Below are some of the most frequently asked questions patients/clients have asked.  If you have a question that is not listed, please call the office at any time.  We like to consider ourselves "user-friendly" and approachable.  We also want you to feel comfortable and safe.  If you prefer, you may e-mail a confidential question to marie@drnagel.com and someone will respond within one business day.


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A: Probiotics are living bacteria that are typically isolated from the healthy human intestine and which, when consumed in adequate amounts, can confer a disease preventative or positive health benefit.
A: Amino Acids are functional building blocks of protiens.  Most are formed from a combination of 21 amino acids (acually 19 animo acids and 2 amedes-asparagine and glutamine), which can all by synthesized by higher plants.
A:

The products carried in our facility are of pharmaceutical grade and are purchased only from manufacturers that we trust, meet our high standards and tend to produce predictable results.  Dr. Nagel researches every product and company personally.  He determines quality by considering:

  1. The quality of science behind the product.
  2. The quality of the ingredients themselves.
  3. The quality of the manufacturing process.
  4. The synergism among product components.
A: Yes.  Male menopause is called Andropause.  It is a similar condition in men that women experience in menopause.  As men (and women) age, their hormones decline.  The main hormones that decline in men during Andropause, which begins roughly between the ages 35-55, are testosterone, growth hormone and DHEA.  As they decline, men will experience symptoms of depression, lack of energy, insomnia, low libido, joint pain, the "spare tire" and grumpiness.  See our Andropause page for more information.
A:

Anti-aging medicine is a clinical/medical speciality and field of scientific research aimed at the early detection, prevention, treatment and reversal of age-related decline.  It is well documented by peer-reviewed medical and scientific journals and employs evidence-based methodologies to conduct patient assessments.  The American Academy of Anti-Aging Medicine was established in 1997 as a professional physician certification and review board, which offers physician recognition in the form of specialty-based examination in Anti-Aging Medicine.  It represents 12,500 physicians and scientists from 73 countries worldwide.

Only a century ago, the average life expectancy was 42 years. Today, it has almost doubled. This is largely due to advances in medicine and technology.  The definition of aging as a natural course of events of which nothing can be done has passed. Today we see healthy and active seniors well into their 90s.

In Anti-Aging medicine there are five key areas –

  • Diet
  • Exercise
  • Stress management
  • Pharmaceutical grade supplements
  • Bio-identical hormone replacement therapy.

Cosmetic procedures also play a role because when people feel younger, they want to look younger as well.

Anti-Aging medicine first emerged in the United States about 15 years ago. It is an extension of preventive health care based on the early detection, prevention, and reversal of age-related diseases.

Research has shown that 90% of all adult illness is due to the degenerative processes of aging. This includes heart disease, most cancers, adult-onset diabetes, stroke, high blood pressure, osteoporosis, osteoarthritis, autoimmune disease, glaucoma, and Alzheimer's disease.

Aging consists of depletion, inflammation and wear and tear. For some people this happens faster than others. This accelerated process of aging will impact on quality and quantity of life.

Anti-Aging medicine incorporates the latest medical advances to deter the aging process, which is largely influenced by lifestyle and cure degenerative diseases at its root, resulting in longer life expectancy. Anti-Aging medicine is not a panacea for all illness because about 30 per cent is determined by your genes. Anti-Aging medicine works on the 70 per cent that can be influenced.

Today's medical science is catching up with the aging models. We now have the ability to test for genetic inheritance and also to check on how the genes are being expressed ahead of the full manifestation of a disease. This gives us the ability to intervene early, rather than wait until cancer, Alzheimer's, heart disease or another major illness occurs.

Diet, exercise and stress reduction are 'Anti-Aging' by virtue of their ability to increase well-being and lifespan. Current research on anti-oxidant supplementation and hormone replacement therapy is gathering evidence of 'Anti-Aging' activity through their ability to prevent and reverse cellular degeneration associated with aging.

To date the most potent weapons against aging are a group of hormones that naturally diminish with age. When replaced at youthful levels, they can have a powerful rejuvenating effect on all the cells of the body.

 
A: Just as athletes on a team need someone to guide them toward a specific purpose, help identify areas for improvement and maximize potential, a life coach offers the same when when it comes to optimizing performance in career and personal arenas.  Life coaching involves weekly or biweekly sessions that focus on goals and life stratagies to be learned.  By listening, asking probing questions and mirroring back what is being said, the coach creates a safe place where the client can explore, stretch and grow.  Each session concludes by identifying steps the individual commits to taking before the next meeeting.  The real productive power comes from a shared purpose and sense of accountability.
A: No. Health insurance is actually disease insurance and will not cover this form of preventive medicine. In a way, it's a good thing. We are able to focus our program entirely on you without considerations of third parties. We are able to maintain complete confidentiality and are not constrained by limits set to maximize insurance company profits. We do not bill insurance, and the Institute is not a Medicare Provider. We are working for you, not them. 
A:

A nurse practitioneris a registered nurse (RN) who has completed an advanced training program in a medical specialty such as pediatrics or internal medicine. Abbreviated NP. An NP may function as a primary direct provider of health care and prescribe medications. An NP may fill another role such as in research rather than in patient care.

The term "nurse practitioner" encompasses the adult nurse practitioner, advanced practice nurse, certified nurse midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, clinical specialist in mental health nursing, family nurse practitioner, gerontological nurse practitioner, neonatal nurse practitioner, pediatric nurse practitioner, and school nurse practitioner.

Patients generally appear to be just as happy -- and in some cases, happier -- to see a nurse practitioner as their primary care doctor, according to a number of studies (British Medical Journal 2000;320:1038-1048).
A:

Whole Body Vibration or Vibration Technology was originally developed for astronauts to counteract the harsh effects of zero technology on the human body.  Scientists first discovered the positive effects vibration technology had on strengthening muscles, increasing flexibility and improving bone density.  Many years of research have revealed that vibration also helps with lymph drainage, blood circulation, combating cellulite as well as decreasing cortisol, which is a hormone released during periods of stress.  Whole body vibration increases the metabolic rate which results in a higher caloric bum and people who trained for ten minutes, three times a week with this vibration technology reduced a considerable more amount of fat than those who did aerobic exercise for one hour, three times a week.

Whole Body Vibration is known to help facilitate natural hormones and nerve delivery substances.  As a result of these effects, users can expect to see improvement from issues related to fat, fatigue and stress.
A: Those familiar with Anti-Aging Medicine and research now define aging as nothing more than a disease state characterized by 3 phases:

1. Sub-Clinical Phase, ages 25 to 35:

Most hormone levels start to decrease. Growth hormone level, for example, has already fallen approximately 14% by age 35. Environmental pollution, poor diet, and stress cause free radical formation and cellular damage not visible to the naked eye. Outwardly, there are few clinical symptoms. While you may look and feel good, internal cellular damage is already happening. Like cancer in its early stages of development, there are no detectable signs and symptoms by conventional standards. You look and feel "normal," but in reality you are in the sub-clinical phase of this disease, whether you like it or not.

2. Transition Phase, ages 35 to 45:                                                

By age 45, production of many hormones have fallen by more than 25%, and biomarkers are beginning to show signs of aging. Clinical symptoms such as decreased visual acuity, graying of the hair, increased pigmenting of the skin, and decreased strength and energy are making their presence felt on the outside. On the inside, cellular damage by free radical continues, where the rate of damage depends on your lifestyle. If not controlled or slowed, mutational changes may lead to cancer.

3. Clinical Phase, ages 45 and above:

Most hormone production continues to decline, including DHEA, Melatonin, hgH, and male and female sexual hormones. The rate of decline accelerates as we get older until age 70 or thereabouts. Outwardly, early signs and symptoms of aging seen during the transition phase worsen. The skin is further dehydrated and thinned as collagen fibers break down. We call these irreversible lines "wrinkles." Musculo-skeletal joint degeneration becomes painfully obvious as arthritis sets in. Fatigue and loss of energy follow us everywhere. Chronic illnesses such as hypertension and diabetes became very apparent as organs begin to fail. Inwardly, as our cells succumb to assaults, mutation and cancer can arise. Cancer has now overtaken heart disease as the number one cause of death.  Anti-Aging medicine is preventative and aimed at slowing pathological aging so people will live longer without disease.

 
A:  

Regenerative Medicine optimizes the body’s endogenous mechanisms of self-repair and adds proven and near future exogenous treatments and technologies. Adult stem cells appear to be our most powerful tool at this time. Previous dogma concerning adult stem cells taught that neurons and myocytes did not have stem cells and the cells present at birth just declined in quantity and quality. It was also believed that hematopoietic stem cells in the bone marrow lacked plasticity and could not transform to other tissues. Current medical literature proves that adult stem cells exist in most tissues including brain, heart, muscles and liver. Hematopoietic stem cells (HSC) and endothelial progenitor cells (EPC) in the bone marrow have plasticity to potentially transform and repair all tissues and organs.

In the hormone optimization component of Anti-Aging Medicine we are already optimizing stem cells. Progesterone via its metabolite allopregnenolone stimulates neural stem cells, testosterone stimulates muscle stem cells and EPC’s which can improve erectile function, and growth hormone treatment for adult growth hormone deficiency improves the quantity and quality of EPC’s. Estradiol improves incorporation and mobilization of EPC’s.

In the lifestyle component of Anti-Aging medicine we are optimizing our adult stem cells with exercise and control of glucose and insulin.

In the nutriceutical component of Anti-Aging Medicine we are optimizing our adult stem cells with Resveratrol as we turn on genes such as SIR1 and with blueberry, green tea and vitamin D3. DHA in omega 3 fish oil promotes neurogenesis from neuronal stem cells.

A new phase of Regenerative Medicine has recently commenced with cryogenic preservation of adult stem cells in healthy patients for future use. These patients are the same pro-active population who follow Anti-Aging programs. After stimulation with granulocyte colony stimulating factor adult stem cells can be collected by aphaeresis and stored in separate aliquots for treatment of specific pathologies such as acute myocardial infarction or for overall immune system reconstitution. This paradigm shift is referred to as bio-insurance.

 
A:

A science-based field of health care that is grounded in the following principles:

Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.

Patient-centered medicine emphasizes "patient care" rather than "disease care," following Sir William Osler’s admonition that "It is more important to know what patient has the disease than to know what disease the patient has."

Dynamic balance of internal and external factors. Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease.

Health as a positive vitality – not merely the absence of disease.

Promotion of organ reserve as the means to enhance health span.

Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include:

  • Hormonal and neurotransmitter imbalances
  • Oxidation-reduction imbalances and mitochondropathy
  • Detoxification and biotransformational imbalances
  • Immune imbalances
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances
  • Structural imbalances from cellular membrane function to the musculoskeletal system

Imbalances such as these are the precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance – in the patient’s environmental inputs and in the body’s fundamental physiological processes – is the precursor to restoring health and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient’s functionality and health. Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.

Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at many levels, rather than a single treatment for a single diagnosis. Functional medicine uses the patient’s story as a key tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the patient’s environmental inputs and his or her physiological function. It is a clinician’s discipline, and it directly addresses the need to transform the practice of primary care.

 
A: Integrative Medicine combines both the best of proven conventional and non-conventional approaches of medicine to the treatment of patients.