AMMG shares the latest research findings, eye-opening presentations, and engaging, interactive panel discussions with experts to introduce and update physicians on the latest science-based clinical information and sophisticated clinical applications. Following is a brief review of the presentations at the 2019 conference which took place in Tucson, November 7-10.

The Over/Mis-Diagnosis of Depression/Anxiety/Bipolar/Mood Disorder and the True Issue Being Hormonal Decline

Jill E. Stocker, D.O., President, Jill E. Stocker, D.O. PC

In 2017, the WHO listed depression as the leading cause of illness and disability worldwide. We’re so emotionally constipated as a society. There’s so much fear and shame around expressing emotions or that maybe you feel “off.” The “I’m fine” mask needs to come off! You deserve a whole SPECTRUM of emotions! We should celebrate, not medicate! All too often patients are over or misdiagnosed with depression or mood disorder, and the underlying issue is truly hormonal imbalance. They are told that their lab values are “normal” and that their symptoms are “just part of aging”, “in their head” or given a label of anxiety/depression/mood disorder/bipolar disorder. When patients are effectively LISTENED to, and a common language of symptoms is established, people are able to go from surviving to THRIVING, with hormonal and life optimization.

How Modern Medicine is Slowly Killing Women: Becoming Part of the Solution and Not the Problem

Angela DeRosa, D.O., MBA, CPE, Founder & President, Hormonal Health Institute, Scottsdale, AZ

In 2002, the Women’s Health Initiative JAMA article was a “shot” which was heard around the world. This changed the landscape of women’s hormonal health and some might argue irreparably harmed women’s health for decades to come. “Hormones were killing women” was the mantra, but unfortunately this “shot” was inappropriately aimed and highly inaccurate. However, the damage was done and this left hormonal and women’s health experts with a tough road to climb in changing the paradigms related to the true data and understanding as it comes to women’s health, hormones and its impacts on long-term health. Unfortunately, modern medicine through its best intentions are slowing killing women with pharmaceuticals and other medical “advances” with disregard to the root causes of what drives women to seek help from their providers. We are slapping band-aids on hormonal symptoms when balancing a women’s hormones would get to the cause and help patients live longer and healthier lives. This lecture reviewed the historical aspects of the WHI and the harms it created for women and more importantly provided the true data to become part of the paradigm shift and gave solutions to help our female patients live longer and healthier lives.

Viagra Surprise: The Blockbuster Age Management Benefits of the PDE5 Inhibitors

Eugene Shippen, M.D., Medical Consulting, Exide Technologies, Inc.; Consulting practice, Wyomissing, PA;  Author, “The Testosterone Syndrome”

There is one blockbuster treatment, that is by far the most cardio-protective treatment to date, but has been completely ignored by cardiologists and mainstream doctors. One recent article shows 81% reductions in all cardiovascular events (MI, revascularization, heart failure or death) in 43,000 men with established CVD who use PDE5 inhibitors regularly! There are even greater reductions in overall mortality if PDE5 inhibitors are combined with other treatments (statins and testosterone) in 857 diabetic men over 3.8 year periods – 60% mortality untreated vs <3% mortality if treated with all three treatments! Amazingly, there are other major benefits that include improved brain function and repair after stroke and possibly prevention for aging dementia. Additional major benefits include treatment of pulmonary hypertension and heart failure. One of the key mechanisms of action is the increased release of endothelial stem cells that populate the major organs. This effect may be the major reason for diverse health benefits way beyond the sexual benefits most doctors see as the major function of this category of drugs. The PDE5 inhibitors, like Viagra and Cialis, have a growing peer reviewed literature that outlines these many benefits. These references were presented.

The Estrogen, Progesterone, Testosterone Link: Aging Men and Women

Benjamin S. Gonzalez, M.D., Medical Director, Atlantis Medical Wellness Center, Silver Spring, MD

This presentation offered a detailed look at the connection between estrogen, progesterone, and testosterone in both women and men in aging. A discussion and literature review of how these three hormones confer a sense of potency, power, and self esteem in both men and women. It offered discussion of how the Hypothalamic-Pituitary-Adrenal axis plays a role in the decline and maintenance of these three hormones. Case studies were reviewed for emphasis.

Utilizing Genomics, Wearable Data and Technology to Create Data Driven Health

Daniel L. Stickler, M.D., Co-Founder, Apeiron Center for Human Potential, Austin, TX; CME & Co-Founder, Apeiron Academy Medicine Education and Technology

We are in a world where everything is becoming highly reliant on data. Clinicians have been slow to adopt this new paradigm. This talk discussed how to utilize precision genomic data, wearable technology data and other measurable tech devices that can create ideal health plans and interventions.

Empowerment through Knowledge: New Insights into Utilizing Genetic Analysis to Optimize “How to Live”

Dennis A. Goodman, MB ChB, FACC, FACP, FCCP, ABIHM; Clinical Professor of Medicine, New York University School of Medicine; Director of Integrative Medicine, New York University School of Medicine; Department of Preventive Cardiology, New York University School of Medicine; Professor of Medicine, University of Cape Town, South Africa

The purpose of this lecture was to understand the difference between genetics, genomics, and epigenetics as applied to clinical practice. As practitioners, it is not only important to counsel patients about their “specific” genetic variations, but also to help them understand what affects their genetic “expression” has through interaction with their environment including diet and lifestyle. Being familiar with the most “cutting edge” testing in the field of genetics helps the practitioner be able to focus on what is important for each patient on an individual basis. And instead of concentrating on genetics that show an “increased risk of dying” the presentation focused on how to use the genetic information, interpretation, and application to show a person “how to live optimally”!

Matching DNA with Interventions to Resolve Obesity and Increase Longevity

Elliot Dinetz, M.D., ABFM, Timeless Health, Miami, FL

As we continue to see the development and utilization of Genomics entering clinical practice, this presentation examined what this will mean for patients now and in the future. The definition of Genetics, Genomics was covered and what Single Nucleotide Polymorphisms (SNPs) are and how they’re helping better the way we practice medicine. With the future of healthcare being personalized medicine, this technology will continue to help enable us to tailor medical care to the individual and maximize health span. SNPs, or our genetic variants, may predispose an individual to health risks but they too may prove beneficial. In reviewing some of the more well-studied SNPs Dr. Dinetz showed how to utilize this tool as part of a systems biology approach for advanced prevention. Additionally, in understanding patients’ metabolic needs, he shared how to customize an ideal lifestyle such as exercise requirements, appropriate nutrition, and even alerting of potential food sensitivities which can cause occult inflammation. By alleviating the need for trial and error we can limit patient suffering and optimal health can be accelerated. With this technology we may improve upon precision care to enable physicians to best target chronic conditions. By identifying susceptibility towards things such as histamine accumulation, high risk variants for clotting disorders as well as cardiovascular disease, and how certain people are more prone to inflammation, we may more effectively treat their root cause. With an integrative approach we may help improve, even reverse, conditions like IBS, migraines, and cardiovascular disease. This physician assist tool may help achieve results that go far beyond the reactive focus in conventional care and allow Primary Care to take control of health care. This is the epitome of personalized medicine.

Natural Aromatase Inhibitors

Derrick DeSilva, Jr., M.D., Teaching Faculty, JFK Medical Center, Edison, NJ; Co-Chair, Department of Complimentary Medicine and Senior Attending Staff, Raritan Bay Medical Center, Perth Amboy, NJ

One of the most dangerous enemies to men when it comes to boosting testosterone is the Aromatase enzyme. This destructive enzyme’s main role is to convert testosterone into the female hormone estrogen. It goes without saying that men who want to keep their testosterone at optimal levels need to take measures to keep this enzyme at reasonable levels because this will ensure that they are protecting testosterone and not allowing it to be converted into estrogen. Of course, we can control aromatase activity with the use of prescription medications, but what about the potential nutrient depletion and the side effects from the prescription drugs. There are “natural aromatase inhibitors” that have well documented effects without the side effects and have the potential for “side benefits” vs. side effects. These natural aromatase inhibitors were reviewed along with some of the other potential side benefits that these natural compounds process.

Treatments for Hyperthyroidism; rT3 and Hypothyroidism; TSH, Treat the Patient not the Lab Result

Jonathan V. Wright, M.D., N.D. (hon), Private Practice, Tahoma Clinic, Tukwila, WA

This presentation was based on research published in 1980 by the Endocrine-Metabolic Service of Walter Reed Army Hospital, which told us that iodine and lithium rapidly controls thyrotoxicosis. The presentation provided detailed case examples including supplementation amounts, testing, and other recommendations until resolution of condition. The next segment of the lecture discussed the relationship of elevated rT3 with toxic metals and how to recognize the problem. The final section dealt with TSH, investigating whether or not TSH should be relied on as an indication of thyroid function. Discussion on the relationship between TSH and TRH, and a few of the other non-thyroidal functions of TRH were provided.

Enteroimmunology & Endocrinology: How Dysbiotic Gut Inflammation Leads to Hormone Imbalances and How Reversing Them is the Key to Resolving Chronic Illness

Dushyant Viswanathan, M.D., ABIM, ABoIM, AACE, Medical Director, The Columbia Center for Integrative Medicine, Columbia, MD and Woodland Hills, CA

Gut dysbiosis is associated with inducing a chronic inflammatory state that affects every organ and is implicated in the pathogenesis of multiple chronic conditions in the scope of internal medicine. Relevance, diagnostic/therapeutic concerns of translational mucosal immunology (“Enteroimmunology”) and the impact on measured cortisone secretion patterns was discussed as demonstrated by 24 hour salivary cortisol testing. Inflammatory cytokines stimulate cortisol secretion, and over time, an endocrinopathy develops: dysfunctional diurnal cortisol secretion, depletion of beneficial hormones such as testosterone, DHEA, progesterone, pregnenolone, thyroid hormone, and sometimes estrogens (although elevations of estrogens due to impaired excretion is more common) occur. These physiologic events are implicit in the process of aging. Treatment approaches were clarified and cases were reviewed featuring gut microbiome repair and restitution of optimal hormone levels as essential to lessening physiologic/cellular aging and inflammation.

The Little Explored Link Between Insulin Resistance and Autoimmune Disease

Ritamarie Loscalzo, BA, MS, D.C., DACBN, CCN, Private Practice, Austin, TX

Insulin resistance can both cause and be caused by an autoimmune condition. This presentation discussed the connections between: Insulin resistance becoming epidemic; Type 2 diabetes on the rise;  and LADA – latent autoimmune disease of adulthood becoming common, and very much overlooked by a lot of medical practitioners. Discussion about insulin resistance and inflammation, the production of auto-antibodies and the effect on blood sugar control, and how all of the complications can be prevented by early detection of insulin resistance – what was termed pre-insulin resistance was covered. “Pre-insulin resistance” can be detected decades before it is clinically recognized, and nutrition practitioners are uniquely positioned to coach clients on how to prevent, detect and reverse it naturally.

Reducing Toxic Load and Body Burden: Resetting the Microbiome with Botanical Medicine 

Emily Poccia, BS, N.D., Medical Director & Owner, Wildcraft Medicine, La Jolla, CA; Clinical Consultant & Practitioner Trainer, Bio-Botanical Research

Infection and endotoxins from biofilms and pathogens in the GI tract contribute to or directly cause systemic inflammation, including autoimmune disorders, heart disease, chronic fatigue/fibromyalgia syndromes, Lyme, periodontal disease and other conditions. Biofilms and chronic infections have been difficult to address with conventional medicine, but research into plant-based approaches have demonstrated great success. The goal of this presentation was to review research and expand participants’ understanding of botanicals and the role that they play in the practice of regenerative medicine.

Dementia Demystified: A Functional Medicine Approach To Reversing Mild Cognitive Impairment and Dementia

Kat Toups, M.D., DFAPA, IFMCP, Private Practice, Functional Medicine Psychiatry, Bay Area Wellness, Walnut Creek, CA; Distinguished Fellow, American Psychiatric Association; Certified Practitioner, Institute for Functional Medicine

Alzheimer’s Disease is a neurodegenerative disorder – but it is not a mysterious, untreatable brain disorder. It is a reversible multisystem illness that occurs due to toxins and infections and inflammation and lack of hormones and other diet and lifestyle factors. It has a strong autoimmune component as well. Neurodegeneration does not just happen. It happens for reasons, and when we can look at the big picture and address all of the driving factors, we can gain traction in stopping and sometimes even reversing the degenerative process. Alzheimer’s Dementia is a multi-factorial disease, and it is rarely due to just one thing. In order to reverse dementia, we have to look at, and rectify, all of the factors that contribute: metabolic, nutritional, toxic, inflammatory, infectious, autoimmune, and/or withdrawal of trophic support (like hormones and nutrients). Dr. Toups discussed the Functional Medicine approach she used to reverse her own dementia, and how to evaluate patients with Mild Cognitive Impairment and Dementia using a Functional approach to determine the root causes of their illness.

A Case Series of Patients Presenting for Functional Medicine Treatment of Cognitive Decline

Myrto Ashe, M.D., MPH, Certified Functional Medicine Practitioner (IFM); Private Practice, San Rafael, CA

This presentation reported on 56 patients who presented between January 15, 2017 and January 15, 2019 for reversal or stabilization of cognitive decline. A multifaceted approach described by Dr. Dale Bredesen was used as guiding methodology. The population demographics, functional parameters including glucose regulation, intestinal barrier function, key nutrient and hormone levels, biotoxin impact, and chronic infections were described. Included were dropouts from the program, description of the intervention, and reports on cognitive outcome where available.

Volumetric MRI/Brain Imaging Assessments and Clinical Correlations with Dementia

Mary Beth Ackerley, M.D., MD(H), ABIHM, Private Practice, Tucson, AZ; Co-Founder and Vice President, ISEAI, the International Society of Environmentally Acquired Illness

Brain MRI imaging with computerized assessment of the volumetric measurements of multiple brain regions is routinely used for diagnosing Alzheimer’s Age-related Atrophy in the Bredesen protocol. Other uses are for Traumatic Brain Injury, changes related to environmental toxins such as mold and Lyme, and limbic dysregulation. The MRI is easily obtained at most radiology facilities and does not use radiation or require contrast. Most insurances will cover the cost with proper coding. This lecture covered the basics in learning to interpret the reports in a way that patients can know if their aging brain is showing changes consistent with Alzheimer’s. Other cause of cognitive impairment including sequalae of traumatic brain injury, neuro inflammation and other brain regions showing neurodegeneration such as the frontal lobes and basal ganglia were covered. Multiple treatment interventions were discussed.

The Aging Brain: Role of Nutrition and Lifestyle in Prevention and Management of Cognitive Decline

Aarti Batavia, MS, RDN, CLT, CFSP, IFMCP, Nutrition & Wellness Consulting; Private Practice, Novi, Royal Oak and Ann Arbor, MI; Visiting Faculty, Wayne State University Coordinated Program in Dietetics. Nutrition and Food Science

“The loss of a human mind – the gradual deterioration of a lifetime’s worth of wisdom, experience and personal relationships is a tragedy.”—Markham Heid.

Alzheimer’s disease is one of the most significant global health threats we face today. It is estimated that 36 million people worldwide live with dementia, with numbers expected to reach 115 million by 2050. Dementia prevention is an urgent priority, not just to reduce incidence but also to slow, stall the progression and possibly reverse cognitive decline especially in patients exhibiting early signs of the disease. A multi-modal programmatic approach utilizing functional medicine has emerged as a potential intervention to enhance clinical outcomes for individuals with dementia. In this presentation, the speaker discussed the role of nutrition and lifestyle strategies in optimizing cognitive health.

For more information on future events, visit the Age Management Medicine Group website.