What You Need To Know

Patrick Kee looks into anti-aging screening and how it is used to fend off the effects of disease and prolong life.

The increasingly visible (and not so visible) effects of aging are a popular conversation topic among those who start to feel and experience them. But is it enough to push us to call on the expertise of an anti-aging specialist?

For centuries, people have scoured the world, and even killed, for a treatment that can restore youth. Fortunately in this modern age, we do not have to resort to such measures as we have medical anti-aging – not so much a miracle cure, but a scientific approach aimed to increase longevity with improved quality of life.

The key, some anti-aging specialists believe, is to understand and manage the effects of chronological or natural aging, and pathological or premature aging (which can be brought on by disease).

According to Dr. Caroline Low, family health and anti-aging physician at Raffles Aesthetics, diabetes, hyperlipidaemia (the presence of too much fat circulating in the blood) and hypertension (better known as high blood pressure), are the major risk factors of pathological aging. Risk factors that are high on the list for men in their 40s and 50s include cardiovascular disease and colon and prostate cancer. For women above the age of 40, major risk factors include breast cancer, obesity and perimenopausal symptoms. Cardiovascular disease, osteoporosis and cancer risks for those above the age of 50 are also common.

Bonfire Years

Even without illness, a decline in our physical and mental capabilities become evident with age. Men are threatened with erectile dysfunction and impotency, while both sexes face a gradual degeneration of their sensory organs, motion and cognitional nerves.

Aging is also not kind to our appearance. Fat begins to accumulate in our thorax and abdominal regions, our hair will thin and grey, and dry skin and wrinkles arrive to blight our face. Our joints will become stiff. Even the dreaded andropause (for men) and menopause (for women) symptoms can make us feel uncomfortable in our own skin.

Knowing how your body is aging genetically and also how your genes respond to external factors, is the first step in the attempt to age gracefully. A number of medical centres in Singapore currently provide preliminary anti-aging health screenings for this purpose.

"Singapore still has some way to go to become a true ageless society," says Dr. Low. She adds, "But we are still quite savvy when it comes to health screening."

At most centres, screening packages have been developed for individuals in their 40s, 50s and 60s. Tests that are performed during an anti-aging screening (aside from the usual cholesterol, glucose and organ tests) are the saliva and spot urine tests. Both provide accurate information about bio-available hormone levels. The tests also seek to determine T3, T4, cortisol and growth hormone levels, as well as the metabolites of estrogens and cortisol.

Knowledge of our hormone levels is important to the anti-aging physician, who will need to determine if your symptoms are related to an imbalance, or lack of, specific hormones. Hormones support a broad range of essential physiological functions, including lipid balance, bone mineral density, fertility, sexuality, brain function, as well as one’s general sense of well-being.

Physicians also test for most cancer markers and the patient’s hormonal and metabolic profile. Numerous radiological examinations are made specific to the package selected.

As Professor Walter Tan, consultant plastic surgeon, puts it, "The anti-aging screening first helps us identify deficient nutrients and important trace elements that are necessary for a healthy life. The presumption is that if you correct these deficiencies, you will help the body achieve optimum conditions for a healthy and long life."

Supplementing with nutraceuticals (a portmanteau of nutrition and pharmaceutical) to achieve optimal daily amount levels, are a trusted ally in the anti-aging fight. For example, people may only require 60 milligrams of vitamin C a day under ordinary circumstances, but an anti-aging specialist may advocate a higher dose for optimal health, although this is on a case-by-case medically prescribed basis.

Following screening, advice will be given to the patient on their hormone deficiencies, along with a prescription for medication and supplements, if needed. Patients usually also receive consultation from a dietician and exercise therapist as part of their programme.

Foundation of Youth

Consultation from a dietician and exercise therapist is important. "In order to prolong life span, we must go beyond just living healthily," says Dr. Low. She continues, "The two most important changes is to reduce calorie intake by about 20 percent from the recommended energy intake based on one’s height and weight, and to burn a minimum of 1500 calories through exercise per week."

The benefits of exercise are well known, but those of caloric restriction are not. It is the only known dietary measure capable of maximising lifespan. Dr. Low explains it with brevity, "The average person needs about 2000 calories per day. Reducing the caloric intake by 10 to 20 percent will, in fact, increase the natural production of all hormones especially the growth hormone."

How does calorie restriction work? According to Dr. Low, "Each time we eat, we produce energy which results in inflammation in our cells. While the process is needed for life, inflammation will cause the cells to age faster. By only taking in just enough calories to survive, we will be able to produce enough energy to sustain our organs and live longer."

Trials conducted at Washington University in 2002 by clinical researcher Dr. Luigi Fontana, observed that subjects who underwent restricted calorie intake seemed to be aging slower compared to others. According to him, systolic blood pressure of a 55-year-old practitioner was at 110 – the level of a 20-year-old.

Could diet play a role in life expectancy? In 2004, around 19.5 percent of the Japanese population were over the age of 65. Life expectancy stretched to 81.25 years in 2006. Japanese elderly continue to be active or healthy after retirement, as well.

In matters of diet, Japanese meals are known to be healthy and of small portions. The Japanese consume healthy amounts of fish and green tea (which contains the potent antioxidant, cathecins).

Oxidation is a chemical process that is naturally occurring in the body, but may produce free radicals. These free radicals start a chain reaction that could damage cells. By fortifying our cells with antioxidants, oxidation and cell damage is reduced, which slows down aging and illness.

According to Dr. Low, numerous studies have been done involving the people of Okinawa, Japan, which is known for having the highest number of centenarians per population in the world. The Okinawan diet consists of millets instead of grains, and they also consume a large amount of vegetables. As farmers, they work in the fields until an advanced age, and hence, also have a much lower incidence of osteoporosis.

Aesthetics of Aging

The face is often a showcase of the most visible signs of advancing years – Shakespeare compared it to ploughed lines and the colour of ash.

A variety of methods are available to address sagging skin. An alternative to a full facelift, albeit a less effective alternative, is the thread lift. Small incisions are made in the facial skin so that a surgical thread can be inserted into the subcutaneous (below the skin) tissue. Once slipped into place, the thread is pulled to tighten the skin to the desired effect.

"Whenever there is a multitude of techniques available, the obvious reason is because there is no ‘perfect’ technique available yet," says Professor Tan. "All the thread lifting techniques have one common problem – the lifting is rather modest in nature, and usually cannot be sustained for a long period," he advises.

He adds, "As long as the surgeon is experienced in these techniques, knows the limitations, and explains it carefully to the patient, then the techniques can be used."

Not many realise that the neck is often a sure give-away of aging, and that a firm and taut face, rubbed over with healthy ingredients and resurfaced with laser, is often betrayed by loose or aged skin at the neck. Professor Tan explains that threads can be used to temporarily lift the neck skin, but for permanent tightening, a lower facelift is a more ideal option. In this procedure, excess skin is removed surgically and underlying muscles are tightened.

Tightened skin will continue to have an aged surface texture, so a combination of non-invasive facial rejuvenation procedures, is still usually necessary to achieve the similar glow we possessed in our youth.

Dr. Chris Foo, consultant dermatologist, elaborates on the factors that cause aging in skin. "Facial skin aging is due to a number of different factors, the proportions of each varies among individuals.

"Chronic ultraviolet (UV) damage to the skin, or photoaging, adds to the changes seen in intrinsic chronological aging, and is probably the single largest factor involved in aging skin. Effects include wrinkling, pigmentary changes and actinic keratoses (scaly and crusty bumps that form on the skin surface)."

According to Dr. Foo, other factors include loss of subcutaneous fat, which leads to the loss of fullness and roundness of facial contours; years of facial expressions constantly folding the skin lead to wrinkles at rest; and gravitational effects from loss of elasticity in our tissues lead to sagging skin.

"Smoking can also accelerate the aging process," Dr. Foo confirms.

Knowledge is often the best antidote. Dr. Low encourages her patients to research into the maladies revealed in their anti-aging screening. "Most people do not have a problem with hormonal deficiencies. They just do not want to hear the word ‘Cancer’," she reflects.

The Role of Hormones

Saliva is tested to measure hormone levels of estrone, estradiol, estriol, testosterone, DHEA and progesterone. Estrone and estriol are two of the three main estrogens produced by the body, and are pertinent to health and disease, while the third estrogen, estradiol, has significant impact on sexual functioning, among others.

Testosterone is a steroid hormone that is produced mainly in the testes of males and ovaries of females, and performs a crucial role in maintaining body mass, strength and keeping up mental energy.

DHEA or Dehydroepiandrosterone is a natural steroid prohormone produced from cholesterol and can be understood as a prohormone buffer for the sex steroids. Levels of DHEA, testosterone and the menopausal hormones are known to decline as we get older.

Progesterone is a major human progestogen, which has numerous effects on health including acting as an anti-inflammatory agent, regulating the immune response and helping to prevent endometrial cancer.

T3 and T4 hormones are secreted by the thyroid glands and affect many processes of the body including body temperature, metabolic processes and physical development.

Cortisol, often called the 'stress hormone', can weaken the immune system and retard bone formation leading to osteoporosis.

Growth hormones stimulate growth and cell reproduction.