Made-to-order medicine

Beverly Kistler would rather give up a vacation in Paris than the rice-grain-size pellets that are implanted in her buttocks every six months. This is her fourth year on the pellets, which carry hormones in amounts her body needs, and she says she feels energized and less stressed, and experiences none of the agonizing symptoms of menopause that troubled her in the pre-pellet days.

But it's not just the pellets - containing estradiol, testosterone, and progesterone - that foster her sense of well-being. She no longer downs a half-gallon of chocolate mint ice cream each week, she shuns most of the cheeses that used to be a staple in her diet, and she sometimes substitutes almond milk for the variety that comes from a cow. She practices qigong, often called Chinese yoga, which gives her, she says, an exquisite mind-body balance.

"I can't imagine going back to feeling the way I did before I started this program," says the just-retired Allentown elementary school teacher.

Kistler is referring to the Great Life Program. Although she has been following its tenets since 2006, the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital introduced the program as part of its repertoire just 2 1/2 years ago. It has served upward of 200 patients.

The program "is the ultimate in personalized medicine," says Daniel A. Monti, the center's director. Based on a genetic profile with information gathered through an exhaustive family and personal history and blood and urine studies, which measure metabolic function, vitamin and mineral absorption, hormone levels, intestinal flora, and immune system status, each participant is prescribed a treatment and lifestyle plan. If they follow it, Monti says, they will enjoy a dramatically enhanced quality and quantity of life.

"I was a little suspect at first," says Bob Kistler, Beverly's husband, who sought a way back from debilitating fatigue following critical spinal surgery and grueling rehabilitation. Relentless research on the Internet led him to Anthony J. Bazzan, a board-certified internist and geriatrician, now codirector of the Great Life Program. At the time, in 2005, Bazzan was in private practice in Jeffersonville, where he still works.

"He knew me up and down before I had my first visit," Kistler recalls. "I had filled in this 14-page assessment that asked everything from did I use recreational drugs to how often I had sex. I had had the blood work he ordered and sent him all of my medical records." His first visit took an hour and 45 minutes.

Before Kistler left the office that day, he was injected with a tiny pellet that Bazzan told him contained bioidentical hormones (those that match what the body produces) in precisely the amounts that Bazzan said he needed to replace his deficiencies. He predicted that Kistler would see a quantum leap in his energy level in less than a week.

Five days later, Kistler was shocked. "I had the most amazing turnaround," he says. "I'm 57, but I feel 25, and I never look back." A year later, Kistler persuaded his wife to see Bazzan.

Those who take Jefferson's program are usually between 40 and 70 (although people of any age are welcome). Many are accomplished and high achievers. "They have the best cars, the best houses," Bazzan says. "And they want the best health. They go to conventional medicine and are not satisfied."

Most people sign on because, like Kistler, they have health issues. Kistler was too fatigued to work and was on permanent disability.

Tony van Veen of Havertown wanted a full midlife health check; his goal was to make a lifestyle change - "to get off my blood-pressure and cholesterol medicines and get in better shape." His father had bypass surgery just after van Veen entered the program, and he didn't want to be next.

Others seek to reduce stress, get a good night's rest, eliminate the tire that circles their waist, or revitalize a sex life that has lost its sparkle.

"Conventional medicine stops at the norms," says Monti. "We are concerned about how you're functioning. We dig deep, and we teach people how to stay out of trouble." Bazzan adds: "We teach them how to stay alive."

Integrative programs can be found in academic centers and hospitals throughout the country, although the flavor of each can differ. The Integrative Medicine and Digestive Center at the Johns Hopkins School of Medicine, headed by Linda Lee, focuses on integrative strategies particularly for women with gastrointestinal disorders. Memorial Sloan-Kettering in New York targets cancer patients.

"There is a lot of flexibility," Lee says. "Some centers bring in massage therapists or specialists in Chinese medicine or homeopathic consultants. But one thing is similar: Patients are usually highly motivated."

"With so many baby boomers turning 65 this year, the timing is perfect," says Gerald Katz, who has been a health-care consultant to hospitals and physicians groups for 30 years. "Integrative medicine is definitely a trend, and the kind of program Jefferson has makes tremendous sense for those who can afford it."

Not everyone in the field agrees. Harvard emeritus professor Arnold Relman insists integrative medicine is "all nonsense." "I believe it's a whole collection of things said to be effective that have never been proven or tested. When patients who are tired or depressed or have no energy say they feel better" after trying integrated medicine, "it is only a placebo effect. They'd be better off going to church or joining an exercise program. Medicine is for people who are sick, not for people who are unhappy. This is just a waste of money."

Bazzan and Monti, who collaborated on the book The Great Life Makeover, are a well-matched pair: Bazzan, born in Verona, Italy, and still with a lyrical Italian swagger in his voice, handles the medical end, ordering the tests, issuing prescriptions, dietary regimens, and supplements. Monti, with a tall, lean body that suggests a close rapport with the ellipticals, uses that information to focus on lifestyle changes - prescribing the optimal exercise program, offering ways to cut stress, and educating patients about nutritional genomics, the complex interaction between diet and DNA - through which altering what you eat and drink can promote healthy aging.

"Constitutional genes can't be changed," Monti says. "I'm not going to wake up tomorrow as a woman. But environment might be 75 percent responsible for how inducible genes express themselves. Altering what you eat, the toxins to which you're exposed, the stress level in your life, how well you sleep play a big role in whether or not you stay healthy."

"The biggest changer of gene expression is food," says Bazzan, who subscribes to the "you-are-what-you-eat" theory. His rules are: Keep vegetarian foods high, animal protein low; choose natural over processed. "Ask yourself, did it grow in a garden or did someone put it together in a factory?"

Bazzan demands that his patients exclude meat and dramatically reduce if not eliminate their consumption of dairy because it gives rise to inflammation associated with development of cancer, heart disease, and other conditions. Yogurt, often touted as a health food, is off limits. So is soda. "They can kill you," Bazzan insists.

Monti is more forgiving and believes in "meeting the patient where he is." He finds ways to steer people around what they may consider an impossible diet. He has discovered a drink sweetened with Stevia, an all-natural herbal sweetener, to replace the sodas. He has put together a medley of dried fruit and nuts - his own version of trail mix that can serve as a midday snack. When Bob Kistler insisted he must have an occasional steak, Monti gave his OK as long as Kistler exchanged potatoes for green vegetables at that meal.

"Starch and red meat are brutal together because they are a nightmare to digest," he says, causing bloating, heaviness, and acid reflux. "They cause a war in your gut. So when you indulge in that steak, you have no rolls, no potatoes, no chocolate brownies." Kistler thought he could live with that and was elated that in six weeks, he shed the last 13 pounds, taking him to his coveted weight of 215.

Kistler doesn't worry about receiving hormones twice a year because he has faith that Bazzan is monitoring him closely, and he is thrilled with his clarity of thinking, the stamina to ride 30 miles on his mountain bike, and a libido on overdrive.

Bazzan insists that bioidentical hormones, compounded by qualified pharmacists based on his customized prescription for each patient, are safer than the synthetic ones churned out by drug firms. But the American Medical Association and the U.S. Food and Drug Administration have said there is no evidence of the increased effectiveness or lower risk of bioidentical hormones.

Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital in Boston, says he knows of no studies addressing the safety of bioidentical hormones, but acknowledges that when delivered through pellets, as they are by Bazzan, they bypass the liver and go directly into the blood, averting blood clots and ending with the exact hormone the body used to make. Still, there could be occasional side effects - facial fuzz and breast sensitivity in women, thinning hair in both men and women, and a rising PSA level that could indicate a higher risk of prostate cancer - all of which are reversible by adjusting the dose or eliminating it. "We believe the tiny doses of hormones we prescribe are safe, but we don't yet have long-term studies," Bazzan says. "That's the big quandary."

Despite the kerfuffle about the safety of hormone therapy, which Judith Volkar, a physician in the women's health division at the Cleveland Clinic, feels has been overblown, both she and Schiff use it selectively, as does Bazzan, only with patients who show a deficiency, and always informing them about the risk/benefit ratio. Once hormone levels have achieved a healthier balance, the hormone therapy can be reduced or even stopped.

Everyone on the program is asked to take supplements of Vitamin D, aiming for a 50 ng/ml blood level, which Bazzan believes protects against myriad conditions including diabetes, non-Hodgkin's lymphoma, and breast, ovarian, and colon cancer; probiotics for a healthy immune system; and omega-3 fatty acids, which he calls "life-giving" fat.

Few would argue against the health benefits of plant-based nutrition with an emphasis on fruit, vegetables, and grains. The federal 2010 Dietary Guidelines for Americans, out this year, are a tamer take on the Great Life diet.

"I hope that in five years the kind of personalized medical care I'm receiving will become standard," Bob Kistler says. "I'm a happy, healthy man now. I feel vibrant. I ride my bike with athletes in their late 20s, and I kill them on the hills. My sex life is like when I was 25 years old.

"If people my age feel like they are going into the winter of their lives . . . I feel like I'm just beginning my summer."

The Great Life Program has two options:

Call the Myrna Brind Center of Integrative Medicine at 215-955-2221, or go to www.jeffersonhospital.org/cim.

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