TOWARDS MANAGED AGING part 2.

The previous chapter covered the commonest problems of aging: cancer, fractures and arthritis.

CARDIOVASCULAR-STROKE CVD AND DEMENTING DISEASE:

It has been recognized for decades that the age-old antioxidants, and the three antihomocysteine vitamins (B6 B9 B12), and nitric oxide promoters eg nitroglycerin NG, are major benefit against chronic CVD and it’s symptoms if not during acute myocardial infarction and stroke. NG remains the mainstay of treatment for angina. Nitric oxide is a key vasodilator, neurotransmitter and immune modulator; it’s therapeutic level is boosted by nitroglycerine; metformin (Kanazawa 2008); human sex hormones and arginine.

As with oxygen, vitamins, minerals, biologicals, foods, alcohol and all therapeutics, balance – the right amount- is everything. But vigorous timely combination of the dozens of natural biologicals that decline with age – the essentials eg fish oil, CoQ10, arginine, carnitine and ribose, and sex hormones, combined with often-diet-deficient minerals and vitamins – virtually avoid disability/ death from and surgery for heart disease (Sinatra and Roberts: Reversing Heart Disease 2007) .

Short of replacement, one cannot fix the worn-out heart, kidney, hip, spine, joints or mind once these are broken – as happens in virtually all aging adults. Half of older people die suddenly- and half of heart attacks and strokes kill suddenly or cripple permanently. Fortunately very few are crippled or killed by the commonest cancers (breast, prostate womb), so the common cancers are the least worry of aging. Of the perhaps 1 in 10 adults who develop breast or prostate cancer, with sensible management, less than perhaps 1 in 20 dies from the cancer.

But nothing can reverse sudden death, or worse, more than the mildest memory loss from dementing diseases (unless these are not due to Alzheimers’ or widespread vascular damage). And without (rare) mental or surgical transformation, very few people manage to reverse obesity back to health. So it is negligence, suicide to wait till obesity, vascular, cancer, fracturing or dementing diseases develop, when these can mostly be prevented.

OBESITY AND DIABETES PREVENTION/ TREATMENT: Overweight is the commonest avoidable cause of the diseases of aging – obesity, aging, vascular, musculoskeletal, dementing and malignant diseases.

Metformin (Werner & Bell 1922) – dimethylguanidine – is the only ‘synthetic’ drug (a tagged antihyperglycemic extract of the galega officinalis plant) that has been proven to be a panacea against virtually all major diseases, a heavy-metal chelating, anti-infection clot-avoiding anticancer antihypertensive antioxidant insulin sensitizer (without increasing C peptide) that also reduces lipidemia; and bone resorption (and thus unblocks obesity-related delayed adolescent growth) via promotion of nitric oxide. It is the only designer drug ever that has been proven in a 20 year randomized controlled trial RCT (mean 13.6yrs- the UKPDS, Holman ea 1998) to reduce all major adverse events including cancer and all-cause mortality by 36% in diabetics; and reduce new diabetes by about 50% (30 – 70%) in major prevention trials in the overweight over a mean of about 3 years in the USA, India and Chinese Diabetes Prevention Programs; and produces and sustains about 8% weight loss in the overweight for at least 4years – without a singe major adverse effect.

No other designer ie invented drug for chronic prevention can claim such multisystemic benefits and lack of adverse effects in sensible tolerable dose Unlike metformin, no new drugs are subjected to rigorous trials of even five years before they are launched on the unsuspecting public. So it is left to chance whether patients die or are crippled by new drugs before there is such outrage that they are cancelled. And the American Government has made it impossible to sue their profiteering devious drug companies for such negligence! . SEX

HORMONE REPLACEMENT SHRT: Estrogen is a known immunostimulator ie it easily awakens (auto)immune reactions and malignant growth; whereas progesterone and testosterone are known immunomodulators ie balance immune responses. In cell cultures, estrogen too may have dimorphic ie opposing effects on nitric oxide (Walsh 2003; Shih 2006; Richette 2007).

But in postmenopausal women transdermal or oral estrogen replacement ERT with or without cyclic synthetic progestins for 6 – months increases NO levels (Serin 2001; Kesim 2005). But progesterone followed by estrogen promotes activation of dormant breast cancer cells – so in both men and women these must always be at physiological bloodlevels with balancing testosterone levels, all at the lowest necessary doses.

Testosterone on the other hand is the well-known crucial stimulator of nitric oxide synthetase (Shabsingh 2004), like vitamin D and metformin an immune balancer fighting infection and cancer, muscle and bone frailty, thrombosis and depression.

So for youthful health (not least lifelong healthy necessary sexuality), most aging men (as often as do women) need physiological ie non-oral testosterone replacement to replace their youthful testosterone and estrogen levels; and women need non-oral replacement of estrogen and testosterone to restore balance. And both need some progesterone as well for optimal health.

It is unfair that aging men are given only safe parenteral testosterone ie spared the risks of testosterone tablets (which were banned some time ago), but aging and more vulnerable women are told it’s OK to take sex hormone therapy – tablets- by mouth. It has been well known for decades that (unlike balanced non-oral hormones) this is risky – especially using xenohormones – hormones foreign to humans: premarin from mares’ urine, and progestin ie synthetics.

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