the kind of individual time-intensive holistic approach that you do? Or is that more a personal choice?

NF: They do. And that’s where I got my original training. I’ve done training from multiple different sources. But absolutely, they advocate the approach that, you know, you have to spend – to get a good idea of what’s going on with a patient, you have to spend minimally two to three hours with them on the first visit, and then close follow-up is really the key to success.

MB: Is there anything else that you would like us to know about, or some hints or advice that you’d like to share with us?

NF: I think the biggest thing, for people in general, is to not stand by and expect health as a given. You do have to, in our culture today, with the dietary stresses, with the environmental stresses that our body is under, and with the epidemic of disease that is out there, you do have to be proactive and you need to take some responsibility to get well-educated on it. It will make a huge impact in your life and your family’s life and your kids’ life. You’ll be around longer and you will enjoy life more. The biggest thing that my patients want to avoid is living to be 90 and spending the last 20-25 years being sick. And we know, with good medical evidence – this is not new things that we have made up or that there’s some new product – we know, looking at good medical research, that we can prevent probably 65 to 70% of disability that you see in the elderly population, if we start early and if we’re proactive and if each individual takes responsibility for their health, for eating well, for exercising. They don’t need to end up in the nursing home like their parents did. They don’t need to end up living with their kids because they can’t live independently.

MB: My role model is the Energizer Bunny on alkaline batteries. You know, with regular batteries, they just kind of wear out gradually, but the alkalines, you get the steady energy level and then when they die, they just die.

NF: Right, they just fall over.

MB: So it just keeps going and going and going. There’s a gentleman in the news, Mr. Rabinowitz, who recently, at 104, broke his 100-yard dash record at about 30 seconds, which is pretty good for 104!

NF: Oh, my goodness.

MB: And then I noticed he had a stroke a couple of months later. To me, that’s a good role model.

NF: Absolutely. You know, we don’t need to cure a lot of these diseases. We just need to delay them coming on. If I get cancer when I’m 94 and die from it, great, you know. But if I’m healthy until that point – you’ve got to die of something. My thing is that I just don’t want to be sick and tired and accept this unfortunate situation that we see so many seniors in now. And I don’t want us as a population to think that’s how it has to be, because it doesn’t. But you do have to work hard and you can’t wait until you’re 80 to do it. When you’re 80, we can still have good impact, but you’re going to do much, much better if you start when you’re 30 or you’re 20 or you’re working on your kids to get them to eat right and to get them outside and get them moving, and ingrain that as part of their lifestyle. You’re going to have much better outcomes. They’re going to have a better life.

MB: Dr. Flora, I just wish we could clone you.

NF: Well, thank you.

MB: Thank you so much for being on the show. I really appreciate it and appreciate all the information you shared with us.

NF: Well, you are so welcome. It has been a pleasure.

MB: As you’ve probably gathered, I’m a big fan of anti-aging medicine. True, it is having its growing pains and there are people who are emphasizing profits as opposed to the kind of careful planning and individualization and holistic health that Dr. Flora talks about, but I think it is destined to become the family practice medicine of the future. And Dr. Flora is a wonderful example of what an anti-aging physician should be like and what an anti-aging physician can do. I like to wrap up programs with a baby step that hopefully will help you live longer, healthier, and happier. In the business world, we place a lot of emphasis on starting with the end in mind, being very clear about the outcome you want, and then figuring out what it takes to achieve that outcome. In our lives, it’s even more important because it’s our lives! And the outcome we want is to be Energizer Bunnies, at 100, 110, 120, maybe even 150, to still be going strong with a snap in our step and a sparkle in our eye – passion and enthusiasm and a zest for life. The alternative might even be a nursing home. So we need to picture in our mind’s eye vividly ourselves as that Energizer Bunny and just see it so vividly and want it so badly, we’re almost salivating, saying, “I’ve got to have that, whatever it takes. That’s what I want. What do I need to do?” What do you need to do? Well, fortunately I think we got a lot of ideas today from Dr. Flora. You’ve been listening to Ageless Lifestyles Radio on Webtalkradio.net. Our expert guest has been Dr. Nicole Flora, an anti-aging physician who practices in the Cincinnati area. Here Cincinnati office website is http://www.cincinnatiagemanagement.com/. Her Cenegenics Institute website is http://www.cenegenics-drflora.com/. Information on anti-aging psychology and my books Defy Aging and 52 Baby Steps to Grow Young, and my free Defy Aging Newsletter is at DrBrickey.com, or you can just go to http://www.notaging.com/  and it’ll take you to DrBrickey.com. This is Dr. Michael Brickey with Ageless Lifestyles Radio, wishing you a very long, healthy, happy life.

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