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The Seven Basic Clinical Concepts of Anti-Aging Medicine and the Aging Equation

Vincent C. Giampapa, M.D., F.A.C.S.

Man’s mind stretched to a new idea, never goes back to its original dimension.

Oliver Wendell Holmes

Optimizing, or more efficiently activating the “genetic code” is based on the ability to use the seven basic clinical anti-aging concepts.

The fundamental idea to grasp is that most age-related changes are caused by seven main processes as we age. These processes are as follows:

1. Glycation, the cross-linking of proteins (collagen, hemoglobin, and albumin), caused by elevated and poorly controlled blood glucose levels (Diagram I-1).^1–27

2. Increased inflammatory processes, which result from abnormal balances of intracellular and extracellular compounds. These compounds include good and bad eicosanoids (prostaglandins), leukotrienes, cytokines, and thromboxanes. These are categories of age-accelerating compounds, which appear mainly as a result of the actions of free radicals. Poor fatty acid levels and ratios in the cell membranes are also responsible for increasing the inflammatory process and these compounds (Diagram I-2).^28–45

3. Inappropriate intake and balance of extrinsic antioxidants to inhibit the action of free radicals,⁷ as well as decreasing intrinsic antioxidant supplies⁴ (e.g., superoxide dismutase, catalase, glutathione peroxidase) (Diagram I-3).

4. Improper methylation, acetylation and phosphorylation of DNA. These processes determine which genes are activated or inhibited and affect DNA masking and, therefore, gene expression^18,46 (Diagrams I-4 and I-5).

5. Changes in the cell membranes and the intracellular environment (pH levels, cell hydration and accumulation of cellular waste products), resulting in suboptimal protein turnover^18,19 caused by insufficient supply of repair building blocks (plasma amino acids, glycosaminoglycans, omega-3 and omega-6 fatty acids) and diminished protein synthesis in general. This leads to accumulation of damaged protein compounds in both the intra-cellular and extracellular compartments, our “cellular soup.”

6. Abnormal ranges, as well as relative imbalances, of hormones (e.g., “increased insulin, increased cortisol, decreased thyroid hormone, decreased sex hormones, and decreased melatonin and growth hormone levels), resulting in poor cell signaling (signal transduction) and poor cell turnover and regeneration.

7. Compromised DNA structural integrity, resulting from the combination of increased DNA damage with decreased DNA repair. This results in the accumulation of DNA errors during cell replication to replace damaged and aging tissue. This also results in faulty protein and enzyme production, which impairs the cellular machinery within each of the 100 trillion cells that make up the human body. It also results in deficiencies and mutations in stem cell reserves within all organ systems. Stem cell reserves are essential for maintaining optimal functional organ reserve as people grow older.

These seven fundamental processes affect genetic expression.⁴⁶ They form the bases of the “new aging paradigm” (Diagrams I-6 and I-7) and can be viewed as being interrelated, one having a direct impact on the other. Genetic expression is the process that regulates which genes are deactivated (“turned off”) and which genes are activated (“turned on”) (see Diagram I-5).⁴⁶ These processes can now be applied to an overall treatment concept that can be viewed as progressing from the intimate level of DNA within the cell and then outward to encompass total body homeostasis and integration (Diagram I-8). Before we begin to attempt to alter these fundamental processes, a review of past and present aging theories will allow for a deeper understanding of age management and anti-aging therapies.

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