We have many ways of expanding your "healthspan," which is the length of optimal health and quality of life over "lifespan." Simiarly, "biological age" is a very different measure than your actual chronological age, and it is determined by many factors including organ health, hormone levels, blood markers, telomere length, and epigenetic methylation patterns affecting DNA expression. Much research has recently been published in some of the most prestigious academic journals showing extraordinary new strides in understanding the molecular mechanisms of aging, stem cells, peptides, hormones, and other treatments and tools that help enable us to live longer, healthier, more fulfilling lives. The mechanisms of aging are complex and multifactorial, ranging from oxidative damage, DNA repair defects, stem cell depletion, cell atrophy or senescence, changes in the epigentic landscape, altered molecular signaling patterns, telomere erosion, mitochondrial dysfunction, intracellular and extracellular waste accumulation, inflammation, and other dysregulated signaling pathways. Many mechanisms have been found to be involved in the aging process, all of which can be modulated in beneficial ways, and these include Sirtuin, mTOR, AMPK, WNT, HDAC, GH, Telomerase, and many other signaling pathways that modify DNA methylation patterns and transcriptional activity involved in the biological processes of aging, thereby driving epigenetic, transcriptomic, and metabolomic changes toward a younger configuration in many types of cells and tissues (1a). Anti-aging treatments can focus on many aspects of your health, from rejuvenating cellular aging effects, increasing strength and endurance, enhancing cognitive functions, losing weight, extending life, restoring immune strength, accelerating healing and injury repair, and improving many other physical functions and quality of life, as described in further detail below.
Interestingly, a recent scientific paper showed that treatments that specifically target aging (rather than only targeting individual diseases as they arise) are extremely valuable to society and the economy. Data have shown that a single anti-aging medication beginning as late as age 75 can still have the potential to extend average life expectancy by an average of 3 years, and by implementing these anti-aging therapies, there is a net worth of $37 trillion dollars for each year of life gained (1b). Moreover, this study showed that these health benefits improve our quality of life as well as life expectancy, and for every progress that is made in improving how we age (e.g., extending cell replication cycles, promoting stem cell repair niches, preventing cardiovascular disease, stroke, cancer, arthritis, etc.), there is exponentially more beneficial feedback onto our quality of life.
We now provide numerous scientifically-backed anti-aging therapies available directly in our clinic, and we provide individualized care with an integrative functional medicine approach to your health. Naturally, this can be as simple as a nutritional approach that protects against some mechanisms of aging (discussed here). For example, the amino acid glycine has shown strong protective anti-aging effects, and can be taken orally or injected. The methylated variant called trimethylglycine (TMG) or anhydrous betaine also appear to impart similar effects on cell turnover and function. Similarly, taurine has been shown to improve many age-related health problems and induce many protective anti-aging effects on muscle, brain, bone marrow, and immune cells (1c). In addition, diets high in natural antioxidants, anti-inflammatory agents, and HDAC-inhibitors, including omega-3 fatty acids, leafy greens (iron, quercetin, numerous vitamins and minerals), blueberries (anthocyanin and pterostilbene), carrots (luteolin, carotenoids, numerous vitamins and nutrients), broccoli (quercetin, luteolin, calcium, phosphorous, zinc, etc.), grapes (resveratrol, quercetin), plus consistent water intake and exercise, have all been shown to provide anti-aging effects. Physical activity and diet influence the health of our cells through numerous well-studied mechanisms, discussed further in this youtube video.
More advanced anti-aging therapies have also been discovered and are now being implemented clinically, as described further below. The 2009 Nobel Prize winning discovery of telomeres and telomerases was first made in the ancient, long-lived Bristlecone Pines, then found to also be at work to a lesser degree in human cells. The discovery of the mTOR enzyme also uncovered a fascinating mechanism of metabolic controls in the cell, where mTOR acts as a major regulator of cell metabolism and is heavily involved in stem cell differentiation, acting as a sort of integrated metabolic switch and fuel sensor of oxygen, amino acids, and energy supply. When mTOR is inhibited under hypoxic or low-calorie conditions (as happens in endurance exercise), it promotes stem cell mainenance and regenerative capabilities. Dr. McMurtrey published a summary of his own stem cell research work describing the complexity of these numerous signaling pathways in the academic journal Stem Cells & Development. In addition to several types of anti-aging medications discussed below, evidence suggests that numerous natural phytochemicals, flavonoids, anti-oxidant-rich, fiber-rich, vegetable-focused diets, along with exercise, can enhance telomere length and inhibit mTOR to promote stem cell maintenance and the cellular regenerative capabilities of more youthful cells both in laboratory culture and in the human body (2a) . Cells can only copy themselves so many cycles before errors and elisions occur, and we now know that telomere length explains most transcriptional changes observed with cellular aging in humans, but fortunately many interventions described below have been shown to counter these aging processes and restore balance to altered transcriptome profiles within aging cells (2b).
Rejuvenation of Cellular Age: Ground-breaking research has shown that NAD+, NR, or NMN can renew stem cell profiles, increase the regenerative capacity of cells, protect organs, and induce more youthful epigenetic landscapes in our DNA via a class of signaling molecules known as "sirtuin modulators" (SIRT1) and "calorie restriction mimetics" that activate or inhibit certain sirtuin gene functions (also including sirolimus and metformin below). In numerous studies these agents have shown measurable anti-aging effects at the cellular and organ levels all the way up to measurable gains in muscle repair strength and physical and mental performance capacity (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23). NAD+ and related co-factors optimize cellular metabolism and prime cells to revert back to a more youthful and robust genetic state where they can better adapt to metabolic demands and regenerate under the wear and tear of repetitive use or old age via these Sirtuin-1 (SIRT1) pathways. SIRT1 is also known as the "longevity gene" because of its role in reducing the risk of diabetes, obesity, adipogenesis, metabolic syndrome, atherosclerosis, kidney disease, liver disease, neurodegeneration, and cancer. There may also be a role for its use in rapid muscle repair as well as several muscle wasting diseases and mitochondrial disorders (24) (25) (26). Many other pathways are also involved in these anti-aging effects, like mTOR and AMPK signaling pathways that increase the capacity of cells to renew, proliferate, and differentiate. We provide sirtuin modulators like NAD+ therapy and other medications that provide a unique anti-aging effect that can be injected or infused intravenously in the clinic for best absorption by cells, providing optimal dosing and bypassing digestive tract and absorption limitations. We also provide prescriptions for other types of anti-aging medications like metformin, sirolimus, and others (see below). Evidence has shown that NAD+ deficiency plays a role in aging of organs and tissues, in mitochondrial dysfunction, and in inflammation; however, administering NAD+ protects organs from these forms of damage (26b)! Interestingly, other variants of this class of molecules like niacin or vitamin B3 do not appear to exhibit these anti-aging effects.
Hypoxic Training & Adaptation: Research has shown that hypoxic adaptations can extend life span (27) in part by enhancing epigenetic, metabolic, and stem cell renewal signaling pathways. We can provide equipment for hypoxic training and adaptation, as discussed on our high altitude training page.
Cognitive Enhancement, Neuroprotection, & Mental Acuity: We also provide many potential options for treating and combating brain or spinal cord injuries, concussion effects, cognitive decline, Alzheimer's disease, and dementia, including prescriptions for neuroprotective agents, nootropic peptides, traditional pharmaceutical agents, methylene blue, NAD+, ergoloid mesylates, and many other types of nootropic agents depending on your particular condition-- see our cognition, peptides, and infusion pages for more details. We can also order a wide variety of diagnostic lab tests and imaging studies to help establish a proper diagnosis and treatment plan in many types of complex cases.
Methylene blue (MeBl) was first noted as a potential therapy for dementia when it was dropped on an Alzheimer's tissue sample and found to dissolve fibrillary tangles and amyloid plaques associated with the disease. Interestingly, in addition to the potential congitive benefits and protective effects against Alzheimer's disease (28) (29) (30) (31) (32), methylene blue appears to have more general neuroprotective memory-enhancing properties and is being studied as a therapeutic agent for improving brain function after concussion and traumatic brain injury (33) (34) (35) (36). MeBl is also being studied for its anti-aging and anti-cancer properties (37) (38) as well as for its therapeutic effects on peripheral neuropathy and nerve pain (39) (40) (41) (42) (43) Interestingly, MeBl has also been shown to enhance fibroblast rejuvenation and collagen production in skin, similar to GHK-Cu peptide, giving a more youthful appearance and texture (44) (45) (46).
In addition to MeBl therapy, some types of dementia may be stopped and even reversed by simple glutathione and B12 injections (47) (48) (49). As we age, B12 levels tend to decline, and low B12 levels and high homocysteine levels have been linked with dementia onset as well as several inflammatory diseases, but B12 injections restore B12 to healthy levels and reduce homocysteine (making it also beneficial for cardiovascular disease). A powerful anti-aging combo infusion includes NAD+, glutathione, methylene blue, and B12-- see the infusions page for more info.
We also offer many therapies for traumatic brain injury, concussion, nerve injury, cognition, dementia, migraines, and post-operative neural tissue healing. Several studies have suggested that brain injuries have many complex interacting mechanisms, often involving a vascular fluid dynamics problem as well as the neural and axonal damage. We can provide counseling on many different therapies and medications specific to your particular injury and condition. Interestingly, in 2015, researchers discovered that the brain has its own lymphatic system and that lymph flow can influence neurodegenerative and neuroinflammatory disease processes (50), which the National Institutes of Health described as one of the 'most promising medical discoveries with potential for enhancing human health' in 2018. The brain must clear out the metabolic byproducts and wastes from each day through the lymph system and into the venous drainage, much like flushing a toilet, and this process requires both sleep and lying down, which maximizes both lymphatic and venous outflow. When this process is inhibited it can result in accumulated proteins, toxins, and metabolic byproducts in the brain that may lead to dementia. This may explain why IV therapy for things like postural orthostatic tachycardia syndrome (POTS) can also help clear brain fog, and we have developed vascular doppler ultrasound analysis, personalized IV infusions, therapeutic nerve blocks, hormone optimization, prolotherapy, and regenerative interventions for the syndrome of brain fog associated with headaches and/or neck pain (poor venous/lymphatic drainage from the brain through the venous outflow of the neck), plus there are also additional medical therapies like peptides (possibly including BPC-157, Semax, or others) and Sirtuin modulators listed above, as well as shockwave therapy, myofascial release, and image-guided nerve releases and injections that can relieve pain, release spasms, and increase lymphatic flow.
Immune System Enhancement: As we age, the function of our immune system also declines dramatically, but it can be boosted by peptides such as Thymosin Alpha-1 (Tα1), which enhances immune responses (including T-cell, dendritic cell, and antibody reponses). Evidence shows that it upregulates MHC-I expression, increases NK cell number, and possesses not only anti-viral replication effects but also anti-tumor and anti-cancer effects (51) (52) (53) (54) (55) (56). Even few doctors are aware that viral infections frequently alter the expression of toll-like receptors (TLRs) in ways that make our immune systems more susceptible to bacterial infections as well (as is seen in the critical care setting where, for example, a viral pneumonia can convert to an even worse bacterial pneumonia or fungal infection), (57) (58) (59) (60) (61) (62) (63), but interestingly the Thymosin Alpha-1 peptide can enhance TLR immune responses to virus, bacteria, mold, and fungi, meaning it can be used to reset the immune system and help fight certain latent, lingering, or subclinical infections, plus it can also be used as an adjunct to enhance vaccine efficacy with evidence showing that it even protects against severe viral infections like COVID-19, significantly reducing COVID-19 mortality (64) (65) (66) (67) (68) (69). You can also ask about other protective therapies against SARS-CoV2 viral infections including fluvoxamine and monoclonal antibodies.
Hormone Optimization & Hormone Replacement Therapy: In addition, as we age, normal levels of hormone can drop precipitously, but using safe and established protocols that replicate natural physiology, these processes can be reversed and youthful vigor restored in healthy and targeted ways. One approach to anti-aging medicine is to restore declining levels of endocrine hormones to more normal youthful levels, including thyroid and sex hormones. For example, when prescribed and used appropriately, testosterone and other hormones can be very safe and effective in improving physical function, lean body mass, bone density, vitality, longevity, energy, mood, and sexual function, while also reducing adiposity, cholesterol, insulin resistance, and when used properly evidence shows such interventions do not increase the risk of prostate cancer (70) (71) (72). Furthermore, numerous studies have shown neuroprotective and neuroregenerative effects of testosterone in addition to accelerated healing from musculoskeletal injuries (73) (74) (75) (76) (77) (78) (79) (80) (81). There can be some small risks with hormone replacement, including reduced sperm count, increased red blood cells (erythrocytosis and polycythemia) along with increased risk of thromboembolism, increased calcium (hypercalcemia), more susceptibility to sleep apnea due to increased neck size, acne skin reactions, gynecomastia, or increased prostate size (BPH). However, these risks were first noted when steroids were abused to supraphysiologic levels, but with proper modern optimization protocols, these risks have proven to be avoidable, rare, or temporary, meaning any risks can easily be minimized by tailoring protocols to your specific personal needs and physiology, and hormone injections can be done in the clinic or in your own home.
Weight Loss Medications: many studies have shown the all-around benefits of exercise and fitness on life extension and quality of life. In many cases, the addition of pharmacological agents can make this path easier and can even confer many benefits of their own. For example, metformin is a classic medication for lowering blood sugar in diabetes, but it has also shown independent effects of causing weight loss (82) and even life-span extension (83) (84), most likely due to its effects on inhibiting mTOR via an AMPK signaling pathway and other pathways. Interestingly, exercise also activates the AMPK pathway just as metformin does, which suggests that metformin acts as an "exercise-mimetic," simulating the effects of exercise on the cell. This is also true of other medications that may promote cellular life-span, such as NAD+/NR, which simulates the state of calorie deprivation ("calorie-restriction mimetics") (85) (86) (87) or Rapamycin, which has traditionally been used in cancer or organ transplant therapies to suppress cell growth (88). Several peptides can also be used for weight loss, as can the classic pharmacologic agents of phentermine or ephedrine. Semaglutide with B12 is another combination that can also induce weight-loss with health benefits similar to metformin. Diabetic patients on metformin should also generally receive methyl-B12/folate supplementation to ensure that their cobalamin, folate, and homocysteine levels remain optimal to avoid peripheral neuropathies (89).
Sexual Health: In addition to the above, many men and women note that their sexual health declines as they age, which has been linked as an early predictor of increased risk of mortality (90), but we have several options that can help dramatically improve sexual health and function in both men and women. These include the traditional treatments such as PDE5-inhibitors, trimix cream, as well as more unique experiences for both men and women, such as oxytocin, apomorphine, tadalafil, and PT-141. These can be specially formulated in a variety of combinations and creams. Oxytocin, Melanotan, and PT-141 (Bremelanotide) are unique peptides that can suppress appetite, promote weight loss, and enhance libido in both men and women, and they can be administered either subcutaneously, intranasally, or simply with tasteful dissolvable sublingual troches. These have also been shown to increase erections and sexual satisfaction even in those who do not respond well to PDE5-inhibitors (91). PT-141 is an analogue of the naturally occurring α-melanocyte-stimulating hormone (α-MSH), and as such after long-term use it can also cause skin tanning, which occasionally may be long-lasting. Oxytocin has also been shown to promote weight loss effects (92) and, even more fascinating, can enhance muscle regeneration and preserve muscle mass as we age, and may even stimulate regeneration of cardiac cells in the heart (93) (94). In addition, we also offer acoustic wave therapy or extracorporeal shockwave therapy for improving erectile dysfunction and Peyronie's conditions (95) (96) (97) (98) (99) (100) .
Hair Regrowth and Restoration: We can also help reverse hair loss using PRF/PRP injections that typically produce excellent results in hair proliferation, and this may be combined with many topical medications and peptide derivatives like the thymosin beta 4 (TB500) peptide (101) (102) (103) (104) (105), as well as topical sprays of PTD-DBM peptide, GHK-Cu peptide, and valproic acid/methyl-vanillate (wnt/b-catenin activators that promote human hair cell proliferation). Topical minoxidil + finasteride preparations can also be customized by compounding pharmacies to provide localized delivery without the systemic side-effects of the oral form of these medications (106). See more information on the PRF and peptides pages.
Youthful Skin Cosmetic Enhancement: We can do botox injections for softening wrinkles of the face, or we can provide a cream that has botox-like peptides to relax muscles under the skin without injections and that also has a peptide to enhance collagen synthesis in the skin (GHK-Cu/Argireline/Leuphasyl Combo Cream with or without Vitamin C). Other peptides that mimic natural MSH can also produce cosmetic improvements and sunless tanning effects on the skin (e.g., Melanotan 1 or PT-141 mentioned above). Recent research has also shown how methylene blue, discussed above, can result in more youthful skin and enhanced collagen synthesis in aged/wrinkled skin (107) (108) (109). For patients who suffer from hyperhidrosis, we can also provide topical treatments and/or botox injections to minimize sweating.
We also offer a wide array of specialized lab testing and screening, including hormone levels, organ functions, as well as the Galleri test for early detection of over 50 types of cancer and the Cleerly test for coronary artery disease calcification scoring with hard and soft plaques. See more information on additional aging therapies such as telomere enhancers (e.g., epithalon) at our peptides page, more information on osteoarthritis treatments (e.g., hyaluronic acid + chondroitin + pentosan + peptides + PRF + stem cells) at our osteoarthritis page, and more information on anti-inflammatory, anti-oxidant, anti-cancer, and immunomodulatory agents on our infusions page and cancer page.
Altogether, the above therapeutic agents show fascinating effects on the internal workings of cells, ultimately steering their functions and fates. These different cell fates can be thought of as a landscape or manifold where cell functions navigate through different topologies and over time they naturally come to rest at steady-states at certain depressions in the landscape. Researchers are vigorously studying cell pathways involved in these different states and have made several interesting and surprising discoveries. For example, by focusing on just three different modes of aging in yeast cells, researchers found that the complex interactions among multiple complex pathways could be modelled mathematically, providing a better understanding of these landscape patterns in aging and allowing them to drive certain gene expression patterns that could optimize cell lifespan (110). We strive to lead the way in keeping up to date with all the latest research and clinical applications in anti-aging therapies.
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*Disclaimer: The information presented here is for informational use and cites the ongoing cutting-edge research and medical advancements on these relevant topics. There are many treatments, interventions, and protocols routinely practiced in medicine and surgery which the FDA has not studied nor formally approved yet which have demonstrated overwhelming evidence of efficacy and clinical benefit. The FDA does not regulate the practice of medicine but rather regulates medical marketing of devices and drugs. The FDA does not conduct clinical trials or attempt to discover new treatments, but rather requires companies or other entities to fund marketing approvals. Breakthrough technologies typically require years to decades of research work to optimize the technology and collect enough data to prove efficacy and superiority, which in some cases can optionally be submitted to the FDA if there is sufficient financial backing to market a specific product or drug. Thus the FDA has not yet studied, evaluated, or formally approved many regenerative therapies currently practiced by many of the top physicians and surgeons in the United States and around the world. Some therapies, products, or interventions may still be considered investigational or "off-label" even with substantial evidence of efficacy, and many different applications of regenerative therapies continue to be researched by our institute and other top institutions around the world. We seek to always provide the highest-quality evidence-based care to our patients, which may include FDA-approved therapies as well as additional investigational or alternative therapies. We always discuss potential risks and benefits of all these options. The rapid evolution and advancement of medicine demands that physicians continually update their knowledge and practice techniques to adapt to future improvements and advancing technologies. These statements have not been evaluated by the FDA, and the treatments and products presented here are for informational purposes and not intended or guaranteed to diagnose, treat, cure, or prevent any specific disease or condition. All injuries and conditions should be formally evaluated by a knowledgeable medical professional whereby standard treatments and/or additional therapeutic interventions may be considered with the diagnosis and treatment plan.