August 30, 2024 • 25 mins
Dr. Florence Comite discusses the importance of proactive healthcare and personalized approaches to health. She emphasizes the need for accurate and reliable information in the field of longevity and aims to help individuals increase their health span. Dr. Comite shares her experience as an endocrinologist and precision medicine physician, highlighting the importance of understanding the aging process and implementing targeted interventions. She explains the significance of data and biomarkers in customizing healthcare and emphasizes the need for a comprehensive approach to health that includes factors such as hormones, metabolism, and body composition. Dr. Comite also shares a case study of a client who successfully reversed the aging process through personalized interventions.
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christopher quindes (00:00)
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Hello and welcome to Healthy Longevity. I'm Dr. Florence Comite of the Comite Center for Precision Medicine and Healthy Longevity in New York City, Palo Alto and Miami Beach. My medical practice is founded on two central truths. One, the most effective healthcare is proactive to stop and reverse disease and aging. And two,
There's no one size fits all approach to your health. My friends and colleagues asked me why a podcast, Lawrence, and why now? And that's a great question because the simple answer is finally, everyone seems to be interested in longevity these days. There's a lot of misinformation, however, out there on social media and everywhere, even in legitimate journals, scientific evidence -based journals. And there's a lot of repetition of information that really isn't good information.
And I worry that people will get advice that's bad and not good for them. And actually at best may be inaccurate, but could even hurt. think most important, I'd like to help you, every one of you out there increase your health span to last your entire lifespan. After all, it's why I set up Cometay Center. I set it up over two decades ago.
to be able to prove that's possible with interventions targeted for the individual to turn the clock back, to age slower biologically, even as you blow out more candles every year. I wanna share those lessons that I've learned with my clients about staying healthy. And my experience as an endocrinologist, a scientist, a precision medicine physician, who's helped thousands of people stop and reverse the diseases triggered by aging.
the aging process itself, which starts right away. As soon as we're born, we start aging under the surface, but it becomes really relevant in our thirties. And as women and men hit the midlife, which is the thirties, hormones, metabolism, and all that goes in the wrong direction. We weren't intended to live much beyond the midlife a century or two ago. And now that we are, it would serve us so well to protect our health span for the rest of our life.
My world for the future is a world free of chronic disease. Medicine is custom tailored to this specific human being and that unique makeup you have and all of the use. You are not your best friend. You are not even your identical twin sister. As I have one and I know we're not alike completely because genes can emerge in different ways depending on the lifestyle, depending on switches that may have even been triggered in utero.
So there's controls we have over some of it and others when we have that knowledge and the wisdom to put it together to connect the dots, we can change the very course of your future health. So your future health trajectory doesn't have to have the diseases that run in your family. If you look around and you see that your folks, your grandparents, your cousins, your aunts and uncles are taking drugs for certain diseases and they're not well and not enjoying life.
It is possible to optimize your health, systematically reversing your aging process and increasing vitality throughout your lifespan. Today we have the knowledge that we can turn into the wisdom, not just the facts of biomarkers or your chief complaint, but rather deep wisdom to connect the dots, to be able to say,
Here's the technology, here are the wearables, here are the tests you need, but how do you put it together? And that's what I intend to do on my podcast to share it with the world, with all of you, to fine tune you. That's very important to me because I know that one size does not fit all and that's what conventional medicine is built on. We start by looking beneath the surface at what's going on in your body at the cellular level.
We are very interested in proactively identifying the data, which I think of as precision medicine. It's the data that we marry to your health story. How do you live life? What's your sleep like? Are you exercising? And if so, what kind of exercise are you mainly aerobic or weights resistance? Do you do high intensity interval training? All of those questions are really important to ask.
and to know how to implement and deploy them because it's not a fit for everyone. Some people need a little of this and a lot of that, and others are the reverse. And there's a lot of data on that. Even when we look at our glucose numbers or sugar, it is not a one size fits all, nor do all of us respond to the same stimuli in the same way all the time. In fact, our very own bodies will vary over time.
If we draw blood one day and we come back and draw it the next day, the numbers are very likely different. So the trends are really important, not the exact number. We know that from sending tests to various labs and seeing how they come back different, even though the tests were drawn at the same time. yet labs and human error and assay variability change the very way we look at numbers and we absorb them.
So the data and the way we've been interpreting it for the last two or more decades made a difference in how we implemented interventions actionable at the level of that unique human being. Conventional medicine is reactive. You have to be sick to get attention. Yeah, many of us do an annual and that's fine. But there's also people who walk out of the doctor's office and drop dead of a heart attack after their annual where they've been told you're within the normal range. Don't worry about it.
And yet normal has no meaning when it comes to that individual. It's optimal. want, we don't want it be just okay. Normal is a wide range that incorporates sick people and we don't even know how they're sick. We just know that that's been created because a thousand people have been studied in Oklahoma and that's where Quest or LabCorp or any one of the labs gets their data from. And that's the basis for what we say you're in the normal range. No such thing as normal.
It's only optimal that we want. We do not want reactive conventional medicine. Reactive conventional medicine takes us to a place where we're already pretty sick. A lot of diseases of aging are brewing under the surface for decades. Certainly diabetes or heart disease, the potential to have a stroke or dementia. Those are all detectable in your genes and in the way you live life and connecting those dots.
integrating it and making sure the interpretation is right on and it's full of the wisdom of deeply knowledgeable clinicians. That is what I dedicated my life to. That is what I realized because when I graduated from medical school, my father asked me a critical question. So I graduated from Yale Medical School and my father and mother and the rest of the clan were there. And my dad turned to me and said, okay, my doctor daughter,
I know you're brilliant, graduated from Yale. Very proud of you, obviously. I remember that. Very touching, because he's now gone. And I miss him. Tell me how I can make myself healthier. And that was a very hard question to answer. It's probably harder than all my boards. He wanted to know, how do I prevent health problems? How do I stop heart disease? And I'm trying to eat right, I'm trying to work out. And I knew he was doing all of that. He was even making his own brand muffins at home.
And honestly, I was really lost for an answer. So I said, dad, I didn't learn that in med school. They taught us how to diagnose and how to treat disease, not keep a person healthy. So I think it set me off on my life's mission. It got me thinking, why do we do things backwards? Why are we waiting for symptoms to appear? Why don't we get out ahead and stop and reverse disease? And that's what I started to do way back then.
by collecting data under the surface, by evidencing my insatiable curiosity and other trait I inherited from my dad, a genetic trait, I think, because it runs in all of us comites. And I asked myself, we can see numbers change under the surface. We can see these trends going in the wrong direction, hormonally, metabolically, you name it. Why aren't we doing something about it at 40, 30, even 20? But 30 is when it becomes really critical as hormones change.
and our metabolism reflects that difference. And as my career progressed, I started seeing these clear cut patterns in my patients. They were presenting with issues that while overlapping was never identical in each person, but hormones were changing, sometimes in different directions because a woman might go through menopause at one age or the other, could be anywhere between 38 and 58, for example.
And in one woman, could happen literally from one month to the next. Men's disease just stops and you're done. And in other women, it could be 10 years or more. And so glucose was changing in almost every single person. I don't think I've met a person with optimal glucose at all. We'll talk more about that in another podcast. But as we look at those changes, we can tell the path somebody is on. We literally have a crystal ball. We know that visceral fat increases.
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out trunks thicken, even people who keep themselves in perfect shape. For example, marathoners and triathletes don't know what changed because they're doing exactly what they always did in their twenties. And all of a sudden they're going to pot, literally. They don't know how to protect their health. They're losing muscle mass. They're putting on fat mass. And that is all going to lead to disease. Muscle.
If there's one thing you should take away is the fountain of youth really. protects us from diseases, both invading from the outside, like COVID, those comorbidities, for example, and why people ended up on respirators, because they had underlying disease and they were getting sicker from the inside out as well. And that is a fact nowadays that a lot of folks began to notice during COVID. I was not happy with COVID. I had it quite early on, but
I was glad that finally maybe there'd be some clarity to why we need to take care of our health and how to best do it and where to go to get legitimate insight, not just what you hear on social media or you might even read in the newspaper, but where do you get true authority information that really guides us and tells us that the outcomes are gonna be phenomenal. That's really what was most important for me to prove when I set up
my approach to looking at people individually and gathering that data to be able to tell what's right for me and what's right for my twin sister and what's right for all of my patients at ComiTech. Metabolism starts changing. And I realized at the time that aging, well, a positive, because you don't want to die young.
You want to stay alive and well and full of life and have that joie de vie, but you want to protect your health so you can make the choices you need to make. But once we hit 30, aging happens at a cellular level. Hormones change, metabolism slows. We can't do the things we're used to doing. And at 40, 50, 60 and beyond, it accumulates more and more damage at the cellular level.
difficulty rising to the occasion, impossible to feel as good as we felt, naps become relevant for some of us, the inability to really participate in life fully becomes challenging. And you can't see any of this unless you do extensive blood work, looking beneath the surface. And you need to be able to connect those dots, those changes that are happening at the cellular level, checking sugar, looking at cholesterol.
body composition, what percent of your body is actually fat? Because you might look great on the outside and have something we call skinny fat. You have too much fat and not enough muscle, but you just look good, which is fabulous. It's a great trick, but it's not going to help you age in great shape. And that's the goal. How do we keep people from slow to slow? How do we stop disease from emerging? How do we stop conditions like diabetes, heart disease, heart attack, stroke, dementia?
cancer, Alzheimer's, all of that information is out there right for the picking, but we have to apply it effectively and we have to do it knowledgeably where we take the bits and bytes of data and we turn it into wisdom at the level of that unique human being. Looking at, for example, endurance is a really important aspect of it and connecting those dots between all these data points and overlaying with it the health history.
I found by doing this, could literally predict a person's future health trajectory. And I literally saw the writing on the wall when somebody was 30, 35, 40 years when I started that. Although truth be told, you can actually see this in children and you can see it in 20 something. It's just until 30, we're well compensated. We can burn the candle at both ends.
and wake up smiling the next morning and go skiing again, even if we've been drinking and partying the night before. That doesn't continue to happen. We pay a big price for it in some ways for some folks, not everybody. You may be the unique person who can fix things a little bit, take some supplements and do that at 35 or even 40 or 45. But at some point it's gonna catch up with you. And that's a guarantee. None of us get out of life.
alive. We all live with disease a long time. But with all the advances that we have now, technology and the knowledge to look under the surface, we can apply that and make sure that our health is preserved instead of failing over time. And that's what I realized as soon as I started doing this work, that we could adjust a person's physiology as readily as they are willing to partner with us.
using all sorts of approaches, starting with figuring out what your sugar is, knowing how it changes during sleep. What does that glass or two of wine do at night to your wake up, when you wake up with your morning sugar? Do you become high or low? And that means something completely different in different folks. Some people can intermittently fast and do fine. Those are all the data points and the details we need about a person's health story.
to be able to then determine how do we change your habits? Do you go to sleep a little earlier or perhaps you can sleep in a little bit and that works for you. We use technology like Aura or whoop to be able to give us those insights at the time they're happening, not just to collect the data, the information by asking questions, but actually to measure it. We then can turn to supplements or medication, optimizing hormones.
and all these different interventions that when put together as a package for each person, literally stops the aging process. So instead of growing a year older biologically every year, instead, we'll blow out a new candle, but we're reversing that rate of aging. Instead of a one -to -one, it could go down as low as a half a year biologically to one year of life or even less. And that's the goal.
We literally can make your cells younger, slowing and reversing biological aging and those diseases of aging and disorders that I think of as aging diseases, disorder of sugar or what's commonly thought of as diabetes type two, or there are many different types of diabetes around the globe. And literally everyone has to deal with it. It affects everyone in one way or the other, even if you're unaware of it.
The heart attack is most likely underlying it is abnormalities in sugar. And so I began to think of diseases that were so common that I studied in school as really an outcome of aging. Our body can no longer compensate. It was meant to be this way and we need to address it. We need to learn to put on muscle, to do resistance training, to maximize and optimize our health below the surface to get a hold
of a process that would slow down and reverse aging. That key to your health span and mine, the length of disease -free active and energetic years is critically weighted on quantifying health and making key life -changing decisions to take a real role in the decisions you make to know yourself and to know beyond yourself if you're lucky enough to have access to your family and have a family.
Even without that, we can tell because the numbers show us the direction and we could tell how they're expressed. But the more information, the more of a basis and foundation, the better you'll be served. But I've seen plenty of folks who have no idea who their biological family is and that's very common nowadays. And yet we can tell based on the data we've accumulated over these past two to three decades.
what direction someone's heading. And we can see the response once we start specifically with targeted and actionable interventions. And we have the proof to show that. We have scientifically determined over the last two decades what works to the tune of changing 98 % of the direction people were headed. There is no one size fits all.
So be wary of promises out there that you can look at your biomarkers, you can look at your labs, you can tell what to do because mostly everybody will get the same direction and that's not what you want. That's population -based data that's built on thousands of individuals and with what we call regression to the mean, which means it's the average and no one is average, everyone is unique. At Comite Center, we treat everyone in that fashion.
I've called it right from the beginning, N of one, meaning you as a unique individual. It's the studies we do is almost like doing a clinical research study or trial of a singular human being, a single person, and take the data that's out there as the initial foundation that's done in thousands, if not millions of individuals around the country, around the globe.
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and applying it at the individual risk benefit for every person. Once we get that person to unique data set, we do a deep dive into that. And that's what I'll be sharing on my podcast. I'm very excited about it. I'll be talking to real folks who've lived through this process with us and have come out at the other end looking like they're in their forties instead of in their sixties.
and people confused about why they're so energetic. They could do whatever they want. Most of them won't stop working because they love what they do and they feel great and energized. We can identify what's brewing under the surface and intervene immediately to stop it and to reverse it. Let me give you an example of how that happens by talking about a young guy in our practice. His name is David.
and wonderful guy. you'd meet David, you'd say he looks amazing for a 33 year old, but David knew better. Actually, he knew that he didn't have the same energy he used to have. In fact, he was newly married and he actually talked about his libido not being on top of his game. The fact that he wore out and he couldn't exercise as much as he used to for a 33 year young human being. And I wasn't surprised when we got his data back.
to see data that went along with David's story. In fact, he had problems at multiple levels and it was critical for him to jump on it. David is 33 years young and as such, those are chronological years he's lived. But underneath his biological age showed a completely different story.
Underneath, looked 20 years older. He had advanced signs of disease, of insulin resistance, for example, with a fasting sugar and insulin that were too high for his stage. And as a result, we could tell him that you are brewing diabetes now. those numbers were too high for someone who fasted more than eight hours. We want insulin to be undetectable after fasting.
Even three hours after a meal, insulin should go back to being undetectable or less than two. And if it doesn't, it means there's an issue there. And depending on what the glucose is, if it's high or low, it speaks to different patterns. With no food in the system and no glucose to chew on, if you will, because you haven't eaten for 12 hours or even eight hours, insulin should be undetectable. And that was one of the red flags. He had a number of them though.
Cholesterol, for example, was way too high. And we particularly pick on, to start with, the cholesterol risk ratio, which is the total cholesterol divided by the high -density lipoprotein, or HDL, as a lot of people call it, the good cholesterol, which is a little bit of a misnomer. It is actually protective, but you have to look at the particles to decide how protective. In any case, David's cholesterol risk ratio
was 4 .5, which was extremely high. We wanted under two to keep his health together and not go down the path that his father went. So in collecting this information, we found out that David's dad really started getting sick in his 30s and early 40s. He had multiple heart attacks and stroke. was in fact no diagnosis even of diabetes, but under the surface for sure, his sugar was abnormal, just like David's is.
And he was at high risk for heart disease as is David. When I inquired about his dad wanting to make sure his dad was doing okay, David looked at me and he was kind of sad and he said, well, we lost him at 60. He had a final heart attack and that was it. And that is no future to look forward to and that's the path David was on. So the high insulin level for David was one of the first red flags.
But then when I took a look at his cholesterol risk ratio by looking at total cholesterol divided by HDL, typically called the good cholesterol, it's protective, but the makeup of that good cholesterol is even more important and more on that later. Are they large particles? Are they small particles? How do they count? How much are they?
In David's case, looking at the cholesterol risk ratio, which is a reliable indicator of developing heart disease, stroke, Alzheimer's, any of the diseases that can block arteries and prevent blood flow, his was 5 .8, almost three times what we want for optimal. Optimal should be two or less. And that was a huge, huge indicator of how high David's risk was at the time.
because this was two, three years ago, and how he was potentially following in his father's path. David's dad, I learned through the intake that we did about the health history and David's health story, that his father had suffered multiple heart attacks and strokes beginning in the late 30s and 40s. I was getting pretty worried when I then hit his free testosterone, which was almost a...
quarter of what it should be for a young guy at 33, his free testosterone was only 56. That's what we see in a boy going through puberty in the morning, a free testosterone of 50. And yet David was far from being that young boy. He was a young man who should have had a free testosterone of 180 or higher. And that was missing. And that's, that was a big tip -off.
that David was no longer experiencing the kind of energy, libido and health he had enjoyed a decade before. In fact, you know, he actually had been told by his doctors 10 years earlier that he had high cholesterol and high sugar and hypertension, but no one did anything about it. They just said, we'll keep an eye on it. When you get sicker, we'll jump all over it.
That is not the way to treat a young man like David or any of us. As we move into each decade of life, beginning of the thirties, it's essential to know what's going on at the cellular level and stop disease before it takes over your body. It's never too late. We have people and clients in their nineties going stronger than ever, but it's always best to start as young as possible. And once you take this knowledge away, you can bring it to your partners, your family, your children.
your relatives and your best friends or all your friends, because that's what we'd want. We want this to spread like wildfire. We want it to be addictive and contagious. So everybody understands how they can partner with us to take care of their health as they age. So they age chronologically in great shape and their health is not an issue. So going back to testosterone for David, testosterone is basically an amazing kind of
hormone in the body that works at every level. It's not just sexual function. And in fact, what was a really big surprise to me is when I first started doing this work close to 25 years ago now, over two decades, I realized that the major complaint I heard from men and women was low energy. Yes, libido, sexual function for sure. Orgasm in women, sexual function in men.
can be affected, but in all different ways. And sometimes it's not. If somebody has a really strong mind and body connection, they can override that testosterone. But that testosterone, when it's low, is having a deleterious effect on your body. It's allowing sugar to build up, which is why diabetes starts penetrating as we age into our 40s, 50s and beyond. Testosterone helps us keep muscle. It also is great for cognition and memory, muscle and bone.
It's protective in terms of cancer. It balances out other hormones and helps with metabolism. Because if you put on muscle, you can only do that if you have adequate testosterone. You can work out to beat the band. You will not increase your testosterone. By increasing testosterone, you get all of that back and more. You get the opportunity to put on muscle that's protective. As I mentioned earlier, it's the fountain of youth. Mood, keeping our hearts healthy. Remember, our heart is a muscle.
Of course we need testosterone. We also need estrogen. Again, more on that later for us women and also men. Low testosterone is connected to insulin resistance and disorders of carbohydrate metabolism. Let's call it what it is, sugar disorders that cause diabetes, which is basically ubiquitous. Every single one of us has a disorder of carbohydrate metabolism.
which is the way I prefer to think of it instead of calling it diabetes type two. Cause I start wondering there's all these other types of diabetes. If you're Asian, diabetes can present some differently than if you're Caucasian or Hispanic. So learning all those facts and rolling it up into what I'm going to share with you is why it's so important to get some guidance on where exactly you stand. Low testosterone happens in each one of us and it gets worse with each decade.
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women and men. So that's important to keep in mind as another factor. So moving on, when you look at these suboptimal biomarkers, fasting insulin in David's case, cholesterol risk ratio, and free testosterone in conjunction with his health history in himself and his family, those were important criteria. In fact,
One of the areas that pops out in terms of profiling is early death from heart disease or stroke in Ashkenazi Jews. And while David's mom was a Puerto Rican, his father was Ashkenazi Jew, and it's genetically there in his family. And we also see it in a subset of Asians where they also have very similar patterns. So in some fashion, we're all connected under the surface.
but the genes may be different. There are actually almost 2000 genetic variants for diabetes. And for sure, David's father, just like David, had a disorder of carbohydrate metabolism that we now corrected in David. So he's a new man. He's reborn and he's more like 20 than 35 right now. As David corrected, he put on muscle, he lost visceral fat. We were able to drill into what David needed through the rest of his blood work.
including what nutrients were going to be critical for him. What are the gene variants that he had? And we explain the relevance of each biomarker. And we started by addressing his low testosterone. This is called hypogonadism in men. And women are affected too, but it isn't so visible in women because our ovaries are not operational on the outside, rather on the inside. But when we hit menopause,
We lose all the eggs. The eggs are no longer active in our ovaries and we go into menopause, no more cycles. Men are different in that they can slow down every decade of life. And that's more complex to think about, but actually easier to address. So by replacing testosterone either directly with testosterone, there are many versions of it, or using what we prefer, which is a more physiological approach.
We use peptide hormones. The particular one I'm talking about is human chorionic and antitropin to trigger the release of native testosterone to keep those testes active and healthy because there's data in the literature that also shows that men who father children later in life and are able to make sperm equally live longer. And so I always felt right from the beginning that it was important to work.
with the body and not replace when you don't have to replace. We women are different. We can no longer stimulate estrogen or progesterone or testosterone on our own once our ovaries call it quits, which is on average at 50, but it can happen at 38 and it can happen at 58. And I've had that whole span. I've even had a family of six sisters back at Yale.
where one went into menopause after six children at age 38 and her sister was able to get pregnant in her 50s and didn't hit menopause until close to 60 at 58. So that's how much variation there can be. We've reduced David's risk of diabetes, more importantly, heart attack and stroke. And David is going stronger than ever, which I'm grateful for, for David and for his family.
So that can happen for you and everyone you love. That is our goal here and why I'm sharing and started to do this podcast because healthy longevity is our do. And if we're living longer, we don't want to be a burden to ourselves or our family. And the cost of disease is far greater than the cost of keeping our health. We just have to invest upfront in knowing what it means to stay healthy.
for each one of us individually, uniquely. I so appreciate everyone following along for this initial introduction. And I can't wait to get deeper into it with other folks here that can teach us more about what their path looked like as well. In future episodes of Healthy Longevity, I'll share many other case studies who...
of clients at Comite who have turned back the clock and are living life to the fullest and having fun while doing it. Not necessarily struggling because when you know what to do, it's not hard to do it because it makes you feel better. So you wanna live life like that and then you can help people around you. We'll also dig into specific health issues like diabetes and heart attack, stroke, cancer, osteoporosis, neurodegenerative diseases like Parkinson's.
Any of those conditions are basically approachable if you start young enough and you get on top of it and you get ahead of it in the decades where the changes are happening, but they may not be visible on the surface and symptoms may be hard to detect. We'll cover also in depth what happens at midlife that sets the stage for this in women.
men, by the way, in women, this perimenopause and menopause, and we are very sensitive to our cycle because we've lived with it from the time we entered puberty with Menarche or our first menstrual cycle. We actually see changes a couple of years before that. And so when that change happens, the change after the change, we need to look forward to a life of vitality because it just signals a transition. And the more we know about what's going on under the surface for women,
the better you'll feel and you'll be able to live life to the fullest. Actually, a little tip off is no worry about pregnancy, right? And we feel good and energized. And I've known a lot of people starting with, I think Margaret Mead, who called it a power surge instead of a hot flash. So those can be very disruptive and more on that because sleep is also interfered with when our neurotransmitters and estrogen falls. So we'll talk more about that in future episodes.
Men are also struggling with hormones. And while it's not clearly defined in conventional medicine, age, whether they like it or not, just like women, it's just slightly different. They don't live as long as women. Something's going on below the surface, right? So hormones change dramatically in men. And there's a different pattern that we have to look at, but we can keep men stronger than ever despite the aging process.
because it's not just about how much you work out, how heavy the weights are, but it is about the whole way you live life and the choices you make. We welcome guests like medical doctors, researchers, and experts, as well as real patient clients who share their stories of their health span improvement and what has changed and why they've turned back the clock so effectively.
We'll take time out to answer burning questions from all of our listeners. That's you. Please don't hesitate to write in, to comment. We love all of it and we'd welcome it. I hope you'll come back to listen because there's so many topics to discuss. I just touched on just a very few of them as I went through the story and the intro. And there were practical solutions that we'll share that can be put in place.
in your life to strengthen yourself and to reverse aging and stop disease, to improve your health span, to match your lifespan and live wonderfully for the rest of your life. Thanks for listening. I'm Dr. Florence Comete and I'd like all of us to keep it up to make our way to healthy longevity.
christopher quindes (00:00)
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Hello and welcome to Healthy Longevity. I'm Dr. Florence Comite of the Comite Center for Precision Medicine and Healthy Longevity in New York City, Palo Alto and Miami Beach. My medical practice is founded on two central truths. One, the most effective healthcare is proactive to stop and reverse disease and aging. And two,
There's no one size fits all approach to your health. My friends and colleagues asked me why a podcast, Lawrence, and why now? And that's a great question because the simple answer is finally, everyone seems to be interested in longevity these days. There's a lot of misinformation, however, out there on social media and everywhere, even in legitimate journals, scientific evidence -based journals. And there's a lot of repetition of information that really isn't good information.
And I worry that people will get advice that's bad and not good for them. And actually at best may be inaccurate, but could even hurt. think most important, I'd like to help you, every one of you out there increase your health span to last your entire lifespan. After all, it's why I set up Cometay Center. I set it up over two decades ago.
to be able to prove that's possible with interventions targeted for the individual to turn the clock back, to age slower biologically, even as you blow out more candles every year. I wanna share those lessons that I've learned with my clients about staying healthy. And my experience as an endocrinologist, a scientist, a precision medicine physician, who's helped thousands of people stop and reverse the diseases triggered by aging.
the aging process itself, which starts right away. As soon as we're born, we start aging under the surface, but it becomes really relevant in our thirties. And as women and men hit the midlife, which is the thirties, hormones, metabolism, and all that goes in the wrong direction. We weren't intended to live much beyond the midlife a century or two ago. And now that we are, it would serve us so well to protect our health span for the rest of our life.
My world for the future is a world free of chronic disease. Medicine is custom tailored to this specific human being and that unique makeup you have and all of the use. You are not your best friend. You are not even your identical twin sister. As I have one and I know we're not alike completely because genes can emerge in different ways depending on the lifestyle, depending on switches that may have even been triggered in utero.
So there's controls we have over some of it and others when we have that knowledge and the wisdom to put it together to connect the dots, we can change the very course of your future health. So your future health trajectory doesn't have to have the diseases that run in your family. If you look around and you see that your folks, your grandparents, your cousins, your aunts and uncles are taking drugs for certain diseases and they're not well and not enjoying life.
It is possible to optimize your health, systematically reversing your aging process and increasing vitality throughout your lifespan. Today we have the knowledge that we can turn into the wisdom, not just the facts of biomarkers or your chief complaint, but rather deep wisdom to connect the dots, to be able to say,
Here's the technology, here are the wearables, here are the tests you need, but how do you put it together? And that's what I intend to do on my podcast to share it with the world, with all of you, to fine tune you. That's very important to me because I know that one size does not fit all and that's what conventional medicine is built on. We start by looking beneath the surface at what's going on in your body at the cellular level.
We are very interested in proactively identifying the data, which I think of as precision medicine. It's the data that we marry to your health story. How do you live life? What's your sleep like? Are you exercising? And if so, what kind of exercise are you mainly aerobic or weights resistance? Do you do high intensity interval training? All of those questions are really important to ask.
and to know how to implement and deploy them because it's not a fit for everyone. Some people need a little of this and a lot of that, and others are the reverse. And there's a lot of data on that. Even when we look at our glucose numbers or sugar, it is not a one size fits all, nor do all of us respond to the same stimuli in the same way all the time. In fact, our very own bodies will vary over time.
If we draw blood one day and we come back and draw it the next day, the numbers are very likely different. So the trends are really important, not the exact number. We know that from sending tests to various labs and seeing how they come back different, even though the tests were drawn at the same time. yet labs and human error and assay variability change the very way we look at numbers and we absorb them.
So the data and the way we've been interpreting it for the last two or more decades made a difference in how we implemented interventions actionable at the level of that unique human being. Conventional medicine is reactive. You have to be sick to get attention. Yeah, many of us do an annual and that's fine. But there's also people who walk out of the doctor's office and drop dead of a heart attack after their annual where they've been told you're within the normal range. Don't worry about it.
And yet normal has no meaning when it comes to that individual. It's optimal. want, we don't want it be just okay. Normal is a wide range that incorporates sick people and we don't even know how they're sick. We just know that that's been created because a thousand people have been studied in Oklahoma and that's where Quest or LabCorp or any one of the labs gets their data from. And that's the basis for what we say you're in the normal range. No such thing as normal.
It's only optimal that we want. We do not want reactive conventional medicine. Reactive conventional medicine takes us to a place where we're already pretty sick. A lot of diseases of aging are brewing under the surface for decades. Certainly diabetes or heart disease, the potential to have a stroke or dementia. Those are all detectable in your genes and in the way you live life and connecting those dots.
integrating it and making sure the interpretation is right on and it's full of the wisdom of deeply knowledgeable clinicians. That is what I dedicated my life to. That is what I realized because when I graduated from medical school, my father asked me a critical question. So I graduated from Yale Medical School and my father and mother and the rest of the clan were there. And my dad turned to me and said, okay, my doctor daughter,
I know you're brilliant, graduated from Yale. Very proud of you, obviously. I remember that. Very touching, because he's now gone. And I miss him. Tell me how I can make myself healthier. And that was a very hard question to answer. It's probably harder than all my boards. He wanted to know, how do I prevent health problems? How do I stop heart disease? And I'm trying to eat right, I'm trying to work out. And I knew he was doing all of that. He was even making his own brand muffins at home.
And honestly, I was really lost for an answer. So I said, dad, I didn't learn that in med school. They taught us how to diagnose and how to treat disease, not keep a person healthy. So I think it set me off on my life's mission. It got me thinking, why do we do things backwards? Why are we waiting for symptoms to appear? Why don't we get out ahead and stop and reverse disease? And that's what I started to do way back then.
by collecting data under the surface, by evidencing my insatiable curiosity and other trait I inherited from my dad, a genetic trait, I think, because it runs in all of us comites. And I asked myself, we can see numbers change under the surface. We can see these trends going in the wrong direction, hormonally, metabolically, you name it. Why aren't we doing something about it at 40, 30, even 20? But 30 is when it becomes really critical as hormones change.
and our metabolism reflects that difference. And as my career progressed, I started seeing these clear cut patterns in my patients. They were presenting with issues that while overlapping was never identical in each person, but hormones were changing, sometimes in different directions because a woman might go through menopause at one age or the other, could be anywhere between 38 and 58, for example.
And in one woman, could happen literally from one month to the next. Men's disease just stops and you're done. And in other women, it could be 10 years or more. And so glucose was changing in almost every single person. I don't think I've met a person with optimal glucose at all. We'll talk more about that in another podcast. But as we look at those changes, we can tell the path somebody is on. We literally have a crystal ball. We know that visceral fat increases.
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out trunks thicken, even people who keep themselves in perfect shape. For example, marathoners and triathletes don't know what changed because they're doing exactly what they always did in their twenties. And all of a sudden they're going to pot, literally. They don't know how to protect their health. They're losing muscle mass. They're putting on fat mass. And that is all going to lead to disease. Muscle.
If there's one thing you should take away is the fountain of youth really. protects us from diseases, both invading from the outside, like COVID, those comorbidities, for example, and why people ended up on respirators, because they had underlying disease and they were getting sicker from the inside out as well. And that is a fact nowadays that a lot of folks began to notice during COVID. I was not happy with COVID. I had it quite early on, but
I was glad that finally maybe there'd be some clarity to why we need to take care of our health and how to best do it and where to go to get legitimate insight, not just what you hear on social media or you might even read in the newspaper, but where do you get true authority information that really guides us and tells us that the outcomes are gonna be phenomenal. That's really what was most important for me to prove when I set up
my approach to looking at people individually and gathering that data to be able to tell what's right for me and what's right for my twin sister and what's right for all of my patients at ComiTech. Metabolism starts changing. And I realized at the time that aging, well, a positive, because you don't want to die young.
You want to stay alive and well and full of life and have that joie de vie, but you want to protect your health so you can make the choices you need to make. But once we hit 30, aging happens at a cellular level. Hormones change, metabolism slows. We can't do the things we're used to doing. And at 40, 50, 60 and beyond, it accumulates more and more damage at the cellular level.
difficulty rising to the occasion, impossible to feel as good as we felt, naps become relevant for some of us, the inability to really participate in life fully becomes challenging. And you can't see any of this unless you do extensive blood work, looking beneath the surface. And you need to be able to connect those dots, those changes that are happening at the cellular level, checking sugar, looking at cholesterol.
body composition, what percent of your body is actually fat? Because you might look great on the outside and have something we call skinny fat. You have too much fat and not enough muscle, but you just look good, which is fabulous. It's a great trick, but it's not going to help you age in great shape. And that's the goal. How do we keep people from slow to slow? How do we stop disease from emerging? How do we stop conditions like diabetes, heart disease, heart attack, stroke, dementia?
cancer, Alzheimer's, all of that information is out there right for the picking, but we have to apply it effectively and we have to do it knowledgeably where we take the bits and bytes of data and we turn it into wisdom at the level of that unique human being. Looking at, for example, endurance is a really important aspect of it and connecting those dots between all these data points and overlaying with it the health history.
I found by doing this, could literally predict a person's future health trajectory. And I literally saw the writing on the wall when somebody was 30, 35, 40 years when I started that. Although truth be told, you can actually see this in children and you can see it in 20 something. It's just until 30, we're well compensated. We can burn the candle at both ends.
and wake up smiling the next morning and go skiing again, even if we've been drinking and partying the night before. That doesn't continue to happen. We pay a big price for it in some ways for some folks, not everybody. You may be the unique person who can fix things a little bit, take some supplements and do that at 35 or even 40 or 45. But at some point it's gonna catch up with you. And that's a guarantee. None of us get out of life.
alive. We all live with disease a long time. But with all the advances that we have now, technology and the knowledge to look under the surface, we can apply that and make sure that our health is preserved instead of failing over time. And that's what I realized as soon as I started doing this work, that we could adjust a person's physiology as readily as they are willing to partner with us.
using all sorts of approaches, starting with figuring out what your sugar is, knowing how it changes during sleep. What does that glass or two of wine do at night to your wake up, when you wake up with your morning sugar? Do you become high or low? And that means something completely different in different folks. Some people can intermittently fast and do fine. Those are all the data points and the details we need about a person's health story.
to be able to then determine how do we change your habits? Do you go to sleep a little earlier or perhaps you can sleep in a little bit and that works for you. We use technology like Aura or whoop to be able to give us those insights at the time they're happening, not just to collect the data, the information by asking questions, but actually to measure it. We then can turn to supplements or medication, optimizing hormones.
and all these different interventions that when put together as a package for each person, literally stops the aging process. So instead of growing a year older biologically every year, instead, we'll blow out a new candle, but we're reversing that rate of aging. Instead of a one -to -one, it could go down as low as a half a year biologically to one year of life or even less. And that's the goal.
We literally can make your cells younger, slowing and reversing biological aging and those diseases of aging and disorders that I think of as aging diseases, disorder of sugar or what's commonly thought of as diabetes type two, or there are many different types of diabetes around the globe. And literally everyone has to deal with it. It affects everyone in one way or the other, even if you're unaware of it.
The heart attack is most likely underlying it is abnormalities in sugar. And so I began to think of diseases that were so common that I studied in school as really an outcome of aging. Our body can no longer compensate. It was meant to be this way and we need to address it. We need to learn to put on muscle, to do resistance training, to maximize and optimize our health below the surface to get a hold
of a process that would slow down and reverse aging. That key to your health span and mine, the length of disease -free active and energetic years is critically weighted on quantifying health and making key life -changing decisions to take a real role in the decisions you make to know yourself and to know beyond yourself if you're lucky enough to have access to your family and have a family.
Even without that, we can tell because the numbers show us the direction and we could tell how they're expressed. But the more information, the more of a basis and foundation, the better you'll be served. But I've seen plenty of folks who have no idea who their biological family is and that's very common nowadays. And yet we can tell based on the data we've accumulated over these past two to three decades.
what direction someone's heading. And we can see the response once we start specifically with targeted and actionable interventions. And we have the proof to show that. We have scientifically determined over the last two decades what works to the tune of changing 98 % of the direction people were headed. There is no one size fits all.
So be wary of promises out there that you can look at your biomarkers, you can look at your labs, you can tell what to do because mostly everybody will get the same direction and that's not what you want. That's population -based data that's built on thousands of individuals and with what we call regression to the mean, which means it's the average and no one is average, everyone is unique. At Comite Center, we treat everyone in that fashion.
I've called it right from the beginning, N of one, meaning you as a unique individual. It's the studies we do is almost like doing a clinical research study or trial of a singular human being, a single person, and take the data that's out there as the initial foundation that's done in thousands, if not millions of individuals around the country, around the globe.
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and applying it at the individual risk benefit for every person. Once we get that person to unique data set, we do a deep dive into that. And that's what I'll be sharing on my podcast. I'm very excited about it. I'll be talking to real folks who've lived through this process with us and have come out at the other end looking like they're in their forties instead of in their sixties.
and people confused about why they're so energetic. They could do whatever they want. Most of them won't stop working because they love what they do and they feel great and energized. We can identify what's brewing under the surface and intervene immediately to stop it and to reverse it. Let me give you an example of how that happens by talking about a young guy in our practice. His name is David.
and wonderful guy. you'd meet David, you'd say he looks amazing for a 33 year old, but David knew better. Actually, he knew that he didn't have the same energy he used to have. In fact, he was newly married and he actually talked about his libido not being on top of his game. The fact that he wore out and he couldn't exercise as much as he used to for a 33 year young human being. And I wasn't surprised when we got his data back.
to see data that went along with David's story. In fact, he had problems at multiple levels and it was critical for him to jump on it. David is 33 years young and as such, those are chronological years he's lived. But underneath his biological age showed a completely different story.
Underneath, looked 20 years older. He had advanced signs of disease, of insulin resistance, for example, with a fasting sugar and insulin that were too high for his stage. And as a result, we could tell him that you are brewing diabetes now. those numbers were too high for someone who fasted more than eight hours. We want insulin to be undetectable after fasting.
Even three hours after a meal, insulin should go back to being undetectable or less than two. And if it doesn't, it means there's an issue there. And depending on what the glucose is, if it's high or low, it speaks to different patterns. With no food in the system and no glucose to chew on, if you will, because you haven't eaten for 12 hours or even eight hours, insulin should be undetectable. And that was one of the red flags. He had a number of them though.
Cholesterol, for example, was way too high. And we particularly pick on, to start with, the cholesterol risk ratio, which is the total cholesterol divided by the high -density lipoprotein, or HDL, as a lot of people call it, the good cholesterol, which is a little bit of a misnomer. It is actually protective, but you have to look at the particles to decide how protective. In any case, David's cholesterol risk ratio
was 4 .5, which was extremely high. We wanted under two to keep his health together and not go down the path that his father went. So in collecting this information, we found out that David's dad really started getting sick in his 30s and early 40s. He had multiple heart attacks and stroke. was in fact no diagnosis even of diabetes, but under the surface for sure, his sugar was abnormal, just like David's is.
And he was at high risk for heart disease as is David. When I inquired about his dad wanting to make sure his dad was doing okay, David looked at me and he was kind of sad and he said, well, we lost him at 60. He had a final heart attack and that was it. And that is no future to look forward to and that's the path David was on. So the high insulin level for David was one of the first red flags.
But then when I took a look at his cholesterol risk ratio by looking at total cholesterol divided by HDL, typically called the good cholesterol, it's protective, but the makeup of that good cholesterol is even more important and more on that later. Are they large particles? Are they small particles? How do they count? How much are they?
In David's case, looking at the cholesterol risk ratio, which is a reliable indicator of developing heart disease, stroke, Alzheimer's, any of the diseases that can block arteries and prevent blood flow, his was 5 .8, almost three times what we want for optimal. Optimal should be two or less. And that was a huge, huge indicator of how high David's risk was at the time.
because this was two, three years ago, and how he was potentially following in his father's path. David's dad, I learned through the intake that we did about the health history and David's health story, that his father had suffered multiple heart attacks and strokes beginning in the late 30s and 40s. I was getting pretty worried when I then hit his free testosterone, which was almost a...
quarter of what it should be for a young guy at 33, his free testosterone was only 56. That's what we see in a boy going through puberty in the morning, a free testosterone of 50. And yet David was far from being that young boy. He was a young man who should have had a free testosterone of 180 or higher. And that was missing. And that's, that was a big tip -off.
that David was no longer experiencing the kind of energy, libido and health he had enjoyed a decade before. In fact, you know, he actually had been told by his doctors 10 years earlier that he had high cholesterol and high sugar and hypertension, but no one did anything about it. They just said, we'll keep an eye on it. When you get sicker, we'll jump all over it.
That is not the way to treat a young man like David or any of us. As we move into each decade of life, beginning of the thirties, it's essential to know what's going on at the cellular level and stop disease before it takes over your body. It's never too late. We have people and clients in their nineties going stronger than ever, but it's always best to start as young as possible. And once you take this knowledge away, you can bring it to your partners, your family, your children.
your relatives and your best friends or all your friends, because that's what we'd want. We want this to spread like wildfire. We want it to be addictive and contagious. So everybody understands how they can partner with us to take care of their health as they age. So they age chronologically in great shape and their health is not an issue. So going back to testosterone for David, testosterone is basically an amazing kind of
hormone in the body that works at every level. It's not just sexual function. And in fact, what was a really big surprise to me is when I first started doing this work close to 25 years ago now, over two decades, I realized that the major complaint I heard from men and women was low energy. Yes, libido, sexual function for sure. Orgasm in women, sexual function in men.
can be affected, but in all different ways. And sometimes it's not. If somebody has a really strong mind and body connection, they can override that testosterone. But that testosterone, when it's low, is having a deleterious effect on your body. It's allowing sugar to build up, which is why diabetes starts penetrating as we age into our 40s, 50s and beyond. Testosterone helps us keep muscle. It also is great for cognition and memory, muscle and bone.
It's protective in terms of cancer. It balances out other hormones and helps with metabolism. Because if you put on muscle, you can only do that if you have adequate testosterone. You can work out to beat the band. You will not increase your testosterone. By increasing testosterone, you get all of that back and more. You get the opportunity to put on muscle that's protective. As I mentioned earlier, it's the fountain of youth. Mood, keeping our hearts healthy. Remember, our heart is a muscle.
Of course we need testosterone. We also need estrogen. Again, more on that later for us women and also men. Low testosterone is connected to insulin resistance and disorders of carbohydrate metabolism. Let's call it what it is, sugar disorders that cause diabetes, which is basically ubiquitous. Every single one of us has a disorder of carbohydrate metabolism.
which is the way I prefer to think of it instead of calling it diabetes type two. Cause I start wondering there's all these other types of diabetes. If you're Asian, diabetes can present some differently than if you're Caucasian or Hispanic. So learning all those facts and rolling it up into what I'm going to share with you is why it's so important to get some guidance on where exactly you stand. Low testosterone happens in each one of us and it gets worse with each decade.
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women and men. So that's important to keep in mind as another factor. So moving on, when you look at these suboptimal biomarkers, fasting insulin in David's case, cholesterol risk ratio, and free testosterone in conjunction with his health history in himself and his family, those were important criteria. In fact,
One of the areas that pops out in terms of profiling is early death from heart disease or stroke in Ashkenazi Jews. And while David's mom was a Puerto Rican, his father was Ashkenazi Jew, and it's genetically there in his family. And we also see it in a subset of Asians where they also have very similar patterns. So in some fashion, we're all connected under the surface.
but the genes may be different. There are actually almost 2000 genetic variants for diabetes. And for sure, David's father, just like David, had a disorder of carbohydrate metabolism that we now corrected in David. So he's a new man. He's reborn and he's more like 20 than 35 right now. As David corrected, he put on muscle, he lost visceral fat. We were able to drill into what David needed through the rest of his blood work.
including what nutrients were going to be critical for him. What are the gene variants that he had? And we explain the relevance of each biomarker. And we started by addressing his low testosterone. This is called hypogonadism in men. And women are affected too, but it isn't so visible in women because our ovaries are not operational on the outside, rather on the inside. But when we hit menopause,
We lose all the eggs. The eggs are no longer active in our ovaries and we go into menopause, no more cycles. Men are different in that they can slow down every decade of life. And that's more complex to think about, but actually easier to address. So by replacing testosterone either directly with testosterone, there are many versions of it, or using what we prefer, which is a more physiological approach.
We use peptide hormones. The particular one I'm talking about is human chorionic and antitropin to trigger the release of native testosterone to keep those testes active and healthy because there's data in the literature that also shows that men who father children later in life and are able to make sperm equally live longer. And so I always felt right from the beginning that it was important to work.
with the body and not replace when you don't have to replace. We women are different. We can no longer stimulate estrogen or progesterone or testosterone on our own once our ovaries call it quits, which is on average at 50, but it can happen at 38 and it can happen at 58. And I've had that whole span. I've even had a family of six sisters back at Yale.
where one went into menopause after six children at age 38 and her sister was able to get pregnant in her 50s and didn't hit menopause until close to 60 at 58. So that's how much variation there can be. We've reduced David's risk of diabetes, more importantly, heart attack and stroke. And David is going stronger than ever, which I'm grateful for, for David and for his family.
So that can happen for you and everyone you love. That is our goal here and why I'm sharing and started to do this podcast because healthy longevity is our do. And if we're living longer, we don't want to be a burden to ourselves or our family. And the cost of disease is far greater than the cost of keeping our health. We just have to invest upfront in knowing what it means to stay healthy.
for each one of us individually, uniquely. I so appreciate everyone following along for this initial introduction. And I can't wait to get deeper into it with other folks here that can teach us more about what their path looked like as well. In future episodes of Healthy Longevity, I'll share many other case studies who...
of clients at Comite who have turned back the clock and are living life to the fullest and having fun while doing it. Not necessarily struggling because when you know what to do, it's not hard to do it because it makes you feel better. So you wanna live life like that and then you can help people around you. We'll also dig into specific health issues like diabetes and heart attack, stroke, cancer, osteoporosis, neurodegenerative diseases like Parkinson's.
Any of those conditions are basically approachable if you start young enough and you get on top of it and you get ahead of it in the decades where the changes are happening, but they may not be visible on the surface and symptoms may be hard to detect. We'll cover also in depth what happens at midlife that sets the stage for this in women.
men, by the way, in women, this perimenopause and menopause, and we are very sensitive to our cycle because we've lived with it from the time we entered puberty with Menarche or our first menstrual cycle. We actually see changes a couple of years before that. And so when that change happens, the change after the change, we need to look forward to a life of vitality because it just signals a transition. And the more we know about what's going on under the surface for women,
the better you'll feel and you'll be able to live life to the fullest. Actually, a little tip off is no worry about pregnancy, right? And we feel good and energized. And I've known a lot of people starting with, I think Margaret Mead, who called it a power surge instead of a hot flash. So those can be very disruptive and more on that because sleep is also interfered with when our neurotransmitters and estrogen falls. So we'll talk more about that in future episodes.
Men are also struggling with hormones. And while it's not clearly defined in conventional medicine, age, whether they like it or not, just like women, it's just slightly different. They don't live as long as women. Something's going on below the surface, right? So hormones change dramatically in men. And there's a different pattern that we have to look at, but we can keep men stronger than ever despite the aging process.
because it's not just about how much you work out, how heavy the weights are, but it is about the whole way you live life and the choices you make. We welcome guests like medical doctors, researchers, and experts, as well as real patient clients who share their stories of their health span improvement and what has changed and why they've turned back the clock so effectively.
We'll take time out to answer burning questions from all of our listeners. That's you. Please don't hesitate to write in, to comment. We love all of it and we'd welcome it. I hope you'll come back to listen because there's so many topics to discuss. I just touched on just a very few of them as I went through the story and the intro. And there were practical solutions that we'll share that can be put in place.
in your life to strengthen yourself and to reverse aging and stop disease, to improve your health span, to match your lifespan and live wonderfully for the rest of your life. Thanks for listening. I'm Dr. Florence Comete and I'd like all of us to keep it up to make our way to healthy longevity.
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