It’s Time to Redefine Aging
Since the beginning of time, humankind has aspired to take the reins on aging, defeat death, and discover—once and for all—a fountain that promises eternal youth. Our appetite for preserving youth continues and is perhaps even more intense at this moment than ever before. But often the approach to turning back the clock and holding onto youth is foiled. Hand and face creams, vitamin pouches, cosmetic procedures, and even growth hormones have never been able to deliver what they promise: an arrest of the decline in physiological and cognitive functioning that’s associated with advancing age.
We are looking in the wrong direction.
Part of this confusion is based on our long-held adherence to the typical Western medical model that frames our understanding of biology in two basic ways: developmental and disease-oriented. This framing is rooted in the evolutionary lens: we are born, we develop to maturation so that we can reproduce, and then we die. Intellectually, we know that we have eclipsed this evolutionary schema—as evidenced by our long lifespans. Indeed, living way beyond our fertile periods is testament enough to the need to reframe our understanding of our own biology that is constrained by a view that the original evolutionary purpose is to design our genotypes and phenotypes.
The Western, allopathic model that has produced modern medical discoveries, procedures, inventions, drug therapies, and other treatment protocols is rooted in the study of disease, and its etiologies, complications, and risk factors. This means studying diseases themselves and trying to trace causes or triggers, assembling risk factors, analyzing complications, and hoping that a certain treatment method or protocol will erase the disease or arrest its progression. Most of the medical training that we all have received stems from this view of aging and disease, which inherently gives aging and disease the upper hand.
As functional and integrative physicians and healthcare practitioners, we have questioned this very premise for decades. Together, through our clinical experience and research, we have made great strides toward offering a comprehensive approach to redefining medicine, from one that is allopathic to one that is focused on preserving health and believing in the body’s inherent capacity to heal based on its inherent drive for homeostasis. This drive toward homeostasis is just as strong—if not stronger at a cellular level—than any Darwinian mandate for survival of the species. Indeed, the power of the human cell, its very intelligence, is at the heart of understanding how and why we don’t have to accept aging as our default. We don’t have to passively wait for physical and cognitive deterioration and disease. We can harness what we know of our cell biology to empower our ability to adapt and live healthy, fruitful, fulfilling lives, regardless of our chronological number.
Over the last few decades, as more and more researchers and clinicians have investigated and begun to adopt a more integrative approach, they have also begun to reshape their research questions and approach to best practices. Why wait for disease? Why blast the body with chemo and radiation if cancer cells may be eradicated by the body’s own immune system? What can we do to interrupt the epigenetic interactions that have spurred so many chronic diseases? How can we apply what we know through modern medical science to update our evolutionary design?
Some medical schools and training programs introduce basic tenets of preventative medicine, yet they still treat them as supplements or afterthoughts, thereby giving them only cursory attention. As both an orthopedic surgeon and integrative medical doctor, I use both traditions in my practice. But more and more, I am adopting a way to interact with my patients that puts prevention first. Of course, I am always motivated to improve my outcomes—I’m a surgeon after all. But I’ve come to realize—both through research and my clinical experience—that focusing on prevention offers many more robust, less harmful, nontoxic opportunities to not only prevent disease, but also to redefine the aging process as we have come to know it.
I have discovered a way for me, my patients, my family, and my medical colleagues to embrace aging. Specifically, I see aging as an opportunity to live our best lives. I feel fortunate to have arrived at this perspective because it’s one that is empowering, optimistic, and accessible. In this book, I am going to introduce a novel way not only to think about aging, but to give you specific, accessible tools, strategies, and suggestions for protocols you can use to intervene with the conditions and diseases that are associated with aging.
And it’s not that complicated. I’ve discovered a simple, yet revolutionary, approach to stimulate all of what prevention means—preserving health, achieving optimal homeostasis, off-setting the allostatic load, and supporting the integrity of the immune system. In short, we can avoid the downside of aging that triggers the onslaught of so many illnesses and disease conditions.
How would you like to understand more about how your patients can
- Improve and potentially reverse type 2 diabetes and metabolic syndrome?
- Prevent the precursors to heart disease from taking root?
- Avoid many cancers?
- Offset neurodegenerative decline?
- Minimize depression and anxiety disorders?
- Support the immune system?
- Fight against bacteria, viruses, and other sources of infection?
- Strengthen sexual functioning?
- Balance hormonal functioning?
- Preserve the vigor and strength of skin, hair, and nails?
- Protect cell efficiency and metabolic flexibility?
The key to this kingdom? Peptides.
We know of at least 7,000 naturally occurring peptides in the body. Peptides are molecules that are a combination of two or more amino acids contained between an amine group and an H2 group on one end, and a carboxyl group on the other. These amino acids are joined by what are called peptide bonds; peptides exist in all cells and are synthesized by the ribosome through translation of messenger RNA. The peptides are then transcribed into hormones and signaling agents. They’re assembled and can become enzymes. They can also be ligands; they can be part of receptors. They can basically be any particular messaging part of a cell.
Typically, to be considered a peptide, a molecule must contain up to about 50 amino acids combined by peptide bonds. When a peptide contains between 50 and 100 amino acids, it is considered a polypeptide, and if more than 100 peptides are strung together to form a peptide molecule, it’s typically called a protein.
All of these peptides have pharmacological profiles and intrinsic properties that offer selective messaging within any particular cell.
In the medical community, we’ve been utilizing peptides since the beginning of the 1920s. The first commercially available peptide in the United States was insulin, which is a sequence of 51 amino acids. It was first commercially available in 1923, making it the first peptide on the market. Insulin originally came from a glandular extract. In 1982, insulin made for human use became the first recombinant peptide that was made, meaning it was synthesized as a recombinant drug or a recombinant peptide.
In many ways, the discovery of insulin changed the world. We were not only able to start treating diabetes, we were also able to address and understand one of the most prolific metabolic diseases in the world. That changed medicine. It is no surprise that the researchers involved, Frederick Grant Banting and John James Rickard Macleod, won the Nobel Prize for the discovery of this peptide.
Since then, we have made huge advances in our understanding of what a peptide is. We know that they are naturally occurring molecules in the body and that a tremendous number of them are circulating in the body at all times. We know they play a crucial role as signaling agents within the cell cycle and that they assist in overall cellular functioning throughout the body. We have also begun to understand what happens when peptide production begins to ebb. But perhaps the most productive area of peptide research comes from the realization that, like insulin, we can re-create these naturally occurring signaling agents in the body. We also continue to look at other ways we may utilize these natural peptides to work the signaling system in a way that is advantageous to the cell. For instance, other peptides, like oxytocin, gonadotropin-releasing hormone, and vasopressin, have advanced our ability to preserve hormonal and cardiac health.
Presently, over 140 peptides are involved in therapeutic treatments and are being explored in clinical trials, and more than 500 therapeutic peptides are being used in preclinical development. We have over 60 U.S. Food and Drug Administration–approved peptide medicines on the market today—a number that continues to grow. Interestingly, back in 2011, the global market space for peptides was about 14 billion. As of 2018, it has expanded to well over 26 billion, and it is still growing.
The primary drivers for clinical research have been dominated by the tremendous and still-growing need to contain metabolic disease and oncology; these two areas are leading the research efforts in how to create peptides. However, lately the interest in peptides is extending beyond these two fields. Currently phase trials are going on in urology, pulmonology, pain, orthopedics, ophthalmology, infertility, hematology, gastroenterology, endocrinology, dermatology, and neurology, as well as in cardiovascular studies. There are antimicrobial and antiviral studies. There are also studies being conducted on allergies, immunity, and bone and connective tissue. All together, these studies show that peptides present a burgeoning, interdisciplinary field of research. The findings are robust and are being used to bring about measurable, sustainable outcomes for diseases that up until now, we have been used to simply managing symptoms of.
These successful outcomes—some of which I have experienced in my own practice—are driving this interest in peptides. If we look back at what’s been happening in the world of technology and drug development, historically the emphasis on research has been on discovering and creating molecules to be used in drugs. Scientists did not really move forward after the amazing discovery of insulin in the 1920s. Indeed, many physicians don’t even realize that insulin is a peptide—a naturally occurring substrate in the body that was then re-created to help millions of people not die from type 1 diabetes. After insulin, we didn’t really harness the power of peptides and what it means for medicine when a substance targets cells so specifically, has no toxicity, is recognizable and tolerated by the body, and causes no immune reactions.
Though many drugs and treatment protocols have helped to stem disease and reduce suffering, the fact is that they all come with side effects and secondary issues that can create problems 5, 10, even 15 years later. These medicines also cost millions of dollars to develop. They drive research funding. And some have been horrible blunders, such as the unforeseen outcomes of drugs such as thalidomide or some of the well-known issues with NSAIDs. The point I’m trying to make is that we’ve also seen, because of the costs in development, that the number of drugs developed has decreased considerably. You would think that with improvements in technology, biotechnology, and the combination of chemistry and computational drug designs, that we would be developing a lot more molecules for other treatment agents in medicine today.
We can spend time thinking about this missed opportunity . . . or we can empower ourselves and our patients to delve into and learn exactly how peptides work, and how they play crucial roles in human physiology—for instance, they are included in interactions between hormones, neurotransmitters, growth factors, ion channel control, ligands, and anti-infective properties of cell function. Perhaps the most appeal...