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Osteoporosis what you need to know about it

As a former anesthesiologist whose practiced for close to 3 decades I am well aware of patients requiring surgical procedures following a fall. Many of such patients are over 65 years old and have co – morbid issues in their medical history making it challenging for the anesthesiologist to provide proper care for such patients. I myself have taken care of thousand of patients over the years some of which required hip surgery. My oldest was a woman that was 101 years old. Though she was a healthy woman it was challenging anesthetic to perform.

The American Academy of Orthopedic Surgeons and the Physicians weekly news letter site that the average cost to the patent is $26,912.00 for hip surgery. Forty percent of these patients re-quire post surgical nursing care costing roughly $200.00 per day. The statistics show that over 300,000 patients over the age of 65 sustain hip fractures and it is estimated by 2040 it will rise by 500,000 patients.

Many patients are not so lucky though. Some patients require and ICU stay after developing pneumonia or other complications. Sadly some never survive in their post-operative stay. Others require extensive painful rehabilitation in an in-patient rehabilitation hospital.

I decided to look at the causes of hip fractures and found that some of the leading causes were from pathologic fractures from cancer and from osteoporosis.

This article is a review of osteoporosis.

Osteoporosis :
involves the porosity of bones and a decreased bone mass leading to increased risk of fractures.

Osteopenia : is the bone loss not severe enough to become osteoporosis

1/3 of woman will develop fractures

At menopause there is a loss of bone.

Risk Factors include :

Sedentary life styles
Excessive Consumption of Alcohol
Smoking History
Family History
Hyperthyroidism
Diabetes
Lung Diseases
Cushings Syndrome ( Excessive Cortisol )
Hyperparathroidism
Glucocorticoids
Anticonvulsants
Antacids

Bisphosphonates : are the most class of drugs used to treat osteoporosis. These drugs have mul-tiple side effects including : esophageal ulcerations, atrial fibrillation, Femoral fractures, osteone-crosis of the jaw.

Other treatments include : Estrogens, Selective Estrogen Receptor Modulators and Calcitonin

Dietary Factors :

Refined sugars lead to low bone mineral density in men and women. There are various beliefs that sugar effects bone loss. These include :

Sugar lacks micronutrients i.e. : minerals and vitamins that are essential for bone health.

Large quantities of sugar ingestion leads to a transient increase of urinary calcium due to the mobilization of calcium from bone to urine

Sugars lead to an increase level of cortisol which leads to bone resorption

Carbonated Beverages :
Both young and older woman that consume large amounts of cola have a lower bone mineral density and suffer from an increased risk of fractures. It is believed that phosphoric acid in the soda cause calcium release from bone making it more porous and fragile. Remember how pour-ing soda on the car paint eats it away, think of what it does to bone.

Caffeine :
A large consumption of caffeine resulted in a lower bone mineral density and more rapid bone loss and an increased risk of hip fractures.

Tea:
Tea seems to have a beneficial effect in increasing bone mass density. Though tea does contain caffeine. It is believed that the Flavanoids has a beneficial effect at maintaining or increasing bone density.

Milk:
There seems to be a conflict of milks benefit in relationship to calcium. However a large popula-tion of people have unrecognized allergies to cow milk proteins. This leads to Gastrointestinal inflammation, malabsorption and nutritional deficiencies.

Sodium :
Patients that consume large quantities of sodium “salt” have large increases of the excretion of calcium due to the loss of hydroxyproline in urine. This is correlative to bone resorption.

Celiac Disease :
is a malabsorption disorder without symptoms. Osteoporosis is a known part of the sequelae
of celiac disease. Loss of nutrients, micronutrients from malabsorption leads to bone loss. Pa-tients whom avoid gluten have an increase in bone mass density. Patients with unexplained os-teoporosis should be evaluated for celiac disease. Studies have shown that patients that have osteoporosis and celiac disease DONOT benefit from supplementation from exogenous calcium and Vitamin D. However patients whom supplement with magnesium in a dosage of 550 mg for 2 years had a higher bone mass density.

Food Allergy :
Chronic inflammatory intestinal diseases from food allergies may leas to lower bone mass densi-ty. The inflammation causes a loss of micronutrients and nutrients from absorption. Additionally due to the release of steroids from food allergenic food may lead to bone resorption.

Protein :
Protein is necessary for the synthesis and maintenance of bone structure and formation. It ap-pears that excessive protein intake could be deleterious to bone density maintenance. This could be do to :

Amino acids that have sulfur in their composition that are metabolized to sulfate which creates an acid load.

Elevated levels of phosphorus impacts bone negatively by increasing parathyroid hormone.

Methionine increases homocysteine which also impacts bone.

The takeaway is that high protein intake is really beneficial to bone due to the intake of Vitamin D, Calcium and Potassium.

Vegetarian Diet :
There is conflicting studies related to bone health. However the most is the nutrients are building blocks for bone. Diets that are low in : zinc, vitamin B12, calcium and Vitamin D and high quality protein impact bone formation and health.

Dried Plums or Prunes :
Studies show that woman that are post-menopausal whom ingest 5-12 prunes daily have de-creased total bone loss. Plums or prunes are rich in Vitamin K, Boron, and Magnesium. These micronutrients are involved in promoting bone health.

Potassium Citrate :
30 meq/day increased bone mass in post menopausal women with osteopenia.

Nutritional Supplements :
Our traditional medical colleagues beat on two supplements : Vitamin D and Calcium. Unfortu-nately bone is a living tissue that requires its own nutritional requirements. In fact maintenance of soft tissue, repair of micro fractures and maintenance of bone requires hormonal balance along with the proper balance of nutrients and micronutrients.

The standard western diet is high in white flour, fat, refined sugar, processed food and canned foods. Along with environmental impacts, genetic factors, and other outside influences upon our own physiology during menopause leads to depletions in : calcium, magnesium, phosphorus, sili-ca, zinc and manganese.

Calcium supplementation ranging from 800 – 1500 mg has been shown to have beneficial ef-fects by slowing the age-related bone loss, and reduced the incidence of fractures. However studies seem to implicate that patients whom supplemented with calcium prior to the onset of menopause for long periods of time and were conscious of their diet had a better result. Addi-tionally as stated calcium should be taken with other minerals ( silicon, magnesium, zinc, phos-phorus, and manganese) as calcium depletes these in bone.

There are many formulations of calcium beneficial for osteoporosis. These include: calcium car-bonate, calcium citrate, calcium citrate malate and tricalcium phosphate. However in some stud-ies calcium citrate malate had a better performance ratio.

Vitamin D:
Vitamin D promotes the absorption and use of calcium. Vitamin D deficiency as you would ex-pect is common in patients with osteoporosis. Studies show that patents that supplement with 700-800 IU/ day reduced their incidence of fractures by 30%. One study showed that doses in the range of 100,000 IU of Vitamin D3 in a single dose every 4 months for 5 years has substan-tial beneficial effects.

Vitamin D has a protective effect against bone loss thus reducing fractures. Vitamin D also has influential properties in enhancing the muscle strength and balance in patients thus reducing the change of a fall and fracture. 800 IU unites daily seems to be the magic number by its effects in slowing bone loss along with preventing the fracture rate.

An additional interesting fact is that different racial and ethnic groups. Thus it should be tailored to the individual.

Calcium and Vitamin D:
Some studies show that the combination of calcium and Vitamin D worked synergistically in re-ducing the incidence of fractures. Therefore the literature shows that the use of both for prevent-ing and treating osteoporosis is evident.

Magnesium:
Magnesium is a cofactor for enzymes to work in our body. Magnesium is necessary for bone mineralization. Women whom are depleted in magnesium showed decreased bone formation and a loss of bone mass and bone volume. Loss of magnesium absorption may be due to the western diet which has an abundance of refined and processed foods.

A dose ranging from 250-750 mg/day for 1-2 years increased bone density in post- menopausal women. Additionally woman with celiac disease benefited from Magnesium supplementation.

Potassium :
Vitamin K1 and Vitamin K2 are the naturally occurring forms of Vitamin K. Vitamin K1 is found in leafy vegetables while K2 is found in milk, meat, cheeses, eggs, and soybeans.

Although Vitamin K is mainly involved in the clotting of blood. It is essential for the formation of osteocalcin which is a large protein in bones and involved in the formation of the bone minerali-zation. Thus Vitamin K is essential in bone formation and remodeling.
Several clinical trials in Japan showed that 45 mg/day of Vitamin K preserved or enhanced bone mass density and reduced the incidence of fractures in woman both post menopausal or elderly woman. This dose however far exceeds what is traditional in the U.S. Dosages of 180 ug/day were effective in preventing bone loss and fracture. Thus Vitamin K is needed in maintaining bone structure.

Vitamins B6,B12,Folic Acid and homocysteine :
Osteoporosis is found early in patients with genetic abnormalities of homocysteinuria. Homocys-teine interferes with collagen cross linking of connective tissue. Thus the strength and stability of bone could be interfered with. Therefore elevated homocysteine can cause a decrease in bone matrix density and bone quality. Folic acid, Vitamin B6 and Vitamin B12 are known to lower ho-mocysteine. Vitamin B12 has osteoblastic activity and Vitamin B6 is involved in bone formation and cartilage growth.

Copper:
Copper is needed for cross-linking and stabilizes collagen in bone tissue along with osteoblastic activity. Children with deficiencies in Copper had developed spontaneous fractures.
The western diets and the grains that are consumed are depleted in copper and are substand-ard in our diet. A double blind study of woman taking 3mg/day of copper for 2 years provided a beneficial effect of bone formation.

Manganese :
Manganese is necessary for bone mineralization and the synthesis of connective tissue in bone and cartilage. A famous basketball player suffered multiple fractures do to osteoporosis. When a deep dive was performed on his mineral composition. Manganese was increased in his diet to a normal range. He was then able to return to playing sports.

Zinc:
Zinc is a co-factor for an enzyme “ alkaline phosphatase “ necessary for bone mineralization. A low zinc level was seen in men ranging from ages 46-68. It again appears that refined and pro-cessed foods maybe causative in low zinc

Boron:
Boron is a trace mineral essential for plant life. Though apparently not essential for humans bo-ron is found in nuts fruits and vegetables. Boron has been associated with a decrease in prostate cancer.

Strontium:
Strontium is found in the human body in the amount of 320 mg. Strontium has 2 effects on bone and connective tissue. Firstly it is present in the crystal lattice of the bone and it stimulates bone formation, inhibits bone resorption and increases bone mass density. Dosages of 170-680mg/day for 2-5 years showed an increase in bone mass density of spine and hip reducing the fracture by 16-49% in post-menopausal women. This was apparently similar to men. However strontium is contraindicated in patents with cardiovascular diseases : which include is-chemic heart disease, peripheral vascular disease and cerebral vascular disease.

Strontium has some other deleterious effects in the formulation of ranelate. This is not available in the U.S. The citrate form of strontium is present in the US and has been to show no systemic effects or toxicity.

Silica or Silicon:
Silica in high concentrations are found in calcifications sites of growing bones. A higher dietary intake of silicon has shown to increase bone mass density. Foods that are processed lead to a decreased amount of silica. Bananas are high in silica or silicon. However the optimal dose is not known.

Phosphorous:
Phosphorous is essential for bone mineralization and hydroxyapatite formation of bone. Adding phosphorous accelerated the healing of fractures. The standard american diet is rich in foods containing phosphorous including ; meats, grains, dairy products, and additives in processed foods.

Vitamins C and A :
Vitamin C deficient patients may develop scurvy. It has been shown that providing additional Vit-amin C had a positive beneficial effect in osteoporosis patient.

Traditional Medicine advocates the use of Prolia.

I searched the internet for the official site for Prolia. Below are the contraindications of Prolia along with the side effects. You as the patient can choose which pathway to take as far as treatment modalities offered.

Contraindications
Prolia® is contraindicated in patients with hypocalcemia. Pre‐existing hypocalcemia must be corrected prior to initiating Prolia®. Prolia® is contraindicated in women who are pregnant and may cause fetal harm. In women of reproductive potential, pregnancy testing should be per-formed prior to initiating treatment with Prolia®. Prolia® is contraindicated in patients with a histo-ry of systemic hypersensitivity to any component of the product. Reactions have included ana-phylaxis, facial swelling and urticaria.

Same Active Ingredient

Prolia® contains the same active ingredient (denosumab) found in XGEVA®. Patients receiving Prolia® should not receive XGEVA®.

Hypersensitivity
Clinically significant hypersensitivity including anaphylaxis has been reported with Prolia®. Symptoms have included hypotension, dyspnea, throat tightness, facial and upper airway ede-ma, pruritus, and urticaria. If an anaphylactic or other clinically significant allergic reaction oc-curs, initiate appropriate therapy and discontinue further use of Prolia®.

Hypocalcemia

Hypocalcemia may worsen with the use of Prolia®, especially in patients with severe renal im-pairment. In patients predisposed to hypocalcemia and disturbances of mineral metabolism, in-cluding treatment with other calcium-lowering drugs, clinical monitoring of calcium and mineral levels is highly recommended within 14 days of Prolia® injection. Concomitant use of calcimi-metic drugs may worsen hypocalcemia risk and serum calcium should be closely monitored. Adequately supplement all patients with calcium and vitamin D.

Osteonecrosis of the Jaw (ONJ)

ONJ, which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients receiving Prolia®. An oral exam should be performed by the prescriber prior to initiation of Prolia®. A dental examination with ap-propriate preventive dentistry is recommended prior to treatment in patients with risk factors for ONJ such as invasive dental procedures, diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disor-ders. Good oral hygiene practices should be maintained during treatment with Prolia®. The risk of ONJ may increase with duration of exposure to Prolia®.

For patients requiring invasive dental procedures, clinical judgment should guide the manage-ment plan of each patient. Patients who are suspected of having or who develop ONJ should receive care by a dentist or an oral surgeon. Extensive dental surgery to treat ONJ may exacer-bate the condition. Discontinuation of Prolia® should be considered based on individual benefit-risk assessment.

Atypical Femoral Fractures
Atypical low-energy, or low trauma fractures of the shaft have been reported in patients receiv-ing Prolia®. Causality has not been established as these fractures also occur in osteoporotic pa-tients who have not been treated with antiresorptive agents.

During Prolia® treatment, patients should be advised to report new or unusual thigh, hip, or groin pain. Any patient who presents with thigh or groin pain should be evaluated to rule out an incom-plete femur fracture. Interruption of Prolia® therapy should be considered, pending a risk/benefit assessment, on an individual basis.
Multiple Vertebral Fractures (MVF) Following Discontinuation of Prolia® Treatment

Following discontinuation of Prolia® treatment, fracture risk increases, including the risk of multi-ple vertebral fractures. New vertebral fractures occurred as early as 7 months (on average 19 months) after the last dose of Prolia®. Prior vertebral fracture was a predictor of multiple verte-bral fractures after Prolia® discontinuation. Evaluate an individual’s benefit/risk before initiating treatment with Prolia®. If Prolia® treatment is discontinued, consider transitioning to an alterna-tive antiresorptive therapy.

Serious Infections
In a clinical trial (N=7808) in women with postmenopausal osteoporosis, serious infections lead-ing to hospitalization were reported more frequently in the Prolia® group than in the placebo group. Serious skin infections, as well as infections of the abdomen, urinary tract and ear were more frequent in patients treated with Prolia®.

Endocarditis was also reported more frequently in Prolia®-treated patients. The incidence of op-portunistic infections and the overall incidence of infections were similar between the treatment groups. Advise patients to seek prompt medical attention if they develop signs or symptoms of severe infection, including cellulitis.

Patients on concomitant immunosuppressant agents or with impaired immune systems may be at increased risk for serious infections. In patients who develop serious infections while on Pro-lia®, prescribers should assess the need for continued Prolia® therapy.

Dermatologic Adverse Reactions
In the same clinical trial in women with postmenopausal osteoporosis, epidermal and dermal ad-verse events such as dermatitis, eczema and rashes occurred at a significantly higher rate with Prolia® compared to placebo. Most of these events were not specific to the injection site. Con-sider discontinuing Prolia® if severe symptoms develop.
Musculoskeletal Pain

Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in pa-tients taking Prolia®. Consider discontinuing use if severe symptoms develop.

Suppression of Bone Turnover

In clinical trials in women with postmenopausal osteoporosis, Prolia® resulted in significant sup-pression of bone remodeling as evidenced by markers of bone turnover and bone histomor-phometry. The significance of these findings and the effect of long-term treatment are unknown. Monitor patients for these consequences, including ONJ, atypical fractures, and delayed fracture healing.

Adverse Reactions

The most common adverse reactions (>5% and more common than placebo) in women with postmenopausal osteoporosis are back pain, pain in extremity, musculoskeletal pain, hypercho-lesterolemia, and cystitis. The most common adverse reactions (>5% and more common than placebo) in men with osteoporosis are back pain, arthralgia, and nasopharyngitis. Pancreatitis has been reported with Prolia®.

In women with postmenopausal osteoporosis, the overall incidence of new malignancies was 4.3% in the placebo group and 4.8% in the Prolia® group. In men with osteoporosis, new malig-nancies were reported in no patients in the placebo group and 4 (3.3%) patients in the Prolia® group. A causal relationship to drug exposure has not been established.

The most common adverse reactions (>3% and more common than active-control group) in pa-tients with glucocorticoid-induced osteoporosis are back pain, hypertension, bronchitis, and headache.

The most common (per patient incidence ≥10%) adverse reactions reported with Prolia® in pa-tients with bone loss receiving ADT for prostate cancer or adjuvant AI therapy for breast cancer are arthralgia and back pain. Pain in extremity and musculoskeletal pain have also been reported in clinical trials. Additionally, in Prolia®‐treated men with nonmetastatic prostate cancer receiv-ing ADT, a greater incidence of cataracts was observed.

Denosumab is a human monoclonal antibody. As with all therapeutic proteins, there is potential for immunogenicity.

In Functional and Integrative Medicine we look at finding the root cause of the disease process and attempting to prevent or reverse this process. Above in this article I sighted various causes that impact the development of osteoporosis.

Exercise is important to maintain bone health. Both aerobic and strength training should be per-formed on a daily basis. There should be an altering of this exercise routine. Studies have shown also that swimming on a dally basis has impacted patients with osteoporosis in a positive way gaining bone formation, health and strength.

Below are recommendations of nutraceuticals that have benefit in preventing and treating the osteoporosis. Remember supplements that are taking should be of the highest quality. Sadly these are not found in local supermarkets, drug stores, or stores that state they sell such items.

1. Avoid refined sugars, caffeine, cola and sodium chloride.
2. Patients that have unexplained osteoporosis should be tested for celiac disease.
3. Minimize exposes to : lead, aluminum, cadmium and tin.
4. Be checked for food allergies
5. Eat dried prunes!!!!
6. Ingest calcium ranging from 600-1200 mg daily
7. Take in magnesium : 300 -600 mg/day
8. Obtain Vitamin D and ingest 800-1200 IU/day
9. Get a mix of Vitamin K1 and Vitamin K2 ranging from 100- 1000 ug/day of K1 and 45mg/day of menaquinone-4
10. take folic acid 0.4-5.0 mg, stress B vitamins which include Vitamin B6 (10-25 mg), B12 ( 20-1000 ug), vitamin C 100-500 mg, strontium 2-6 mg, manganese 3-20 mg, silicon 1-5 mg, boron 1-3 mg, copper 1-3 mg
11. Hormone replacement therapy.

Your can find out more information by visiting our website; antiagingim.com or contacting our office in Melbourne FL at 321-421-7111 for a consultation.

Dr. Yale R. Smith Featured in the Brevard Business News

By Ken Datzman:

Driven by the rise in technological advancements and a growing consumer demand for aesthetic and rejuvenation procedures, the anti-aging market has been on an upward revenue trajectory for at least the last five years.

The fast-expanding segment is forecast to generate revenue of $303 billion by 2025. Earlier this year, an executive from biotech firm Juvenescence predicted the field of longevity will eventually “dwarf the dotcom boom.”

The business of anti-aging and integrative medicine is starting to reshape and transform health care in America, and is attracting veteran physician specialists like Dr. Yale Smith.

Integrative medicine is an approach to care that puts the patient at the center and addresses all factors that influence health, wellness, and disease, using scientifically sound treatment concepts. And more physicians are incorporating concepts of integrative medicine into their practices, according to a market survey from consultancy Pure Branding.

The survey sample was more than 1,000 physicians around the nation. On average, integrative doctors spend at least twice as much time with their patients as conventional physicians. That’s one of the highlights of the survey. Another is 84 percent of these physicians utilize nutritional protocols to support their patients’ health. The report is titled the “Integrative Physicians Market Landscape” and is touted as the most comprehensive assessment of the state of integrative medicine in America.

Dr. Smith has broad experience in medicine, including a career as an anesthesiologist practicing in both the local market and in other states.

Early in his career, he practiced as a plastic surgeon before becoming a board-certified anesthesiologist. He also worked as an emergency room physician during his anesthesiology residency years. “I would get on a plane on a Friday afternoon and fly out to Indiana or to another state where I would ‘moonlight’ as an ER physician at a hospital for 36 hours. Then I would fly back. I had licenses to practice in 14 states.”

He started his anesthesiology residency at Vanderbilt University in Nashville, Tenn., and finished at Jackson Memorial Health System in Miami, where he rotated at six different hospitals. He transferred to Jackson Memorial “to be closer to his father,” who died from cancer in 1999.

Dr. Smith also did a two-year research fellowship at Duke University Medical Center, one of the top plastic surgery programs in the nation. His work there focused on using “growth factors to improve wound healing in a burn model.” Now Dr. Smith is rolling all of his medical expertise, which spans more than three decades, into his new practice The Center for Antiaging Aesthetic and Rejuvenation Medicine.

His venture is located at 700 Spyglass Court, Suite 300, in Viera. He calls it a boutique one-stop practice offering integrative and functional medicine, along with age-management modalities. His practice treats the patient as a whole being, focusing on optimal health versus disease management. It’s a personalized approach to medicine. “I’m excited,” said Dr. Smith. “This is a new chapter in my life. In functional medicine, we look at the patient’s physiology a deep dive into their blood, everything from food allergy testing to cardiac profiles. We treat metabolic syndrome diabetes, Crohn’s disease, autoimmune disease, sleep disorders, biomedical hormone replacement, and gastrointestinal disease, for example.” The Center for Antiaging Aesthetic and Rejuvenation Medicine offers a new noninvasive cardiac test called Protein Unstable Lesion Signature, or PULS. “This is an FDA-approved test that was designed by an interventional cardiologist in Los Angeles. The test is based on more than 42,000 profiles. It can predict an individual’s risk of having an MI (myocardial infraction or heart attack) within five years.

“We look at the patient’s heart age and compare it to their chronological age. If the patient is at a very high risk, we send them to a cardiologist,” he said.

Coronary heart disease remains the number-one cause of death and disability in the U.S., yet it is 80 percent preventable. Many individuals who appear “healthy” by current coronary heart disease detection methods, such as cholesterol testing, often go on to have a heart attack.

The American Heart Association’s recent “Get With the Guidelines” study showed that 70 percent of people who had a “cardiac event” requiring hospitalization had cholesterol levels that were within target levels. The PULS cardiac test is a simple blood test that uses “breakthrough medical technology” to identify individuals with active, yet undetected sub-clinical coronary heart disease who are at risk of experiencing a heart attack, and for whom early intervention can help, said Dr. Smith.

He said the test detects the early stages of heart disease by detecting the initial “arterial or endothelial” damage leading to the unstable cardiac lesion rupture the number-one cause of heart attacks. When the lining of the artery is damaged, the body’s immune system is activated, causing a cardiac lesion to form.

The PULS test measures “multiple biomarkers of the immune system’s response to arterial damage, and predicts whether a cardiac lesion could rupture within a five-year period.” Seventy-five percent of heart attacks are caused by unstable cardiac lesion rupture, according to a study in the “American Heart Journal.” His practice also treats male erectile dysfunction using “GAINSWave,” a new procedure. Dr. Smith said GAINSWave is an “all-natural solution” that addresses the root cause of the issue using “low- intensity extracorporeal soundwaves” to remove “micro- plaque, stimulate the growth of new blood vessels, and improve blood flow.” On the aesthetic side of the practice, Botox and fillers are some of the offerings.

The Center for Antiaging and Rejuvenation Medicine also features The Aura MedSpa. The practice’s aesthetician is Anna Valdez, who holds licenses in aesthetics and cosmetology. She is certified in acupuncture, chemical peels, LED light therapy, microdermabrasion, and other procedures.

The Aura MedSpa offers top-of-the-line anti-aging products favored by Hollywood stars such as Sandra Bullock and Halle Berry. “I did a lot of research before starting The Center for Antiaging Aesthetic and Rejuvenation Medicine,” said Dr. Smith, who is board certified by the American Board of Anti-Aging and Regeneration Medicine and is an Advanced Fellow in Anti-Aging, Metabolic, and Functional Medicine.

Dr. Smith is also a clinical assistant professor of anesthesiology at the University of Central Florida School of Medicine. “I believe we have a unique practice, in that we are not only dealing with a patient’s internal health, but we also focus on antiaging and longevity.” Weight loss and diet and exercise are areas of the practice. “We have a nutritional consultant. We sell nutraceuticals, too, which are pharmaceutical-grade vitamins. You have to be a licensed physician in practice to sell these kinds of vitamins,” he said.

A recent article in the “Journal of the American Medical Association” said that physicians need to pay more attention to nutrition in their practices. The commentary points out obesity, diabetes, heart disease, and many forms of cancer are driven by unhealthy diets, and that “most doctors do not have the knowledge to turn this problem around.” In a 2018 survey, 61 percent of internal medicine residents reported having “little or no training in nutrition.”

Research shows that a diet rich in fruits, vegetables, grains, and beans can help fight heart disease, hypertension, diabetes, and cancer. But just 9.3 percent of U.S. adults meet the daily vegetable intake recommendation, while only 12.2 percent of adults get enough fruit, according to the article. Legislators throughout the U.S. are calling for nutrition education for physicians.

In June of this year, Washington, D.C., councilwoman Mary Cheh introduced a bill recommending continuing education on nutrition for physicians, nurses, and physician assistants. In New York, lawmakers have introduced similar legislation.

To showcase his new practice to the community, Dr. Smith will host a Medical Health Fair from 1-5 p.m. on Sunday, Sept. 15. The Medical Health Fair will be set up on the three floors of the building that houses The Center for Antiaging Aesthetic and Rejuvenation Medicine. The companies that are sponsoring the event include: Allergan, PULS cardiac testing, Metagenics, Neuroscience, Thorne, OnMacabim, Emerson, MitoQ, Klaire Labs, Marty’s Skin Care, Genova Diagnostics, Supreme Nutrition, DaVinci, Vinco, Shields Peptide Pharmacy, and Rockledge Discount Pharmacy.

“These companies will have booths at the Medical Health Fair and there will be 10-minute lectures on various health-related topics. The presentations will include the avenue for a physician to take to transition into this field of medicine and how to become board certified.”

The American Academy of Anti-Aging Medicine, or A4M, a nonprofit organization with more than 26,000 members, is dedicated to educating health-care professionals and practitioners, scientists, and members of the public on biomedical sciences and breakthrough technologies.

The A4M also promotes the research of practices and protocols that have the potential to “optimize the humanaging process.” Dr. Smith added, “We invite the community to see our new practice and what we have to offer. We’re looking forward to this event and providing consumers with information about how they can improve their health and maintain their health.”

Dr. Yale Smith brings lifetime of experience to new Viera practice – By: Maria Sonnenberg

You could say that Dr. Yale Smith is a Renaissance physician, for, unlike many specialists, he has experience in a broad range of aspects of the medical field. His 33 years in medicine include a career in plastic surgery, which led Dr. Smith to do research in it before he transferred his focus to clinical medicine. He later switched to anesthesiology because this aspect of medicine allowed him to do both technical and critical decisions for the patient.

Dr. Smith is also well acquainted with medicine from the patient’s perspective after a bout with swine flu left him in intensive care for six weeks and almost killed him not once, but twice.

“I coded twice and spent six weeks in a coma and five weeks in a rehabilitation hospital learning how to walk again,” said the Rockledge physician.

The illness required two years of extensive outpatient rehabilitation and affected his lungs to such a degree that he was forced to retire from practicing anesthesiology.

Dr. Smith’s latest chapter in his long medical career is the unique practice he will open September 9 at 700 Spyglass Ct., Suite 300, Viera. The Center for Antiaging Aesthetic and Rejuvenation Medicine will be a boutique one-stop practice that will help patients regain their health and their looks.

“We are specializing in an integrated approach to health solutions,” said Smith.

The practice will offer integrative and functional medicine, along with age-management modalities. The Center will treat issues such as cardiovascular and lipid abnormality disease processes, metabolic syndrome, nutrition, diabetes, male erectile dysfunction, bioidentical hormone replacement, gastrointestinal disease, sleep disorders, auto-immune problems and other issues.

Within the Center is the Aura MedSpa, which will offer state-of-the-art rejuvenative procedures, as well as top-of-the-line anti-aging products favored by Hollywood elite such as Sandra Bullock and Halle Berry.

Dr. Smith started his journey in medicine with an interest in plastic surgery. After medical school, he received a research fellowship at Duke University Medical Center, one of the top plastic surgery programs in the nation. At age 28, Temple University in Philadelphia hired him as director of research, but the lure of hands-on medicine lured him back and he accepted a surgical residency at Memorial Health System in Georgia.

Anesthesiology also interested him, so he switched gears and attended Vanderbilt University, the “Harvard of the South.” eventually transferred to Jackson Memorial Hospital in Miami to be closer to his father, who had contracted a rare form of cancer.

“My father was and remains my best friend, father and brother, but he passed away in 1999 from cancer,” said Dr. Smith.

For 26 years, he served as an anesthesiologist around the country, until a bout with swine flu, which he contracted while working at a hospital, put him in a coma. After extensive recuperation and rehabilitation, Smith began questioning why he had been spared, and decided to devote the rest of his career to functional and integrative medicine. This “joined discipline” helps re-establish an individual’s physiology by analyzing outside factors that impact health. Treatment modalities are more natural and less intrusive than in mainstream medicine.

“It’s the fastest growing medical specialty in the world,” said Smith.

Gastroesophageal Reflux Disease (GERD) – Acid Reflux – Treatment Options

Everyone today sees advertisements on Television and Radio for the treatment of Gerd. I find it interesting that one commercial will advertise foods or a restaurant that’s menu propagates GERD while the next commercial provides a medication to treat the symptoms of GERD.

GERD leads to the backward flow of the gastric contents from the stomach or esophagus into the esophagus or into the throat region. The contents could be undigested food particulate matter to liquid acid.

Symptoms can include: heartburn which sometimes can mimic a myocardial infarct (heart attack) TO regurgitation, silent or microscopic aspiration leading to the person coughing. This refluxing can lead to a set up for aspiration pneumonia.

Other complications include esophagitis which is an inflammation of the esophagus to chronic inflammation leading to cellular changes and the eventual possibility of developing cancer.

There is an anatomical flap of tissue that separates the stomach from the esophagus. This flap or sphincter of tissues is known as the Lower Esophageal Sphincter or LES. When this sphincter becomes incompetent due to a pressure change or a valve abnormality then fluids or particulate food matter will flow backwards into the esophagus or in the patient’s throat.

Patients that are Diabetic, Obese, Smokers and those whom have dietary choices can potentiate GERD. These patients are at higher risk.

Current treatments include the following:

  • Elevating the head of the bed by 30 degrees with pillows or a wedge or lift.
  • Eating small frequent meals and not eating late in the evening
  • Avoiding food or beverages that may provoke the reflux process
  • Weight loss and better control of Diabetes along with cessation of smoking
  • The use of proton pump inhibitors, antacids and Histamine 2 blockers

Now let us take a deeper dive into the convergence and divergence in treatment methods of traditional and non-traditional (Integrative and Functional Medicine) Medical practice.

In both traditional and Integrative and Functional Medicine practice it is important for everyone to chew their food more thoroughly to break down the food into small particles that can be digested.

The human body is an amazing machine. Along with chewing our salivary glands produce saliva that has many factors that assist in breaking down the food. These include: mucin, bicarbonate, prostaglandin E2, and various growth factors.

As the food moves into the stomach it is churned or mixed back and forth. Acid is needed to further breakdown the food into its basic nutrients. Other organs such as the pancreas and gallbladder release enzymes and bile to breakdown fats, proteins and carbohydrates into smaller structures that our body uses as building blocks.

So, what happens if a person takes a H2 blocker, Antacids, or proton pump inhibitors chronically. I myself took these medications every day for years due the stress of being an anesthesiologist.

Long term use of these medications show the following adverse outcomes:

Nutritional depletions in the following vitamins; B12, Folic Acid, Vitamin D, Calcium, Magnesium, Iron, Zinc and protein Beta Carotene. All of these elements are essential for our bodies normal physiological function. In their absence the bodies function will go off the track and we end up complaining of a variety of symptoms.

Increased risk of developing poor Kidney or Renal function leading to insufficiency.

Increased risk of developing Clostridium Difficile infection. This can be a devastating intestinal bowel infection leading to watery uncontrolled diarrhea.

Increased risk of osteoporosis and osteopenia and fractures.

Irritable bowel syndrome

Increased risk of community acquired pneumonia

Increased risk of respiratory illnesses along with asthma

Association of increased risk of Alzheimer’s

Many times, the GERD can be avoided. Integrative and Functional Medical Physicians will order extensive testing to elicit the root cause of the reflux. Sometimes just performing a food allergy test leads to the culprit.

I truly believe that H2 blockers, antacids and proton pump inhibitors have their place in treating patients. However, at some point these medications should be weaned.

Below is a step by step techniques that is used in the weening of PPI’s:

Remove all wheat from the diet. The human gut has no ability to break down gluten. Gluten will cause a rise in zonulin and thus enterocyte separation in all humans. Removing wheat will often resolve someone’s need for PPI.

Remove Dairy as much as possible. Especially milk, cream and ice cream. A little cheese a couple times per week may be tolerated but all other dairy is ideally removed.

Order a IgG & IgE food panel and remove inflammatory foods.  These foods need to be out of the diet for 2 weeks minimum before attempting PPI reduction.

Add a probiotic to help stabilize the immune response. Higher doses if the patient has a long history of gut or autoimmune issues.

Below are natural treatments for GERD which include the following:

  •  Klaire Complete Powder
  •  Orthobiotic 100
  •  Orthobiotic 20
  •  DaVinci 50+ Mega
  •  EnteroMend
  •  GlutAloeMine
  •  Inflammacore

Sodium bicarb (Arm & Hammer baking soda) can be taken at bedtime to neutralize any pepsin in the esophagus. This is a good habit to employ throughout this process. Sodium bicarb is healthy for kidney function and actually protective. The amount of sodium is negligible and not a contraindication for hypertensive patient unless they are acutely sensitive to salt which is the vast minority of hypertensives.

Patients should commit to dietary changes and refrain from eating allergic foods. Avoiding alcohol is necessary along with modifying diet weight loss and other provocative causes such as stress , sleep and hormone evaluations.

Finally, patients can find relief from acid reflux disease by alternative methods such as the above. Patients can find an Integrative and Functional Medicine physician that can treat such diseases. The Center for Antiaging Aesthetic and Rejuvenation Medicine can assist in this and other medical issues.

Crohn’s Disease Explained – Treatment Options

This is a chronic inflammatory process which affects the small intestine. It mainly affects the last segment of the small intestine called the terminal ilium. However any part of the gastrointestinal tract can be involved.

A symptom complex can involve : diarrhea with or without pain, generalized abdominal pain along with weight loss. This is an extremely debilitating disease process. Many patients suffer from alternative or accessory organ inflammatory issues involving the kidneys in developing stone formation TO arthritis.

This chronic inflammation leads patients to suffer from continual intestinal fistula formation. Scarring can lead to bowel obstructions requiring the patient to present to the emergency room for a surgical bowel resection. Often times such patients have large resections of their small intestine that can develop post operative infections along with nutritional deficiencies.

Remember it is the small intestines function or job to absorb the nutrients, vitamins and minerals our body needs to maintain normal physiology. In the absence of sections of the small intestine these required nutrients the body requires can cause abnormalities in the patients body from functioning normally. Another wards the patients wounds may not be able to heal or the patient may not be able to fight off a smoldering infectious process.

The root cause or etiology of Crohn’s is thought to be auto-immune in nature. Thus patients whom develop Crohn’s disease often may have a co-existing auto-immune process such as arthritis.

Current treatments involve both medical and surgical options. This disease can be so debilitating that patients may have their entire small bowel removed. This can and is catastrophic.

Medications such as : anti-inflammatories, steroids, antibiotics, anti-diarrhea, immune suppressive drugs and modulation medications have been tried. However as stated above more than 2/3 of the patients require surgery and up to 10% will die form this disease.

Patients that develop diarrhea often develop several deficiencies in nutrients often leading to lacking the building blocks that their bodies need. These include : minerals, proteins, vitamins, fats and calories. For example many patients lack vitamin B,C and D.

Food allergy testing should be performed since there are elevated levels in blood markers showing an inflammatory process is present in the patients body.

Since these patients often are nutritionally depleted a broad spectrum vitamins, minerals should be replaced. These include : zinc, Vitamin B2,B6,B3, Vitamin D, Vitamin B12, omega 3 fatty acids and Vitamin C just to name a few.

Often chemotherapeutic agents ( like what is used in cancer) are used. These medications have many untoward side effects !!!!!

Alternative Integrative and Functional Medical Treatments involve : eliminating foods that are or show signs of causing or exacerbating the disease along with using several natural substances like : Enteromend, Moducare and Low Dose Naltrexone.

Enteromend is a compound made by Thorne Pharmaceuticals. It contains the following ingredients: Glutamine, Aloe, Curcumin ands Boswella. It functions in gastrointestinal repair, producing butyrate for healing the cells ( enterocytes), anti-inflammatory properties, mucous production to coat and cushion the cells for healing and producing fiber to give nutrition to the enterocytes.

Moducare is a plant sterol ( plant steroid ). It is natural and its has natural properties to affect the cells dealing with fighting infections. Specifically it affects the T-cells ( both T-1 and T-2) that work again in immune function.

Finally patents may require low dose naltrexone. This is a narcotic agonist antagonist. It is similar to naloxone which is used in narcotic overdoses. This medication has shown have great benefit not only in Crohn’s disease but other auto immune diseases. It not only assists as an anti inflammatory and pain killer but also as a “nerve cell modulator”

A Board Certified Integrative and Functional Medicine physician can and will treat patients with these natural supplements along with other alternatives.