Q & A with Terry Grossman M.D. Medical Director, Grossman Wellness Center, Lakewood CO

Q: I have been reading about Metformin and how it is now being used to treat several other diseases besides diabetes. Can you elaborate on any new findings?
A: The only FDA-approved use for metformin is in the treatment of non-insulin-dependent or type II diabetes. However, conventional physicians have been using metformin to treat other conditions such as PCOS (polycystic ovary syndrome), antipsychotic drug-induced weight gain and NAFLD (non-alcoholic fatty liver disease) for many years. More recently, complementary physicians have begun to utilize metformin in their practices in other ways. These include the prevention and treatment of cancer and as a calorie restriction (CR)-mimetic or mimic. It has been well known since the 1930s that cancer cells can only subsist on a diet of sugar or glucose. The use of metformin capitalizes on this "Achilles heel" of cancer cells. By reducing circulating blood sugar levels, metformin essentially starves them. Over the past several years, a number of studies have appeared in the peer-reviewed medical literature demonstrating that metformin users tend to develop cancer at a lower rate than non-metformin users and diabetic cancer patients treated with metformin respond dramatically better to chemotherapy and other cancer treatments compared to diabetics who rely on other medications including insulin. In addition, the only proven method of consistently extending lifespan in animal experiments is by way of restricting their calories. CR or calorie restriction, however, is very difficult for the overwhelming majority of humans, yet it appears that metformin results in many of the same biochemical processes taking place within the body as occur when full-blown caloric restriction is performed. Elegant gene studies have shown that metformin turns on youthful genes and turns off aging genes in a fashion very similar to caloric restriction. Mice given metformin in their drinking water lived 37% longer. As a result, some anti-aging physicians are now recommending metformin to their nondiabetic patients. Metformin is safe, inexpensive, and, taken properly, (under physician supervision) remarkably free of side effects.

Q: Why would banking stem cells from skin be preferred over the banking of stem cells from fat or marrow?
A: There remains debate among stem cell researchers as to the relative value or potency of bone marrow versus fat- or skin-derived stem cells. It is my personal belief that bone marrow stem cells may have increased viability and plasticity compared to skin- or fat-derived stem cells, but there are dramatically more stem cells in skin and fat and they are far, far easier to access. Relatively few people would be willing to undergo a bone marrow aspiration, a painful procedure, just to bank their stem cells. Similarly, few people would be willing to undergo liposuction just to obtain fat for the purpose of storing their stem cells. As such, if an individual is simply interested in stem cell banking, a skin biopsy would seem to make the most sense. If, however, an individual is already undergoing liposuction for another purpose such as body sculpting, then it would be a simple matter to take some of this fat, extract the stem cells and bank them for future use.

Q:Is there any benefit for someone who has a chronic disease to bank their stem cells or is it only an option for healthy, young people?
A: The answer to this question depends on the nature of the underlying disease. A patient with a genetic or systemic disorder that affects all of their cells might not be helped by being treated with their own stem cells. In this case, allogenic cells (coming from someone else) would be needed.

Q: Are older people less likely to have good quality stem cells that could be banked? Are you banking skin stem cells for kids and pets too? Can they be stored indefinitely? Is it expensive to extract them and then store them?
A: Like all the cells in the body, stem cells are continuously growing older and undergoing the aging process. The reality is, however, that you are never going to be any younger than you are right now, so by banking stem cells today, an individual has the opportunity to, in effect, "freeze themselves in time."
Stem cell banking today ranges in price from $3500 for skin-and fat derived stem cell storage up to $8000 or more for bone marrow-derived stem cells. These prices typically include the first year of storage and then run about $150-$200 annually for the storage fee. It is unknown how long frozen stem cells will remain viable, but most researchers think at least 20 years and banking can be done for children and pets.

Q: I have read that testosterone should not be taken by men who have prostate cancer. I have also read that it should be. There are so many conflicting reports about some things that I have no idea what is true or not. What do you say?
A: Virtually everything that physicians believe in the world of hormones seems to change radically every few years. The conventional wisdom just a few years ago was that testosterone was dangerous and was related to the development of prostate cancer. Recent studies, notably by Dr. Abraham Morgenthaler of Harvard, suggest that the truth is exactly the opposite and that low levels of testosterone increase a man's risk of prostate cancer. If a man already has prostate cancer and takes testosterone, it is possible for the prostate cancer to grow more quickly, but testosterone itself does not cause prostate cancer and may help prevent it. Once an individual is diagnosed with prostate cancer and successfully undergone treatment, there may be a time and a place for the use of testosterone therapy as part of that individual's follow-up protocol, but this needs to be done under the guidance of a physician who specializes in the treatment of prostate cancer.

Q: Do you think hormone replacement therapy is a good idea in general for the aging population or is it more a case by case decision?
A: Like most things in medicine, there is no one-size-fits-all for hormone replacement therapy. I make it a point to check hormone levels on the majority of patients who consult with me at Grossman Wellness Center in Denver. I have been shocked to find the number of young people, men and women in their 20s and 30s, not to speak of individuals in their 40s, 50s, 60s and beyond, who have not merely sub optimal hormone levels, but levels that are frankly low. For these individuals, we discuss the value of hormonal therapies on a case-by-case basis, weighing the risks versus the benefits and also the patient's preferences. I feel the use of bio identical hormones (hormones chemically identical to those found naturally in the body) have a high margin of safety and an acceptable risk:benefit ratio. The beneficial changes seen in individuals with low hormone levels after optimizing them are among the most gratifying things that I see as a practicing physician.

Q: What kind of diseases could be treated with skin stem cells? If we can't get treated in the U.S. because of the FDA, then what is the purpose of banking them?
A: The FDA suggests that patients in the United States undergoing stem cell therapies do so as part of approved trials since the FDA has not approved any stem cell therapies as yet. This situation will not last forever and, in the not-too-distant future, I am confident that the FDA will approve a number of stem cell therapies in the United States. At that time, individuals who have banked their cells will have access to the most youthful stem cells possible for their future use when these therapies are approved. In the interim, should they need to undergo a stem cell therapy that is unavailable at the present time in the United States, they are free to take their stem cells out of the country and undergo treatments elsewhere.

Q: I am confused as to what hormone replacement therapy is. Does it involve injections, supplements, or what and what is the goal? Can it have side effects?
A: Hormone therapy involves the use of synthetic hormones to raise the levels in people who are low. Some hormones such as DHEA, pregneneolone, some forms of progesterone and melatonin are available over-the-counter. Other hormones such as estradiol, testosterone and HGH (human growth hormone) require a physician's prescription and monitoring. Some hormones such as DHEA, melatonin and progesterone are best taken orally. There are advantages to using topical or intravaginal estrogen preparations. Testosterone is available as topical creams or patches, injections or pellets that can be inserted under the skin and slowly dissolve over a period of several months. As with any medication, there is always the chance of side effects, but with appropriate medical supervision, these should be self-limited, and an individual should be able to receive benefits of more youthful hormone levels without virtually any side effects.

Q: How much skin is removed during the process for stem cell banking? Does it require anesthesia? Can it be done at a doctor's office?
A: I know of two forms of stem cell banking using skin. In one, a tiny “punch biopsy” is taken, typically from the hip. Another protocol involves the excision of a small ellipse of skin from the groin region - along the crease between the upper thigh and pubic area. Both procedures involve local anesthesia only, an injection of lidocaine to numb the skin, take only a few minutes and are easily performed in a doctor's office.

Q: If metformin helps with blood sugar spikes, would this be good for the general population? I imagine a lot of people experience this after eating. Is it taken long term? Any side effects? It seems like it might help a person lose weight.
A: Grossman Wellness Center, as the name suggests, is dedicated to wellness, and most of our patients come to us seeking not merely good, but optimal health. A slogan that we commonly use for our wellness program is "good is not good enough.” We are not satisfied with good, we strive for optimal. This applies to cholesterol levels, hormone levels, blood pressure levels and blood sugar levels. Most physicians feel that a fasting blood sugar less than 99 is normal or "good." I disagree wholeheartedly as studies from the medical literature have shown that optimal blood sugars are less than 85. People who have fasting blood sugar between 85 and 99 have 40% increased risk of suffering a heart attack. As such, in our clinic, we look to get our patients’ blood sugar levels less than 85. Very often, we do so with the help of metformin - even though these patients do not have diabetes. The main side effect of metformin is abdominal upset or loose stools, but we find that if people begin to take this medication very, very slowly, these side effects can be minimized. Some people lose a few pounds after beginning metformin.

A few words from Dr Grossman:
I want to thank each of you for taking the time to allow me to share my thoughts and philosophy with you and offer a special thanks to Barb Hanson for inviting me to participate in this edition of "Ask the Doctor."

Terry Grossman, M.D.
Medical Director
Grossman Wellness Center
2801 Youngfield St., Ste 117
Lakewood CO 80401
(303) 233-4247