A4M MMI - Anti-Aging Medical News - Winter 2018 by Tarsus Medical

WELCOME! Greetings, and a warm welcome from the team at A4M/MMI. We are proud to be celebrating 26 years of redefining medicine, and continuing our journey of exploration, discovery, and innovation.

Ronald Klatz, MD, DO President, A4M

For too long, the practice of traditional, allopathic medicine has too heavily relied on sickness: as opposed to wellness. We know that Anti-Aging medicine has become increasingly important in today’s healthcare system, given the growing prevalence of chronic disease, as it highlights the critical importance of treating root symptoms, locating underlying causes, and emphasizing the importance of the patient as a whole, comprehensive person. Our members, and the healthcare practitioners & professionals who practice Anti-Aging medicine through A4M/MMI, embody the original—but often forgotten—model of health and wellness, and understand the value of comprehensive wellness. We continue to strive for a paradigm shift through our overarching objective, educational offerings, and annual conferences: to enhance the quality of life, increase longevity, and decrease the frequency and risk of chronic disease.

Robert Goldman, MD, PhD, DO, FAASP Chairman, A4M

This year, we have curated a program that highlights the ways in which clinicians and thought-leaders are changing the field of modern medicine. Through the 26th World Congress, we will continue to push boundaries and focus on entrepreneurial opportunities in integrative medicine, the application of technology in healthcare, the critical trend of physician burnout and its impact on mental health, and the most cutting-edge clinical breakthroughs in longevity. It is this conference—the largest event in Anti-Aging medicine—that drives the transformations in the field, and we are proud of our efforts, successes, and continued discoveries & developments. As always, we thank you for your engagement and involvement. Our efforts are impossible without your support.

ANTI-AGING MEDICAL NEWS

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ANTI-AGING MEDICAL NEWS

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TABLE OF CONTENTS General Information . . . . . . . . . . . 6 Product Announcements . . . . . . . . 74 Exhibit Hall Floormap . . . . . . . . . 109 Exhibitor Index . . . . . . . . . . . . 110

ARTICLES

Exhibitor Listings . . . . . . . . . . . 113

14 26

34 40 46 54 65 68 84 91 102

Fasting: An Emerging Method For Weight Management By: Victoria Hahn, MS, RDN

Methylation and Cognitive Decline By: Patricia M. Devers, DO

Neuroprotective Effects of the Ketogenic Diet By: Milene Brownlow, PhD

New Perspectives on Testosterone’s Role in Shaping Male Behavior By: Kate Placzek, PhD

VITAMIN E: Emerging Research Sheds Light On Controversies And Its Benefits By: Andreas M. Papas, MSc, PhD

The Science Behind Vitamin E Tocotrienols By: Barrie Tan, PhD

Vitamin K2: The Anti-Aging Nutrient By: Thomas Bayne

Identifying Candidates for Pellet Hormone Replacement Therapy By: Enrique Jacome MD, FACOG, Bev Blessing, MSN, PHD, FNP-BC

The Anti-Aging Potential of Bovine Colostrum By: Mark J. Tager, M.D.

Restoring Youth, Sexual Function, & Health. Reversing functional decline via Peptide Therapy By: Anthony J. Campbell, PharmD

A Study of the Effect of Extracorporeal Shockwave Therapy (ESWT) for the Treatment of Women’s Sexual Health By: Maryann E. Prewitt, MD, Amy E. Shoultz, PhD, and Sara Martinez

Show Regulations 1. An official picture ID is required to pick up name badge. 2. Name badge must be worn at all times during show hours and official events. 3. No one under the age of 18 will be admitted into the Exhibit Hall. 4. This event is open to healthcare professionals and their invited guests only. 5. Photography is permitted in the Exhibit Hall only by press, with the prior permission of show management, and prior permission from the firm(s) whose booth(s) are being photographed. Videography in the Exhibit Hall (motion video, film, or digital) is permitted only at discretion and with advance permission of show management and the prior permission of individual(s) and/or firm being photographed. 6. Audio and video recording (tape or digital) of this event is expressly prohibited. 7. Unauthorized solicitation is prohibited. In addition, non-A4M and/or commercial literature of any kind may not be distributed near or at the event registration area and all event-related general public areas. 8. No medical procedures are permitted to take place in Exhibit Hall booths without prior permission of show management. 9. Show management reserves the right to expel any individual and/or company without recourse or refund at its sole discretion. 10. PHOTO RELEASE: Anyone in attendance at any A4M event may be subject to any photography or videography conducted during the event which may be used in any form for future media purposes. Please contact A4M with any concerns.

The American Academy of Anti-Aging Medicine (A4M.) All rights reserved. ISSN 1533-6700. AntiAging Medical News publishes materials in good faith and makes no claims or endorsements for products, services or procedures that appear in the publication. Opinions expressed in articles and advertisements are not necessarily those of Anti-Aging Medical News, its owners, affiliates, or its staff. The publisher is not liable for advertiser product claims or representations. Advertisers assume total responsibility for the contents of their advertisements. Under no circumstances is the content of Anti-Aging Medical News to be construed as medical advice. Always consult your personal physician prior to beginning a new therapy, or changing any current regimen.

PHOTO RELEASE: Anyone in attendance at any A4M event may be subject to any photography or videography conducted during the event which may be used in any form for future media purposes. Any concerns, please contact A4M.

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ANTI-AGING MEDICAL NEWS

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WELCOME RECEPTION

HAPPY HOUR

THURSDAY

FRIDAY

December 13th 4:00 pm - 6:00 pm

December 14th 4:00 pm - 6:00 pm

Exhibit Hall

December 15th â&#x20AC;˘ 12:30 pm The Mercedes-Benz on display and the prize that will be won differs from the photograph.

Drawing - Exhibit Hall

Saturday December 15th at 12:30 pm Your entry form can be found in your attendee bag or at the A4M/MMI booth.

GRAND PRIZE

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Pass Plus 2 Night Stay at the Gaylord Palms Resort, Orlando, Fl. Valued at over $1,500

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TO OUR SPONSORS

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FUNCTIONAL TESTING EXPERTS Canada RNA Biochemical Inc.

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PROFESSIONAL MEDICAL EDUCATION (Non-CME)

Wednesday, December 12th - 6:15pm Nutritional Support for Methylation: The Missing Link for Detoxification Presented by:

Deanna Minich, PhD, CNS, IFMCP

Location:

Titian Ballroom 2301

Why Your Genes Aren’t Your Destiny: 3 New Insights into How to Optimize the Exposome with Personalized Lifestyle Medicine

Presented by:

Sara Gottfried, MD

Location:

Veronese Ballroom 2403

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• WINTER 2018

Sponsored by:

Thursday, December 13th - 6:15pm Connect the Dots - Lifestyle, Nutraceuticals, Hormone Optimization and Telomerase Activation with TA-65® Presented by:

Ron Rothenberg, MD - of the California Healthspan Institute

Location:

Veronese Ballroom 2401

Overcoming Challenges In Incorporating BHRT Into Your Practice Presented by:

Enrique G. Jacome, MD, FACOG and Kenneth Orbeck, DO, FMNM, ABAARM

Location:

Veronese Ballroom 2403

3 Proven Secrets Successful Practices Use to Identify New Revenue Presented by: Mark White, CEO Gainswave Location:

Titian Ballroom 2303

Sponsored by:

GAINSWave® Sponsored by:

What Are You Missing? An In-Depth Comparison of Urine, Serum and Saliva Testing Presented by:

Clifford Morris – Chief Chemist and Research Scientist

Location:

Titian Ballroom 2301

Friday, December 14th - 6:15pm Time is Money – How Much is Yours Worth? Presented by:

Sponsored by:

Jennifer Landa, MD Alongside other successful BodyLogicMD network practitioners

Location:

Veronese Ballroom 2401

Sponsored by:

Clinical Application of the Fasting Mimicking Diet Presented by:

James LaValle, RPh, CCN, ND(trad)

Location:

Veronese Ballroom 2403

Sponsored by:

The Untold Truths of The Stem Cell Industry Presented by:

Rafael Gonzalez, PhD & Alan Gaveck, MD

Location:

Titian Ballroom 2303

ANTI-AGING MEDICAL NEWS

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PRODUCT

Location: Exhibit Hall

SHOWCASE (Non-CME)

Thursday, December 13th 11:30 AM

12:00 PM

PCR Parasitology and Advanced Stool Testing

12:30 PM

4:30 PM

5:00 PM

Sponsored by:

Restoring Sexual Function & Health Presented by:

Presented by:

Jennifer Landa, MD

Michael Chapman, ND

Sponsored by:

New and Exciting Peptides! Presented by:

Sponsored by:

Ryan Smith, VP of Tailor Made Compounding

How to Hack Your NAD: Scientifically Validated Strategies for Resisting Stress and Aging Better

Sponsored by:

Presented by: Dr. Charles Brenner, Roy J. Carver, Chair and Head of Biochemistry; University of Iowa and Discoverer of NR as a Vitamin

Vivace™ RF Microneedling: The Next Generation of Your Skin! Presented by:

Sponsored by:

Edward M. Zimmerman, MD

ANTI-AGING MEDICAL NEWS

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PRODUCT

SHOWCASE (Non-CME) Friday, December 14th 11:30 AM

Sponsored by:

I Am Woman Hear Me Roar: Sexual Health and Incontinence Presented by:

Shelena Lalji, MD

Sponsored by:

12:00 PM

12:30 PM

4:30 PM

5:00 PM

Distinguishing Gluten-Related Disorders Presented by:

Hilary Jericho, MD

Sponsored by:

Combining Shockwave and Regenerative Therapy for ED Solutions Presented by:

Farshad Shafizadeh, MD - Board Certified Urologist

Sponsored by:

Improve Health With Nutrient-Dense Meals Presented by:

Stacey Bell, RDN

Chief Science Officer at Nutrient, Reno, NV

Exogenous Ketones as an Adjunct to Hypocaloric Diets for Weight Loss and Metabolic Health Presented by:

Sponsored by:

Hector Lopez, MD, CSCS, FAAPMR, FISSN

Co-Founder- Supplement Safety Solutions, LLC. Principal /Partner- The Center for Applied Health Sciences, LLC. CEO- NovaNutra, LLC

Tim Ziegenfuss, PhD, CSCS, FISSN

Saturday, December 15th Sponsored by:

1:00 PM

Fitness in and Out Presented by:

Action Martial Arts

ANTI-AGING MEDICAL NEWS

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Fasting:

An Emerging Method For Weight Management By: Victoria Hahn, MS, RDN Bio: Victoria is a Registered Dietitian and Nutrition Science Liaison with a Master of Science in Nutrition, Healthspan, and Longevity from the University of Southern California. She also functions as an inpatient clinical dietitian and has a background in nutrition research covering a wide range of topics including nutritional sufficiency in specific populations and the ketogenic diet. She has a passion for research and evidence-based practice.

The following article is not endorsed and/or supported by The American Academy of Anti-Aging Medicine. The purposes of this publication do not imply endorsement and/or support of any author, company or theme related to this article.

ABSTRACT: Fasting has been shown to be a topic of growing

interest not only within the scientific field, but also with consumers. As this science becomes commercialized, we must sort out the evidence from the fiction to support the claims that surround fasting as a strategy for weight loss. Fasting can be broken up into three types: time restricted eating (TRE), intermittent fasting (IF), and prolonged or periodic fasting (PF). Each type of fasting appears to impact weight loss, but evidence suggests that PF is the optimal method for this. Ultimately, more evidence is needed to support fasting as a medical intervention with validated protocols to ensure that the fasts are done in a safe manner.

Introduction

1), and protein kinase A (PKA). It has been established that key regulators of these nutrient sensing pathways include glucose, amino acids, and the energy status within the cell.6 There are several distinct methods of fasting, including time restricted eating (TRE), intermittent fasting (IF), and prolonged or periodic fasting (PF) (See Table 1). These categories are separated by a difference in duration of fasting, as well as the physiological impact of each type. Due to these differences, it has been hypothesized that there is an optimal amount of time during which the body needs to be in the fasting mode in order to induce a more pronounced physiological impact.3,8 This brief review of fasting will try to tease out the rationale to support each type of

fast in the clinical setting as it pertains to weight loss. Fasting is an ancient practice that has its roots in religious practices, 1 and appears to be present universally among all cultures. The definition of fasting is “to abstain from food.”2 It has been cited Time Restricted Eating that fasting is now being used as a medical intervention in many Time restricted eating (TRE) gains its roots from circadian clinics for disease prevention and weight management.3,4 More so, rhythms; these are daily cycles of ~24 h that control a multitude of there has been a rise in the interest of fasting over the last few physiological and behavioral processes including, but not limited years and increase in consumer interest that has followed.5 With to, energy metabolism, gastrointestinal motility, and sleep-wake all this new information, it can be difficult for the clinician to cycles.9 TRE has been defined as a daily eating pattern that is find evidence-based information on this emerging topic, especially conducted over the span of usually ≤12h in which all nutrition given the inherent risk of over-fasting, or inducing starvation. is consumed within this timeframe; there is no regard to the One of the main benefits of fasting rests in the natural ability of Table 1: Types of Fasting the body to downregulate Type of Fast Definition Example the nutrient-sensing A daily pattern of eating, usually pathways (6) which can in 8-h Diet (8 hours of eating, conducted between 10-12h. The rest turn stimulate a protective Time Restricted Eating with the remaining 16h of the of the day would be non-eating hours, day fasting) response that results in or fasting. stress resistance.3,6-8 Perhaps 5:2 Diet (5 days of normal A pattern of eating little to no calorie nutrition intake with 2 days the most well-categorized Intermittent Fasting intake conducted 2 to 3 times per of no calorie or low calorie nutrient sensing pathways week. intake per week) are the mechanistic target of A pattern of eating little to no calorie Periodic or Prolonged rapamycin (mTOR), insulinintake conducted for 4 or more 5 day fasting mimicking diet Fasting consecutive days. like growth factor 1 (IGF-

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Supplementation with Specialized Pro-resolving Mediators Reduces Inﬂammatory Biomarkers in Subjects with Chronic Inﬂammatory Conditions: a Multi-Clinic Open-Case Series

composition of nutrition, rather, the focus is when food is consumed.10 The mechanism by which the circadian rhythm is regulated is complex.10-12 Briefly, the circadian rhythm is sustained by an organ specific process that is cell-autonomous, albeit the master oscillator is the suprachiasmatic nucleus (SCN) feedback loop in which specific transcription activators help to increase the production of the CRY and PER protein levels.10,12 The reason this is important is because both of these proteins, CRY and PER, interact with the nutrient sensing pathways, including TOR and AKT, as well as other pathways that are upregulated during fasting, such as AMPK and SIRT1.13-17 There is now evidence to support the postulation that TRE within a period of 8-12h without nutrient fluctuation may be utilized to help re-establish these diurnal patterns and potentially serve as a novel therapy for treating obesity as well as metabolic diseases.18-20 Human

data are sparse in this emerging field. In a 16-week feasibility trial, eight overweight individuals were instructed to consume their entire daily caloric intake over the span of a self-selected 10-12h period to determine if this would lead to a reduction in body weight.21 They found that all subjects were not only able to reduce their eating duration, but also lost weight (average of 3.27 kg). Although the reduction in eating time also induced a decrease in estimated caloric intake, which may have contributed to the weight loss observed, there is new evidence to show that the benefits of TRE may be independent of weight loss in a specific population.22 It is also worth noting that different physiologies may require a different period of TRE, as seen with the obese population potentially benefitting from an 8h TRE period for weight loss.23 Although TRE has proven to be beneficial in a multitude of areas, more research is needed within this area to determine TRE’s overall effectiveness as a weight loss strategy.

Intermittent Fasting

Intermittent fasting (IF) goes by many definitions in the literature, but will be defined as very little (~25% energy restriction) to no calorie intake conducted 2-3 times per week; the majority of studies discussed in this section represent the 2-day non-contiguous restriction and 5-day feasting model. With IF, the upregulation of autophagy, stress resistance, and antioxidant activity, as well as extension of lifespan while decreasing cellular proliferation, have all been observed.3,24 Note that because of the reduction in the duration of fasting with IF, the fasting effects are less pronounced when compared to a PF.3 Somewhat surprisingly, it has also been found that IF may not impact lifespan at all, so more evidence with a standardized process is needed to support or refute these findings.25 IF has become more prevalent over the years as an alternative to caloric restriction; however, clinical trial results have been inconclusive and occasionally contradictory to popular belief.26-28 In a 1-year trial, 112 subjects who had a BMI between 30-45 kg/m2 followed a meal pattern where they were to restrict calories to 400/600 kcal (female/male)

for two non-consecutive days per week.29 After 1 year, the IF group had similar weight loss (8.0 kg in the IF group versus 9.0 kg, p = 0.6) and improvements in their cardiovascular risk factors in comparison to the continuous calorie restricted group. In a separate study, 107 premenopausal women with a BMI between 24-40 kg/m2 followed 2 days of 25% kcal restriction and 5 days of normal intake each week over 6 months.30 After 6 months, the women in the IF group had comparable weight loss, which was on average 6.4 kg in the IF group compared to 5.6 kg (p= 0.4). Comparable body fat reduction and cardiovascular risk marker reduction were also observed between the groups, but greater declines in fasting serum insulin and improvements in insulin sensitivity in comparison to the continuous calorie restricted group. There is evidence to show that the weight loss observed in these studies may be contingent on the spontaneous reduction of caloric intake on non-IF days, so it may be an overall behavior change that is enabling the potential weight loss to occur rather than the effects of fasting.31

Periodic Fasting

Periodic fasting (PF) can be described as an extension in duration and sequence of IF in that it is greater than 2-3 days, as well as consecutive days. PF can be categorized as consecutive days of fasting for 4 or more days. The mechanism of PF is a prolongation of IF because the fast is conducted for a longer period of time, enabling a more pronounced metabolic switch to occur which in turn causes glycogen reserve depletion to enable fat and ketone body catabolism.3 With this longer period of time (72h) in the fasting mode, it has been observed to promote a greater upregulation in the stress response gene HO-1 and antioxidant enzymes SOD2, Gpx1, and GSR.32,33 Moreover, there is evidence to show that a 72h fast in mice decreases key regulators of the nutrient sensing pathways, such as IGF-1 and glucose.34 As eluded to, there appears to be an ideal duration of time to be spent in the fasting mode in order to achieve the benefits of autophagy and multi-system regeneration.35 Due to the difficulty of PF and inherent risk of adverse events, a novel modality that mimics fasting with a diet has been elucidated.35 The diet is a five-day regimen low protein, moderately low carbohydrate, and moderately high fat diet that is also moderately restricted in calories. This diet that mimics PF was found to decrease IGF-1, reduce visceral fat mass, extend median lifespan, promote neurogenesis, enable hepatic regeneration, and increase hematopoietic and mesenchymal stem and progenitor cells in mice.35 Within this same article, a pilot clinical trial of 19 healthy individuals utilizing this 5-day PF mimicking diet found that after three consecutive cycles done once a month, participants lost an average of 3% of body weight and had no lean body mass loss. Additionally, anti-inflammatory effects, such as C-reactive protein reduction, were observed. The pilot trial was replicated in a larger clinical trial with 71 additional healthy individuals who experienced a reduction in body weight (2.6 kg on average), total body fat, trunk fat, waist circumference, IGF-1, and blood

ANTI-AGING MEDICAL NEWS

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Supplementation with Specialized Pro-resolving Mediators Reduces Inﬂammatory Biomarkers in Subjects with Chronic Inﬂammatory Conditions: a Multi-Clinic Open-Case Series

pressure without any lean body mass loss.36 Moreover, the effects on body weight, waist circumference, IGF-1, and blood pressure appeared

opinion in neurobiology. 2013;23(5):724-731. doi:10.1016/j.conb.2013.02.018. 13. Zheng X, Sehgal A. AKT and TOR Signaling Set the Pace of the Circadian Pacemaker. Current biology : CB. 2010;20(13):1203-1208. doi:10.1016/j.cub.2010.05.027.

to persist even 3.2 months after having discontinued the protocol.

14. Lamia KA, Sachdeva UM, DiTacchio L, et al. AMPK Regulates the Circadian Clock

Conclusion - Where do we go next?

15. Asher G, Gatfield D, Stratmann M, et al. SIRT1 regulates circadian clock gene

an emerging medical therapy. Novel interventions in order to induce

16. Nakahata Y, Kaluzova M, Grimaldi B, et al. The NAD+-Dependent Deacetylase SIRT1

that enable the body to fast, but for a brief period of time. Although

17. Nakahata Y, Sahar S, Astarita G, et al. Circadian control of the NAD+ salvage pathway by

For instance, while all types of fasting appear to yield some amount of

18. Chaix A, Zarrinpar A, Miu P, Panda S. Time-restricted feeding is a preventative and

overall decreased caloric intake, and the weight loss attributed to IF

19. Hatori M, Vollmers C, Zarrinpar A, et al. Time restricted feeding without reducing

PF appears to induce a significant amount of weight loss due to the

20. Melkani GC, Panda S. Time�restricted feeding for prevention and treatment of

may be the root etiology of the effectiveness of the weight lost. We are

21. Gill S, Panda S. A smartphone app reveals erratic diurnal eating patterns in humans that

PF regimens or regimens that mimic PF, may be the most advantageous

22. Sutton EF, Beyl R, Early KS, et al. Early Time-Restricted Feeding Improves Insulin

by Cryptochrome Phosphorylation and Degradation. Science (New York, NY). 2009;326(5951):437-440. doi:10.1126/science.1172156.

Fasting is a wide-ranging topic that spans from a religious practice to fasting have also been elucidated, as well as a variety of eating patterns each type of fasting may yield unique findings, there are similarities. weight loss, it appears the weight loss for TRE may be attributable to

may be comparable to continuous caloric restriction. On the other hand, sustained physiological changes of fasting for consecutive days, which now starting to obtain evidence that certain types of fasting, particularly

expression through PER2 deacetylation. Cell. 2008 Jul 25;134(2):317-28. doi: 10.1016/j. cell.2008.06.050. Modulates CLOCK-Mediated Chromatin Remodeling and Circadian Control. Cell. 2008;134(2):329-340. doi:10.1016/j.cell.2008.07.002. CLOCK-SIRT1. Science. 2009 May 1;324(5927):654-7. doi: 10.1126/science.1170803. Epub 2009 Mar 12. therapeutic intervention against diverse nutritional challenges. Cell metabolism. 2014;20(6):991-1005. doi:10.1016/j.cmet.2014.11.001. caloric intake prevents metabolic diseases in mice fed a high fat diet. Cell metabolism. 2012;15(6):848-860. doi:10.1016/j.cmet.2012.04.019. cardiometabolic disorders. The Journal of Physiology. 2017;595(12):3691-3700. doi:10.1113/JP273094. can be modulated for health benefits. Cell metabolism. 2015;22(5):789-798. doi:10.1016/j. cmet.2015.09.005.

for not only weight loss, but also for receiving the most benefits of

Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with

in clinic for any indication other than maintaining general wellness, it

23. Gabel K, Hoddy KK, Haggerty N, et al. Effects of 8-hour time restricted feeding on body

patients through their fasting regimens, no matter the type initiated.

24. Harvie MN, Howell T. Could Intermittent Energy Restriction and Intermittent Fasting Reduce

to further support or refute PF as an ideal strategy, as well as if there are

25. Goodrick CL, Ingram DK, Reynolds MA, Freeman JR, Cider N. Effects of intermittent

any type of fast. However, if any of these therapies are to be initiated

would be of the utmost importance for trained clinicians to guide their While early indications are encouraging, more evidence will be needed ideal ways to implement IF and TRE for weight loss.

Prediabetes. Cell Metab. 2018 Jun 5;27(6):1212-1221.e3. doi: 10.1016/j.cmet.2018.04.010. Epub 2018 May 10. weight and metabolic disease risk factors in obese adults: A pilot study. Nutrition and Healthy Aging. 2018;4(4):345-353. doi:10.3233/NHA-170036. Rates of Cancer in Obese, Overweight, and Normal-Weight Subjects? A Summary of Evidence. Advances in Nutrition. 2016;7(4):690-705. doi:10.3945/an.115.011767. feeding upon body weight and lifespan in inbred mice: interaction of genotype and age. Mech Ageing Dev. 1990 Jul;55(1):69-87. 26. Anton S, Leeuwenburgh C. Fasting or caloric restriction for Healthy Aging. Experimental gerontology. 2013;48(10):1003-1005. doi:10.1016/j.exger.2013.04.011.

Disclosures:

27. Collier R. Intermittent fasting: the science of going without. CMAJ : Canadian Medical

The author is affiliated with L-Nutra, Inc.

28. Anton SD, Moehl K, Donahoo WT, et al. Flipping the Metabolic Switch: Understanding

Association Journal. 2013;185(9):E363-E364. doi:10.1503/cmaj.109-4451. and Applying Health Benefits of Fasting. Obesity (Silver Spring, Md). 2018;26(2):254-268.

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2010;10:161-177. doi:10.1100/tsw.2010.8. 35. Brandhorst S, Choi IY, Wei M, et al. A periodic diet that mimics fasting promotes multi-

10. Longo VD, Panda S. Fasting, circadian rhythms, and time restricted feeding in healthy lifespan. Cell metabolism. 2016;23(6):1048-1059. doi:10.1016/j.cmet.2016.06.001. 11. Reddy AB, O’Neill JS. Healthy clocks, healthy body, healthy mind. Trends in Cell Biology. 2010;20(1):36-44. doi:10.1016/j.tcb.2009.10.005.

system regeneration, enhanced cognitive performance and healthspan. Cell metabolism. 2015;22(1):86-99. doi:10.1016/j.cmet.2015.05.012. 36. Wei M, Brandhorst S, Shelehchi M, et al. Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease. Sci Transl Med. 2017 Feb 15;9(377).

12. Hardin PE, Panda S. Circadian timekeeping and output mechanisms in animals. Current

29. Sundfør TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy

pii: eaai8700. doi: 10.1126/scitranslmed.aai8700.

ANTI-AGING MEDICAL NEWS

• WINTER 2018

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Attend our non-CME educational workshop featuring key Attend ouron non-CME educational key experts Friday, December 14thworkshop at 6:15 PM featuring in the experts on Friday, December 14th at 6:15 PM in the Veronese Ballroom 2403

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When: Friday, December 14th, 2018 6:15 PM MST

Learn how BodyLogicMD’s one-on-one practice reviews, practitioner workshops, and annual offsites have helped practitioners increase their income and unlock the power of passive revenue.

Where: The Venetian Las Vegas Veronese Ballroom 2401

Hosted by: Jennifer Landa, MD—Chief Medical Officer of BodyLogicMD With Special Guest Speakers:

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Please stop by Booth #4032 or contact Deborah Astern for more information. Email: dastern@BodyLogicMD.com | Phone: 561-972-9529 © 2018 BodyLogicMD Franchise Corp. All rights reserved. This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for information purposes only. Currently, the following states regulate the offer and sale of franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington, and Wisconsin. If you are a resident of or want to locate a franchise in one of these states, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your state. This advertisement is not an offering. An offering can only be made by a prospectus filed first with the Department of Law of the State of New York. Such filing does not constitute approval by the Department of Law. The franchisor, BodyLogicMD Franchise Corp., is located at 4850 T-Rex Avenue, Suite 125, Boca Raton, Florida 33431, and is registered as File Number F-6930 in the state of Minnesota. BLMD-A4M-FP-AD-2018-09-20

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GRADUATES We would like to extend a well-deserved congratulations to our 2018 graduates! These Fellows have completed the necessary clinical coursework for the

following: Fellowship in Anti-Aging, Metabolic and Functional Medicine;

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and the Aesthetic Anti-Aging Fellowship. Best wishes to this year’s graduates!

Gary Adams MD

Kenneth Adams MD, DDS

Sarfraz Ahmed MBBS, MD, ABAARM

Reem Al Kaddah MD, MS

Faisal Alnaser, MBBS FPC MICGP FRCGP FFPH PhD

Anoud Alreyahi MD, MRCGP

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Carrie Ballas FNP-C

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Kyle Bergquist DC

Ross Carter PhD

Jenna W. Clack PharmD FAAMFM ABAAHP

Paul Constante DC

Christian Davila Ruales MD

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ANTI-AGING MEDICAL NEWS

• WINTER 2018

Philip Ham DO

Sani Hanh, Pham, PharmD, MBA FAAMFM

Seema Hashmi MD

Claudia Herrera MD

Abid Husain, MD, FACC ABAARM

Ashkan Jalili, DC, DACNB FACFN

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P M Maese MSN, FNP, NP-C

Darlina K. Manthei DO, FAAFP, FACOFP

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Lindsay Marie Smith DO

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Angela Mazza DO, FAAMM, CDE

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Ryan Morrissey MD

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Maynolia Naidoo MBChB

Jean-Claude Nerette Jr. DO ABAARM

Stephanie Nerette MSN, ARNP, ABAAHP

Richard Nkwenti RPh ABAAHP

Catherine Oseni PharmD, ABAAHP, FMNM

Jimi Oluwole DO

Victor Paviani MD

Bita Pour-Jafari MD

Christopher H. Roberts MD

Sukhsagar Ratol, MBBS, MD, DDV, MPH

Lina Sakr MD

Aleya Salam MD

Mark Scheutzow MD, PhD, MHA, MPH

Donald Siclari ACP, NRP, FMNM

Gary Tharp MD

Lyda TymiakLindell MD

Sukhsagar Ratol, MBBS, MD, DDV, MPH

Yvette Suarez MD

Rehana Sajjad MD

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ANTI-AGING MEDICAL NEWS

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Nutritional Support for Methylation: The Missing Link for Detoxification NON-CME

With the advent of nutrigenomics, the use of specific SNPs like MTHFR and COMT have been increasingly used in clinical medicine to target nutritional therapies. In this presentation, learn some of the evidence-based foundational principles of methylation. These include the biochemical pathways and laboratory diagnostics for pattern recognition, along with the food and lifestyle practices to ensure efficient methylation in a variety of health conditions.

JOIN US: Wednesday, Dec. 12th @ 6:15pm Titian Ballroom 2301

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Deanna Minich, PhD, CNS, IFMCP Dr. Deanna Minich is an internationallyrecognized teacher, author, scientist, speaker, and artist. She has more than 20 years of diverse, well-rounded experience in the fields of nutrition and functional medicine, including clinical practice, research, product formulation, writing, and education.

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Methylation and Cognitive Decline By: Patricia M. Devers, DO

Cognitive decline occurs throughout aging and is often multi-factorial. In addition to genetics, nutritional and behavioral factors can contribute to dementia and cognitive impairment. Rather than managing symptoms, a focus on preventative measures may prove valuable. Smoking, alcohol, physical activity, and exposure to toxins are clear modifiable risk factors.1 Nutrition’s role in cognitive decline has been extensively studied and is widely accepted. The Mediterranean diet, and nutrients such as omega-3 fatty acids, dietary antioxidants (blueberries, strawberries, dark chocolate), and vitamin E (mixed tocopherols) are associated with less cognitive dysfunction and reduced dementia risk.2 Additionally, B-vitamin deficiencies have been found in patients with Alzheimer’s dementia, and older patients with decreased dietary vitamin B₆ intake were four times more likely to develop cognitive impairment. 3 B-vitamin supplementation has therefore been studied in cognitive decline as a preventative measure.4 The relationship between B-vitamins and cognitive decline involves homocysteine and methylation. Methylation is a complex process in which methyl groups (CH₃) are transferred or donated between molecules, thereby changing their structure and function. This happens billions of times per second in every cell in the body.5 Dietary amino acids, vitamins, and minerals are processed through chemical reactions to be converted into important physiologic end products. Many of these reactions involve the methylation cycle.6 Proper methylation is crucial in an enormous number of biochemical processes, including creatine production for skeletal muscle contraction, DNA and RNA synthesis, gene regulation (epigenetics), hormone regulation and detoxification, energy production, cell membrane repair, fat metabolism, myelination, and immune function.7-11 Methylation plays a critical role in vascular endothelial function and maintaining cardiovascular health. One important methylation byproduct is tetrahydrobiopterin (BH4). Tetrahydrobiopterin is vital for neurotransmitter production and metabolism, and vascular endothelial nitric oxide production.12 Given the extensive effects of methylation, evaluation of a patient’s methylation status may prove to be invaluable for preventative and therapeutic interventions.

In the methylation cycle, dietary methionine is converted to S-adenosylmethionine (SAM), which acts as the universal methyl donor. Using methyltransferase enzymes, SAM donates a methyl group and becomes S-adenosylhomocysteine (SAH), a precursor to homocysteine (Hcy). Hcy is then remethylated back to methionine or irreversibly drawn into the transsulfuration pathway to create glutathione, a powerful antioxidant. Folic acid and vitamins B₂, B₆, and B₁₂ act as cofactors for several enzymes in the methylation pathway. Proper methylation balance involves an interplay between folate metabolism, the methionine methylation cycle, and homocysteine transsulfuration.12 The body continually adapts to maintain homeostasis within these interconnected pathways.13 However, key amino acid deficiencies, lack of vitamin and mineral cofactors, genetic enzymatic predispositions, and a wide array of oxidative stressors can affect each of these pathways and a patient’s overall methylation status.14-16 Although methylation defects have been implicated in many diseases, their role in cognitive decline has received increased attention.17,18 Elevated Hcy has been shown to be a risk factor for Alzheimer’s disease, as well as cardiovascular disease, stroke, thrombosis, and overall neurocognitive dysfunction. These associations could be due to Hcy’s neurotoxic effect or decreased SAM availability, resulting in DNA hypomethylation.19 More importantly however, elevated Hcy reverses adenosylhomocysteinase (the enzyme responsible for Hcy production in the methylation cycle), causing a passive elevation in SAH. SAH directly inhibits methyltransferase reactions. In contrast to the known risk associated with Hcy, studies show SAH elevation to be a more sensitive predictor of cardiovascular disease, renal disease, and Alzheimer’s dementia.20,21 Therefore, proper Hcy elimination is important to prevent passive SAH elevation. There are several ways to metabolize Hcy. The enzyme cystathionine beta-synthase (CBS) draws Hcy into the transsulfuration pathway to ultimately make glutathione, a reaction which requires vitamin B₆ as a cofactor. Hcy can also be remethylated using two different pathways. One pathway requires folic acid and oxidized B₁₂. An additional

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Methylation and Cognitive Decline

(+): GSH, Leptin, IGF-1, TNF-α

Methionine

(-): Alcohol, Free Radicals

MAT ATP, Mg, K

SAM

THF Choline Serine

Oxidized

(-): SAM, DMG, Met

B12 SHMT

Glycine

Betaine

B6, Fe

SAM, B2, B3

Glycine

(-): Alcohol

MTR

MTRR

5,10-MTHF

GNMT

(+): Vit. A, Glucagon

Zn Reduced

(-): Elevated SAH, EGCG, Mycotoxins

Sarcosine

DMG

MTHFR

(+): Omega-3, T4

METHYL GROUP

5-MTHF

Transsulfuration Methylation

(+): GSH, Leptin, IGF-1, TNF-α

B12

B2, B3

(-): SAM, Low T4

(-): MTHF, IR

BHMT

SAH B3

AHCY

Homocysteine

Serine, B6, Fe

(+): SAM, TMG, TNF-a, TMAO

Pyruvate

CBS

(-): CO, Co, Hg, NO, ONOO

CTH B6

CDO/CSAD

H2 S

Energy Production Cysteine

CTH

Detoxification CTH

Cystathionine

Cysteine

GSS

Glutathione

Taurine

Methylation & Transsulfuration Pathways salvage pathway to remethylate Hcy in the presence of B₁₂ and folate deficiency requires adequate betaine and choline levels. Optimization of these nutrients is useful in lowering Hcy levels.22-24 As patients age, they become more susceptible to nutritional deficiencies. Besides poor dietary intake and underlying GI diseases, intestinal malabsorption is one of the main causes of vitamin deficiency in the elderly population. Atrophic gastritis affects 20-50% of patients aged >60, which leads to hypochlorhydria, causing reduced intestinal absorption. 25 Additionally, many older patients are taking a multitude of medications which may interfere with nutritional absorption, such as proton pump inhibitors. Because of these nutritional deficiencies, methylation defects are common, and cognitive decline, mood disorders, and dementia remain prevalent in older patients.26 Nutritional evaluation is one way to individualize interventions which may help to delay cognitive dysfunction. However, there have been a number of conflicting outcome studies regarding the effects of vitamin B supplementation to treat or reverse cognitive impairment after onset. 27-29 Although many studies have shown that Hcy levels can be lowered with B-vitamin supplementation, studies showing improved cognition are lacking.30,31

There are promising studies, both human and animal, using SAM supplementation to treat neurological conditions and alleviate Alzheimer’s dementia-like features.34-36 SAM-e has been available in the US, under the Dietary Supplement and Health Education Act, as an over-thecounter nutraceutical supplement since March, 1999.37 SAM-e has been shown to be as effective as prescription tricyclic antidepressants and non-steroidal anti-inflammatory drugs to treat osteoarthritis, 38 with additional efficacy in treating some liver conditions. 39 SAM-e is well tolerated, and no serious side effects have been observed.38,40 Routine laboratory measurement of SAM, SAH, and the methylation index (SAM:SAH ratio) are novel at present, though they may be the cornerstone of future research regarding treatment strategies and clinical outcomes in cognitive decline.41

References

The implication is that merely supplementing B-vitamins is not enough to reverse cognitive dysfunction. Current research is shifting toward therapeutics which optimize methylation.32,33

ANTI-AGING MEDICAL NEWS

Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. 2014;14(1):643.

van de Rest O, Berendsen AA, Haveman-Nies A, de Groot LC. Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr. 2015;6(2):154-168.

Hughes CF, Ward M, Tracey F, et al. B-Vitamin intake and biomarker status in relation to cognitive decline in healthy older adults in a 4-year follow-up study. Nutrients. 2017;9(1):53.

Mikkelsen K, Stojanovska L, Tangalakis K, Bosevski M, Apostolopoulos V. Cognitive decline: A vitamin B perspective. Maturitas. 2016;93:108-113.

• WINTER 2018

Methylation and Cognitive Decline

Barić I, Staufner C, Augoustides-Savvopoulou P, et al. Consensus recommendations for the diagnosis, treatment and follow-up of inherited methylation disorders. J Inher Metab Dis. 2017;40(1):5-20.

36.

Montgomery SE, Sepehry AA, Wangsgaard JD, Koenig JE. The effect of S-adenosylmethionine on cognitive performance in mice: an animal model metaanalysis. PLoS One. 2014;9(10):e107756.

Locasale JW. Serine, glycine and one-carbon units: cancer metabolism in full circle. Nat Rev Cancer. 2013;13(8):572.

37.

Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside-molecular basis of a pleiotrophic molecule. Am J Clin Nutr. 2002;76(5):1151s-1157s.

Moore LD, Le T, Fan G. DNA methylation and its basic function. Neuropsychopharmacology. 2013;38(1):23.

38.

Brosnan JT, Jacobs RL, Stead LM, Brosnan ME. Methylation demand: a key determinant of homocysteine metabolism. ACTA BIOCHIM POL-ENGLISH EDITION-. 2004;51:405-414.

Sharma A, Gerbarg P, Bottiglieri T, et al. S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research. J Clin Psychiatry. 2017;78(6):e656-e667.

39.

Mischoulon D, Fava M. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr. 2002;76(5):1158S-1161S.

Smazal AL. Oral S-adenosyl methionine (SAM) mediates disruptions in methyl group metabolism due to retinoic acid therapy and alters neurotransmitter metabolism: Implications for major depressive disorder, Iowa State University; 2013.

40.

Hao X, Huang Y, Qiu M, et al. Immunoassay of S-adenosylmethionine and S-adenosylhomocysteine: the methylation index as a biomarker for disease and health status. BMC Res Notes. 2016;9(1):498.

10.

Lawson BR, Eleftheriadis T, Tardif V, et al. Transmethylation in immunity and autoimmunity. Clin Immunol. 2012;143(1):8-21.

41.

11.

Abu-Lebdeh HS, Barazzoni R, Meek SE, Bigelow ML, Persson X-MT, Nair KS. Effects of insulin deprivation and treatment on homocysteine metabolism in people with type 1 diabetes. J Clin Endocrinol Metab. 2006;91(9):3344-3348.

Dayon L, Guiraud SP, Corthésy J, et al. One-carbon metabolism, cognitive impairment and CSF markers of Alzheimer pathology: homocysteine and beyond. Alzheimers Dement. 2017;13(7):P705.

12.

Schalinske KL, Smazal AL. Homocysteine imbalance: a pathological metabolic marker. Adv Nutr: An International Review Journal. 2012;3(6):755-762.

13.

Mudd SH, Brosnan JT, Brosnan ME, et al. Methyl balance and transmethylation fluxes in humans–. Am J Clin Nutr. 2007;85(1):19-25.

14.

Anderson OS, Sant KE, Dolinoy DC. Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation. J Nutr Biochemi. 2012;23(8):853-859.

15.

Ho V, Massey TE, King WD. Effects of methionine synthase and methylenetetrahydrofolate reductase gene polymorphisms on markers of onecarbon metabolism. Genes Nutr. 2013;8(6):571-580.

16.

Cuskelly GJ, Stacpoole PW, Williamson J, Baumgartner TG, Gregory III JF. Deficiencies of folate and vitamin B6 exert distinct effects on homocysteine, serine, and methionine kinetics. Am J Physiol Endocrinol Metab. 2001;281(6):E1182-E1190.

17.

Smith AD, Refsum H. Homocysteine, B vitamins, and cognitive impairment. Annu Rev Nutr. 2016;36:211-239.

18.

Miller AL. The methionine-homocysteine cycle and its effects on cognitive diseases. Alt Med Rev. 2003;8(1):7-19.

19.

Selhub J. Folate, vitamin B12 and vitamin B6 and one carbon metabolism. J Nutr Health Aging. 2002;6(1):39-42.

20.

Chang PY, Lu SC, Chen CH. S-adenosylhomocysteine: a better marker of the development of Alzheimer’s disease than homocysteine? J Alzheimers Dis. 2010;21(1):65-66.

21.

Kerins DM, Koury MJ, Capdevila A, Rana S, Wagner C. Plasma S-adenosylhomocysteine is a more sensitive indicator of cardiovascular disease than plasma homocysteine–. Am J Clin Nutr. 2001;74(6):723-729.

22.

Brattström L. Vitamins as Homocysteine-Lowering Agents. J Nutr. 1996;126(suppl_4):1276S-1280S.

23.

Spence JD, Howard VJ, Chambless LE, et al. Vitamin Intervention for Stroke Prevention (VISP) trial: rationale and design. Neuroepidemiology. 2001;20(1):16-25.

24.

Olthof MR, Van Vliet T, Boelsma E, Verhoef P. Low dose betaine supplementation leads to immediate and long term lowering of plasma homocysteine in healthy men and women. The J Nutr. 2003;133(12):4135-4138.

25.

Selhub J, C Bagley L, Miller J, Rosenberg I. B Vitamins, homocysteine, and neurocognitive function in the elderly. Vol 712000.

26.

Araújo JR, Martel F, Borges N, Araújo JM, Keating E. Folates and aging: Role in mild cognitive impairment, dementia and depression. Ageing Res Rev. 2015;22:9-19.

27.

Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, Dyck CH, Weiner MF. Highdose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. JAMA. 2008;300.

28.

Balk EM, Raman G, Tatsioni A, Chung M, Lau J, Rosenberg IH. Vitamin b6, b12, and folic acid supplementation and cognitive function: A systematic review of randomized trials. Arch Int Med. 2007;167(1):21-30.

29.

Moore E, Mander A, Ames D, Carne R, Sanders K, Watters D. Cognitive impairment and vitamin B12: a review. Int Psychogeriatr. 2012;24(4):541-556.

30.

Forbes SC, Holroyd-Leduc JM, Poulin MJ, Hogan DB. Effect of nutrients, dietary supplements and vitamins on cognition: a systematic review and meta-analysis of randomized controlled trials. Can Geriatr J. 2015;18(4):231.

31.

Dangour AD, Allen E, Clarke R, et al. Effects of vitamin B-12 supplementation on neurologic and cognitive function in older people: a randomized controlled trial1,2. Am J Clin Nutr. 2015;102(3):639-647.

32.

Chan A, Tchantchou F, Graves V, Rozen R, Shea T. Dietary and genetic compromise in folate availability reduces acetylcholine, cognitive performance and increases aggression: critical role of S-adenosyl methionine. J Nutr Health Aging. 2008;12(4):252-261.

33.

Shea TB, Chan A. S-adenosyl methionine: a natural therapeutic agent effective against multiple hallmarks and risk factors associated with Alzheimer’s disease. J Alzheimers Dis. 2008;13(1):67-70.

34.

Rudolph ML, Rabinoff M, Kagan BL. A prospective, open-label, 12 week trial of S-adenosylmethionine in the symptomatic treatment of alzheimer’s disease. Neurosci Med. 2011;2(03):222.

35.

Lee S, Lemere CA, Frost JL, Shea TB. Dietary supplementation with S-adenosyl methionine delayed amyloid-β and tau pathology in 3xTg-AD mice. J Alzheimers Dis. 2012;28(2):423-431.

About The Author Dr. Patricia M. Devers is a board certified internal medicine physician with a specialty in hospitalist medicine. She has been trained in functional medicine by both A4M and IFM. Dr. Devers is currently the Content Manager at Genova Diagnostics. Pdevers@gdx.net 1.800.522.4762

ANTI-AGING MEDICAL NEWS

• WINTER 2018

The LDN 2019 Conference is being held on 7-9th June 2019 in Portland, Oregon USA at Sheraton Portland Airport Hotel Join us online or watch the recordings at a time to suit you! The Conference examines life-changing breakthroughs for treating Autoimmune Diseases, Cancers, Pain etc using Low Dose Naltrexone (LDN). Go to www.ldn2019.com and check out our amazing line up of speakers, details on Tickets, LiveStream, Sponsorship Opportunities and more.

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Why Your Genes Aren’t Your Destiny Presented by Sara Gottfried, MD Date: December 12, 2018 Time: 6:15 PM Location: Veronese 2403 Food and drink will be served at this Metagenics Institute-sponsored reception

Until recently, scientists believed our DNA held the blueprint to prevent and reverse disease. But we now know that environment—not our genes—is the primary driver of health and longevity. In this talk, Dr. Gottfried will discuss the complex interplay between DNA and environment—and explain the proven diet, lifestyle, and behavioral strategies that can effectively lengthen the period of time you feel healthy and in your prime. Metagenics Chief Medical Officer and President of Metagenics Institute Sara Gottfried, MD is a systems-based hormone expert, a Harvard-educated physician-scientist, and an MIT-trained bioengineer as well as board-certified in Obstetrics and Gynecology. She is also a New York Times bestselling author of three books: The Hormone Cure, The Hormone Reset Diet, and Younger.

Neuroprotective Effects of the Ketogenic Diet By: Milene Brownlow, PhD

Metagenics Institute 9770 44th Ave. NW, Ste 100, Gig Harbor, WA 98332

Ketosis is a natural metabolic state that occurs when there is an absence or shortage of dietary carbohydrates (sources of glucose) consumed as the main energy source for the body. While in ketosis, the body shifts towards the use of fat as the primary energy source. The body increases the breakdown of fat into ketone bodies which are readily used by most tissues, including muscle and brain, as the main fuel. A ketogenic diet refers to a dietary approach that promotes ketosis by restricting carbohydrates (usually to < 50 g/day) and increasing the intake of fat with adequate (low to moderate) consumption of protein. Ketogenic diets were originally used for seizure control in the treatment of childhood epilepsy. Today, it is now considered a promising metabolic therapy for several other neurological conditions currently being tested in both clinical and laboratory settings. New research findings are published every week, and exciting pieces of this intricate puzzle that is our metabolic machinery are slowly coming together in support of the neuroprotective properties of the ketogenic diet.

Preclinical Study Evidence In rodents, diet-induced ketosis has been shown to reverse motor deficits in a model of amyotrophic lateral sclerosis (ALS),1 reduce lesion volume after traumatic brain injury (TBI),2 improve pathology and behavioral performance in Alzheimer’s disease (AD) transgenic model,3 and attenuate stress-induced deficits in behavioral performance and hippocampal brain-derived neurotrophic factor (necessary for synaptic plasticity) levels in adult rats.4 Addition of the ketone body beta-hydroxybutyrate (bHB) to cell cultures prevented neuronal death following exposure to toxins associated with AD and Parkinson’s disease (PD).5 However, the large variability in experimental design (diet composition, model used, treatment duration, age at the start of study) highlights the challenges associated with the translatability of preclinical models and the importance of human clinical trials.

differences in study design, researchers observed that improved cognitive outcomes were: • Positively correlated with the level of ketosis6-7, 9 • Associated with duration in ketosis (performance returned to baseline levels following washout period)9 • More pronounced in patients who are ApoE4 negative (genetic isoform of the apolipoprotein E that confers increased risk for developing AD)6-8, 10 • Also observed in elderly, non-demented subjects11 Moreover, in an era of increasing need for individualized approaches, case studies demonstrate: • Oral administration of a ketone monoester for 20 months improved mood, affect, and cognitive ability in a patient with advanced AD12 • Personalized ketogenic protocols with lifestyle modifications such as physical exercise and brain training resulted in better cognitive scores in patients with comorbid cognitive impairment and metabolic syndrome13-14 ·

Other Neurological Conditions & Emerging Science

The neuroprotective properties associated with decreased inflammation, oxidative stress, and improved mitochondrial bioenergetics also render ketogenic approaches a promising metabolic therapy for several other neurological disorders, such as: • TBI and stroke: Ketosis has been associated with higher tolerance to hypoxic environments and neuroprotection following TBI, stroke, and ischemia-induced brain edema; however, these conditions require early delivery of ketones to maximize therapeutic effectiveness, and an optimal therapeutic window is still unclear2

Ketogenic Diet Interventions In Patients With Cognitive Decline

• Diet- or fasting-induced ketosis in patients with brain tumors: Some cancer cells are highly dependent on glucose. Carbohydrate restriction has been shown to result in smaller tumors with better-defined borders, facilitating surgical resection and decreasing chemotherapy side effects15

So far relatively few human trials have been conducted leveraging the use of ketogenic medium-chain triglycerides (MCT) in patients with mild-to-moderate AD.6-9 Despite

• Enhancing motor function in neuromuscular diseases such as PD16 and ALS1 and attenuating brain inflammation and oxidative stress in a mouse model of multiple sclerosis17

Neuroprotective Effects of the Ketogenic Diet

• Autism Spectrum Disorders (ASD): Recent studies have implicated mitochondrial dysfunction in ASD, characterized by behavioral deficits in sociability and communication and clinical manifestations may include seizures and sleep disturbances18 • Chronic cluster headaches (CCH): A small 12-week clinical study implementing a ketogenic diet resulted in significant reduction in average CCH attacks, and in responders, the majority experienced full resolution of CCH,19 which is considered the most severe type of headache • Migraines: Although the precise mechanisms are unclear, ketosis may provide migraine relief via modulation of brain excitability and energetic metabolism, in addition to decreased neuroinflammation and oxidative stress20

Summary Overall, relatively few human trials have been completed so far. However, numerous clinical and proof-of-concept studies are underway and will likely contribute to the greater clinical acceptance and adaptation of ketogenic programs to better suit different patients and conditions. When it comes to neurodegenerative disorders, the underlying brain pathology starts developing decades before the appearance of clinical symptoms. Consequently, by the time a patient is diagnosed, the disease is well-established and more challenging to revert. As a result, prevention and early diagnosis remain the best approaches to improve the quality of life of patients, caregivers, and loved ones.

• While KD-induced benefits are explored in the context of neurological disorders, a few research groups are investigating its potential for cognitive augmentation in healthy subjects with modest, yet encouraging results4,21

About the Author Dr. Brownlow earned her PhD from the University of South Florida, studying the role of diet-induced ketosis and calorie restriction on Alzheimer’s pathology.

References 1.

Zhao W et al. Caprylic triglyceride as a novel therapeutic approach to effectively improve the performance and attenuate the symptoms due to the motor neuron loss in ALS disease. PLoS One. 2012;7(11):349191.

Prins ML et al. The collective therapeutic potential of cerebral ketone metabolism in traumatic brain injury. J Lipid Res. 2014;55(12):2450-7.

Van der Auwera I et al. A ketogenic diet reduces amyloid beta 40 and 42 in a mouse model of Alzheimer’s disease. Nutr Metab. 2005;2:28.

Brownlow ML et al. Nutritional ketosis affects metabolism and behavior in Sprague-Dawley rats in both control and chronic stress environments. Front Mol Neurosci. 2017;10:129.

Kashiwaya Y et al. D-β-Hydroxybutyrate protects neurons in models of Alzheimer’s and Parkinson’s disease. Proc Natl Acad Sci USA. 2000;97(10):5440-4.

Reger MA et al. Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. Neurobiol Aging. 2004;25(3):311-4.

Henderson ST et al. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer’s disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutr Metab (Lond). 2009;6:31.

Ohnuma T et al. Benefits of use, and tolerance of, medium-chain triglyceride medical food in the management of Japanese patients with Alzheimer’s disease: a prospective, open-label pilot study. Clin Interv Aging. 2016;11:29-36.

Taylor MK et al. Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer’s disease. Alzheimers Dement. 2017;4:28-36.

10. Rebello CJ et al. Pilot feasibility and safety study examining the effect of medium chain triglyceride supplementation in subjects with mild cognitive impairment: A randomized controlled trial. BBA Clin. 2015;3:123-5. 11. Ota M et al. Effect of a ketogenic meal on cognitive function in elderly adults: potential for cognitive enhancement. Psychopharmacology (Berl). 2016;233(21-22):3797-3802. 12. Newport MT et al. A new way to produce hyperketonemia: use of ketone ester in a case of Alzheimer’s disease. Alzheimer’s Dement. 2015;11(1):99-103. 13. Dahlgren K et al. Ketogenic diet, high intensity interval training (HIIT) and memory training in the treatment of mild cognitive impairment: A case study. Diabetes Metab Syndr. 2018;pii:S1871-4021(18)30116-4. 14. Brown D et al. Metabolic syndrome marks early risk for cognitive decline with APOE4 gene variation: A case study. Diabetes Metab Syndr. 2018;pii:S18714012(18)30115-2. 15. Poff A et al. Targeting the Warburg effect for cancer treatment: Ketogenic diets for management of glioma. Semin Cancer Biol. 2017;pii:S1044578X(17)30124-4. 16. Paoli A et al. Ketogenic diet in neuromuscular and neurodegenerative diseases. Biomed Res Int. 2014;2014:474296. 17. Kim DY et al. Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis. PLoS One. 2012;7(5):e35476. 18. Cheng N et al. Metabolic dysfunction underlying Autism Spectrum Disorder and potential treatment approaches. Front Mol Neurosc. 2017;10:34. 19. Di Lorenzo C et al. Efficacy of modified Atkins ketogenic diet in chronic cluster headache: an open-label, single-arm, clinical trial. Front Neurol. 2018;9:64. 20. Barbanti P et al. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci. 2017;38(Suppl 1):111-115. 21. Murray AJ et al. Novel ketone diet enhances physical and cognitive performance. FASEB J. 2016; 30(12):4012-32.

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New Perspectives on Testosterone’s Role in Shaping Male Behavior By: Kate Placzek, PhD The following article is not endorsed and/or supported by The American Academy of Anti-Aging Medicine. The purposes of this publication do not imply endorsement and/or support of any author, company or theme related to this article.

Testosterone, so meaningful to a man’s behavior, is the evolutionary force behind everything intrinsically “male.” Historical perspectives peg testosterone as the macho elixir of legendary proportion – the “chest-thumping hormone of aggression.” Testosterone Beyond Aggression

Testosterone plays a key role in the maintenance of physical masculinization and modulates behavioral processes critical to survival and reproduction. Much behavioral research has focused on understanding antisocial behaviors, linking those that are stereotypically male, such as aggression and anger, to higher levels of circulating testosterone. However, testosterone-driven atavistic residues of aggressive behavior that prevail in the animal kingdom, are attenuated in humans by factors rooted in social, familial and self-construal considerations [1]. Far beyond the broad media coverage of incidents of “road rage,” human aggression takes on a much more nuanced angle with testosterone playing a prominent role as a fuel for dominance rather than haphazard reactivity. New research is beginning to tease out the subtleties of how testosterone shapes neurocognitive processes that promote prosocial responses. Testosterone provides the psychological groundwork for male behavior, which is non-trivial for social adaptation – increasing levels enhance generosity [2], cooperation[3], honesty [4], and cognitive performance [5].

ANTI-AGING MEDICAL NEWS

Prosocial in some cases and antisocial in others, testosterone’s actions are not diametrically opposed after all. The abovementioned studies pave a way for viewing testosterone’s effect on male behavior from the perspective of establishing dominance, rather than being aggression-centric. Predictably in social contexts where status is threatened by perceived provocation, this motivation may indeed lead to increased aggression; in others, nonaggressive behaviors, such as generosity, may be more appropriate for advancing social status and will, therefore, be promoted by testosterone.

Altered Consumer Preferences after Testosterone Dosing

A new study published in Nature Communications conducted a “positional consumption” study, exploring the effects of testosterone supplementation on men’s preference for luxury products [6]. Researchers asked 243 men to apply gel on their upper body that contained either testosterone or placebo. The study participants were then asked to carefully examine pictures and descriptions of items that varied on 3 distinct dimensions: status, power, and quality. • WINTER 2018

New Perspectives on Testosterone’s Role in Shaping Male Behavior

When Men Want Fancy Things

It turns out that men in the testosterone group had a much stronger preference for goods perceived as having higher status, compared to men that received placebo, suggesting that consumption of status goods may stem from neuroendocrine motives. Meanwhile, men that received placebo tended to choose the powerful and high-quality versions of the goods over the high-status ones. The surge in testosterone, confirmed by testing salivary hormone levels in the participants, suggests that some region in the brain was stimulated to promote stronger attitudes toward status-enhancing goods, and not those associated with power or high quality – thereby reinforcing a sort of nuanced “consumer aggression” as a means to gain social status.

Fuel for Dominance to Promote Status

The results of this “buying under the influence” study yet again emphasize testosterone’s role in social adaptation, highlighting its role in status-enhancing behaviors. For humans - American men, at least - this testosterone-driven display of prowess finds its expression in a preference for status goods. This and other studies [7] emphasize that the pursuit of status enhancement appears to be hardwired into the male neurophysiology - human males no longer have a need for indiscriminate aggression, which, after all, is just one of many means to achieve status. Men who are knowledgeable or skilled in a particular area can nowadays achieve social dominance without physically conquering their adversaries.

actions [14]. What this means is that testosterone, directly and indirectly via its metabolite, recruits dopamine to facilitate focused thinking and behavior to attain a chosen goal. These and other neurocognitive pathways all work in concert to regulate complex processes such as decision making and cognitive flexibility.

Final Words

If testosterone propels men to seek status, research into the theoretical frameworks of neuroeconomics might improve our understanding of gender-specific social behaviors. Psychometrics behind behavioral tests provide a glimpse into the multi-dimensional neurobehavioral labyrinth. The gamut of structural and functional endpoints affected by testosterone is further broadened when testosterone metabolism is considered. Future studies should probe deeper into the role of testosterone metabolism in reward-based behavior of status seeking. Approaching this challenge will only be feasible using noninvasive body fluids, such as saliva or urine, and testing them for hormones like testosterone and its metabolites by the state-of-the-art mass spectrometry used in the recently reported study [6].

References

Testosterone Affects Attitudes to Competition

Testosterone not only fuels the desire to dominate but also rapidly boosts men’s perceptions of their own physical dominance [8]. In this context, men’s competitive motivation is highly influenced by competition-induced fluctuations in testosterone concentration - its levels spike as an individual embarks upon a task that may significantly affect status [9]. In other words, testosterone drives anticipatory vigor and enhances self-perception in social situations where status matters. Moreover, male winners have higher testosterone levels compared to losers [10]. Additionally, vicariously experiencing a win by a favorite sports team can also induce a spike in testosterone levels [11]. The motivation to continue after losing a competition seems to be strongly affected by the rise in testosterone – losers with more testosterone are more likely to compete again [12]. In a real-life scenario, prior to performing a particularly challenging and demanding task testosterone levels have been shown to rise to the occasion [13].

The Testosterone – Dopamine Connection

What is it about testosterone’s actions that resonates with the feel-good reward-enhancing actions of the neurotransmitter dopamine? Testosterone is prominently featured within the executive function and reward pathways [14, 15]. Turns out, testosterone is particularly arousing to the dopaminergic system, stimulating dopamine biosynthesis and potentiating its signaling throughout the brain [14, 16]. Furthermore, a downstream metabolite of testosterone, 5α-androstanediol, binds to dopamine receptors in the brain and enhances its

ANTI-AGING MEDICAL NEWS

[1] K.M. Welker, R.E. Norman, S. Goetz, B.J.P. Moreau, S. Kitayama, J.M. Carre, Preliminary evidence that testosterone’s association with aggression depends on self-construal, Horm Behav 92 (2017) 117-127. [2] C. Eisenegger, M. Naef, R. Snozzi, M. Heinrichs, E. Fehr, Prejudice and truth about the effect of testosterone on human bargaining behaviour, Nature 463(7279) (2010) 356-9. [3] J. van Honk, E.R. Montoya, P.A. Bos, M. van Vugt, D. Terburg, New evidence on testosterone and cooperation, Nature 485(7399) (2012) E4-5; discussion E5-6. [4] M. Wibral, T. Dohmen, D. Klingmuller, B. Weber, A. Falk, Testosterone administration reduces lying in men, PLoS One 7(10) (2012) e46774. [5] M.F. Warren, M.J. Serby, D.M. Roane, The effects of testosterone on cognition in elderly men: a review, CNS Spectr 13(10) (2008) 887-97. [6] G. Nave, A. Nadler, D. Dubois, D. Zava, C. Camerer, H. Plassmann, Single-dose testosterone administration increases men’s preference for status goods, Nat Commun 9(1) (2018) 2433. [7] L. Wagels, M. Votinov, T. Kellermann, A. Eisert, C. Beyer, U. Habel, Exogenous Testosterone Enhances the Reactivity to Social Provocation in Males, Front Behav Neurosci 12 (2018) 37. [8] L.L. Welling, B.J. Moreau, B.M. Bird, S. Hansen, J.M. Carre, Exogenous testosterone increases men’s perceptions of their own physical dominance, Psychoneuroendocrinology 64 (2016) 136-42. [9] J.M. Carre, N.A. Olmstead, Social neuroendocrinology of human aggression: examining the role of competition-induced testosterone dynamics, Neuroscience 286 (2015) 171-86. [10] S.N. Geniole, B.M. Bird, E.L. Ruddick, J.M. Carre, Effects of competition outcome on testosterone concentrations in humans: An updated meta-analysis, Horm Behav 92 (2017) 37-50. [11] P.C. Bernhardt, J.M. Dabbs, Jr., J.A. Fielden, C.D. Lutter, Testosterone changes during vicarious experiences of winning and losing among fans at sporting events, Physiol Behav 65(1) (8/1998) 59-62. [12] P.H. Mehta, R.A. Josephs, Testosterone change after losing predicts the decision to compete again, Horm. Behav 50(5) (12/2006) 684-692. [13] P.A. Brennan, M.K. Herd, R. Puxeddu, R. Anand, L. Cascarini, J.S. Brown, C.M. Avery, R.T. Woodwards, D.A. Mitchell, Serum testosterone levels in surgeons during major head and neck cancer surgery: a suppositional study, Br J Oral Maxillofac Surg 49(3) (2011) 190-3. [14] D.J. Tobiansky, K.G. Wallin-Miller, S.B. Floresco, R.I. Wood, K.K. Soma, Androgen Regulation of the Mesocorticolimbic System and Executive Function, Front Endocrinol (Lausanne) 9 (2018) 279. [15] E. Mhillaj, M.G. Morgese, P. Tucci, M. Bove, S. Schiavone, L. Trabace, Effects of anabolicandrogens on brain reward function, Front Neurosci 9 (2015) 295. [16] T.D. Purves-Tyson, S.J. Owens, K.L. Double, R. Desai, D.J. Handelsman, C.S. Weickert, Testosterone induces molecular changes in dopamine signaling pathway molecules in the adolescent male rat nigrostriatal pathway, PLoS One 9(3) (2014) e91151.

Author: Kate Placzek, PhD

Bio: In her role as the Senior Research Scientist, Dr. Placzek combines clinical observation with published research findings to create and develop innovative functional medicine test profiles used by practitioners around the globe. Prior to joining ZRT Laboratory, Dr. Placzek earned her PhD in Medicinal Chemistry and Molecular Pharmacology at Purdue University and worked at Oregon Health and Science University as a Postdoctoral Researcher in endocrinology. Dr. Placzek is passionate about educating providers through blogs, webinars and lectures at national conferences

• WINTER 2018

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David T. Zava, Ph.D. al SW Creekside Place are for information8605 Laboratory Director The above results and comments to be construed as medical Beaverton, OR 97008 purposes only and are not for David T. Zava, Ph.D. Phone: 503-466-2445 Fax: 503-466-1636 practitioner . your healthcare , Ph.D l 8605 SW dCreekside Place for informationa advice. Please consult Director Davi T. Zava tor LLC. All Laboratory results and comments are rights reserved. treatment. Beaverton, OR 97008 Direc andabove ZRTyLaboratory, diagnosisThe © 1998-2018 CLIA Lic # 38D0960950 rator to be construed as medical not are Labo and only purposes for Phone: 503-466-2445 Fax: 503-466-1636 practitioner . your healthcare tional Samples Received Collected # 2018 07 27 200 SB 8/13/2018 3:32:17 PM consult Please rma advice.for T. Zava, Ph.D Samples info d Davi Director LLC. All rights reserved. ments are ed and treatment. ZRTyLaboratory, medical © 1998-2018 07/27/2018 Labosrator Saliva - 07/24/18 08:05 stru as reserved. lts and com bediagnosis Ordering Provider: con for resu right er All ve l to tition Samples ReceivedSaliva Samples Collected # 2018 07The 27abo 200 SB and are not ratory, LLC. re prac informationa - 07/24/18 12:10 Sara Getuwell 8 ZRT Labo r healthca ts are for as medical 960950 MD purposes only -201 you men 38D0 Report Date 1998 # sult © 07/27/2018 and com trued se con Saliva - 07/24/18 08:05 CLIA Lic reserved. Saliva - 07/24/18 18:50 Provider: PM resu vetme nt.lts are not to be cons practitioner for 3:32:17Ordering abo advice. Plea LLC. All rights y, 08/01/2018 The trea rator 8/13/2018 re and and Labo Saliva 07/24/18 12:10 lthca Sara Getuwell - 07/24/18 23:15 ZRT nosis purposes only your hea diagMD 38D0960950 Report DateSaliva © 1998-2018 se consult CLIA Lic # Saliva 18:50 Blood Spot- 07/24/18 - 07/24/18 08:00 3:32:17 PM advice. Plea treatment. 08/01/2018 8/13/2018 and Saliva - 07/24/18 23:15 diagnosis

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0.5-3.0 µU/mL

20-80 ng/ml (50-200 nmol/L)

11 4.2

5.8

CLIA Lic # 38D0960950 8/23/2018 2:19:07 PM

Cortisol Cortisol

Blood Sugar Low

Body Temperature Cold Blood

BoneBreast Loss Cancer

Vitamin D, 25-OH, D3

Breasts - Tender Chemical Sensitivity

Vitamin D, 25-OH,

Vitamin D, 25-OH, D3

46 46

<6%

Depressed Constipation

advice. Please consult your healthcare practitioner for diagnosis and treatment.

David T. Zava, Ph.D. Laboratory Director

TSH

Foggy Thinking specified 1) Alisonotherwise McAllister, ND. on pageBlood Fibromyalgia 1 Spot of 6

Insulin

(Ordering Provider unless Goiter

Foggy Thinking otherwise specified on page 1)

Hair - Dry or Brittle

Sleep Stamina DisturbedDecreased

Triglycerides UrinaryElevated Urge Increased Urinary Urge Increased

Uterine Fibroids

Weight # 2018 Management 07 27 200 SB # 2018 07 27 200 SB

BMI BMI 28.3

RANGE

Uterine Fibroids

Vaginal Dryness

Water Retention

Weight Gain - Hips

Weight Gain - Waist

04/09/18 04/09/18

Comments LabLab Comments

40% 40% 0.8-12 pg/mL Estrogen Rplcmnt (optimal 1.3-3.3) 0.8-12 pg/mL Estrogen Rplcmnt (optimal 1.3-3.3) 34% 34%

Estradiol is within physiological range withestrogen topical estrogen replacement therapy. Maintaining healthy physiological Estradiol is within physiological range with topical replacement therapy. Maintaining healthy physiological estradiol lev healthy distribution fat inthighs, hips, breasts, thighs, breasts, and subcutaneous tissues. also Estrogen alsogood supports good choleste healthy distribution of fat inofhips, and subcutaneous tissues. Estrogen supports cholesterol ratios an serotonin production, whichregulate helps regulate hunger and suppresses vasomotor (hot and nightFor sw serotonin production, which helps hunger and suppresses vasomotor symptomssymptoms (hot flashes andflashes night sweats). toweight, lose weight, estrogen levels may asdrops, weightsodrops, so low estrogen may as you achieve to lose estrogen levels may drop asdrop weight low estrogen symptomssymptoms may appear as appear you achieve your weight y

58%pg/mL (1)(1) 30-300 pg/mL Oral Progesterone (100-300 58% 30-300 Oral Progesterone (100-300 mg)mg)

(2)(2) 12-100 pg/mL Postmenopausal 12%pg/mL 12-100 Postmenopausal

12% 33% 100-500 when E2 1.3-3.3 pg/mL 33% Optimal: Optimal: 100-500 when E2 1.3-3.3 pg/mL 56% 56% 32% 32% 16-55 pg/mL (Age Dependent) 16-55 pg/mL (Age Dependent) 49% 49% 2-23 (Age Dependent) 2-23ng/mL ng/mL (Age Dependent)

Progesterone is within expected physiological (luteal) range with oral with progesterone supplementation. Oral supplementation res Progesterone is within expected physiological (luteal) range oral progesterone supplementation. Oral supplem rapid rapid increase and clearance of progesterone with levels usually thewithin lower the limits of the observed > 12 range hrs followin increase and clearance of progesterone with levelswithin usually lower limits of therange observed > 12 supplementation. Within Within 12-24 hr following oral progesterone therapy progesterone levels in the bloodstream and saliva have supplementation. 12-24 hr following oral progesterone therapy progesterone levels in the bloodstream and closercloser to baseline levels seen to prior progesterone supplementation; however, however, it is important keep in mind thatinsalivary leves to baseline levelsprior seen to progesterone supplementation; it is to important to keep mind that dosing (usually ranging from 50-300 mg), and time from last use. Oral progesterone is usually more effective when used at nig dosing (usually ranging from 50-300 mg), and time from last use. Oral progesterone is usually more effective when because metabolites formedformed in the gastrointestinal tract from progesterone (allopregnanolone) help with sleep. In this case In it ist because metabolites in the gastrointestinal tract from progesterone (allopregnanolone) help with sleep. salivasaliva in the in morning to allowtoan 6-10an hr 6-10 time frame lastfrom use of progesterone. If symptoms of estrogen/progesterone imba the morning allow hr timefrom frame last use of progesterone. If symptoms of estrogen/proges resolved with oral therapytherapy it would itbe worthwhile to consider changing changing dosage or dosage mode ofor delivery transder resolved withprogesterone oral progesterone would be worthwhile to consider mode (e.g. of delivery (e instead of, or in combination with oral). If symptoms of estrogen imbalance remain problematic with the oral progesterone, it w instead of, or in combination with oral). If symptoms of estrogen imbalance remain problematic with the oral proges to consider increasing or decreasing the estrogen level (assuming greater than the optimal range of 1.3-3.3 pg/ml) or change t to consider increasing or decreasing the estrogen level (assuming greater than the optimal range of 1.3-3.3 pg/ml) progesterone delivery (eg. topical) to achieve an optimal Pg/E2 ratio of 100-500 (note: if estradiol is within optimal range this o progesterone delivery (eg.8 topical) achieve an optimal Pg/E2 ratio of 100-500 (note: if estradiol is within optimal is likely achieved during the first hours oftooral progesterone supplementation).

3.7-9.5 (morning) 3.7-9.5ng/mL ng/mL (morning)

 

1.9 1.9

1.2-3.0 (noon) 1.2-3.0ng/mL ng/mL (noon)

0.5 L

0.6-1.9 ng/mL (evening)

0.4

0.4-1.0 ng/mL (night)



0.6-1.9 ng/mL (evening) 0.4-1.0 ng/mL (night)

<4 if not supplementing (< 10 nmol/L)

15 L

20-80 ng/ml (50-200 nmol/L)

15 L

20-80 ng/ml (50-200 nmol/L)

15 L

Blood Spot Thyroids

Fatigue - Evening

Total D, 25-OH, Vitamin Total

Sleep Disturbed Skin Thinning

TearfulTriglycerides Elevated

Weight Management

Ranges Ranges adjusted adjusted for for supplementation supplementation

Chemical Sensitivity Cholesterol High

Fatigue - Morning Fatigue - Evening TSH Alison McAllister, ND. Fibromyalgia Blood1 Spot of 6 Fatigue - Morning (Ordering Provider unless

8.1 8.1

0.4

Spot

Vitamin D, 25-OH, D2

Breast Cancer Breasts - Fibrocystic

Constipation Cholesterol High

0.4

Breasts - Fibrocystic Breasts - Tender

David T. Zava, Ph.D. Laboratory Director

2.3 2.3 11

0.7

1-15 µIU/mL (optimal 2-6)

15 15LL

0.4

Blood Spot

Blood Sugar Low

(2)

55LL

0.7

Cortisol

Blood Pressure LowCortisol

Blood Pressure Low

22(2) 22

1.5 1.5

Cortisol

Blood Pressure High

4.7 4.7

9.0 9.0

 

Bleeding Changes

4.2 <6% is less than the detectable limit. H = High. L = Low. Depressed N/A = Not applicable; 1 or more values used in this calculation

The above results and comments are for informational purposes only and are not to be construed as medical advice. Please consultare your practitioner for The above results and comments forhealthcare informational and to treatment. purposes onlydiagnosis and are not be construed as medical

Weight Weight 170 lb

RESULTS | 07/24/18 04/09/18 RESULTS 07/24/18 RESULTS || 07/24/18

Cortisol Cortisol

BodyBone Temperature Cold Loss

0.5-3.0 µU/mL

<dL = Less than the detectable limit of the lab. N/A = Not applicable; 1 or more values used in this calculation is less than the detectable limit. H = High. L = Low. CLIA Lic # 38D0960950 8/23/2018 2:19:07 PM

28.3

Appraisalof of 88 Appraisal hormoneimbalances imbalances hormone

15 L

Allergies

<4 if not supplementing (< 10 nmol/L)

20-80 ng/ml (50-200 nmol/L)

Blood Spot Thyroids

170 lb

SYMPTOM CHECKLIST SYMPTOM CHECKLIST

Aches Pains Aches and and Pains

Thinning Rapid Skin Heartbeat

Sweating Decreased Swelling or Puffy Eyes/Face

Waist

Hysterectomy (ovaries removed)

22% Estrogen / Progesterone Deficiency 22% Estrogen / Progesterone Deficiency Estradiol 2.2 Estradiol 2.2 20% Estrogen Dominance / Progesterone Deficiency 20% Estrogen Dominance / Progesterone Deficiency 37% LowLow Androgens (DHEA/Testosterone) Androgens (DHEA/Testosterone) (1) 37% Progesterone 73 Progesterone 73(1) 11% HighHigh Androgens (DHEA/Testosterone) 11% Androgens (DHEA/Testosterone) 23% LowLow Cortisol 23% Cortisol Ratio: Pg/E2 Ratio: Pg/E2 33 33LL 29% HighHigh Cortisol 29% Cortisol Testosterone 21%35 HypometabolismTestosterone 21% Hypometabolism 35 38% Metabolic Syndrome 38% Metabolic Syndrome DHEAS DHEAS 5.0 5.0

Anxious <4 if not supplementing (< 10 nmol/L) Anxious

15 L

Color-coded Color-coded patient results patient results

Vitamin D,Total 25-OH, Total

Height

Unspecified

TEST NAME 100-500 when E2 1.3-3.3 pg/mL Salivary Steroids SYMPTOM CATEGORIES 5 L Optimal: Optimal: 100-500 when E2 1.3-3.3 pg/mL Salivary Steroids SYMPTOM CATEGORIES

Rapid Rapid Aging Heartbeat

Sugar Sweating Cravings Decreased

Waist 32 in 32 in

12-100 pg/mL Postmenopausal

1.9

15 L

3/22/1961 (57 yrs)

StressSugar Cravings

Height 5 ft 5 in 5 ft 5 in

(1) 30-300

Aging Pulse Rapid Rate Slow

Stress Stamina Decreased

Disclaimer: pg/mL Oral Progesterone (100-300 mg) Symptom Categories below show percent of symptoms self-reported by the patient compared to total available symptoms for each category. For Disclaimer: Categories below show of symptoms self-reported by the patient compared to total available symptoms for each category. For Oral Progesteronedetailed (100-300 mg) Symptom information on category breakdowns, go percent to www.zrtlab.com/patient-symptoms. TEST NAME RESULTS | 07/24/18 04/09/18 RANGE 22(2) (2) 12-100 pg/mLpg/mL Postmenopausal (2) detailed information on category breakdowns, go to www.zrtlab.com/patient-symptoms. (1) 30-300

8.1

0.8-12 pg/mL Estrogen Rplcmnt (optimal 1.3-3.3)

AcneAcne

Vitamin D, 25-OH, D3

TSH

Last Menses Last Menses Unspecified

TEST REPORT | Patient ReportedHysterectomy Symptoms 0.8-12 pg/mL Estrogen Rplcmnt (optimal 1.3-3.3) DOB Menses Status 3/22/1961 (57 yrs) (ovaries removed)

2.3

0.4

Blood Spot Blood Spot

TSH

Gender Gender Female

RANGE

0.5 L 0.5 L0.6-1.90.6-1.9 (evening) ng/mLng/mL (evening)

0.7

0.7 0.4

Blood Spot - 07/24/18 08:00

Pulse Rate Slow SYMPTOM CHECKLIST

Swelling or Puffy Eyes/Face Tearful

Patient Phone Number: 555 555 5555

TEST REPORT DOB | Patient ReportedMenses Symptoms Status

4.7

Samples Collected

Patient Name: Weight Management PatientPhone Name:Number: Weight Management Patient 555 555 5555

15 L 15 L16-55 pg/mL (Age Dependent) 16-55 pg/mL (Age Dependent)

Cortisol Cortisol Cortisol Cortisol

Cortisol Cortisol

170 lb

RANGE

04/09/18

4.7

2.2

73(1)

Progesterone

Ratio: Pg/E2

32 in

Female

Salivary Steroids

Ratio: Pg/E2

5 ft 5 in

SYMPTOM CHECKLIST

07/27/2018 Saliva -Collected 07/24/18 08:05 Samples Received Samples Saliva - 07/24/18 12:10 07/27/2018 - 07/24/18 08:05 Report Date Saliva Saliva - 07/24/18 18:50 Saliva - 07/24/18 12:10 08/01/2018 Saliva - 07/24/18 23:15 Report Date Saliva - 07/24/18 18:50 Blood Spot - 07/24/18 08:00 08/01/2018 Saliva - 07/24/18 23:15

Ordering # 2018 Provider: 07 27 200 SB Sara Getuwell MD

We # 20

TEST REPORT | Patient Reported Symptoms continued

Phone: 503-466-2445 503-466-1636 8605 SW Fax: Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636

Blood Spot - 07/24/18 08:00

Patient Name: Weight Management PatientPatient Phone Name: Number: 555 Management 555 5555 Weight

TEST REPORT | Patient Reported Symptoms continued

8605 SW Creekside Place Beaverton, OR 97008

TEST REPORT # 2018 07 27 200 SB

15 L

1.0

CardioMetabolic Markers

6.4

Personalized Personalized comments comments

is likely achieved during the first 8 hours of oral progesterone supplementation).

Testosterone is within physiological range with topical testosterone therapy. Adequate testosterone is necessary to build and m Testosterone range with therapy. Adequate is necessary to muscle mass which is is within directlyphysiological tied to metabolic rate andtopical calorietestosterone burning to help with weight loss. testosterone Muscle building exercise can muscleproduction mass which is boost directly to metabolic testosterone and thetied metabolic rate. rate and calorie burning to help with weight loss. Muscle building ex

<4 if not supplementing (< 10 nmol/L)

testosterone production and boost the metabolic rate.

20-80 ng/ml (50-200 nmol/L)

DHEAS is within range with topical DHEA therapy. DHEA partners with testosterone as an anabolic hormone to maintain musc DHEAS is within topical DHEA therapy. DHEA partners with(and testosterone as an anabolic to hormone to lea ma density, metabolic rate, range overallwith sense of well-being, and libido. Adequate DHEA testosterone) contributes increased boosts metabolic rate andrate, calorie burning to help with weightand loss. DHEA may alsoDHEA enhance insulin sensitivity contributes and naturallytoinc density, metabolic overall sense of well-being, libido. Adequate (and testosterone) in whichboosts helps to control satiety and calorie appetite. metabolic rate and burning to help with weight loss. DHEA may also enhance insulin sensitivity and

20-80 ng/ml (50-200 nmol/L)

which helps to control satiety and appetite.

0.5-3.0 µU/mL

0.5-3.0 µU/mL 1-15 µIU/mL (optimal 2-6)

Cortisol is within high-normal range in the morning but drops precipitously to lower levels the remainder of the day. Suppressio be due to androgen therapy (DHEA and/or or but to low adrenal reserve. Intothis individual a significant number sym Cortisol is within high-normal range testosterone) in the morning drops precipitously lower levels the remainder of theofday. associated with adrenal stressors self reported. Under stress situations the adrenal glandsInnormally respond increasing be due to androgen therapyare (DHEA and/or testosterone) or to low adrenal reserve. this individual a by significant nu However, when cortisol levels are within normal underUnder situations of excessive as reported this respond suggests bth associated with adrenal stressors are selfrange reported. stress situationsstress, the adrenal glandsherein, normally overworking to keep with thelevels demands of the normal stressors, which couldsituations eventuallyoflead to adrenal exhaustion. HPA herein, axis dysfun However, whenupcortisol are within range under excessive stress, as reported this commonly caused by stressors which include: psychological stress (emotional), sleep deprivation, poor diet (low protein-partic overworking to keep up with the demands of the stressors, which could eventually lead to adrenal exhaustion. HPA in vegetarians), nutrient deficiencies (particularly low vitamins C and B5), physical insults (surgery, injury), diseases (cancer, di commonly caused by stressors which include: psychological stress (emotional), sleep deprivation, poor diet (low pr exposure (environmental pollutants, excessive medications), low levels of cortisol precursors (pregnenolone and progesterone in vegetarians), nutrient (particularly low of vitamins B5), physical insults (surgery, injury), disease infections (bacteria, viruses anddeficiencies fungi). A normal daily output cortisol C is and essential to maintain normal metabolic activity, help r (environmental pollutants, excessive medications), lowand levels of cortisol precursors and pc state exposure glucose levels (important for brain function and energy production), optimize immune function.(pregnenolone Depletion of adrenal infections (bacteria, and fungi). normaldeficiencies daily output(particularly of cortisol vitamins is essential to maintain by a chronic stressor, sleepviruses deprivation, and/or Anutrient C and B5) often normal leads tometabolic symptomsas state glucosedysfunction), levels (important for sensitivity, brain function production), and optimize immune function.about Depletion allergies (immune chemical cold and bodyenergy temp, and sugar craving. For additional information strate

Goiter

Insulin

6.4

A1c Hair - Increased Facial Hemoglobin or Body

Hair - Dry or Brittle

Hair - Scalp Loss

= Less than the detectable limit of the lab. A1c Hair - Increased Facial Hemoglobin or<dL Body

Headaches

Hair - Scalp Loss Hearing Loss

5.8

4.2

1-15 µIU/mL (optimal 2-6)

<6%

N/A = Not applicable; 1 or more values used in this calculation is <6% less than the detectable limit. H = High. L = Low. 5.8 4.2

<dLCLIA = Less the detectableThe limitabove of theresults lab. N/A = Not applicable; 1 or more values used in this calculation is lessT.than detectable limit. H = High. L = Low. Lic #than 38D0960950 and comments are for informational David Zava,the Ph.D.

Headaches

Heart Palpitations

Hearing Loss Hoarseness

Heart Palpitations Hot Flashes

8/23/2018 2:19:07 PM

CLIA Lic # 38D0960950 8/23/2018 2:19:07 PM

Hoarseness Incontinence

Laboratory Director

purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for

The above results and comments are for informational diagnosis and treatment. purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for diagnosis and treatment.

Hot Flashes Infertility

David T. Zava, Ph.D.

Alison McAllister, ND. (Ordering Provider unless otherwise specified on page 1)

1 of 6

by a chronic stressor, sleep deprivation, and/or nutrient deficiencies (particularly vitamins C and B5) often leads to The above results and comments are for informational David T. Zava, Ph.D. craving. For additional information Alison McAllister (immune dysfunction), chemical sensitivity, cold body temp, and sugar purposes only and are not to be construed as medical Laboratory Director (Ordering Provide

CLIA Lic #allergies 38D0960950 8/23/2018 2:19:07 PM

advice. Please consult your healthcare practitioner for

CLIA Lic # 38D0960950 results and comments are for informational David T. Zava, Ph.D. diagnosis The and above treatment. 1998-2018 ZRT Laboratory, LLC. All rights reserved. 8/23/2018 2:19:07 PM purposes only and are not to be construed as©medical Laboratory Director advice. Please consult your healthcare practitioner for diagnosis and treatment. © 1998-2018 ZRT Laboratory, LLC. All rights reserved.

Incontinence Irritable Infertility Libido Decreased Memory Lapse Irritable Mood Swings Libido Decreased

Muscle Size Decreased Memory Lapse Nails Breaking or Brittle Mood Swings Nervous Muscle Size Decreased Sweats NailsNight Breaking or Brittle

Numbness - Feet or Hands

Nervous

CLIASweats Lic # 38D0960950 Night

The above results and comments are for informational purposes only and are not to be construed as medical

8/23/2018 2:19:07 PM

advice. Please consult your healthcare practitioner for Numbness - Feet or Hands diagnosis and treatment.

CLIA Lic # 38D0960950 8/23/2018 2:19:07 PM

The above results and comments are for informational purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for diagnosis and treatment.

TRUSTED FOR 20 YEARS

David T. Zava, Ph.D. Laboratory Director

Alison McAllister, ND. (Ordering Provider unless otherwise specified on page 1)

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www.zr tlab.com | 866.600.1636

otherwise specifie

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VITAMIN E: Emerging Research Sheds Light On Controversies And Its Benefits By: Andreas M. Papas, MSc, PhD Adjunct Professor, Health Sciences, East Tennessee State University

Introduction

in nature. The potency advantage of the natural d-alpha-

the decade of the 1990s, taken regularly by nearly a quarter of

Administration (FDA), the World Health Organization

Vitamin E was one of the most widely used supplements in

adults ages 55 and over. The results of several major clinical studies created a major controversy on its function and

(WHO) and the United States Pharmacopoeia (USP).

benefits. Emerging research in the last two decades shed light

The major controversy. Human blood and tissue contain

understanding of its natural forms, functions, uses and benefits.

tocopherols and tocotrienols as results of a specific transfer

on the causes of the controversy and greatly expanded our

Vitamin E consists of a family of eight different compounds,

four tocopherols and four tocotrienols (designated as alpha, beta, gamma and delta). Tocopherols and tocotrienols have similarities and differences in their molecules. The

tocopherols consist of a head (chroman ring) and a tail (phytyl). The chroman ring carries the active antioxidant group. Each tocotrienol has an identical chroman ring as

the corresponding tocopherol. Tocotrienols differ from tocopherols on their tail; the tocotrienols have three unsaturated sites while tocopherols have none. Our food

contains all eight compounds. In many countries, including

the United States, the typical diet supplies higher levels of non-alpha tocopherols, especially gamma-tocopherol. In

the past vitamin E became synonymous with only alphatocopherol and, as a result, alpha-tocopherol is the most

commonly form used in food fortification, supplements, and, most importantly, in the human clinical trials.

much more alpha-tocopherol than any of the other mechanism. At the heart of this mechanism is the alphatocopherol transfer protein which recognizes the alpha-

tocopherol and preferentially puts more of it in the blood. Conclusive evidence showed that supplementation with alpha-tocopherol, especially at high levels, causes depletion

of gamma-tocopherol and probably of the other tocopherols

in the blood and the tissues. The major significance of this

depletion on the efficacy of vitamin E received increased attention following results of major human clinical studies

such as the Selenium and Vitamin E Cancer Prevention Trial (SELECT) and the Heart Outcomes Prevention Evaluation

(HOPE) study and several metanalyses. As a result, the efficacy and even the safety of supplemental vitamin E as alpha-tocopherol were questioned. These results, coupled

with increasing, research based understanding of the role of

the other tocopherols and the tocotrienols in nutrition and

health contributed to the emerging perspective on vitamin E.

Natural vs. synthetic. alpha-Tocopherol is available

Emerging Research

forms. For most vitamins, the synthetic forms are identical

tocotrienols, and probably their bioactive metabolites, exhibit

for alpha-tocopherol. All molecules in the naturally occurring

that those of alpha-tocopherol. These responses, which

dl-alpha-tocopherol is a mixture of eight different molecular

and tumor cell specific toxicity and apoptosis, support

commercially in the naturally occurring and the synthetic

Significant ongoing research shows that tocopherols and

to the natural and have identical function in the body. Not so

individually and in combination, responses that are different

d-alpha-tocopherol are identical. In contrast, the synthetic

include inflammation, cell signaling and gene expression,

entities known as stereoisomers. Of these eight, only one is

tocopherol is officially recognized by the Food and Drug

identical to the natural form. The other seven do not exist

the emerging perspective that only the complete family of

tocopherols and tocotrienols provides the full potential of

ANTI-AGING MEDICAL NEWS

â&#x20AC;˘ WINTER 2018

VITAMIN E: Emerging Research Sheds Light On Controversies And Its Benefits

vitamin E to produce nutritional and health benefits. Below is

synthase (NOS) cofactor BH4. Impaired function of NOS

tocopherol and the tocotrienols.

Additional research showed that both gamma and delta

a brief summary of significant findings on the role of gamma-

produces excessive free radicals which damage the tissue. tocotrienols reduce injury to bone marrow and hematopoietic

Inflammation

Researchers at Berkeley University reported that gamma-

tocopherol is more effective than alpha in quenching

system and stimulate hematopoiesis. These findings have major implications not only in protection to major radiation exposure to nuclear accident or attack but also in radiation

nitrogen radicals which contributes to inflammation and

therapy and wound healing.

cNOS protein expression. gamma-Tocopherol and its

Cardiovascular. The function of gamma-tocotrienol as an

prostaglandin E2 (PGE2) in both lipopolysaccharide-

cholesterol synthesis) and its relationship to the nitric oxide

cells. In contrast, alpha-tocopherol reduced slightly PGE2

observations on cardiovascular benefits of tocotrienols.

cells. The corresponding metabolite of alpha-tocopherol was

and anti-atherogenic effects of tocotrienol including stroke.

chronic disease. Gamma-Tocopherol but not alpha increased

major metabolite reduced synthesis of the inflammatory

inhibitor of HMG-CoA reductase (the key enzyme in LDL

stimulated macrophages and IL-1b-treated human epithelial

synthase (NOS) cofactor BH4 and inflammation support

formation in macrophages, but had no effect in epithelial

Clinical studies are currently evaluating the neuroprotective

not active.

Neuroprotection/Aging. The research on the role of alpha-

The anti-inflammatory properties of gamma-tocopherol were

tocopherol has been expanded to include the other tocopherols

of North Carolina, Michigan State, Berkeley and Purdue

of gamma-tocopherol and alpha-tocotrienol in age related

evaluated further in a collaborative research by the University

and tocotrienols with very promising initial results for the role

Universities and funded by the National Institutes of Health.

cognitive conditions including Alzheimerâ&#x20AC;&#x2122;s disease.

oxidative stress and inhibited important inflammatory pathways

Wound healing, burn injury and surgical scars. The protective

eosinophil infiltration, pulmonary production of PGE2,

mechanisms of action suggest benefits in wound healing,

nasal expression of interleukins IL-4, -5, -13 and Interferon-

University is evaluating the efficacy of tocotrienols on the

The results showed that gamma-tocopherol reduced systemic

associated with allergic rhinitis and asthma. These included

effects of tocotrienols on radiation injury and other

leukotriene B4 receptor (LTB4) and cysteinyl leukotrienes, and

burn injury and surgical scars. A clinical study at Ohio State

gamma (IFN- ). The researchers suggested that their results

treatment of surgical scars.

support therapeutic efficacy of gamma-tocopherol to inhibit ozone exacerbation of allergic airway responses.

Overcoming malabsorption of vitamin E. Conditions which

affect liver, pancreatic and gastrointestinal function cause poor

Cancer. Several researcher groups reported effects of

absorption of vitamin E and other fat-soluble vitamins and

Dr. Jiang of Purdue University summarized the research

These conditions include cholestasis, cystic fibrosis, bariatric

gamma and delta-tocotrienols have far superior potential than

form of vitamin E, d-alpha-tocopheryl polyethylene glycol

improving prevention, therapy, and control of cancer. Human

to overcome malabsorption and correct vitamin E deficiency.

tocotrienols in cancer including pancreatic, breast, ovarian,

like particles and is used to formulate other fat-soluble

tocopherols and tocotrienols on mechanisms carcinogenesis.

nutrients which in some cases is severe and life-threatening.

which indicates that gamma and delta-tocopherols and

surgery, and inflammatory bowel disease. A water-soluble

alpha-tocopherol for cancer prevention or as adjuvants for

1000 succinate (TPGS) has been shown in clinical studies

clinical studies are evaluating the role of tocopherols and

In addition to function as vitamin E, TPGS forms micelle

lung and colorectal cancers.

nutrients and naturals compounds (vitamins A, D, K,

Radioprotection. Researchers at the Armed Forces

Formulation of TPGS are available both as alpha-tocopherol

CoQ10, carotenoids and others) for increased absorption.

Radiobiology Research Institute (AFRRI) and the University

or in combination with tocopherols plus tocotrienols.

protection to radiation exposure. It functions as an inhibitor

Summary and Conclusions

synthesis), which prevents the depletion of the nitric oxide

of tocopherols and tocotrienols, coupled with the strong

of Arkansas reported that gamma-tocotrienol exhibits major of HMG-CoA reductase (the key enzyme in LDL cholesterol

ANTI-AGING MEDICAL NEWS

The emerging research on the unique individual effects â&#x20AC;˘ WINTER 2018

VITAMIN E: Emerging Research Sheds Light On Controversies And Its Benefits

evidence of synergistic effects indicate that: 1. The use of alpha-tocopherol and often the synthetic dl-form contributed to the absence of clinical benefit in major clinical studies by:

SELECTED REFERENCES

1. Papas, A. The Vitamin E Factor, HarperCollins Publishers, New York, 416 pages, 1999 2. Yusuf S, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:154-60.

a. Providing the form that may not be the most beneficial for the specific application.

3. Ranard KM, Erdman JW Jr. Effects of dietary RRR α-tocopherol vs allracemic α-tocopherol on health outcomes. Nutr Rev. 2018;76:141-153 4. Cooney R, et al. Gamma-tocopherol detoxification of nitrogen dioxide: superiority to alpha-tocopherol. Proc Natl Acad Sci U S A 1993;90:17711775.

b. Causing the depletion of the other tocopherols and tocotrienols from the blood and the tissue thus causing an adverse imbalance and eliminating their benefits and synergies.

5. Burbank AJ, et al. Gamma tocopherol-enriched supplement reduces sputum eosinophilia and endotoxin-induced sputum neutrophilia in volunteers with asthma. J Allergy Clin Immunol. 2018;141:1231-1238. 6. Mills K, et al. Vitamin E, γ-tocopherol, diminishes ex vivo basophil response to dust mite allergen. Allergy. 2014;69:541-4.

2. The proven synergistic effects of tocopherols and tocotrienols and their unique individual effects indicate that vitamin E supplements should contain the complete family of tocopherols plus tocotrienols. Additional tocotrienols and/or non-alpha tocopherols may be appropriate for people with special needs and at high risk for certain disease conditions.

7. Singh VK, et al. Radioprotective Efficacy of Gamma-Tocotrienol in Nonhuman Primates. Radiat Res. 2016;185:285-98. 8. Berbée M, et al. gamma-Tocotrienol ameliorates intestinal radiation injury and reduces vascular oxidative stress after total-body irradiation by an HMGCoA reductase-dependent mechanism. Radiat Res. 2009;171:596-605. 9. Jiang Q. Natural Forms of Vitamin E as Effective Agents for Cancer Prevention and Therapy. Adv Nutr. 2017;8:850-867. 10. Abraham A, et al. Vitamin E and its anticancer effects. Crit Rev Food Sci Nutr. 2018:1-23. 11. Husain K, et al. δ-Tocotrienol, a natural form of vitamin E, inhibits pancreatic cancer stem-like cells and prevents pancreatic cancer metastasis. Oncotarget. 2017;8:31554-31567.

3. The development of nutritional and health guidelines and products such as dietary supplements and health products specific for specific diseases or health conditions must consider all vitamin E homologs and bioactive metabolites, and their individual and combined effects in relation to their absorption, metabolism and tissue uptake.

12. Galli F, et al. Vitamin E: Emerging aspects and new directions. Free Radic Biol Med. 2017;102:16-36. Review. 13. Grimm MO, et al. Vitamin E: Curse or Benefit in Alzheimer’s Disease? A Systematic Investigation of the Impact of α-, γ- and δ-Tocopherol on Aß Generation and Degradation in Neuroblastoma Cells. J Nutr Health Aging. 2015;19:646-56. 14. Papas K, et al. Bioavailability of a novel, water-soluble vitamin E formulation in malabsorbing patients. Dig Dis Sci. 2007;52:347-52.

4. The water-soluble form of vitamin E (TPGS) overcomes malabsorption of vitamin E associated with major liver, pancreatic and gastrointestinal conditions and corrects deficiency. In addition, it enhances absorption of other fat-soluble and poorly

15. Perin J, et al. A Randomized Trial of a Novel Chewable Multivitamin and Mineral Supplement Following Roux-en-Y Gastric Bypass. Obes Surg. 2018;28:2406-2420.system regeneration, enhanced cognitive performance and healthspan. Cell metabolism. 2015;22(1):86-99. doi:10.1016/j. cmet.2015.05.012. 16. Wei M, Brandhorst S, Shelehchi M, et al. Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease. Sci Transl Med. 2017 Feb 15;9(377). pii: eaai8700. doi: 10.1126/

absorbed nutrients and natural compounds.

scitranslmed.aai8700.

Recommendations

The emerging scientific consensus and perspective on vitamin E indicates that only products that contain the complete vitamin E family of tocopherols plus tocotrienols in their natural form provide the full spectrum of benefits. Specially formulated products rich in the specific active homologs can play a significant role in health programs for major disease conditions such as neurodegenerative, immune/ inflammatory, some cancers and cardiovascular. The protection of gamma and delta-tocotrienols against radiation injury and associated mechanisms of actions and research, support benefits in skin heath, wound healing, burn injury and surgical scars. The antioxidant properties of tocopherols and tocotrienols, coupled with the unique functions reviewed above suggest a major role in antiaging programs.

Andreas M. Papas, PhD

Dr. Papas is Adjunct Professor of Health Sciences of East Tennessee State University and CEO and member of the Board of Directors of Antares Health Products. A Fulbright Scholar, Dr. Papas is a graduate of the University of Illinois and author of The Vitamin E Factor paperback and editor of the scientific book Antioxidant Status, Diet, Nutrition and Health. Telephone: 423-943-3973 E-mail: apapas@embarqmail.com

ANTI-AGING MEDICAL NEWS

• WINTER 2018

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The Science Behind Vitamin E Tocotrienols By: Barrie Tan, PhD

Tocotrienols are novel components of the vitamin E family. The vitamin E family consists of two subgroups: tocotrienols (T3) and tocopherols (T). Tocotrienols are naturally derived from several sources, including rice bran, palm, and annatto. Numerous studies have uncovered the benefits and superior function of annatto-derived delta- and gamma-tocotrienols, including their role in cholesterol reduction and cardiovascular disease, influence on metabolic syndrome and diabetes, novel function for bone health, and support for eye and skin health. Additionally, the substantial potential for tocotrienols as adjuncts to conventional cancer therapies has been addressed in a previous paper.120

Structures of Tocotrienol, Tocopherol, and Isomers

History and Discovery of Tocotrienols

Alpha, beta, gamma, and delta are among the isomers of tocotrienol as well as tocopherol. The potency of cholesterol inhibition by these tocotrienol isomers is delta > gamma > alpha > beta. Tocopherols are inactive in lowering cholesterol.5

Although vitamin E (in the form of alpha-tocopherol) was discovered in the 1920s,1 it was not until the 1960s that tocotrienols were assessed to be part of the vitamin E family.2 Vitamin E is known as a “vitamin” because it is essential for reproduction, and has been dubbed the “birth vitamin.” Its antioxidant activity was discovered soon after (1930s).3 Tocotrienols from current sources (rice, palm and annatto) were first developed and brought to the dietary supplement market by Dr. Barrie Tan, inventor of numerous tocotrienol extraction processes from natural sources. These discoveries include tocotrienols from palm (1992), then rice (1998), and finally annatto (2002). The first ever tocopherol-free tocotrienol product derived from annatto seeds – DeltaGold® –became available around 2005. Annatto as a natural colorant was introduced into the US during the 17th century, and today it is used in the food industry worldwide. The “tocopherol-free” aspect of annatto tocotrienol is important, since research has shown alpha-tocopherol to interfere with tocotrienol functions and benefits. Contrary to annatto, both palm and rice contain a significant amount of alpha-tocopherol (25-50% of total vitamin E) (Figure 1). Annatto remains the first and only true source of naturederived vitamin E that supplies tocotrienol only.

Tocotrienol and tocopherol both have a chromanol nucleus, which is the site of antioxidant activities. Tocotrienol and tocopherol differ in the tail region of the molecule. Tocotrienol has a farnesylated tail, allowing it to downregulate 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase – an essential enzyme for cholesterol synthesis – whereas tocopherol has a longer phytyl tail without double bonds, disallowing a similar function. The downregulation of HMG-CoA reductase has been shown to decrease total and LDL cholesterol levels, and is considered a critical pathway that involves tocotrienol in the inhibition of several cancers.4

Desmethyl tocotrienol is a collective term for reduced methyl substituents on the vitamin E molecule, and primarily refers to delta- and gamma-tocotrienol. Desmethyl tocotrienols are more potent, especially in the absence of a methyl group at the C5 position on the chromanol ring system. Delta-tocotrienol is monomethylated at the C8 position of the chromanol ring system, making it the least substituted, and therefore the most potent isomer of the four tocotrienol compounds. The majority of vitamin E dietary supplements contain mostly tocopherols, of which alpha-tocopherol is the most common. Typically, only traces of tocotrienol are found, which is due to its scarcity in plants from which vitamin E is extracted. While tocopherols have high antioxidant value, they lack the ability to regulate aberrant cells (e.g., cancer), cholesterol synthesis (hypercholesterolemia) and triglyceride synthesis/ transport (hypertriglyceridemia). Large clinical studies on alpha-tocopherol benefits to treat cardiovascular or other diseases have been equivocal or without effect,6 and have shown alpha-tocopherol to possibly be harmful.7, 8

Tocotrienol Mechanism

The mechanism of tocotrienol’s hypolipidemic action involves

The Science Behind Vitamin E Tocotrienols

Figure 1. Typical compositions of vitamin E in natural tocotrienol sources.

post-transcriptional suppression of HMG-CoA reductase via controlled degradation of the reductase protein.9, 10 Recently it has been reported that only gamma- and delta-tocotrienol stimulate the degradation of HMG-CoA reductase, and block processing of sterol regulatory element-binding protein (SREBP). Blocking SREBP processing has implications for triglyceride synthesis (and reduction), with importance in diabetes and prediabetes. Therefore, the mechanism for cholesterol reduction by tocotrienol shown 20 years ago was revalidated some 15 years later. This study came from the Brown and Goldstein research group that discovered the LDL cholesterol receptor, explaining how cholesterol is regulated. Brown and Goldstein were awarded the 1985 Nobel Prize for this work.11 These tocotrienol mechanisms of cholesterol and triglyceride synthesis – collectively controlling hyperlipidemia – have manifested into clinical significance for cardiovascular disease (CVD), such as hypercholesterolemia,12 chronic inflammation,13 atherosclerosis,14 and obesity and liver function associated with NAFLD.15 Other forms of vitamin E (all four tocopherols and alpha- and beta-tocotrienols) do not degrade, downregulate, nor block SREBP processing.10 Delta-tocotrienol was also found to have the greatest antioxidant properties among the tocotrienol isomers,16 which is due to the decreased methylation on the chromanol ring that allows the molecule to be more easily incorporated into cell membranes.17 A comparative in vitro study showed that gamma- and delta-tocotrienols were 4-fold more efficient as scavengers of peroxyl radicals than other tocotrienol isomers.18

Tocotrienol Mechanism

Tocopherols do not have the cholesterol-lowering ability that tocotrienols do.9 In fact, the opposite is true. Alpha-tocopherol has been repeatedly shown to attenuate or interfere with the cholesterol-lowering action of tocotrienols.19 Combinations effective in cholesterol-lowering consist of 15% (or less) alphatocopherol and 60% (or more) gamma- and delta-tocotrienol, whereas ineffective formulations consist of 20% (or more) alphatocopherol and 45% (or less) of gamma- and delta-tocotrienol. Substantiating these formulating guidelines are clinical studies in which supplements with high alpha-tocopherol content did not contribute to the lowering of cholesterol,20-22 whereas supplements containing low amounts of alpha-tocopherol and high amounts of gamma- and delta-tocotrienol led to a significant decrease in total and LDL cholesterol.13, 23-25

While tocotrienols are absorbed better than tocopherols, tocopherols have been shown to prevent absorption and organ/tissue delivery of tocotrienols. 26-30 To summarize, alpha-tocopherol is thought to interfere with tocotrienol benefits directly by: • Compromising cholesterol and triglyceride reduction19, 30, 31 • Lowering antioxidant capacity32 • Attenuating cancer cell inhibition33, 34 • Blocking absorption26-29 • Inducing tocotrienol catabolism35 • Preventing adipose and liver storage30 • By itself, alpha-tocopherol may lead to other predicaments, potentially: • Causing the premature catabolism of prescription drugs36 • Interfering with chemotherapy drug action 34, 37, 38 • Increasing cholesterol and blood pressure19, 31, 39-41 • Increasing prostate cancer and glioblastoma risk in humans7, 42, 43 • Exacerbating stroke injury44 • Decreasing bone mass45 • Increasing LDL oxidation46

Tocotrienol Absorption and Bioavailability

As part of the vitamin E family, tocotrienols are fat-soluble, and are absorbed in a similar fashion as fats from food in the gut, aided by bile salts. These vitamin Es are mixed into large emulsified particles (1,000um) called chylomicrons that absorb through the gut. These particles that carry both tocopherols and tocotrienols travel in the lymph and blood. Along the way, the particles become smaller and denser, variously named VLDL (~65um), IDL (~45um), and LDL (~25um). The larger particles mainly contain tocotrienols. The IDL sheds the denser HDL (~10um) that enter the cells and organs, and the less dense LDL that stay in the blood and return to the liver. Therefore, lipoproteins are “fat shuttles” transporting cholesterol and lipid nutrients alike to organs including the liver. At this stage, the path of tocopherols and tocotrienols part way (this is a preferential picture, not an absolute one). Tocotrienols progressively deposit into cells as larger lipoproteins move to smaller ones. Alpha-tocopherol progressively remains in the LDL and returns to the liver or gets repackaged into LDL in the liver. Therefore, tocotrienols are particularly bioavailable, and have been shown to deposit in lipid-rich organs, including the brain, spleen, lung, kidney, and heart [27, 47], with particular preference in the adipose, skin, and heart [48] prior to hepatic circulation. Conversely,

The Science Behind Vitamin E Tocotrienols

alpha-tocopherol is particularly bioavailable to the liver and blood [48] after hepatic circulation. An alpha-tocopherol transport protein (ATTP) exists and adds to the complexity. When vitamin E is returned to the liver (entero-hepatic circulation), ATTP preferentially repackages alpha-tocopherol into LDL without (or little) recognition of the other tocopherols and tocotrienols. Hence, the blood alpha-tocopherol level remains high (≥10-fold that of tocotrienol), providing the perception that alpha-tocopherol is more bioavailable. It means only that alpha-tocopherol is conserved in the blood, and not destructed in the liver. Since tocotrienols have been shown to be present in many organ tissues – and in some cases at levels comparable to alphatocopherol – tocotrienols are deported to cells and organs prior to entero-hepatic circulation, thereby not destructed in the liver. Tocotrienol’s rapid drop in the blood after ~4 hours (whereas alpha-tocopherol remains in the blood for longer) attests to the fast absorption of tocotrienols into organs rather than the presumption that tocotrienols are excreted. It is now generally accepted that all vitamin E molecules absorb through the intestines equally via triglyceride-rich chylomicrons (TRC) into the lymphatic blood system [49]. All tocotrienols are higher in TRC and HDL (particularly delta-tocotrienol) [50], allowing for rapid absorption while alpha-tocopherol retains preferentially in the LDL, the main task of which is to return to the liver. Two studies on DeltaGold® confirmed the bioavailability of tocopherol-free annatto tocotrienol [51, 52]. An openlabel randomized trial involved 125, 250, 500, 750, and 1000 mg/day dosage groups. Many pharmacokinetic parameters were studied in healthy subjects to ascertain that delta- and gamma-tocotrienol were absorbed. When taken with a meal, both tocotrienols were absorbed and are bioavailable. A trial is now underway to ascertain tocotrienol’s bioavailability in adipose tissue, considered the main depot for tocotrienol.

Tocotrienol’s Antioxidant Properties

Vitamin E is uniquely shaped to reside within cell membranes to protect against oxidation. Aside from protecting cell membranes (tocotrienols were shown to be ~50x more potent as an antioxidant compared to tocopherols54), tocotrienols also protect lipids such as omega-3s in softgel products and foods and beverages.55 The antioxidant efficiency of tocotrienols was evaluated as the ability of the compounds to inhibit lipid peroxidation and reactive oxygen species (ROS) production. Delta-tocotrienol was found to have the greatest antioxidant properties among the tocotrienol isomers,56 which is due to the decreased methylation of the chromanol ring that allows the molecule to be more easily incorporated into cell membranes.57 In lipid ORAC studies, delta- and gamma-tocotrienols had the highest antioxidant value of all vitamin E isomers at 5.5x and 3x the potency of alpha-tocopherol, respectively. Interestingly, delta- and gamma-tocopherol were also strong antioxidants.16 In vitamin E mixtures containing both tocotrienols and tocopherols, a higher concentration of alpha-tocopherol was associated with lower antioxidant activity.32 Regulation of Cholesterol Synthesis in Animal and Clinical Studies: Approximately one in every three adults in the US

has high total cholesterol (240 mg/dL and above).59 Recently, animal studies supported the earliest studies first conducted by University of Wisconsin, Madison researchers in the early 1980s.60 Mechanisms of cholesterol reduction were elucidated then and confirmed today by University of Texas researchers.10 Animals whose diet was supplemented with gamma- and delta-tocotrienols showed the greatest decrease in cholesterol levels (32% total and 66% LDL cholesterol), whereas alphatocopherol had no effect on cholesterol-lowering. In this study, HDL/LDL cholesterol ratios were improved by 123-150% in chickens, which more closely reflect the lipogenic activity and cholesterol levels of humans.5

In a recent clinical trial, researchers tested the dose-dependent effects of annatto tocotrienols ranging from 125 – 750mg per day on hypercholesterolemic individuals.13 Results showed that after only 4 weeks, the optimum daily dose of 250mg decreased total cholesterol by 15%, LDL cholesterol by 18%, and triglycerides by 14%. Furthermore, cytokines associated with cardiovascular disease and their gene expression, including TNF-alpha, IL-2, IL-4, IL-6, and IL-8, were down-regulated 39-64%. Selected microRNAs that are typically down-regulated in hypercholesterolemic individuals were upregulated by tocotrienol treatment, suggesting a beneficial effect on these biomarkers. Anti-Inflammation: The traditional view of cardiovascular disease combines the clogging of arteries with elevated cholesterol. Surprisingly, however, half of the patients presenting with heart attacks have normal cholesterol levels. Today, it is well-known that inflammation is cholesterol’s aid in furthering cardiovascular disease progression, recruiting white blood cells to arterial walls, causing them to stick and initiate plaque buildup. Tocotrienols were shown to have potent anti-inflammatory properties. New research focused on the effect of tocotrienols in reducing inflammation in experimental mice.61 They demonstrated that alpha-, gammaand delta-tocotrienols strongly inhibited the inflammatory response using such markers as chymotrypsin, trypsin and tumor necrosis factor-a (TNF-a), with delta-tocotrienol being the most effective. The results of this study demonstrated that the use of tocotrienols can function as a powerful proteasome modulator, while increasing the immune system’s ability to fight inflammation. At the same time, tocotrienols induce a hormone that produces an anti-inflammatory steroid to block inflammation directly. One tocotrienol clinical study underscores the supplement’s impressive anti-inflammatory benefits.12 Among the most notable biomarkers to be affected by a 250mg tocotrienol dosage were C-reactive protein (CRP; a predictor for chronic inflammation), nitric oxide (NO), and malondialdehyde, with decreases of 40%, 40%, and 34%, respectively. Total antioxidant status, on the other hand, increased 22%. Several inflammatory cytokines and microRNAs were found to be modulated by tocotrienol treatment, suggesting more favorable outcomes in cardiovascular and aging diseases with supplement use. When combined with other anti-inflammatory ingredients, tocotrienols showed synergistic efficacy. Two clinical studies

The Science Behind Vitamin E Tocotrienols

show that delta-tocotrienol in combination with antioxidant polyphenols curb inflammation and manage dyslipidemia.62, 63 One of the placebo-controlled studies was conducted in two groups of elderly subjects, one with normal levels and the other with elevated lipid levels. The product formulation was composed of delta-tocotrienol from annatto (as found in DeltaGold®), along with niacin and polyphenols. In both groups, supplementation led to a significant drop in CRP and γ-glutamyl-transferase (a predictor for non-fatal myocardial infarction and fatal coronary heart disease), while increasing total antioxidant status, a measure of the body’s capacity to counteract reactive oxygen species. In the hypercholesterolemic group, LDL cholesterol (20-28%) and triglycerides (11-18%) also dropped. C-reactive protein dropped in healthy elderly (21-29%) as well as hyperlipidemic elderly (31-48%), as did γ-glutamyl-transferase (14-20%). There were no adverse effects associated with the 6-week supplementation period. Tocotrienol and Monocyte-Endothelial Cell Adhesion and Platelet Aggregation: The adhering of “activated” cells in the blood to artery walls is undesirable. It is a stressed condition prompted by inflammation and an attempt to remove chemicals and particles out of circulation. This process of arterial adhesion is termed chemotaxis. Tocotrienol’s role is anti-chemotactic. Studies have shown that tocotrienols positively affect monocyte-endothelial cell adhesion and platelet aggregation. In other words, tocotrienols may prevent artery walls from getting narrower and clots from forming, important elements for cardiovascular health. One of the first steps of atherogenesis is fatty streak formation in arteries, which begins with the adherence of circulating monocytes to the endothelium. Tocotrienols have been shown to reduce cellular adhesion molecule expression and monocyte adherence.64, 65 In particular, delta-tocotrienol showed the most profound inhibitory effect on monocyte adherence compared to tocopherols and other tocotrienol isomers. Delta- and gamma-tocotrienol were 60x and 30x more potent than alpha-tocopherol, respectively.66 It has been suggested that this phenomenon occurs via inhibition of VCAM-1 expression by delta- tocotrienol.66 Essentially, delta-tocotrienol dramatically reduces the “Velcro-effect” of circulating monocytes on the arterial wall, a process known to initiate plaque formation.67 Elevated LDL is a risk factor for CVD, especially atherosclerosis. It is generally understood that it is oxidized LDL particles, not non-oxidized particles, that are atherogenic.68 In a clinical trial where all four tocotrienols were studied, delta-tocotrienol alone reduced oxidized LDL, a significant indicator to reduced atherosclerosis. Contrary to this, alpha-tocotrienol can potentially pro-oxidize LDL to oxidized LDL.46 Tocotrienol and Hypertension: Approximately 32% of American adults have hypertension, and 25% have prehypertension.69 Animal studies showed that tocotrienols lower blood pressure, reduce plasma and blood vessel lipid peroxides, and improve total antioxidant status.70 Gamma-tocotrienol was shown to reduce systolic blood pressure significantly, and

improved nitric oxide synthase activity, both of which play a critical role in the pathogenesis of essential hypertension. 71 In humans, tocotrienols have been shown to increase arterial compliance and reduce blood pressure.72, 73 Tocotrienol and Atheroma Formation: Before turning 35, two out of three Americans will have some degree of plaque buildup in their arteries.74 This may be variously termed coronary, carotid, or peripheral atherosclerosis and/or stenosis. The effects of tocotrienols on atheroma formation have been compared in vivo. Comparison studies on animals investigated the impact of tocotrienol supplementation vis-à-vis tocopherol or non-supplementation. Results to date indicate that animals on an atherogenic diet and given desmethyl tocotrienols had 60% lower plasma cholesterol than the control group, and the size of atherosclerotic lesions was reduced 10-fold. Alpha-tocopherol, on the other hand, had no effect.75 This finding was further corroborated in a similar independent study, where desmethyl tocotrienols inhibited atherosclerotic lesions in hyperlipidemic mice. Atherosclerotic lesion size in mice supplemented with desmethyl tocotrienols was decreased by 42%, whereas with alpha-tocopherol, lesion size was only decreased by 11%.76 Fully methylated tocotrienols and tocopherols – namely alpha- and beta-isomers – do not have the cardiovascular benefits characteristic of desmethyl tocotrienols. Later studies with advanced designs pinned this concept down even further. Tocotrienols, especially deltaand gamma-tocotrienols, significantly reduced plaque scores, plaque stabilization, and inflammation, three of the pillars responsible for overall atherosclerosis.77, 78 Tocotrienol and Carotid Arteriosclerosis: A 4-year study on patients taking a 240 mg/day dosage with carotid arteriosclerosis showed that tocotrienol-tocopherol supplementation caused regression of the disease. In 88% of patients that took the supplement, carotid artery stenosis was regressed or stabilized. Of the control group receiving a placebo, 60% deteriorated, and only 8% improved.79, 80 Interestingly, total cholesterol in the supplemented group decreased 14% and LDL cholesterol fell 21% in the fourth year of the study.14

Cardiovascular Benefits of Tocotrienols

According to the American Diabetes Association, 30 million Americans have diabetes, with an additional 85 million Americans diagnosed with prediabetes, representing more than one-third of all Americans. Furthermore, metabolic syndrome – defined by a cluster of distinct abnormal cardiovascular measurements – is on the rise and mirrors the US obesity pandemic, with two in three adults being overweight or obese.81 Some of the AHA and NIH defining hallmarks of metabolic syndrome include:82, 83 • Increased serum triglycerides (above 150mg/dL) • Elevated blood pressure (above 130/85mmHg)

• Elevated serum glucose (100mg/dL and higher)

• Decreased HDL (under 40mg/dL for males; under 50mg/ dL for females)

• Increased waist circumference (above 40in. for males; above 35in. for females)

The Science Behind Vitamin E Tocotrienols

MetS Animal Studies: In one study, researchers gave rats a high-carb, high-fat diet to induce obesity with accompanying cardiac remodeling, insulin resistance, hypertension, and fatty liver.84 Animals then received oral alpha-tocopherol, alpha-, gamma-, or delta-tocotrienol at 85mg/kg/day, corresponding to a 60kg human dose of ~800mg/day. Results showed that, while all isomers reduced collagen deposition and inflammatory cell infiltrates in the heart, only delta- and gamma-tocotrienol improved cardiovascular function and systolic blood pressure. Delta-tocotrienol normalized eccentric hypertrophy shown by lower left ventricular internal diameter (during diastole), stroke volume and cardiac output. Furthermore, only delta-tocotrienol affected important markers of metabolic syndrome and diabetes by enhancing glucose metabolism and improving insulin sensitivity, while reducing lipids and abdominal adiposity. The mechanism of action appears to be reduction in organ inflammation, especially of the heart, liver, and abdominal fat. A similar study confirmed this anti-inflammatory mechanism in a high-fat-fed mouse model, which examined the effects of tocotrienol on obesity-related adipocyte hypertrophy, inflammation, and hepatic steatosis.85 The approximate human equivalent of tocotrienol given to the mice was 160-640mg/ day for 14 weeks, at which point improvements in glucose tolerance along with reduced hepatic steatosis and triglycerides were observed. In addition, adipocyte size and macrophage infiltration into the liver were reduced, with the result being an overall improved metabolic profile. Closely related research further added to this MetS construct using tocotrienols. One group separately looked at delta-T3 and gamma-T3, and these tocotrienols attenuated “nascent flames” – called inflammasomes – of macrophages that protected chronic metabolic diseases.86-88 The other research group looked at the impact of tocotrienols with alpha-tocopherol removed.30 They found that tocopherol-free rice bran tocotrienol had anti-lipidemic effects, simultaneously reducing cholesterol by 15% and triglycerides by 28%. Further, tocotrienol upregulated both carnitine palmitoyltransferase by 67% (responsible for triglyceride drop) and cytochrome P450 by 47% (responsible for cholesterol drop). When alpha-tocopherol was added to the tocotrienols, the coadministration abrogated the tocotrienols’ anti-lipidemic effects and decreased the presence of all tocotrienols in the liver by about 2.5-fold. Alpha-tocopherol on its own had almost no anti-lipidemic effects. MetS Clinical Studies: In several clinical studies with metabolic syndrome and diabetes patients, tocotrienol was shown to reduce the symptoms associated with the disease. Rice bran water solubles (270ppm of >90% tocotrienols) reduced hyperglycemia, glycosylated hemoglobin, and increased insulin levels, while rice bran fiber (30ppm of >90% tocotrienols) reduced hyperlipidemia in both type 1 and type 2 diabetics.89 In another large clinical study, vitamin E intake from diet was associated with reduced risk of type 2 diabetes.90 In patients with type 2 diabetes, progression of atherosclerosis is more rapid, and 80% of patients die of atherosclerotic events. In addition, LDL-lowering therapies normally prescribed for patients with diabetes have many side-effects, creating a need for alternative treatments. Tocotrienols, which have no known side-effects, were shown to decrease serum total lipids by 23%, total cholesterol by 30%, and LDL-cholesterol by

42% (from 179mg/dL to 104mg/dL) within 60 days in type 2 diabetics. 91 Clinical studies have shown that tocotrienols – when taken apart from alpha-tocopherol (due to interference issues25) – lower total cholesterol, LDL, and triglyceride levels between 15-20%. 13 Further, a daily dose of 250mg tocotrienols (without tocopherols) lowered C-reactive protein and other inflammatory markers between 35-60%.12 Combinations with other anti-inflammatory ingredients, such as quercetin, resveratrol, and B-vitamins can synergize with tocotrienols’ cardiometabolic benefits, as was shown in clinical trials.62, 63 However, in patients with MetS on tocopherol-tocotrienol mixtures, cardiometabolic benefits were not observed22 nor was the chemotaxis/platelet aggregation reduced.92 Non-Alcoholic Fatty Liver Disease (NAFLD): An ailment closely associated with obesity and MetS is NAFLD, which occurs when excess fat is stored in the liver. Based on findings by the National Institutes of Health, NAFLD affects 30-40% of US adults, and treatment is limited to diet and exercise. To examine the effects of tocotrienol on fatty liver disease, a 12week randomized, double-blind, placebo-controlled study was conducted with 71 NAFLD patients.15 Significant improvements in liver biomarkers indicative of hepatic stress reduction were evident after 12 weeks, with decreases of 15-16% in ALT and AST. Furthermore, significant decreases in triglycerides (11%), MDA (14%), and hs-CRP (18%) were indicative of reduced inflammation and are consistent with results of previous clinical trials conducted with DeltaGold® in hypercholesterolemic subjects. Notably, the fatty liver index (FLI) score decreased a significant 11%, suggesting intrahepatic fat reduction. During the 12-week treatment period, patients in the tocotrienolsupplemented group lost an average of 9.7 pounds.

Tocotrienol’s Protective Effect on Skin

Vitamin E, and in particular delta- and gamma-tocotrienol and tocotrienol-rich fractions (TRF), have been shown to be superior protectors against environmental stressors such as UV-irradiation of the skin.94 TRF have significantly higher potency than alpha-tocopherol, and are effective against protein oxidation and lipid peroxidation at low concentrations.95,96 Normally, UV-irradiation destroys the antioxidants in the skin, but prior application of TRF to mouse skin preserved the vitamin E.97 Also, the largest fraction of vitamin E was found in the subcutaneous layer of the skin, which shows that applied vitamin E penetrates rapidly through the skin,98 and therefore combats oxidative stress induced by UV or ozone.99 In addition, delta- and gamma-tocotrienol have been shown to reduce inflammation, 61, 100, 101 and are potent skin whitening agents via reduction of tyrosinase activity, while also blocking UV-induced melanogenesis.102-104 Delta-tocotrienol has the greatest sun protection factor (SPF) of the tocotrienol isomers at SPF 5.5.104 Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans, and also a common reason for skin and soft-tissue infections worldwide. This is a particular concern in hospice and hospital settings. For the first time, a study in animals showed that DeltaGold® tocotrienol can be an immunomodulator to help fend off infections and improve wound repair.105 In the prevention model, the MRSA-infected animals were

The Science Behind Vitamin E Tocotrienols

administered tocotrienol, antibiotics, or tocotrienol plus antibiotics, and compared to infected controls (no treatment). Tocotrienol was given orally to animals eight days before wound infection and antibiotics were given intraperitoneally two days following infection. Other conditions were the same for all groups. The results showed that tocotrienol reduced bacterial load by a factor of 10, antibiotics by 1,000 times, and tocotrienols in combination with the antibiotic by 10,000. This suggests that, while antibiotics were effective as expected, tocotrienol potentiated the antibiotics’ bacterial kill by reducing bacterial load in animals. Responsible for potentiating the antibiotic properties, at least in part, was tocotrienol’s effect on natural killer cells. Although the number of natural killer cells remained unchanged throughout the treatments, their activity was dramatically improved in parallel to decreased bacterial load with a ranking order of: tocotrienol + antibiotics > antibiotics >> tocotrienol > control. In addition to being a potent immune adjuvant to antibiotics, tocotrienol had dramatic wound healing effects. Compared with antibiotics, which showed adverse effects in wound healing, tocotrienol was 2-6 times more effective in improving wound healing biomarkers, indicating efficacy in wound healing in the order of: tocotrienol > tocotrienol + antibiotics >> control > antibiotics. The authors of the study speculated that DeltaGold® could work to reduce bacterial load and improve wound healing due to a local protection and regenerative action because of its accumulation in the skin.

Eye Health

Vitamin E has long been regarded as a beneficial nutrient to support eye health. It was included in the original Age-Related Eye Disease Study (AREDS), as well as in AREDS2, which also examined addition of lutein, zeaxanthin, DHA and EPA. Vitamin E has since become a staple ingredient in the standard AREDS formula as well as other eye health formulations. While the AREDS study investigated only the alphatocopherol form of vitamin E, new studies suggest tocotrienol deserves a closer look. Tocotrienols may have application in improving eye conditions, especially those of angiogenic nature. In macular degeneration, central vision loss occurs due to abnormal neovascularization in the retina beneath the macula, and leaking blood vessels push up the retina. Similarly, diabetic retinopathy is caused by damage to blood vessels of the retina, and is the leading cause of adult blindness in the West. In both cases, angiogenesis – the aberrant growth of new blood vessels – is to blame. Recent studies found tocotrienol to be a superb anti-angiogenic agent, with delta-tocotrienol being the most potent in reducing angiogenesis dose-dependently.93, 107 The Glaucoma Research Foundation estimates that over 3 million Americans have glaucoma, a condition where patients present with raised intraocular pressure that may lead to permanent damage of the optic nerve and can cause blindness. Tocotrienols reduce scarring of the Tenon’s fibroblast that occurs during glaucoma filtration surgery.108 As a potent antioxidant, tocotrienol accumulates in the eye to

combat cataract development,109 one of the most common eye problems of the aging population. A Malaysian study tested the effect of tocotrienols from annatto (DeltaGold®) on cataract formation in galactosemic rats.110 In the study, topically applied tocotrienol at 0.01-0.05% delayed the onset and progression of cataract by reducing lenticular oxidative and nitrosative stress. In a follow-up study on diabetic rats, tocotrienols were applied topically via eye drops at a low concentration of 300ppm.111 Diabetic rats that did not receive tocotrienols quickly progressed to stage 3 and 4 cataracts, whereas for those receiving the tocotrienols progression was arrested. Notably, tocotrienol restored lens transparency to normal. The anti-cataract effect of tocotrienol may in part be attributed to the vitamin’s anti-inflammatory action and ability to reduce oxidative stress, while mitochondrial function was improved.

SUMMARY

Most studies published to date, especially in the last decade, point clearly to delta- and gamma-tocotrienol as the key isomers for vitamin E health benefits in reversing chronic conditions or aging maladies. This has been shown for reducing cholesterol and triglycerides, with implications for CVD9, 10, 107 and diabetes,5, 107, 118 and blood hypercoagulation/ chemotaxis, with implications for arteriosclerosis.14, 66, 76 These effects are in addition to tocotrienol’s known power as lipidsoluble antioxidant.56, 99 Compared to other major sources of tocotrienol, annatto has a distinct advantage in lowering lipids and enhancing cellular health without the interferences that would be expected from alpha-tocopherol. With all these positive reports, annatto tocotrienol is an excellent candidate for addressing chronic conditions, particularly those associated with aging. Deltatocotrienol is considered to be the 21st Century vitamin E.

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93. Shibata, A., et al., delta-Tocotrienol suppresses VEGF induced angiogenesis whereas alpha-tocopherol does not. J Agric Food Chem, 2009. 57(18): p. 8696-704.

94. Traber, M.G., et al., Diet-derived and topically applied tocotrienols accumulate in skin and protect the tissue against ultraviolet light-induced oxidative stress. Asia Pac J Clin Nutr, 1997. 6(1): p. 63-67. 95. Kamat, J.P., et al., Tocotrienols from palm oil as effective inhibitors of protein oxidation and lipid peroxidation in rat liver microsomes. Mol Cell Biochem, 1997. 170(1-2): p. 131-7. 96. Mutalib, M.S.A., H. Khazaâ&#x20AC;&#x2122;ai, and K.W.J. Wahle, Palm-tocotrienol rich fraction (TRF) is a more effective inhibitor of LDL oxidation and endothelial cell lipid peroxidation than alpha-tocopherol in vitro. Food Res. Int., 2003(36): p. 405-413. 97. Weber, C., et al., Efficacy of topically applied tocopherols and tocotrienols in protection of murine skin from oxidative damage induced by UV-irradiation. Free Radic Biol Med, 1997. 22(5): p. 761-9.

98. Traber, M.G., et al., Penetration and distribution of alpha-tocopherol, alpha- or gamma-tocotrienols applied individually onto murine skin. Lipids, 1998. 33(1): p. 87-91. 99. Packer, L., S.U. Weber, and G. Rimbach, Molecular aspects of alpha-tocotrienol antioxidant action and cell signalling. J Nutr, 2001. 131(2): p. 369S-73S.

100. Qureshi, A.A., et al., delta-Tocotrienol and quercetin reduce serum levels of nitric oxide and lipid parameters in female chickens. Lipids Health Dis, 2011. 10: p. 39. 101. Yam, M.L., et al., Tocotrienols suppress proinflammatory markers and cyclooxygenase-2 expression in RAW264.7 macrophages. Lipids, 2009. 44(9): p. 787-97.

102. Michihara, A., et al., Delta-tocotrienol causes decrease of melanin content in mouse melanoma cells. J Health Sci, 2009. 55(2): p. 314-318.

103. Michihara, A., et al., Effect of delta-tocotrienol on melanin content and enzymes for melanin synthesis in mouse melanoma cells. Biol Pharm Bull. 33(9): p. 1471-6. 104. Yap, W.N., et al., Gamma- and delta-tocotrienols inhibit cutaneous melanosis (hallmark of melanoma) by suppressing constitutive and UV-induced tyrosinase

activation., in 102nd Annual Meeting of the American Association for Cancer Research2011: Orlando, FL.

105. Pierpaoli, E., et al., Supplementation with tocotrienols from Bixa orellana improves the in vivo efficacy of daptomycin against methicillin-resistant Staphylococcus aureus in a mouse model of infected wound. Phytomedicine, 2017. 36: p. 50-53.

106. Tan, B. and A.M. Mueller, Tocotrienols in Cardiometabolic Diseases., in Tocotrienols: Vitamin E beyond Tocopherol, R. Watson and V. Preedy, Editors. 2008, AOCS/CRC Press. p. 257-273.

107. Miyazawa, T., et al., Antiangiogenic and anticancer potential of unsaturated vitamin E (tocotrienol). J Nutr Biochem, 2009. 20(2): p. 79-86. 108. Tappeiner, C., et al., Antifibrotic effects of tocotrienols on human Tenonâ&#x20AC;&#x2122;s fibroblasts. Graefes Arch Clin Exp Ophthalmol, 2009. 109. Tanito, M., et al., Distribution of tocopherols and tocotrienols to rat ocular tissues after topical ophthalmic administration. Lipids, 2004. 39(5): p. 469-74.

110. Abdul Nasir, N.A., et al., Effects of topically applied tocotrienol on cataractogenesis and lens redox status in galactosemic rats. Mol Vis, 2014. 20: p. 822-35.

111. Abdul Nasir, N.A., et al., Reduction of oxidative-nitrosative stress underlies anticataract effect of topically applied tocotrienol in streptozotocin-induced diabetic rats. PLoS One, 2017. 12(3): p. e0174542.

112. Rink, C., et al., Tocotrienol vitamin E protects against preclinical canine ischemic stroke by inducing arteriogenesis. J Cereb Blood Flow Metab, 2011. 31(11): p. 221830. 113. Kuhad, A. and K. Chopra, Attenuation of diabetic nephropathy by tocotrienol: involvement of NFkB signaling pathway. Life Sci, 2009. 84(9-10): p. 296-301.

114. Anderson, S.L., J. Qiu, and B.Y. Rubin, Tocotrienols induce IKBKAP expression: a possible therapy for familial dysautonomia. Biochem Biophys Res Commun, 2003. 306(1): p. 303-9.

115. Anderson, S.L. and B.Y. Rubin, Tocotrienols reverse IKAP and monoamine oxidase deficiencies in familial dysautonomia. Biochem Biophys Res Commun, 2005. 336(1): p. 154-6. 116. Nur Azlina, M.F., et al., Tocotrienol Attenuates Stress-Induced Gastric Lesions via Activation of Prostaglandin and Upregulation of COX-1 mRNA. Evid Based Complement Alternat Med, 2013. 2013: p. 804796.

117. Rodzian, M.N., et al., Pure tocotrienol concentrate protected rat gastric mucosa from acute stress-induced injury by a non-antioxidant mechanism. Pol J Pathol, 2013. 64(1): p. 52-8. 118. Zaiden, N., et al., Gamma delta tocotrienols reduce hepatic triglyceride synthesis and VLDL secretion. J Atheroscler Thromb, 2010. 17(10): p. 1019-32. 119. Sylvester, P.W. and S.J. Shah, Mechanisms mediating the antiproliferative and apoptotic effects of vitamin E in mammary cancer cells. Front Biosci, 2005. 10: p. 699-709.

120. Tan B and Trias A. Emerging Cancer Research in Vitamin E Tocotrienol. Anti-Aging Therapeutics, Ed, R Klatz & R. Goldman. Vol 15 Ch 20m 227-239.

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Vitamin K2: The Anti-Aging Nutrient By: Thomas Bayne

DC & President of MBL.

While aging as a whole is inevitable, some aspects of aging may actually be caused by a simple vitamin deficiency. That’s right – wrinkles, stiff muscles, and decreased athletic performance can all be symptoms of just one micronutrient deficiency: vitamin K2. Though K2 was discovered about 80 years ago, scientists are just now beginning to understand the major role that this vitamin plays in the body. Some of the main benefits include improved heart and bone health, as vitamin K2 is responsible for removing calcium from the tissues and shuttling it back into the bone. As a result, vitamin K2 has been shown to be incredibly useful for conditions like atherosclerosis, vascular calcification, and osteoporosis.1 However, some of the more recent discoveries demonstrate that vitamin K2 can play a role in the treatment and prevention of wrinkles, varicose veins, diabetes, and even prostate, breast, and liver cancers.2

Healthy Skin In order to maintain youthful, healthy skin, the body needs a plentiful supply of collagen and elastin. Collagen is the protein responsible for skin’s firm and supple nature, though it also plays a role in connecting the tissues found in bone, muscles, tendons, cartilage, and organs. Elastin is the protein that gives structure to the skin and organs, allowing the skin to resume its original shape after stretching. Together, these proteins help maintain skin that is firm yet elastic. However, by age 20, collagen stores begin to decline by 10% every decade, which can have negative effects on the skin as well as the bones.3,4 In fact, some studies show that the severity of a woman’s facial wrinkles after menopause can actually predict her risk of osteoporosis, mostly due to the fact collagen loss in the skin occurs at the same rate as collagen loss in the bone.5 Until now, creams and lotions have led the anti-aging movement in an attempt to replace collagen stores, but research now indicates that excessive skin wrinkling may actually be a sign of vitamin K2 deficiency. In population studies, Japanese women appear to have fewer wrinkles and more supple skin than women of the same age

ANTI-AGING MEDICAL NEWS

living in North America.5 Some people attribute this youthful skin to Asian genetics, but even when compared to women from Shanghai and Bangkok, Japanese women appeared to show the least visible signs of aging. Interestingly, the women from these three Asian groups shared many similar diet and lifestyle factors with one exception –the Japanese women had a much higher consumption of natto. Natto, or fermented soybean, is considered a staple of Japanese cuisine and happens to be the richest food source of vitamin K2. As a result, Japanese women have much higher circulating levels of this vitamin than any other Asian population which may account for their more youthful complexions.

Athletic Performance One of the main reasons that aerobic athletic performance declines with age is that the body becomes less effective at utilizing oxygen. The maximal ability to utilize oxygen can be measured by VO2max, an assessment of how much oxygen your body can use per kilogram of body weight. As a result, a high VO2max will indicate that a person can effectively utilize oxygen, which is often seen in well-trained endurance athletes. Unfortunately, after the age of 30, VO2max will begin to decline. For non-athletes, VO2max tends to decline by about 10% every decade. However, athletes who continue their rigorous training can reduce the decline to only 5% every decade.6 The main reason that VO2max declines with age is because the maximal heart rate (max HR) decreases as well. Cardiac output = stroke volume x maximal heart rate Because cardiac output is the product of stroke volume and maximal heart rate, a decrease in max HR will directly decrease cardiac output, and in turn, oxygen delivery to the muscles. This translates to a lower VO2max and decreased athletic endurance with age. Fortunately, vitamin K2 appears to increase cardiac output by improving mitochondrial function. In fact, a recent study conducted at the University of North Texas found that only 8 weeks of high dose supplementation with vitamin K2 (MK• WINTER 2018

Vitamin K2: The Anti-Aging Nutrient

7) was associated with a whopping 12% increase in maximal cardiac output in aerobically trained athletes.7 Interestingly, it’s estimated to take 6 to 9 months of high intensity training without K2 supplementation to achieve the same increase in cardiac output. Researchers also reported slight increases in stroke volume and maximal heart rate in the test group, which may help explain the significant increase in cardiac output.

The Vitamin K2 Solution

The good news is that many of the conditions discussed in this article can be remedied with an increased intake of vitamin K2. The bad news is that vitamin K2 is fairly elusive in the modern Western diet. The best natural source of K2 is natto, which contains approximately 1,100 mcg of vitamin K2 in a 3.5 oz serving. However, natto is very pungent and bitter, which can make patient compliance a significant challenge. Other good sources of vitamin K2 include goose liver, various organ meats, and soft cheeses like Gouda and Brie. These natural food sources contain vitamin K2 in its menaquinone-4 form (MK-4), which has a short half-life of roughly 4-6 hours.

This means that patients would need to consume these foods every 4-6 hours in order to maintain optimal K2 levels in the blood. When considering supplementation with K2, research indicates that MK-7 is superior to MK-4 and vitamin K1 in regards to half-life, bioavailability, and safety. With more and more synthetic formulations of MK-7 entering the market, it’s also important to choose naturally-fermented forms of MK-7, as synthetic MK-7 is not as well-studied or held to the same quality standards as natural MK-7. One of the highest quality sources of all-natural MK-7 is a brand known as Menaquin Gold, which can be found in various vitamin K2 products. In conclusion, supplementation with all-natural MK-7 appears to reduce skin wrinkling and improve aerobic athletic performance in aging populations, making it one of the most powerful anti-aging nutrients available today. Dr. Thomas Bayne, DC & President of MBL.

References 1. Cranenburg EC, Schurgers LJ, Vermeer C. Vitamin K: the coagulation vitamin that became omnipotent. Thromb Haemost. 2007;98(1):120-5. 2. Cario-Toumaniantz C, Boularan C, Schurgers LJ, et al. Identification of differentially expressed genes in human varicose veins: involvement of matrix gla protein in extracellular matrix remodeling. J Vasc Res. 2007;44(6):444-59. 3. Shuster S. Osteoporosis, a unitary hypothesis of collagen loss in skin and bone. Med Hypotheses. 2005;65(3):426-32. 4. Gheduzzi D, Boraldi F, Annovi G, et al. Matrix Gla protein is involved in elastic fiber calcification in the dermins of pseudoxanthoma elasticum patients. Lab Invest. 2007;87(10):998-1008. 5. Yoneda PP, Biancolin SE, Gomes MS, et al. Association between skin thickness and bone density in adult women. An Bras Dermatol. 2011;86(5):878-84. 6. Tanaka H, Seals DR. Endurance exercise performance in Masters athletes: age-associated changes and underlying physiological mechanisms. J Physiol. 2008;586(1):55-63. 7. McFarlin BK, Henning AL, Venable AS. Oral Consumption of Vitamin K2 for 8 Weeks Associated with Increased Maximal Cardiac Output During Exercise. Altern Ther Health Med. 2017;23(4):26-32.

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Identifying Candidates for Pellet Hormone Replacement Therapy By: Enrique Jacome MD, FACOG, Bev Blessing, MSN, PHD, FNP-BC

Abstract

In clinical practice, there is a measure of uncertainty regarding selection of appropriate candidates for hormone replacement therapy (HRT). Pellet based hormone therapy presents a unique challenge because it is longer-lasting than more commonly used methods, but it is well liked by many because of its ability to provide a sustained customized approach. Although pellets have been available for 70+ years, they are receiving renewed interest in the media and are included in ongoing discussions in the lay community. As a result, many patients are interested in the potential benefits of pellet HRT and are seeking guidance from their providers. Historically due to concern regarding HRT, a level of caution accompanies the elevated level of interest. Many organizations have agreed that use of HRT is contraindicated for certain patients such as those with previous strokes, atherosclerotic cardiovascular disease, liver disease and diagnosis of either breast or prostate cancer. However newer studies challenge long held perceptions which makes an individualized assessment more complex. We are proposing a sequenced combination of validated tools to help assess patient candidacy for HRT and to establish an objective baseline score for evaluating progress after treatment. This would include the absolute contraindication list, the Cardiovascular 10-year risk scale, and the Menopause Rating scale for women or the Androgen Deficiency of the Aging Male scale for men. This organized approach should aid in the clinician /patient decision-making process.

Introduction

This type of therapy is often recommended to relieve common symptoms of menopause and to take advantage of some of the benefits noted with hormone supplementation, such as delaying/minimizing bone loss. The most common combinations include estrogen alone or estrogen with a progestogen such as progesterone, or a synthetic progestin. Other variations may include the use of testosterone, DHEA, pregnenolone, and or melatonin.

The current popularity of pellet hormone replacement therapy (HRT) among the general population, including both men and women has placed a demand on clinicians to be prepared to provide knowledge-based guidance, and treatment strategies that are not only effective but safe. With pellet HRT, there are multiple considerations, but the primary starting point would be the patient’s personal risk/benefit profile associated with hormone replacement therapy (HRT). This would include consideration for current medications, medical history, social history, and potential allergies. The second major area of concern are those risks associated with the procedure itself, including the potential for bleeding, infections, extrusion, local reactions, dosing challenges, pain control, insertion technique, and provider experience. This second category, although important is not considered for the purposes of this paper. The identified risks associated with hormone replacement therapy have gone through many iterations and have been based on lessons learned in various controlled trials and meta-analyses. It is now known that with proper patient selection, our patients can safely take advantage of the many benefits of hormone therapy. This premise is very different from a time when the reports of increased cardiovascular death and cancer were enough reason not to pursue hormone replacement therapy.

Risks of Hormone Replacement Therapy

For women, the most common HRT involves supplementation of declining hormones at or near the time of menopause.

The availability of hormone replacement products and the growing demand from the public to benefit from them warrants a careful look by the clinician. The most recognized body of study about the risks and benefits of HRT in women comes from the randomized control trials, sponsored by the National Institute of Health as part of the Women’s Health Initiative (WHI) (Stefanick, M, et al.). These included the: • The WHI Estrogen-plus-Progestin Study, in which women with a uterus were randomly assigned to receive either a hormone medication containing both estrogen and progestin (Prempro™) or a placebo. • The WHI Estrogen-Alone Study, in which women without a uterus were randomly assigned to receive either a hormone medication containing estrogen alone (Premarin™) or a placebo. More than 27,000 healthy women who were 50 to79 years of age at the time of enrollment took part in the two trials. The primary focus of the study was to explore potential beneficial effects of hormones on disease prevention like cardiovascular disease, breast cancer, and fracture prevention. Although both trials were stopped prematurely (in 2002 and 2004, respectively) when it was believed that both types of therapy

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Identifying Candidates for Pellet Hormone Replacement Therapy

were associated with specific health risks, longer-term follow up of the participants continues to provide new information about the health effects of hormone therapy (The Women’s Health Initiative Study Group). For example, in a recent analysis on the findings of the WHI studies, the researchers found there was no difference in cardiovascular risk in the younger women in the study and the placebo group. But the older women >60, who initiated hormone therapy later with the oral meds had an increased risk due to the impact on atheromatous plaque that had built up in those years prior to using hormone therapy (Manson, J, et al.). Conversely, a study on transdermal estradiol showed that by avoiding first pass metabolism in the liver, the overproduction of triglycerides was inhibited, which resulted in a lower systolic blood pressure, and increased stroke volume. As a result, this transdermal method of delivery decreased the risk of cardiovascular events (Mohammed, K, et al.). It is interesting to note that the long-term CVD death rate was higher in the WHI placebo group than in the test groups. There was also an increased risk of breast cancer with the estrogen / progestin arm in the study, but there was a reduction in breast cancer in the estrogen alone group. The all-cause mortality was higher in the placebo group than for either arms of the study, but especially in the younger group with a 33% difference (Manson, J, et al.). Finally, the total cancer death rate was neutral across both studies. For the male, the primary focus for hormone replacement has been on testosterone. Again, the knowledge base for this is constantly changing. It is well known that testosterone impacts the brain, peripheral nerves, muscles, fat, bone, cardiovascular system and the reproductive system. Low levels may increase the risk for diabetes and metabolic syndrome, contribute to bone mineral density (BMD) loss, and is associated with both all-cause and cardiovascular mortality (Morgentaler, A, et al.). In an international consensus position on testosterone deficiency reviewing available knowledge base and research, the group agreed there was no increased risk for cardiovascular events in men or increased risk of prostate cancer with testosterone therapy. It was found that testosterone increases lean muscle mass, and it may improve glycemic control. There are no specific recommendations regarding age, but the potential for erythrocytosis should be monitored and addressed when indicated. Additionally, mortality rates were reduced by half in men with known deficiency when treated, compared to untreated men. Even with the known benefits, potential worsening of prostate cancer, prostate hyperplasia, polycythemias, and obstructive sleep apnea should be considered when evaluating candidacy (Osterberg, E, et al.)

Assessing Risk at the Individual Level

It is evident new data and perspectives are forever emerging in medicine. Therefore, an organized strategy may prove beneficial in discussing this information with our patients considering pellet hormone replacement therapy. A three-step approach therefore is being recommended. 1. Evaluate for absolute and relative contraindications to hormone therapy 2. Assess risk for long term cardiovascular disease 3. Clearly understand the symptoms and concerns of the patient

The first step is to understand the absolute and relative risks of hormone therapy. Although absolute contraindications don’t seem to really exist, most areas of concern are relative risks. These could include: • history of cancer (endometrial, breast, prostate) • severe active liver disease • thromboembolic disorders • heart disease • unexplained bleeding • anaphylaxis of unknown causes (Kaur) Patients with self assessed sensitivities, drug abuse/ polypharmacy disorders and psychiatric conditions should also be assessed carefully. Other considerations would be: • patient with a pacemaker or valve disease atrial fibrillation on anticoagulants coronary artery disease hypertriglyceridemia • autoimmune disease HIV • elevated PSA • patients with multiple breast biopsies endometriosis • fibroids • smokers. Although patients with these issues may be candidates for hormone replacement, additional consideration may be necessary such as addressing the impact of anticoagulants on pellet implantation, need for SBE prophylaxis, or an endometrial biopsy to evaluate bleeding issues. Taking time to discuss these additional considerations will be important in developing the plan for care. The second step is to generally evaluate the patient for cardiovascular risk. The ACC/AHA developed a simple calculator that uses common information to screen for CVD risk (Goff, D, et al.). The experienced clinician starts by evaluating the patient for general risk factors to include hypertension, diabetes, smoking, family history, chronic kidney disease, and obesity. Then simply using the CVD risk calculator the HDL and total cholesterol can be used in combination with age, BP, race, hypertensive medications, and history of diabetes to determine a risk factor. Less than 5% is low risk, 5-7.5% is intermediate risk, and > 7.5% is high risk (Wilson). The higher risk patient may still be a candidate for HRT, but it may indicate a need to decrease the dosage, refer for further assessment with a cardiologist or internist, or follow different labs to assess any early indicators for change. The calculator can be located at http://www.cvriskcalculator.com/. It has been criticized by some for overestimating risk but can be helpful in honing-in on patients that need further consideration. Finally, the third assessment is related to the symptoms that need to be addressed. Two commonly used tools have been validated to assess symptoms related to hormone changes. The Menopausal-Rating Scale (MRS) for women and the Androgen Deficiency in Aging Males (ADAM) for men. The MRS has 11 questions, with ratings from 0-4, covering psychiatric related changes, somatic complaints, and urogenital symptomology. Having the patient complete the questionnaire prior to treatment, provides an objective baseline starting point, as well as an indication of where to best address therapy. The higher the score the worse the symptomology but the greater potential for improvement.

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Identifying Candidates for Pellet Hormone Replacement Therapy

Population studies have determined that patients with little/ no complaints before therapy improved by 11% with HRT, those with mild complaints at entry by 32%, with moderate by 44%, and with severe symptoms by 55% compared with the baseline score (Heinemann, L, et al.). The 11 items include the following:

The scoring scheme of the MRS scale is simple: • The questionnaire has for each of the 11 item an option to

1. Hot flushes, sweating (episodes of sweating) 2. Heart discomfort (unusual awareness of heart beat, heart skipping, heart racing, tightness) 3. Sleep problems (difficulty in falling asleep, difficulty in sleeping through, waking up early) 4. Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings) 5. Irritability (feeling nervous, inner tension, feeling aggressive) 6. Anxiety (inner restlessness, feeling panicky) 7. Physical and mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness)

check one of 5 degrees of severity of symptoms (severity 0 [none]…5 [very severe] points at the questionnaire), • The scoring points of each of the items can be placed into the form below • The composite scores for each of the three dimensions (sub-scales) is based on adding up the scores of the items of the respective dimensions.

8. Sexual problems (change in sexual desire, in sexual activity and satisfaction) 9. Bladder problems (difficulty in urinating, increased need to urinate, bladder incontinence) 10. Dryness of vagina (sensation of dryness or burning in the vagina, difficulty with sexual intercourse) 11. Joint and muscular discomfort (pain in the joints, rheumatoid complaints) (A copy of the questionnaire can be downloaded for clinical use from this link: http://www.menopause-rating-scale.info/ documents/MRS_English.pdf) The total score of the MRS ranges between 0 (asymptomatic) and 44 (highest degree of complaints). The minimal/maximal scores vary between the three dimensions depending on the number of complaints allocated to the respective dimension of symptoms: • Psychological symptoms: 0 to 16 scoring points ( 4 symptoms: depressed, irritable, anxious, exhausted) • Somato-vegetative symptoms: 0 to 16 points (4 symptoms: sweating/f lush, cardiac complaints, sleeping disorders, joint & muscle complaints) • Urogenital symptoms: 0 to 12 points (3 symptoms: sexual problems, urinary complaints, vaginal dryness). The composite scores for each of the dimensions (sub-scales) is based on adding up the scores of the items of the respective dimensions. The composite score (total score) is the sum of the dimension scores (Heinemann, L, et al.).

• The composite score (total score) is the sum of the three dimension scores. The “total score” is the sum of the scores of the three subscales. The authors of the MRS published a poster that is available for download from this link: http://www.menopause- ratingscale.info/documents/poster.pdf. The conclusion of the creators of the MRS is that a score improvement of at least 4 to 7 points is recommended to establish clinically meaningful efficacy. So, as an example of how this could be used, if a woman’s MRS score was low and she had any potential risk factors for cardiovascular disease or cancer, the benefit to risk ratio would be small and the clinician would be prudent to advise against pellet HRT. However, if a woman’s MRS score was in the higher range of possible scores and she had no risk factors, she most likely represents a good candidate for pellet HRT. The ADAM scale has been used to assess androgen deficiency. It has 10 “yes or no” questions and an 88% sensitivity and 60% specificity (Mohamed, O, et al.). Because it is “yes or no” answers rather than a Likert type of scale, there is very little opportunity to grade for varying degrees of change. Although criticized for its lower specificity scores, when combined with testosterone levels, it can provide an excellent starting place for assessment and establish a baseline for following improvement in symptomology. The questions include the following:

ANTI-AGING MEDICAL NEWS

1. Do you have a decrease in libido (sex drive)? 2. Do you have a lack of energy? 3. Do you have a decrease in strength and/or endurance? • WINTER 2018

Identifying Candidates for Pellet Hormone Replacement Therapy

4. Have you lost height? 5. Have you noticed a decreased ‘‘enjoyment of life’’?

available and at no cost to the user. The results can then be incorporated into the patient’s medical record to document the assessment and counselling process.

6. Are you sad and/or grumpy? 7. Are your erections less strong? 8. Have you noted a recent deterioration in your ability to play sports? 9. Are you falling asleep after dinner? 10. Has there been a recent deterioration in your work performance? The rationale for the questions is based on previous studies that demonstrated that as testosterone levels decline, certain symptoms are more commonly present in males based on the low bioavailable testosterone levels. The questionnaire is given as part of the initial evaluation and used to determine whether blood testosterone levels should be drawn with the objective of identifying men who should receive pellet HRT with testosterone (Morley, J, et al.)

Dr. Jacome is a pioneer and innovator with a unique background in minimally invasive surgery and hormone pellet insertion. Bev Blessing and Dr. Jacome are committed to improving the insertion technique. Email info@pellecome.com or 1-888-773-9969.

References

A positive result on the ADAM questionnaire is defined as an affirmative answer (‘‘yes’’) to questions 1 or 7 or any 3 other questions. So, as an example of how this could be used clinically, if a man does not have a positive result on the ADAM questionnaire, it may not even be necessary to draw blood testosterone levels. Those with a positive result are more likely to have low bioavailable testosterone levels and be considered for pellet HRT, if the cardiovascular risk profile is suitable, and the patient has no risks associated with prostate cancer.

Conclusion

More and more patients are interested in getting the longerlasting hormone pellet for treatment of hormone related symptomology. The three-step approach of assessing relative / absolute contraindications and cardiovascular risk, then establishing an objective baseline for evaluating treatment seems to be an effective organized approach to assessment and counselling for these patients. The proposed tools are readily

ANTI-AGING MEDICAL NEWS

Goff, D, et al. “ACC/AHA Guideline on Assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines.” Circulation, vol. 129, 12 Nov 2013, pp. S49-S73, doi:10.1161/01. cir.00043771.41’4860.6.98. Heinemann, L, et al. “The Menopause Rating Scale (MRS) as outcome measure for hormone treatment? A validation study.” Health and Quality of Life Outcomes, vol. 2, no. 67, 22 November 2014, pp. 1-7, doi:10.1186/1477-7525-2-67. Kaur, K. “Menopausal hormone replacement therapy.” Medscape, 4 Jan 2018. Manson, J, et al. “Menopausal hormone therapy and long term all cause and cause specific mortality: The Women’s Health Initiative randomized trials.” JAMA, vol. 318, no. 10, 2017, pp. 927-938, doi:10.1001/jama.2017.11217. Mohamed, O, et al. “The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism.” International Journal of Impotence Research, vol. 22, no. 1, 2010, pp. 20-24, doi:10.1038/ijir.2009.35. Mohammed, K, et al. “Oral vs transdermal estrogen therapy and vascular events: A systematic review and meta-Analysis.” Journal of Clinical Endocrinology & Metabolism, vol. 100, no. 11, 2015, pp. 4012-4020, doi:10.1210/jc.2015-2237. Morgentaler, A, et al. “Fundamental concepts regarding testosterone deficiency and treatment: International Expert Consensus resolutions.” Mayo Clinical Proceedings, vol. 91, no. 7, 2016, pp. 881-896, doi:10.1016/j.mayocp.2016.04.007. Morley, J, et al. “Validation of a screening questionnaire for androgen deficiency in aging males.” Metabolism, vol. 49, no. 9, Sep 2000, pp. 1239-1242, doi:10.1053/meta.2000.8625. Osterberg, E, et al. “Risks of testosterone replacement therapy in men.” Indian Journal of Urology, vol. 30, no. 1, 2014, pp. 2-7, doi:10.4103/0970-1591.124197. Stefanick, M, et al. “The Women’s Health Initiative postmenopausal hormone trials: Overview and baseline characteristics of participants.” Annals of Epidemiology, vol. 13, 2003, pp. S78-S86, doi:10.1016/S1047-2797(03)00045-0. The Women’s Health Initiative Study Group. “Design of the Women’s Health Initiative clinical trial and observational study.” Controlled Clinical Trials, vol. 19, 1998, pp. 61-109. Wilson, P. “Cardiovascular disease risk assessment for primary prevention: Our approach.” UpToDate, July 2018.

• WINTER 2018

The Science for Better Living NEW

Live Demonstration Workshop Thursday, December 13th at 6:15 pm in Veronese BR 2403* (serving cocktails and hors d’oeuvres)

Reg

enerate

•

Visit Booth #7021 to meet the Pellecome Team and experience the latest patent pending technology in BHRT Pellet Delivery ne

*Non-CME

What’s in Your Protocol?

BOTANICAL SUPPORT IN:

G.I. Dysbiosis Biof ilms Lyme Candida SIBO Dental Care Healthy Immune Response Inf lammation

Biocidin® Periodontal Study

Cells /ml

2,000,000 1,800,000 1,600,000

BEFORE

1,400,000 1,200,000 1,000,000 800,000 600,000 400,000

0 min

10 min

20 min

30 min

60 min

120 min

Time (min) BIOCIDIN

BIOCIDIN LSF ®

AFTER LIPOSOMAL FORMULA

4 month usage of Biocidin® LSF

Rate of Borrelia Cell Death After Application

BIO-BOTANICAL RESEARCH INC.

Clinically Effective, Evidence Based

Biocidin.com

PRODUCT ANNOUNCEMENTS

AETHERN® Advanced Skin Beauty Program

BC-380 Booth #9032

Booth #4065

Booth #9055 ACCUNIQ BC380 delivers clinically accurate body composition results in less than 1 minute. ACCUNIQ’s precise measurement technology, which shows a high correlation with DEXA equipment (Lean body mass R=0.983), analyzes body composition and monitors body fat and muscle changes. Easy to use with on-screen step by step instructions and provided body composition management program on PC. Call 1-844768-0815 or E-mail sales@accuniqusa.com for more information.

Ph: 1-844-768-0815 www.accuniqusa.com

AnteAGE HAIR Treatment System

Booth #3085 Introducing the first global line of multifunctional prescribed hair care compounding vehicles optimized for use with active agents. The TrichoConcept™ line consists of 7 calming and aromatic vehicles formulated with patented TrichoConcept™ technology. This exclusive intelligent technology is a phytocomplex, acting on the balance of the entire hair system - bulb, scalp and shaft.

AnazaoHealth Corporation Ph: 800.995.4363 www.anazaohealth.com

AETHERN® Advanced Skin Beauty Program is a unique liquid “shot” formula that acts on the four cutaneous aging factors – Hydration, Radiance, Firmness and UV Protection – helping to maintain young-looking skin.

Aethern Ph: 212-937-8447 www.aethern.com

ACCUNIQ

TrichoConcept™

ROOT OF SKIN™ MD

ROOT OF SKIN™ MD is a revolutionary new skincare line capturing the unique messaging system and ingredients of skin stem cells to address the visual signs of aging. We capture the complete set of factors, in their natural relative concentrations, from the very cells responsible for the maintenance and renewal of young skin. Sales of ROOT OF SKIN™ MD products support the treatment of women with ovarian cancer.

AIVITA Biomedical Ph: 949-872-2555 www.rootofskinmd.com

Trizomal™ Glutathione Booth #1020

Booth #8020-8021 The AnteAGE® HAIR Treatment System is a breakthrough in the promotion of natural, healthy hair growth - without surgery or hormonal side effects. The Hair Microneedling Solution contains Bone Marrow Stem Cell Cytokines and Growth Factors, specially cultured to influence signaling towards the Wnt-1a pathway for follicle activity. The in-office treatment is augmented with the AnteAGE Hair System, a home care kit containing hair growth factors and 24 botanical extracts shown to promote hair growth.

AnteAGE MD Ph: 949-419-4153 www.anteage.com

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Trizomal™ Glutathione is a breakthrough new approach to glutathione supplementation. It features, for the first time in a liposomal solution, S-acetyl L-glutathione (SAG), combined with reduced glutathione (GSH), and N-acetyl L-cysteine (NAC). It utilizes three ways to support glutathione—intracellular with SAG, intracellular biosynthesis with NAC, and extra/intracellular (systemic) support with GSH. The liposomal S-acetyl L-glutathione provides a double layer (acetylation + liposomes) of protection to the glutathione molecule, further supporting its intracellular bioavailability.

Apex Energetics Ph: 800-736-4381 www.apexenergetics.com

Pros-Tech Ultra Booth #3042 Pros-Tech Ultra is a unique combination of ingredients formulated to support prostate, urinary, and male reproductive health.*

Booth #9037

FRANZ Dual Mask System Booth #2015

FRANZ Dual Mask System makes your skin glow and moist since its micro-current allows hydrolyzed hyaluronic acid and active ingredients penetrate to inner skin. These can successfully enable key ingredients with high molecular weight, such as hyaluronic acid, vitamins, and peptides, to be non-invasively absorbed into the deep skin.

Bio-Tech Pharmacal

BioSensor Laboratories, Inc.

Ph: 800-345-1199 www.biotechpharmacal.com

Ph: 713-725-8983 www.franzskincare.com

Chronoceuticals is pleased to present Resverchron, the first all-inclusive chronobiology-based regimen for anti-aging. Resverchron is a well-balanced combination of the best-researched vitamins, minerals, nutrients, and plant substances for supporting healthy cellular inflammatory processes, protecting against oxidative stress, maintaining a healthy cardiovascular and nervous system, and promoting healthy cell growth. Resverchron’s carefully-formulated AM/PM doses assure that vital substances are administered in the optimal combination at the right time of day, to ensure optimal anti-aging results.

Chronobrands, Inc. Ph: 855-247-6668 www.chronoceuticals.com

Percepta Professional Booth #5070 Percepta Professional is the first professional nootropic to target the real reason we lose memory as we age -brain “plaques and tangles”. The product was developed by two of the world’s most renowned brain aging and memory loss researchers, Dr. Alan Snow, CEO and Dr. Rudy Tanzi, Chief Scientific Advisor, of Cognitive Clarity Inc. Percepta Professional contains three proprietary ingredients that target brain plaques and tangles, including PTI-00703® cat’s claw, oolong tea extract (MemorTea®) and black currant. Each lot of Percepta Professional is validated for “plaque and tangle” inhibitory and reducing activity through proprietary assays and is now exclusively available to physicians and healthcare companies.

Cognitive Clarity Inc.

Ph: 425-678-8485 www.perceptabrain.com

ezPRF

Hepaxa

Booth #4101

Booth #8043

ezPRF is an all new 100% natural, additive free, autologous blood concentrate procedure that significantly improves the skin’s texture and helps fight the aging process! ezPRF, The Rose Gold Gel ™, will revolutionize aesthetic medicine. This new technique is more efficient, with instantly visible results in volume enhancement and long-term benefits such as improving skin quality and texture, as well as promoting the synthesis of collagen.

Introducing Hepaxa: the first-in-class medical food product indicated for the dietary management of steatosis in earlystage non-alcoholic fatty liver disease (NAFLD). Hepaxa(R) has been clinically shown to: stop de novo lipogenesis; reactive fatty acid oxidation and improve triglyceride synthesis. Best responders are those patients presenting with Fatty Liver Index (FLI) scores>40.

DIEM Labs LLC

CosmoFrance

Ph: 800-971-3721 ext 3 www.Hepaxa-USA.com

Ph: 305-538-0110 www.ezprf.com

ANTI-AGING MEDICAL NEWS

PRODUCT ANNOUNCEMENTS

Vitamin D3, Vitamin E Tocotrienols, Zinc, Beta-Sitosterol and a Proprietary Blend containing Green Tea Extract, Quercetin dihydrate, Cranberry Extract, and Curcumin C3 Complex.

Resverchron

• WINTER 2018

PRODUCT ANNOUNCEMENTS

Rest Reset™

Diagnosis in Chinese Medicine,

Booth #5013 Rest Reset™ combines Lactium® casein decapeptide, passion flower extract and melatonin to support multiple facets of sleep: falling asleep, deep sleep, nocturnal rhythms, stress support and cortisol regulation. Lactium® has been shown to provide a calming effect and may support sleep patterns by normalizing the Hypothalamic-Pituitary-Adrenal axis feedback loop, which is affected by stress. ǂThese statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Ph: 215-239-3900 www.elsevierhealth.com

Ph: 800-245-4440 www.douglaslabs.com

Formula 82S

Defy Your DNA

Booth #9039

Booth #6044

Formula 82S® is a 3-in-1 (shampoo + conditioner + anti-hair loss) product that leaves hair feeling soft, healthy and easy to comb—without the need for a separate conditioner. We have recently made changes to 82S that have led to greater sudsing and conditioning while retaining the core benefits of the formula. Formula 82S is an excellent complement to a daily regrowth regimen and a great general restorative shampoo for dry, thin and damaged hair.

Hair Science

Written by world-renowned author and teacher Giovanni Maciocia, Diagnosis in Chinese Medicine, 2nd Edition is a comprehensive, highly illustrated, and easy-to-understand resource. With a focus on clear interpretations of “real world” signs and symptoms, this new edition addresses the practice beyond the theory and leads you through both basic and sophisticated levels of diagnostic interpretation. This practical resource helps students and practitioners alike carefully interpret a wide range of diagnostic nuances.

Elsevier

Douglas Laboratories®

Ph: 866 558-1744 www.hairsciencecorp.com

Booth #8078

Kashi Clinical Laboratories has launched a brand new Defy your DNA Program. This groundbreaking health panel provides fast and accurate information on a wide range of SNP’s affecting weight management, diabetes, cardiac heath, nutritional function, bone health, estrogen metabolism, brain health, mood disorders, and methylation. Test results are summarized in an easyto-interpret report that identifies risk profiles and pinpoints gene function. Staff physicians are available for a complimentary consultation.

Kashi Clinical Laboratories Ph: 503-206-4989 www.kashilab.com

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Methylation Booth #4015 Genova’s Methylation Panel is an innovative genotypic and phenotypic assessment designed to offer insight into the biochemical methylation pathway. This profile directly measures levels of key amino acids and intermediate metabolites involved in methylation, homocysteine transsulfuration, and folate metabolism to help clinicians design more targeted and specific treatment strategies to optimize patient outcomes. Single nucleotide polymorphisms (SNPs) are also assessed to offer insight into genetic predispositions that affect enzymes within these pathways.

Genova

Ph: 1-800-522-4762 www.gdx.net

Acumen Booth #6073 Klaire Labs’ Acumen offers the robustly studied, high potency, standardized whole plant CDRI 08 Bacopa monnieri extract. Clinically demonstrated to support spatial working memory, new information retention, stress management, and mood. Each capsule of Acumen contains 320 mg of Bacopa monnieri extract CDRI 08.

Klaire Labs

Ph: 1-888-488-2488 www.klaire.com

Kyoui Sonic 3000

COPADERM™

Booth #5044

Booth #7086

Kyoui is an unique patented oral care device created to prevent and control Periodontal Disease that affects 75% of adults leading to Heart Disease, Stroke, Pancreatic Cancer, Alzheimer’s, etc

NEW COPADERM™ – the first and only topical scar treatment combining the unique healing attributes of copaiba oil with the proven properties of silicone. Copaiba oil is extracted from copaifera trees in the Amazonian rainforest and has been used medicinally for thousands of years. COPADERM™ works on multiple levels to promote healing and fading of scars while providing a luxurious treatment experience.

Ketogenic Family of Products

Kyoui

Metagenics Ph: 800-692-9400 www.metagenics.com

Ph: 514-333-7811 www.copaderm.com

Pain Relief Cream

HiFlora-50™

Booth #4048

Booth #6079

MindBody Matrix Pain Relief Cream is an all natural paraben and cruelty pain cream designed to eliminate pain without the use of opiate prescription drugs. The cream is a blend of herbal extracts and oils imprinted with specific bioenergetic frequencies designed to liberate, correct, and align your mind and body allowing you to live painlessly and peacefully.

HiFlora-50™ delivers 50 billion CFU of a powerful probiotic blend containing 12 synergistically balanced strains to support the body’s own microbiome function.* These probiotic strains are well known for supporting immune function, healthy body composition and helping to establish a healthy microbial balance by competing with harmful bacteria.*

Ph: 5596235489 www.mindbodymatrix.com

This innovative practitioner-grade line of ketogenic formulas is designed to provide quick, convenient options to help incorporate macronutrients and support patients in reaching their wellness goals. Featuring a 70:20:10 ratio of fat, protein, and carbohydrates, formulas include Ketogenic Soup, Ketogenic Shake(with 22 essential vitamins and minerals), MCT Oil, MCT Powder, and Exogenous Ketones-for a convenient, multifaceted approach to a ketogenic lifestyle.

MEDISCA

Ph: 855-465-9684 www.Kyoui.com

MindBody Matrix

Meeting the requirements of a ketogenic lifestyle can be challenging.

Re3™ Advanced Pellet Delivery System Booth #7021 Re3™ Advanced Pellet Delivery System includes: Ergonomically designed INSERTION TOOL with NEEDLE GUIDE ensures pellets are always delivered in target subcutaneous tissue plane and in a linear retrograde manner.

Pellecome LLC

NuMedica®

Ph: 800-869-8100 www.numedica.com

ANTI-AGING MEDICAL NEWS

PRODUCT ANNOUNCEMENTS

From MEDISCA, a leader in innovative personalized patient solutions. Available exclusively through physicians.

Booth #6007

Ph: 888 773-9969 www.Pellecome.com • WINTER 2018

PRODUCT ANNOUNCEMENTS

Micro-Contaminant Detox Therapy

Mineral2O™ powder Booth #8042 Offers a taste-free, fully soluble blend of essential minerals to add to water to support daily wellness and cellular function. Includes trace mineral complex blend of over 72 minerals from the Great Salt Lake to enhance water with a healthy mineral profile, such as that from natural mineral springs. These statements have not been evaluated by the Food & Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

Support the clearance of heavy metals and the liver’s abiity to eliminate many other micro-contaminants without IV. * Contains 500mg EDTA, NAC, chlorella, 250mg tumeric, MCP, garlic, broccoli sprouts, 150mg milk thistle extract, green tea leaf and more. It is critical to not only chelate contaminants from tissue and plasma, but to promote their removal from the body. Thus great sophistication is requiered for a multi-component detox formula. Recommended for prophylactic and maintenance therapy.

Rejuvenation Science

Ph: 800-753-2277 www.pureencapsulations.com

Ph: 888-737-3588

Booth #8080

Booth #7065

Booth #3039

Pure Encapsulations

SALT and Sound Booth®

PiXel9-RF

www.Rejuvenation-Science.com

PRO Curcumin-LD™ Booth #4033

The SALT and Sound Booth® is the first and only SALT Booth® to incorporate Halotherapy (dry salt), Sonotherapy (sound) and Chromotherapy (color). Similar to its predecessors, the Original SALT Booth® and Multi SALT Booth®, the SALT and Sound Booth® provides therapeutic and wellness benefits and is perfect for both residential and commercial use. The SALT and Sound Booth® is 10-inches wider, however, making it more comfortable for one person to spread out and relax, and roomy enough to accommodate two individuals.

As leaders in liposomal delivery technology, Sovereign Laboratories announces its newest product, organic PRO Curcumin-LD™. PRO Curcumin-LD™ utilizes LD technology to improve the body’s absorption of the health-enhancing curcuminoids – five times more bioavailable than traditional curcumin supplements. PRO Curcumin-LD™ contains 98% organic turmeric extract standardized to 95% curcuminoids. Used for centuries in Ayurvedic medicine, curcumin helps support the immune system; improve digestive function; enhance circulatory and heart health; provide neuro-protection; and ease

SALT Chamber

Sovereign Laboratories

Ph: 855-588-7258 www.saltchamberinc.com

Ph: 480-553-7768 www.colostrumtherapy.com

Radio Frequency Micro-needling is a non-surgical procedure with little to no down time and is considered “the newest essential” for a successful aesthetic practice. The PiXel8-RF was developed to combat the signs of aging for all skin types. After a single treatment, most patients notice the area treated is tighter, smoother and softer. The PiXel8-RF uses bi-polar, RF energy to facilitate effective, non-surgical, skin tightening and can be placed in your office for $12,500.

Rohrer Aesthetics, LLC Ph: 205-940-2200 www.rohreraesthetics.com

E-ZMg Booth #7036 Our plant-based, multifonn magnesium is made from Swiss chard (beet leaf) and buckwheat, grown on our sustainable and certified organic farm in Wisconsin. Designed to help fill nutritional gaps - naturally. Each package holds 30 individual stick packs for on-the-go convenience. Mix with water, blend into a smothie or even sprincle on food.

arthritic pain.

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Standard Process, Inc Ph: 800-558-8740 www.standardprocess.com

SP Detox Balance

MF3 PE EVOLUTION

Booth #7036

Booth #4074

The SP Detox Balance™ program provides key nutrients and phytonutrients during all three phases of detoxification that unlock, neutralize and eliminate toxins. The simple 28-day or 10 .. day protocol features a tasty, all-in-one detox shake supported by sample meals.

MF3 PE Evolution is an enhanced version of MF3 PE Softgels AF.

Ph: 800-558-8740 www.standardprocess.com

Jubilance Booth #4060 Jubilance (oxaloacetate) is a nutritional supplement for relief of Emotional Premenstrual Syndrome (PMS). In randomized, blinded, placebo-controlled trials, Jubilance significantly reduced Anxiety and Gloomy Mood by over 50%. Perceived Stress and Irritability were also significantly reduced. Each bottle of Jubilance states the US FDA submitted Structure/Function Claim: “Oxaloacetate may help alleviate the mild to moderate psychological and/or behavioral symptoms associated with Premenstrual Syndrome (PMS).” Recommended by Doctors, Jubilance is a ground breaking supplement for women.

Booth #3071

Combining Sheep Placenta Extract, Fish DNA Cellular Extract and Ubiquinol, MF3 PE Evolution provides complete nutrients to the human body that is essential for overall wellness. It works on cellular renewal and stimulation to prevent premature aging cause by external factors, improve immune system, energy, support musculoskeletal and skin health. MF3 PE Evolution is suitable for everyone who seeks for complete wellness.

Stellar Biomolecular Research UG

From the company that launched the world’s first body fat scale in 1992, comes the very latest in body composition technology. Tanita Corporation proudly introduces the MC-980Uplus. This multifrequency analyzer performs a detailed segmental examination the body, reviewing fat and muscle mass while identifying water distribution. The Windows® operating system allows maximum flexibility in recording and exporting data, along with a full color consultation sheet. The MC980Uplus is designed to enhance all service provider businesses.

Tanita Corporation of America

Ph: 608-844-8989 www.mf3swiss.com

Ph: 847-640-9241 www.tanita.com

MycoTOX Profile

Tru Niagen®

Booth #7039 Mycotoxins are metabolites produced by fungi like mold, which can infest buildings, vehicles, and food. Diseases and symptoms linked to mycotoxin exposure include pneumonia-like symptoms, heart disease, rheumatic disease, asthma, sinusitis, cancer, memory loss, vision loss, chronic fatigue, skin rashes, depression, and liver damage. The MycoTOX Profile now screens for 10 different mycotoxins, all in one urine sample. It uses the power of advanced mass spectrometry (MS/MS), which is necessary to detect lower levels of these fungal toxins.

Booth #9010 We use NAD every day for basic functions like sleeping, breathing, eating, and drinking. But our NAD levels decline over time and under stress which contributes to changes in health. Tru Niagen increases your NAD, every time you take it.* TRU NIAGEN® is a unique form of vitamin B3 clinically proven to safely increase your cell’s ability to make energy, with NAD.*

Terra Biological LLC

The Great Plains Laboratory, Inc.

Tru Niagen

Ph: 858-947-5722 www.jubilancecom

Ph: 913-341-8949 www.greatplainslaboratory.com

Ph: 888-642-4361 www.truniagen.com

ANTI-AGING MEDICAL NEWS

• WINTER 2018

PRODUCT ANNOUNCEMENTS

Standard Process, Inc

MC-980Uplus Body Composition Analyzer

PRODUCT ANNOUNCEMENTS

Viome’s Gut Intelligence Test

TrueLight by TrueDark Booth #8064

Booth #9009

TrueLight™ by TrueDark®, a patentpending photobiomodulation therapy (LED) mat and pillow. These devices deliver optimal Yellow, Red, and Near-Infrared light wavelengths which can positively react with mitochondria to repair and stimulate cellular regeneration. Increased collagen production, muscle recovery, reduction in scars & wrinkles, plus reducing rosacea and skin irritation are some of the benefits TrueLight can provide. We have created these lightweight, portable tools as an affordable solution for at home use.

TrueDark

Viome

Ph: 206-227-5910 www.truedark.com

Ph: 913-636-4652 www.viome.com

INCEPTION MD Epidermal Growth Factor Stem Cell Creme

HP Mini Hand Piece Complete Set For Z Wave Pro

Booth #1040

Introducing the new Zimmer Hand Piece, HPMini, specifically designed for smaller, harder to reach areas. It works with all Z WavePro units. Ergonomic and smallerthan-standard, the HPMini allows for more focused and refined treatment. Complete set includes the HPMini hand piece, two smaller, differently shaped applicator heads (15 mm and 25 mm versus the standard 39 mm) and ten specially sized, smaller silicone caps. The HPMini is backed by Zimmer’s 2 million pulse warranty.

E.G.F. Stem Cell Crème is a powerful revitalizer that contains synergistically blended Peptides, Epidermal Growth Factors, Plant-derived Stem Cells and a pro-Vitamin Complex. This daily use Crème is formulated to stimulate keratinocyte proliferation and fortify the epidermis. **Features five bio-sourced growth factors (IGF-1, EGF, acidic FGF, basic FGF, and VEGF).

Vitelle Labs Private Label Ph: 604-279-5552

www.VitelleLab.com

Viome offers personalized recommendations based on an analysis of your unique gut microbiome all in the convenience of an app. First, we send your easy to use at-home kit to collect samples from you. Then, we analyze your samples in order to understand what nutrients and toxins are being produced by your gut organisms. Finally, we recommend which foods to enjoy and which foods to minimize to balance your gut microbiome!

Booth #4036

Zimmer Aesthetic Division Ph: 800-327-3576 http://shop.zimmerusa.com/hpmini-hand-piece-complete-set-forz-wave-pro/

ANTI-AGING MEDICAL NEWS

• WINTER 2018

BiofilmX Booth #3049 BiofilmX combines multiple fibrinolytic & mucolytic enzymes to help breakdown biofilms. * Serrapeptase - a potent mucolytic enzyme that help reduce the inhibitory effects of bacterial biofilms, enhance anti-microbial effect, and decrease chronic inflammation.

Vita Aid Professional Therapeutics Ph: 800-490-1738 www.vitaaid.com

Certification Programs Whether you are interested in a course that focuses on an advanced Certification in cardiovascular care or peptide therapies, we have developed a range of courses to meet your specific learning needs and interests. Our newer Certifications highlight the most clinically current and popular topics in modern integrative medicine, including endocrinology & hormone dosing, brain optimization, and comprehensive weight loss.

Advanced Metabolic Endocrinology Certification Designed to introduce and familiarize healthcare practitioners & professionals with key topics in endocrinology, this Certification will focus on the fundamental principles of endocrinology, hormonal therapies, and hormonal dysfunction in both men and women: including advanced topics in adrenal health, breast health, estrogen metabolism, late life hypogonadism, and prostate cancer. Module A A Metabolic Approach to Endocrinology Module B Advanced Hormonal Prescribing and Herbal Therapies for Women Module C Advanced Insulin Therapies and Hormones/Botanicals and Pregnancy Module D Menâ&#x20AC;&#x2122;s Health and Advanced Compounding for Hormonal Treatments

Weight Management Certification This Certification focuses on the factors and causes of weight gain, in addition to designated practices and protocols that can help manage weight. Participants will not only learn individualized weight management techniques, but also comprehensive weight loss strategies. Modules will additionally concentrate on the more pragmatic and practical aspects of weight loss programs, and the ways in which to effectively integrate health-centered components into practice. Module A Individualized Weight Management for the Patient

Live or Online!

Module B Comprehensive Weight Loss for the Integrative Physician Module C Weight Management Module D Brain Directed Weight Loss

561.997.0112 â&#x20AC;˘ www.a4m.com

Advanced Metabolic Cardiovascular Certification This Certification provides participants with a comprehensive review of advanced cardiology, focusing on the biological basis of cardiovascular structure and function, and diagnosis and treatment of CVD. Modules will review topics including vascular biology and disease, endothelial dysfunction, the roles of inflammation and oxidative stress, hypertension, causes of vascular aging, various testing strategies, early detection and treatment with nutrition, dyslipidemia, different cardiovascular risk factors, and more. Module A How to Apply Nutrition, Exercise and Weight Management Programs Related to Vascular Biology Module B Components of Cardiovascular Disease Module C Nutritional and Dietary Therapies for Prevention and Treatment of Cardiovascular Disease Module D Various Conditions in Cardiovascular Disease

Brain Optimization & Restoration Certification Focusing on the fundamental tenets of brain fitness and memory maintenance, initial sessions will instruct participants in different diagnosis techniques and screenings, with a review and assessment of cognitive biology, anatomy, and physiology of the brain. Later modules will discuss the spectrum of dementia disorders through the perspective of neuropsychiatry, while reviewing brain fitness therapies utilized for disease prevention, memory maintenance, cognitive function and preservation. Module A The Basics of Brain Fitness and Memory Maintenance Module B How the Brain Learns and Metabolism of the Brain Module C Dementia Disorders: A Practical Guide for Clinicians Module D Brain Fitness Therapies

Certification Requirements ▶ Completion of 4 Certification Modules

▶ Board Certification *(where applicable)

▶ Membership

The Anti-Aging Potential of Bovine Colostrum By: Mark J. Tager, M.D.

Nearly three decades ago, a study published in the New England Journal of Medicine by Rudman et al. generated a lot of interest in synthetic human growth hormone as an effective means of slowing the aging process. It offered a much-sought-after solution to those seeking a Fountain of Youth for the unwanted physical effects of advancing age. Rudman and colleagues surmised that the diminishing secretion of growth hormone (GH) and low plasma concentrations of insulin-like growth factor 1 (IGF-1) were partially responsible for decreased lean body mass, increased adipose tissue mass, and thinning of the skin that occurs with normal human aging. It was well-known at the time that changes in body composition were synonymous with aging, at least in men, for they were the gender being studied. In youth, bone comprised approximately ten percent of body weight, muscle thirty percent, and adipose tissue twenty percent but by age seventy-five, the composition was eight percent, fifteen percent, and forty percent, respectively. Of course, these percentages are likely much higher today due to the increase in obesity rates. The initial excitement over Rudman’s results was celebrated perhaps only more by the pharmaceutical industry for the enormous boost to the synthetic growth hormone market it received. Synthetic human growth hormone (hGH) had been developed in 1985 and was FDA-approved for specific uses in children and adults, yet the unapproved uses had great allure. Rudman’s later research showed that longerterm administration of hGH could induce adverse side effects, such as carpal tunnel syndrome and gynecomastia. Cessation of hGH treatment reversed the side effects within three months, but the benefits also reversed. Over time, subsequent research and clinical observation came to include additional side effects including joint and muscle pain; soft tissue edema; elevated fasting blood glucose and increased risk of diabetes; elevated cholesterol levels; and lack of improvement in functional ability., There was also concern that isolated hormone replacement therapy may promote the growth of cancerous cells. What may have initially appeared to be a Fountain of Youth was fraught with serious health risks, but for many, that was not a deterrent. Some doctors were willing to prescribe hGH for off-label uses, and hGH could be obtained easily through internet pharmacies and anti-aging clinics. There is no doubt that hGH, whether chemically synthesized or the product of recombinant DNA technology or simply

endogenous GH, can lead to the expansion of lean body mass and contraction of adipose tissue. Additional purported benefits include but are not limited to: increased stamina and energy, increased metabolism, weight loss, increased bone density, reduced sarcopenia, increased flexibility, decreased muscle and joint pain, increased skin elasticity, improved memory, more restful sleep, improved mood, improved immunity, faster wound healing, improved insulin sensitivity, and increased libido and sexual performance. All these wonderful benefits are not directly due to hGH or endogenous GH, but due to the action of IGF-1. The pituitary gland secretes GH throughout the day which travels to the liver and stimulates the liver to produce IGF-1. IGF-1 is a hormone with a similar molecular structure to that of insulin and plays a major role in cellular division and cell growth for nearly every tissue in the body, as well as promoting glucose homeostasis. IGF-1 is effectively the real growth hormone which also declines with advancing age. Therefore, a safe, legal, and all-natural source of IGF-1 without adverse side effects would truly be the Fountain of Youth hoped for by anti-aging experts and consumers. Around the time of Rudman’s research, Australian researchers identified IGF-1 and IGF-2 in bovine colostrum., Within a short few years, Australian exercise physiologists were examining bovine colostrum’s effect on elite exercise performance, finding improved stamina, increased peak anaerobic power, shorter recovery time, and less frequent symptoms of upper respiratory infections.,, The Australian’s keen interest in bovine colostrum prompted their Olympic teams to supplement athletes’ training with powdered bovine colostrum. Following a higher than anticipated number of medal wins in the 2000 Olympic Games, the International Olympic Committee (IOC) launched an inquiry into whether powdered bovine colostrum was a potentially banned substance., The IOC determined that four weeks of colostrum supplementation at 60 grams per day did not alter blood levels of IGF-1 nor did it elicit a positive drug test result. Why focus on athletic performance? Athletic performance and staying young are mediated by essentially the same physiological concepts, so by utilizing bovine colostrum on a daily basis, it may be possible to retard the aging process. Bovine colostrum contains copious amounts of IGF-1. It also contains a plethora of growth factors including colony-stimulating factor-1 (CSF-1), epidermal growth

ANTI-AGING MEDICAL NEWS

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The Anti-Aging Potential of Bovine Colostrum

factor (EGF), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), insulin-like growth factor-2 (IGF-2), insulin-like growth factor binding proteins (IGFBP), platelet-derived growth factor (PDGF), transforming growth factor-alpha (TGF-α), transforming growth factor-beta (TFG-β), tumor necrosis factor (TNF) and vascular endothelial growth factor (VEGF). The growth factors with the most significant impact for anti-aging are IGF-1,TGF-α, and TGF-β; they help repair DNA and RNA in the body’s cells, thereby stimulating cellular and tissue growth, regeneration, and repair, which extends to muscle, bone, cartilage, skin, nerve tissue, and new blood vessels. This results in faster and more complete recovery from injury, surgery, infection, and disease. Another consideration in the aging process is the relationship between intestinal hyperpermeability (“leaky gut”) and the development of autoimmune disease and/or chronic health conditions for which we have seen a significant spike in recent decades. Unabated leaking of undigested food proteins, pathogenic microbes, and toxins into the bloodstream leads to a cascade of inflammatory responses that eventually may cause chronic inflammation and associated cellular, tissue, and organ damage or destruction. Epithelial growth factor in colostrum helps maintain the tight junctions of the G.I. lining so that permeability is returned to normal. Bovine colostrum supplementation has been well documented as a natural substance for healing G.I. tissue damage caused by

NSAID use and increased permeability resulting from heavy exercise.,,, Bovine colostrum contains in excess of a hundred different bioactive components that contribute to its anti-aging, antioxidant, anti-inf lammatory, and antiinfective properties. Some have speculated that colostrum may influence anti-aging by slowing the rate of telomere degradation. To determine whether bovine colostrum could affect telomeres and promote anti-aging, an in vitro test of different concentrations of colostrum was conducted on human adult primary fibroblasts in culture. Telomeres for the colostrum groups and the control group were evaluated at weekly intervals using the Telomere Analysis Test (Life Length, Madrid, Spain) which is able to analyze individual telomere length via HT microscopy. Eight weeks of fibroblast proliferative capacity was assessed under normal culture conditions and with exposure to H202 for oxidative stress. At all concentrations, the bovine colostrum appeared to exert a protective effect on telomere length erosion. However, this protective effect was not detected as significant by the statistical analysis. Researchers hypothesized that longer times (e.g. 12 weeks) might reveal a significant protective effect under these conditions. Two concentrations of bovine colostrum did exhibit a statistically significant protective effect on telomere length erosion under oxidative stress conditions. See Figure 1.

Figure 1. Growth curves of human adult primary fibroblasts; untreated (control), treated with colostrum (0.25% and 0.125%) under standard and oxidative (10 μM H2O2) condition. Each point on the population curve represents one week. In conclusion, bovine colostrum’s unique ability to enhance health, maintain an optimally functioning body, and help heal chronic conditions gives it the power to halt the deleterious and undesirable effects we associate with human aging. It is the only natural substance to contain the anti-aging hormones in

perfect balance which replace the body’s declining production following puberty. Unlike isolated synthetic or plant-derived hormones, bovine colostrum is mammalian-created for mammals to consume. From elite athletes to those just trying to age well, bovine colostrum may hold the key to staying well longer.

ANTI-AGING MEDICAL NEWS

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The Anti-Aging Potential of Bovine Colostrum

References Rudman D, Feller AG, Nagraj HS, Gergans GA, Lalitha PY, Goldberg AF, Schlenker RA, Cohn L, Rudman IW, Mattson DE. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5;323(1):1-6. Rudman D. Growth hormone, body composition, and aging. J Am Geriatr Soc. 1985 Nov;33(11):800-7. Review. Cohn L, Feller AG, Draper MW, Rudman IW, Rudman D. Carpal tunnel syndrome and gynaecomastia during growth hormone treatment of elderly men with low circulating IGF-I concentrations. Clin Endocrinol (Oxf). 1993 Oct;39(4):417-25. Liu H, Bravata DM, Olkin I, Nayak S, Roberts B, Garber AM, Hoffman AR. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007 Jan 16;146(2):104-15. Review. Papadakis MA, Grady D, Black D, Tierney MJ, Gooding GA, Schambelan M, Grunfeld C. Growth hormone replacement in healthy older men improves body composition but not functional ability. Ann Intern Med. 1996 Apr 15;124(8):708-16. Francis GL, Read LC, Ballard FJ, Bagley CJ, Upton FM, Gravestock PM, Wallace JC. Purification and partial sequence analysis of insulin-like growth factor-1 from bovine colostrum. Biochem J. 1986 Jan 1;233(1):207-13. Francis GL, Upton FM, Ballard FJ, McNeil KA, Wallace JC. Insulin-like growth factors 1 and 2 in bovine colostrum. Sequences and biological activities compared with those of a potent truncated form. Biochem J. 1988 Apr 1;251(1):95-103. Buckley JD, Abbott MJ, Brinkworth GD, Whyte PB. Bovine colostrum supplementation during endurance running training improves recovery, but not performance. J Sci Med Sport. 2002 Jun;5(2):65-79. Brinkworth GD, Buckley JD. Effect of bovine colostrum on anaerobic exercise performance and plasma insulin-like growth factor I. Eur J Nutr. 2003 Aug;42(4):228-32. Brinkworth GD, Buckley JD. Concentrated bovine colostrum protein supplementation reduces the incidence of self-reported symptoms of upper respiratory tract infection in adult males. Eur J Nutr. 2003 Aug;42(4):228-32. Leppäluoto A, et al. Bovine colostrum supplementation enhances physical performance on maximal exercise tests. 2000 Pre-Olympic Congress Sports Medicine and Physical Education, International Congress on Sport Science, Brisbane, Australia. Buckley JD, et al. Bovine colostrum supplementation during training increases vertical jump performance. 2000 Pre-Olympic Congress, Sports Medicine and Physical Education, International Congress on Sport Science, Brisbane, Australia. Kuipers H, et al. Effects of oral bovine colostrum supplementation on serum insulin-like growth factor-I levels. Nutrition. 2002;18(7-8):165-172. Keech AM. Peptide Immunotherapy: Colostrum – A Physician’s Reference Guide. 2009. AKS Publishing. Playford RJ, Floyd DN, Macdonald CE, Calnan DP, Adenekan RO, Johnson W, Goodlad RA, Marchbank T. Bovine colostrum is a health food supplement which prevents NSAID induced gut damage. Gut. 1999; 44:653-658. Playford RJ, MacDonald CE, Calnan DP, Floyd DN, Podas T, Johnson W, Wicks AC, Bashir O, Marchbank T. Co-administration of the health food supplement, bovine colostrum, reduces the acute non-steroidal anti-inflammatory drug-induced increase in intestinal permeability. Clin Sci (Lond). 2001 Jun;100(6):627-33. Marchbank T, Davison G, Oakes JR, Ghatei MA, Patterson M, Moyer MP, Playford RJ. The nutriceutical bovine colostrum truncates the increase in gut permeability caused by heavy exercise in athletes. Am J Physiol Gastrointest Liver Physiol. 2011 Mar;300(3):G477-84. Davison G, Marchbank T, March DS, Thatcher R, Playford RJ. Zinc carnosine works with bovine colostrum in truncating heavy exercise-induced increase in gut permeability in healthy volunteers. Am J Clin Nutr. 2016 Aug;104(2):526-36. Life Length. In vitro proliferative and telomere length analysis for colostrum. July 2018.

Mark J. Tager, MD is CEO of ChangeWell Inc. (changewell.com) where he works with healthcare practitioners to help them enhance their presence in person, on camera and online. Dr. Tager is actively involved with A4M where he directs courses in practice enhancement and speaks on topics of gut and skin health. He is the author of ten books, the latest out in December, 2018 is entitled, A Practitioner’s Guide to Cash Pay Healthcare: How to Start, Grow & Perfect Your Business (with Stewart Gandolf). Mark J. Tager, MD CEO ChangeWell Inc. mtager@changewell.com Cell: 858-472-1491 Skype: drtager

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Restoring Youth, Sexual Function, & Health

Reversing functional decline via Peptide Therapy By: Anthony J. Campbell, PharmD

Introduction How many times has it been said, “With age, comes experience”? Perhaps many of those reading this have even used the phrase themselves in an attempt to make someone, or themselves, feel better about the chronological number assigned to them each passing year. I’m betting there are just as many that feel as though the “experience” they’ve gained with age has been less than satisfying and the only thing that seems to have come with age is grey hair, wrinkles, and incontinence. The truth is, while there are few things in life as persistent as aging, there have been substantial advancements in decelerating the progression of the negative effects associated with aging. Relentlessly, aging slowly chips away at one’s youthful vigor and sexual vitality, gradually deteriorating things such as lean body mass, bone density, aerobic exercise & healing capacity to name a few. However, while aging is an inescapable part of life, ever pursuing us from the moment we draw our first breath to the day we breathe our last, peptide therapies such as Modified GRF (1-29), PT-141, & BPC-157 have been used with great success to thwart the effects of aging, helping to ensure the so-called experience gained as we age is an enjoyable one. In this brief article, the discussion will focus on these newer, emerging peptides that have been studied with great

1. Restoring Youth Growth Hormone Homeostasis And The Advantage Of Modified Grf(1-29) To fully understand how a GHRH peptide such as Modified GRF (1-29) or CJC-1295 should be used, its function, and preference over rh-GH, one must first fully comprehend the physiologic nature of how endogenous GH is produced, secreted and regulated. In clinical literature, Melmed reports that GH secretion typically peaks at puberty at about 150µg/kg/day, then gradually and relentlessly decreases to approximately 25µg/kg/day by the age of 55.1 Of particular interest is the fact that while the amplitude, or strength, of recurring GH pulses throughout the day are significantly reduced in older individuals, the frequency, or number of pulses, remain nearly unchanged (Figure 1). While it has been reported in the literature that there are as many as 10

pulses of GH secretion per day, each lasting approximately 90 minutes with a separation of about 2-3 hours, the highest and most important secretory activity occurs within an hour after the onset of deep sleep.2

Figure 1 Patterns of GH secretion in younger & older women and men. There is a marked age-related decline in GH secretion in both sexes and a loss of nighttime enhancement of GH secretion see during deep sleep. This decrease is primarily due to a reduction in GH pulse amplitude, with little change in pulse frequency. L=large pulse, S=small pulse. (From Ho et al 1987)3 The release of GH subsequently stimulates the production of insulin-like growth factor-1 (IGF-1) which, in addition to GH, happens to be a potent inhibitor in the negative feed-back loop of growth hormone releasing hormone (GHRH) and subsequent GH secretion (Figure 2). Therefore, because IGF-1 production is primarily regulated by GH, the consequence of the feedback is a decrease in endogenous GH secretion via this negative feed-back loop. Due to the feedback mechanism and homeostatic nature of the pituitary, it is easy to comprehend how directly administering rh-GH (or IGF-1) to patients with low levels of endogenous GH production can all but shut down the pituitary’s existing endogenous output, making the patient reliant on exogenously administered GH rather than enhancing their own biological output. With unnatural peaks, unavoidable feedback inhibition, and troublesome adverse effects associated with rh-GH, the case strengthens for the use of GHRH peptides that promote and enhance the natural, biological secretion of GH.

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Restoring Youth, Sexual Function, & Health Reversing functional decline via Peptide Therapy

position 2 prevents cleavage of dipeptidyl amino peptidase IV (DDP-IV) thereby increasing the t ½ severalfold; Gln at position 8 which serves to reduce asparagine rearrangement or amide hydrolysis to aspartic acid; Ala in position 15 to enhance bioactivity; and Leu substituted in position 27 assists in the prevention of methionine oxidation, increasing stability. These changes make Modified GRF (1-29) especially beneficial considering, as stated above, the GH pulse can last up to 90 minutes. With the increased stability in-vivo and a prolonged t ½, there is prolonged stimulation for GH release during a normal, physiologic pulse; thereby, elevating GH and IGF-1 levels to a greater extent and with more efficiency than what is achieved with the use of Sermorelin alone.

Adverse Reactions The most frequent side effects associated with CJC-1295 with or without DAC based on clinical research in healthy adult subjects were reported to be injection site reactions which consisted of transient pain, swelling, and induration sometimes accompanied by local urticaria. Although uncommon, injection site reactions tend to be more severe/ prolonged with higher doses. Other events such as headache, diarrhea, and flushing were also observed with use.5

Suggested Dosing Of Modified Grf (1-29)

Figure 2

Regulation of the GH/IGF-1 axis. Pituitary inhibition of GH secretion results from an increase in Somatostatin as well as decreased GHRH stimulation, both of which result from increased levels of circulating IGF-1. (Mayo Communiqué March 2006)4

Modified Grf (1-29): A Physiologic Ghrh Mimetic With Prolonged Activity In the complete sequence, hGHRH is a 44-amino acid chain. However, it is recognized that biological activity is induced solely utilizing only the first 29 amino acid sequence. Modified Growth Releasing Factor 1-29, usually referred to as Modified GRF (1-29), or also known as CJC-1295 without DAC (Drug Affinity Complex) is a synthetic analog of the endogenous peptide signaling hormone GHRH. [CJC1295 with DAC extends the t ½ by several days as compared to CJC-1295 without DAC which has a t ½ of approximately 30 minutes]. Like Sermorelin (with a t ½ of only 8-12 minutes), this truncated synthetic form of GHRH also has the necessary 29 amino acid chain needed to induce the physiologic release of GH. Although Modified GRF (1-29) is identical in function to Sermorelin, it differs in structure and its potential to stimulate GH secretion; namely, in the duration of action. Modified GRF (1-29) has four substituted amino acids in its chain that serve the purposes of preventing degradation and oxidation in vivo, while also increasing binding affinity to the GHRH receptors. These substitutions create a much more stable peptide as compared to Sermorelin and increases the t ½ up to 300%, prolonging pituitary exposure during the occurrence of the normal physiologic pulse of GHRH. The substitutions are composed of d-Ala, Gln, Ala, and Leu at positions 2, 8, 15, and 27 respectively (Figure 3). The insertion of d-Ala at

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Recommended dosages are variable and dependent, in part, upon patient response, reported lab values, and goals of therapy. Although clinical studies have implemented dosages between 30 and 90 mcg/kg without the occurrence of significant adverse events, these are not dosages typically utilized in clinical practice. However, this is of importance because many of the currently employed and successful dosing protocols utilize nightly subcutaneous doses that fall between 200 to 300mcg (3 to 4 mcg/kg) giving practitioners and patients alike at least some semblance of certainty that the risk of experiencing an adverse event is quite low. A more thorough discussion on GHRH dosing strategies can be seen in a previous edition of this periodical (Spring 2017).

2. Restoring Sexual Function Prevalence Of Sexual Dysfunction In recent years, the medicinal use of pharmaceuticals for male sexual dysfunction, namely erectile dysfunction (ED), has revolved around the use of vasodilating agents such as PDE-5 inhibitors. While PDE-5 inhibitors are often effective, success rates range from as little as 40% to about 80%, depending upon the etiology and severity of ED.6 Furthermore, research has indicated that approximately 50% of men receiving prescriptions for sildenafil discontinue use over time.6 In addition to the rising cost and poor success rates, contraindications and side effects also contribute to the reasons for discontinuation. On the horizon is a new approach for the treatment of not only male sexual dysfunction, but also the rapidly growing cases of female sexual dysfunction, such as female hypoactive sexual disorder • WINTER 2018

Restoring Youth, Sexual Function, & Health Reversing functional decline via Peptide Therapy

Figure 3 Modified GRF 1-29 (CJC-1295 without DAC) (Diagram Source: peptidesciences.com)

(FHSD) and/or female sexual arousal disorder (FSAD). With nearly 150 million estimated cases of ED worldwide, and approximately 40 million reported U.S. cases of FSD, there is one peptide, PT-141 (bremelanotide), that seems poised to overtake the sexual dysfunction market by storm.

Pt-141 Peptide: A New Approach For Male And Female Sexual Dysfunction The cyclic, heptapeptide melanocortin analogue and active metabolite of Melanotan II, PT-141 has been demonstrated to be an agonist at the melanocortin receptors which are primarily found within the central nervous system. Unlike other agents used for ED inducing an effect on the vascular system, PT-141 works by activating melanocortin receptors in the brain, directly increasing sexual desire centrally via the nervous system. Recent clinical trials under commercial development for the treatment of both male and female sexual dysfunction have successfully proven efficacy in both intranasal and subcutaneous routes of administration for erectile dysfunction.7

have been shown to be approximately 15 minutes and >60% base rigidity lasting up to 40 minutes. Due to potential for unwanted side effects, it is recommended that initial doses begin with 1mg and titrate up to effect and tolerability. Common subcutaneous female dosing in research trials with proven efficacy fall between 1mg and 2mg.11 Doses less than 4mg intranasally and less than 0.3mg subcutaneously have been found to be indistinguishable from placebo and can be considered a no effect dose.8

Safety & Tolerability While much of the published clinical research centers around the response to a single-dose, the use of PT-141 can safely be administered as frequently as 2-3 times a week. The most common AEs reported in healthy subjects receiving PT141 were dose-related episodes of headache (10%), cephalic flushing (15%), nausea (25%), and vomiting (3%). The severity of AEs are often most evident after initial use and decline with subsequent dosing. Pre-medicating with an anti-emetic may be a wise approach as the incidence of severe nausea has been widely reported. There have not been reports of clinically significant changes in blood pressure, heart rate, or ECG evaluations in either male or female subjects. Priapism has not been reported with the use of PT-141 at the doses described here.6,8,9,10 While pharmaceutical compounding of PT-141 is currently an exciting and promising option for treating sexual dysfunction, it must be noted that Palatin Technologies, Inc. exclusively licensed North American rights to develop and commercialize bremelanotide to AMAG Pharmaceuticals, Inc. with anticipated completion of FDA review by early Spring 2019.

• Intranasal Administration Intranasal formulations chosen for further clinical development reveal that PT-141 is safe and erectogenic at doses as little as 7mg intranasally with a mean t ½ of 2hrs and a duration of action approximately 25 minutes and a time of onset of approximately 30 minutes (>60% base rigidity). 8 Higher intranasal doses of 20mg were found to result in significantly greater erectogenic effects with a duration of action up to 2 hours (>60% base rigidity) and 25 minutes (>80% base rigidity)8 with reports of up to 12 hours intermittently after dosing. In most studies, erectogenic onset was approximately 30 minutes (>60% base rigidity) providing some insight in regard to the timing of an intranasal dose. Premenopausal females with primary diagnoses of FSAD have also shown great benefit from a single 20mg intranasal doses of PT-141 with increases in desire, arousal, and satisfaction. While the time of sexual arousal onset was in-time with male studies, the duration of action extended up to 10 hours for some test subjects. This clinical research data in the treatment of FSD also indicated nearly 70% of women reported an increase in sexual arousal, desire and satisfaction.9 • Subcutaneous Injection Given via subcutaneous injection, lower doses between 4mg - 6mg prove to be equally effective in males with inadequate response to sildenafil.10 Mean durations of base rigidity >80%

3. Restoring Health & Healing Bpc-157 Peptide: A Peptide With A Plethora Of Possibilities The quick and efficient restoration of damaged tendons or muscle is an athlete’s dream, the elderly’s wish, and sometimes the subject of many Sci-Fi movies. With the introduction of BPC-157 – a pentadecapeptide derived from human gastric juice and widely known to promote healing of a variety of tissues including skin, muscle, bone, ligament and tendon in many animal studies – the dreams and wishes of many appear to be now obtainable outside the confines of a Sci-Fi movie. Similar to a portion of the human Body Protective Compound (BPC) amino acid sequence found in gastric juice, peptide BPC-157 is composed of a 15 amino-acid sequence known to enhance the healing of wounds in a great number of studies performed over the last dozen years. Although it does not directly affect cellular proliferation, study results have shown that it does significantly increase the survival of cells under oxidative stress and increase fibroblast migration to damaged tissue. Additionally, Chang et al clearly demonstrated that GH receptors were increased by BPC-157 – increasing in significance up to 3 days after treatment – and show that pretreatment with BPC-157 can enhance the effect of GH in a dose and time-dependent manner.12 As one of the most

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Restoring Youth, Sexual Function, & Health Reversing functional decline via Peptide Therapy

impactful studies performed, this demonstrated a different way to promote tissue healing by increasing the expression of growth hormone receptor in damaged tissue, promoting the beneficial effect of growth hormone and potentially reducing the amount of growth hormone used for such injuries. The number of treatment options and studies performed exceed what is available to discuss in this forum; however, there are dozens of scientific studies widely available for review. In brief, BPC-157 has been extensively researched and found to accelerate the healing of transected rat tendons as well as other injurious and chronic conditions such as: chemical burns, cornea injuries, gastric ulcers, and inflammatory bowel diseases such as ulcerative colitis and Crohn’s Disease.

horizon, closely monitored individuals under a physician’s direct care can immediately benefit from their availability via compounding pharmacies knowledgeable with their use and ability to provide appropriate dosage forms.

References

Common Dosing Protocol While human dosing protocols in published clinical literature are currently limited, effective daily subcutaneous doses in humans range from 200mcg to 600mcg often given in two divided doses for 30 days. Results are often spontaneous and improve over 2-4 weeks without reported adverse events or unwanted side-effects. Also known as “stable gastric pentadecapeptide” it is, as the name implies, stable in human gastric juice and therefore also effective with oral or sublingual dosing which, again doesn’t have pages of clinically published research behind it but, has been successfully used in doses of 500mcg to 1mg daily for 20 days.

2. Hersch EC, Merriam GR. Growth hormone (GH)-releasing hormone and GH secretagogues in normal aging: Fountain of Youth or Pool of Tantalus? Clin Interv Aging 2008:3(1) 122-123. 3. Ho KY, Evans WS, Blizzard RM, et al. Effects of Sex and Age on the 24-Hour Profile of Growth Hormone Secretion in Man: Importance of Endogenous Estradiol Concentrations. J Clin Endocrinol Metab 1987 Jan;64(1):51-58. 4. MAYO CLINIC Mayo Medical Laboratories Communique March 2006;31(3) Available at: http://www.mayomedicallaboratories.com/ media/articles/communique/mc2831-0306.pdf 5. Teichman S, Neale A, Lawrence B, et al. Prolonged Stimulation of Growth Hormone (GH) and Insulin-Like Growth Factor I Secretion by CJC-1295, a Long-Acting Analog of GH-Releasing Hormone, in Healthy Adults. J Clin Endocrinol Metab, March 2006, 91(3):799-805. 6. Diamond L, Earle D, Garcia W. Co-Administration of Low Doses of Intranasal PT-141, a Melanocortin Receptor Agonist, and Sildenafil to Men with Erectile Dysfunction Results in an Enhanced Erectile Response. Urology 65(4); 2005.

Discussion While the stimulation of GH with ModGRF 129 – rather than direct GH replacement – clearly has the advantage of being more akin to mirroring a physiologic approach of increasing endogenous GH pulsatility and secretion, there still remains important and unanswered questions that need resolution before conclusive statements about efficacy and benefits can be made. Defining measurable, therapeutic endpoints, measuring a reduction in frailty, and the safety of chronic, long-term therapy are a few of the clinical outcomes that have yet to be determined. Certainly, Mod GRF 1-29 has been shown to afford a place in therapy for the aging adult, but much larger and extended clinical trials will need to be completed before it takes its place among routine medicine for the aged. As the stigma surrounding sexual dysfunction declines and treatment options rise, peptides such as PT-141 are proving to be a viable option for the millions suffering from loss of libido as they age. Unknown and adverse long-term physiologic effects and potential for induced resistance with chronic use have yet to be reported; however, the recent research and the pending commercialization of PT-141 indicate it will soon takes its place at the forefront of treatment options for sexual dysfunction. For the competitive athlete, the physically active weekend-warrior and elderly alike, injuries are a known risk and nearly always expected at some point. Peptides such as BCP-157 appears to obtain great potential for accelerating healing and recovery time, promoting fibroblast migration and rapid repair of damaged tissue. With the proven efficacy and absence of adverse events and side-effects, BPC-157 is poised to become a potential standard in therapy for dozens of susceptible indications and medical conditions. Although commercialization of these peptides may one day be on the

1. Melmed S. Physiology of growth hormone In: UpToDate 2006 [online]. Accessed 13 Jan 2017. URL: http://www.utdol.com Cited by: Hersch EC, Merriam GR. Growth hormone (GH)-releasing hormone and GH secretagogues in normal aging: Fountain of Youth or Pool of Tantalus? Clin Interv Aging 2008:3(1) 121-129.

ANTI-AGING MEDICAL NEWS

7. Hellstrom W. Clinical applications of centrally acting agents in male sexual dysfunction. Intl J Impotence Research. (2008) 20, S17-S23. 8. Diamond L, Earle D, Rosen R, et al. Double-blind, placebocontrolled evaluation of the safety, pharmacokinetic properties and pharmacodynamic effects of intranasal PT-141, a melanocortin receptor agonist, in healthy males and patients with mild-to-moderate erectile dysfunction. Intl J Impotence Research. (2004) 16, 51-59. 9. Diamond L, Earle D, Heiman J, et al. An Effect on the Subjective Sexual Response in Premenopausal Women with Sexual Arousal Disorder by Bremelanotide (PT-141), a Melanocortin Receptor Agonist. J Sex Med 2006;3:628-638. 10. Rosen R, Diamond L, Earle D, et al. Evaluation of the safety, pharmacokinetics and pharmacodynamic effects of subcutaneously administered PT-141, a melanocortin receptor agonist, in healthy male subjects and in patients with an inadequate response to Viagra®. Intl J Impotence Research (2004) 16, 135-142. 11. Clayton A, Althof S, Kingsberg S, et al. Bremelanotide for female sexual dysfunctions in premenopausal women: a randomized, placebo-controlled dose-finding trial. Women’s Health 2016 (Epub ahead of print) Research Article available at: http://journals.sagepub. com/doi/pdf/10.2217/whe-2016-0018 12. Chang C, Tsai W, Hsu Y, et al. Pentadecapeptide BPC 157 Enhances the Growth Hormone Receptor Expression in Tendon Fibroblasts. Molecules 2014, 19, 19066-19077; doi:10.3390/molecules191119066

Dr. Anthony J. Campbell received his Doctor of Pharmacy degree in 2003 from the University of Florida and has since been compounding in a professional environment exclusively; primarily focused on sterile product formulation, research and development, and clinical education to practicing physicians and pharmacy students.

• WINTER 2018

MAY 3-5, 2019 Phoenix, AZ Advancing Cardiometabolic Health from East to West Taking place at a venue that provides attendees a unique opportunity to learn about the Native American culture, the resort is built and designed to be a visually & structurally authentic representation of the Gila River Indian Community's heritage and culture--and celebrates the architecture, design, and legends of the Pima (Akimel O'otham) and Maricopa (Pee Posh) tribes.

Sheraton Grand at Wild Horse Pass: Arizona’s premier Native-American owned luxury resort

Not only is the venue devoted to cultural sustainability, with tribal heritage woven into each aspect of the resort, but the conference agenda will also focus on aspects of cardiometabolic health specific to indigenous communities. Sessions will spotlight: • Recent Results from Clinical Trials • Thought-Provoking & Innovative Educational Formats • Obesity and Lifestyle Medicine Research • Dyslipidemia, Atherosclerosis, and Thrombosis • Heart Failure and Hypertension • Diabetes Management Strategies

SPERO MANSON, PHD Distinguished Professor of Public Health & Psychiatry at the Colorado School of Public Health, and one of the nation's leading authorities in regard to Indian & Native health, Dr. Manson will lecture on "Health and Diabetes in the Native American Population:" a lecture designed to connect attendees with the geographical areas culture and proximate healthcare communities.

ONSITE SPECIAL

www.cardiometabolichealth.org

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IV Therapy & Chelation Available Online!

Enroll today for our online IV Therapy & ChelationSymposium. This online offering is designed for physicians, nurse practitioners, and other medical professionals seeking to develop their knowledge of intravenous nutritional therapies. The course will focus on the fundamental basics of the practice, while expanding upon the use of vitamins, minerals, amino acids, and other unique parenteral compounds. Clinicians will gain the ability to immediately and effectively implement various IV protocols into their practices. Sessions will also include hands-on demonstrations, in addition to protocols targeted to optimize patient health and immune support, and recently added supplementary education surrounding chelation.

Learning Objectives

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Martin Gallagher MD, DC, MS

Dorothy Merritt MD

• Describe how to safely administer IV therapy and assess patient progress • Review diagnostic and evaluation testing requirements • Evaluate compatible combinations of solutions and potential complications

Paul Anderson ND

• Discuss vitamins, minerals, and amino acids, and learn how to create targeted IV therapies • Explore chelation therapy and specifics on how to remove toxic heavy metals

561.997.0112 • www.a4m.com

A Study of the Effect of Extracorporeal Shockwave Therapy (ESWT) for the Treatment of Women’s Sexual Health By: Maryann E. Prewitt, MD, Amy E. Shoultz, PhD, and Sara Martinez

ABSTRACT

To date, treatments for female sexual dysfunction have not been single-handedly successful due to its multifactorialfactorial etiologies. These etiologies include social elements, biological elements, health status, disease, certain medications, psychological factors, dissatisfaction with relationship, and disappointment with partner performance, all leading to personal distress. Historically, treatments included counseling, pharmaceuticals (bupropion, Flibanserin), and hormone therapy: systemic estrogen; vaginal estrogen; exogenous testosterone; and, thyroid therapy. Over the past decade, new research has utilized the application of laser energy to address degradation of vaginal health and structural function. CO2 laser as well as radio-frequency laser applications are very promising, with one device already receiving FDA approval. Plateletrich plasma (PRP) therapy has also been demonstrated to be effective in areas of desire, arousal, lubrication, and orgasm. Two standardized questionnaires, the Female Sexual Function Index (FSFI) and the Questionnaire for Urinary Incontinence Diagnosis (QUID), were administered prior to and after completion of Extracorporeal Shockwave Therapy (ESWT) and were used to measure the response of ESWT. Our data determined moderate increase in the FSFI and a mild but significant improvement in the QUID. Due to the limitation of our sample size, further research is warranted.

Keywords: Female sexual dysfunction; Extracorporeal Shockwave Therapy; hyposexual desire disorder; arousal disorder; orgasmic disorder; dyspareunia; incontinence; quality of life; longevity; sexual medicine

Introduction

In an era when the U.S. population is living longer than ever before, maintaining optimal sexual desire and function throughout our health span is increasingly vital. As we age, a whole host of sexual issues plague men and women—this is the case for heterosexual, homosexual, and transgender Americans. Because of this increasing longevity, novel alternatives to pharmaceutical, psychological therapeutics,

104

and surgical interventions for the treatment of sexual dysfunction have been propelled forward. For decades, clinicians and researchers have studied male sexual behavior and dysfunction, resulting in an array of therapeutic options. Comparatively little is known about successful treatment of sexual dysfunction of women. Extracorporeal Shockwave Therapy (ESWT) has been proposed as an effective non-invasive treatment option for men suffering from erectile dysfunction (ED); however, little is known about the potential of ESWT for the treatment of female sexual dysfunction. Among women, 40% experience some form of sexual dysfunction1; 33% lack interest in sex; 15% of postmenopausal women have decline in sexual desire; 75% of patients with panic disorder have sexual problems, with sexual aversion affecting 50% of these women; and, 10% of all women never attain an orgasm. Types of sexual dysfunction in women include desire disorders, such as lack of sexual desire or interest in sex; arousal disorders, such as inability to become physically aroused or excited during sexual activity; orgasm disorders, such as delay or absence of orgasm (climax), or anorgasmia, the inability to achieve orgasm; vaginal dryness; and dyspareunia. The most prevalent sexual dysfunction in woman across all ages is lack of sexual desire.1 The physiology of low sexual desire is complex and is impacted by health, illness, medications, psychological, social, and financial factors. The Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking (PRESIDE) study found that 8.9% of women 1844 years, 12.3% of women 45-64 years, and, 7.4% of women older than 65 exhibited low desire and distress, showing that distressing sexual problems peaked during middle age.2 Absence of sexual desire and lack of sexual pleasure present significant implications for women’s well-being, quality of life, and potential for longevity. Among postmenopausal women with hypoactive sexual disorder, the psychosocial manifestations are profound; these women experience greater health burdens, including more comorbid medical conditions, and are nearly twice as likely to report fatigue, depression, memory problems, back pain, and

ANTI-AGING MEDICAL NEWS

• WINTER 2018

A Study of the Effect of Extracorporeal Shockwave Therapy (ESWT) for the Treatment of Women’s Sexual Health

a lower quality of life.1 Once hyposexual issues are identified and treated, patients report significantly less psychological and emotional stress, they feel more self-confident, and experience greater overall satisfaction with life. In addition, a vibrant sexuality has been proven to boost immunity, regulate blood pressure, and improve sleep, all of these contributing to an improved quality of life In recent years, low intensity Extracorporeal Shockwave Therapy (ESWT) has emerged as a treatment option for male sexual dysfunction and decreased sensitivity and has been proposed as a potential cure for vasculogenic erectile dysfunction (ED). 3 Considering the precedent of ESWT in clinical practice, as well as its proven safety, we treated female patients who presented with varying degrees of sexual concerns, including incontinence

Methods

In what is an ongoing study, twenty females, ages 27-68, presenting with complaints associated with incontinence, hypoactive sexual arousal disorder, and female orgasmic disorders, were evaluated according to the Female Sexual Function Index (FSFI) and the Questionnaire for Urinary Incontinence Diagnosis (QUID) and treated with ESWT. The patients were volunteers from our existing practice, many of whom were aware of the success of ESWT in treatment of ED which we offer in our clinic. Volunteers received informed consent of the experimental nature of ESWT in females and received no compensation for their participation. Th is study was and is entirely self-funded; however, a shockwave generator was provided. The equipment and materials included the following: (1) ultrasound gel, (2) gloves, (3) condom, (4) drape, (5) ESWT device.

We reviewed, assessed, and evaluated the patient’s vital signs and medical history. The FSFI and the QUID were administered prior to the fi rst treatment. In lithotomy position, ultrasound gel was applied to the entire vulva and the device with C-15 Grey Tip, with condom, was glided at Bar 3.0, Dose 3000 pulses over each of the following areas: 1. Clitoris 2. Mons

83 to 75). All other participants experienced marked to moderate change, ranging from a gain of from 2-43, a mean average of 15% increase in FSFI scores. Among the nineteen who completed the study, two participants showed no change in pre- and post-procedure evaluation QUID scores, with one lost to follow-up. All other participants showed a moderate improvement in preand post-QUID scores, ranging from 1-21, a mean average of 6.42%.

Discussion

Our study is the fi rst of its kind on ESWT in female sexual medicine. Although women are typically less vocal about sexuality than are male patients, with only 14% of women having a conversation with their physician about their sexuality,4 their concerns are no less valid. Female sexual dysfunction is extremely common, as high as 40% of women experiencing it at some point in their life span, peaking in mid-life. Our data suggests that ESWT represents a safe, result-driven part of a comprehensive treatment protocol for women’s sexual health and wellness. It is clear that due to the multi-factorial causes of female sexual dysfunction, we must have a diverse portfolio of science-driven and evidence-based therapies. Furthermore, we must employ multiple modalities to address the individual components of sexual dysfunction that are unique to each individual woman as predicated on her personal health history and psycho-social events. There are some obvious limitations to our study, including the relatively small sample size, the fact that our study is ongoing, as well as its observational and subjective nature which can be influenced by the patient’s current state of mind and stage of life.

Conclusion

Preliminary findings indicate that ESWT as a treatment modality has a place in treatment therapies to enhance sexual pleasure, heighten sensitivity, improve incontinence, and in the elevation of self-esteem. We believe that physicians must actively create an environment that is safe and conducive to conversations about sexual wellness and its role in longevity in women’s health. Male patients demand attention and get solutions for sexual concerns. As providers—and realizing that many female patients are reluctant to voice concerns— we must advocate on their behalf and drive academic research to further therapeutic options that treat the diversity of etiologies of female sexual dysfunction.

3. Left Pudendal Canals – from clitoris to rectum

4. Right Pudendal Canals – from clitoris to rectum 5. Labia Majora/Minora

Results

1. Kingsberg SA, Woodward T. Female sexual dysfunction, focus on low desire. Obstet Gynecol 2015; 125: 477-486.

Twenty women presented with baseline evaluation of their FSFI and QUID scores. Nineteen completed the study, with one person lost to follow-up. Two participants showed no change in the pre- and post-procedure evaluation FSFI scores. One participant experienced an 8-point drop (from

2. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008; 112: 2, 970-8. 3. Fode M, Lowenstein L, Reisman Y. Low-intensity extracorporeal shockwave therapy in sexual medicine: a questionnaire-based assessment of knowledge, clinical practice patterns, and attitudes in sexual medicine practitioners. Sexual Med 2017; e94-e98. 4. Runels C, Melnick H, Debourbon E, Roy L. A pilot study of the effect of localized injections of autologous platelet rich plasma (PRP) for the treatment of female sexual dysfunction. J Women’s Health Care 2014; 3:4.

ANTI-AGING MEDICAL NEWS

• WINTER 2018

105

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BOSTON, MA The Cardiometabolic Event of the YearTM

ONSITE SPECIAL

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Access the Most Current Clinical Education With session topics that include recently emerging topics in cardiometabolic health, attendees will internalize current & contemporary developments in the field.

Listen to World-Renowned Faculty & Clinicians Spearheaded by illustrious and eminent experts that include clinicians, researchers, and thought leaders, the event is both planned and guided by top-tier authorities.

Socialize and Network with Peers & Colleagues Through an Exhibit Hall and planned networking opportunities, this conference enables attendees to interact with each other during events, Happy Hours, & scheduled breaks.

Discover Hands-On Practices & Protocols for Patients Given the escalating epidemic of cardiovascular disease, the conference is not only dedicated to didactic education, but also directly applicable strategies.

www.cardiometabolichealth.org

EXHIBIT FLOORPLAN Food Court & Lounge 1105

1101

2105 3104

3105 4104

4105 5104

6105 7104

7105 8104

2103 3102

3103 4102

4103

6103 7102

7103 8102

2101 3100

3101 4100

4101 5100

6101 7100

7101 8100

9104 9102 9100

5075 6074 5073 6072

1016 2014

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December 13-15, 2018

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EXHIBITOR INDEX A.C. Grace Company . . . . . . . . . . . . . . . . . . . . . . . 6036

BirdEye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3072

Access Medical Laboratories . . . . . . . . . . . . . . . . . . 1037

BrainMaster Technologies, Inc. . . . . . . . . . . . . . . . . 3061

Absolute Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . 2048

AcCELLeratedbiologics.com . . . . . . . . . . . . . . . . . . 7081

ACCUNIQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9032

AccuVein Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4096

AccuView Imaging . . . . . . . . . . . . . . . . . . . . . . . . 4064

Acella Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . 5104 ACMEDI KOREA Co., Ltd . . . . . . . . . . . . . . . . . . . . . 2101

Advice Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8048

Aerodiagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . 1052 Aesthetic Management Partners . . . . . . . . . . . . . . . 2054

Aethern Nutraceuticals, BOP USA . . . . . . . . . . . . . . . 9055

Allergan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8032 Allergy Research Group . . . . . . . . . . . . . . . . . . . . . 5065

Alletess Medical Laboratory . . . . . . . . . . . . . . . . . . 2032

Ambra BioScience . . . . . . . . . . . . . . . . . . . . . . . . . 7060

American BioSciences - ABS/Rx . . . . . . . . . . . . . . . . 1048

American Biotech Labs . . . . . . . . . . . . . . . . . . . . . 5043

American Herbal Labs & Nano Herbs Light . . . . . . . . . 4038

AnazaoHealth Corporation . . . . . . . . . . . . . . . . . . . 3085

AnteAGE MD . . . . . . . . . . . . . . . . . . . . . . . 8020 - 8021 Apeiron ZOH Inc. . . . . . . . . . . . . . . . . . . . . . . . . . 2079

Apex Energetics . . . . . . . . . . . . . . . . . . . . . . . . . . 1020 APS Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . 8047

Argentyn 23 by Natural-Immunogenics Corp. . . . . . . . 7042

ARKRAY INC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7101 ArminLabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2065

Asteria Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 4067 AtCor Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . 7062

Attix Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . 7079 AYUMETRIX LLC . . . . . . . . . . . . . . . . . . . . . . . . . 9049

Bellaire Industry / MesoPen . . . . . . . . . . . . . . . . . . 3045

Belmar Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . 4043 Berkeley Life Professional . . . . . . . . . . . . . . . . . . . 2044

BHI Rejuve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3093

Bio Essence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3063

Bio-Botanical Research . . . . . . . . . . . . . . . . . . . . . 7027 Bio-Tech Pharmacal, Inc. . . . . . . . . . . . . . . . . . . . . 3042

Bioclinic Naturals . . . . . . . . . . . . . . . . . . . . . . . . . 9025 Biogenetix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3043

BioProtein Technology . . . . . . . . . . . . . . . . . . . . . . 7045 BioSensor Laboratories, Inc. (USA office) . . . . . . . . . . 2015

Biosound Technologies . . . . . . . . . . . . . . . . . . . . . 9027

BIOSRX, Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7066

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Biotics Research Corporation . . . . . . . . . . . . . . . . . 1016

BodyLogicMD . . . . . . . . . . . . . . . . . . . . . . . . . . . 4032

Boston Heart Diagnostics . . . . . . . . . . . . . . . . . . . . 8033 BTL Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . 4062

Calmoseptine, Inc. . . . . . . . . . . . . . . . . . . . . . . . . 4078 Calroy Health Sciences - Arterosil . . . . . . . . . . . . . . . 8046 Canada RNA Biochemical Inc. . . . . . . . . . . . . . . . . . 7043

Cancer Control Society . . . . . . . . . . . . . . . . . . . . . . 1050

Canfield Scientific, Inc. . . . . . . . . . . . . . . . . . . . . . . 6048 CardioDx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3079

Cardiometabolic Health Congress . . . . . . . . . . . . . . . 8001 Cell Surgical Network . . . . . . . . . . . . . . . . . . . . . . 1030 Cellular Medicine Association . . . . . . . . . . . . . . . . . 1047 Central Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . 2027

Cerbo by MD HQ . . . . . . . . . . . . . . . . . . . . . . . . . . 9013 Chetu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3094

Chi’s Enterprise, Inc. . . . . . . . . . . . . . . . . . . . . . . . 5042

Chronobrands, Inc. . . . . . . . . . . . . . . . . . . . . . . . . 9037 Cleveland Heart Lab . . . . . . . . . . . . . . . . . . . . . . . 7054

Clinical Resolution Lab, Inc . . . . . . . . . . . . . . . . . . . 2071 CNS Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . 1036

CoachCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6057 Cognitive Clarity Inc. . . . . . . . . . . . . . . . . . . . . . . . 5070

College Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . 6038

Complete Medical Services . . . . . . . . . . . . . . . . . . . 8062 Compounded Nutrients . . . . . . . . . . . . . . . . . . . . . 3075 Cosmofrance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4101

CRE8 Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . 6061 Crystal Clear Digital Marketing . . . . . . . . . . . . . . . . 6032 CS Health, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . 9045 Curatronic Ltd. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3055 CUTERA, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3097

CV Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4061

Cypress Membership Medicine . . . . . . . . . . . . . . . . 7104 Cyrex Laboratories, LLC . . . . . . . . . . . . . . . . . . . . . 3032 DaVinci Laboratories . . . . . . . . . . . . . . . . . . . . . . . 2014 Delgado Protocol . . . . . . . . . . . . . . . . . . . . . . . . . 9041

Designs For Health . . . . . . . . . . . . . . . . . . . . . . . . 4021

DHA Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . 1087

DiagnosTechs, Inc. . . . . . . . . . . . . . . . . . . . . . . . . 8070 Diagnostic Solutions Laboratory . . . . . . . . . . . . . . . 1021 DIEM Labs, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . 8043 DNA Connexions . . . . . . . . . . . . . . . . . . . . . . . . . 3091

Doctor.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2026 Doctor’s Data, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . 2073

ANTI-AGING MEDICAL NEWS

• WINTER 2018

DoseLogix | Topi-CLICK . . . . . . . . . . . . . . . . . . . . . 3074

Innovation Compounding . . . . . . . . . . . . . . . . . . . . 7085

DR FUJI / ACIGI . . . . . . . . . . . . . . . . . . . . . . . . . . 3067

Intelligent Bioenergetics, Inc. . . . . . . . . . . . . . . . . . 7074

Douglas Laboratories . . . . . . . . . . . . . . . . . . . . . . 5013 Dp Derm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2046

Dr. Mercola- NHP LLC, . . . . . . . . . . . . . . . . . . . . . . 2036

Dunwoody Labs . . . . . . . . . . . . . . . . . . . . . . . . . . 9036

eClinic.care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5062

Eclipse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4091

Elemis Corporation . . . . . . . . . . . . . . . . . . . . . . . . 7070 Elsevier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8078

EMPATHIQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9086

Empirical Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . 4039

Empower Pharmacy . . . . . . . . . . . . . . . . . . . . . . . 4079 Endothelix Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . 2095

EndyMed Medical Inc. . . . . . . . . . . . . . . . . . . . . . . 4072

Eniva Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7073

Enzyme Science . . . . . . . . . . . . . . . . . . . . . . . . . . 2063

Erchonia Corporation . . . . . . . . . . . . . . . . . . . . . . 8026

Essential Formulas . . . . . . . . . . . . . . . . . . . . . . . . 4042

Factor Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . 1044 Fotona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3033 Freedom Practice Coaching . . . . . . . . . . . . . . . . . . . 8086

Functional Genomic Analysis . . . . . . . . . . . . . . . . . 5046

GAINSWave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6033 Genetic Direction . . . . . . . . . . . . . . . . . . . . . . . . . 2091

Genomind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9020

Genova Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . 4015 GLOBAL HEALTH LABS . . . . . . . . . . . . . . . . . . . . . 8066 Global Life Rejuvenation . . . . . . . . . . . . . . . . . . . . 7056

Great Plains Laboratory . . . . . . . . . . . . . . . . . . . . . 7039

GX Sciences, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . 3046 Hair Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9039 Hallandale Pharmacy . . . . . . . . . . . . . . . . . . . . . . 4055

Hawaiian Moon . . . . . . . . . . . . . . . . . . . . . 5048 - 7071 Healeon Medical . . . . . . . . . . . . . . . . . . . . . . . . . . 4080 Health and Beauty Connection . . . . . . . . . . . . . . . . 8084 Healthcare Success/Patient Fetch . . . . . . . . . . . . . . . 9022

HealthSnap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3064

High Tech Health . . . . . . . . . . . . . . . . . . . . . . . . . 5047

Hormone Consultants . . . . . . . . . . . . . . . . . . . . . . 8096

Hormone Therapy Centers of America . . . . . . . . . . . 4047

Hotze Elite Physicians . . . . . . . . . . . . . . . . . . . . . . 6047 IAS group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8055

ICA Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7064 Ideal Protein of America . . . . . . . . . . . . . . . . . . . . 9021 Immuno Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . 7090

Immunosciences Lab, Inc. . . . . . . . . . . . . . . . . . . . . 1034

InBody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2020 Incredible Marketing . . . . . . . . . . . . . . . . . . . . . . . 1046 Induction Therapies™, makers of Collagen P.I.N. . . . . . 9042 Innergy Development . . . . . . . . . . . . . . . . . . . . . . 7013

Integrative Therapeutics . . . . . . . . . . . . . . . . . . . . 3066

Intellectual Medicine 120/The Drip Bar . . . . . . . . . . 5072

International Peptides Society . . . . . . . . . . . . . . . . . 1029 Jigsaw Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3044 Kashi Clinical Laboratories . . . . . . . . . . . . . . . . . . . 6044 KBMO Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . 3047 Kion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3096

Klaire Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6073 KYOUI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5044 L-Nutra, Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3011 Laboratory for Advanced Medicine . . . . . . . . . . . . . . 2097 Legally Mine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6027

Leptica Research, LLC . . . . . . . . . . . . . . . . . . . . . . 9088 Life Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8036 LightStim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5036 Liquivida Lounge . . . . . . . . . . . . . . . . . . . . . . . . . 9035

Liveyon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5021

LivOn Laboratories . . . . . . . . . . . . . . . . . . . . . . . . 6067 McGuff Compounding Pharmacy Services . . . . . . . . . 4049

McGuff Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . 3100 MDware Software . . . . . . . . . . . . . . . . . . . . . . . . . 7049 Medesthetics Magazine . . . . . . . . . . . . . . . . . . . . . 9047 MEDISCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7086

Medithread LLC . . . . . . . . . . . . . . . . . . . . . . . . . . 8092 Meditime Co. Ltd . . . . . . . . . . . . . . . . . . . . . . . . . 2042

Medizap LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7072 Meridian Valley Lab . . . . . . . . . . . . . . . . . . . . . . . 8034 Merit Pharmaceutical . . . . . . . . . . . . . . . . . . . . . . 4037 Metagenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6007 Microbiome Labs . . . . . . . . . . . . . . . . . . . . . . . . . 3021 Millennium Medical Technologies . . . . . . . . . . . . . . 6060

MindBody Matrix . . . . . . . . . . . . . . . . . . . . . . . . . 4048 MitoQ Ltd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2047 Molecular Pharmagroup . . . . . . . . . . . . . . . . . . . . 7096

Mushroom Science . . . . . . . . . . . . . . . . . . . . . . . . 9046

MWC Medical Sales . . . . . . . . . . . . . . . . . . . . . . . . 4095 My Practice Connect . . . . . . . . . . . . . . . . . . . . . . . 5060 Natural Ophthalmics, Inc. . . . . . . . . . . . . . . . . . . . . 4046 Natural Partners Fullscript . . . . . . . . . . . . . . . . . . . 7084

Nature-Throid . . . . . . . . . . . . . . . . . . . . . . . . . . . 4070 Nelly De Vuyst . . . . . . . . . . . . . . . . . . . . . . . . . . . 5055 NeuroScience . . . . . . . . . . . . . . . . . . . . . . . . . . . 7095 New Voice - energyDOTs . . . . . . . . . . . . . . . . . . . . 5039

Novus Optimum . . . . . . . . . . . . . . . . . . . . . . . . . . 6042 NuMedica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6079

NuSkin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2055 Nutrafol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3036

Okyanos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5032

Olympia Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . 8027

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EXHIBITOR INDEX Omax Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5064

Specialty MED Training . . . . . . . . . . . . . . . . . . . . . 2035

OrthoMolecular Products . . . . . . . . . . . . . . . . . . . . 4026

Stellar Biomolecular Research . . . . . . . . . . . . . . . . . 4074

Ondamed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2015

Organicell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4090

Oska Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . 6071 Oxy Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4027

Oxygenetix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7091

Park Compounding, Inc. . . . . . . . . . . . . . . . . . . . . . 1035 PCCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3078 Pellecome LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . 7021

Personalized Nutrients . . . . . . . . . . . . . . . . . . . . . 3075

PhotoMed Technologies, Inc. . . . . . . . . . . . . . . . . . . 7093 Physician Compounding Alliance . . . . . . . . . . . . . . . 8038

Physicians Lab Inc. . . . . . . . . . . . . . . . . . . . . . . . . 3027

Plasma Solutions, LLC . . . . . . . . . . . . . . . . . . . . . . 6062

Power2Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 6026

Precision Analytical Inc. . . . . . . . . . . . . . . . . . . . . . 5033 Predictive Biotech . . . . . . . . . . . . . . . . . . . . . . . . 6037

Premier Research Labs . . . . . . . . . . . . . . . . . . . . . 8090

Prestige Products Direct/ TRIADAER . . . . . . . . . . . . 9051 Prevé . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3070

ProductsthatWork.GURU . . . . . . . . . . . . . . . . . . . . 1049

PROSOMA THERAPEUTICS LLC . . . . . . . . . . . . . . . . 8045 Protocols For Life Balance . . . . . . . . . . . . . . . . . . . 8037 PULS CaRoadiac Test . . . . . . . . . . . . . . . . . . . . . . . 3090

Pure Encapsulations . . . . . . . . . . . . . . . . . . . . . . . 8042

Purium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7061

Qest, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8074 Quicksilver Scientific . . . . . . . . . . . . . . . . . . . . . . . 9054

Quincy Bioscience . . . . . . . . . . . . . . . . . . . . . . . . 9044 Quten Research Institute . . . . . . . . . . . . . . . . . . . . 7075

ReadiSorb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7037 Real Ketones . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5100

Rebel Herbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2085

Refine USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1062

Regen Lab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4073

Regenerative Tissue Science, LLC . . . . . . . . . . . . . . . 8060 Rejuvenation Science . . . . . . . . . . . . . . . . . . . . . . . 3039 Researched Nutritionals . . . . . . . . . . . . . . . . . . . . . 2060

Rhein Consulting Labs . . . . . . . . . . . . . . . . . . . . . . 4045 RioRoadan Technologies . . . . . . . . . . . . . . . . . . . . 1024

Rohrer Aesthetics, LLC . . . . . . . . . . . . . . . . . . . . . . 7065 Root Of Skin™ MD by Aivita Biomedical . . . . . . . . . . . 4065 RXQ Compounding, LLC . . . . . . . . . . . . . . . . . . . . . 5063

SALT Chamber, Inc. . . . . . . . . . . . . . . . . . . . . . . . . 8080

Sciton, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3038

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Spectracell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2021 Standard Process Inc. . . . . . . . . . . . . . . . . . . . . . . 7036

Stratpharma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7097 Surgenex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4097

SYGENX, INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5096 Syneron Candela . . . . . . . . . . . . . . . . . . . . . . . . . 7100

TA Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5007 Tailor Made Compounding . . . . . . . . . . . . . . . . . . . 6021 Tanita Corporation of America . . . . . . . . . . . . . . . . . 3071 Terra Biological LLC . . . . . . . . . . . . . . . . . . . . . . . 4060

The CORE Group . . . . . . . . . . . . . . . . . . . . . . . . . 9090 THOR Photomedicine . . . . . . . . . . . . . . . . . . . . . . 6043

Tree Top Essentials . . . . . . . . . . . . . . . . . . . . . . . . 7092

Tru Niagen® . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6095 True Health Diagnostics . . . . . . . . . . . . . . . . . . . . . 3073 TrueDark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9010

U. S. JACLEAN, INC . . . . . . . . . . . . . . . . . . . 1027 - 7046 Ulta Lab Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . 3081

University Compounding Pharmacy . . . . . . . . . . . . . 6013

US Biotek Laboratories . . . . . . . . . . . . . . . . . . . . . 1032 Venus Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . 3057 vFit PLUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3095

Vibrant America . . . . . . . . . . . . . . . . . . . . . . . . . . 2039 Vielight Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9026 Viome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9009

Virtual Health Partners . . . . . . . . . . . . . . . . . . . . . 3084 Vita Aid Professional Therapeutics . . . . . . . . . . . . . . 3049

Vital Choice Wild Seafood . . . . . . . . . . . . . . . . . . . . 6064 Vitelle Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1040

Viveve, Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2033 Viviscal Professional . . . . . . . . . . . . . . . . . . . . . . . 2038 Web.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4063

WebtoMed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3060 WeightLoss MD Training . . . . . . . . . . . . . . . . . . . . 1058

Wellness Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . 8072

Wells Pharmacy Network . . . . . . . . . . . . . . . . . . . . 4007

Women’s International Pharmacy . . . . . . . . . . . . . . 9033 Y LIFT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5027 Zimmer Aesthetic Division . . . . . . . . . . . . . . . . . . . 4036 Zizion Group Inc. . . . . . . . . . . . . . . . . . . . . . . . . . 4054

ZRT Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . 7007 ZYTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1033

seca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7032 Sovereign Laboratories . . . . . . . . . . . . . . . . . . . . . 4033

ANTI-AGING MEDICAL NEWS

• WINTER 2018

EXHIBITOR LISTINGS Absolute Pharmacy • Booth #2048 16011 North Nebraska Avenue, Suite 103, Lutz, FL 33549 USA Ph: 844-338-2200 • Fax: 813-999-2701 Email: sales@absoluterx.com • Website: www.absoluterx.com Absolute Pharmacy opened in 2014 with one purpose; to supply the highest quality compounded medications available with the shortest turnaround time in the industry. Four years later we are licensed in 48 states, average an under 24-hour processing time and have a formulary with over 100 medications. Contact a pharmacy representative today at (844)338-2200 to experience the Absolute difference and have Absolute Pharmacy meet all your Anti-Aging, Weight Loss and HRT needs.

A.C. Grace Company • Booth #6036 P.O. Box 570, Big Sandy, TX 75755 USA Ph: 903-636-4368 • Fax: 903-636-4051 Email: info@acgrace.com • Website: www.acgrace.com A.C. Grace Company provides a line of Vitamin E products for whole health support and specific condition needs. UNIQUE E® branded: Mixed Tocopherols Concentrate, Annatto Tocotrienols, Natural Moisturizing Cream, Derma Cream, Omega Krill Oil and Omega E+ (for cardiovascular support) formulated in collaboration with Dr. Mark Houston, along with AquaE® - a water-soluble E, and IronUP™ - a grape flavored product for children.

AcCELLeratedbiologics.com • Booth #7081 304 Tequesta Drive, #400, Tequesta, FL 33469 USA Ph: 800-367-0844 • Fax: 561-658-0429 Email: info@accelleratedbiologics.com • Website: www.accelleratedbiologics.com

Patt

AcCELLerated Biologics is an independent medical distribution company focused on consulting and providing the physician, their staff and community with FDA cleared information and products related to Platelet Rich Plasma, Stem Cells, Bone Marrow Concentrate and other products that support the use of biologics. Confidently, we know that our science, research and data backed products produce optimal outcomes for patients. A clinician/practice has many product options to choose from for their biologic needs, but few true partners

Access Medical Laboratories • Booth #1037

ACCELLERATED B I O L O G I C S

Gradient

5151 Corporate Way, Jupiter, FL 33458 USA Ph: 866-720-8386 • Fax: 866-610-2902 Email: info@accessmedlab.com • Website: www.accessmedlab.com

Pantone 297

Pantone Medium Blue C

Fonts: Ubuntu Light Ubunutu Bold

acCELLerated biologics Design Exploration 07.31.2014 5424 Tally Green Drive | Marietta, Georgia 30068 | 770.643.6808 | newsomedesign@

Access is the nation’s premier full-service diagnostic laboratory, specializing in Anti-aging and preventative testing through blood, saliva and urine. We remain on the cutting edge of technology to ensure we provide our physicians with the most accurate results, within 24hrs.

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ACCUNIQ • Booth #9032 4616 West Howard Lane, Suite 960, Austin, TX 78728 USA Ph: 1-844-768-0815 • Fax: 512-837-2011 Email: sales@accuniqusa.com • Website: www.accuniqusa.com Selvas Healthcare is a global supplier of the ACCUNIQ brand of body composition analyzers and blood pressure monitoring systems known for accuracy and durability. The company has a long well-earned reputation for excellence in quality and innovation. The line includes our new BC-380 Body Composition Analyzer as well as BC-720 high-end model to health and fitness providers that help improve the diagnostic evaluation and treatment plans.

AccuVein Inc • Booth #4096 3243 Route 112, Building 1 Suite 2, Medford, NY 11763 USA Ph: 888-909-8888 Email: hello@accuveincom • Website: www.accuveincom AccuVein helps personalize aesthetic procedures with improved vein visualization. The AccuVein AV400, a non-contact, 9.7 oz., portable vein illumination device, provides a visual road map of a patient’s vasculature by highlighting the hemoglobin in veins. This added information allows for a more customized approach based on each patient’s unique anatomy.

Acella Pharmaceuticals • Booth #5104 1880 McFarland Parkway, Suite 110, Alpharetta, GA 30005 USA Ph: 678-697-3065 Email: info@acellpharma.com • Website: acellapharma.com Acella Pharmaceuticals, LLC is a specialty pharmaceutical company committed to innovating the healthcare field by delivering quality products at affordable prices – bringing value to our customer base while providing savings and choice to patients nationwide. Our diverse portfolio of therapeutic products helps patients with a variety of healthcare needs in the following areas: endocrinology, dermatology, Women’s health, pain management, cough and cold, and nutritional supplementation. In relation to endocrinology and thyroid health we manufacture and sell NP Thyroid – a natural desiccated porcine thyroid extract therapy, indicated for the treatment of hypothyroidism.

Acmedi Korea Co., Ltd • Booth #2101 #611, Hyundai 41 Tower, 293, Mokdong dong-ro, Yangcheon-gu, Seoul, KR11 07997 KR Ph: 82-705-200-0000 • Fax: 8-226-971-9764 Email: sales@acmedikorea.com • Website: www.acmedikorea.com ACMEDI KOREA Co., Ltd is a specialized exporting company based in Seoul, Korea. We handle all kinds of Aesthetic & Dermatological products and cosmetics for professional uses such as Hyaluronic Acid filler, CE Certified PDO Threads, HIFU, Plasma devices, and so on. ACMEDI KOREA Co., Ltd is here to be your business partner with manufacturing & distribution all over the world.

Advice Media • Booth #8048 PO Box 982064, Park City, UT 84098 USA Ph: 435-575-7470 Email: sales@advicemedia.com • Website: www.advicemedia.com What does success mean to you and your aesthetic practice? Advice Media has partnered with 1000s of aesthetic practices over our 20 years of helping doctors achieve their personal and professional success. We bring you patients through website design and digital marketing, allowing you to help more patients and achieve your own definition of success! With easy to understand marketing bundles we have options to fit any practice’s budget. Contact us today to become our next success story.

Aerodiagnostics • Booth #1052 561 Virginia Road, Suite 100, Concord, MA 01742 USA Ph: 1-617-608-3832 • Fax: 617-860-6617 Email: customerservice@aerodiagnostics.com • Website: www.aerodiagnostics.com

Walnut | 675 Brea Canyon Rd. #8, Walnut, CA 91789 | (909) 274-7700 Los Angeles | 3600 Wilshire Blvd. #1016, Los Angeles, CA 90010 | (213) 351-0001

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At Aerodiagnostics we strive to provide accurate and timely information you and your family can depend on. We empathize with the challenges you face managing symptoms related to your gastrointestinal disorder(s). Our passion drives us to minimize your time in the process of diagnosis so together with your health care provider, you can resolve your symptoms quickly and accurately. Our mission is Advancing Healthcare into info@meditimeusa.com Human Care. www.meditimeusa.com

ANTI-AGING MEDICAL NEWS

• WINTER 2018

Aesthetic Management Partners • Booth #2054 2492 Walnut Avenue, Suite 120, Tustin, CA 92780 USA Ph: 877-267-2670 Email: support@ampgrowth.net • Website: www.ampgrowth.net We believe in starting with the patient first. Then we source innovative technology to deliver the absolute best outcomes. Delivering optimum results is the key to growing your practice. When you achieve exceptional patient outcomes, your practice will thrive. Our team carefully curates a portfolio of technologies that keep your practice at the cutting-edge of science and patient demand. We focus on safety and efficacy so you can focus on excellent clinical outcomes.

Aethern Nutraceuticals, BOP USA • Booth #9055 57 West 57th Street, 4th Floor, New York, NY 10019 USA Ph: 212-937-8447 • Fax: 646-416-8001 Email: sales@aethern.com • Website: www.aethern.com BoP-USA, Inc. is a subsidiary of BiorganicPharma, S.L., a European company from Barcelona (Spain) with strong expertise in Natural Supplements. The team in Barcelona includes specialists in the fields of Nutrition, Organic Chemistry, Pharmacy, and Biotechnology, collaborating with Barcelona Polytechnic University and focused on finding optimal health solutions. We develop and make special complex formulas with nutritional supplements in liquid form, using the nest natural ingredients, offering innovative solutions that seek to meet the Personal Care, Beauty and Well-being people’s needs. After more than 3 years of market research in the United States, in October 2016 we launched a specific product under the AETHERN® brand: Advanced Skin Beauty Program

Allergan • Booth #8032 2525 Dupont Drive, Irvine, CA 92612 USA Ph: 714-246-4500 • Fax: 908-947-1087 Email: melissa.krein@allergan.com • Website: www.allergan.com Allergan’s portfolio features best-in-class facial aesthetics, body contouring, plastic surgery and regenerative medicine offerings, which includes products such as BOTOX Cosmetic®, CoolSculpting®, Natrelle® and more.

Allergy Research Group • Booth #5065 2300 North Loop Road, Alameda, CA 94502 USA Ph: 510-263-2000 • Fax: 510-263-2100 Email: info@allergyresearchgroup.com • Website: www.allergyresearchgroup.com Allergy Research Group® offers the highest quality hypoallergenic nutritional supplements, following strict cGMP. Countless allergic/sensitive customers rely on our products. ARG first-to-market products in the US include Nattokinase NSK-SD®, Melatonin, Acetyl-Glutathione, and Buffered Vitamin C. Our purpose is to help healthcare practitioners improve their patients’ quality of life with innovative, scientific products, purity of ingredients, education and outstanding service.

Alletess Medical Laboratory • Booth #2032 14 Howard Street, Rockland, MA 02370 USA Ph: 800-225-5404 • Fax: 781-871-4182 Email: alletess@foodallergy.com • Website: foodallergy.com Alletess Medical Laboratory is a world leader in allergy and immunology testing. For almost 40 years we have provided excellent service to practitioners worldwide. Our quick turn-around time, transparent pricing and unrivaled customer service make us the best choice for your food sensitivity, allergy and immunology testing needs. We are well positioned to support you, your practice and your patients. Visit our booth to find out more.

The first step... Alletess

Ambra BioScience • Booth #7060 1850 Diamond Street, Suite 101, San Marcos, CA 92078 USA Ph: 858-914-4822 • Fax: 858-436-2125 Email: marty.brown@ambrabio.com • Website: www.ambrabio.com Ambra BioScience is focused on improving your understanding of the complex relationship between nutrition, digestion and health. We use that knowledge to develop dietary supplements and medical foods that deliver meaningful improvement in human health. Ambra’s first product, Lovidia for hunger control, leverages our patented gut sensory modulation platform.

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GOT SENSITIVITIES? Visit us at Booth 2032 to learn more about our food sensitivity panels In our 40 years of testing, we’ve found these common foods are frequently problematic:

Dairy

Wheat

Eggs

Almonds

Beans

•

Food Sensitivity and Allergy

•

Candida albicans

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Mold Panels

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Customized Wellness Plans

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Inhalant Allergy

• Celiac Profile

800-225-5404

• Unexplained Fatigue Profile •

and more….

foodallergy.com

American BioSciences - ABS/Rx • Booth #1048 560 Bradley Parkway, Unit 4, Blauvelt, NY 10913 USA Ph: 888-884-7770 • Fax: 845-727-0864 Email: customerservice@abs-rx.com • Website: www.abs-rx.com American BioSciences, Inc. (ABS) and its health care professional division, ABS-Rx are dedicated to helping doctors and their patients get the most from natural medicine - with more science, better research, and better results. ABS-Rx has earned an outstanding reputation for identifying and offering natural compounds with significant health benefits. From mitochondrial rescue to hemp extracts, ABS-Rx leads the way in products that are clinically tested and can be trusted to be both safe and efficacious.

AnazaoHealth Corporation • Booth #3085 7465 West Sunset Road, Suite 1200, Las Vegas, NV 89113 USA Ph: 800-995-4363 • Fax: 800-238-8239 Email: customerservice@anazaohealth.com • Website: www.anazaohealth.com AnazaoHealth is a full service nationwide compounding pharmacy, with a 503A Compounding Pharmacy and a separate 503B FDA-Registered Outsourcing Facility. We provide patient-specific and office use preparations that are not commercially available for Addiction Detoxification & Recovery, Aesthetics, Age Management, Hair Care - TrichoConcept™, HRT, Men’s and Women’s Health, Mental Clarity and Acuity, Mesotherapy, Urology, Vitamin Injectables, Weight Management and more.

AnteAGE MD • Booth #8020 - 8021 18218 West McDermutt, Suite A1, Irvine, CA 92614 USA Ph: 949-419-4153 Email: ian@cellese.com • Website: www.anteage.com AnteAGE MD is a cosmeceutical product line harnessing the power of Bone Marrow Stem Cells. We’ve decoded the biosignal language these cells use to manage skin health at the cellular level. The right mix of these biosignals, called Growth Factors & Cytokines, can create a natural, youthful healing response at the deepest level. Research-proven, clinically-tested products include skincare, microneedling adjuncts, hair rejuvenation treatment, laser post-care, and vaginal rejuvenation solutions.

Apeiron ZOH Inc. • Booth #2079 101 Colorado Street, #3403, Austin, TX 78701 USA Ph: 828-505-8087 Email: info@apeironcenter.com • Website: www.apeironacademy.com Apeiron Academy is the educational platform for a new paradigm in human performance and potential, one that places us as the Master of our destiny and the architects of evolution. A precision, whole systems genomic and epigenetic approach to designing the human system has enormous clinical applications in the emerging field of human performance optimization. The game-changing Science of Epigenetics assists us to create personalized and precise optimization strategies by taking the reins of gene expression to adapt and thrive under modern environmental pressures. Our 120-hour online training and ongoing support allow coaches and clinicians to thrive in this new and exciting field.

Apex Energetics • Booth #1020 16592 Hale Avenue, Irvine, CA 92606 USA Ph: 800-736-4381 Email: tim@apexenergetics.com • Website: www.apexenergetics.com For over 25 years, Apex Energetics™ has served the healthcare community by sponsoring cutting-edge functional medicine education and offering an innovative portfolio of research-guided nutritional formulas. Our unique approach to nutrition involves capturing and integrating science and healthcare practitioner insights into successful performance-based health strategies for patients. At Apex Energetics, you and your patients are at the center of everything we do. TM

APS Pharmacy • Booth #8047 34911 US Highway 19 North, #600, Palm Harbor, FL 34684 USA Ph: 855-927-7633 • Fax: 727-330-7840 Email: feedback@apsmeds.com • Website: www.apsmeds.com Our mission is to support patients’ health with quality, customized medications that are safe, reliable, and affordable. APS works with our healthcare partners, physicians and patients, to accomplish this mission. APS prepares sterile and nonsterile medications “from scratch” to meet individual needs. The 11,000-square-foot APS facility is compliant with USP nonsterile, sterile, and hazardous compounding guidelines. The pharmacy is licensed to dispense prescriptions in 48 states and Puerto Rico.

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Argentyn 23 by Natural-Immunogenics Corp. • Booth #7042 7504 Pennsylvania Avenue, Sarasota, FL 34232 USA Ph: 888-328-8840 • Fax: 941-702-6101 Email: sales@n-icorp.com • Website: www.natural-immunogenics.com Made from the purest silver (99.999%) and pharmaceutical-grade water that meets USP or USP standards, Argentyn 23 Bio-Active Silver Hydrosol™ is composed of more than 98% bio-active silver ions and silver nanoclusters. With a consistent dispersion of particles as small as 0.8 nanometers, Argentyn 23 represents the ultimate refinement of the colloidal silver category and offers your patients unmatched safety*, efficacy* and purity in a professional formulation.

Arkray Inc • Booth #7101 Kyoto Laboratory Yousuien-nai, Gansuin-cho 59 Kamigyo, Kyoto, JP22 602-0008 JP Ph: 8-175-366-1397 Email: yamadah@arkray.co.jp • Website: www.arkray.co.jp/english We, ARKRAY, Inc., are a global leader of IVD equipments and reagents during the last half century. With such experience and technology in IVD field, we are proudly to present a newly developed system for detecting toxic metals in urine based on our proprietary technology as well as a small meter measures the reducing power of reducing substances in blood (vitamin C concentration).

ArminLabs • Booth #2065 Zirbelstrasse 58 persönlich ArminLabs Augsburg, DE02 86154 DE Ph: 498-218-000-0000 • Fax: 498-218-000-0000 Email: info@arminlabs.com • Website: www.arminlabs.com ArminLabs is a laboratory specialized in diagnosing infections, especially Lyme disease and coinfections. We offer diagnostic services for doctors, naturopaths and patients from allover the world. In the complexity of tick-borne and opportunistic infections, we are specialized in EliSpots, antibodies and CD57cells for several bacterial, viral, parasitic, and fungal infections. ArminLabs is accredited internationally according to DIN EN ISO 15189:2014 in the areas microbiology, immunology and virology.

Asteria Health • Booth #4067 7004 Champion Boulevard, Suite 100, Birmingham, AL 35242 USA Ph: 855-771-0505 • Fax: 844-771-0505 Email: info@asteriahealth.com • Website: www.asteriahealth.com VISIT ASTERIA HEALTH AT BOOTH #319 TO WIN AN APPLE IPAD MINI! Asteria Health is a 503B Compounding Pharmacy in Birmingham, Alabama. As an FDA Registered Outsourcing Facility, Asteria Health is a growing company that is dedicated to making a difference in the lives of patients. At the center of this mission is an evolving line of quality-driven products such as bioidentical hormone replacement pellets, intravenous nutrition, and other health and wellness products.

AtCor Medical • Booth #7062 One Pierce Place, Suite 225W, Itasca, IL 60143 USA Ph: 630-228-8871 • Fax: 815-366-5953 Email: info@atcormedical.com • Website: www.atcormedical.com AtCor Medical develops SphygmoCor, the gold standard for arterial stiffness assessment. SphygmoCor provides a fast noninvasive measurement of arterial stiffness -- a proven early marker of hypertension and heart disease. Measure your arterial stiffness during the A4M World Congress at AtCor Medical booth 7062

Attix Pharmaceuticals • Booth #7079 425 University Ave., Unit 800., Toronto, ON M5G 1T6 CA Ph: 416-594-1881 • Fax: 416-594-3737 Email: salesteam@attixpharmaceuticals.com • Website: www.attixpharmaceuticals.com Attix Pharmaceuticals is an FDA & Health Canada inspected supplier of pharmaceutical ingredients (Human & Veterinary APIs), peptides, cosmetic peptides, nutraceuticals, natural herbal extracts, and fine chemicals, as well as custom designed products produced in partnership with FDA registered, cGMP and ISO Certified manufacturers. Please download all product lists from our website (www. attixpharmaceuticals.com)

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Ayumetrix Llc • Booth #9049 17387 63rd Avenue, Lake Oswego, OR 97035 USA Ph: 503-344-1344 • Fax: 503-344-1355 Email: info@ayumetrix.com • Website: www.ayumetrix.com AYUMETRIX is a smart lab of the future founded to empower individuals to take charge of their health and wellness using innovative and convenient self-sample collection anywhere any time in their own privacy. It is a global company, which offers integrative laboratory testing services with intuitive results and actionable insights.

Bellaire Industry / MesoPen • Booth #3045 11 Heather Court, Middle Island, NY 11953 USA Ph: 631-924-2751 • Fax: 631-995-0809 Email: info@bellaireindustry.com • Website: www.bellaireindustry.com Bellaire Industry provides quality skin care equipment for medical and aesthetic professionals throughout the world. Our objective is to supply innovative devices that are effective, reliable, and user-friendly. We carry powerful microneedle and micropigmentation devices that are designed to withstand heavy usage in busy practices. Our new. machines are the radio frequency auto-injection needling system for PRP treatments and microneedling with RF function.

Belmar Pharmacy • Booth #4043 231 Violet Street, Suite 140, Golden, CO 80401 USA Ph: 800-525-9473 • Fax: 866-415-2923 Email: pharmacy@belmarpharmacy.com • Website: www.belmarpharmacy.com Belmar Pharmacy specializes in dosage forms for BHRT. What sets us apart is our unique BLA™ (Bioavailable Lymphatic Absorption) lipid matrix tablet system designed for oral HRT; our exclusive parabenfree, petroleum-free hormone cream base; true sublingual tablets; and our outstanding customer service and value. We also compound Low Dose Naltrexone, acetyl-glutathione, oxytocin, and custom amino acid and mineral blends. Belmar Select Outsourcing is our 503B Outsourcing Facility for hormone pellet implants.

Berkeley Life Professional • Booth #2044 350 North Orleans Street, Suite 900N, Chicago IL 60654 USA Ph: 773-750-7745 • Fax: 916-244-0500 Email: johnhalbert@lifes2good.com • Website: berkeleylifeprofessional.com Berkeley Life Professional functional foods and supplements deliver the bioactive nutrients found in nitrate rich, plant-based diets to enhance our bodies’ production of nitric oxide (NO). Optimal levels of NO are associated with cardiovascular health and athletic performance. Utilizing patented NO saliva test strips (berkeleytest.com) to validate bioconversion of nitrate rich foods or NO supplements. Each serving of Berkeley Life Professional delivers the same amount of dietary nitrate found in about a 5 oz. serving of spinach.

BHI Rejuve • Booth #3093 800 Montauk Highway, West Islip, NY 11795 USA Ph: 1-855-553-8500 • Fax: 631-893-3904 Email: fdesmar@mehlingorthopedics.com • Website: bhirejuve.com BHI Rejuve is a trusted leader in anti-aging sciences and rejuvenation therapies, founded by Brian Mehling, M.D. Dr. Mehling is a leader in anti-aging technologies and can be seen at any number of elite and prestigious conferences worldwide.

Bio-Botanical Research • Booth #7027 PO Box 2499, Aptos, CA 95001 USA Ph: 800-775-4140 • Fax: 831-688-1733 Email: info@biocidin.com • Website: www.biocidin.com Biocidin®, our flagship product, has been found effective in research trials and in clinical practice for over 27 years. Bio-Botanical Research serves and helps to provide health care professionals with Brd-Spectrum botanical formulations, which address G.I. Dysbiosis, Lyme, Biofilms, and Systemic Immune Challenges. For more information go to: www.biocidin.com or call: 800.775.4140.

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Bioclinic Naturals • Booth #9025 #104-3686 Bonneville Place, Burnaby, BC V3N 4T6 CA Ph: 1-844-384-7502 • Fax: 844-384-7503 Email: customercare@assurednatural.com • Website: www.bioclinicnaturals.com Natural health pioneer, Dr. Joseph Pizzorno with fellow naturopathic physician and author, Dr. Michael T. Murray collaborated with Canada’s leading functional food manufacturer to develop the ultimate professional line -- Bioclinic Naturals. Bioclinic Naturals’ commitment is to quality; pure, potent, tested and trusted products. Made in Canada, GMP, TGA (Australia) and USP certified. Call 1.877.433.9860/www. bioclinicnaturals.com.

Bio Essence • Booth #3063 620 Newport Center Drive, Suite 350, Newport Beach, CA 92660 USA Ph: 949-706-9966 Email: peter@bioessence.com • Website: www.bioesence.com Bio Essence Corporation, established in 2000, is a globally integrated health supplement provider, that offers research-intensive products, and a genuine customer experience. Our mission is to incorporate a holistic lifestyle by using natural, simple, and effective products that reflect a balanced, and sustainable diet. Since its establishment, Bio Essence Corporation has extended its reach to the Asian market in Taiwan, Hong Kong, and China as well as in the United Kingdom, and various regions internationally.

Biogenetix • Booth #3043 4750 South Santa Fe Circle, Unit 3, Englewood, CO 80110 USA Ph: 720-287-2155 • Fax: 720-287-2190 Email: support@biogeentix.com • Website: www.biogenetix.com We are proud to offer innovative, high-quality nutritional supplements that are manufactured with the highest standards of purity and safety. Biogenetix starts with a formula designed with sound research and carefully monitors every stage of production to deliver a finished product that lives up to the demands and needs of today’s health care practitioner.

BioProtein Technology • Booth #7045 14100 McCormick Drive, Tampa, FL 33626 USA Ph: 800-280-2456 Email: info@bioproteintech.com • Website: www.bioproteintech.com BioProtein Technology is a manufacturer of natural liquid supplements designed to improve sleep, balance hormones, increase libido and aid recovery. We offer a professional-only line, private labeling as well as contract manufacturing.

BioSensor Laboratories, Inc. (USA office) • Booth #2015 6601 Northwest 26th Way, Boca Raton, FL 33496 USA Ph: 713-725-8983 Email: drewwilson@biosensorlab.com • Website: www.franzskincare.com BioSensor Laboratories, Inc. is a biotechnology based company focused on current skin care treatment. We have developed the FRANZ Dual Mask System provides a novel alternative to conventional skin care treatment and is able to help users recover lost biomaterials in the skin. By using micro current, our FRANZ Dual Mask System can successfully enable key ingredients of high molecular weight such as hyaluronic acid, vitamins and peptides to be non-invasively absorbed into the deep skin. By using our product, customers save time, money, stress, and receive a boost of self-confidence.

Biosound Technologies • Booth #9027 276 Plymouth Street, Safety Harbor,FL 34695 USA Ph: 888-495-1946 • Fax: 727-400-6155 Email: sales@biosoundhealing.com • Website: www.biosoundhealing.com The Biosound Therapy System is a combination of biofeedback, music therapy, sound frequency massage, and meditation. During a session, patients experience full body low frequency vibrations, which enhance the relaxation response and reduce muscle tension and pain. Distinguish your practice and improve growth by becoming a provider of innovative healing therapy.

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Biosrx, Inc • Booth #7066

® Innovation Science Art

1300 East Bidwell Street, #105, Folsom, CA 95630 USA Ph: 800-280-9277 • Fax: 916-850-0244 Email: inquiries@biosrx.com • Website: www.biosrx.com At BIOSRX we simplify dosing to make it easy for patients to adjust their dosages. Founded by pharmacists, our products were developed in direct response to physicians’ requests. Our vaginal and transdermal applicators operate on the same dosing mechanism to reduce patient retraining and unnecessary calls from pharmacy to physician. Experience a new micro-CLICK to fine-tune your patients’ dosage to optimal wellness. Visit www.BIOSRX.com to request patient training units or accuracy studies.

Bio-Tech Pharmacal, Inc. • Booth #3042 PO Box 1927, Fayetteville, AR 72702 USA Ph: 800-345-1199 Email: customerservice@bio-tech-pharm.com • Website: www.biotechpharmacal.com Bio-Tech Pharmacal, Inc., provides premium nutrition at the cellular level. Bio-Tech was established in 1984, is a cGMP registered / FDA registered nutraceutical (dietary supplements) manufacturer specializing in innovative high quality hypoallergenic preventative healthcare products, shipped to physicians, clinics, hospitals and pharmacies worldwide. Bio-Tech Pharmacal has over 100 research affiliations including Mayo, Cleveland, Emory, Harvard, etc. Bio-Tech Pharmacal has introduced many innovative products including D3-50,000 IU available in a water soluble delivery form. Some products are Kosher/Halal certified.

Biotics Research Corporation • Booth #1016 6801 Biotics Research Drive, Rosenberg, TX 77471 USA Ph: 800-231-5777 • Fax: 281-344-0725 Email: dgarces@bioticsresearch.com • Website: www.bioticsresearch.com Biotics Research Corporation was formed in 1975 and from day one the foundation has been “Innovation and Quality.” Our goals remain unchanged - innovative ideas, carefully researched concepts, and product development with advanced analytical and manufacturing techniques to develop and produce nutritional products of superior quality and effectiveness available exclusively to healthcare professionals.

BirdEye • Booth #3072 2479 East Bayshore Road, 100, Palo Alto, CA 94303 USA Ph: 406-570-1901 Email: peter.stoilov@birdeye.com • Website: www.birdeye.com BirdEye is the new word of mouth for your practice. BirdEye is trusted by over 40,000 business. With BirdEye, your business is found by search engines — accurately and up-to-date — across all the major consumer sites Birdeye aggregates your reviews from top review sites. See what customers are saying about you, in real-time With BirdEye, your business can manage negative reviews with easy-to-use tools to address customer feedback quickly.

BodyLogicMD • Booth #4032 4850 T-Rex Avenue, Boca Raton, FL 33431 USA Ph: 561-972-9529 • Fax: 877-457-1564 Email: dastern@bodylogicmd.com • Website: www.joinbodylogicmd.com You be the doctor. We’ll handle the rest. BodyLogicMD is a turn-key solution exclusively for top-level physicians who are seeking to maximize the potential of their practice while simultaneously gaining more time with family or for pursuing educational endeavors. Join the nation’s most prestigious group of medical practitioners specializing in integrative medicine and bioidentical hormone replacement therapy and put an end to working long hard hours and falling victim to the confines of insurance-based conventional medicine.

Boston Heart Diagnostics • Booth #8033 175 Crossing Boulevard, Framingham, MA 01702 USA Ph: 508-877-8711 Email: customercare@bostonheartdx.com • Website: www.bostonheartdiagnostics.com Boston Heart Diagnostics is transforming the treatment of cardiovascular disease by providing healthcare providers and their patients with novel, personalized diagnostics and integrated customized lifestyle programs that have the power to change the way clinicians and patients communicate about disease and improve heart health. Boston Heart looks beyond the “good” and “bad” cholesterol assessment that conventional labs provide to give a more complete picture of heart health.

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JOIN.BodyLogicMD.com Make More. Work Less. You Be The Doctor—We’ll Handle The Rest.

“

BodyLogicMD embodies the essence of how I believe medicine should be practiced and provides me the necessary support to make patient care my primary focus. —Dr. Jennifer Landa Chief Medical Officer, BodyLogicMD

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Franchise Owner, BodyLogicMD of Orlando, FL

JOIN the country’s most prestigious group of medical practitioners specializing in BHRT and integrative medicine. With over 60 practitioners nationwide and 14,000+ patients, BodyLogicMD offers unparalleled service to ensure every practice is a success! Joining BodyLogicMD means you get to focus on what you do best—caring for your patients. BodyLogicMD’s professional and patient services teams will guide you through the process of buying or joining a franchise location from start to finish and continue to help you manage your business while you are a member of our network. When buying a franchise, you also have the option to contract another practitioner to help you handle patient demand as your practice grows. BodyLogicMD is a turn-key solution exclusively for top-level physicians who are seeking to maximize the potential of their practice while simultaneously gaining more time with family or for pursuing educational endeavors. ■■

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For more information, please visit JOIN.BodyLogicMD.com or contact Deborah Astern, Franchise Sales Manager, at dastern@BodyLogicMD.com or 561-972-9529 © 2018 BodyLogicMD Franchise Corp. All rights reserved. This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for information purposes only. This offering is made by prospectus only. The franchisor, BodyLogicMD Franchise Corp., is located at 4850 T-Rex Avenue, Suite 125, Boca Raton, Florida 33431, and is registered as File Number F-6930 in the state of Minnesota. BLMD-A4M-FP-AD-2018-08-14

BrainMaster Technologies, Inc. • Booth #3061 195 Willis Street, Bedford, OH 44146 USA Ph: 440-232-6000 • Fax: 440-232-7171 Email: billm@brainm.com • Website: www.brainmaster.com A single source manufacturer of Clinical EEG, QEEG and Neurofeedback systems. BrainMaster is proud to introduce the most advanced Brain Analysis and Neurofeedback Training software: BRAINAVATAR. Combining State of the Art Dry Wireless EEG Headsets and BrainAvatar has given birth to the next generation of 3D Brain projection, brain mapping (QEEG), and Database guided Neurotherapy. BrainAvatar is an essential tool in the management of cognitive decline and other brain dysregulation related issues. BrainMaster systems are proudly manufactured in the USA, have multiple FDA 510K Clearances, have been mastering brains and changing lives for 23 years.

BTL Industries • Booth #4062 362 Elm St., Marlboro, MA 01752 USA Ph: 866-285-1656 • Fax: 888-499-2502 Email: info@btlnet.com • Website: www.btlaesthetics.com/en Founded in 1993, BTL has grown to become one of the world’s major manufacturers of medical and aesthetic equipment. With over 1,500 employees located in more than 53 countries, BTL has revolutionized the way to offer the most advanced non-invasive solutions for body shaping, skin tightening & other medical aesthetic treatments, including women’s health and wellness. BTL Aesthetics’ brands include EMSCULPT, BTL Emsella, BTL Vanquish ME, BTL Exilis ULTRA, BTL Cellutone. Additional information can be found at http://bodybybtl.com.

Calmoseptine, Inc. • Booth #4078 16602 Burke Lane, Huntington Beach, CA 92647 USA Ph: 714-840-3405 • Fax: 714-840-9810 Email: Info@calmoseptine.com • Website: www.calmoseptine.com Calmoseptine® Inc. promotes Calmoseptine® Ointment for the prevention and treatment of skin irritations from moisture such as urinary and fecal incontinence. It is also effective for irritations from perspiration, wound drainage, fecal & vaginal fistulas and feeding tube site leakage. Calmoseptine® Ointment temporarily relieves discomfort and itching. Free samples at our booth!

Calroy Health Sciences - Arterosil • Booth #8046 11445 Via Linda, Scottsdale, AZ 85259 USA Ph: 800-609-6409 Email: info@calroy.com • Website: www.arterosil.com Arterosil® is a patent-pending nutraceutical that rebuilds the endothelial glycocalyx — the protective “nonstick” lining of the arteries. Preliminary results from a human pilot study indicate that Arterosil therapy results in reduction of atherosclerotic carotid plaque and a corresponding decrease in arterial stenosis, as demonstrated by reduction in lipid-rich necrotic core and increase in artery lumen size. Based on the promising initial findings a larger multicenter vulnerable plaque regression study is currently being designed.

Canada RNA Biochemical Inc. • Booth #7043 4400 Hazelbridge Way, # 680, Richmond, BC V6X 3R8 CA Ph: 604-273-2233 • Fax: 604-273-2236 Email: info@canadarna.com • Website: www.canadarna.com We specialize in niche natural medicine for practitioners: Boluoke (lumbrokinase), the most potent and best researched fibrinolytic agent hands-down; CordImmune™ (Cordyceps sinensis), the only Cordyceps on the market that tests for and declares its cordycepin content; and Corio-PSP™ (Coriolus versicolor), the best researched mushroom species for immune support. Remember to stop by our booth for a FREE coagulation health check ($85 value)!

Canada RNA Biochemical Inc.

Cancer Control Society • Booth #1050 2043 North Berendo Street, Los Angeles, CA 90027 USA Ph: 323-663-7801 • Fax: 323-663-7757 Email: cancercontrol@att.net • Website: www.cancercontrolsociety.com The Cancer Control Society is a non-profit organization whose mission is public education in the Prevention and Control of Cancer and other diseases through nutrition, tests and non-toxic therapies. It holds its Annual Cancer Convention each Labor Day Weekend consisting of 40 speakers and 60 exhibitors. Throughout the year it attends a number of events, distributing literature as well as selling books and DVD’s on alternative medicine.

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Canfield Scientific, Inc. • Booth #6048 4 Wood Hollow Road, Parsippany, NJ 07054 USA Ph: 973-434-1201 • Fax: 973-887-0784 Email: sarahjine.bien-aime@canfieldsci.com • Website: www.canfieldsci.com Canfield Scientific is the global leader in developing and distributing imaging and photographic systems for the medical and skin care industries. Used in medical and aesthetic practices, skin care and wellness centers, spas and medical spas, Canfield’s advanced photographic imaging solutions are an integral part of aesthetic consultations. Today, thousands of surgical and non-surgical consultations begin with images captured by Canfield’s powerful imaging tools, improving communications, aligning doctor-patient expectations, facilitating treatment planning, and highlighting results.

CardioDx • Booth #3079 600 Saginaw Drive, Redwood City, CA 94063 USA Ph: 650-475-2788 • Fax: 650-475-2799 Email: info@cardiodx.com • Website: www.cardiodx.com Corus CAD is the first and only commercially available blood test that can safely and conveniently help clinicians assess whether or not their patients symptoms are due to obstructive coronary artery disease. The test incorporates age, sex and gene expression into a single score corresponding to the likelihood of obstructive CAD. The Corus CAD test has been recognized by The Wall Street Journal’s Technology Innovation Awards, Gold Edison Award, and TIME’s Top 10 Medical Breakthroughs.

Cardiometabolic Health Congress • Booth #8001 1801 North Military Trail, Suite 200, Boca Raton, FL 33431 USA Ph: 877-571-4700 • Fax: 866-218-9168 Email: info@cardiometabolichealth.org • Website: www.cardiometabolichealth.org The Cardiometabolic Health Congress (CMHC) is not only an annual conference or regional meeting. CMHC provides today’s health professionals with a focused point of access—designed to assist them in staying current with newly evolving scientific technologies. Cardiometabolichealth.org allows practitioners to learn about clinical advances, while receiving education in cardiometabolic disease prevention and treatment. Through its array of communications, CMHC provides an extensive educational platform, and delivers content to a brder audience of frontline clinicians: all of whom have a shared investment in cardiometabolic health.

Cell Surgical Network • Booth #1030 73700 Dinah Shore Dr., Ste. 301, Palm Desert, CA 92211 USA Ph: 760-424-8263 • Fax: 760-464-0388 Email: campaigns@cellsurgicalnetwork.com • Website: www.stemcellrevolution.com The Cell Surgical Network is the largest international team of physicians investigating the deployment of stromal vascular fraction (SVF, loaded with adipose derived stem cells) under IRB approved protocols. CSN Affiliates rely on an online HIPAA compliant database to collect patient information and follow ups to determine the safety and efficacy of each cell surgical procedure. CSN uses this data and published the largest safety data paper to date on the IV infusion of SVF.

Cellular Medicine Association • Booth #1047 52 S SeCourtion Street, Suite A, Fairhope, AL 36532 USA Ph: 1-888-920-5311 Email: support@vampiremarketing.zendesk.com • Website: www.cellularmedicineassociation.org This group of scientists, physicians, and nurse-practitioners works to discover and become expert at the best uses of cell biology to improve health and beauty. The methods include stem cells, peptides, glycosaminoglycans, retinoic acid, platelet rich fibrin matrix, hormones, nutritional strategies, and cosmetic peels. http://vampirefacelift.com/members/workshops/

Central Drugs • Booth #2027 520 West La Habra Boulevard, La Habra, CA 90631 USA Ph: 877-447-7077 • Fax: 562-694-3869 Email: marketing@centraldrugsrx.com • Website: www.centraldrugsrx.com Central Drugs is an industry leader in the art and science of custom compounding, specializing in bioidentical hormone replacement therapy and sterile injectable medications. We offer the best in custom solutions through our state-of-the-art compounding laboratories across our pharmacy locations and outsourcing facility. With an expert team of 15 compounding pharmacists, we are dedicated to helping prescribers improve patient care and wellness across the country through our quality products, expert advice, and friendly customer service.

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BOOTH 3103

Cerbo by MD HQ • Booth #9013 5714 Southeast Powell, Suite 202, Portland, OR 97206 USA Ph: 888-315-2642 Email: sales@md-hq.com • Website: cer.bo Cerbo by MD HQ is a complete solution – EHR + Patient Portal + Practice Management – and the backbone of your thriving functional medicine practice. Enjoy flexible quick charting tools, markable charting templates, integrated supplements and inventory, tools for IV infusions and injections, white-labeled Patient Portal with custom forms, merchant services, lab integrations (including with functional labs), and MUCH more, plus incredible configuration and support. Full demo available: cer.bo/try-cerbo. Love your EHR!

Chetu • Booth #3094 10167 West Sunrise Boulevard, Suite 200, Plantation, FL 33322 USA Ph: 954-342-5676 Email: shows@chetu.com • Website: www.chetu.com

World-Class Software Solutions

Chetu provides custom software development services for the preventive and integrative medicine industry. They possesses extensive healthcare technology experience that encompasses the entire continuum of care including EHRs, e-Prescribing, health information exchange, hospital & practice management, revenue cycle management, HL7, pharmacy management, telehealth plus lab information systems. Their skilled developers program software compliant with industry regulations on meaningful use and HIPAA for secure, interoperable healthcare information technology solutions. For more information visit: https://www.chetu.com/healthcare-software-solutions.php.

Chi’s Enterprise, Inc. • Booth #5042 1435 North Brasher Street, Anaheim, CA 92807 USA Ph: 714-777-1542 • Fax: 714-777-7186 Email: postmaster@chi-health.com • Website: www.chi-health.com For over 30 years, Chi’s Enterprise has offered quality natural supplements with clearly defined mechanisms and backed by scientific studies, including MYOMIN, an aromatase reducer for lowering estradiol and increasing testosterone. It is also recommended for BHRT users. Other supplements include ANGIOSTOP for inhibiting angiogenesis and tyrosine kinases, VEGFR, EGFR, PDGFR, FGFR and IGFR and activating caspases; and OXYPOWER for reducing C-Reactive Protein/inflammation and improving the heart, lungs and energy.

Chronobrands, Inc. • Booth #9037 3960 Howard Hughes Parkway, #500, Las Vegas, NV 89169 USA Ph: 855-247-6668 • Fax: 855-660-9805 Email: info@chronobrands.com • Website: www.chronoceuticals.com

CHRONO CEUTICALS®

by Chronobrands®

Chronobrands is a medical supplement company specializing in the science of chronobiology. As the manufacturer of the Chronoceuticals supplement line, Chronobrands offers a complete line of supplements that has been scientifically formulated to provide the optimal combination of nutrients at the right time of day in an effort to provide the most beneficial outcome. All of the Chronoceuticals supplements are pharmaceutical grade and manufactured with the highest quality standards.

Cleveland Heart Lab • Booth #7054 6701 Carnegie Avenue, Cleveland, OH 44108 USA Ph: 330-285-8212 Email: komalley@clevelandheartlab.com • Website: www.clevelandheartlab.com Cleveland Heart Lab is a premier, next-generation clinical reference laboratory committed to advancing cardiovascular risk assessment through unique and novel biomarkers. CHL offers unique inflammation testing which provides additional and complementary insight into cardiovascular risk beyond cholesterol testing alone. This additional information allows for targeted treatment to reduce risk over one’s lifetime.

Clinical Resolution Lab, Inc • Booth #2071 1400 West Lambert Road, Suite C, Brea, CA 92821 USA Ph: 213-384-0500 • Fax: 213-365-0053 Email: info@clinicalresolution.com • Website: www.skincarecrl.com Clinical Resolution Laboratory, Inc. (CRL) is a US medical device manufacturer and a full service product development laboratory serving wholesalers and skin care professionals. CRL is the sole developer of the InnoPen and MTS Roller, microneedling devices that are both uniquely patented, non-ablative skin treatment tools designed for use by professionals in skin health, drug delivery and hair restoration. Proudly made in the USA, we present the highest quality and safety in all our products.

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CNS Vital Signs • Booth #1036 598 Airport Blvd., Ste. 1400, Morrisville, NC 27560 USA Ph: 888-650-6795 Email: support@cnsvs.com • Website: www.cnsvs.com CNS Vital Signs, a reimbursable in-office neurocognitive testing platform providing a noninvasive clinical procedure which can efficiently and objectively evaluate and manage neuro-psych conditions. CNS Vital Signs maintains a large normative database from ages 8 to 89 upon which clinicians obtain the age matched neurocognitive report scores. Those scores, both at the test and domain level can help determine the level of potential impairment. Reports, both immediate and historic, are available immediately in either a local or web environment.

CoachCare • Booth #6057 150 West 28th Street, Suite 502, New York, NY 10001 USA Ph: 646-847-9959 Email: madalyn@coachcare.com • Website: www.coachcare.com The award-winning CoachCare technology platform powers health clinics across a number of specialties, including weight loss, pain management and chiropractic care. A custom-branded mobile app, coach dashboard and connected devices combine in one integrated platform to improve patient care and increase clinic revenues.

Cognitive Clarity Inc. • Booth #5070 7500 212th Street Southwest, Suite 214, Edmonds, WA 98026 USA Ph: 425-678-8485 Email: dralansnow@cognitiveclarityinc.com • Website: www.perceptabrain.com Cognitive Clarity Inc. (CCI) is a Edmonds, Washington-based nutraceutical product Company that has developed breakthrough nootropics for the aging brain, cognition and memory, backed by numerous issued patents. The Company was founded by Dr. Alan Snow, CEO and Dr. Rudy Tanzi, Chief Scientific Advisor, two of the world’s leading researchers in the brain aging and memory fields. Percepta® is the world’s first nootropic to target the real reason we lose memory as we age -brain “plaques and tangles”. Percepta Sport is NSF Sport Certified and provides natural plant-based memory support for athletes. Percepta Professional is specifically designed for physicians and healthcare companies.

College Pharmacy • Booth #6038 3505 Austin Bluffs Parkway, Suite101, Colorado Springs, CO 80918 USA Ph: 800-888-9358 • Fax: 888-556-5893 Email: info@collegepharmacy.com • Website: www.collegepharmacy.com Knowledge Changes Everything : Quality. Innovation. Experience. Since 1974. Our compounding process, attention to detail, and quality of the compounding components continues to make our formulations exceptional. Our expertise includes: BHRT (Expanded Pellet Implant Selection), Specialty Injectables, IV Protocols, Chelation, Environmental Medicine, Addiction Medicine, and more. College Pharmacy’s state-of-the-art USP 795 & 797 compliant facility and ISO 8 compounding lab enables us to produce the highest quality sterile formulations.

Complete Medical Services • Booth #8062 105 Peyerk Court, Romeo, MI 48065 USA Ph: 586-532-1142 • Fax: 586-261-5105 Email: sverellen@completemedicalservices.com • Website: www.completemedicalservices.com Complete Medical Services has 22 years of experience working with Physician Offices and have the expertise to help you build your cash practice through patient health and wellness. We offer unique solutions with medical devices and products that will help patients achieve total body transformation and optimal health with a strong Return on Investment to your practice.

Compounded Nutrients • Booth #3075 68994 North Pine Street, PO Box 2436 Sisters, OR 97759 USA Ph: 541-549-1951 Email: info@compoundednutrients.com • Website: www.compoundednutrients.com Compounded Nutrients gives healthcare professionals the freedom to formulate their own high quality custom formulas, order them in as little as 24 bottle batch sizes, and have them ship in 1/3rd the average industry timeframe. Our unique Mass Customization Manufacturing Model makes it possible to consolidate nutritional protocols into one bottle by cutting down on overlap and pinpointing specific daily dosages. This results in significantly lower serving size requirements for patients, exclusive brand building opportunities, and overall better inventory management of fresh custom formulas for the practitioner.

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Freedom to Formulate in Reasonable Quantities.

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Cosmofrance • Booth #4101 1444 Biscayne Boulevard, Suite 218, Miami, FL 33132 USA Ph: 305-538-0110 • Fax: 305-675-2642 Email: office@cosmofrance.net • Website: www.cosmofrance.net CosmoFrance Inc., established in 1997, specializes in the distribution of non-invasive aesthetic medical devices. Our DermaSculpt blunt-tipped microcannulas are revolutionizing dermal fillers injections. Other devices include Microneedling and PRF disposable kits.

COS MO FR ANCE

CRE8 Pharmacy • Booth #6061 3700 Northwest 126th Avenue, Coral Springs, FL 33065 USA Ph: 754-529-8353 • Fax: 754-529-8294 Email: communications@cre8pharmacy.com • Website: www.cre8pharmacy.com CRE8 Pharmacy offers compounding services for personalized medicine and patient-specific prescriptions. We are a team, working at creating perfect formulations, dispensing orders reliably and resolvin issues promptly. Our line of natural supplements, CRE8 Vitality Nutrition, is designed to support well-being and promote digestive health. Everything a patient needs is shipped in one simple order: - Sterile & non-sterile compounds/ - Nutritional supplementation/ - Generic & Brand medications. Welcome to the future of compounding pharmacy.

PHARMACY

Crystal Clear Digital Marketing • Booth #6032 5750 Major Boulevard, Suite 500, Orlando, FL 32819 USA Ph: 407-793-9254 • Fax: 407-793-9254 Email: aneff@crystalcleardm.com • Website: www.crystalcleardm.com Crystal Clear is the industry leader in providing world-class software, marketing and consulting solutions for the modern medical aesthetic practice.

CS Health, LLC • Booth #9045 1402 West Main Street, Suite 5, Louisville, KY 40203 USA Ph: 502-583-4402 Ex130 Email: dsmith@caudillseed.com • Website: www.cs-health.com CS Health is a subsidiary of Caudill Seed LLC, Louisville KY who has developed a processed PVP Broccoli Seed to supply a Dietary Supplement, enzyme activated, to provide Liver Detox, Anti-Oxidant, Immune System Support, Brain Function, Digestive Health, Joint/Artery Health, Post Exercise recovery, and assist with appearance and will also lower oxidative stress.

, LL

Curatronic Ltd. • Booth #3055 101 Hebron Road, Jerusalem, 9348001 Israel Ph: 119-723-000-0000 • Fax: 119-723-000-0000 Email: info@curatronic.com • Website: www.curatronic.com Curatronic Ltd. is a leading innovator and manufacturer of PEMF [Pulsed Electro-Magnetic Field] therapy devices for a range of diseases, wellness and anti-aging. Tens of millions Curatron PEMF therapy sessions have successfully been done in more than 90 countries around the world. Curatronic has established itself as a supplier of very high quality and super reliable PEMF systems. R&D and manufacturing takes place in Israel, where many high-tech innovations originate.

Cutera, Inc. • Booth #3097 3240 Bayshore Boulevard, Brisbane, CA 94005 USA Ph: 415-657-5500 Email: info@cutera.com • Website: www.cutera.com CUTERA® is a leading provider of laser and other energy-based systems for practitioners worldwide. CUTERA’s premium portfolio of products include Secret™ RF, Juliet™,xeo®, truSculpt® 3D, excel V™, excel HR™ and enlighten™, the industry’s first picosecond + nanosecond dual wavelength laser system.

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THRIVE YOUR WORLD IN

AFTER

Committed to delivering the most trusted hyperbaric chambers in the world.

BREATHING IN OURS

VISIT US AND TAKE A DIVE! www.oxyhealth.com

CV Sciences • Booth #4061 10070 Barnes Canyon Road, Suite 100, San Diego, CA 92121 USA Ph: 855-758-7223 • Fax: 619-546-7201 Email: wholesale@cvsciences.com • Website: www.cvsciences.com CV Sciences, Inc. is in the business of developing, producing, marketing and selling raw materials and endconsumer hemp extracts containing cannabidiol (CBD). We primarily focus on developing consumer products under our own PlusCBD Oil™ brand, and sell to numerous markets including the nutraceutical, beauty care, and functional food sectors. We are committed to pioneering the emerging global trend to re-energize the production of agricultural hemp as the world’s leading producer of quality full spectrum hemp extracts.

Cypress Membership Medicine • Booth #7104 501 Corporate Centre Drive, Suite 250, Franklin, TN 37067 USA Ph: 855-493-7477 • Fax: 615-432-2603 Email: jrobinson@yourcypress.com • Website: www.yourcypress.com Cypress Membership Medicine is based in Nashville, Tennessee, and specializes in providing direction and support for physicians who have a desire to convert their traditional practice to membership medicine. Although Cypress does not own or directly manage physician practices, we provide direction, oversight, regulatory support and control, on-going legal review, tools and methods necessary for a physician to provide a positive experience for each patient encounter.

Cyrex Laboratories, LLC • Booth #3032 2602 South 24 Street, Phoenix, AZ 85034 USA Ph: 657-303-3898 Email: michelle.c@cyrexlabs.com • Website: www.joincyrex.com Cyrex® is a clinical immunology laboratory specializing in functional immunology and autoimmunity. Cyrex offers multi-tissue antibody testing, and assessments of predictive antibodies to a variety of key antigens, for the early detection and monitoring of today’s complex autoimmune conditions. Through continuous collaboration with leading experts in medical research and clinical practice, Cyrex develops innovative arrays that address the cross-connections between the body’s immune, gastrointestinal and neurological systems.

DaVinci Laboratories • Booth #2014 929 Harvest Lane, Williston, VT 05495 USA Ph: 802-878-5508 • Fax: 802-878-0549 Email: bkanya@foodsciencecorp.com • Website: www.davincilabs.com For over 45 years, DaVinci® Laboratories has been a leader in nutritional research, product development and innovation from our home state of Vermont. Our dedication to higher integrity, and insistence on superior quality are a reflection of Vermont values. We are a family-owned and managed company and are always willing to assist you in any way possible on matters relating to nutrition. Every day, DaVinci® continues to set new standards for quality and product innovation so we can keep you as healthy and informed as possible.

Delgado Protocol • Booth #9041 711 West 17th Street, H6, Costa Mesa, CA 92627 USA Ph: 866-319-0566 • Fax: 949-666-5134 Email: agedoc2004@yahoo.com • Website: www.delgadoprotocol.com Learn about the prevention through nutrition & alternative therapies, and hormone balance.

Designs For health • Booth #4021 980 South Street, Suffield, CT 06078 USA Ph: 860-623-6314 • Fax: 206-333-0408 Email: info@designsforhealth.com • Website: www.designsforhealth.com Our Company Since 1989, Designs for Health has been the health care professional’s trusted source for research-backed nutritional products of superior quality. By providing comprehensive support through our extensive product line, ongoing clinical education, and practice development programs, we are able to maximize the potential for successful health outcomes. Our wide array of added-value services not only set us apart, but indicate the depth of our commitment to you.

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DHA Laboratory • Booth #1087 411 East Business Center Drive, Suite 107, Mount Prospect, IL 60056 USA Ph: 847-222-9546 • Fax: 847-222-9547 Email: Info@dhalab.com • Website: www.dhalab.com DHA Laboratory is a third generation, family owned and operated laboratory performing unique biochemical and nutrient based blood, urine, and hair testing. Located in Mount Prospect Illinois, DHA was founded by Ellen Hanson in 2003 to support the treatment model of the original Pfeiffer Treatment Center. Ellen started work to validate the kryptopyrrole quantitative urine procedure in the late 1970’s, and has since worked with the top clinicians worldwide to provide reliable biochemical assays. This procedure has been used in research and treatment of over 50,000 patients with conditions ranging from autism, to AD(H)D, to other behavioral and emotional conditions.

DiagnosTechs, Inc. • Booth #8070 19110 66th Avenue South, Building G, Kent, WA 98032 USA Ph: 1-800-878-3787 • Fax: 425-251-0637 Email: diagnos@diagnostechs.com • Website: www.diagnostechs.com C L I N I C A L & R E S E A R C H L A B O R AT O R Y

Established in 1987, DiagnosTechs is a leading international salivary and noninvasive clinical and research laboratory. DiagnosTechs was the first laboratory to introduce saliva cortisol testing into routine clinical practice, creating a powerful tool for evaluating stress and adrenal function. DiagnosTechs has since added saliva and stool based panels to include gastrointestinal health assessment, sex hormone measurement, and food sensitivity testing. DiagnosTechs continues to research new tests and panels with meaningful clinical applications.

Diagnostic Solutions Laboratory • Booth #1021 31 Lupi Court, Suite 250, Palm Coast, FL 32137 USA Ph: 877-485-5336 Email: cs@diagnosticsolutionslab.com • Website: www.diagnosticsolutionslab.com Since the introduction of the GI-MAP™ (GI Microbial Assay Plus) in 2015, Diagnostic Solutions Laboratory has established itself as the leader in quantitative PCR GI testing. With a commitment to research, and by using the latest in qPCR technology, we have experienced unparalleled growth while providing our practitioners with the most sensitive, specific and diagnostically relevant GI stool testing results available.

DIEM Labs, LLC • Booth #8043 221 Dino Drive, Suite A, Ann Arbor, MI 48103 USA Ph: 1-800-971-3721 • Fax: 307-316-0328 Email: jcurrie@diemlabsllc.com • Website: www.adiposano.com DIEM Labs, LLC / Hepaxa & Adiposano DIEM Labs is dedicated to excellent product quality and proven clinical benefits for managing the metabolic needs of your patients. Our medical food products go BEYOND DIET and EXERCISE to address key underlying dietary-based deficiencies not met through diet alone. Hepaxa is indicated for early stage NAFLD/ steatosis. Adiposano is indicated for modulation of excess white adipose tissue (eWATS). Adiposano reduces inflammation and relives OA knee pain.

DNA Connexions • Booth #3091 4685 Centennial Boulevard, Colorado Springs, CO 80919 USA Ph: 888-843-5832 Email: info@dnaconnexions.com • Website: www.dnaconnexions.com DNA Connexions is a CLIA certified, biosafety level 2 laboratory specializing in the detection of microbial DNA found in the oral environment and urine. Polymerase Chain Reaction (PCR) technology, with its high specificity and sensitivity, is the cornerstone of our testing methodology. We offer the following tests: Lyme panel, Oral panel, ApoE Genotyping, and Gluten intolerance. Our sister company, Biocomp Laboratories, offers biocompatibility testing for dental material reactivity.

Doctor.com • Booth #2026 85 5th Avenue, Floor 7, New York, NY 10003 USA Ph: 646-798-8200 Email: info@corp.doctor.com • Website: www.doctor.com Doctor.com is the only complete platform built to help healthcare organizations deliver a better customer experience at every step of the patient journey. The company’s industry-leading technology seamlessly integrates provider data warehousing, web-wide listings management, reputation insights, universal online scheduling, and patient communications. All of these services are enhanced by Doctor.com’s 50+ integrations with the most prominent healthcare directories, search engines, social media platforms, and EHR/PM systems.

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Doctor’s Data, Inc. • Booth #2073 3755 Illinois Avenue, Saint Charles, IL 60174 USA Ph: 630-377-8139 • Fax: 630-587-7860 Email: info@doctorsdata.com • Website: www.doctorsdata.com Doctor’s Data, Inc. has provided innovative specialty testing to healthcare practitioners around the world from our advanced, CLIA-licensed clinical laboratory since 1972. A specialist and pioneer in essential and toxic elemental testing, the laboratory provides a wide array of functional testing to aid in decision making and better patient outcomes. Choose DDI to help you assess and treat heavy metal burden, nutritional deficiencies, gastrointestinal function, hormone status, cardiovascular risk, liver and metabolic abnormalities, and more.

FUNCTIONAL TESTING EXPERTS

DoseLogix | Topi-CLICK • Booth #3074 300 Parkbrooke Place, Suite 140, Woodstock, GA 30189 USA Ph: 877-870-8448 • Fax: 678-623-5975 Email: info@doselogix.com • Website: www.doselogix.com Topi-CLICK® by DoseLogix provides patients automated, metered topical dosing applicators that are accurate, innovative and easy-to-use; which is the focus of every product design including the NEW Topi-CLICK® Micro™ and the Perl™ Vaginal Dosing Method. Stop by booth 3074 for your FREE sample kit or request one at http://doselogix.com/samples. We’ll also provide a copy of the ARL PEER Reviewed Accuracy Study proving Topi-CLICK® is the most accurate topical dosing dispenser among those tested. Visit http://www.doselogix.com for product and ordering information.

DoseLogix

Douglas Laboratories • Booth #5013 112 Technology Drive, Pittsburgh, PA 15275 USA Ph: 800-245-4440 • Fax: 888-245-4440 Email: dlcusservice@atrium-innovations.com • Website: www.douglaslabs.com Douglas Laboratories® researches, develops and manufactures science-based, healthy aging supplements and provides customized practice support. With a 60-year heritage of innovating and designing products to meet the needs of healthcare professionals, we push the potential of both clinical practices and patients to continually perform at their personal best. Douglas Laboratories is GMP and NSF International registered, and is approved to produce NSF Certified for Sport® products.†

Dp Derm • Booth #2046 14651 Biscayne Boulevard, Suite 259, North Miami, FL 33181 USA Ph: 305-552-0550 Email: info@dpderm.com • Website: www.dpderm.com Dp Derm LLC is the n. American distributor of Dp Dermaceuticals – the only true protocol based product range designed for microneedling. This compliments our 3rd generation device – the 3MD, the worlds No. 1 microneedling pen. Soon we will release the 4MD – the only 4th generation device of its kind on the market. Other devices include an aesthetic skin lesion removal device: Dp Cryo and a Non-Laser Tattoo removal system: Dp Tattoff.

DR FUJI / ACIGI • Booth #3067 4399 Ingot Street, Fremont, CA 94538 USA Ph: 510-651-9088 • Fax: 510-651-6188 Email: marketing@drfuji.com • Website: www.fujichair.com Dr. Fuji Cyber-Relax Health & Wellness massage equipment, is the fruit of further evolution of intelligent pneumatic and mechanical milt-technology designed to partner with medical and health professionals in their clinical stress managements.

Dr. Mercola- NHP LLC, • Booth #2036 125 Southwest 3rd Place, Suite 205, Cape Coral, FL 33991 USA Ph: 813-433-2526 Email: wholesale@mercola.com • Website: www.mercola.com Dr. Mercola, providing quality nutritional supplements to licensed physicians worldwide.

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Dunwoody Labs • Booth #9036 9 Dunwoody Park, Suite 121, Dunwoody, GA 30338 USA Ph: 678-736-6374 • Fax: 770-674-1701 Email: info@dunwoodylabs.com • Website: www.dunwoodylabs.com Dunwoody Labs is an innovator of testing solutions that assist in the diagnosis and management of conditions commonly addressed by integrative medicine. Our unique profiles are designed to help practitioners address comprehensive approaches to patient care. We also offer educational programs to empower practitioners and patients.

Dutch Test by Precision Analytical Inc. • Booth #5033 3138 Northeast Rivergate Street, Suite 301C, McMinnville, OR 97128 USA Ph: 503-687-2050 • Fax: 503-687-2052 Email: info@dutchtest.com • Website: www.dutchtest.com Precision Analytical is committed to improving wellness by providing important insight into hormones and their function. Precision’s state-of-the-art innovation in testing uses the acronym DUTCH (Dried Urine Test for Comprehensive Hormones). The DUTCH Test™ quickly caught the attention of functional and integrative medicine influencers like Christiane n.rup, MD and Joseph Mercola, MD, and has become the world leader in hormone testing as their method is the most comprehensive informationally and offers the easiest sample collection.

Eclipse • Booth #4091 5916 Stone Creek Drive, Suite 120, The Colony, TX 75056 USA Ph: 800-759-6876 Email: sales@eclipsemed.com • Website: www.eclipsemed.com Eclipse leads the market in innovation and is known for its portfolio of professional products such as their top-selling Eclipse PRP®. Additional offerings include: the eVIVE, Pulse wave therapy device; Eclipse MicroPen®, micro-needling device; Theradome®, laser hair helmet; PowerMask, single use micro-current face mask among others.

Elemis Corporation • Booth #7070 4010 Technology Way, Suite A, Carson City, NV 89706 USA Ph: 775-297-4778 • Fax: 775-297-4776 Email: sales@elemiscorp.com • Website: www.elemiscorp.com

Rejuvenation Advanced

Elemis Corporation is a market leader and cutting-edge biomedical device company specializing in superior disposable trocar kits and devices. FDA Registered, ISO Compliant, US Engineered and American Made products. Our innovation focuses on providing both physician precision instrumentation while delivering patient procedural comfort. Elemis offers product solutions that carry across various customer verticals including national BHRT training programs, compounding pharmacies and straight to practioners. See us to elevate your practice and experience firsthand the Elemis Edge…Quality, Usability, and Exceptional Service.

Elsevier • Booth #8078 1600 John F Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103 USA Ph: 215-239-3900 Email: csexhibits@elsevier.com • Website: www.elsevierhealth.com Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, and deliver better care.

EMPATHIQ • Booth #9086 9707 Waples Street, #102, San Diego, CA 92121 USA Ph: 866-407-6020 Email: info@empathiq.io • Website: www.empathiq.io EMPATHIQ provides review management and patient experience software for health providers. We help health providers monitor, understand, and optimize reviews across 70+ review sites. We help providers collect more positive reviews from patients and make use of review insights to understand and make better decisions about patient experience.

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Empirical Labs • Booth #4039 1501 Academy Court, #5, Fort Collins, CO 80524 USA Ph: 970-232-3951 • Fax: 907-232-3955 Email: info@empirical-labs.com • Website: www.empirical-labs.com 29 years strong! Empirical Labs is the preferred natural liposome company. Our technology, designed to improve nutrient bioavailability, is backed by real studies and vast experience. We offer low private label and customer formulation minimums. We stock liposomal: Multivitamins, CoQ10, Curcumin/Resveratrol, Glutathione (GSH), vitamin C, B12/MTHF, and Algae DHA. We make many more unique liposome formulations for customers—we can combine both oil and water soluble ingredients in a single formula! We are also a USDA organic contract manufacturer strong in capsules, powders and liquids.

Empower Pharmacy • Booth #4079 5980 West Sam Houston Parkway. N, Ste 300, Houston, TX 77041 USA Ph: 832-678-4417 • Fax: 832-678-4419 Email: intake@empower.pharmacy • Website: www.empower.pharmacy Empower Pharmacy is a FDA Registered 503B outsourcing facility and compounding pharmacy. With state-of-the-art facilities that tout the latest cGMP equipment, cleanrooms, environmental controls, and professional staff we are proud to be a leader in the compounding pharmacy industry. We specialize in Weight Management, Anti-Aging, IV Therapy, and Hormone Replacement Therapy.

Endothelix Inc • Booth #2095 3000 El Camino Real, Building 4 Suite 200, Palo Alto, CA 943062100 USA Ph: 650-263-7636 • Fax: 650-425-3383 Email: contact@endothelix.com • Website: www.endothelix.com Join leading physicians and KOLs, go Beyond Blood Pressure®, and bring Endothelial Function monitoring to your clinic. Endothelix’s VENDYS-II combines BP and EF monitoring in one easy-to-use, fully-automated office-based test that is FDA cleared and CMS reimbursed. Any office staff can operate a VENDYS-II machine and the report is patient-friendly. VENDYS-II is available to purchase or rent. Request a live demo or a quote at www.endothelix.com or contact peggy.cosner@endothelix.com 650-263-7636

EndyMed Medical Inc. • Booth #4072 790 Madison Avenue, Suite 402, New York, NY 10065 USA Ph: 212-772-0077 • Fax: 212-772-0077 Email: info@endymed.com • Website: www.endymed.com NDYMED offers energy based medical aesthetic treatment systems for both the professional and consumer markets. ENDYMED’s proprietary, FDA cleared 3DEEP radiofrequency technology is a clinically proven, effective solution for wrinkle treatment, skin tightening, body contouring and acne scar treatment. ENDYMED’s unique, patented 3DEEP technology delivers RF energy 3 layers deep into the skin, without any pain or risk, reactivating the natural collagen production to remove wrinkles and noticeably life and tighten skin.

Eniva Health • Booth #7073 2700 Campus Drive, Minneapolis, MN 55441 USA Ph: 260-615-8057 • Fax: 866-226-7443 Email: rswedzinsk@aol.com • Website: www.ehqrpo.com DETOXIFICATION SPECIALISTS. 7 Day Non-Fasting Total Body Detox. No GMO’s, gluten free, no dairy, vegetarian friendly, non-pasteurized and non-irradiated. Gentle, safe, effective and affordable ($79.40/kit). Average person will lose 10 pounds of unwanted sludge and toxins in 7 day program.

Enzyme Science • Booth #2063 771 Commerce Drive, Venice, FL 34292 USA Ph: 941-505-5565 Email: bdattani@enzyscience.com • Website: www.enzyscience.com Enzyme Science™ is an exclusive brand of formulas for natural digestive health and wellness, designed specifically for healthcare practitioners. Providing unique enzyme blends and formulated with vital nutraceuticals, these products support various health functions including cardiovascular, immune, and joint support.* This is the professional division of the #1 selling retail enzyme brand and clear leader in digestive and therapeutic supplemental enzymes for over 18 years. Enzyme Science™ utilizes proven technology for blending multiple strains of enzymes, shown to be far superior in potency over competing brands.

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Erchonia Corporation • Booth #8026 650 Atlantis Road, Melbourne, FL 32904 USA Ph: 888-242-0571 • Fax: 888-242-0571 Email: Info@erchonia.com • Website: www.erchonia.com Erchonia is the global leader in low level laser healthcare applications. Over the last 16 years Erchonia has researched & developed with the world’s leading physicians to advance the science of lasers. Erchonia lasers are proven through rigorous Level (1) clinical trials to prove their efficacy.

Essential Formulas • Booth #4042 1861 Valley View Lane, Suite 180, Farmers Branch, TX 75234 USA Ph: 972-255-3918 • Fax: 972-255-3918 Email: info@essentialformulas.com • Website: www.essentialformulas.com Essential Formulas Incorporated (EFI) was established in 2000 as the sole U.S. distributor of worldrenowned microbiologist Dr. Iichiroh Ohhira’s award-winning probiotic dietary supplements and skin care products; always an innovator EFI introduced REG’ACTIV® in 2015. These exceptional formulas ontain ME-3, a probiotic catalyst that produces the “Master’” Oxidant Glutathione inside the body’s cells. A family-owned and operated business, EFI was founded on the philosophy of providing high-quality preventative, supportive and comprehensive pro-health products for the entire family.

Factor Medical • Booth #1044 940 Town Center Drive, Suite F20, Langhorne, PA 19047 USA Ph: 215-702-1200 Email: kristin@factormedical.com • Website: www.selphyl.com The Selphyl® System is designed for the safe and rapid preparation of Platelet-rich Fibrin Matrix (PRFM) from a small sample of blood at the patient point of care. Many PRP systems require operator skill, have varying results and have extensive contamination with red blood cells and white blood cells. Selphyl® removes virtually all contaminating cells and is independent of operator technique. PRP is converted to PRFM through a controlled process, creating a scaffold that serves to protect and preserve platelets. Think of Selphyl® PRFM as the next generation PRP.

Fotona • Booth #3033 2307 Springlake Road, Suite 518, Dallas, TX 75234 USA Ph: 972-598-9000 Email: aeng@fotona.org • Website: www.fotona.com Fotona, celebrating 50 years of laser expertise and leadership, has sold over 25,000 lasers worldwide with distribution in over 60 countries. Fotona produces award winning lasers in dentistry, aesthetics, dermatology, gynecology, and surgery, leading the industry in quality, reliability, ease-of-use and durability. Fotona is dedicated to its motto, “Choose Perfection”.

Freedom Practice Coaching • Booth #8086 1723 North Loop 1604 East, Suite 202, San Antonio, TX 78232 USA Ph: 210-330-5332 Email: miranda@freedompracticecoaching.com • Website: www.freedompracticecoaching.com Doctors who have the biggest impact are both great practitioners AND great entrepreneurs. If you’re struggling with: patient retention, compliance, attracting new patients, or isn’t highly profitable, it’s likely because you may not have the right systems in place. Come say hello & find out how you may qualify to receive a limited spot at our FREE Discovery Day event. Why? Because you care about your patients, you deserve to have freedom of time and finances.

Functional Genomic Analysis • Booth #5046 15 Pleasure Road, Ephrata, PA 17522 USA Ph: 717-466-5700 • Fax: 717-733-1756 Email: yvonnel@dnasupplementation.com • Website: www.yourgenomicresource.com People are turning to genetic testing to help find answers to their health and need an experienced practitioner to help them. Functional Genomic Analysis-TM online software is the tool you need to easily guide you through this seemingly complex process. Functional Genomic Analysis-TM creates nutritional protocols, based upon one’s unique DNA, lab work, and presenting symptoms, giving you the ability to Assess, Analyze and Design Support-TM. This will take your practice into the future of care.

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GAINSWave • Booth #6033 211 North Ervay Street, Site 520, Dallas, TX 75201 USA Ph: 1855-383-5779 Email: jeremy@gainswave.com • Website: www.joingainswave.com GAINSWave is the natural ED treatment consumers prefer for increased sexual performance and overall vitality.

GAINSWave®

Genetic Direction • Booth #2091 211 N. Ervay St. Site 520, Dallas, TX 75201 USA Ph: 817-914-3634 Email: info@geneticdirection.com • Website: www.geneticdirection.com Genetic Direction improves individuals’ lives by utilizing genetic testing and the latest genetics research to develop personalized health management programs. These health management programs include genetic trait scores and protocols around a multitude of genetic markers. The programs are delivered through a cobranded program for healthcare providers, a white labeled program for marketing partners and directly to consumers via the Web. Our programs address Healthy Aging, Weight Loss and Peak Athletic Performance.

Genomind • Booth #9020 2200 Renaissance Boulevard, Suite 100, King of Prussia, PA 19406 USA Ph: 877-895-8658 • Fax: 844-364-5850 Email: customerservice@genomind.com • Website: www.genomind.com Genomind is a unique personalized medicine platform that brings innovation to healthcare around the world. Genomind, comprised of pioneering scientists and thought leaders in brain health and genetics, delivers actionable insights to clinicians, healthcare partners and individuals in order to improve the quality of human life. Learn more at www.genomind.com.

Genova Diagnostics • Booth #4015 63 Zillicoa Street, Asheville, NC 28801 USA Ph: 800-522-4762 • Fax: 828-252-9303 Email: info@gdx.net • Website: www.gdx.net Genova Diagnostics is a leading clinical laboratory applying systems-based testing approaches to the diagnosis, treatment and prevention of complex chronic disease. Genova specializes in clinical laboratory services with actionable information.

Global Health LabS • Booth #8066 548 Broadhollow Road, Melville, NY 11747 USA Ph: 631-988-5285 Email: kit.luong@globalhealthlabs.com • Website: www.globalhealthlabs.com Global Health Labs, an expert in custom-formulated products, delivers cutting-edge, health-enhancing nutritionals. Global excels with critical aspects such as vertical integration, and we offer 100 percent in-house capabilities, as well as certified, inspected and licensed, debt-free, cutting-edge facilities. We partner with clients in all channels, domestic and international. Our goal is long-term, profitable, lasting success with high-quality products.

548 BROADHOLLOW ROAD MELVILLE, NY 11747 USA OFFICE: (631) 293-0030 DIRECT: (631) 944-5557

100 CLEMENTS ROAD #J216 LONDON SE16 4DG ENGLAND OFFICE: +44(0)-207-231-3589 DIRECT: 001-631-944-5557

G L O B A L H E A LT H L A B O R AT O R I E S GLOBALHEALTHLABS.COM

Global Life Rejuvenation • Booth #7056 161 East Main Street, Denville, NJ 07834 USA Ph: 973-627-1750 • Fax: 973-627-4158 Email: dglaab@globalliferejuvenation.com • Website: www.globalliferejuvenation.com Leader in Anti-Aging Medicine, medical weight loss, practice development and patient edu-cation. Creating a national physicians network. Marketing each location, educating patients and scheduling appointments, connecting doctors to patients and patients to state-of-the-art compounding pharmacies.

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Great Plains Laboratory • Booth #7039 11813 West 77th Street, Lenexa, KS 66214 USA Ph: 913-341-8949 • Fax: 913-341-8949 Email: sales@gpl4u.com • Website: www.greatplainslaboratory.com The Great Plains Laboratory, Inc. is a global leader in metabolic, environmental, and genetic testing for chronic illnesses and diseases. We provide easy access to the most reliable, comprehensive, and understandable scientific results, using the latest technology and proven techniques to maintain optimal health at all ages. All tests are designed to measure the contributing metabolic factors which cause symptoms of Alzheimers disease, chronic fatigue, fibromyalgia, migraines, multiple sclerosis, Parkinsons disease, rheumatoid arthritis, and more.

GX Sciences, Inc. • Booth #3046 4150 Freidrich Lane, Suite H, Austin, TX 78750 USA Ph: 844-258-5564 • Fax: 877-720-8273 Email: info@gxsciences.com • Website: www.gxsciences.com GX Sciences™, a biotechnology company / laboratory is proud to introduce a provider only Nutrigenomic testing and interpretation platform for the medical marketplace. Our experts have designed a solution for practitioners to offer patients affordable Nutrigenomic Testing through a simple cheek swab and the choice of 14 nutrigenomic panels and PGx testing. Our proprietary software, SNP Genius™, provides interpretation of the abnormal genetic results and reports targeted nutrition, lifestyle recommendations and potential lab work.

Hair Science • Booth #9039

HAIR SCIENCE DEVELOPERS OF ADVANCED HAIR LOSS FORMULAS

1900 North Placita El Zacate, Tucson, AZ 85749 USA Ph: 866-558-1744 • Fax: 619-374-7383 Email: dgreif@hairsciencecorp.com • Website: www.hairsciencecorp.com Hair Science is a research and development company dedicated to advancing products that improve hair and scalp health. Come visit our booth to learn about our prescription-based hair loss treatments, Formulas 82M & 82F, and our over-thecounter hair loss shampoo, Formula 82S.

Hallandale Pharmacy • Booth #4055 1109 East Hallandale Beach Boulevard, Hallandale, FL 33009 USA Ph: 954-455-3822 • Fax: 954-455-3835 Email: info@hallandalerx.com • Website: www.hallandalerx.com Meeting the demands of today’s medicine, we provide HRT formulations with quality and precision at affordable prices. As dedicated pharmacists and owners, we pride ourselves in our comprehensive pharmaceutical services to fulfill the unique needs of physicians and their patients.

Hawaiian Moon • Booth #5048 321 South Missouri Avenue, Clearwater, FL 33756 USA Ph: 727-466-1856 • Fax: 866-618-6480 Email: customerservice@hmaloe.com • Website: www.aloecream.biz Say Goodbye to Dry Skin with Hawaiian Moon Organic Aloe Cream! It is free of dyes, fragrance, parabens, sulfates, mineral oil?, and any other harsh chemicals, including petroleum. Our cream penetrates the skin up to 7 layers deep, and absorbs into the skin instantly.

Healeon Medical • Booth #4080 1111 Rancho Conejo Boulevard, #204, Newbury Park, CA 91320 USA Ph: 805-499-7482 • Fax: 805-435-1488 Email: sales@healeonmedical.com • Website: www.healeonmedical.com Healeon Medical provides innovative medical devices, clinical expertise and support for autologous pointof care treatments and regenerative medicine. Healeon Medical’s technologies and techniques surpass the competition by offering simpler, quicker, safer solutions that isolate unparalleled cell counts to meet individual practice and patient needs, from the comfort of the clinician’s treatment room. Healeon is the exclusive distributor for Nouveaux Medical’s Almi branded products which offer the patient an all-natural solution to rejuvenation using their own tissues.

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Health and Beauty Connection • Booth #8084 5271 Giron Circle, Kissimmee, FL 34758 USA Ph: 407-331-6292 Email:info@hnbc.u • Website: www.HnBconnection.com We specialize in whole body vibration therapy where you merely step onto the platform; you can stand, sit, lie down, or even focus the platform on specific body parts. The platform creates a vibration, which is sent through the body. In reflex, the muscles contract. This causes tendons to stretch, and increases blood flow and improved blood oxygenation. This strengthens and tones without effort on the person’s part since the vibrations get sent through the entire body, all the muscle groups are affected.

HealthSnap • Booth #3064 1951 Northwest 7th Avenue, Suite 600, Miami, FL 33136 USA Ph: 888-780-1872 Email: info@healthsnapsolutions.com • Website: www.healthsnapsolutions.com HealthSnap provides a centralized platform that aggregates and interprets lifestyle data from wearables, digital health devices, and applications. We make sense of raw collected ifestyle health data, so it can be used in healthcare. Our clients range from small to large healthcare practices, corporate wellness providers, and enterprise healthcare companies. When 7 out of 10 deaths each year are linked to preventable chronic diseases, HealthSnap is fueling the shift from a reactive “disease-care” systems towards proactive valuebased care.

High Tech Health • Booth #5047 5621 Arapahoe Avenue, Suite D, Boulder, CO 80303 USA Ph: 800-794-5355 • Fax: 303-449-9640 Email: info@hightechhealth.com • Website: www.hightechhealth.com High Tech Health International pioneered detoxification of heavy metals and chemicals via infrared sauna therapy 20 years ago. More than 4000 health practitioners in 57 countries now use our saunas. High Tech Health was just awarded patent 9,770,386 for low. total EMF infrared sauna heater. Vital Reaction is the leading brand of molecular hydrogen products including tablets with the highest ppm and inhaled molecular hydrogen.

Hormone Consultants • Booth #8096 67 Ladoga Avenue ,Tampa, FL 33606 USA Ph: 727-308-9638 Email: info@hormoneconsultants.com • Website: www.hormoneconsultants.com Hormone Consultants is a network of physicians providing online consults to patients nationwide. Specializing in hormone-related issues of Menopause, Men’s Health, and Anti-Aging, we employ physicians to provide consultations in their spare time, on their own schedule. Our proprietary patient-physician portal is pre-loaded with all pertinent history, medications, and laboratory/hormone test results making this the easiest and safest online consultation system for doctors and patients. Join our network of doctors at www.HormoneConsultants.com

Hormone Therapy Centers of America • Booth #4047 5345 Town Square Drive, Suite 165, Plano, TX 75024 USA Ph: 469-208-9409 Email: Info@ht-ca.com • Website: www.ht-ca.com HTCA provides a full turnkey solution to practitioners who are desiring to add BioIdentical Hormone Pellet Therapy to their practices. We provide comprehensive hands on training, patient screening tools, dosing site, real time physician support and marketing strategies to promote their BioIdentical Hormone Pellet Therapy services to existing patients as well as new patients in their immediate market area.

Hotze Elite Physicians • Booth #6047 20214 Braidwood Drive, #215, Katy, TX 77450 USA Ph: 281-698-8756 • Fax: 281-579-2686 Email: wehelpphysiciansgrow@hotzeelite.com • Website: www.hotzeelite.com Do you want more time, more money and more freedom to enjoy your life? Hotze Elite Physicians will teach you to heal your patients, naturally and profitably, using Dr. Hotze’s proprietary business and medical protocols, delivered via on-demand virtual training or on-site training. If you’re feeling overworked, unfulfilled, and underpaid then “Do a 180” in your practice and join the Wellness Revolution. For more information, visit www.hotzeelite.com or find us on Facebook and LinkedIn.

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IAS group • Booth #8055 2, LG1 Mirror Tower 61 Mody Road,Tsim Sha Tsui Kowloon Hong Kong Hong Kong+44 208 123 2106 Ph: 44-208-123-2106 Email: b2b@iasgroup.com • Website: www.antiaging-systems.com IAS is a 27 year-old global resource for scientifically proven preventative & regenerative therapies to slow, reverse & prevent various aspects of aging. If you need the latest evidence-based nutrition, bio-identical hormones, medicines & peptides then IAS is your partner. Visit our booth & get a personal AGE scan, see our latest products (including Rapamycin), converse with Ward Dean, M.D. & receive a FREE subscription to the Aging Matters magazine worth $32.

ICA Health • Booth #7064

PO Box 26021, Tucson, AZ 85726 USA Ph: 800-522-4762 • Fax: 520-395-9491 Email: ericka@icahealth.com • Website: www.icahealth.com Supplements and protocols designed by Dr. James L. Wilson for healthcare providers who want clinically effective results that address the source, not just symptoms, of stress, adrenal fatigue, blood sugar metabolism, digestive health and immune function.

Ideal Protein of America • Booth #9021 3135 SR580, Suite 5, Safety Harbor, FL 34695 USA Ph: 866-314-4447 Email: jsykes@idealprotein.com • Website: www.idealprotein.com The Ideal Protein Weight Loss Protocol is medically designed and developed and is consistent with evidence-based guidelines, to help obese and overweight patients or clients achieve safe, long-term weight loss and maintain it. The Protocol helps to reverse the imbalance in insulin that occurs with the typical w.ern diet and that contributes to weight gain and metabolic syndrome. Physicians report that after successful completion of the Ideal Protein Weight Loss Protocol, patients experience significant improvement in metabolic parameters. Individualized, professional health coaching helps patients or clients learn proper nutrition and new eating habits.

Immuno Labs • Booth #7090 6801 Powerline Road, Fort LaudeRoadale, FL 33309 USA Ph: 954-691-2500 • Fax: 954-827-2750 Email: info@immunolabs.com • Website: www.immunolabs.com If there was just one food triggering your patient’s symptoms, would you want to know which food? For 40 years we’ve been precisely identifying inflammatory foods through our proprietary algorithms using the most advanced testing methodologies. We’re the only laboratory with a 100% money-back guarantee, proving our dedication to reliable, reproducible, and relevant results. We partner with physicians to achieve the best clinical outcomes. Visit us for tradeshow specials on getting your own Bloodprint® test!

IENCES L

IMMUN

Immunosciences Lab, Inc. • Booth #1034

INC. I. S . L .

822 South Robertson Boulevard, #312, Los Angeles, CA 90035 USA Ph: 310-657-1077 Email: Immunsci@gmail.com • Website: www.immunoscienceslab.com Immunosciences Lab., Inc. (ISL) is a state-of-the-art clinical reference and research laboratory, a leader and innovator in the field of molecular medicine. Licensed in California and CAP-approved, ISL specializes in utilizing the most highly sensitive and accurate testing methods for detecting lyme disease, autoimmunity,and viral infection. The information provided by these tests can help clinicians not only pinpoint the cause of the illness but treat and perhaps even reverse the course of the disease’ development.

InBody • Booth #2020 13850 Cerritos Corporate Drive, Suite C, Cerritos, CA 90703 USA Ph: 323-932-6503 • Fax: 323-952-5009 Email: contact@inbody.com • Website: www.inbody.com Since 1996, InBody has made one of the most accurate and precise DSM-BIA devices. Used by professionals in the anti-aging, regenerative and functional medicine fields, InBody devices provide a holistic approach to preventing and treating disease. In less than 60 seconds, InBody Tests produce outputs like Visceral Fat Analysis, Percent Body Fat and BMR. These outputs can set more effective treatment plans, predict outcomes and accurately assess your clients’ health status. To learn how an InBody can benefit your practice, visit www.InBody.com.

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Incredible Marketing • Booth #1046 310 Goddard, Suite 200, Irvine, CA 92618 USA Ph: 800-949-0133 Email: sales@incrediblemarketing.com • Website: www.incrediblemarketing.com Forget the battle over the bottom line, become the anchor in a sea of commoditization that your patients can trust. Take the lead without cutting your profits. It’s Incredible, really. Marketing that deepens – not cheapens – your patient relationships. Allow Incredible Marketing to guide the way. Our experience in SEO, social media, content marketing and website solutions for the aesthetic medical space can help you poise your practice as a leader in your industry. The time to move forward is now.

Induction Therapies™, makers of Collagen P.I.n. • Booth #9042 3600 Chamberlain Lane, Louisville, KY 40241 USA Ph: 877-746-4407 • Fax: 877-746-4407 Email: cathy@collagenpin.com • Website: www.inductiontherapies.com Breakthrough to ageless skin with Collagen P.I.n., an advanced and powerful medical-grade, automated, microneedling device featuring more power, more needles and more depth to deliver more collagen. Our private label skincare is the result of years of research, expertise, and input from physicians seeking very specific formulations, resulting in more than 30 unique products that no other skincare company offers. Plus, we now offer the A Method by Tina Alster M.D., based on years of clinical expertise.

Innergy Development • Booth #7013 215 S Mountainlands Drive, Orem, UT 84058 USA Ph: 801-837-1340 • Fax: 801-837-1340 Email: info@innergydev.com • Website: www.innergydev.com For more than 25 years we have developed health products and services that best serve the people. Innergy Development prides itself in manufacturing the best quality, most innovative non-invasive technologies available today. With minds like Albert Einstein, Nikola Tesla and Dr. Royal Rife something amazing was sure to develop and now we’re making it available to you!

Innovation Compounding • Booth #7085 6095 Pine Mountain Road Northwest, Suite 108, Kennesaw, GA 30152 USA Ph: 800-547-1399 • Fax: 866-635-2329 Email: info@innovationcompounding.com • Website: www.innovationcompounding.com For over ten years, Innovation Compounding has provided compounding services to physicians, clinics, and patients nationwide. Many of the medications we compound are used to treat complex conditions and unique disease states. Our specialty-trained compounding pharmacists work hand-in-hand with doctors to customize medications for patients’ needs. We are here to answer questions, provide recommendations, and offer the care and compassion we would want for our own family.

Integrative Therapeutics • Booth #3066 825 Challenger Drive, Green Bay, WI 54311 USA Ph: 800-931-1709 Email: sales@integrativepro.com • Website: www.integrativepro.com A top-tier manufacturer of dietary supplements, Integrative Therapeutics strives to offer products and education to healthcare professionals to provide choices to their patients to lead healthy lives. Integrative Therapeutics supports national and local organizations, student education opportunities, and community outreach efforts. Committed to both student and professional education, Integrative Therapeutics is also the founding sponsor of TAP Integrative, a dynamic resource for practitioners to learn with and from leading experts and fellow clinicians.

Intellectual Medicine 120/The Drip Bar • Booth #5072 250 Centerville Road, Building E, Warwick, RI 02886 USA Ph: 401-921-5934 • Fax: 401-921-5936 Email: shannon@im-120.com • Website: www.im-120.com Once frustrated with current trends in healthcare, my vision was a practice with no health insurance and cash-based. One that gives you the freedom to practice the type of medicine you always wanted and allows you to earn income far beyond your current level. A practice that incorporated anti-aging therapy, advanced IV support, weight loss, and aesthetics—all into one patient satisfying, profit generating center. Learn about the Intellectual Medicine franchises today- Dr. Stephen Petteruti

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Intelligent Bioenergetics, Inc. • Booth #7074 317 North El Camino Real, Suite 407, Encinitas, CA 92024 USA Ph: 858-539-6111 • Fax: 866-319-1361 Email: lisa@intellbio.com • Website: www.intellbio.com Eletro-Equiscope... Pain Free Electrically Presenting the Electro-Equiscope®; a truly unique device that is controlled by a Sophisticated Guidance System correcting injured or abnormal tissue. The Equiscope® is result driven electrical therapy. It normalizes and relaxes damaged tissue, thereby allowing the body to return to homeostasis and heal itself. The Equiscope® combines Picocurrent, Analog and Digital twoway feedback, adjusting its electrical therapy through the skin. Our non-invasive Equiscope® therapy is a painless calming experience, delivering results within three sessions.

International Peptides Society • Booth #1029 4737 North Ocean Drive, #132, Fort Lauderdale, FL 33308 USA Ph: 855-279-1695 Email: emily@peptidesociety.org • Website: www.peptidesociety.org IPS is a nonprofit organization founded by orthopedic surgeon Dr. William A. Seeds, MD and nationally recognized clinical pharmacist Jim LaValle, R.Ph., MS., CCN in late 2017 to better educate physicians who are new to peptides. The website houses a large repository of literature on peptides that only members can access. For each peptide, the literature includes the molecular formula, suggested dosage, an in-depth description of the peptide, clinical research studies with the full pdf at your fingertips, and much more.

Jigsaw Health • Booth #3044 9035 East Pima Center Parkway, Suite 3, Scottsdale, AZ 85258 USA Ph: 480-951-0840 Email: help@jigsawhealth.com • Website: www.jigsawhealth.com Since 2005, Jigsaw Health -- “The Magnesium People” -- has been developing science-based dietary supplements with a focus on Magnesium featuring Sustained Release Technology (w/SRT®), which controls the release of active ingredients so absorption can happen over time. MagSRT® by Jigsaw Health is America’s #1 Time Release Magnesium and clinically shown to increase Magnesium in the body.* MagSRT® was evaluated in the Scottsdale Magnesium Study (SMS), a placebo-controlled, human clinical trial of 91 participants. The study measured Serum Magnesium, Red Blood Cell (RBC) Magnesium, and Magnesium Deficiency symptoms.

Kashi Clinical Laboratories • Booth #6044 10101 Southwest Barbur Boulevard, Portland, OR 97219 USA Ph: 503-206-4989 Email: vsimonis@kashilab.com • Website: www.kashilab.com Kashi Clinical Laboratories is a fully-accredited clinical laboratory that specializes in a range of genomic healthcare services from HLA testing for Bone Marrow Transplants to UA toxicology/drug testing and genetic health panel testing. Kashi Lab offers a distinctive one-on-one approach in developing laboratory testing services to meet organization and project requirements. We promote well-being and quality of life by delivering the highest standard of laboratory work because we recognize our service as more than a test result.

KBMO Diagnostics • Booth #3047 4 Business Way, Hopedale, MA 01747 USA Ph: 617-933-8130 • Fax: 617-933-7660 Email: info@kbmodiagnostics.com • Website: www.kbmodiagnostics.com KBMO Diagnostics is a fully integrated medical diagnostics company offering food sensitivity testing. Using our unique Food Inflammation Test (FIT) panel, KBMO tests 132 foods for IgG and C3D complement. We provide an individualized, user-friendly color report. Patients will have access to a meal plan and mobile app. Continuing to grow with the addition of new assays, KBMO Diagnostics has added the Zonulin Test that measures gut permeability.

Kion • Booth #3096 3980 North Broadway, Suite 103-183, Boulder, CO 80304 USA Ph: 855-387-5466 Email: partners@getkion.com • Website: www.getkion.com Visionary Ben Greenfield dreamed of a supplement and functional food company that valued honesty, integrity, and creativity. By blending ancient wisdom with modern science, Kion creates cutting-edge, research-proven and trench-tested products, like blood-sugar and metabolism supporting Kion Lean and delicious, high-antioxidant, organic Kion Coffee. Powered by clean products made with the purest ingredients and no unnecessary fillers, Kion enables the world’s high achievers, health seekers, and life enthusiasts to live limitless lives at the pinnacle of health, performance, and longevity.

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Klaire Labs • Booth #6073 795 Trademark Drive, Reno, NV 89521 USA Ph: 1888-488-2488 • Fax: 775-850-8810 Email: customerserviceusa@sfihealth.com • Website: www.klaire.com Klaire Labs represents decades of excellence and maintains a strong reputation among the most selective healthcare practitioners. Through well-respected legacy brands and continuous new product innovation, Klaire Labs offers a robust, multi-category portfolio of nutraceuticals. Our primary areas of focus are Mood and Cognition, Healthy Aging, Women’s Health, and most notably, Microbiome and GI Health, where Klaire proudly claims the leading professionally distributed probiotic line in the United States, Ther-Biotic®.

KYOUI • Booth #5044 6787 West Tropicana Avenue, #274, Las Vegas, NV 89103 USA Ph: 855-465-9684 • Fax: 855-465-9684 Email: info@kyoui.com • Website: www.kyoui.com Kyoui is a manufacturer of a unique patented device created to control and prevent periodontal disease that affects 75% of Americans leading to several systemic diseases such as stroke, cardiovascular disease diabetes, etc. Our mission is to raise awareness about oral-systemic health link and our goal is to help people prevent and control periodontal disease for a better overall health.

L-Nutra, Inc • Booth #3011 8322 Beverly Boulevard, Suite 202, Los Angeles, CA 90048 USA Ph: 310-775-3655 Email: aperez@l-nutra.com • Website: www.prolonpro.com ProLon® is the first Fasting Mimicking Diet™ (FMD™) developed to provide the beneficial effects of fasting including stem cell-based rejuvenation, optimized glucose and cholesterol levels, and quick abdominal fat loss. The fasting mimicking period is made safe and pleasant because ProLon® contains plant-based soups, bars, crackers, olives, drinks, and supplements in a proprietary 5-day dietary program. It is based on innovative research carried out at two of the world’s leading centers for biomedical and longevity research located at the University of Southern California (USC), the Longevity Institute and the Diabetes and Obesity Research Institute.

Laboratory for Advanced Medicine • Booth #2097 9950 Research Drive, Irvine, CA 92618 USA Ph: 844-489-4363 Email: info@ivygenelabs.com • Website: www.ivygenelabs.com The Laboratory for Advanced Medicine is a bio medical company focused on development of life saving technologies, specifically for the early detection and intervention of cancer. One of those technologies is the IvyGene test, which is a simple blood test that confirms the presence of multiple cancers, as early as stage 1.

Legally Mine • Booth #6027 1337 East 750 N Street, Orem, UT 84097 USA Ph: 800-375-2453 • Fax: 888-801-6454 Email: johnson@legallymineusa.com • Website: www.legallymineusa.com The mission of Legally Mine is to empower members of the medical, dental, and business communities with the knowledge and tools to protect their assets from lawsuits, legitimately reduce their tax liability, and to cultivate an environment wherein they can thrive financially. Legally Mine is a full service legal structuring business that provides documents, service, implementation, and support for the asset protection, lawsuit prevention, and tax reduction needs of each of our clients.

Leptica Research, LLC • Booth #9088 PO Box 717, Bisbee, AZ 85603 USA Ph: 602-427-5602 Email: leptinworks@gmail.com • Website: www.lepticamedical.com Welcome to our exclusive world of isopathic cell signaling factor formulas. From the researchers and developers of homeopathic hGH in 1998 we now bring you individual formulas including hCG, EPO, EGF, and complex formulas for (1) healthy aging (2) mental well-being: PTSD, anxiety & depression, (3), immune strengthening, (4) neurodegenerative afflictions like Parkinson’s, dementia, (5) addictions: food, alcohol, opioids, and (6) women’s hormonal balancing: PMS, PCOS, menopause, PPD. Current case studies include stroke and chronic fatigue. Please come and visit us.

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The Most Impactful & Informative Event in Clinical and Aesthetic Dermatology

F E B R UA R Y 7 - 1 0 , 2 0 1 9 Miami Beach, Florida Loews Hotel

Taking place February 7-10, 2019 at the Loews Hotel, our 17th Annual South Beach Symposium will feature an increasingly dynamic agenda, rooted in the most current research in clinical dermatology & aesthetics, and focused on interpersonal attendee engagement. With a faculty team committed to implementing the newest, most innovative technologies, the event is dedicated to providing hands-on clinical applications that can immediately be integrated into practice.

SYMPOSIUM CHAIR Mark S. Nestor, MD, PhD Aventura, Florida Dermatology

PLANNING COMMITTEE Michael H. Gold, MD, FAAD Nashville, Tennessee Dermatology David J. Goldberg, MD, JD New York, New York Dermatology Z. Paul Lorenc, MD New York, New York Plastic Surgery Leon Kircik, MD Louiseville, Kentucky Dermatology

Lawrence Schachner, MD Miami, Florida Pediatric Dermatology

TOP 5 REASONS TO JOIN US CME

EARN UP TO

26.75

CME/CE CREDITS

EDUCATIONAL OPPORTUNITIES WITH WORLDRENOWNED EXPERTS

NETWORKING & SOCIALIZING WITH LIKE-MINDED CLINICIANS

POSITION YOURSELF

AS AN EXPERT IN THE FIELD

LEARN NEW TECHNIQUES TO ENHANCE YOUR PRACTICE

ONSITE SPECIAL

595

SPECIALTY SESSIONS THURSDAY, FEBRUARY 7

Masters of Pediatric Dermatology: This one-day session, held prior to each year's South Beach Symposium, advances education surrounding skin diseases & disorders in pediatric age groups, and fosters an exchange of information between physicians and health professionals interested in the field of pediatric dermatology.

Superficial Radiation Therapy: Often utilized as a treatment modality for non-melanoma skin cancer, this session will explore the impacts & effects of superficial radiation therapy as a treatment modality for cutaneous oncology.

SATURDAY, FEBRUARY 9

Practice Management Symposium: With a focus on essential strategies specific to running dermatology practices, this specialty session includes the fundamentals of compliance, coding and reimbursement, MACRA, and legal advice. Lectures will further highlight various tools for growing medical practices through additional revenue streams, optimizing social media channels, and discovering supplementary tactics.

Advances in Hair Restoration: This advanced track will provide the most recent clinical updates in hair restoration, supplemented by scientific research, topical treatments, and procedural innovations including PRP.

Anti-Aging & The Dermatologist: This track will review hormonal practices & protocols, the implications of the microbiome in dermatology, integrative protocols for dermatologic procedures, and new advances in Regenerative Medicine: all through the lens of clinical dermatology.

P H O N E 5 6 1 - 8 9 3 - 8 6 2 5 | www.s outhb e achs ymp os ium.or g

Life Length • Booth #8036 1801 North Military Trail, Boca Ratón, FL 33431 USA Ph: 34-917-37-12-98 • Fax: 34-91-310-1753 Email: info@lifelength.com • Website: www.lifelength.com Life Length is the world leader in providing telomere diagnostics and telomerase activity measurements for use in clinical and diagnostic medicine. Life Length has developed unique and proprietary technologies. Our robust, sensitive and reproducible tests can be combined with other analyses to provide a comprehensive picture of a patient’s health. Life Length’s TAT®, is the only test that measures critically short telomeres, for people wanting to optimize their health for the longest, healthiest possible lives.

LightStim • Booth #5036 16552 Von Karman Avenue, Irvine, CA 92606 USA Ph: 949-502-4088 • Fax: 949-502-4090 Email: info@lightstim.com • Website: www.lightstim.com LightStim, used and recommend by Medical Doctors, Dermatologists, Plastic Surgeons and Skin Care Professionals for over 15 years is committed to changing the face of health and wellness through a holistic approach. LightStim MultiWave® Patented Technology brings proven, consistent and lasting results for the treatment of Anti-Aging, Acne and Pain.

Liquivida Lounge • Booth #9035 3349 Northeast 33rd Street, # B, Fort Lauderdale, FL 33308 USA Ph: 44-518-2100 Email: info@liquividalounge.com • Website: www.liquividalounge.com IV Nutrients Therapy made easy for your practice!

Liveyon • Booth #5021 7700 Irvine Center Drive, Suite 800, Irvine, CA 92618 USA Ph: 844-548-3966 Email: info@liveyon.com • Website: www.liveyon.com We are the leader in umblical cord derived products for use in regenerative medicine therapies.

LivOn Laboratories • Booth #6067 2534 Anthem Village Drive, Stuite 100, Henderson, NV 890525539 USA Ph: 866-790-2107 • Fax: 702-946-0873 Email: service@livonlabs.com • Website: www.livonlabs.com LivOn Laboratories has been the industry leader formulating high performance dietary supplements that offer genuine health benefits for over 12 years. LivOn Labs Lypo-Spheric™ Vitamin C was the world’s first unidose Liposomal vitamin C gel. Other LivOn Labs’ products are Lypo-Spheric™ B Complex+, Lypo- Spheric™ Glutathione, Lypo-Spheric™ R-ALA (R-Alpha Lipoic Acid), and Lypo-Spheric™ ALC (Acetyl-LCarnitine). LivOn Labs’ invites all attendees to visit our booth, sample our products and get a free copy of the latest book from Dr. Thomas E Levy MD, JD. “Hidden Epidemic”.

McGuff Compounding Pharmacy Services • Booth #4049 2921 West MacArthur Boulevard, Suite 142, Santa Ana, CA 92704 USA Ph: 877-444-1133 • Fax: 877-444-1155 Email: chuck@mcguff.com • Website: www.mcguffpharmacy.com McGuff Compounding Pharmacy Services provides a level of commitment and value that is unsurpassed. We are independently certified as ISO 9001:2008 compliant and accredited by the Pharmacy Compounding Accreditation Board (PCAB). We compound all dosage forms including sterile injections and deliver to all US states, territories and protectorates. Product quality and patient safety are our number one concern. Stop by the booth to find out more.

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McGuff Pharmaceuticals • Booth #3100 3524 West Lake Center Drive, Santa Ana, CA 92704 USA Ph: 800-854-7220 • Fax: 714-918-7274 Email: pharmaceuticalanswers@mcguff.com • Website: www.mcguffmedical.com McGuff Pharmaceuticals is the manufacturer of Ascor® Ascorbic Acid Injection. Ascor® is the only FDA approved ascorbic acid injection available in the United States. Ascor® is manufactured in a cGMP facility to ensure quality and has a two year expiration date from the date of manufacture.

MDware Software • Booth #7049 1788 Drew Road, Unit A, Mississauga, ON L5S 1L7 CA Ph: 800-798-6199 • Fax: 905-362-4374 Email: sales@mdware.com • Website: www.mdware.com MDware Software is the number one medical spa software in the industry. We offer you the option of owning your software and if you don’t own your software you don’t own your medical records. MDware offers the fastest charting, the most intuitive practice management and the most advanced integrated marketing in the business. Your business can have a seamless flow from reception through treatment and on to check out, vastly increasing your efficiency and productivity.

Medesthetics Magazine • Booth #9047 7628 Densmore Avenue, Van Nuys , CA 91406-2042 USA Ph: 800-442-5667 • Fax: 818-782-7450 Email: lfisco@creativeage.com • Website: www.medestheticsmagazine.com MedEsthetics Magazine serves medical professionals and private practices that offer noninvasive, minimally invasive and surgical cosmetic procedures by providing coverage on practice management, practice building, industry news, and the latest equipment and treatment trends.

MEDISCA • Booth #7086 661 Route 3, Suite C, Plattsburgh, NY 12901 USA Ph: 800-932-1039 • Fax: 855-850-5855 Email: mus-customerservices@medisca.com • Website: www.medisca.com With over 25 years of experience, MEDISCA has developed a solid reputation as an innovative company in the pharmaceutical compounding industry. We are a leading FDA-registered supplier of quality pharmacy compounding products, such as Active Pharmaceutical Ingredients (APIs), Fine Chemicals, Bases, Equipment & Devices, Excipients, and Compounding Kits.

Medithread LLC • Booth #8092 100 South Biscayne Boulevard, Suite 300, Miami, FL 33131 USA Ph: 786-778-0419 Email: info@medithread.com • Website: www.medithread.com What sets MediThread’s apart from what is currently out in the PDO market. Quality, Medithread’s needle is designed to fit a thicker thread for better results. The needles are slightly more flexible to make the insertion and movement virtually painless. Medithread consults top plastic surgeons when developing each product. Medithread packs products in smaller units per bag so that you can use what you need without risking the sterilization or durability of the remaining threads.

Meditime Co. Ltd • Booth #2042 #600 Medical Device Complex Center , Wonju-si, KR06 26354 KR Ph: 8231-777-3900 Email: ybk0808@gmail.com • Website: www.meditimekorea.com Distributor for specialized Medical Aesthetic Devices

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Medizap LLC • Booth #7072 4010 Technology Way, Suite A, Carson City, NV 89706 USA Ph: 775-386-6677 Email: customerservice@medizap.co • Website: www.medizap.co MediZap is n. America’s premier turn-key service provider of cutting-edge E-Beam sterilization for compounded pharmaceutical products. Our exclusive Four Pillar Service provides an all-inclusive program with E-Beam Sterilization, Packaging Solutions, Compliance, and Exclusive Partnerships to provide a world-class client experience.Utilizing a network of over 25+ 503A compounding pharmacies & 503B outsourcing facilities across n. America, MediZap clients can leverage exclusive group pricing in addition to shared industry knowledge and trends.

Meridian Valley Lab • Booth #8034 6839 Fort Dent Way, Suite 206, Tulwila, WA 98188 USA Ph: 855-405-8378 • Fax: 206-209-4200 Email: info@meridianvalleylab.com • Website: www.meridianvalleylab.com Meridian Valley Lab is a world leader in urine hormone and food sensitivity testing. Founded in 1976 by Dr. Jonathan Wright, Meridian Valley Lab has always been at the forefront of laboratory testing in large part due to Dr. Wright’s pioneering spirit and his fearless dedication to serving humanity. Every test ordered comes with a free consultation with Meridian Valley Lab’s very own consulting physicians.

Merit Pharmaceutical • Booth #4037 2611 North San Fernando Road, Los Angeles, CA 90065 USA Ph: 800-696-3748 • Fax: 323-227-4833 Email: solutions@meritpharm.com • Website: www.meritpharm.com Offering IV Infusion from Merit Pharmaceutical? Getting your med/surg/pharma from us? Your colleagues are and they have higher profits. Merit supplies Anti Aging/Aesthetic/Integrative practitioners better prices on the products you use. Stop by our booth and learn why successful clinics partner with us. IV Therapy Nutrition/ Hydration, Weight Loss, Hormones, IV solutions, PRP products, exam/surgical supplies and more. Merit offers pharmaceuticals (2, 3, 3N, 4), and related medical products. www.meritpharm.com or (800) 69-MERIT!

Metagenics • Booth #6007 25 Enterprise, Suite 200, Aliso Viejo, CA 92656 USA Ph: 800-698-9400 Email: Info.customerservice@metagenics.com • Website: www.metagenics.com Metagenics was founded on a revolutionary idea: Our genes do not predetermine our health potential, and through nutrition, we can impact how our genes express themselves. Embodied by our company motto— genetic potential through nutrition—this groundbreaking principle drives us to deliver high-quality, sciencebased nutritional supplements, medical foods, and lifestyle programs to support healthcare practitioners in their efforts to help patients achieve their health and wellness goals.

Microbiome Labs • Booth #3021 101 East Town Place, Suite 210, Street Augustine, FL 32092 USA Ph: 904-940-2208 • Fax: 904-940-2209 Email: info@gomegaspore.com • Website: www.microbiomelabs.com Microbiome Labs was originally established as Physicians Exclusive in 2013 as an organization focused on providing probiotic bacteriotherapy. In the past several years our business model has grown and so has public awareness for gut health issues. Microbiome Labs comes to you as an all inclusive resource center designed to address the needs of physicians and health care practitioners.

Millennium Medical Technologies • Booth #6060 6352 Corte Del Abeto, Suite A, Carlsbad, CA 92011 USA Ph: 949-215-8560 • Fax: 949-215-8564 Email: info@mmt-us.com • Website: www.mmt-us.com Millennium Medical Technologies is an FDA registered manufacturer committed to providing comprehensive solutions and support for harvesting, isolation, and deployment of 361 compliant tissue and cells. We manufacture and distribute devices in liposuction and body shaping, adipose tissue collection, fat grafting, and autologous cell processing as well as provide device development and clinical support services.

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MindBody Matrix • Booth #4048 P.O. Box 3108, Clovis, CA 93612 USA Ph: 559-451-6690 Email: khoa@mindbodymatrix.com • Website: www.mindbodymatrix.com MindBody Matrix’s purpose on this earth is to change the way we view pain while making a huge impact on the world’s dependency on opioid medication. True altruistic purpose drives each and every member and we firmly believe in the adage “Be the change you want to see in the world”. MindBody Matrix combines the revolutionary science of Energetic Medicine with a specific blend of all natural herbs and essential oils finally giving those in chronic pain a solution to their problem.

MitoQ Ltd • Booth #2047 Level2, ViaduCourt Harbour Avenue, Auckland, NZE7 1010 NZ Ph: 642-172-0892 Email: gmacpherson@mitoq.com • Website: www.mitoq.com MitoQ Limited is a New Zealand based company that is dedicated to promoting the importance of mitochondrial health to overall wellbeing, advancing the science of mitochondria-targeted antioxidant solutions and helping to revitalize and rejuvenate humankind. Supported by over $50m of independent research funding and with over 300 peer reviewed articles published on pubmed.com, MitoQ continues to develop evidence-based application of its products across a range of health-related subjects, to help validate its true potential.

Molecular Pharmagroup • Booth #7096 755 Central Avenue, Unit 2, New Providence, NJ 07974 USA Ph: 321-223-8876 Email: lsgarlato@yahoo.com • Website: www.molecularpg.com Molecular Pharmagroup is your Health and Wellness 503B Bulk Manufacturing Strategic Partner. MPG specializes in creating medicinal sterile injectables that are compounded to cGMP standards that include potency, stability and sterility testing on each batch. Our focus is to create sterile products that will enhance revenue streams and advance the practitioner’s services and profitability.

Mushroom Science • Booth #9046 1025 Conger Street, Suite 6, Eugene, OR 97402 USA Ph: 541-344-1396 Email: shannon@mushroomscience.com • Website: www.mushroomscience.com Mushroom Science has been providing high potency mushroom extracts through its practitioner brand JHS Natural Products for the past 2 decades. Mushroom extracts have historically been prepared as a tea/ decoction, also known as a hot water extract. The scientific literature has numerous human clinical trials on the dehydrated tea form, indicating the percent of actives. Mushroom Science ingredients are certified organic, tested for purity, and guarantee levels of active compounds on every bottle.

MWC Medical Sales • Booth #4095 1191 Magnolia Avenue, Suite D342, Corona, CA 92879 USA Ph: 888-692-0299 • Fax: 951-582-4948 Email: mwcmedicalsales1@gmail.com • Website: www.mwcmedicalsales.com MWC MEDICAL SALES SPECIALIZES IN WEIGHT LOSS. WE PROVIDE - Prepackaged Medication, Injectables, and IV Therapy. NCREASE INCOME - Learn how much significant revenue you can generate for your practice. COMPLIANCE - Feel at ease with complete DEA compliance. BETTER SERVICE - In-Office dispensing provides service that enhances the doctor-patient relationship, and gives you better control of patient care. STOP BY AND ENTER OUR RAFFLE TO WIN AN AMAZON GIFT CARD

MWC

Medical Sales

My Practice Connect • Booth #5060 2744 Summerdale Drive, Clearwater, FL 33761 USA Ph: 727-754-3696 • Fax: 727-230-1437 Email: info@mypracticeconnect.com • Website: www.mypracticeconnect.com MyPracticeConnect™ is a cloud-based, mobile-friendly platform that acts as an electronic bridge between you and a network of compounding pharmacies. Our technology allows you to prescribe and track wellness meds without changing your EMR, and also comes pre-loaded with Nutrient IV protocols, patient and practice resources, and more. Whether you currently offer or want to start offering wellness solutions, we can help your practice thrive. We also offer hands-on, integrative physician training, including Peptide Therapy.

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Natural Ophthalmics, Inc. • Booth #4046 P.O Box 1510, Dillon, CO 80435 USA Ph: 970-468-9020 • Fax: 970-468-9042 Email: axelrod@natoph.com • Website: www.naturaleyedrops.com Natural Ophthalmics, Inc. makes homeopathic, preservative-free eye drops and oral pellets. All drops are safe for use with contact lenses in place and do not sting. We have treatments for Dry Eye, Allergy, Cataracts, Glaucoma and Macular Degeneration. Our new. product addresses Traumatic Brain Injury. The products are well priced and dispensed through your office. A trial pack will be mailed upon request. Please come and meet us. 877-220-9710 www.NaturalEyeDrops.com

Natural Partners Fullscript • Booth #7084 245 Cooper Street, 6th Floor, Ottawa, ON K2P 0G2 CA Ph: 1866-807-3828 Email: support@fullscript.com • Website: www.fullscript.com No matter how you dispense, Natural Partners Fullscript has you covered. In-practice, online, or both, we have the solution for you, with over 300 high-quality professional brands and more than 15,000 products. Visit naturalpartners.com to stock your in-office dispensary with the essentials for acute care. Improve patient adherence and win the refill business by setting up your online dispensary at fullscript.com.

Nature-Throid • Booth #4070 29455 North Cave Creek, Ste. 118-629, Cave Creek, AZ 85311 USA Ph: 877-797-7997 • Fax: 623-879-8683 Email: sales@rlclabs.com • Website: www.getrealthyroid.com Nature-Throid and WP Thyroid are natural hypothyroid medications containing both T4 and T3 hormones. Two natural thyroid solutions. Because no two people are alike. RLC Labs also manufactures a-Drenal and i-Throid, (iodine 12.5mg & 6.25mg), which can be used alone or with either Nature-Throid or WP Thyroid for a well-rounded thyroid protocol.

Nelly De Vuyst • Booth #5055 4930 Chemin du Bois-Franc, St-Laurent, QC H4S 1A7 CA Ph: 1-800-263-8888 • Fax: 514-333-4008 Email: derme@info.ca • Website: www.nellydevuyst.com Nelly De Vuyst® is a premium skin care brand with a longstanding reputation as one of the most effective, antiaging and corrective skincare lines on the market that is compatible with all medical aesthetic practices. We pride ourselves on our customers’ success and our NEW organic skincare lines BioTense, BioAcne and Elle from Nelly De Vuyst® which are deemed the very first COSMOS® and Ecocert® organic certified professional products. The COSMOS® certification is the highest European organic standard in the cosmetic industry.

NeuroScience • Booth #7095 373 280th Street Osceola, WI 54020 USA Ph: 888-342-7272 • Fax: 715-294-3921 Email: customerservicegroup@neurorelief.com • Website: www.neuroscienceinc.com Established near Osceola, Wisconsin in 2000 as a family-owned professional grade dietary supplement company, NeuroScience began offering pioneering proprietary blends of amino acids designed specifically to provide precursors for nervous system molecules called neurotransmitters. After nearly two decades and with our Kavinace, AdreCor, and Calm supplement suites, NeuroScience is recognized as a top pro-grade brand delivering premium products containing amino acids, botanicals, vitamins, and minerals exclusively to thousands of licensed healthcare providers.

New Voice - energyDOTs • Booth #5039 13 Blackswan, Irvine, CA 92604 USA Ph: 949-551-3397 • Fax: 949-552-9041 Email: marcus@newvoice.net • Website: www.smartdots.us EMF Products for cell phones and wireless devices that provide effective solutions from the harmful electromagnetic radiations being emitted. These innovative European technologies alter these energies to be more human compatible. Meet Drs. Elizabeth and Marcus Plourde, the authors of EMF Freedom: Solutions for the 21st Century Pollution. Discover why we should be concerned and what can be done to reduce the impact from wireless devices.

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Novus Optimum • Booth #6042 840 South Rancho Drive, #4-372, Las Vegas, NV 89016 USA Ph: 702-405-7999 • Fax: 702-982-0480 Email: novusoptimum.sales@gmail.com • Website: www.novusoptimum.com Novus Optimum Lab New Product : Artery Cleanser™ Brain Sharpener™, Iq-Maximizer™, 4-Stress™, The Energizer™, Herbal Hormone Balance™, 4-Endocrine Health™, Apoptosin™, Virgin-Again™ - Libido Enhancer, Pleasure Ehnancer™ - It Is Not Viagra But Is Erectile Enhancer™, Optimum Man™ - Anti-Aging For Men & Prostate Health, Prolong Ecstasy™ 4-Weightloss™, Elasteen™, Vitamin 4-Hair™, Bone-Health™, Painless™, 4-Healthy Joints™, HerbSulin™ Optimum All-Inone™, Sleep Ezzy™, Brain Sharpener 4-Kids™, 4-Acne™, Age-Spots Cleanser™

NuMedica • Booth #6079 9503 East 55th Place, Tulsa, OK 74145 USA Ph: 800-869-8100 • Fax: 877-270-2005 Email: mail@numedica.com • Website: www.numedica.com NuMedica® is the leading manufacturer of research-based clinical nutrition in the professional market. Nutritional performance is based on clinical results. Healthcare practitioners trust NuMedica® to deliver quality formulations addressing key healthcare focus areas. Through a research and development strategy driven by an extensive and diverse network of innovators, educators and industry opinion leaders, NuMedica® has set the standard for nutritional quality, safety and performance.

NuSkin • Booth #2055 2251 North Ramparat Boulevard, #353, Las Vegas, NV 89128 USA Ph: 702-363-5343 • Fax: 702-363-7443 Email: russ.karlen@gmail.com • Website: www.nuskinusa.com AgeLOC Youth delivers an all-encompassing anti-aging protection. It promotes a wide range of functions from your heart to your brain, your bones to your metabolism. A variety of aging aggressors cause us to age, but our aging defense mechanisms help keep us young. Now you can hold onto your youth so you can keep doing what you love throughout your life.

Nutrafol • Booth #3036 28 West 27th Street, 10th Floor, New York, NY 10001 USA Ph: 888-454-3320 Ex2 Email: partners@nutrafol.com • Website: www.nutrafol.com Nutrafol is a science based nutraceutical company focused on restoring hair health in men and women. Our brand goes beyond conventional hair loss support, by taking a multi-factorial approach to combat hair loss. Nutrafol contains a patented Synergen ComplexTM, a group of botanicals and nutrients, that work synergistically to strengthen and nourish hair from within.

Okyanos • Booth #5032 First Commercial Center East Mail Drive, Freeport, GB Bahamas Ph: 855-659-2667 • Fax: 855-404-5012 Email: drpenn@okuanos.com • Website: www.okyanos.com Okyanos is a global leader in regenerative medicine, using stem cell therapy to engage the body’s natural processes to treat chronic injury, degenerative diseases and conditions. Our team includes expert and renowned stem cell researchers, board certified orthopedists, surgeons, and cardiologist. Okyanos’ uses advanced treatments based on the latest science and data to restore function and help people live well longer. Based in Freeport, Okyanos is licensed and accredited by the Bahamas’ National Stem Cell Ethics Committee (NSCEC) and the Ministry of Health.

OKYANOS

Center for Regenerative Medicine

Olympia Pharmacy • Booth #8027 6700 Conroy Road, Suite 155, Orlando, FL 32835 USA Ph: 407-673-2222 • Fax: 407-673-1234 Email: sales@olympiapharmacy.com • Website: www.olympiapharmacy.com 503B COMPOUNDING EXCELLENCE YOU CAN RELY On. FDA Registered 503B Outsourcing Facility | Compliant. Reliable. Safe. At Olympia Compounding Pharmacy, our consultants work closely with individuals and physicians to design a treatment regimen tailored to specific needs. When choosing a compounding pharmacy to partner with, it is important that the pharmacy is compliant with all new rules and regulation to insure the medications you build your practice around will be available long term, without interruption. Olympia, as always, is the front runner in compounding, already meeting USP 800 regulations for sterile, non-sterile, hazardous and lyophilized drugs.

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Omax Health • Booth #5064 2601 Ocean Park Avenue, #214, Santa Monica , CA 90405 USA Ph: 609-288-8514 Email: sales@omaxhealth.com • Website: www.omax3pro.com

Health

Omax Health is a sciene based, health and wellness company focused on developing premium quality nutraceuticals for healthcare professionals

Organicell • Booth #4090 4045 Sheridan Avenue, #239, Miami Beach, FL 33140 USA Ph: 305-606-3430 Email: info@organicellc.om • Website: www.organicell.com Based in South Florida, Organicell ™ , doing business as Biotech Products Services & Research is a biotechnology company committed to the research, development, and processing of placental tissue, amniotic fluid and membrane. We focus on stem cells and bioactive proteins for regenerative applications. We are a fully integrated regenerative medicine company. We currently distribute cryopreserved placentalderived stem cell flow product, amniotic membrane patches, and bioidentical placenta skin care serums. Our products are marketed under Organicell ™.

OrthoMolecular Products • Booth #4026 1991 Duncan Place, Woodstock, IL 60098 USA Ph: 800-332-2351 • Fax: 800-476-4664 Email: contactus@ompimail.com • Website: www.orthomolecularproducts.com Ortho Molecular Products, Inc. has been manufacturing dietary supplements with unsurpassed efficacy for over 25 years. Deeply committed to their long-standing pledge to honor the doctor-patient relationship, Ortho Molecular Products believes evidence-based, lifestyle and nutri-tional therapies will transform the practice of medicine. To that end, Ortho Molecular Products is dedicated to creating innovative clinical models to help healthcare professionals implement lifestyle medicine into their clinical practice.

Oska Wellness • Booth #6071 300 Carlsbad Village Drive, #111A, Carlsbad, CA 92008 USA Ph: 844-630-9932 Email: sales@oskawellness.com • Website: www.oskawellness.com Oska Pulse provides clinically proven pain relief in the convenience of a wearable Pulsed Electromagnetic Field (PEMF) device. This FDA registered device is 100% non-drug, non-invasive and has no known side effects. Working at the source of pain, instead of just masking symptoms, Oska Pulse will increase circulation, reduce inflammation, improve mobility and relieve minor to chronic pain.

Oxy Health • Booth #4027 10719 Norwalk Boulevard, Santa Fe Springs, CA 90670 USA Ph: 562-906-8888 • Fax: 562-906-8885 Email: information@oxyhealth.com • Website: www.oxyhealth.com OxyHealth is the world’s leading provider of hyperbaric chambers. Presently, OxyHealth is the pioneer of the industry with over 12,000 chambers in use, more than all other providers combined. OxyHealth continues to remain at the forefront of superior performance, quality and cutting-edge design concepts that far exceed industry safety standards.

Oxygenetix • Booth #7091 9663 Santa Monica Boulevard, Suite 223, Commerce, CA 90210 USA Ph: 888-500-1672 Email: info@oxygenetix.com • Website: oxygenetix.com Oxygenetix the worlds #1 breathable foundation, covers and soothes multiple skin conditions, injuries, wounds, rashes, acne, rosacea and more. Post procedure, patients are assured that their aftercare treatment conceals evidence of laser, peel, or injection. Oxygenetix overcomes social downtime; a patient’s most frequent objection when considering a facial procedure. Oxygenetix reduces patients concerns, converting more consults into procedures. Now available Oxygenetix Acne Control foundation with all of the same benefits plus 2% salicylic acid.

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Park Compounding, Inc. • Booth #1035 9257 Research Drive, Irvine, CA 92618 USA Ph: 949-551-7195 Email: info@imprimisrx.com • Website: www.parkrx.com Park Compounding is dedicated to delivering high-quality medicines to physicians and their patients at accessible prices. Park Compounding offers unique formulations commonly prescribed by physicians specializing in integrative medicines. Our team at Park can assist you with formulations including intravenous nutritionals, vitamins and minerals, botanicals, and many more.

PCCA • Booth #3078 9901 South Wilcrest Drive, Houston, TX 77099 USA Ph: 800-331-2498 • Fax: 281-933-6016 Email: sarthur@pccarx.com • Website: www.pccarx.com PCCA helps pharmacists and prescribers create personalized medicine that makes a difference in patients’ lives. As a complete resource for independent compounding pharmacists, PCCA provides high-quality products, education and support to more than 3,500 pharmacy members throughout the United States, Canada, Australia and other countries around the world. Incorporated in 1981 by a network of pharmacists, PCCA has supported pharmacy compounding for more than 37 years. Learn more at www.pccarx.com.

Pellecome LLC • Booth #7021 111 Canfield Avenue, Suite A-7, Randolph, NJ 07869 USA Ph: 888-773-9969 • Fax: 888-381-3828 Email: info@pellecome.com • Website: www.pellecome.com Pellecome LLC is a company of scientists and clinicians that was established to provide physicians with a safer, faster and more reliable delivery system for bio-Identical hormone pellets, as well as, advanced pellet formulations. Pellecome was created by a physician with a passion for helping his patients achieve a balanced endocrine environment using measured hormone treatments to support their quest for better health. The passion was fueled by over 20 years of experience in BHRT and a long, established clinical practice. Pellecome’s products will include the Re3™ Advanced Pellet Delivery System and Re3™ Advanced Pellet Formulations.

Personalized Nutrients • Booth #3075 68994 North Pine Street, PO Box 2436 Sisters, OR 97759 USA Ph: 541-549-0333 Email: info@personalized-nutrients.com • Website: www.personalized-nutrients.com Personalized Nutrients was created to empower Healthcare Professionals through custom, patientindividualized Nutraceutical formulas.When you’re ready to offer your patients a solution that is 100% designed for them, contact us to get started.

PhotoMed Technologies, Inc. • Booth #7093 65 Franciscan Way, Kensington, CA 94707 USA Ph: 510-526-7373 • Fax: 510-526-2764 Email: allan@photomedtech.com • Website: www.photomedtech.com Featured Product: PhotoMed Technologies introduces its non-invasive light-therapy tool, Vari-Chrome™ Pro, the world’s only variable wavelength device (430-680nm). PhotoMed’s physical therapy product, Vari-Chrome™ Pro, efficiently eases aches & pains by re-synchronizing the body and improving movement and sensation. Now, the practitioner can select wavelengths (precise rainbow colors) to meet the needs of their patients. The device is perfect for practitioners in physical therapy, wellness, Qi-rebalancing, Chakras, and anti-aging.

PHOTOMED ™

TECHNOLOGIES

Physician Compounding Alliance • Booth #8038 3225 Templeton Gap Road, Colorado Springs, CO 80907 USA Ph: 303-495-5525 Email: drinfo.pca@gmail.com • Website: www.physiciancompoundingalliance.com Capture a new stream of revenue while providing patients better care. Physician dispensed and administered compounded drug therapies provide added convenience and improved patient compliance. Formularies are tailored to practice needs. Choose dosage forms best suited to your patient’s needs. [Pellet Implants, Oral, Slow-Release and Sublingual Tablets, Topical Creams, Liquids etc]. Discover how easily you can improve patient care and practice income.

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An Innovative Practitioner-Grade Line of Ketogenic Formulas Meeting the requirements of a ketogenic lifestyle can be challenging. These nutritional formulas are designed to provide quick and convenient ways to support patients in reaching their ketogenic program goals. • Delicious Ketogenic Soup in Savory Chicken flavor • Tasty Ketogenic Shake in Chocolate and Vanilla flavors • MCT Oil & MCT Powder • Exogenous Ketones—designed to induce acute ketosis within 15 minutes!*† Contact your Metagenics representative today to learn more, or visit Metagenics.com/ketogenic

Acute ketosis occurs when blood ketone levels temporarily rise above 0.5 millimoles per liter.

†

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. © 2018 Metagenics, Inc. All Rights Reserved.

Physicians Lab Inc. • Booth #3027 4950 Communications Avenue, 250, Boca Raton, FL 33431 USA Ph: 1-877-316-8686 • Fax: 877-536-4497 Email: info@physicianslab.com • Website: www.physicianslab.com Physicians Lab is the nation’s leading urinary hormone testing facility, delivering State-of-the-art Science with Superior Solutions. We deliver hormone assessment tools* to enhance your knowledge and leadership in the field of hormone therapy with ease and grow your practice.

Plasma Solutions, LLC • Booth #6062 7 West 41st Avenue, #130, San Mateo, CA 94403 USA Ph: 800-353-1507 Email: support@plasma.solutions • Website: www.plasmasolutions.com Plasma Solutions, LLC is a biologics company that develops, manufactures, and markets regenerative medicine products for the repair, restoration and revitalization of damaged and diseased cellular tissue for (i) musculoskeletal injuries and conditions; (ii) peripheral neuropathy, and (iii) non-healing wounds. Acellerate GF™, our proprietary plasma treatment, promotes rapid healing of soft tissue, tendons, ligaments, muscles, bones and joints, and nerves, with minimal to no pain. AGF uses the patient’s own blood, free of infection risk.

Plasma S luti ns

Power2Practice • Booth #6026 2907 Butterfield Road, Suite 100, Oak Brook, IL 60523 USA Ph: 800-590-7459 Email: info@power2practice.com • Website: www.power2practice.com Power2Practice is a driving force in integrative health, helping foster healthier practices and healthier lives. Built on a specialized EMR and practice management platform, P2P helps practices improve their business, simplify care, and increase patient satisfaction.

Predictive Biotech • Booth #6037 2765 East Parleys Way, Suite 205, Salt Lake City, UT 84109 USA Ph: 888-407-9761 • Fax: 801-487-2477 Email: info@predictivebiotech.com • Website: www.predictivebiotech.com Predictive Biotech, Inc., a Salt Lake City, UT life sciences company formed in 2015, is a leader in human cell and tissue products for use in regenerative medicine. A growing national network of clinics, health systems, researchers and physicians leverage Predictive’s four main placental-derived and Wharton’s Jelly umbilical cord-derived products. Predictive Biotech products are regulated by the FDA under 21 CFR part 1271 section 361 as minimally manipulated allografts intended for homologous use.

Premier Research Labs • Booth #8090 3500 Wadley Place, Building B, Austin, TX 78728 USA Ph: 800-325-7734 • Fax: 512-341-3931 Email: vramirez@prlabs.com • Website: www.prlabs.com Premier Research Labs (PRL) was founded to deliver uncompromising quality and effectiveness by providing 100% non-toxic and effective products. In fact, PRL has achieved an industry first in creating premier nutritional products based on quantum cellular resonance technology. Our products are free of undesirable chemical tag-alongs and are designed to deliver the very best quality to you and your patient

P REM IER R ESEARCH L ABS

Prestige Products Direct/ TRIADAER • Booth #9051 12440 Southwest 117th Court, Miami, FL 33186 USA Ph: 305-234-8081 • Fax: 305-234-8053 Email: triadadirect@gmail.com • Website: www.triadear.com Triad Aer, an air purification system that combines three innovative technologies to reduce particles and microbes to create a healthier environment with minimal energy consumption.

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Prevé • Booth #3070 1100 Revolution Mill Drive, Greensboro, NC 27405 USA Ph: 336-235-0750 Email: info@prevewellness.com • Website: www.prevewellness.com The word Prevé means to predict or foresee, and our company’s mission is to empower individuals to proactively foresee a lifetime of health and wellness. We offer our physician and wellness partners an opportunity to both improve their practice economics and provide advanced health and wellness diagnostic metrics for their patients. Our advanced laboratory test offerings combine current health status with predictive health information to provide people with a lifetime of health and wellness.

ProductsthatWork.GURU • Booth #1049 P.O. Box 156, Spring City, UT 84662 USA Ph: 801-787-8835 Email: rod@productsthatwork.guru • Website: www.productsthatwork.guru What if you had a resource that had already done the research, tested the efficacy, had identified “the best” supplement and wellness products the market had to offer, and the entire list was quickly and easily accessible to you? Productsthatwork.guru IS that resource! We have done all of the leg work with you the wellness professional - in mind. Visit our booth #1049 and see for yourself the extraordinary products we’ve selected for you. Learn how you can supplement your Practice income and get paid when you’re not in the office.

Prosoma Therapeutics LLC • Booth #8045 1932 Drew Street, #11, Clearwater, FL 33765 USA Ph: 727-648-2791 • Fax: 727-221-7725 Email: info@prosomacorp.com • Website: www.prosomacorp.net PROSOMA has the science to live better. We manufacture Sarcotropin®, a medical food, containing ingredients that oppose sarcopenia. Sarcopenia is the progressive loss of muscle or lean body mass (LBM) that occurs during aging. Physicians choose Sarcotropin® for their patients’ treatments because of PROSOMA’s commitment to the highest certified Good Manufacturing Practice (cGMP) standards for safety and quality to produce medical foods.

Protocols For Life Balance • Booth #8037 244 Knollwood Drive, Bloomingdale, IL 60108 USA Ph: 877-776-8610 • Fax: 855-833-9012 Email: sales@protocolforlife.com • Website: www.protocolforlife.com Protocol for Life Balance is a well-researched, potent, and efficacious brand of high-quality dietary supplements and natural products sold exclusively through licensed healthcare practitioners. Protocol for Life Balance offers many unique formulas and products that come with a money -back guarantee if any patient is less than 100% satisfied. Our mission is simply to provide quality products that lead to healthy patients and satisfied physicians.

PULS CaRoadiac Test • Booth #3090 13885 Alton Parkway, Suite B, Irvine, CA 92618 USA Ph: 866-299-8998 • Fax: 888-424-7505 Email: info@pulstest.com • Website: www.pulstest.com

C A R D I AC T E ST

The PULS Cardiac Test is a simple, non-invasive blood test that uses 9 protein biomarkers to identify individuals with active, yet undetected subclinical Coronary Heart Disease (the “vulnerable patients”) who are at risk of experiencing an acute coronary event due to endothelial damage leading to unstable lesion rupture, and in whom early intervention can help.

Pure Encapsulations • Booth #8042 490 Boston Post Road, Sudbury, MA 01776 USA Ph: 800-753-2277 Email: info@purecaps.com • Website: www.pureencapsulations.com At Pure Encapsulations, we manufacture hypoallergenic, research-based dietary supplements that are designed to deliver predictable and desired results. We are committed to sourcing pure, premium ingredients and working with experienced healthcare professionals to create safe and effective dietary supplements to help you achieve optimal health. We help provide you with the tools and dietary supplements you need to achieve your health and wellness goals.

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Purium • Booth #7061 14962 East Fantz Avenue, Parlier, CA 93648 USA Ph: 559-999-0216 Email: myleffel@gmail.com • Website: www.wellnessmadebetter.com “Purium” is high concentrations of pure food with no additives of any kind. It’s organic and non GMO. Safe wholesome foods give you high energy and health; so that the body heals and builds itself. Purium doesn’t believe in diets or starving the body. The goal is to feed the body the nutrients needed daily with high nutrition low calorie food. Checkout our 1500 mg CBD spray.

Qest, LLC • Booth #8074 204 West Pope Street, Sylvester, GA 31791 USA Ph: 229-777-7712 • Fax: 229-776-6467 Email: info@naturalsolutionsphc.com • Website: www.naturalsolutionsphc.com Qest, LLC offers the Qest4 Original or Qest4 Mobile Bio-Resonance system. The Qest4 system is a fully automated hardware and software package that allows the technician to “zone in” on problem areas and generate individualized balancing frequencies.

Quicksilver Scientific • Booth #9054 1376 Miners Drive, Suite 103, Lafayette, CO 80026 USA Ph: 303-531-0861 Ex291 Email: support@quicksilverscientific.com • Website: www.quicksilverscientific.com Quicksilver Scientific was founded in 2005 in Lafayette, Colorado. Quicksilver Scientific is a CLIA-certified laboratory specializing in superior liposomal delivery systems and blood metal testing for human health. We use state-of the-art technology, including patented mercury speciation, for the most accurate, reliable testing available on the market. Our liposomal supplements incorporate Quicksilver Delivery Systems™, which brings the power of intravenous therapy to oral delivery and dramatically increases absorption and effectiveness. Our product lines and protocols help restore the body’s natural detoxification system, supporting health and optimum functioning.

Quincy Bioscience • Booth #9044 726 Heartland Trail, Suite 300, Madison, WI 53717 USA Ph: 888-895-6463 • Fax: 608-237-2124 Email: customerservice@prevagenpro.com • Website: www.prevagenpro.com Prevagen, from Quincy Bioscience, is a first in class brain health support supplement that has been clinically shown to help with mild memory problems associated with aging. Only Prevagen contains apoaequorin, an ingredient originally discovered in jellyfish. In a computer assessed, double blinded, placebo controlled study, Prevagen showed the ability to improve aspects of cognitive function in participants with normal to very mild cognitive impairment, as determined by pre-trial screening.

Quten Research Institute • Booth #7075 22 Audrey Place, Fairfield, NJ 07004 USA Ph: 561-445-4828 Email: kim.hassett@mkmkting.com • Website: www.qunol.com When it comes to supplements, it’s not what you take, it’s what you absorb that matters. Qunol®’s formulations are enhanced to provide superior absorption compared to regular forms. Qunol® CoQ10 is a powerful antioxidant that can help support heart and vascular health. It can also help replenish CoQ10 that can be depleted by age and cholesterol-lowering statin drugs. Qunol® Turmeric contains antioxidants called curcuminoids and can help support healthy inflammation response associated with physical overexertion.

ReadiSorb • Booth #7037 555 Bryant Street, 305, Palo Alto, CA 94301 USA Ph: 877-303-3238 Email: info@readisorb.com • Website: www.readisorb.com ReadiSorb is well known for its uniquely formulated Liposomal Glutathione (patented in 2013) that has been manufactured in the U.S.A. since 2004. It has been the subject of 12 peer-reviewed studies archived on PubMed including 2 double-blind placebo controlled clinical trials that showed absorption and immune support. Our popular Liposomal Melatonin and Methyl B-12 sprays are easy to use and work fast. Stop by our booth for more information or a sample!

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Real Ketones • Booth #5100 111 2nd Avenue Street, Suite 1401, Saint Petersburgh, FL 33701 USA Ph: 844-534-3649 Email: danielle@kegenix.com • Website: www.realketones.com N1 Metabolic Research embodies the philosophy that we are not all created equal when it comes to our own metabolic health. We believe that each patient can thrive with a custom program designed specifically for their unique needs. N1 supports this individuality with proven ketone supplementation science that works in targeted ways to produce real, proven results.

Rebel Herbs • Booth #2085 855 South College Mall Road, PMB 161, Bloomington, IN 47401 USA Email: orderrh@nuaxon.com • Website: www.rebelherbs.com We are a line of herbal products made from plants that grow on our certified organic farms in India. We offer the most unique delivery systems in the industry including powerful dual extracted powders, simplified Ayurvedic formulas, massage oils and fast acting herbal vapors. We use no chemicals, no synthetics, no propylene glycol, no vegetable glycerin only pure plant extracts. Let’s simplify Ayurveda for the modern world.

Refine USA • Booth #1062

REFINEUSA AESTHETIC TECHNOLOGIES

340 3rd Avenue South, Jacksonville Beach, FL 32250 USA Ph: 866-590-5533 • Fax: 888-842-0395 Email: support@refineusa.com • Website: www.refineusa.com Refine USA®, LLC located in Jacksonville, FL has been a market leader in manufacturing and distribution of premier aesthetic technologies for over a decade. We pride ourselves in designing and developing medical devices that meet the clinical and financial needs of aesthetic health care providers. The Rejuvapen® Micro-Pigmentation System, the Purespin PRP® System, and the Ontogeny C skincare line are just a few examples of our “market changing” technologies.

Regen Lab • Booth #4073 575 Madison Avenue, Suite 1006, New York, NY 10022-2511 USA Ph: 1800-220-9082 • Fax: 800-220-9082 Email: info@regenlabusa.com • Website: www.regenlabusa.com RegenLab® is recognized as a certified global leader in medical biotechnologies, specializing in cellular therapies. RegenLab® is at the forefront of innovation, with an expertly designed medical device for the preparation of platelet rich plasma from the patient’s own blood. Regen® A-PRP® was developed with a focus on product quality, patient safety, and preparation efficiency. Our patient-centered technology has led to over one million treatments provided worldwide using RegenLab® products. As we look to the future, we are committed to guiding new standards for emerging categories within the field of regenerative medicine.

Regenerative Tissue Science, LLC • Booth #8060 5 Executive Drive, Suite A, Toms River, NJ 08755 USA Ph: 888-779-9225 • Fax: 888-373-0594 Email: marketing@zycalbio.com • Website: www.rts.ostinol.com Using Cyplexinol®, a natural bioactive protein complex which signals stem cells that grow new tissue, Regenerative Tissue Science, LLC (RTS) offers powerful bone, joint and GI products for healthcare professionals and their patients. RTS is committed to the education and distribution of breakthrough products with proven scientific and clinical data, leading the way in natural, regenerative medicine with its flagship product Ostinol™ Advanced. RTS is a wholly owned subsidiary of ZyCal Bioceuticals Healthcare Company, Inc.

Rejuvenation Science • Booth #3039 811 North Catalina Avenue, Stuite 3208, Redondo Beach, CA 90277 USA Ph: 310-798-2830 • Fax: 310-798-2830 Email: sales@rejuvenation-science.com • Website: www.rejuvenation-science.com Rejuvenation Science supplements are recommended by progressive physicians, chiropractors, and naturopathic doctors who practice functional, regenerative, integrative and anti-aging med-icine. Sophisticated supplements contain brand name components used in published research supporting our products. Our Maximum Vitality® is an antioxidant phytonutrient multivitamin, rated for the past 12 years in the top 1 percent of multivitamins in North America. Also phospho-lipid-bound Krill Oil, Telomere Optimizer, Microcontaminant Detox, and Daily Packs.

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IPS IS THE OFFICIAL ACADEMIC PARTNER OF THE A4M OUR GOAL

OUR MISSION

Our goal is to provide the most up to date knowledge and information, to implement the use of these advanced therapeutics in clinical practice. Peptides are taking advantage of our natural physiologic infrastructure, so there is little to no disease or condition that they can’t treat or affect. Almost every specialty is being affected by the development of new peptides and we hope that we will have every specialty involved in sharing the newest and most up-to-date information. Together, we can help influence a pivotal change in medicine, and further the development and expansion of the best treatments available.

The International Peptide Society (IPS) was founded to advance the research and practice of the clinical use of Peptides. At IPS we share the commitment to sound scientific principles and evidence-based medicine, we encourage research and development in these fields to complement therapeutic strategies.

MEMBER-ONLY BENEFITS • The most relevant and up to date full journal articles, not just abstracts. This includes current Peptides in clinical use as well as future Peptides in development. • Access to learning opportunities including conference weekends, bi-weekly webinars, and the annual IPS Congress.

MEMBERS ONLY

$495 *normally

$600

TO OUR LARGEST NATIONAL CONFERENCE

• After completing the A4M certification program you will become eligible for our full fellowship certification program. • Exclusive backend access to the website for the doctor only forum, where doctors can share clinical outcomes, de-identified data pages, and protocols with each other.

International Peptide Society I 4737 N Ocean Dr. Suite #132 Fort Lauderdale, FL 33308

VISIT US AT PEPTIDESOCIETY.ORG

Researched Nutritionals • Booth #2060 PO Box 224, Los Olivos, CA 93441 USA Ph: 800-755-3402 • Fax: 805-693-1806 Email: customerservice@researchednutritionals.com • Website: www.researchednutritionals.com Physician-only line of clinically researched formulations: CytoQuel®-clinical research demonstrated statistically significant pain reduction in just 2 weeks; ATP Fuel®-mitochondrial product with published researched showing 31% fatigue reduction and 30% cognitive improvement; Tri-Fortify™– liposomal glutathione with published research demonstrating 28% increase in red blood cell (intracellular) glutathione in just two weeks; Transfer Factor Multi-Immune™ - demonstrating 620% increase in Natural Killer Cell function.

Rhein Consulting Labs • Booth #4045

R HEIN C ONSULTING L ABORATORIES

4475 Southwest Scholla Perry Road, Suite 101, PORTLAND, OR 97225 USA Ph: 503-292-1988 • Fax: 503-292-2012 Email: ingridnordt@rheinlabs.com • Website: www.rheinlabs.com Rhein Consulting Laboratories, specializing in hormone profiling, is a research driven facility, which provides patients and their physicians with state-of-the-art, cost-effective means of assessing sex and adrenal hormone levels. In contrast to salivary testing, hormones assayed in urine are clinically relevant, accurate, and reproducible as well as widely accepted in medical and academic scientific circles.

RioRoadan Technologies • Booth #1024 11496 Luna Road, 900, Farmers Branch, TX 75234 USA Ph: 972-590-8732 Email: aidan@aidanproducts.com • Website: www.neilriordan.com Riordan Technologies strives to improve the human condition through innovation in scientific research, regenerative medicine, and stem cell therapy. Riordan Technologies comprises companies founded by Neil Riordan, PA, PhD: Dallas-based Aidan Products, Signature Biologics, and Riordan Medical Institute, and Panama-based Stem Cell Institute and Medistem.

Rohrer Aesthetics, LLC • Booth #7065 105 Citation Court, Homewood, AL 35209 USA Ph: 205-940-2200 Email: mportera@rohreraesthetics.com • Website: www.rohreraesthetics.com Rohrer Aesthetics provides lasers, IPL and a RF-Micro-needling system at AFFOrdABLE prices. Our products include the Spectrum, Phoenix CO2 and the PiXel8-RF. The Spectrum is the only multi-platform system that includes 4-lasers, an IPL and is priced under $55,000. The Phoenix CO2 Laser designed for skin resurfacing is priced under $35,000. The PiXel8-RF uses bi-polar, RF energy alongside micro-needles for effective, nonsurgical, skin tightening with little to no downtime and can be placed in your office for $12,500.

Root Of Skin™ MD by AIVITA Biomedical • Booth #4065 18301 Von Karman Avenue, Suite 130, Irvine, CA 92612 USA Ph: 949-872-2555 Email: sales@aivitabiomedical.com • Website: www.rootofskinmd.com ROOT OF SKIN™ MD is a revolutionary new skincare line capturing the unique messaging system and ingredients of skin stem cells to address the visual signs of aging. We capture the complete set of factors, in their natural relative concentrations, from the very cells responsible for the maintenance and renewal of young skin. AIVITA Biomedical, developers of ROOT OF SKIN™ MD, is a therapeutic development company pursuing stem cell-based treatments for debilitating diseases and disorders, including a cancer immunotherapy currently in Phase II clinical trials. Sales of ROOT OF SKIN™ MD products support the treatment of women with ovarian cancer.

RXQ Compounding, LLC • Booth #5063 2364 Blizzard Lane, Albany, OH 45710 USA Ph: 866-280-0031 • Fax: 740-994-3887 Email: info@rxqcompounding.com • Website: www.rxqcompounding.com RXQ Compounding, LLC manufactures sterile and non-sterile medications including products that are on the FDA Short List. RXQ must comply with current good manufacturing practice (CGMP) guidelines and US Pharmacopeia Guidelines (USP) and we are subject to risk based inspections by the Federal Drug Administration at any time. Our products do not require a patient prescription and can be used for office use. We are required by the FDA to follow strict testing standards for sterility, potency, and endotoxins. Guarantee safety, availability, and compliance by making RXQ Compounding, LLC your FDA 503B Outsourcing Facility.

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Regenerative medicine has made incredible strides in the past decade, becoming a revolutionary subspecialty. Comprised of five modular courses, the Stem Cell Therapy Fellowship program has been recently redesigned to fit the educational needs of today’s health professionals and practitioners. The curriculum covers a variety of topics, ranging from the basics of stem cell biology to treatment methods for specific regenerative conditions using novel and cutting-edge therapies. This program features a faculty of top educators and thought leaders in the field of functional and regenerative medicine.

OBJECTIVES

Stem Cell Fellowship ADVANCED MEDICAL EDUCATION

MODULE I:

The Biological and Molecular Basis for Regenerative Medicine

MODULE II:

• Possess a thorough understanding of cell anatomy & biology, and basic stem cell properties and processes.

Best Practices in Cell Biology

• Develop expert understanding of harvesting methods for various stem cell procedures.

In-Office Applications of Regenerative Therapies: Focus on Cardiovascular, Vascular, & Respiratory Conditions

• Demonstrate a working knowledge surrounding cardiovascular, vascular, and respiratory conditions with relation to stem cell therapies. • Understand the treatment of musculoskeletal & neurodegenerative conditions through the use of various stem cell sources. • Learn best practices for implementing and integrating regenerative medical treatments into practice. • Assess the ethical considerations and controversies surrounding cellular therapy, while discussing the risks, benefits, applications, and current legalities surrounding cell cryopreservation and cell banking.

MODULE III:

MODULE IV:

In-Office Applications of Regenerative Therapies: Focus on Musculoskeletal, Neurological & Neuro-Degenerative Conditions

MODULE V:

Stem Cell Harvesting and Isolation (Hands-On)

Modules I-IV are available online.

• Participate in interactive sessions with leading experts practicing live stem cell demonstrations.

www. a4m.com | 561.997.0112

novothor.com

Irrationally Committed, meet Obsessively Engineered. The science of photobiomodulation isn’t new. After thirty years of dedicated study, our extensive knowledge of its application and dose-response relationship has culminated in the NovoTHOR WholeBody Light Pod, a breakthrough device delivering photobiomodulation therapy (PBMT) from head-to-toe.

NovoTHOR embodies our commitment to healing without drugs or surgery, and our mission to design the most effective devices possible. Engineered to exacting standards for dose and wavelength, NovoTHOR produces patient outcomes unmatched by any other device of its kind.

NovoTHOR sessions can be used to achieve the following: ♦ Restoration of motion to joints ♦ Redevelop muscles ♦ Adjunct to obesity as part of a diet and exercise program ♦ Temporary relief of minor muscle and joint aches, pain and stiffness ♦ Relaxation of muscles and relief from muscle spasms ♦ Temporary relief of minor muscle and joint aches, pain and stiffness ♦ Temporary relief of minor pain and stiffness associated with arthritis ♦ To temporarily increase blood circulation

Visit Booth #6043 to see the NovoTHOR in action Mark Granic I mark.granic@thorlaser.com I Toll-free 1 877 355 3151

SALT Chamber, Inc. • Booth #8080 120 Northwest 11th Street, Boca Raton, FL 33432 USA Ph: 855-588-7258 • Fax: 561-244-9914 Email: leo@saltchamberinc.com • Website: www.saltchamberinc.com Headquartered in Boca Raton, Florida, SALT Chamber is the industry leader in educating, consulting, manufacturing, marketing, training, and distributing the most innovative and advanced Dry Salt Therapy products and services around the globe. With decades of combined experience in both the Salt Therapy and Spa industries, SALT Chamber manufactures and distributes Halotherapy equipment, Himalayan salt décor, offers turnkey solution services, and has over 450 installations to date.

Sciton, Inc. • Booth #3038 925 Commercial Street, Palo Alto, CA 94303 USA Ph: 1-650-493-9155 Email: info@sciton.com • Website: www.sciton.com Sciton is committed to providing best-in-class laser and light solutions for medical professionals who want unprecedented product performance, ROI, versatility and reliability. Sciton’s JOULE is the world’s only expandable laser platform with three distinct delivery methods: arm, fiber and BrdBand Light. As a result, practitioners can customize and offer the widest range of aesthetic procedures from a single platform including skin revitalization, vascular and pigmented lesions, body contouring, women’s health, and hair and specialty applications.

seca • Booth #7032 13601 Benson Avenue, Chino, CA 91710 USA Ph: 800-542-7322 • Fax: 888-705-7397 Email: info.us@seca.com • Website: www.mbca.seca.com seca medical Body Composition Analyzer (mBCA) is the first and only body composition analyzer designed for medical use, and validated to the Four Compartment Model - the gold standard for fat mass calculation. Improve BHRT results with early detection of aromatase activity. Gain insights on how treatment is effecting visceral fat and assess water weight versus muscle mass fluctuations to determine the best approach to optimize therapy.

SilverLeaf Global LLC • Booth #8100 PO Box 409, Moscow, PA 18444 USA Ph: 570-904-8791 • Fax: 570-955-3783 Email: stephanie@silverleafglobal.com • Website: www.silverleafglobal.com SilverLeaf Global, LLC is the marketing and distribution arm for Lea Black Enterprises. The LEA BLACK BEAUTY COLLECTION contains a number of customized skin care products synergistically aligned with antiaging goals and objectives. Lea Black (LB) products are established and scientifically proven by clinical tests. LB Beauty Products are globally renowned due to LB optimal skin care solutions consistently producing a notable youthful appearance. Lea Black is also an author and star on The Real Housewives of Miami.

Sovereign Laboratories • Booth #4033 2020 ContraCourtors Road, Suite 5, Sedona, AZ 86336 USA Ph: 928-202-4031 • Fax: 928-862-4039 Email: info@sovereignlaboratories.com • Website: www.sovereignlaboratories.com Sovereign Laboratories is dedicated to developing natural products that provide the most efficacious solutions for optimal health, vitality, and aesthetics. Sovereign Laboratories’ signature product Colostrum-LD® is clinically proven to heal the G.I. lining; prevent infection and inflammation of the bowel; and increase bowel surface area for better nutritional absorption. Colostrum-LD® is considered the premier foundational supplement for optimal gut and immune health, and it was designed for successful aging no matter where one is on the spectrum of life.

Specialty MED Training • Booth #2035 19646 Dinner Key Drive, Boca Raton, FL 33498 USA Ph: 561-408-7248 Email: info@specialtymedtraining.com • Website: www.specialtymedtraining.com Specialty MED is a national training, research and marketing company; dedicated to helping physicians bring the latest regenerative therapies and treatment options to their patients. Our mission is to provide and collect the most current scientific and clinical data to drive protocol and best practice decisions while leading the path towards evidence-based medicine.

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Spectracell • Booth #2021 10401 Town Park Drive, Houston, TX 77072 USA Ph: 800-227-5227 • Fax: 713-621-3234 Email: spec1@spectracell.com • Website: www.spectracell.com The SpectraCell Solution: SpectraCell Laboratories, the leader in functional nutritional test-ing, now ffers comprehensive hormone testing and a cardiometabolic panel which includes a pre-diabetes risk score. Combined with our genetic test menu, SpectraCell offers the most integrative lab diagnostics for personalized medicine.

Standard Process Inc. • Booth #7036 1200 W Royal Lee Dr., Palmyra, WI 53156 USA Ph: 262-495-3069 Email: info@standardprocess.com • Website: www.standardprocess.com Since 1929, Standard Process® has been a visionary leader in whole food nutrient solutions. The company creates quality nutritional supplements based on the whole food philosophy of its founder, Dr. Royal Lee. Palmyra, Wisconsin-based Standard Process also offers Veterinary Formulas? and is the exclusive U.S. Distributor of MediHerb® herbal supplements.

Stellar Biomolecular Research • Booth #4074 Asia Pacific Fulfillment Centre, Wisma NXG Unit 67 & 68, Block K, Kota Kinabalu, MY16 88450 MY Ph: 6088-448 989 • Fax: 608-844-7676 Email: info@sbi-europe.com • Website: www.sbi-europe.com Stellar Biomolecular Research is a German scientific research company specializing in the emerging fields of integrative, regenerative and biological medicine. With the rapidly growing interest towards these specialized fields, the company also provides training and consulting services for its clients worldwide. The areas of consulting expertise include the commercialization strategies and management of integrated biological laboratory and biological medicine centers, as well as clinical and technical trainings on integrative, regenerative and biological medicine.

Stratpharma • Booth #7097 7676 Hazard Center Drive, Suite 880, San Diego, CA 92108 USA Ph: 619-930-5788 • Fax: 619-930-5788 Email: cbentzel@us.stratpharma.com • Website: www.stratpharma.com Stratpharma Switzerland AG specializes in innovative film-forming full-contact topical medical products to improve medical and aesthetic outcomes in post-procedure care in aesthetic dermatology, plastic surgery, and oncology. Our product portfolio features breakthrough technology in wound, scar and radiation dermatitis. Portfolio comprise: Strataderm (a scar therapy gel), Stratamed (an advanced film-forming wound dressing), Stratacel (an advanced dressing for fractional procedures) and StrataXRT (the only self-drying wound dressing for the prevention and treatment of radiation dermatitis).

Surgenex • Booth #4097

SURGENEX Pioneering the Future Today

15444 North 76th Street, Suite 110, Scottsdale, AZ 85260 USA Ph: 877-880-1862 • Fax: 602-900-9960 Email: andrewrichetto@surgenex.com • Website: www.surgenex.com SURGENEX® is the producer and distributor of the highest quality of amniotic membrane tissue allograft in the industry. Our bioactive amnion products are used for a wide variety of clinical applications including orthopedics, sports medicine, podiatry, pain management and wound care. The Company has developed innovative processes and safety protocols, which deliver the highest tissue viability and safety standards.

SYGENX, INC. • Booth #5096 10245 West Little York Road, Suite 400, Houston, TX 77242 USA Ph: 1-800-218-3199 Email: info@sygenx.com • Website: www.sygenx.com Sygenx, Inc. provides cutting-edge regenerative therapies and products that facilitate restoration. We offer the highest of product quality, physician education, and patient satisfaction. Our goal is to discover and bring to the forefront “Science for an Active Life” through therapies and medications to license and develop for market opportunities.

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Syneron Candela • Booth #7100 530 Boston Post Road, Wayland , MA 01778 USA Ph: 949-716-6670 Email: info@syneroncom • Website: www.syneron-candela.com Syneron Candela is a leading global aesthetic device company with a comprehensive product portfolio. The Company’s technology enables physicians to provide advanced solutions for a brd range of applications including body contouring, hair removal, tattoo removal, wrinkle reduction, and the treatment of vascular/pigmented lesions, acne, leg veins and cellulite.

TA Sciences • Booth #5007 420 Lexington Avenue, Suite 2900, New York City, NY 10170 USA Ph: 888-360-8886 • Fax: 212-588-0058 Email: eric@tasciences.com • Website: www.tasciences.com T.A. Sciences® is the first healthcare company dedicated exclusively to creating research-based, clinically tested wellness products that help address cellular aging through the science of telomerase activation. TA-65® is a patented, all natural, plant-based compound which can help maintain or rebuild telomeres. It is currently available in TA-65MD® Nutritional Supplements, in 250 unit and 100 unit capsules, and TA-65® for Skin which provides cosmetic benefits in all layers of the skin.

Tailor Made Compounding • Booth #6021 200 Moore Drive, Nicholasville, KY 40515 USA Ph: 859-887-0013 • Fax: 59-406-1242 Email: admin@tailormadehealth.com • Website: www.tailormadecompounding.com Tailor Made Compounding pharmacy has established itself as a leading compounding pharmacy specializing in tailor made medications and peptides, providing a high level of patient care to compliment physician’s therapies, and forming a holistic prescriber-pharmacy-patient interface. Located in Nicholasville, Kentucky we are able to provide you with all your compounding needs.

Tanita Corporation of America • Booth #3071 2625 South Clearbrook Drive, Arlington Hights, IL 60005 USA Ph: 847-640-9241 • Fax: 847-640-7978 Email: 4health@tanita.com • Website: www.tanita.com Tanita is a world leader in weight and body composition measurement. For more than 70 years the quality and accuracy of our products have made Tanita THE STANDArd by which other scales and body compositions monitors are measured. Tanita offers a full line of innovating, versatile, and easy to use scales and monitors used by people around the world.

Terra Biological LLC • Booth #4060 3830 Valley Centre Drive, Suite 705 PMB 561, San Diego, CA 92130 USA Ph: 858-947-5722 • Fax: 888-850-3455 Email: acash@benagene.org • Website: www.benagene.com Terra Biological researches enhancements to metabolism for improvement of the human condition. Our flagship product, benaGene (oxaloacetate) continues to provide more energy, more health and more life to our customers. benaGene is now being examined by many researchers for its ability to mimic the calorie restricted metabolic state, increasing the NAD+/NADH ratio, activating AMPK, reducing free glutamate, increasing mitochondrial density, and supporting oxidative phosphorylation within the cells.

The CORE Group • Booth #9090 40 Hampshire Road, Mahwah, NJ 07430 USA Ph: 800-650-4234 Email: rxdispensing@vanguardpharma.com • Website: www.coregroupmedical.com The CORE Group (Clinical Outcomes + Revenue Enhancement) brings you products that drive positive outcomes for patients as well as increase incremental revenue to your practice. Whether you’re a cash only practice or work with insurance, our prescription medication dispensing program works with your patients’ prescription coverage plans to open a significant new revenue stream! We do the work to license and credential you, and then we manage the program with exceptional service to you!

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THOR Photomedicine • Booth #6043 5021 Michael’s Meadow Drive, Hampstead, MD 21074 Ph: 877-723-4804 Email: valerie@thorlaser.com • Website: www.novothor.com THOR Photomedicine specializes in developing technologies for delivering PBM Therapy (formerly LLLT). Our hand-held LX2 and NovoTHOR Whole-Body Light Pod have become indispensable tools for over 3,000 customers in pioneering clinics and hospitals across 70 countries. We are the only PBM Therapy company with the appropriate FDA, CE, TGA, Health Canada and NATO clearances/approvals. Our dedication to R&D are what sets THOR Photomedicine apart from all other manufacturers. THORlaser.com | novothor.com

Tree Top Essentials • Booth #7092 2315 Asheville Highway, Suite 60, Hendersonville, NC 28791 USA Ph: 828-623-9880 • Fax: 828-698-1572 Email: treetopessentials@gmail.com • Website: www.treetopessentials.com Tree Top Essentials is engaged in exploring targeted essential oil therapy. With a team consisting of a well respected physician and two experienced compounding pharmacists we hope to expand applications of essential oils to better serve our customers. We are proud to present Essential Blend Soreness Relief.

Soreness Relief Contains Natural Essential Oils Net wt 2.12 oz(60g)

Tru Niagen® • Booth #6095 10005 Muirlands Boulevard, Suite G Irvine, CA 92618 USA Ph: 888-642-4361 Email: customercare@truniagen.com • Website: www.truniagen.com TRU NIAGEN® is a next-generation form of vitamin B3 clinically-proven to safely and effectively increase levels of the critical co-factor nicotinamide adenine dinucleotide (NAD). NAD regulates the response of important genetic pathways to stressors, including aging. Increased NAD levels encourage healthy mitochondrial function, stimulate cellular energy production, and support healthy sirtuin activity. Learn more at truniagen.com.

True Health Diagnostics • Booth #3073 3803 Parkwood Boulevard, Suite 400, Frisco, TX 75043 USA Ph: 1-877-443-5227 Email: info@truehealthdiag.com • Website: www.truehealthdiag.com True Health Diagnostics specializes in earlier-stage diagnosis and prevention of chronic disease, including allergy, diabetes, cancer, genetic disorders and autoimmune disease. True Health is a CLIA-certified, CAP-accredited laboratory leader in comprehensive biomarker testing focused on transforming patient care through integrated diagnostics and healthcare services. True Health is headquartered in Frisco, Texas, with operations across the country.

TrueDark • Booth #9010 1819 Central Avenue South, Suite D54, Kent, WA 98032 USA Ph: 206-227-5910 Email: info@truedark.com • Website: www.truedark.com TrueDark is a health and wellness technology brand that is committed to improving health and performance through the use of light. We help the world stop junk light, then recognize and harness healthy light for your sleep-wake cycle, healing, and more. Our products, tools and education help your control the light in your environment. Through the use of patented light blocking/filtering eyewear and innovative red light therapy devices, our goal is to help you sleep, feel and perform better.

U. S. Jaclean, Inc • Booth #1027 - #7046 1816 West 135th Street Gardenia, CA 90249 USA Ph: 310-538-2298 • Fax: 310-538-4521 Email: order@usjaclean.com • Website: www.daiwamassage.com Health And Wellness Massage Chair Company

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Ulta Lab Tests • Booth #3081

Ulta Lab Tests

Know Your Health, One Lab Test at a Time!

8436 East Shea Boulevard, Suite 102, Scottsdale, AZ 85260 USA Ph: 480-681-4081 Email: contactus@ultalabtests.com • Website: www.ultalabtests.com Ulta Lab Tests provides discounted laboratory services through a free web-based practice solution that is easy to use. Save your patients up to 90% on Quest Diagnostics tests. Select from over 2,000 tests, 400 panels, and create custom panels to use with “Quick Order.” Specimens may be collected onsite or at one of 2100 locations nationally. Most results are available in 12 - 48 hours and reports can be aggregated to show patient outcomes over time.

University Compounding Pharmacy • Booth #6013 1875 Third Avenue, San Diego, CA 92101 USA Ph: 619-683-2005 • Fax: 619-683-2008 Email: info@ucprx.com • Website: www.ucprx.com University Compounding Pharmacy specializes in the formulation of drugs that are not com-mercially available. Our pharmacists use state of the art technology with quality chemicals so that your finished medication meets the doctor’s exact specifications. We employ the highest standards in compounding, following nationally recognized United States Pharmacopoeia. In addition to the highest quality of compounds, UCP prides itself with providing the best physician and patient experience.

US Biotek Laboratories • Booth #1032 16020 Linden Avenue North, Shoreline, WA 98133 USA Ph: 877-318-8728 • Fax: 206-363-8790 Email: reporting@usbiotek.com • Website: www.usbiotek.co Antigen-specific IgA & IgG for Foods, Inhalants, and Candida panels. All ELISA testing is conducted in duplicate for assured precision, reproducibility, and accuracy. Chemiluminescence robotic-systems are employed to focus on IgE Foods, Molds, & Regionalized Inhalant Panels and Celiac Disease. Urine Organic Acidsand Environmental Pollutantsvia LC-triple quadrapole-MS/MS: dried urine spot collection. CLIA-certified and accredited, COLA-compliant and CAP-surveyed. Competitively Priced. Dried blood or urine spot used for most assays. US BioTek Laboratories is here for you. Serving the World. 877-318-8728

Venus Concept • Booth #3057 255 Consumers Road, Suite 110, Toronto, ON M1J 2R4 CA Ph: 888-907-0115 • Fax: 855-907-0115 Email: events@venusconcept.com • Website: www.venusconcept.com Venus Concept is a global leader in the medical aesthetics device industry. We are present in 60 countries and offer cutting-edge devices that address the most in-demand aesthetic needs. Together with innovative technology, Venus Concept operates with a unique business model that offers the first and only subscription plan.

vFit PLUS • Booth #3095 1430 34th Avenue, Seattle, WA 98122 USA Ph: 844-872-8578 • Fax: 206-219-6445 Email: hello@getvfit.com • Website: www.getvfit.com vFit PLUS is the first energy-based home-use intimate wellness device sold exclusively through doctors in the U.S. OB/GYN designed and scientifically validated, vFit PLUS allows you to capitalize on the explosive intimate wellness market and complement your existing wellness treatments without large capital investments. vFit PLUS is designed by Joylux, a global women’s health technology company offering patented light-energy, home-use, intimate wellness devices under the vFit and vSculpt brands.

Vibrant America • Booth #2039 1021 Howard Avenue, Suite B, San Carlos, CA 94070 USA Ph: 866-364-0963 • Fax: 650-508-8262 Email: support@vibrant-america.com • Website: www.vibrant-america.com Our passion to serve physicians and patients drive our technology to provide the highest quality testing with shorter turnaround times. Our comprehensive test menu includes celiac disease, wheat & gluten sensitivity, leaky gut syndrome, food sensitivities, connective tissue, inflammation, and micronutrient deficiencies.

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Vielight Inc • Booth #9026 346A Jarvis Street, Toronto, ON M4Y2G6 CA Ph: 1-877-355-8012 Email: dominic@vielight.com • Website: www.vielight.com Vielight Inc is poised at the forefront of brain photobiomodulation technology. We combine science with engineering ingenuity to develop devices that incorporate novel methods of delivering photons to the brain and inner systems.

Viome • Booth #9009 20380 Town Center Lane, Suite 240, Cupertino, CA 95014 USA Ph: 505-672-5785 Email: info@viome.com • Website: www.viome.com Viome offers personalized recommendations based on an analysis of your unique gut microbiome all in the convenience of an app. First, we send your easy to use at-home kit to collect samples from you. Then, we analyze your samples in order to understand what nutrients and toxins are being produced by your gut organisms. Finally, we recommend which foods to enjoy and which foods to minimize to balance your gut microbiome.

Virtual Health Partners • Booth #3084 106 East 19th Street, 2nd Floor, New York, NY 10003 USA Ph: 1-877-586-1733 Email: info@virtualhp.com • Website: www.virtualhealthpartners.com

enticity.ca

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Vita Aid Professional Therapeutics • Booth #3049 #302-20285 Stewart Crescent, Maple Ridge, BC V2X 8G1 CA Ph: 604-465-1688 • Fax: 604-465-1299 Email: info@vitaaid.com • Website: www.vitaaid.com With 20+ years of experience in the natural health industry, Vita Aid Professional Therapeutics strives to provide high-quality and effective nutraceuticals for health care practitioners worldwide. We focus on products for safe and effective therapeutic use and follow strict pharmaceutical-grade standards. What differentiate Vita Aid from others are: *Exclusive to health care practitioners/ *Clinical evidence based formulations/ *No added stearic lubricants, for higher bioavailability of the active ingredients/ *Vegetarian formulas.

Vital Choice Wild Seafood • Booth #6064 PO Box 4121, Bellingham, WA 98227 USA Ph: 800-608-4825 Email: info@vitalchoice.com • Website: www.vitalchoice.com Vital Choice is the leading source for fast home delivery of the world’s finest wild Alaskan seafood, Omega-3 rich supplements, and certified organic fare – the purest foods available. The company is committed to providing an unsurpassed level of purity and nutritional value for optimal wellness. Vital Choice products are recognized for their superior taste and health benefits, and are endorsed by world renown thought leaders and leading health and wellness experts.

W ILD S EAFOOD & O RGANICS

Vitelle Labs • Booth #1040 120-8365 Ontario Street, Vancouver, BC V5X3E8 CA Ph: 1-877-902-2332 • Fax: 604-279-5519 Email: info@vitellelab.net • Website: www.vitellelab.com Vitelle Labs is the manufacturer behind many recognizable brands in the professional skincare market. For over 20 years Vitelle has created unique, powerful skincare offered for private branding. INCEPTION MD is an outstanding turnkey medical skincare collection formulated for doctors seeking private branding opportunities. As a Vitelle customer you will have access to a wide range of packaging; graphic design services and product support. We are known for exceptional quality natural-source; plant-derived formulations synergistically enhanced with intensive concentrations of cosmeceuticals.

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Viveve, Inc • Booth #2033 345 Inverness Drive South, Building B, Suite 250, Englewood, CO 80112 USA Ph: 720-696-8100 • Fax: 720-696-8199 Email: lscarafiotti@viveve.com • Website: www.viveve.com Viveve, Inc. is a global women’s intimate health company. Viveve has the only system indicated for treatment of urinary incontinence, vaginal laxity or sexual function in more than 60 countries, and for electrocoagulation and hemostasis in general surgery in the U.S. Viveve is a single session, cryogen-cooled monopolar radiofrequency (CMRF) treatment. InControl Products by Viveve, treat all forms of incontinence by strengthening the pelvic floor muscles and calming the detrusor muscle. Together, these products make up the Viveve Solutions.

Viviscal Professional • Booth #2038 500 Charles Ewing Boulevard, Ewing Township, NJ 08628 USA Ph: 888-444-9084 Email: info@viviscalprofessional.com • Website: www.viviscalprofessional.com ViviscalPRO is a 100% drug free nutraceutical that nourishes hair follicles from the inside out. Available exclusively in salons and doctors’ offices, the effectiveness of this #1 clinically proven supplement is backed by numerous clinical trials and more than 25 years of continuous research and development. XFusion Hair Fibers are made of all-natural keratin protein that clings to existing hair to hide fine or thinning areas.

Web.com • Booth #4063 12808 Gran Bay Parkway West, Jacksonville, FL 32258 USA Ph: 800-862-8921 • Fax: 844-479-9729 Email: shows@web.com • Website: www.web.com Web.com Group, Inc. provides a full range of Internet services to small businesses to help them compete and succeed online. Web.com is owner of several global domain registrars and further meets the needs of small businesses anywhere along their lifecycle with affordable, subscriptionbased solutions including website design and management, search engine optimization, online marketing campaigns, local sales leads, social media, mobile products, eCommerce solutions and call center services.

WebtoMed • Booth #3060 900 National Parkway, Suite 470, Schaumburg, IL 60173 USA Ph: 866-999-8550 Email: info@webtomed.com • Website: www.webtomed.com WebToMed™ helps healthcare practitioners reach qualified patients, generate more appoint-ments and grow their practices through innovate digital marketing solutions including search engine optimization, patient education, responsive website design, email marketing and social media marketing.

WeightLoss MD Training • Booth #1058 9925 Haynes Bridge Road, Suite 320, Alpharetta, GA 30022 USA Ph: 678-517-1069 • Fax: 770-777-7459 Email: dave@weightlossmdtraining.com • Website: www.weightlossmdtraining.com We offer Medical Professionals a complete business model for comprehensive medical weight loss. Our job is to teach you how to make your patients healthier and your practice more profitable. Whether you have an existing practice or are starting a new brick and mortar clinic we have a solution for you.

Wellness Pharmacy • Booth #8072 3401 Independence Drive, Suite 231, Birmingham, AL 35209 USA Ph: 800-227-2627 • Fax: 800-369-0302 Email: info@wellnesspharmacy.com • Website: www.wellnesspharmacy.com With 50 years of compounding experience, Wellness Pharmacy® is considered the industry leader in quality and customer service. Some of our specialties include chelation, bio-identical hormones, autism support, thyroid preparations, antifungals, pain gels and a large selection of preservative-free injectables. Wellness Pharmacy® is also the only pharmacy to successfully patent the preparation of injectable glutathione, guaranteeing that you are receiving one of the most stable and potent formulas available. PCAB Accredited ™ (800) 227-2627 www. wellnesspharmacy.com

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Wells Pharmacy Network • Booth #4007 1210 Southwest 33rd Avenue, Ocala, FL 34474 USA Ph: 800-622-4510 • Fax: 877-401-5653 Email: info@wellsrx.com • Website: www.wellsrx.com Wells Pharmacy Network is a compounding pharmacy operating as a 503A pharmacy in Florida and a FDA Registered 503B Outsourcing pellet & numbing cream facility in Tennessee. Wells specializes in wellness, anti-aging, sexual health, peptide & regenerative therapy, and weight management. Our comprehensive formulary encompasses an array of strengths and sizes of medications including testosterone, hCG, and vitamin injectables. Preparations come in many dosage forms such as creams, capsules, injectable, troches and sterile implantable pellets.

Women’s International Pharmacy • Booth #9033 2 Marsh Court, Madison, WI 53718 USA Ph: 800-279-5708 • Fax: 800-279-8011 Email: info@womensinternational.com • Website: www.womensinternational.com Women’s International Pharmacy specializes in custom compounded bioidentical hormone prescriptions for men and women. Our pharmacy earned accreditation through the Pharmacy Compounding Accreditation Board (PCAB) by following stringent proficiency and quality assurance standards. Our pharmacists focus on meeting individual needs for licensed medical practitioners and their patients. Whether you are a practitioner or patient you can be assured Women’s International Pharmacy is here for you and we respect your freedom of informed personal choice.

Y LIFT • Booth #5027 2 East 61st Street, Suite 413, New York, NY 10065 USA Ph: 212-861-7787 Email: info@ylift.com • Website: www.ylift.com Founded and developed by Dr. Yan Trokel, a board certified surgeon specializing in facial aesthetics, the Y LIFT® is a revolutionary non-surgical, minimally invasive facial contouring procedure based on Dr. Trokel’s Structural Volumizing® technique yielding beautiful, natural, and instantaneous results. Y LIFT® restores youthful facial contours by replenishing lost volume in specific anatomic layers and zones utilizing a specialized anatomically correct marking device, resulting in a dramatic rejuvenation of the face and upper neck.

Zimmer Aesthetic Division • Booth #4036 3 Goodyear, Suite B, Irvine, CA 92618 USA Ph: 800-327-3576 • Fax: 949-727-2154 Email: info@zimmerusa.com • Website: www.zimmerusa.com Zimmer USA, with its parent company in Neu-Ulm, Germany, has 45 years of expertise in manufacturing high quality medical devices. Zimmer rapidly evolved as a global leader in the aesthetic industry. Zimmer’s Aesthetic Division offers award-winning devices for the treatment of cellulite and enhancing body shaping, as well as skin cooling during laser and other dermatological treatments. The company’s flagship products, Z Wave and Z Cryo, utilize advanced Radial Pulse Therapy and Cryo Therapy technologies.

Zizion Group Inc. • Booth #4054

Zizion

141 Northwest 20th Street, Suite G1, Boca Raton, FL 33431 USA Ph: 561-221-1000 • Fax: 561-526-2400 Email: info@zizion.com • Website: www.zizion.com Zizion Group is a medical distribution company with a focus on natural integrative therapies. We bring technologically advanced products, targeted training, and innovative marketing expertise, to empower physicians to expand their practice. We are an end-to-end provider, identifying appropriate solutions and deployment methodologies while working with your team to ensure success. You are never considered a customer; you are a valued physician partner.

ZRT Laboratory • Booth #7007 8605 Southwest Creekside Place, Beaverton, OR 97008 USA Ph: 866-600-1636 • Fax: 503-466-1636 Email: amslater@zrtlab.com • Website: www.zrtlab.com Since the beginning, ZRT has maintained a singular focus: helping people get and stay healthy. This people- first mindset means that while our results are complex, our tests are not. The education and support we provide helps practitioners understand how to use our results to improve patient health. And while our range of test methodologies and technologies has multiplied over the years, our commitment to end-user simplicity hasn’t wavered. With 20 years of experience and results from over eight million tests, ZRT Laboratory is a recognized leader in innovative, safe, and meaningful hormone and wellness testing.

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ZYTO • Booth #1033 1172 West, 700 North, Suite 300, Lindon, UT 84042 USA Ph: 801-224-7199 Email: info@zyto.com • Website: www.zyto.com ZYTO’s innovative decision support technology takes the guesswork out of choosing nutritional products and wellness options. The scanning involves presenting questions in the form of digital signatures that the body answers directly. The ZYTO hand cradle then measures the body’s galvanic skin response to produce an easy-to-read report that displays a ranking of items whose corresponding digital signatures resulted in greater biological coherence, or preference.

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The national conference on pain for frontline practitioners.

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Global Education Group (Global) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education to physicians. Global Education Group designates this live activity for a minimum of 36.0 AMA PRA Category 1 Credit(s)â&#x201E;˘. This activity will be approved for continuing pharmacy, psychology, nurse practitioner, nursing, and dentistry education. Applications for certification of social work NASW and family physician AAFP hours will be applied for. For more information and complete CME/CE accreditation details, visit our website at www.painweek.org.

MARCH

DECEMBER

Marriott Marquis Houston Houston, TX

Venetian/Palazzo Las Vegas, NV

Clinical Endocrinology Spring Symposium March 7-9 Modules II: Cardiology March 7-9

World Congress December 13-15

SEPTEMBER

ABAARM & ABAAHP Written Exams December 12

Marriott Marquis San Diego Marina San Diego, CA

ABAARM Oral Exams December 13-15

Clinical Endocrinology Fall Symposium September 26-28

Module I - Endocrinology December 13-15

ABAARM & ABAAHP Exams September 25-28

Module V: Clinical Intensives December 13-15

Module III: Neurology September 26-28

Online Certifications

MAY Gaylord Palms Orlando, FL Spring Congress May 16-18 ABAARM & ABAAHP Written Exams May 15 ABAARM Oral Exams May 16-18 Module V: Clinical Intensives May 16-18

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