lifestyle

As a resident doing open heart surgery at the Miami University Hospital, Dr. Michael Sigler, who went to the Sint Eustatius School of Medicine, outwardly looked fairly fit but was living an unhealthy lifestyle of too many Snickers bars and not a very good exercise routine. Inside, blood cholesterol levels and other tests were also indicating that some changes were in order.

A colleague recommended some changes, including a daily injection of human growth hormone (HGH), which intuitively didn't sound right to Sigler, then not yet 30 years old. He took some months to read all the literature, and then tried it. He says the improvement, not only in his cholesterol levels, was dramatic.

Sigler changed his specialty. "I don't need to be a heart surgeon to prevent sickness," he told the audience at Exedra Books for the May 27 Tuesday Talk. What he's doing now is "about preventing disease, about taking a pro-active approach," he said, contrasting it to "a failed disease-based medical practice."

And strictly speaking, Dr. Sigler isn't actually practicing medicine. His Age Management Panama clinic, in the Consultorios Punta Pacifica, has licensed Panamanian physicians to perform the actual diagnoses, prescriptions and dispensing of drugs and medicines that require a medical license to do. Sigler's neither Panamanian nor one of those relatively rare non-citizens who has a license to practice medicine in this country. Sigler is more of a salesman --- promoting an age management system that goes by the registered trademark Cenegenics and the hormones and nutrition supplements that go with the program. He's also planning to both expand the clinic at Punta Pacifica to employ three full-time physicians and to branch out into manufacturing, an ambition that has him negotiating with Chinese pharmaceutical producers with the aim of setting up a hormone production lab in Panama.

Cenegenics age management is not cheap. It starts with a series of initial tests that cost about $3,000, and with all the consultations, hormones, dietary supplements and monitoring may cost $12,000 per year here in Panama. That's much less than people in the USA pay, because the prices that that doctors charge to do the tests, consultation and monitoring for this or just about anything else are lower here.

So what is Cenegenics?

For starters, it's some fairly standard advice about nutrition and exercise, probably more up to date than a lot of non-specialized doctors would give.

Diet? In the United States, 79 percent of the people are considered obese --- as is this reporter --- and the grand consensus of medical opinion is that this is a bad thing. In school you may have had a health class where they told you about the basic food groups and eating a balanced diet, and although that's in general considered sound advice, Sigler says that people need to learn about the glycemic indices of what they would eat.

A food's glycemic index is, roughly speaking, its tendency to make your blood sugar spike after eating it. Sugar and white bread are high, and you want to pick foods that are low. Unfortunately, Sigler says, most of the fruits that Panama produces --- bananas, pineapple, papayas and so on --- score high on the index. You want to do an Internet search for "glycemic index" and emphasize foods that score 50 or lower in your diet. Papaya stands at 50, as compared to strawberries at 22.

And no white bread? The old hippie adage that the closer to natural the better would apply here: Sigler speaks highly of the sprouted grain breads you can get at the Organica health food store in Paitilla. Yes, and do brown rice rather than white if you can, and when you are eating starchy foods combine them with some low-fat protiens to slow down your body's absorption of the starches.

Sigler's discussion of macro-nutrients is something akin to the old balanced diet adages, but he believes that to keep the intake of micro-nutrients right it's a good idea for people to take vitamin and mineral supplements to manage their aging process. So, should someone go out and buy the special Centrum one-a-day pills? Sigler says that the supplements that his clinic sells are better than Centrum because the body absorbs them better.

Exercise? Well, everyone's for that but Sigler says that the most recent studies have shown that what's most important for older people is not the cadiovascular exercise that was the standard recommendation back in the 80s but rather exercises that build strength. Resistance strength training, preferably in forms that don't hammer the body with too much jarring and pounding, is what he advises aging patients to do.

Hormone modulation? Sigler admits that this is controversial, but claims that "that's what I am an expert at."

Sigler opens with a broadside against the pharmaceutical industry for producing human hormone replacements that are not "bio-identical." As an example, he notes that a lot of the estrogen prescribed to post-menopausal women is extracted from horses, and argued that such equine estrogen is not chemically identical to that produced in the human body, while estrogen produced from potatoes is. As another example, he notes standardized dosages of hormone replacements dispensed to patients en masse, but argues that each patient's needs are specific and that, just like an old-fashioned pharmacy that mixes its own compounds, the right mixture of age management hormones must be custom-made for each patient.

Human Growth Hormone, which is naturally produced by the pituitary gland but diminishes with age, is the biggest controversy of all. In the United States it's not approved by the FDA for age management, but it is allowed for children with short stature, kidney problems or several other conditions, adults with pituitary tumors or other conditions that block production of HGH, and for patients of any age whose muscles are wasting from AIDS. To get that much approval from the FDA, HGH is supposed to have been proven "safe." And indeed, Dr. Sigler doesn't look like the late wrestler Andre the Giant.

Studies have shown that HGH increases muscle mass and decreases body fat. There is also disputed evidence that it builds bone mass. For those reasons athletes caught using it will be thrown out of the Olympic movement, and a lot of poople who can afford the expensive daily injections --- notoriously including Hollywood star Sylvester Stallone --- are using it for purposes other than what the FDA allows.

(Can you take your HGH orally? There are pills on the market, Sigler says, but he says that the body's digestive process destroys the hormone before it gets into the system. There is an experimental HGH nasal spray that shows some promise, he notes. Right now if you go to his clinic, any HGH prescription will come in the form of daily injections.)

Is HGH "effective," however?

There are conflicting opinions on that, and these are supported by very few controlled studies. Because the use of HGH for anti-aging purposes is relatively new, there is no good evidence on its effect on longevity. The shift of body weight from fat to muscle is accepted, but doctors disagree on what this means. On the Mayo Clinic's website they don't dismiss the possible benefits of HGH, noting that the studies of the hormone's effects lead some people to believe that "synthetic human growth hormone can help healthy older adults who have naturally low levels of growth hormone regain some of their youth and vitality." The Mayo Clinic does add, however, that "There's little evidence to suggest human growth hormone is the Fountain of Youth."

Cenegenics, however, is a growing medical movement with its own scholarly publications and professional organizations. If more numerous and rigorous studies bear out its principal claims about hormone modulation, then it may become another board-certified medical specialty. 

Still, there will be a strong current in the medical profession, and in philosophy, that maintains that it's part of nature's cycle that people age, see their faculties diminish and die and that whatever tinkering may be done can't alter these basic facts.

Sigler told the folks at Exedra that "I don't have the Fountain of Youth, but I do have three years of reading the literature." One of his clinic's patients told this reporter that "I know people get old and die, but I'd rather have some quality years, without a walker."

"I hope that I helped people become aware that there is a better way to live full of vitality and energy," Dr. Sigler said about his talk.