Most articles about anti aging are directed to women, but nowadays men are just as interested as their female counterparts in fighting the clock. There are two main aspects to consider, the health side and the cosmetic side and I hope to discuss them both in this article. In terms of staying healthy, hundreds of books have been written about it in the past and new ones are coming out every day, so I won’t be able to cover it comprehensively in a few pages. We all want to enjoy a good quality of life as we age, not just a longer lifespan. To do this, the most important thing is still lifestyle… diet, exercise, don’t smoke and minimal booze. It’s common to find patients who want a magic pill to fix all the things that they have done to themselves, but unfortunately, it’s not possible. Diet is the cornerstone of a healthy lifestyle. You are what you eat and food is medicine…it raises blood pressure, lowers blood pressure; affects blood sugar levels; contributes to depression; increases or decreases your risk of dying of a heart attack… the list goes on. The most important part of a healthy diet is to keep it as natural and close to the earth as possible. Man usually ruins everything he touches; the same is true for the processing of food. You can’t eat burgers and fries all day and expect to be operating at peak function, just like you can’t put poor quality fuel into a Ferrari and expect it to perform to its optimum ability. The food industry, fast food outlets and the departure from a natural diet are all contributing to an unhealthier generation and we are now seeing a massive epidemic of childhood obesity which will result in our children’s generation not living as long as our generation. We simply eat too much as a society. Your mother is gonna kill me for saying this but skinniness is healthier. The one thing that we have found to prolong life without question is calorie restriction. The lowest body weight short of being anorexic is also healthiest, it reduces your risk of developing diabetes three fold compared to being a “normal” weight. Without writing a diet book, let’s review the basic principles…Eat fruits, veggies, lean protein (ie fish, seafood, chicken, lean pork, veal, lean beef and eggs), nuts and seeds. Avoid anything man has touched (breads, pasta, obvious junk food, such as sweets, chips, fast food, anything in a “box” at the supermarket). You might not want to hear it but there is no such thing as a healthy bread, nor have I ever seen a study showing that one exists. All refined foods cause a rapid rise in sugar in the bloodstream, followed by an increase in insulin to lower the blood sugar. This can contribute to insulin resistance and metabolic syndrome…a fancy way to say big belly, high blood pressure, high cholesterol and diabetes. All of which reduce lifespan and quality of life. It’s terrible to say but sometimes the “health benefits” of a lifestyle change aren’t enough to motivate a patient to make the changes, but other “fringe” benefits such as cosmetic improvement might do the trick. This happens frequently when I try to encourage women to quit smoking…it’s not unusual that they are more motivated by the improvement in their skin than they are the lower risk of heart and lung disease. In this case, metabolic syndrome is associated with a reduced effect of nitric oxide, which in turn can affect a man’s ability to get and maintain an adequate erection. In fact Viagra and other such drugs work directly on nitric oxide and that’s how they can help men. This can be improved with a low glycemic index diet by itself. A few other stats to convince you that diet is the most important aspect of anti-aging: 30 % of cancer is diet related 90% of diabetes can be improved by diet and exercise The majority of high blood pressure and high cholesterol can be improved by dietary changes Fish oil and fish consumption can reduce sudden cardiac death by 50% Vitamin D deficiency likely occurs in more than 50% of Canadians (officially 30%, but my experience is more) and is associated with multiple chronic diseases and can be corrected by a simple supplement. For the significant women in your life: iodine deficiency is common in North America and leads to thyroid and breast disease…seaweed is a great source of iodine and Japanese women don’t have the same thyroid and breast problems that North Americans do. Alzheimer’s disease is linked to low levels of DHA in the brain. Once again, the list goes on. Suffice it to say that if you are serious about improving the quality of your life, you wont’ get it from a pill. You need to make a healthy diet your number one priority. Exercise: I hate to admit it but I’m incredibly lazy. I find diet much easier to do than exercise. Saying that, exercise is the second most important part of your anti aging plan. For those of you that are like me, even a small amount of exercise will help. Walking, running, stairs, biking…it doesn’t really matter. Any exercise will improve bone mass, mental function, cardiac health, and raise testosterone levels… all good things for a man. One shouldn’t fall into the trap of “perfection paralysis”, meaning that if you can’t do it perfectly, you don’t’ bother doing it at all. Cosmetic: As you can see, diet and exercise have tremendous effects on health, but they also provide cosmetic benefits as well. If diet and exercise aren’t enough, there are other treatment options that we have to assist patients wanting to look “younger”. I must admit that I don’t try to make patients look “younger”, instead I like to make you look good for your age. If you try too hard to look younger then often you can end up looking silly; you can see many examples of that in the media. The most common cosmetic concerns that men come to see me for are: • Wrinkles and Folds • Hair Removal • Skin Texture, • Fat For wrinkles and folds, nothing works as well as Botox Cosmetic and Restylane. Botox Cosmetic works to relax muscle action that causes a wrinkle, so it works best on “dynamic wrinkles”, while Restylane is a filler and is used to fill in a deep wrinkle, fold or lift up falling cheeks. On men, the most common area treated with Botox are the frown lines that make one look angry, the crows feet and the horizontal lines on the forehead. In women I don’t usually like to treat the horizontal forehead lines because it can reduce the amount of eyebrow lift they can get. Men tend to have a lower set brow so it’s not a problem, although I still tend to treat that area conservatively. It lasts 3-4 months at the beginning, but lasts longer the longer you’ve been treating with Botox. Side effects are minimal; a small bruise is possible in the crows feet area. With too much treatment in the forehead lines, one can develop a bit of a “brow ptosis”, which means the eyebrows drop. Again, in men it’s not as troubling as in a woman, but it can still be bothersome and last 3 months or more. There is also a less than 1% chance of dropping the eyebrow a bit, but that usually resolves in 2 weeks or so, and can be improved with eyedrops. The chance of side effects is almost eliminated when you go to an experienced injector. You always want to know how long the doctor has been performing the procedure that you are interested in; this applies to all cosmetic procedures, not just Botox. You want to make sure the doctor attends continuing medical education and an added bonus would be if the physician teaches or trains other physicians. Some men don’t want to do Botox because they like the rugged “lines” or wrinkles that make them look masculine. In that case, one can simply lower the dose to reduce the lines rather than eliminate them. The most common area for Restylane is to lift and fill the cheeks and improve the smile lines (from the nose to the corner of the mouth), although it can be used all over the face and your doctor can advise you best of all of your options. Restylane is non animal stabilized hyaluronic acid…the same stuff that’s in your own body which holds water and plumps up the skin. Restylane works exceptionally well in men to raise the dropped cheeks that happen as we age, as well as provide a chiseled jaw line or raise and fill a dropping chin. The possibilities are endless since with Restylane, you are “sculpting” and you can achieve great results. I find it tremendously helpful for the patient to bring in a picture of 10 or 20 years ago and see how their face has changed, to provide a framework of what they want to achieve. My philosophy is not to “change” the face, but to restore it to a more youthful appearance in a natural way. My patients don’t want to look “done” they want to look rested or relaxed. One wants to look good for their age, so it keeps your friends guessing. Restylane usually lasts between 8-12 months, although I’ve had patients in which it has lasted over two years, and others who break it down within 4 months. It all depends on your body. You guessed it…smokers and sun worshippers break it down faster. Hair removal: Men are most bothered by hair on their shoulders, backs, ears and a “unibrow”. Laser hair removal is now a common treatment and I think the best. Men have terminal hairs in those areas and they respond very well to laser. The best candidates have lighter skin with darker hair. Most areas need between 6-8 sessions. It is important to start early before the hair goes grey, because nothing really works well on grey hair. It is very important to stay out of the sun during your laser treatments to reduce any chance of burning and hyperpigmentation. Skin texture: Again, diet is going to come into play. Your skin is the largest organ of the body so if you are unhealthy, it will show up in the skin. Over and above quitting smoking, reducing excessive sun exposure and a healthy diet, you should use good quality skin products to nourish and hydrate your skin. I’m a big fan of Vitamin C and E topically. Fraxel is a fractional non ablative laser that works to improve general skin texture, reduce pores, and improve scars, stretch marks and acne pitting. It’s easiest (although not accurate) to think of it as an “aerator” for the skin…it creates microthermal heat zones directly into the dermal layer to stimulate collagen production. It works well on both men and women and starts to provide results within 1 month, with continued improvement over 6-12 months. Fat: You guessed it…diet. The leaner you are, the less fat you will have. Over and above that, one can consider liposuction or some of the new machines (ultrasound and radiofrequency) that can improve localized areas of fat. I do not have a lot of experience with the machines so it would be best to consult a reputable, experienced physician to see if you are a good candidate. Hopefully this article shed some light on the principle of “anti-aging.”
Written By: Dr. Matta
Some of the concerns that are pertinent to men include heart disease, high blood pressure, diabetes, high cholesterol, sexual dysfunction, alcohol use, mood disorders and anxiety and stress. Diabetes, High Blood Pressure, Cholesterol and Heart Disease I’ve grouped these four together because they all have a strong lifestyle component. There are many things to consider but the cornerstone of any lifestyle change to reduce your risk of all of the above is diet and exercise. Since the advent of Penicillin, North American society has tended to rely on a “magic bullet”, a pill that fixes everything. Unfortunately no such pill exists, especially to reduce or reverse the effects of bad lifestyle choices. I’ve addressed healthy diets in previous articles, but to recap in a nutshell: eat a low calorie, low glycemic index (GI), high fiber diet with fruits, land and sea vegetables, lean protein (fish, veal, poultry, egg whites, game meats), good quality fat (especially mono unsaturated and poly unsaturated fat with an emphasis on omega three fats) from olives, avocado, nuts and seeds. For the most part eat from the land and sea and ignore everything that man has touched. If it’s in a package or box with an expiry date into next year, you can imagine that it’s not the way God or evolution intended you to eat. A low glycemic index diet means eating natural unrefined sugars that are absorbed into the bloodstream very slowly as opposed to refined sugars that are absorbed into the bloodstream quickly. When sugar is absorbed quickly it causes a rapid rise in blood glucose, triggering a release of insulin from the pancreas to bring the sugar back down to normal. The body, and brain especially, doesn’t like high blood sugars or volatile levels…it gets very cranky. The rise in insulin does many negative things. First insulin travels to the liver and turns on an enzyme called HMG CoAReductase (the same enzyme that is turned off by the popular anti-cholesterol medications). Studies have shown that an elevated insulin and sugar level after eating results in a 51% increase in cholesterol. I have had patients lower their cholesterol by 58% within six weeks of shifting to a low glycemic index diet. High insulin levels as well as general poor nutrition and lack of exercise are also significant causes of high blood pressure. High levels contribute to salt retention by the kidneys and poor nitric oxide response by the blood vessels resulting in constricted rather than dilated vessels. They have also shown insulin is atherogenic, meaning it leads to the hardening of the arteries. Hyperinsulinemia contributes to diabetes by worsening what we call insulin resistance. This is a genetic tendency to having a poor response to the effects of insulin, resulting in higher levels of insulin being required to lower blood sugar. When an individual with a genetic predisposition to diabetes (usually one that gains weight on their belly more than their hips) eats a high GI diet for prolonged periods, it eventually causes the pancreas to lose its ability to produce enough insulin to lower blood sugar, thereby resulting in diabetes. Many years of hyperinsulinemia and insulin resistance have transpired by the time a person finds out they are diabetic. It often takes a heart attack to change a man’s behaviour; it’s just the way we are. Heart attacks are caused by a blockage to one or more of the main blood vessels that supplies the heart. The “hardening of the arteries” that people talk about is a collection of inflammation and fat in the inner wall of the blood vessel. One of the major things we have discovered over the last few years is the importance of inflammation in the development of the plaque. In fact, one of the major areas of research for all aspects of health, from cancer to aging, is the role that chronic inflammation plays. When inflammation occurs for years combined with poor diet, the plaque gets bigger and bigger until it eventually blocks the entire internal diameter of the artery, leading to a heart attack of the muscle fed by the affected vessel. Believe it or not, it’s not the heart attack that usually kills somebody. It’s usually a condition called ventricular fibrillation (the thing you see on TV when the good looking doctor has the paddles on someone’s chest and calls out “clear”). VFib, as we call it, occurs because of an electrical instability secondary to a heart attack. When the heart goes into Vfib, it twitches instead of pumping blood to the rest of the body and the body and brain are then deprived of oxygen and the individual dies. One of the recommendations we’ve made for years is the use of a baby aspirin every day to reduce the inflammation that contributes to the plaque formation in the first place. While the aspirin does reduce the risk of GETTING a heart attack, patients that get a heart attack while on Aspirin actually have a 20% higher chance of dying from that heart attack. Patients, on the other hand, who take fish oils every day, or eat fish twice a week, have a 50% lower chance of dying from that same heart attack. That’s because EPA and DHA (both long chain omega 3 fatty acids) have an electrically stabilizing effect on the heart, so that even if one gets the heart attack, their risk of Vfib is reduced by 50%, so is their risk of death. Sexual Dysfunction, Alcohol Use, Mood and Anxiety Many men are using Viagra, Levitra or Cialis for recreational use. Men in their forties or higher often present to the office requesting medication to restore their erectile function back to when they were younger. While most men find that erections aren’t as strong or long lasting as they were when they were younger, there are many things they can do to improve the situation or at least reduce the worsening of the condition. Viagra taught us a lot about the nitric oxide we talked about above. Viagra affects nitric oxide and was originally designed as a cardiac medication to increase blood flow to the heart. Unfortunately it didn’t work out very well for that, but none of the men wanted to give it back due to the effect it had down below. Low GI diets also have a favorable response on nitric oxide, the chemical responsible for dilating blood vessels with a resultant increase in blood flow to the penis. Insulin resistance reduces the effect of nitric oxide on blood flow. This is one of the reasons many diabetic men have difficulty with erections. Alcohol is another common cause of erectile dysfunction. Most university grads will remember “brewer’s droop”, even at a prime age they saw the effect of alcohol on stamina. As we age, alcohol has an inhibitory effect both on drive, initial erection and ability to maintain an erection. It is common for middle aged men to rely on a drink or two when they get home at night to relax from a day of stress. I have many patients that use it as an escape, part of the “mid life crisis” that most men don’t want to talk about. They go to work, come home and go back to work and realize that this is their life. They often feel the vibrancy and excitement of their youth is over and this leads to the proverbial mid-life crisis. They tend to escape in many different ways, fancy car, big house, other women, spending money unnecessarily or alcohol and drug use. It usually happens insidiously but becomes a routine. I often have patients describe reckless and dangerous practices and that they “know better” but they still do it. The most common form of escape is alcohol, and men who never drank much as university students find that they are drinking more regularly, and they don’t really know why. Some of these patients are depressed, while others have a depressant effect from the alcohol. We know that alcohol depletes the brain of DHA, the principal fish oil fat that we talked about earlier. What comes first, the chicken or the egg? We don’t know. Mood disorders in middle aged men are very common. The causes are multifactorial. Some of it comes from a genetic predisposition. Other contributing factors include diet, lack of exercise, Vitamin D deficiency, trace mineral (magnesium, zinc etc..) deficiency, dropping testosterone levels and social circumstances (marriage, work, kids etc..). Again, in North America we tend to look at things with a one-dimensional eye, while we really need to look holistically. Men in North America are funny. As soon as they hear the word “holistic” they think of some yoga master with a long beard sitting on top of a mountain meditating. What we really mean is looking at all the factors that are contributing to the cause and addressing them all. You cannot come up with a solution without addressing the problem. It seems obvious, but think about how many of us actually address the underlying cause rather than provide a band aid solution. Commonly, depressed mood and anxiety coexist together. The same causes apply genetics, diet, testosterone etc… Many individuals, men and women alike, are on antidepressants; either for depression or anxiety or both. If you think about it, do you think that God would have created us all with such flaws as to depend on medication for basic things like not wanting to kill ourselves? I classify depression into intrinsic and reactive. Intrinsic depression is the kind that makes someone want to kill themselves despite a “perfect life”. This kind of depression requires some intervention, whether it’s medication, counseling, shock therapy etc… Reactive depression on the other hand occurs from some source in our lives; family, work and financial stress are the most common triggers. Anxiety or nervousness can also occur from external sources or have a genetic basis. I have found over the years that diet, supplements, meditation, hypnosis and relaxation techniques are more effective than medication. Supplements I’m not a huge proponent of supplements simply for the reason that I like simple ideas. I can’t imagine that God or evolution would create this world and require us to take supplements to live. That being said, there are a few supplements that are completely necessary, and others that are recommended. I encourage all patients to get their vitamin D levels checked. The studies show that at least 30% of Canadians are vitamin D deficient, and in my experience, that number is closer to 50%. I recommend all patients take vitamin D between October and March. I also recommend all patients take fish oil supplements, either in liquid or pill form. Magnesium is necessary for over a hundred chemical reactions in the body and is especially helpful for people with muscle aches, migraines and constipation. Patients who do not change their diet and end up on cholesterol medication should also take coenzyme Q10. Zinc is helpful for immune and hormone function; I usually recommend 50- 100 mg/day for men. One of my pet interests these days is iodine deficiency. The soil of the great lakes region is deplete in iodine and the average North American consumes less than a hundredth of the average Japanese individual. It is no surprise that we have so much thyroid insufficiency in North America. Iodine is responsible for thyroid function as well as many other organs including breast and prostate. It is also the most important mineral to prevent cretinism and mental retardation. There are suggestions that it has a role to play in the increase in breast cancer that we see. I do not recommend anybody starting iodine supplementation without speaking to their health professional first but for many years doctors recommended using Lugol’s iodine as a daily supplement. I encourage men, especially in their forties, to have their testosterone levels checked. Andropause is a very real medical condition in which drops in testosterone cause a myriad of symptoms. The discussion of andropause is a whole article by itself. Some men will benefit from testosterone supplementation. Summary As for women, men need to pay strict attention to their lifestyle, especially diet, exercise, alcohol consumption and smoking (not discussed in this article, but I assume you all know it’s not good for you). With the current state of the health care system, many men understand that they have to take their health into their own hands. The first step is to find a qualified doctor who can address all of the concerns in a holistic fashion. Twenty five percent of heart disease presents with sudden cardiac death, without warning. It is far more beneficial to be proactive rather than reactive.
Written By: Dr. Matta
I often have patients ask why my prices are different than the local spa down the road. Why should they pay $10 or $12 per unit of Botox in my office rather than pay 7 or 8 dollars elsewhere? What distinguishes someone who charges 500 or 600 dollars for a syringe of Restylane/Juvederm from someone who charges $350? Why pay $150 for laser hair removal when the local hair salon does it for $50? There are many reasons you pay more at a qualified, accredited physician’s office rather than a Botox or Restylane party. One of the most important reasons is the experience of the injector. Doctors, who charge more typically have more experience, attend continuing medical education, train other physicians etc…You cannot put a dollar value on experience. The majority of problems that occur from injectables happen in the hands of those who do not do a lot of injections. Thankfully, the College of Physicians and Surgeons of Ontario is taking steps to make sure that doctors who inject are qualified, but up until recently, not every injector was properly trained. As well, many injectors are not physicians at all. They may not have a good grasp of anatomy, sensitive structures in the face or how to deal with a potential complication. I will present a couple of cases at the end of the article on patients who were treated by unqualified personnel and had significant problems from it. Another reason one physician may charge more than another is skill and artistry. You might not realize it as a patient, but creative skill and an esthetic eye are crucial to do a great job. People think Botox or Restylane are point-and-shoot. It is absolutely crucial where the doctor injects the Botox or filler and I have seen many patients treated by others who do not have an esthetically appealing result because the injector just “didn’t get it”. When I train other doctors, they often ask me where to inject (this is much more important for hyaluronic acid fillers such as Restylane or Juvederm but still important for Botox), while there are general guidelines, each face is different and one has to be able to look at a patient’s face and see what would result in the most pleasing placement of the product. Qualified injectors also give you what you pay for. There have been stories of counterfeit product being injected into patients. Many of us have heard of these horror stories from abroad, but don’t expect or believe that happens in Canada. It is not something that is talked about often, but it exists. It can be something simple like being charged for 10 units of Botox but they only gave the patient 5. Or it can be something more serious such as bringing in product from another country which may not have the same rigorous certification that we require in Canada. Qualified providers also ensure that your treatment is provided in the safest manner possible. Whether it is properly sanitizing the area, or ensuring resuscitation equipment in case of a crisis, this is crucial to patient safety and is expected as a minimum requirement in all top offices. I will present two cases of patients who went to non qualified providers. The first is a patient who went to a “Botox party” and had Restylane (or what she believed was Restylane) injected under her eyes, in her eyelid area. She was told that it was a nurse that administered the treatment and states that the box she saw clearly said Restylane (this unfortunately isn’t always accurate since reproduction techniques are very advanced these days). She presented to my office two weeks later hoping I could correct the swelling under her eyes. She was embarrassed to leave the house and at the beginning she could barely open her eyes. She came to my office regularly for four sessions for hyaluronidase treatment. She did have a good result, although we still need to wait for time to get rid of the last bit of product. Below are before and after pictures. The second patient went to a local laser hair clinic which provided laser hair removal. Many patients are surprised to learn that anybody can buy a laser hair removal machine. While some people are highly educated in laser hair removal physics, many are not and they simply take a 4 hour course on how to use their machine. As a brown skinned individual she was more susceptible to burning and any qualified provider would know this and understand the increased risk. Unfortunately, the salon that she went to treated her whole legs, back and front from bikini to ankle and permanently burned her. In situations where skin is burned, there is often not a lot we can do to fix it. Below you will see the residual hyper pigmentation on her legs. Common problems that can occur include drooping of the eyelid or eyebrow from Botox, or an asymmetric smile that can continued from page 74 – Qualified Provider make a patient look like they had a mini stroke. Risks associated with hyaluronic acid fillers such as Restylane or Juvederm include inadvertently injecting into a blood vessel with subsequent ulceration of skin or causing numbness by injecting in the area of a nerve. We’ve all seen pictures of people who have had “too much” done, lips that are too big or cheeks that look like a chipmunk. The biggest risk with lasers or photo facials is the risk of burning, which can result in permanent hyper pigmentation in some people. It is important to understand that Botox, fillers, laser treatment and most other cosmetic procedures done these days are medical procedures and have a small amount of risk associated with them. The job of a qualified provider is to deliver optimal results with minimal risk.
Written By: Dr. Matta