WASHINGTON, DC, March 7, 2013 - We are all looking to get well and stay well for the duration.
Every once in awhile a medical physician steps outside the allopathic, disease-treatment approach of medicine and helps people prevent disease from developing in the first place.
Dr. Giannotto became a patient before he began his journey into wellness.
Dr. Giannotto, thank you for taking the time to join us in this interview. When and why did you get into the field of metabolic medicine?
My foray into metabolic medicine started as a patient. Heart disease runs in the family, and I wanted to be certain that it would not be the end of me. I enrolled at Cenegenics and followed a plan of nutritional guidance, exercise and hormone replacement. I achieved great results and decided to train with the physicians at the center.
I graduated and passed the exams and became certified. Cenegenics was devoted mainly to hormone optimization and I realized that there was much more to metabolic medicine. I attended several seminars sponsored by the American Academy of Anti-Aging Medicine (A4M) and enrolled in their advanced fellowship program.
I am now an Advanced Fellow and am pursuing my Master’s Degree in Metabolic and Nutritional Medicine from the University Of South Florida Medical School in Tampa Florida in conjunction with A4M. These advanced certifications allowed me to broaden my appreciation for the scope of Metabolic Medicine and develop a proactive comprehensive program that encourages wellness and metabolic balance.
And you currently practice this type of healthcare?
Yes, my practice now consists of Metabolic Wellness (40%), Hair Restoration with automated Follicular Unit Extraction (40%) and anti-aging skin care protocols (20%).
Tell me more about Metabolic Medicine and the five keys to your body.
Metabolic Medicine is a proactive approach to one’s wellness and vitality. It is a paradigm shift in that one does not wait to become ill in order to be treated. Metabolic medicine is not reactive in its scope but preventative in the sense that action now will avert chronic disease later and eventually slow down the aging process. Age can be managed and one can live a very active and productive life well into one’s nineties and beyond. Allopathic medicine on the other hand is more reactive in its scope. The patient becomes ill and then presents him/herself to be treated. Proactivity does not exist in this latter model.
The elements in Metabolic Medicine which cause the patient to attain and sustain wellness are not part of Allopathic Medicine. The metabolic approach is a more personalized approach in that I use genetic mapping in addition to blood and sputum studies, and I use functional testing, such as VO2Max to measure aerobic capacity, FEV testing to measure pulmonary capacity, etc. as part of every evaluation. Treatment is thus specific and personalized for each patient based upon results and genetic tendencies identified. Every patient is guided through nutrition, exercise and stress management as part of the work-up.
I feel that this approach to the patient will become widespread as the knowledge of Metabolic Medicine is studied and accepted by more and more physicians.
The five keys are important because one cannot achieve metabolic balance and hence Wellness without balance in each of the categories. One’s metabolic balance is determined by hormonal balance which is determined by nutrition, exercise habits, stress levels and toxins. Hence, if hormones are in balance, ones Metabolic Wellness is directly determined by lifestyle habits.
The five areas address these habits as well as the hormone balance in the body. We use blood chemistries including inflammatory and age markers, cancer markers such as PSA, urine and stool testing, sputum testing to map out DNA for the personalized and optimal approach to this endeavor. The patient undergoes functional testing to measure resistance capacity, VO2Max to measure aerobic capacity, range of motion and muscle testing. We also use Bioelectric Impedance Analysis (BIA) to measure body fat, bone density and calculate BMI. Cognitive testing for dementia and Alzheimer’s Disease is also used.
The patients fill out a rather lengthy medical history questionnaire and lifestyle assessment. They are also asked to keep a detailed four consecutive day food diary. The information is entered into a software program and a detailed nutritional analysis is created. Nutrition is important especially if the patient has one or more risk factors such as obesity, diabetes or hypertension. Once all of the testing is completed, all of the results are scored via software and the patient’s biologic age is calculated. A treatment program is created for the patient based upon all of the data.
Hormonal imbalances are tricky. If one hormone is found to be deficient or in excess, other hormonal systems are all affected. The endocrine system is a symphony and must be in complete balance at all times. Bio-identical hormones are used for replacement purposes, but one must be aware of stress levels when one balances hormones and treat appropriately.
Toxic burden can also influence a response to hormone therapy. Appropriate heavy metal levels need to be measured and some patients detoxified. Most importantly, ones nutritional status needs to be vigorously measured and corrected for imbalance.
The use of supplements and nutraceuticals is extremely important here. My top four nutraceuticals for patients include Resveratrol, Vitamin D, CoenzymeQ-10 and Omega-3-Fish Oils. In essence each of the five areas needs to be investigated and a treatment plan encompassing all of them elaborated.
It is also important that an exercise program with achievable goals is implemented and sustained. The body needs movement. Our recommended program includes 40 minutes resistance and core training coupled with 20 minutes of high intensity interval cardio. This 60 minute session is done 4 times a week.
You are talking about the basics, which well-meaning physicians tend to forget. These are paramount to building health.
The length of telomere located on the ends of the chromosomes shortens with every cellular division. Is this a practical way to determine the aging process or in your opinion are there other ways to determine the aging process? Or does this even matter?
Teleomere length is directly correlated to biologic age and is an accurate method of measurement. We use this test and compare it to the results of the software program mentioned above. Correlation is high. Determination of biologic age is important because of the proactive nature of the program. We need to identify areas of potential problems and treat appropriately before they become frank disease.
In pop media there are anecdotes about far-away tribespeople living more than 120 years and entrepreneurial companies trying to bottle and sell what these people eat or drink. Aren’t we all programed to live 120 years old without having to take some secret herb only grown in the Peruvian jungle or only along interstate 80 in Pennsylvania?
The idea of living to 120 years can be a reality if one is Metabolically balanced. These tribes live a hunter-gatherer existence and their diets are lacking in refined carbohydrates and sugar. Their daily life is exercise and chronic stress is minimal. There are no persistent organic pollutants to create a toxic burden. In other words, they live the balanced life and the chronic diseases of aging are practically non-existent. We can draw a lesson from all of this. There is no magic elixir or one “super” supplement that does this. It is a balanced lifestyle with good nutrition - especially avoiding refined carbs and sugars, exercise, stress management, detoxification if needed and hormone balance.
Where do you think we can go with metabolic wellness?
The increase in life span over the last hundred years or so is one thing; the quality of those extra years is another. When insurance tables estimate lifespans, the elderly who are dependent upon others in nursing homes and invalids with chronic disease who are also not independent are counted. Yes, lifespan has increased but the quality of life in the later years has decreased as the chronic diseases of aging appear due to our rather horrible lifestyle habits. Metabolic Wellness seeks to not only extend a lifespan, but extend the quality of that lifespan so that the individual lives longer and lives actively for a longer period of time. Nutrition and hormone optimization are very important here. Many people are living with sub-optimal hormone levels. These hormone levels are important in regulating metabolism and extending longevity and need to be balanced. Poor nutrition habits lead to obesity and diabetes which result in chronic morbidity and mortality. Lack of exercise results in frailty.
The generation of children born in the year 2000 and beyond, will likely be the first generation to have a SHORTER lifespan than that of their parents. The main culprit is poor nutrition- a diet geared toward a combination of refined carbohydrates, sugar and saturated fat! We now have an epidemic of Type 2 Diabetes and obesity. 70% of all Americans are now classified as obese. It should come as no surprise that heart disease, stroke, cancer and dementia claim as many lives as they do- and early on.
The epic Norfolk Study out of England showed that changing four simple behaviors could extend an average lifespan of participants by 14.5 years. The behavior modifications included: (a) cease smoking; (b) exercise; (c) drink moderate amounts of alcohol (defined as 6oz of red wine for women and 12oz for men) and (d) eat five servings of fruits and vegetables daily. We desperately need to alter our lifestyle habits if we want to conquer the chronic ravages of aging!
How is modern medicine retarding or enhancing the aging process today?
Modern medicine lives to prescribe medications. Chronic drug therapy results in deficiencies of vitamins and minerals that act as cofactors in many enzymatic reactions of the body. For instance, chronic statin use results in CoQ-10 deficiency. CoQ-10 is needed in the electron transport chain in the mitochondria to generate ATP for cellular energy.
Most physicians are ignorant of this fact and patients become severely depleted and fatigued. By ignoring the fact that “cholesterol” itself does not cause heart disease and that refined carbohydrates and sugar actually do, physicians are doing patients a disservice.
Despite all of the evidence available, agencies like the American Heart Association and the American Diabetes Association still recommend “healthy whole grains” to combat heart disease and diabetes. These healthy grains are anything but healthy. They are very high glycemic and are broken down into sugar (glucose) in the bloodstream creating a hyperglycemic state. In the face of a rising incidence of insulin resistance, this excess sugar can be directly transformed metabolically into triglycerides, which are the precursors of small LDL-C particles. These particles make up plaque which in turn predisposes an individual to an acute MI or stroke!
We need a new model for medicine - one that not only treats existing disease, but also is in itself proactive to prevent chronic disease.
Yes we do! We have to change our approach to taking care of people - the whole person. We cannot continue down this road much longer. I know you have one or two people that you’ve worked with who will illustrate what you do. Could you share one with us briefly?
A 55 year old gentleman with metabolic syndrome, which is a combination of obesity, high blood pressure, abnormal fasting blood sugar and dyslipidemia, came to the office with fatigue, weight gain, decreased libido and energy and short term memory problems. The patient was going through andropause and testosterone levels were extremely low. Testosterone is important for libido and energy but also needed to prevent heart disease and osteoporosis in men. The patient was evaluated for other hormonal imbalances and none found. In this patient, we instituted a “paleo” type nutrition plan to regulate his blood sugar and lipids. Supplements included alpha lipoic acid for insulin sensitivity, Omega-3 Fish Oils to combat the dyslipidemia and Vitamin D. resveratrol was added as this simulated a “caloric restriction” and actually increases longevity. The patient was given bio-identical Testosterone.
In twelve weeks, his blood studies normalized and he had lost 15 pounds. He was thinking clearly, was more active and had his libido restored. Blood sugar was normal and his lipid levels were returning toward normal. By six months into the program, his body composition had changed. He was lean and muscular, and his body fat percentage went from 28% to 21%. He continued his exercise and nutritional regimens.
These results are not the exception, but the rule. We now have a productive 55 year old with a biologic age of 45 who will remain active, productive and vigorous until his final days. He will likely be free of the chronic diseases of aging such as heart disease, stroke, cancer and dementia. Proactive approaches such as this can ultimately save “billions” of dollars on health care spending!
Way to go Dr. Giannotto! Not only changing a person present symptoms without medication but changing his future! Now that’s health care. Could you give each of us a little advice - we all would like a little free advice from you.
Live a balanced lifestyle metabolically. Pay attention to hormone levels, nutrition, exercise and stress management. Change your behavior and decrease your toxic burden. Have someone knowledgeable in the field of metabolic medicine evaluate you and follow his/her recommendations. Always be proactive! Remember the four behaviors - cease smoking, exercise, drink alcohol moderately and eat five servings of fruits and vegetables daily - these are a great start off point! And what’s more…they work!
Thank you, Dr. Giannotto, for your kind insights on this desperately needed type of health care.
If you would like more information about Dr. Giannotto and his clinic please visit http://www.giannottoclinic.com/preventative-aging/
Dr Peter Lind practices metabolic and neurologic chiropractic in his wellness clinic in Salem, Oregon. USA. He is the author of 3 books on health, one novel, and hundreds of wellness articles. His clinical specialty is in physical, nutritional, and emotional stress.
For more health tips go to http://www.wellnessreport.net