Asst. Prof. Patana Teng-umnuay, M.D., Ph.D.
08:45 - 09:45 Fructotoxicity, Hyperuricemia, Metabolic Syndrome, and Renal Failure
18:30 - 19.00 Pycnogenol and Astaxanthin: The Perfect Combination for Skin Supplementation
17.00 - 17.45 Combating Aging Forces
11:55 - 12:20 Platelet Rich Plasma versus Platelet Rich Fibrin
Dr. Teng-umnuay received his medical degree with first class honors from Chulalongkorn University, Thailand in 1986 and also board certification in Internal Medicine and Nephrology in 1990 and 1992. Then, he went to study at the University of Florida in the field of Molecular Cell Biology where he earned his PhD degree in 1998.
Dr. Teng-umnuay is one of the well-known lecturers on the subjects of nutraceutical supplements, stem cell biology, and anti-aging medicine. He serves as an assistant professor of the Anti-aging and regenerative program of Dhurakij Pundit University. He also works as a consulting physician for S Medical Clinic and Phyathai 2 Hospital, Thailand. Currently, he is the vice-president of the American Academy of Anti-aging Medicine, Thailand (A4M Thailand)
Fructotoxicity, Hyperuricemia, Metabolic Syndrome, and Chronic Kidney Disease
During the last decades, excessive consumption of sugar is one of the primary causes of obesity epidemic and metabolic disorders like diabetes and cardiorenal syndrome. Table sugar or sucrose is a disaccharide compound composed of one molecule of glucose and one molecule of fructose. Both fructose and glucose are hexose with the same chemical formula, C6H12O6. However, their molecular structures and metabolism pathways are different. Since only blood glucose has been used as a diagnostic indicator of diabetes, most people including doctors get the wrong impression that fructose is safe. Some nutritionists even recommend fructose for diabetic patients because it has very low glycemic index and does not trigger the production of insulin. As a matter of fact, fructose can be converted into glucose, triglyceride, and LDL-cholesterol in the liver. Excess fructose consumption can cause obesity, insulin resistance, hypertension, and metabolic syndrome.
In the past, dietary fructose consumption was trivial. But since 1960s, a corn industry has manufactured high fructose corn syrup (HFCS), a high concentration of fructose and glucose mixes. HCFS has become a primary ingredient in a vast majority of sweetened beverages and processed foods due its low cost and delicious sweet taste. In addition, while glucose suppresses the hunger hormone ghrelin and stimulates leptin, which suppresses the appetite, fructose has no effect on ghrelin or leptin production leading to overeating that help increasing product sales.
Another health hazardous effect of fructose is hyperuricemia. The metabolism of fructose within the cell generates a large amount of AMP, which in turn metabolized into uric acid that cause gout, endothelial dysfunction, hypertension, kidney stone, and renal failure. While doctors recommend patients, who have gout to restrict high-purine diets such as poultry, only few of them recognize the de novo effect of fructose that can lead to uric acid overproduction. There have been numerous studies found a significant risk of hyperuricemia, gout, and metabolic syndrome associated with the consumption of fructose or fructose-rich foods.
Elevated uric acid level in patients with chronic kidney disease (CKD) has been related to increased risks for the development of hypertension and cardiovascular diseases. Many studies have shown that reduction of uric acid level with allopurinol therapy improves endothelial function, reduces cardiovascular and hospitalization, and most importantly, slows down the progression of kidney disease in CKD patients. Since metabolic syndrome and chronic kidney disease have become one of the major health problems, it is crucial that doctors need to know about the disastrous metabolic effects of fructose and consider uric acid as a potential treatable risk factor in metabolic syndrome and CKD.
Pycnogenol and Astaxanthin: The Perfect Combination for Skin Supplementation
Skin, just like every cell in the body, needs nutrients. Oxidative stress and inflammation are two major mechanism of aging that effect the body as a whole as well as the skin. The damaging effect of sunlight is contributed mainly to singlet oxygen, one of the reactive oxygen species. The effects of singlet oxygen cause skin wrinkle, decreased collagen and elastin production, skin hyperpigmentation, and a risk of skin cancer. Astaxanthin is a reddish pigment that belongs to a group of chemicals called carotenoids. Diets high in carotenoids are considered to be the first line of defense against singlet oxygen toxicity. Astaxanthin occurs naturally in certain algae and causes the pink or red color in salmon, trout, lobster, shrimp, and other seafood. In nature, highest levels of astaxanthin are found in the microalgae Haematococcus pluvialis. These special red algae have been cultivated and their extract rich in astaxanthin has been used as a nutraceutical supplement and also a cosmetic ingredient. Many lines of evidence indicate that astaxanthin might be the most potent anti-oxidant against photoaging found in nature. An experimental study has shown that singlet oxygen quenching activities of astaxanthin is 75 times higher than lipoic acid, 110 times higher than vitamin E, 800 times higher than coenzyme Q10, and 6000 times higher that vitamin C. Clinical studies have shown the benefits of astaxanthin for the skin and the eye. Astaxanthin supplements improve skin appearance, prevent skin photo damage, reduce eye fatigue, and improve visual performance. Pycnogenol is a pine bark extract that numerous studies have shown that it enhances skin microcirculation and anti-inflammation. It also has the positive effects on skin hyperpigmentation, hyaluronic acid production, and collagen and elastin protection.
When taken together, these two anti-oxidants will provide complementary benefits for the skin. While astaxanthin protects the skin from the harmful effects of UV ray and singlet oxygen, pynogenol will reduce the collagen and elastin degradation, and inhibit melanogenesis. In addition to skin health, both supplements are strong anti-oxidants and anti-inflammatory agents that can provide benefits for overall health.
Combating Aging Force
Aging is the accumulation of changes in the cells and tissues that increase the risk of organ dysfunction and death. Only if we understand these aging forces, we can combat aging. These aging forces are oxidative stress, glycation end products, inflammation, toxins, acidosis, and stress. Oxidative Stress is one of the major factors of aging process. We can reduce our oxidative stress by restrict our caloric intake and use the right combination of anti-oxidants. Excessive consumption of refine carbohydrate is one of the important causes of chronic illness. We need to reduce the amount of sugar we are consuming. Both oxidative stress and sugar toxins will lead to inflammation, underlying pathology of many chronic illnesses. To combat inflammation, we need to select the right kind of dietary fat. While omega 3 and omega-9 fatty acid are precursors for anti-inflammatory prostaglandins, omega 6 fatty acids can be converted into pro-inflammation mediators, arachidonic acids.
Toxins accumulation in the body has been accounted for various health problems. These toxins have been contaminated in the food we eat, the air we breathe, the water we drink, and even medication we take. The body has the system for detoxication using liver, kidney, lung, and skin. The principles of these detoxification programs involve the body resting by fasting while refueling the body with healthy nutrients, stimulate the liver detoxification process, improving blood and lymphatic circulation, and promoting toxin elimination through the intestines, the kidney, and the skin. These integrative programs are detox diet, vitamins and anti-oxidants, sauna, detox massage, colon hydrotherapy, and chelation. Each program has its own benefits and limitations. Although these programs are usually safe, proper patient selection is required in order to prevent complications. It is very important that medical practitioners are capable of choosing the right detoxification method for the patient.
Anti-aging clinics now provide several intervention programs to combating these aging forces such as the use of anti-oxidants and nutraceutical supplements, detoxification program, and also stem cell therapy. But these interventions alone won't be enough to combat aging forces in these patients, it also requires their understanding and willingness to change their life style. Food, exercise, and stress reduction are important keys of successful anti-aging story. Because individuals are different, we cannot tell them what to do but can only guide them to find the way to a better and healthier life style.
PRP versus PRFM
Platelet Rich Plasma (PRP) is a concentrate of platelet rich plasma found in buffy coat after citrate blood is centrifuged to remove red blood cells. It contains high concentration of numerous growth factors including platelet alpha granules, platelet‑derived growth factor (PGDF), transforming growth factors‑β (TGF‑β), vascular endothelial growth factor (VEGF), and epidermal growth factor. After activation with calcium chloride, these PRP will release bioactive molecules that provide healing benefits. In humans, PRP has been used for several types of treatment including chronic tendinitis, osteoarthritis, alopecia, and collagen stimulation in aesthetics.
Platelet Rich Fibrin Matrix (PRFM) is a second-generation PRP. In this procedure, the citrate blood is collected in a special designed tube containing a special gel that have less density than white cells and red cells. After low speed centrifugation, white and red blood cells will be trapped underneath the gel while platelets are floating in the platelet rich plasma on the top. After stimulation with calcium chloride, the doctors will have 10 minutes to perform injection through a cannula allowing fibrin clot to form matrix. The benefits of PRFM over PRP is the matrix can protect growth factors from proteolysis and allowing the neo-collagen synthesis
For autologous fat transfer, PRFM should be mixed with adipose tissue at the ratio of 2:1 since the growth factors within PRP will enhance fat cell survival. PRFM can also be mixed with any types of filler at the ratio of 4:1 to give additional long-term rejuvenation effects.