Presentation on theme: "Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE Edward Lichten, M.D. FACS, FACOG, FABAAM American Academy of Anti-Aging Medicine December."— Presentation transcript:
Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE Edward Lichten, M.D. FACS, FACOG, FABAAM American Academy of Anti-Aging Medicine December 14-15, 2007
The Worst Diabetic Male 50 years old, dark skinned man on insulin No regular source of work, food, healthcare Junk food and history of homelessness Confused and disoriented If you were faced with What Would You Do?
Send him to the hospital? Refer him to an endocrinologist, who handle 75% of all diabetics? Treat him? Even if you were a Board Certified Gynecologist?
Hemoglobin A1c= 18: Uncontrolled Diabetic Anthony
There is a new way of thinking about staying healthy.. And it is called Anti-Aging Medicine Ageless 75 year old Mary won the Alcatraz swim by going directly across San Francisco Bay
Ten Years Ago the Future of Anti-Aging Medicine was Using Bio-Identical Hormones that identically match the hormones produced in the body – Sustained release T4 and T3 thyroid – DHEA – Pregnenolone
Ten Years Ago the Future of Anti-Aging Medicine was Using Gender-Specific Hormones – Estradiol and Estriol for women – Progesterone for women – Testosterone for women – Testosterone for men Because a man and a woman are different, their body respond differently. Medical therapy must be based on matching their innate ratio of natural sex hormones. And that was good and the A4M increased in members
Because of the Ground Breaking Exposure to B-HRT from the A4M and the Life Extension Foundation A4M LOFTY GOALS: Anti-Aging medicine seeks to identify the root cause of ones symptoms...We age because our hormones decline, our hormones dont decline because we age. Michael Galitzer, M.D. There is a Greater Awareness that Staying Healthy can be assisted by Replacing and Maintaining, these Natural, Bio-Identical Bio-Identical Hormones Hormones But we must remember 1991:
The problem with Anti-Aging Medicine Is that our Antidotal Reports do not have a Scientific Methodology: Therefore, our detractors say we are snake-oil salesmen
There are 6 Endocrine Glands in the human body that release biologic hormones Hypothalamus Pineal Pituitary Thyroid Adrenal Pancreas Ovaries-Testes Scientifically,
When in Balance 12 MAJOR HORMONES Released by these six endocrine glands work together, Exciting your body to Energy and Health Growth Hormone Thyroxin & T3 DHEA & Cortisol Insulin & Glucagon Testosterone Estradiol & Progesterone Calciferol
Suggested that proper replacement of bio-identical hormones holds great promise in the future in slowing the aging process, and as a Treatment for age-related diseases In Suzanne Somers book it is
When you have a Disease like Diabetes You have no Balance, No Energy, And Inadequate levels of Bio-identical Hormones
When you have Diabetes may shorten life expectancy 10 years and be the cause of multiple end-organ failures This imbalance
21 st Century Diabetic Epidemic With twice as many MORE still to be diagnosed!
The Future of Anti-Aging Medicine is here! Treating Diabetes With Bio-identical Testosterone In Men
Diabetes Mellitus Today, we will re-teach the physiology of diabetes. Diabetes Mellitus is the leading cause of morbidity, mortality and 80% of non-cancer medical office visits: it is the primary cause of heart disease high blood pressure Cholesterol elevation cerebral vascular stokes and obesity.
Diabetes Mellitus What do we really know about 1. The cause of diabetes? 2. The diagnostic tests for diabetes? 3. Best medication to control diabetes? 4. The mechanism of action of the medications available for diabetes? 5. The future for treating diabetes?
The Definition of Diabetes Mellitus The Websters Deluxe Unabridged Dictionary Second Edition defines diabetes mellitus as: Diabetes mellitus is a chronic form of disease characterized by excess of sugar in the blood and urine, hunger, thirst, and gradual loss of weight: also called sugar diabetes. Wikipedia incorporates a more scientific description Diabetes mellitus is a disorder of carbohydrate metabolism. It is a disease characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes. Medical Practice The presence of abnormally elevated glycogenated hemoglobin is diagnostic of diabetes mellitus The World Publishing Company- William Collins Publishers, Inc. 1979
The Cause of Diabetes Mellitus: The ancient Egyptians, Chinese, Macedonians (Hippocrates) and Romans (Aretaeus of Cappadocian) recognized this disease to be one of excessive urine (polyuria), leading to wasting and death. Today, we scientifically characterize this disease by its specific anomaly of carbohydrate metabolism Type I: Inability to make insulin Type II: Resistance to the insulin made
The Cause of Diabetes Mellitus: Type I: Insulin Deficiency characterized by – Destruction of the pancreatic islet cells by some infection or autoimmune reaction – Typically occurring in a child or adolescent Type II: Resistance to the Action of Insulin characterized by – Resistance to insulin at the cellular level with the initial excessive insulin production being unable to clear glucose from the blood stream Pre-Diabetes: Metabolic Syndrome is a pre-diabetic condition with excessive insulin production effectively keeping the glycogenated hemoglobin in normal range.
What are the Diagnostic Tests for Diabetes Mellitus? Screening tests – Urine: presence of glucose – Blood: elevated glucose level Diagnostic tests – Blood: elevated fasting serum glucose – Insulin: elevated fasting insulin level – Red Cell: elevated glycogenated hemoglobin measured directly or as Hemoglobin A1c Comprehensive testing – Glucose Tolerance Test with Insulin levels
Glucose Tolerance Test with Insulin Levels The GTT shows the dynamic response of glucose being cleared from the blood after the stress of a glucose load. GTT-I was described by Kraft in 1976; any glucose >145 or insulin >50 is strongly suggestive of obesity and/or the metabolic syndrome. RL Kraft, M.D. Chairman, Dept. Of Pathology, St. Josephs Hospital, Chicago, Ill. In Radio-assay: Clinical Concepts. Proceedings from a Symposium On Radioimmunoassay Held in Washington, DC January 28-29, 1974; Glucose Levels Fact- 1: GTT-I needed to classify type of diabetes
The Glucose Tolerance Test with Insulin Levels The GTT-I shows the dynamic response of insulin in presence of the stress of a glucose load. Normal 4 fold increase at first hour; 50% drop at 2hr Type II diabetes is a progressive disease characterized by increasing demands for insulin. Hollenbeck C, Reaven GM. Variations in Insulin-Stimulated Glucose Uptake in Healthy Individuals with Normal Glucose Tolerance. JCEM 1987;64: Normal Insulin Levels
Type-I and Type-II late AODM lack an insulin dynamic response Type I: SumI <70Normal: SumI Type II-late SumI <70Type II-early SumI >130 Fact-2: Type I and Type II late have inadequate, flat insulins < 70
The Standard of Care protocol for treating diabetes mellitus is Type I: add subcutaneous insulin Type II: add oral hypoglycemic agents, insulin- sensitizers and newer oral and injectable agents Type II-late: add insulin injections if all else fails Based on the hospital approved Evidence Based Protocols With the goal is to control hyperglycemia
But since Type I and Type II late are practically identical! Type I diabetes Normal screened group – Obese, aging population Type II diabetes – Early Type II diabetes – Late GTT-I: no Insulin changes GTT-I: normal or metabolic syndrome based on normal GTT-I: hyperglycemia and higher insulin release GTT-I: No or poor insulin response Why would you treat Type-I or Type-II late differently?!
Scientific Method: Lab Tests must dictate treatment Scientific Methodology 1.Cannot treat NIDDM without a GTT-I 2.Type I and Type II-late are virtually identical 3.Stop oral hypoglycemic agents Type I & II late. 4.Ask why would a U.S. Doctor start oral agents to temporarily treat hyperglycemia while accelerating the transition from Type II early to Type II late? Especially when we now know that better bio-identical treatments exist? Fact-3: Hypoglycemic agents are not indicated for Type I or late Type II
The Failure of Evidence Based Medicine American physicians have been taught to treat by protocol the diseases like heart, diabetes, obesity and high blood pressure. DIABETES MELLITUS GIVES US A CHANCE TO THROW AWAY THE PROTOCOLS AND TREAT THE CAUSE.
But You Already Know the Cause and Treatments? Right?! Type I is an autoimmune disease that destroys the Beta islet cells that produce insulin. Treat with insulin. Type II is caused by insulin resistance. Treat with oral hypoglycemic agents.
NORMAL PHYSIOLOGY is Facilitated Transport Promotes glucose storage CELL Only in the presence of INSULIN is GLUCOSE taken into the cell. INSULIN (Big Cheese) GLUCOSE (Sugar Bag)
Is the Cause of Poor Type I diabetic control unavailability of physician supervised Insulin? No
Type I Diabetes Mellitus Treatment: Injectable Insulin FACT: Ideal control of Diabetes, lowest possible Hemoglobin-A1c is the single, most important predictor of a long-life and freedom from complications. M Rizzo, ADA FACT: Adding insulin alone brought less than 40% of volunteers to HgB-A1c of Mathew Riddle, M.D. Letter to the Editor: JAMA. 1997; 297(19): Hayward RA. Maning WG, Kaplan SH, Wagner EH. Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications and resource utilization. JAMA 1997; 278: The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England J Medicine 11993;
Insulin Therapy is Not Enough for Type I Diabetics! UNDERSTANDING the Role of Testosterone Therapy for Men with Insulin Requiring Diabetes Mellitus
Oral Therapy is Not Enough for Type II Diabetics! UNDERSTANDING the Role of Testosterone Therapy for Men with Non-Insulin Requiring Diabetes Mellitus
All Diabetic Men are Testosterone Deficient! A4M: 1998 Lichten keynote speaker JAMA: 2006 Ding EL. Harvard Medical group Higher levels of testosterone are protective A4M: 1998 Lichten: Add-back testosterone JAMA: 2006 Ding: Higher bio-testosterone Cross-sectional studies indicated that testosterone level was significantly lower in men with type 2 diabetes....Similarly, prospective studies showed that men with higher testosterone levels (range, ng/dL) had a 42% lower risk of type 2 diabetes Fact-4: A4M attendees heard it first! Eric L. Ding, BA; Y. Song MD et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA. 206; 295:
Physiology of Diabetes- Cells Need Energy as well as Insulin Glucose must be cleared from the blood stream to minimize AGEs, accumulated glycogen end-products, that clog the cell. Energy is needed for facilitative transportation to move glucose across the cell membrane. The ATP Cycle that produces Energy is activated by bio-available sex hormones. In the male, the key bio-available sex hormone is TESTOSTERONE. Fact-5: Need energy Why Testosterone? Low levels of testosterone predict death. Shores MM. Low Serum Testosterone and mortality in male veterans. Arch Inter. Med 2006 Aug 14; 166(15): After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, ; P<.001)
There are two keys to opening the cell wall to transport glucose 1.INSULIN: discovered by Banting and Best in Sex Hormone Binding-Sex Hormone ligand discovered in 1955 but not recognized for its role in glucose transport until today Fact-6: Two keys to cell wall dynamics: insulin and testosterone in men
Understanding SHBG Sex Hormone Binding Globulin (SHBG) when bound to the sex hormone of TESTOSTERONE or ESTRADIOL is the ligand that affixes to and changes the 3-dimensional cellular wall characteristics to facilitate entry of not only hormones but glucose and nutrients.
Examples of better glycemic control in Type I diabetics Since Harvard now agrees with the A4Ms lecturer Dr. Lichten that all diabetic men are testosterone deficient First, and Foremost TESTOSTERONE ADD-BACK BIO-IDENTICAL TESTOSTERONE To all diabetic men
Insulin Dependent Diabetes Mellitus Testosterone IM Reduces Insulin Requirements 72 yo. White male in year Testosterone reduced hyperglycemia and almost all of the 40 units/day of insulin required in 2 months! T-2 protocol: Testosterone injections 100mg IM twice a week. Gangrene unresolved- amputation necessary. Insulin Use in case of Gangrene
Insulin Dependent Diabetes Mellitus Testosterone IM Improved Glycemic Control A.M. 50 year old Black Male presented on 16units/insulin/day – HgB-A1c >18% – Glucose fasting: 488mg/ml T1-protocol: increased insulin while starting add-back Testosterone weekly IM 20 weeks later: – HgB-A1c = 7.4% – Glucose fasting: 47 mg/ml in AM asymptomatic
Hypoglycemia and impending coma in brittle, insulin-requiring diabetics is the reason doctors err on keeping the blood sugar high. Testosterone allows tighter control by preventing symptomatic hypoglycemia and coma The Key to Tight Glycemic Control is that men on Testosterone rarely experience HYPOGLYCEMIC Crash!
The Key to IDDM Control is that Testosterone Prevents Hypoglycemia Fact-8: Testosterone prevents hypoglycemia Stored Tissue Glycogen Blood Stream Glucose Insulin Glucagon Testosterone ATP Energy Cycle As effectively as Testosterone improves clearance of glucose from the blood stream, it reconverts glycogen to glucose preventing hypoglycemia.
Protecting Men Diabetics from Hypoglycemia Is Unique to Testosterone Makes addition of Testosterone MANDATORY for OPTIMAL DIABETIC CONTROL!! This may well be one of the most important healthcare discovery in the last 100 years!
Insulin Requiring Diabetic Men (Type I and Type II late) Need Testosterone to improve their glycemic control and reduce their requirements for insulin. What about Type II diabetic men? Conclusion: Type I and II-late need testosterone and insulin
Adult Onset Diabetes Mellitus : has the same complications as Type I Hyperglycemia and Hyperinsulinemia precede DIABETES: – OBESITY – HEART DISEASE – RETINOPATHY – GANGRENE and Shortened life expectancy by up to 10 years!
Adult Onset Diabetic Men need Testosterone!! Before and 1-year after testosterone replacement: year Abnormal GTT-I Low Testosterone Normal GTT-I Normalized Testosterone
Non-insulin Dependent Diabetes Testosterone Improves Hyperglycemia Discontinues 20mg of micronase and lowers fasting glucose on T-2 protocol with twice weekly testosterone injections Fact-4: All Diabetic Men are Testosterone Deficient Fact-10: All NIDDM, Diabetic men may benefit from Testosterone
Testosterone improves Hemoglobin A1c Without meds, change in diet, exercise, or weight loss, DB was able to drop his HgBA1c from 11 to 6.5 in 4 months without oral agents. Fact-11: Testosterone improves glycemic control with/out weight loss JULY AUG SEPT OCT 2001 Hemoglobin A1c !!
Screen Everyone for Diabetes and pre-diabetes ( metabolic syndrome) Fasting: – Glucosenormal < 105 mg/dl – Insulinnormal < 10 uIU/ml – Hemoglobin A1c normal < 6 percent – Triglyceridesnormal < 130 mg/dl Testosterone: – Total Testosteronenormal> 450 ng/dl – Sex Hormone Bindingnormal < 15 nmol/L – Estradiolnormal < 25 pg/ml Fact-12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids-- and for men, bio-available testosterone
U.K. Treats Diabetic Men with IM Testosterone D. Kapoor in 2006 published double-blind cross-over study confirming that testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypo-gonadal men with type 2 diabetes. Statistical findings – Reduce insulin resistance – Reduced insulin required – Reduced fasting glucose – Reduced HgB-A1c – Reduced waist measure – Reduced total cholesterol 10 men on insulin pre-study 14 men not on insulin Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol, 154(6):
Adult Onset Diabetes Mellitus: When treating a 35+ years old male, with sexual complaints or medical conditions… Demand a measurement of Bio-available Testosterone! Because Testosterone affects every cell in a mans body Brain: libido, mood Muscle/ Bone: strength Liver: synthesis proteins Sex Organs: penile growth, reproduction
Measurement of Bio-Available Testosterone Serum Testosterone Levels – Total Testosterone – Free Testosterone FAI= Sex Hormone binding globulin Free Androgen Index (FAI) – Ratio of Testosterone/SHBG – Ideal: 0.7 to 1.0 __[Testosterone total]__ 30x [SHBG]
Diabetic Men are Testosterone Deficient! (also Obese, Heart, Lipid, Hypertensive) The Europeans measure unbound testosterone as the FREE ANDROGEN INDEX [TT]/[SHBG] Normal: Ratio greater than.7 MaleNormalMetabolic Syndrome Total Testosterone450 ng/dl250 ng/dl Sex Hormone BG 15 nmol/L50 nmol/L Free Androgen Index> to 0.4
Avoid treating Type II-early diabetes with oral agents (sulfonylureas, insulin sensitizers) It is bad practice to treat the symptom (of hyperglycemia) while ignoring the scientific proof that these protocol medications may accelerate destruction of the pancreatic islet cells…
FACTS to REMEMBER 1: GTT-I needed to classify type of diabetes 2: Type I (autoimmune) and Type II late (burn out) are similar: insulin requiring 3: Oral hypoglycemic agents are rarely indicated 4: All diabetic men are testosterone deficient 5: Glucose movement takes energy: energy takes testosterone 6: Insulin and Sex Hormone+SHBG ligand are keys to cell wall permeability 7: Testosterone improves glycemia for IDDM: Insulin dependent diabetic men 8: Testosterone may help prevent hypoglycemia, crisis and coma 9: Only Injectable forms of Testosterone are Effective for Diabetes 10: All NIDDM men may benefit from Testosterone 11: Testosterone may improve glycemic control with or without weight loss 12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids --and for men, testosterone measurements
Putting it all together INSULIN is still involved in facilitated (glucose) transport but transport takes ENERGY! TESTOSTERONE is the source of ATP energy from the Krebs (citric acid) cycle that facilitates the action of insulin! INSULIN & GLUCOSE
Hippocratic Oath: Above all, physician, Do No Harm! Practicing the Standard Medical Treatment Protocols for Adult Diabetic Men 1.Ignores the appropriate treatment of one scientifically recognized cause of Diabetes in men: testosterone deficiency 2.Exposes the patients to unnecessary drugs, side-effects and expense. The annual cost of diabetic outpatient medications are
Health Care is in Flux Paradigm Shift from prescription Pharma to prevention is being fueled by 50 million paying baby-boomers who are taking an active role in maintaining and improving their physical and mental health. This is called Anti-Aging! – Exercise and diet – Vitamins and supplements – Reading, researching and exploring new and alternative medical avenues for prevention.
We have learned today that Gender-Specific hormones are the key to living well I dont buy the Pharma storyIll do what is best for me! Nutrition, exercise, avoid toxic smoke, food and environments.. – But most importantly Take Bio-Identical Hormones!
Testosterone Alone End of the Pharmaceutical Stranglehold on Diabetic and Medical Practice So we are offering our patients FDA approved injected testosterone at a cost of $15 per month and, an entirely new concept that may herald in the
Or a U.S. DOCTOR who puts his patients first? Diabetes Education: Screen, test, treat: low testosterone and diabetes Men with diabetes have a 2x greater risk of having total testosterone less than 300 ng/dl. Endocrine Today: October 2006 American Association of Diabetic Educators, Donna Rice MBA, RN, CDE president
You need to decide Testosterone Injections and Pellets can be dispensed in your office practice Along with better medical care
TESTOSTERONE is the key to life for men…period. Testosterone has been studied and used since 1939; before there was an F.D.A. Higher levels of testosterone are associated with living longer and is truly, Anti-aging medicine
You, Doctors, are the Masters of Medicine Staying Healthy and Treating Disease is by keeping us all Anabolic! Say Yes to Testosterone! If you learn only one thing today, remember For you and your patients,
The purpose of science is not to cure us of our sense of mystery... but to constantly reinvent and reinvigorate it. Robert M Sapolsky, M.D., professor of biology and neurosciences, Stanford University and author of The Trouble with Testosterone. Simon and Schuster. NY. 1997
So Become the Anti-Aging Doctor of the future Be the doctor that knows the science behind the causes of diabetes Be the doctor in your area with the knowledge to truly treat the disease, naturally Be the doctor that shows your patients they can discontinue the synthetic, Pharmaceutical expensive oral agents and reduce their insulin and have less complications and feel better and have better sex!
The Future of Medicine Is in your hands
Edward M. Lichten, M.D., FACS, FACOG WEBSITE: Office: (248) Lichten Wellness Center –180 East Brown Street –Birmingham, MI For copies of this lecture or study course, I hope I have done that for you today.
Insulin Resistance predicts Age- Related Disease including Cancer Metabolic Syndrome (Increased Fasting Insulin, Exaggerated Insulin Response, or Reduced Insulin Response to glucose load) predicts Heart Disease, Obesity, Dyslipidemia, Hypertension, and Diabetes GM Reaven MD shocked the medical establishment by following 208 apparently healthy men and women for 4 to 11 years. Those in the upper 1/3 of steady-state plasma glucose (or area under 2hr-OGTT insulin curve) had 28 of 40 clinical events including cancers. Middle 1/3 had 12. Lower 1/3 had none! FS Facchini, GM Reaven. Insulin Resistance as a Predictor of Age-Related Diseases. Journal Clinical Endocrinology Metab 2001:86;
Hypothesis: Add Back Testosterone is Anti-Aging Men who are testosterone deficient by FAI will live longer and better because they will have less METABOLIC SYNDROME Measured as lower fasting insulin, normalized GTT-I are associated with reduced risk factors: obesity, heart disease, hyperlipidemia and hypertension
Personal and Medical Experience Personal and Medical Experience 50 My own andropause at 45 trigger my interest and I knew that without finding that natural treatment, I would not have been here with you today!