October 15, 2024 • 37 mins
Don’t try to manage menopause alone as your mother did. Actively seeking help and resources to comprehend and navigate perimenopause and menopause is the new plan for women to manage symptoms and improve their health. Join Dr. Comite in an open conversation about how to embrace this significant life phase with Jessica Shepherd, MD, a board-certified OB/GYN and author of the new book Generation M: Living Well in Perimenopause and Menopause.
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How participating in open dialogues with other women and your partner will facilitate understanding of changes, alleviate symptoms, and reduce feelin
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Episode Transcript
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Florence Comite (00:10)Welcome to Healthy Longevity. I'm here today with Dr. Jessica Sheppard, who's a board certified OB -GYN. She completed a residency in that field at Drexel University at Hanuman Hospital in Philadelphia, and then spent six years as director of minimally invasive gynecology at the University of Illinois and entered the field subsequently of functional medicine.
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Currently, she's the CEO and founder of her concierge medical practice, Sanctum Medical and Wellness in Dallas. you've been honored multiple times as one of Dallas's best doctors and you're seen regularly. on ABC as the woman's health expert
Dr. Shepherd (01:01)wellness.
Florence Comite (00:49)on Good Morning America, the Today Show, CNN, CBS. So congrats, you've done so much. I had the pleasure of meeting you, online first and then in person and was blown away when monitored and moderated sessions at our Longevity Docs Conference.
Jessica, it's so great to have you here today.
Dr. Shepherd (01:08)So great to see you again. And I'm so glad that we had the opportunity to meet in New York. I think sometimes, you know, in this day and age when so many people connect and meet over, you know, whether it's social media or whatever that is, it's so nice to still be able to meet in person. So it was delightful to be able to meet you.
Florence Comite (01:27)I agree completely. here we are, the science of longevity is booming. I think every day or maybe multiple times a day, I hear about a new startup everywhere around the world, but particularly in America.
and there's a lot to talk about, but first tell me the genesis of Sanctum Med and Wellness and what you hope to accomplish there. And then I know you have another startup you're brewing as well.
Dr. Shepherd (01:48)so saying to med and wellness really came from, you know, having practiced for 15 years in academic medicine. And really it's the ability, like we were just talking about, to connect to our patients. And so there was a point in which the connection is somewhat lost because you either have to send them somewhere or you want them to continue some sort of lifestyle medicine or longevity, but you don't have the ability to do that in the.
practice model that we have in academic medicine today. And so coming out of that and using holistic practices, Eastern modalities, longevity, core goals, I developed Saint Demed in Wellness to be able to incorporate all of that. And so what we have is we have our traditional medicine set up where I see patients and practice evidence -based medicine. But in our center, we still have all of the other holistic practices, including yoga. We have two licensed therapists, life coaches. We have a
traditional Chinese medicine doctor, two of them doing acupuncture. We have red light therapy and massage therapists and a registered dietician.
Florence Comite (02:50)that's fantastic I think back in the day, everybody was talking about integrating medicine and sounds like you've done that fantastically.
Dr. Shepherd (02:58)Yeah.
Florence Comite (02:58)What is your general idea of clients, what they do? I call them clients sometimes because I don't want them to be sick patients,
Dr. Shepherd (03:06)So I think, you know, I kind of have like two pools of patients, I guess you could say, because I've done gynecology for so long and had a very, very strong surgical practice because I did a fellowship in minimally invasive gynecology. So I still have a lot of patients who see me and come for their, I guess you can say their annual, their well woman visit, sometimes any bleeding issues from a gynecology standpoint. But I really have solidified myself in the perimenopause and menopause space.
and really giving breath to that in allowing women to feel heard and giving them as many options as possible and how to navigate through that. And so then I have a lot of patients coming to me for that because I speak a lot on menopause and perimenopause and what that experience is. So I'd say that's kind of like the buckets of patients that I see. But yeah, it makes it very nice for me to be able to still practice what I've done for.
for time and time again and then working in the menopause space is really navigating the newest innovation that they have in the field and being able for patients to really see the scope of what menopause has for it, whether it's from the metabolic perspective, whether it's from the hormone perspective, whether it's from the sexual health perspective, and then from the mind and mental wellness perspective. So we really are able for them to see it on all different levels.
Florence Comite (04:23)No, you're a tremendous advocate, for women. And you share what you know. And we both, I'm sure, have grown well out of our very specific and discreet practice. I know you even write for consumer magazines. You love education. It just comes through in the way you're describing it. What is the issue out there? Why is there so much misinformation? I'm always disturbed by it because now on social media,
everything glows. So like you think it's all good, but most of it is not. And I think in some ways it induces a lot of anxiety in the people I see and I hear or ask me questions.
Dr. Shepherd (05:00)Yeah, I have seen an increase in how we take in problems and or issues, how we think the world sees us. And I think that plays a lot into our psyche, which then I really believe and I know for sure mind body connection and the things that happen for us mentally does manifest in our body. And so the way that I'm able to connect that for patients, a lot of patients will come in with issues that they're having at home and relationships at work and
then they'll have manifestation of that in symptoms. And so when they're able to see that, that actually allows us to give space and time for ourself when we think of our emotions, when we think of trauma, emotional wounds, and helping that, nurturing that, while still paying attention to our physical symptoms and creating again, this continuum between the two.
Florence Comite (05:50)I don't think most outsiders, people who are not in medicine realize the trust our patients put into us. A lot of times they share who they are. They really want to get insight and they don't know where to go. And so if your doctor can't be your trusted confidant, if her, the way she delivers or he delivers on the promise of what medicine and health and wellness can do.
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Dr. Shepherd (05:59)Thank you.
Florence Comite (06:17)we're missing an opportunity, I think. And so it sounds like you feel similarly because that's where I feel the real heart and soul of medicine still exists, that trust between our patients and us and really guiding them effectively.
Dr. Shepherd (06:31)Yeah, and being able to guide them to the other, I guess, providers that can also create safe spaces for them. Because I have really done a lot of research and time spent with people in other settings, whether it's mindfulness, whether it's Eastern modalities, whether it's from a therapist perspective, and learning their crafts, but not being an expert, so that I'm able to better serve my patients and know some of the signs
that come up when they're suffering from something else outside of a medical condition. And so being able to make that connection and then send them off, that again is that trust of I know what you're going through and I also know where to get you to get the help that you're going to need in order to have the better outcome.
Florence Comite (07:18)And we know as doctors, it's hard to get our colleagues even on the phone. They're seeing 20 to 40 people a day. They don't have time to, you know, all of this new electronic way of engaging is fabulous. But fax machines are a way of life. So you don't have to be interrupted. And unfortunately, it's not a reality anymore.
What drew you to longevity and functional medicine?
Dr. Shepherd (07:40)I think that part of it definitely came from when you look, one, at the current health care system. I think the health care system really failed us into we're still a very diseased country. And when you think of chronic conditions, seven out of 10 chronic conditions are actually avoidable. And so when you look at the aging process and then also disease and how that increases,
Florence Comite (07:48)so to speak.
Dr. Shepherd (08:07)Obviously you're going to have more disease and the likelihood of having disease as you age, but you also have the opportunity and the choices to offset that. And that's where longevity really came into the practice for me was for me personally, I was like, how do I want to show up later on in life? And with the training that I have as a medical doctor and also seeing this scope of alternatives and Eastern modalities,
What can I do in addition to that, which is what longevity medicine provided, because I wanted patients to be able to see themselves differently than just aging and what comes with aging, with the stigma of now I'm just gonna get sick. And I think that there's a very strong messaging when we think of the healthcare system is that it's unavoidable. And so changing that perception of what people think of themselves and what they're actually able to accomplish.
is actually remarkable when you either understand it, when you believe it, when you get it. And so I think my job is to be that cheerleader for my patients and saying, I know you can do this and I know that there are some really good features that can enhance that journey for you. So it's not for everyone. I think that you really have to have a sense, a true sense of, I really want this for myself in order for it to really work.
But being able to offer it for me was the best part of it. Because if I don't offer it, then the people who do want to adhere to it or are interested in it would never have heard of it. And so I think that my job is really to be the messenger.
Florence Comite (09:44)That's fantastic. I use the word guide, but I think too that there's a ton of knowledge out there. How do you know if it's good or bad? And so I always think, and as you well articulated, it's turning that knowledge and all the disparate pieces into wisdom. And that's what you're able to do. What is really fascinating, but in your wonderful state of Texas, there was a 71 year old who showed up on stage.
Dr. Shepherd (09:52)Mm -hmm.
Florence Comite (10:09)with the 21 year olds competing for, I think it's either Miss America or Miss USA. And I heard this last night on the news and I saw her, she looked incredible. And more importantly, what she said when they asked her, the newscaster was on CBS, when they asked her, you know, like, what did you think and how did it feel to show up 50 years older than most of the other women? She said, first of all, they were really supportive.
And I was able to show them how you can look and feel if you make the right choices. She wasn't even on a bully pulpit. She was actually saying, this is what I chose to do, and this is how I'll do it. And here's what's missing. We're not proactive in medicine. We can't be. We're so busy taking care of chronically ill folks when they show up so sick after decades of it brewing under the surface. So I completely get where you're coming from. And I think it's amazing because I was blown away when I saw her and so.
Dr. Shepherd (10:55)Mm -hmm.
Florence Comite (11:03)proud of being a woman. Yeah. Yeah. I believe it was Texas. I hope it was Texas. It might have been Arizona, but I think it was Texas. Yeah. Yes.
Dr. Shepherd (11:04)And that's what I love, is that you were blown out.
But I think that's like fabulous that be blown away by someone of that age. But I really do think, and this is where the mind body connection comes into it. She had to believe it for herself. Right. Yeah. Yeah.
Florence Comite (11:21)Exactly, she said it even, you know? You're 1000 % right. She like, I had to be convinced and I saw why did I wanna age like my mother? And I see that a lot, but then a lot of women say, well, I know I'm gonna turn into my mother and I have to tell them that your genes don't have to be your destiny. You can make choices if you have the bits and bytes of information under the surface. You may not know it, but you know at 40, you're not 20.
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Dr. Shepherd (11:31)Thank you.
Florence Comite (11:48)And you keep thinking, well, you can't really take care of yourself. Maybe you're a busy career woman and rising in the ranks. Maybe it's kids, whatever it is, you think, well, if I just, but the answer is not in just being what you were at 25, because your body is evolving. And so giving them that it's a gift. It's a gift of life, actually, because you only have one body. So where are you going to live if your body deteriorates, right?
Dr. Shepherd (12:00)Yeah.
Hmm?
And that's the other thing is that we only have like one shunt at this. And so in order for us to get that outcome, I also say it's very similar to what I would say financially. I would never tell you to wait until you retire to start saving. You start saving earlier in life so that it's ready for you, right? When you retire, same thing with age. Your health is one of the...
Florence Comite (12:34)your financial portfolio, right?
Dr. Shepherd (12:38)most important things that you can have for yourself later on in life. And so if you want that return on investment, then you have to put in the work and the time now until it becomes your lifestyle and your habit. And then you'll be so pleased with yourself when you want your body to come through for you and you want your health and wellness to come through for you that it does because you gave it the time and effort. And so that's why I try to focus the conversation on what do you want? And putting it back.
Florence Comite (13:00)Yes.
Dr. Shepherd (13:05)to the person having the autonomy to say, this is what I want. And I'm like, well, then let's work on that. And step by step, I think that it's an approach to people being open to seeing the results and then wanting more.
Florence Comite (13:19)Yeah, no, absolutely.
And in order to do that, there is an investment, but the good news is if you start it as young as possible and you can bring it even home to your family once you're aware of what are the issues, How do you sort out the good, the bad, the neutral?
why do you think there's still so much misinformation about perimenopause and menopause? I feel sad about it because I remember answering these questions for the mothers. I wasn't close to being menopausal at the time. I started way too young. And when I had these women, menopause was in the closet.
and they wanted to feel, they thought life was ending, you know, and the transition was clear. It starts in the 30s, it heads into the 40s, and most of the time, by the time you're 50, 51, you're gonna be menopausal. Your ovaries have stopped, you're not cycling for a year. But there's so much misinformation. How do we get that straight?
Dr. Shepherd (14:12)That is probably the million dollar question. I think we are on our way to a better future in menopause than I've seen in the past. When I was practicing, or in residency rather, in training, that's really when the kind of WHI came along and kind of kaboshed everything and there is just a really distinct change in how we approached hormones. And not to say that
hormones of the end all be all to the menopausal experience, but it is a good part of it. With that came, again, hiding and stigma and shame. Then comes the disconnect between what we as providers can offer and then patients wanting to, again, address something that already was a pain point for them. There was a lot of rolling around not knowing what to do on both ends.
And then we didn't really have any tools as providers. And the other thing that I would say is we kind of put menopause into this box of one, it's horrible. And your life is just horrible after menopause. I'm trying to change that narrative.
Florence Comite (15:25)Well, life ends after menopause. You know, you're menopausal, you don't talk about it. You're old, basically. Yeah.
Dr. Shepherd (15:28)And so exactly, so that's the message. No one wants to go through it, right? And so if no one wants to go through it, then we can't even really do good education in preparing for it because everyone's trying to avoid it. And so I think that now that we're kind of expanding the experience of education, knowledge, treatment modalities into the pyramid of puzzle space.
Florence Comite (15:34)Right.
Dr. Shepherd (15:53)I'm very hopeful that in the next generation to come that, one, they're going to have things on board before they get to menopause. There will be a change in the messaging behind it. And then we're going to have, as providers, more validity, more evidence towards how hormones actually are beneficial. And so this change is going to take some time, but I'm glad we're out of kind of this dark cloud of hormones are bad, menopause is horrible.
and then having the stigma behind it. So that, I think now that we've changed that narrative, it will probably take for me, in my opinion, maybe another 10 years before we're actually just speaking about perimenopause and menopause and it's no big deal. Kind of like what we saw in the breast cancer phase. It started with Susan B. Komen and making it something that people could discuss, not be ashamed about, and now...
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Florence Comite (16:37)All right.
Dr. Shepherd (16:45)who doesn't know about October and Breast Cancer Awareness Month when before it used to be so taboo to talk about breast and breast cancer.
Florence Comite (16:52)Yeah. Plus the more attention you bring to something. I remember that I found a photograph around the time I started Women's Health and when we talked about heart disease. And I remember inviting the chairman of cardiology at the time I was married to a cardiologist who ultimately became associate chairman there. And also all the other participants in sort of working up heart disease.
Dr. Shepherd (17:03)me.
Mm -hmm.
Florence Comite (17:18)And I remember giving them a lecture and putting up slides side by side, the 1900 and 1990s, one woman in the cardiology department. So attention wasn't given, the voice wasn't there. We didn't think of women. And the only article I could find about women in heart disease was at the American Heart Association, where they talked about your husband's heart and what you have to do to take care of it. And this is over 20 years ago, almost 30.
Dr. Shepherd (17:31)Right.
What?
Florence Comite (17:45)and actually 30 and the women's health initiative trial at the time I remember thinking in 20 years. So I'm optimistic that you said 10. I don't know. Optimistic. It takes a very long time. Even like, I don't know if you saw recently, but my own field in endocrinology, there was a new statement of vitamin D not being necessary until you're 75 or maybe when you're pregnant.
Dr. Shepherd (17:53)I'm trying to be very...
Florence Comite (18:09)and that it's all a lot of hoopla -la over everything. And I think the lack of proactive understanding of our bodies evolving in women and in men is actually very hurtful. And there was a quote from the Wall Street Journal that I came across from Naomi Watts, where she talked about her struggles with perimenopause. So I agree getting it earlier and earlier and out there in the dialogue.
Dr. Shepherd (18:21)Good night.
Florence Comite (18:36)is that there was no information, no community, not even a conversation with my own mother, no blame to her. And that was so common. And then today when I hear these women, the same story, it just makes me sad and it's been a long time. So, so yeah.
Dr. Shepherd (18:51)I know, and it's one thing that I would say that 100 % of women are gonna go through, right?
Florence Comite (18:56)Yes, it's inevitable, but what doesn't have to happen is we don't have to deteriorate, you know, we... Right?
Dr. Shepherd (19:01)Yeah, I think we can change that whole outcome and really now we have the tools. I think we have more credence to, want to look at all the solutions rather than just saying this is what it is and this is what you're going to suffer through.
Florence Comite (19:16)And yeah, you know, just suck it up. Which a lot of people hear from their regular doctors, you know, sorry, it's tough, you're getting older. What do you expect? Aches and pains. But no, I remember thinking around the time I started Women's Health, because I was looking at why do we take care of our athletes and their pitching arm and their knees and their, why do we let people age and get, you know, arthritis and...
crippled instead of proactively working with them to preserve their strength and energy. And that's where I started with the tools I used, as well as hormones, because it's hormones that trigger in the whole downward decline.
Dr. Shepherd (19:41)Thanks.
Florence Comite (19:51)And it turns out testosterone's a huge trigger and yet even in today's world, testosterone isn't approved formally by the FDA for women. I mean, I've been using it and prescribing it for how many decades? We don't need testosterone, we don't have testosterone and men don't have estrogen, wrong, right? Anyway, yeah. Is that, that's your experience too? Yeah.
Dr. Shepherd (19:59)Now, I mean, why would you?
(01:25):
Anyway.
Right, right.
gosh, completely. I think that's my experience. And I think even today, even though I'm very comfortable prescribing testosterone and recommend it to a lot of my patients, they still are very, very hesitant. And I think even some of my colleagues who are not comfortable with testosterone are, they're like, I don't know if that's something that should be recommended. So we have a lot of work to do, but I'm very excited.
Florence Comite (20:14)Yeah.
We do. I mean, even educating my colleagues when I first was segueing into New York I had to educate my colleagues along with my patients because otherwise they'd hear a different story and still today. And I would say to them, what do you think sustains our muscles? Do you know the data on cognition and memory? Do you know that the heart's a muscle, by the way?
Dr. Shepherd (20:51)you
Right.
Mm -hmm.
Yeah.
Florence Comite (21:04)And all these diseases that come out emanate from the fact that our sugar goes south. We can't put it anywhere if we don't have enough muscle. That's testosterone. And we women have a fraction of what men have. So physiologically, we want to be who we are. And I always felt that my transition came when I was saying to myself, you know, aging is really leading to this downfall. And aging isn't bad. I was always against the term anti -aging because I was pro -aging. Otherwise, to me, it was like early death.
Dr. Shepherd (21:11)See you.
Mm -hmm.
Florence Comite (21:33)But I knew that we had to maintain physiological function. that brings up an interesting topic that I don't know if you've read about this, but a researcher who looks to taking a piece of the ovaries and then planting it in women as they age so that they never go through menopause so that they could sustain. Could you imagine? I mean, I can think of all the pros and cons, but I love the idea.
Dr. Shepherd (21:53)No.
I know. I'm like, I was literally, as you just said that I was like, well, I am a minimally invasive gynecologist. I wonder if. Please, I'm going to be like, maybe I should start this therapy. I think it's like exciting. And that's what I love to see in innovation in medicine is, and especially in the longevity space and the regenerative space is these things that no one would ever.
Florence Comite (22:02)Exactly! That's what came to mind. I'll find that paper and send it to you.
Dr. Shepherd (22:22)you know, think of or dream of and now like putting the thought into your head and where can we go with that?
Florence Comite (22:28)Yeah, no, absolutely. I still remember with the changes in gene -RH analogs and fertility so that women in their 50s, I see billboards when I travel up north from New York to Vermont where women are there hiking saying, I beat my cancer. I had decided to put off having children and at 58, I have a child. Now it's not recommended for everyone. I personally would have loved to continue to have children whenever, but I'm happy with my two sons and I sort of have a daughter who's like,
Dr. Shepherd (22:49)Right.
Florence Comite (22:58)special to me. I think about it, let me tell you, but I've decided I have too many babies percolating in the business world. I don't know that I could handle it. So now, because it is a lot of work, but it's also fun. I feel regenerated, rejuvenated when I'm around, like even training younger people. And I love that educational piece of it because I feel like their life is in front of them. They have so much, just like us, because we're
Dr. Shepherd (22:58)You sure you don't need another one?
(01:46):
Thank you.
Florence Comite (23:25)reinventing where medicine and healthcare should really, it should really be about health, not about only medicine, you know? Yes. Yeah. Yeah.
Dr. Shepherd (23:30)Mm -hmm. And the sustainability of health. I think it's the sustainability of it and how long you can get your body to do its best work for you. And feeling it.
Florence Comite (23:43)Yeah, that's why seeing this woman, you know, compete and proud of it. And she, I, I would be hard pressed to say that she was as old as she claimed chronologically, because I bet biologically she was half that age. And that's all our goal. Like I do that constantly looking at biological age. Our data is feeding some of the algorithms going forward. And there are some secrets that we all carry within us that if we knew
we could manage better. I think there's huge promise, for example, for plasmapheresis, young blood for old blood, although I personally like the notion that we give it to ourselves, we clean our system out in some fashion by plasmapheresis or hyperbaric oxygen. And those are all very forward thinking for 99 % of doctors, I would say. And I think the public is more ready to embrace it because they're frustrated by the lack of
Dr. Shepherd (24:24)and
Thank you.
Florence Comite (24:38)what they guidance and what they should be doing to keep their health for life. We are living a longer life, right? Yeah.
Dr. Shepherd (24:45)We are. Yes. Well, our life expectancy has increased, but I want to know, like what, you know, with all the things that you were just mentioning about hyperbaric and plasma freezes, what are some of your routines that you do?
Florence Comite (24:59)that's a great question. And I'm going to turn around the question to you, but I'll answer first. So first of all, I have a shake every morning. I actually have it here. I don't start eating because I'm not a purposeful intermittent faster, but I do intermittently fast. It's always been my thing. I'm never hungry when I get up. And I discovered the reason for why there are people who are starving and
Dr. Shepherd (25:05)Good night.
Florence Comite (25:20)I believe, and people who are not hungry. If you wake up with a higher than normal sugar, you're not necessarily gonna be hungry. But if you tend to reactive hypoglycemia, which you know in OBGYN, almost every woman who's pregnant has a brief glucose, a short glucose tolerance test. It is so common. I actually have come to think over the last half a dozen years from the studies and work I've done with continuous glucose monitoring.
Dr. Shepherd (25:32)Mm -hmm.
Florence Comite (25:46)that every single person is on a path to diabetes because it's a Darwinian survival. And I'm working towards that premise. It's probably going to be the focus of the book I'm going to be trying to write over the next few months. I'm addicted to data and wearables. So I will try everything. I'm wearing a continuous glucose monitor because when I'm on your watch.
Dr. Shepherd (25:52)This is the end.
I have a whoop. This is a whoop. Yes.
Florence Comite (26:07)you have the woof. So yeah, and I have the aura, you know, so sleep to me is paramount. I was bad for a number of years because I always want to accomplish more and more. And I was lucky. I'm a good sleeper and deep sleeper. So you get what I've learned is if you're good at deep sleep, which I am, you can sleep shorter periods of time and still feel like you can thrive. And I experimented with plasma for Isis.
Dr. Shepherd (26:13)Isn't it?
Florence Comite (26:34)over a six month period at the end of 2021 when I was creating the app And the first three months of PlasmaFresus, I did it monthly. My biological age dropped by 15 years, less significant.
And I was blind to the data. I just drew the data every month and I like evaluated it. I had nothing to do with analyzing it or anything. I'd already had a relationship with people where we test everybody looking at it. Then I stopped really sleeping because I had to drive the product for three months. And if I had four hours, it was a good night. And I still ran the same practice So you know how hard that is and how much energy it's that.
Dr. Shepherd (27:13)Right.
(02:07):
Florence Comite (27:14)At the end of the next three months, I shot up older with my biological age than I had been before. And so it became clear to me that even though I could get away without sleeping, which a lot of people think you'd be, you'd probably be shocked at how many people over the years say, I'll sleep when I'm dead. And I'm like, what? You know, sleep is rejuvenation, right? I knew what I was doing.
Dr. Shepherd (27:33)No, not for my good life.
Florence Comite (27:36)And then afterwards it was like, no way, I'm not giving up at least six hours a night. And on weekends, if I can get eight or 10, I will. And the difference is night and day. Yeah.
Dr. Shepherd (27:44)on the screen.
I sleep has, it's new for me in the sense of, I guess you can think of our careers and what was expected of us, the time that was taken to when you're in residency and you don't really get time off, you didn't have the shift work like you see today. And so I have always been someone who can run pretty long hours without necessarily feeling like completely diminished of sleep. So I do not necessarily sleep.
Florence Comite (28:04)Yeah.
Dr. Shepherd (28:16)seven to eight hours. That's a lot for me. But I do, I think I pay attention now to the quality of my sleep. And that's helped as well and really focusing on it and making sure when it's time for bed, it's time for bed. So I think the sleep habit portion of everything for me has changed. The other thing that I would say is in this time in my life and looking at all the things that I can incorporate them just like you or when I get up in the morning, I'm not really hungry.
Florence Comite (28:23)Yeah.
Dr. Shepherd (28:42)Coffee can carry me over till maybe like one o 'clock. So with that being said, then I focus on, okay, how am I gonna nourish my body? And I try to not eat at nighttime, anything, you know, maybe before dusk. So I really focus on the middle portion of my day to fuel myself and I do then more protein. So protein for me is like where I thrive and focus a lot of my nutrients and my macros.
And so I think that's really helpful. That's really helped me, especially going through perimenopause because I know that there's such a decrease in muscle mass and then weight training. So I do work out quite often and I focus again more on weight training and weight bearing exercises in order to, again, give me the best outfit that I can because skeletal muscle again is one of those organs that really, really is our longevity, right? That's our longevity.
Florence Comite (29:37)Yes, fountain of youth to have muscle and he does wear testosterone and doing resistance training and eating enough protein. So I'm in total agreement and was one of the hardest things for me to do to stop grazing at night. But our system, when we sleep and the rejuvenation of our immune system, all the hormones, if you stop eating at least two hours before bed, maybe three, and I was a grazer, I realized it like I really didn't dinner I would have, but then I would get a little
Dr. Shepherd (29:40)Absolutely.
and
Florence Comite (30:07)bit of ice cream or grab something else. And that was the hardest thing and I've been doing it now for years. The difference is incredible for me. I mean, it doesn't mean that it's a hard and fast rule, but I would say most of the time I'm just, I'm not even hungry anymore at night and because my body got used to it. But grabbing a piece of dark chocolate and telling myself, well, dark chocolate's good for you. It has phenols and flavonols and all the other. But yes, so that.
Dr. Shepherd (30:08)Right.
Yeah.
Florence Comite (30:36)resistance training, the protein that you mentioned, those are all incredible habit changing, decreasing your risk of diabetes, heart disease, stroke, osteoporosis even, and now some of that's genetically dependent, but you can overcome the genetics if you pay attention because you don't have to decline. Yeah. Right.
Dr. Shepherd (30:56)Yes. And I think that's the construct in how I present to my patients is through personal experience of what I've noticed and looking at data and being able to give them really good data on what we do have currently. And I think that it changes people's scope of who they are, what they want to be, and what they thrive to be. And giving them
kind of the empowerment to think of themselves in a different light. I think that's important as well.
Florence Comite (31:25)Absolutely, and I think beyond that, one of the reasons I went into this in a serious way about 20 years ago is that I am an identical twin. And so I knew that even my twin and I, I know there's two of me, can you imagine? And she's better than me. She became a dermatologist. And my mother used to say, you got to go see your sister because you know your face. And I'm like, mom, I'm doing health from the inside out.
Dr. Shepherd (31:39)I love it.
(02:28):
you
Florence Comite (31:51)My mom, actually didn't, you know, I wish she's still here. We lost her a couple of years ago. She was 102. And I think the fact that we're living life, she guarded and did everything, you know, she was a model for what she did. It was amazing. And so I think I came by that naturally thinking you can work until you don't want to, you know, and if you keep your health.
Gardening was her go -to exercise and that's hard. I'm a failure as a gardener. My sister is great at it and so, and where so many differences. So that's where I actually began to see this epigenetic difference between identical twins, cause I'd lived it. And I knew that from the beginning, but you can share what looks good, what the data says.
Dr. Shepherd (32:31)Yeah.
Florence Comite (32:36)even though the data to me, which I would base everything on evidence -based medicine, but it's a one size fits all. So unless you can define what I think of as the N of one, which is the core concept, and then how do you implement it in your own life? So it was...
Dr. Shepherd (32:46)Thank you.
Florence Comite (32:52)is the ability to look at these numbers under the surface, even if you were 25 or 30, that had me saying, wait a minute, let me find out about your family history. And
we can see it even earlier. In fact, that's why we found out heart disease starts so young, because it was the Vietnam vets that came home. Unfortunately, they were killed. And when they did autopsies during the war, they realized that they could see plaques at 18. So owning that understanding and connecting the dots from the data to me, to that individual, was critically important. I think of it as the health story.
Dr. Shepherd (33:27)Yeah.
Florence Comite (33:28)So family history to me is as vital as genetics, which is also really important. Have you found that your patients know how their mothers and grandmothers have lived and died? And does that help you guide them in some way into their choices?
Dr. Shepherd (33:32)Yeah.
it absolutely helps how I'm gonna guide them. I think I'm still maybe at 50 -50 of people really knowing their family history. And like, I hear a lot of they know how, but they don't know the why, right? She died at this age because I think it was something, some cancer. Well, which cancer? I'm not sure. You know? So yeah.
Florence Comite (34:08)And also families keep secrets. They don't like sometimes, some families don't like to be thought of as ill.
Dr. Shepherd (34:11)Thank you.
Florence Comite (34:15)And that data that we're now beginning to see is just that much better adding to family history. But I actually changed my vision. Years ago, I used to think of family history as a poor man's genetic test. And now I think it's far richer because it's where genes emerge, where the diseases that run in your family.
Dr. Shepherd (34:14)Yeah.
Great.
Florence Comite (34:35)For example, osteoporosis runs in my family pretty heavily. So from a young age, I've looked at my sons and extended family to show them that, you know, you can't miss, dairy and enough vitamin D is critical. So the children in my family start on vitamin D quite young. And that's one of the things I watch in myself too.
Dr. Shepherd (34:55)I love seeing us work towards in seeing how we know from the data that we're able to extract, whether it's through wearables, whether it's through the testing that we have, that's much more looking at genetic expression and then how to tailor healthcare to someone and allowing them to be their best selves through what they have, like what they're able to provide in their DNA.
Florence Comite (35:17)Exactly. Yes.
Dr. Shepherd (35:19)Yeah, and genetics as well.
(02:49):
Florence Comite (35:20)If somebody just taps you on the shoulder or you go to these studios and do your media and you're interviewed and they say, I have a question for you from the anchor or on a plane, what is the one most important thing they need to be healthy? And if they do to take one step, what would your response be?
Dr. Shepherd (35:38)say the one step is the thing that they can do on their self without me having to be there or any doctor. I would say nutrition and exercise are your kind of fundamental key of life as far as like how you can actually change your health is nutrition and exercise because those are the things that outside of my O .R., outside of my exam room, the things that you can actually take on as your own individual self and really change your life.
Florence Comite (36:07)And to wrap that up, because you said it earlier, so from nutrition, it's focused on protein, the rest will fall into place. And for exercise, a resistance training and strength training above all. Like do aerobics, you need to move always, but you can get that probably in your regular day -to -day life, running around and getting those steps that so many people count nowadays. Do you agree?
Dr. Shepherd (36:12)Thank you.
Right, I absolutely agree.
Florence Comite (36:30)Well, this has been fantastic. I really had fun talking to you as I knew I would, because you're delightful. Yeah, it was so wonderful meeting you. I have to confess you are the top favorite of mine at the meeting, at the longevity meeting. Yes, because you are so approachable and open and kind.
Dr. Shepherd (36:42)Aww, thank you.
Florence Comite (36:46)And I think it's wonderful to be a really wonderful human being on top of being a physician. So thank you for that.
Dr. Shepherd (36:51)Thank you. And thank you for being who you are. And I think that I have learned so much from you and I'm so glad that in our space, we have the ability to be mentors, be colleagues, be friends, and I find that in you.
if people wanted to find me, I think the best place to find me is on Instagram. So my Instagram handle is Jessica Shepherd MD. I love new followers. I love to interact with people. So find me there.
Florence Comite (37:18)we will.
Jessica. It was a pleasure.
Dr. Shepherd (37:20)it's completely fine.
Florence Comite (37:20)thank you for your kindness Take care, Jessica. Bye
Dr. Shepherd (37:22)Okay.
Florence Comite (00:10)Welcome to Healthy Longevity. I'm here today with Dr. Jessica Sheppard, who's a board certified OB -GYN. She completed a residency in that field at Drexel University at Hanuman Hospital in Philadelphia, and then spent six years as director of minimally invasive gynecology at the University of Illinois and entered the field subsequently of functional medicine.
(00:01):
Currently, she's the CEO and founder of her concierge medical practice, Sanctum Medical and Wellness in Dallas. you've been honored multiple times as one of Dallas's best doctors and you're seen regularly. on ABC as the woman's health expert
Dr. Shepherd (01:01)wellness.
Florence Comite (00:49)on Good Morning America, the Today Show, CNN, CBS. So congrats, you've done so much. I had the pleasure of meeting you, online first and then in person and was blown away when monitored and moderated sessions at our Longevity Docs Conference.
Jessica, it's so great to have you here today.
Dr. Shepherd (01:08)So great to see you again. And I'm so glad that we had the opportunity to meet in New York. I think sometimes, you know, in this day and age when so many people connect and meet over, you know, whether it's social media or whatever that is, it's so nice to still be able to meet in person. So it was delightful to be able to meet you.
Florence Comite (01:27)I agree completely. here we are, the science of longevity is booming. I think every day or maybe multiple times a day, I hear about a new startup everywhere around the world, but particularly in America.
and there's a lot to talk about, but first tell me the genesis of Sanctum Med and Wellness and what you hope to accomplish there. And then I know you have another startup you're brewing as well.
Dr. Shepherd (01:48)so saying to med and wellness really came from, you know, having practiced for 15 years in academic medicine. And really it's the ability, like we were just talking about, to connect to our patients. And so there was a point in which the connection is somewhat lost because you either have to send them somewhere or you want them to continue some sort of lifestyle medicine or longevity, but you don't have the ability to do that in the.
practice model that we have in academic medicine today. And so coming out of that and using holistic practices, Eastern modalities, longevity, core goals, I developed Saint Demed in Wellness to be able to incorporate all of that. And so what we have is we have our traditional medicine set up where I see patients and practice evidence -based medicine. But in our center, we still have all of the other holistic practices, including yoga. We have two licensed therapists, life coaches. We have a
traditional Chinese medicine doctor, two of them doing acupuncture. We have red light therapy and massage therapists and a registered dietician.
Florence Comite (02:50)that's fantastic I think back in the day, everybody was talking about integrating medicine and sounds like you've done that fantastically.
Dr. Shepherd (02:58)Yeah.
Florence Comite (02:58)What is your general idea of clients, what they do? I call them clients sometimes because I don't want them to be sick patients,
Dr. Shepherd (03:06)So I think, you know, I kind of have like two pools of patients, I guess you could say, because I've done gynecology for so long and had a very, very strong surgical practice because I did a fellowship in minimally invasive gynecology. So I still have a lot of patients who see me and come for their, I guess you can say their annual, their well woman visit, sometimes any bleeding issues from a gynecology standpoint. But I really have solidified myself in the perimenopause and menopause space.
and really giving breath to that in allowing women to feel heard and giving them as many options as possible and how to navigate through that. And so then I have a lot of patients coming to me for that because I speak a lot on menopause and perimenopause and what that experience is. So I'd say that's kind of like the buckets of patients that I see. But yeah, it makes it very nice for me to be able to still practice what I've done for.
for time and time again and then working in the menopause space is really navigating the newest innovation that they have in the field and being able for patients to really see the scope of what menopause has for it, whether it's from the metabolic perspective, whether it's from the hormone perspective, whether it's from the sexual health perspective, and then from the mind and mental wellness perspective. So we really are able for them to see it on all different levels.
Florence Comite (04:23)No, you're a tremendous advocate, for women. And you share what you know. And we both, I'm sure, have grown well out of our very specific and discreet practice. I know you even write for consumer magazines. You love education. It just comes through in the way you're describing it. What is the issue out there? Why is there so much misinformation? I'm always disturbed by it because now on social media,
everything glows. So like you think it's all good, but most of it is not. And I think in some ways it induces a lot of anxiety in the people I see and I hear or ask me questions.
Dr. Shepherd (05:00)Yeah, I have seen an increase in how we take in problems and or issues, how we think the world sees us. And I think that plays a lot into our psyche, which then I really believe and I know for sure mind body connection and the things that happen for us mentally does manifest in our body. And so the way that I'm able to connect that for patients, a lot of patients will come in with issues that they're having at home and relationships at work and
then they'll have manifestation of that in symptoms. And so when they're able to see that, that actually allows us to give space and time for ourself when we think of our emotions, when we think of trauma, emotional wounds, and helping that, nurturing that, while still paying attention to our physical symptoms and creating again, this continuum between the two.
Florence Comite (05:50)I don't think most outsiders, people who are not in medicine realize the trust our patients put into us. A lot of times they share who they are. They really want to get insight and they don't know where to go. And so if your doctor can't be your trusted confidant, if her, the way she delivers or he delivers on the promise of what medicine and health and wellness can do.
(00:22):
Dr. Shepherd (05:59)Thank you.
Florence Comite (06:17)we're missing an opportunity, I think. And so it sounds like you feel similarly because that's where I feel the real heart and soul of medicine still exists, that trust between our patients and us and really guiding them effectively.
Dr. Shepherd (06:31)Yeah, and being able to guide them to the other, I guess, providers that can also create safe spaces for them. Because I have really done a lot of research and time spent with people in other settings, whether it's mindfulness, whether it's Eastern modalities, whether it's from a therapist perspective, and learning their crafts, but not being an expert, so that I'm able to better serve my patients and know some of the signs
that come up when they're suffering from something else outside of a medical condition. And so being able to make that connection and then send them off, that again is that trust of I know what you're going through and I also know where to get you to get the help that you're going to need in order to have the better outcome.
Florence Comite (07:18)And we know as doctors, it's hard to get our colleagues even on the phone. They're seeing 20 to 40 people a day. They don't have time to, you know, all of this new electronic way of engaging is fabulous. But fax machines are a way of life. So you don't have to be interrupted. And unfortunately, it's not a reality anymore.
What drew you to longevity and functional medicine?
Dr. Shepherd (07:40)I think that part of it definitely came from when you look, one, at the current health care system. I think the health care system really failed us into we're still a very diseased country. And when you think of chronic conditions, seven out of 10 chronic conditions are actually avoidable. And so when you look at the aging process and then also disease and how that increases,
Florence Comite (07:48)so to speak.
Dr. Shepherd (08:07)Obviously you're going to have more disease and the likelihood of having disease as you age, but you also have the opportunity and the choices to offset that. And that's where longevity really came into the practice for me was for me personally, I was like, how do I want to show up later on in life? And with the training that I have as a medical doctor and also seeing this scope of alternatives and Eastern modalities,
What can I do in addition to that, which is what longevity medicine provided, because I wanted patients to be able to see themselves differently than just aging and what comes with aging, with the stigma of now I'm just gonna get sick. And I think that there's a very strong messaging when we think of the healthcare system is that it's unavoidable. And so changing that perception of what people think of themselves and what they're actually able to accomplish.
is actually remarkable when you either understand it, when you believe it, when you get it. And so I think my job is to be that cheerleader for my patients and saying, I know you can do this and I know that there are some really good features that can enhance that journey for you. So it's not for everyone. I think that you really have to have a sense, a true sense of, I really want this for myself in order for it to really work.
But being able to offer it for me was the best part of it. Because if I don't offer it, then the people who do want to adhere to it or are interested in it would never have heard of it. And so I think that my job is really to be the messenger.
Florence Comite (09:44)That's fantastic. I use the word guide, but I think too that there's a ton of knowledge out there. How do you know if it's good or bad? And so I always think, and as you well articulated, it's turning that knowledge and all the disparate pieces into wisdom. And that's what you're able to do. What is really fascinating, but in your wonderful state of Texas, there was a 71 year old who showed up on stage.
Dr. Shepherd (09:52)Mm -hmm.
Florence Comite (10:09)with the 21 year olds competing for, I think it's either Miss America or Miss USA. And I heard this last night on the news and I saw her, she looked incredible. And more importantly, what she said when they asked her, the newscaster was on CBS, when they asked her, you know, like, what did you think and how did it feel to show up 50 years older than most of the other women? She said, first of all, they were really supportive.
And I was able to show them how you can look and feel if you make the right choices. She wasn't even on a bully pulpit. She was actually saying, this is what I chose to do, and this is how I'll do it. And here's what's missing. We're not proactive in medicine. We can't be. We're so busy taking care of chronically ill folks when they show up so sick after decades of it brewing under the surface. So I completely get where you're coming from. And I think it's amazing because I was blown away when I saw her and so.
Dr. Shepherd (10:55)Mm -hmm.
Florence Comite (11:03)proud of being a woman. Yeah. Yeah. I believe it was Texas. I hope it was Texas. It might have been Arizona, but I think it was Texas. Yeah. Yes.
Dr. Shepherd (11:04)And that's what I love, is that you were blown out.
But I think that's like fabulous that be blown away by someone of that age. But I really do think, and this is where the mind body connection comes into it. She had to believe it for herself. Right. Yeah. Yeah.
Florence Comite (11:21)Exactly, she said it even, you know? You're 1000 % right. She like, I had to be convinced and I saw why did I wanna age like my mother? And I see that a lot, but then a lot of women say, well, I know I'm gonna turn into my mother and I have to tell them that your genes don't have to be your destiny. You can make choices if you have the bits and bytes of information under the surface. You may not know it, but you know at 40, you're not 20.
(00:43):
Dr. Shepherd (11:31)Thank you.
Florence Comite (11:48)And you keep thinking, well, you can't really take care of yourself. Maybe you're a busy career woman and rising in the ranks. Maybe it's kids, whatever it is, you think, well, if I just, but the answer is not in just being what you were at 25, because your body is evolving. And so giving them that it's a gift. It's a gift of life, actually, because you only have one body. So where are you going to live if your body deteriorates, right?
Dr. Shepherd (12:00)Yeah.
Hmm?
And that's the other thing is that we only have like one shunt at this. And so in order for us to get that outcome, I also say it's very similar to what I would say financially. I would never tell you to wait until you retire to start saving. You start saving earlier in life so that it's ready for you, right? When you retire, same thing with age. Your health is one of the...
Florence Comite (12:34)your financial portfolio, right?
Dr. Shepherd (12:38)most important things that you can have for yourself later on in life. And so if you want that return on investment, then you have to put in the work and the time now until it becomes your lifestyle and your habit. And then you'll be so pleased with yourself when you want your body to come through for you and you want your health and wellness to come through for you that it does because you gave it the time and effort. And so that's why I try to focus the conversation on what do you want? And putting it back.
Florence Comite (13:00)Yes.
Dr. Shepherd (13:05)to the person having the autonomy to say, this is what I want. And I'm like, well, then let's work on that. And step by step, I think that it's an approach to people being open to seeing the results and then wanting more.
Florence Comite (13:19)Yeah, no, absolutely.
And in order to do that, there is an investment, but the good news is if you start it as young as possible and you can bring it even home to your family once you're aware of what are the issues, How do you sort out the good, the bad, the neutral?
why do you think there's still so much misinformation about perimenopause and menopause? I feel sad about it because I remember answering these questions for the mothers. I wasn't close to being menopausal at the time. I started way too young. And when I had these women, menopause was in the closet.
and they wanted to feel, they thought life was ending, you know, and the transition was clear. It starts in the 30s, it heads into the 40s, and most of the time, by the time you're 50, 51, you're gonna be menopausal. Your ovaries have stopped, you're not cycling for a year. But there's so much misinformation. How do we get that straight?
Dr. Shepherd (14:12)That is probably the million dollar question. I think we are on our way to a better future in menopause than I've seen in the past. When I was practicing, or in residency rather, in training, that's really when the kind of WHI came along and kind of kaboshed everything and there is just a really distinct change in how we approached hormones. And not to say that
hormones of the end all be all to the menopausal experience, but it is a good part of it. With that came, again, hiding and stigma and shame. Then comes the disconnect between what we as providers can offer and then patients wanting to, again, address something that already was a pain point for them. There was a lot of rolling around not knowing what to do on both ends.
And then we didn't really have any tools as providers. And the other thing that I would say is we kind of put menopause into this box of one, it's horrible. And your life is just horrible after menopause. I'm trying to change that narrative.
Florence Comite (15:25)Well, life ends after menopause. You know, you're menopausal, you don't talk about it. You're old, basically. Yeah.
Dr. Shepherd (15:28)And so exactly, so that's the message. No one wants to go through it, right? And so if no one wants to go through it, then we can't even really do good education in preparing for it because everyone's trying to avoid it. And so I think that now that we're kind of expanding the experience of education, knowledge, treatment modalities into the pyramid of puzzle space.
Florence Comite (15:34)Right.
Dr. Shepherd (15:53)I'm very hopeful that in the next generation to come that, one, they're going to have things on board before they get to menopause. There will be a change in the messaging behind it. And then we're going to have, as providers, more validity, more evidence towards how hormones actually are beneficial. And so this change is going to take some time, but I'm glad we're out of kind of this dark cloud of hormones are bad, menopause is horrible.
and then having the stigma behind it. So that, I think now that we've changed that narrative, it will probably take for me, in my opinion, maybe another 10 years before we're actually just speaking about perimenopause and menopause and it's no big deal. Kind of like what we saw in the breast cancer phase. It started with Susan B. Komen and making it something that people could discuss, not be ashamed about, and now...
(01:04):
Florence Comite (16:37)All right.
Dr. Shepherd (16:45)who doesn't know about October and Breast Cancer Awareness Month when before it used to be so taboo to talk about breast and breast cancer.
Florence Comite (16:52)Yeah. Plus the more attention you bring to something. I remember that I found a photograph around the time I started Women's Health and when we talked about heart disease. And I remember inviting the chairman of cardiology at the time I was married to a cardiologist who ultimately became associate chairman there. And also all the other participants in sort of working up heart disease.
Dr. Shepherd (17:03)me.
Mm -hmm.
Florence Comite (17:18)And I remember giving them a lecture and putting up slides side by side, the 1900 and 1990s, one woman in the cardiology department. So attention wasn't given, the voice wasn't there. We didn't think of women. And the only article I could find about women in heart disease was at the American Heart Association, where they talked about your husband's heart and what you have to do to take care of it. And this is over 20 years ago, almost 30.
Dr. Shepherd (17:31)Right.
What?
Florence Comite (17:45)and actually 30 and the women's health initiative trial at the time I remember thinking in 20 years. So I'm optimistic that you said 10. I don't know. Optimistic. It takes a very long time. Even like, I don't know if you saw recently, but my own field in endocrinology, there was a new statement of vitamin D not being necessary until you're 75 or maybe when you're pregnant.
Dr. Shepherd (17:53)I'm trying to be very...
Florence Comite (18:09)and that it's all a lot of hoopla -la over everything. And I think the lack of proactive understanding of our bodies evolving in women and in men is actually very hurtful. And there was a quote from the Wall Street Journal that I came across from Naomi Watts, where she talked about her struggles with perimenopause. So I agree getting it earlier and earlier and out there in the dialogue.
Dr. Shepherd (18:21)Good night.
Florence Comite (18:36)is that there was no information, no community, not even a conversation with my own mother, no blame to her. And that was so common. And then today when I hear these women, the same story, it just makes me sad and it's been a long time. So, so yeah.
Dr. Shepherd (18:51)I know, and it's one thing that I would say that 100 % of women are gonna go through, right?
Florence Comite (18:56)Yes, it's inevitable, but what doesn't have to happen is we don't have to deteriorate, you know, we... Right?
Dr. Shepherd (19:01)Yeah, I think we can change that whole outcome and really now we have the tools. I think we have more credence to, want to look at all the solutions rather than just saying this is what it is and this is what you're going to suffer through.
Florence Comite (19:16)And yeah, you know, just suck it up. Which a lot of people hear from their regular doctors, you know, sorry, it's tough, you're getting older. What do you expect? Aches and pains. But no, I remember thinking around the time I started Women's Health, because I was looking at why do we take care of our athletes and their pitching arm and their knees and their, why do we let people age and get, you know, arthritis and...
crippled instead of proactively working with them to preserve their strength and energy. And that's where I started with the tools I used, as well as hormones, because it's hormones that trigger in the whole downward decline.
Dr. Shepherd (19:41)Thanks.
Florence Comite (19:51)And it turns out testosterone's a huge trigger and yet even in today's world, testosterone isn't approved formally by the FDA for women. I mean, I've been using it and prescribing it for how many decades? We don't need testosterone, we don't have testosterone and men don't have estrogen, wrong, right? Anyway, yeah. Is that, that's your experience too? Yeah.
Dr. Shepherd (19:59)Now, I mean, why would you?
(01:25):
Anyway.
Right, right.
gosh, completely. I think that's my experience. And I think even today, even though I'm very comfortable prescribing testosterone and recommend it to a lot of my patients, they still are very, very hesitant. And I think even some of my colleagues who are not comfortable with testosterone are, they're like, I don't know if that's something that should be recommended. So we have a lot of work to do, but I'm very excited.
Florence Comite (20:14)Yeah.
We do. I mean, even educating my colleagues when I first was segueing into New York I had to educate my colleagues along with my patients because otherwise they'd hear a different story and still today. And I would say to them, what do you think sustains our muscles? Do you know the data on cognition and memory? Do you know that the heart's a muscle, by the way?
Dr. Shepherd (20:51)you
Right.
Mm -hmm.
Yeah.
Florence Comite (21:04)And all these diseases that come out emanate from the fact that our sugar goes south. We can't put it anywhere if we don't have enough muscle. That's testosterone. And we women have a fraction of what men have. So physiologically, we want to be who we are. And I always felt that my transition came when I was saying to myself, you know, aging is really leading to this downfall. And aging isn't bad. I was always against the term anti -aging because I was pro -aging. Otherwise, to me, it was like early death.
Dr. Shepherd (21:11)See you.
Mm -hmm.
Florence Comite (21:33)But I knew that we had to maintain physiological function. that brings up an interesting topic that I don't know if you've read about this, but a researcher who looks to taking a piece of the ovaries and then planting it in women as they age so that they never go through menopause so that they could sustain. Could you imagine? I mean, I can think of all the pros and cons, but I love the idea.
Dr. Shepherd (21:53)No.
I know. I'm like, I was literally, as you just said that I was like, well, I am a minimally invasive gynecologist. I wonder if. Please, I'm going to be like, maybe I should start this therapy. I think it's like exciting. And that's what I love to see in innovation in medicine is, and especially in the longevity space and the regenerative space is these things that no one would ever.
Florence Comite (22:02)Exactly! That's what came to mind. I'll find that paper and send it to you.
Dr. Shepherd (22:22)you know, think of or dream of and now like putting the thought into your head and where can we go with that?
Florence Comite (22:28)Yeah, no, absolutely. I still remember with the changes in gene -RH analogs and fertility so that women in their 50s, I see billboards when I travel up north from New York to Vermont where women are there hiking saying, I beat my cancer. I had decided to put off having children and at 58, I have a child. Now it's not recommended for everyone. I personally would have loved to continue to have children whenever, but I'm happy with my two sons and I sort of have a daughter who's like,
Dr. Shepherd (22:49)Right.
Florence Comite (22:58)special to me. I think about it, let me tell you, but I've decided I have too many babies percolating in the business world. I don't know that I could handle it. So now, because it is a lot of work, but it's also fun. I feel regenerated, rejuvenated when I'm around, like even training younger people. And I love that educational piece of it because I feel like their life is in front of them. They have so much, just like us, because we're
Dr. Shepherd (22:58)You sure you don't need another one?
(01:46):
Thank you.
Florence Comite (23:25)reinventing where medicine and healthcare should really, it should really be about health, not about only medicine, you know? Yes. Yeah. Yeah.
Dr. Shepherd (23:30)Mm -hmm. And the sustainability of health. I think it's the sustainability of it and how long you can get your body to do its best work for you. And feeling it.
Florence Comite (23:43)Yeah, that's why seeing this woman, you know, compete and proud of it. And she, I, I would be hard pressed to say that she was as old as she claimed chronologically, because I bet biologically she was half that age. And that's all our goal. Like I do that constantly looking at biological age. Our data is feeding some of the algorithms going forward. And there are some secrets that we all carry within us that if we knew
we could manage better. I think there's huge promise, for example, for plasmapheresis, young blood for old blood, although I personally like the notion that we give it to ourselves, we clean our system out in some fashion by plasmapheresis or hyperbaric oxygen. And those are all very forward thinking for 99 % of doctors, I would say. And I think the public is more ready to embrace it because they're frustrated by the lack of
Dr. Shepherd (24:24)and
Thank you.
Florence Comite (24:38)what they guidance and what they should be doing to keep their health for life. We are living a longer life, right? Yeah.
Dr. Shepherd (24:45)We are. Yes. Well, our life expectancy has increased, but I want to know, like what, you know, with all the things that you were just mentioning about hyperbaric and plasma freezes, what are some of your routines that you do?
Florence Comite (24:59)that's a great question. And I'm going to turn around the question to you, but I'll answer first. So first of all, I have a shake every morning. I actually have it here. I don't start eating because I'm not a purposeful intermittent faster, but I do intermittently fast. It's always been my thing. I'm never hungry when I get up. And I discovered the reason for why there are people who are starving and
Dr. Shepherd (25:05)Good night.
Florence Comite (25:20)I believe, and people who are not hungry. If you wake up with a higher than normal sugar, you're not necessarily gonna be hungry. But if you tend to reactive hypoglycemia, which you know in OBGYN, almost every woman who's pregnant has a brief glucose, a short glucose tolerance test. It is so common. I actually have come to think over the last half a dozen years from the studies and work I've done with continuous glucose monitoring.
Dr. Shepherd (25:32)Mm -hmm.
Florence Comite (25:46)that every single person is on a path to diabetes because it's a Darwinian survival. And I'm working towards that premise. It's probably going to be the focus of the book I'm going to be trying to write over the next few months. I'm addicted to data and wearables. So I will try everything. I'm wearing a continuous glucose monitor because when I'm on your watch.
Dr. Shepherd (25:52)This is the end.
I have a whoop. This is a whoop. Yes.
Florence Comite (26:07)you have the woof. So yeah, and I have the aura, you know, so sleep to me is paramount. I was bad for a number of years because I always want to accomplish more and more. And I was lucky. I'm a good sleeper and deep sleeper. So you get what I've learned is if you're good at deep sleep, which I am, you can sleep shorter periods of time and still feel like you can thrive. And I experimented with plasma for Isis.
Dr. Shepherd (26:13)Isn't it?
Florence Comite (26:34)over a six month period at the end of 2021 when I was creating the app And the first three months of PlasmaFresus, I did it monthly. My biological age dropped by 15 years, less significant.
And I was blind to the data. I just drew the data every month and I like evaluated it. I had nothing to do with analyzing it or anything. I'd already had a relationship with people where we test everybody looking at it. Then I stopped really sleeping because I had to drive the product for three months. And if I had four hours, it was a good night. And I still ran the same practice So you know how hard that is and how much energy it's that.
Dr. Shepherd (27:13)Right.
(02:07):
Florence Comite (27:14)At the end of the next three months, I shot up older with my biological age than I had been before. And so it became clear to me that even though I could get away without sleeping, which a lot of people think you'd be, you'd probably be shocked at how many people over the years say, I'll sleep when I'm dead. And I'm like, what? You know, sleep is rejuvenation, right? I knew what I was doing.
Dr. Shepherd (27:33)No, not for my good life.
Florence Comite (27:36)And then afterwards it was like, no way, I'm not giving up at least six hours a night. And on weekends, if I can get eight or 10, I will. And the difference is night and day. Yeah.
Dr. Shepherd (27:44)on the screen.
I sleep has, it's new for me in the sense of, I guess you can think of our careers and what was expected of us, the time that was taken to when you're in residency and you don't really get time off, you didn't have the shift work like you see today. And so I have always been someone who can run pretty long hours without necessarily feeling like completely diminished of sleep. So I do not necessarily sleep.
Florence Comite (28:04)Yeah.
Dr. Shepherd (28:16)seven to eight hours. That's a lot for me. But I do, I think I pay attention now to the quality of my sleep. And that's helped as well and really focusing on it and making sure when it's time for bed, it's time for bed. So I think the sleep habit portion of everything for me has changed. The other thing that I would say is in this time in my life and looking at all the things that I can incorporate them just like you or when I get up in the morning, I'm not really hungry.
Florence Comite (28:23)Yeah.
Dr. Shepherd (28:42)Coffee can carry me over till maybe like one o 'clock. So with that being said, then I focus on, okay, how am I gonna nourish my body? And I try to not eat at nighttime, anything, you know, maybe before dusk. So I really focus on the middle portion of my day to fuel myself and I do then more protein. So protein for me is like where I thrive and focus a lot of my nutrients and my macros.
And so I think that's really helpful. That's really helped me, especially going through perimenopause because I know that there's such a decrease in muscle mass and then weight training. So I do work out quite often and I focus again more on weight training and weight bearing exercises in order to, again, give me the best outfit that I can because skeletal muscle again is one of those organs that really, really is our longevity, right? That's our longevity.
Florence Comite (29:37)Yes, fountain of youth to have muscle and he does wear testosterone and doing resistance training and eating enough protein. So I'm in total agreement and was one of the hardest things for me to do to stop grazing at night. But our system, when we sleep and the rejuvenation of our immune system, all the hormones, if you stop eating at least two hours before bed, maybe three, and I was a grazer, I realized it like I really didn't dinner I would have, but then I would get a little
Dr. Shepherd (29:40)Absolutely.
and
Florence Comite (30:07)bit of ice cream or grab something else. And that was the hardest thing and I've been doing it now for years. The difference is incredible for me. I mean, it doesn't mean that it's a hard and fast rule, but I would say most of the time I'm just, I'm not even hungry anymore at night and because my body got used to it. But grabbing a piece of dark chocolate and telling myself, well, dark chocolate's good for you. It has phenols and flavonols and all the other. But yes, so that.
Dr. Shepherd (30:08)Right.
Yeah.
Florence Comite (30:36)resistance training, the protein that you mentioned, those are all incredible habit changing, decreasing your risk of diabetes, heart disease, stroke, osteoporosis even, and now some of that's genetically dependent, but you can overcome the genetics if you pay attention because you don't have to decline. Yeah. Right.
Dr. Shepherd (30:56)Yes. And I think that's the construct in how I present to my patients is through personal experience of what I've noticed and looking at data and being able to give them really good data on what we do have currently. And I think that it changes people's scope of who they are, what they want to be, and what they thrive to be. And giving them
kind of the empowerment to think of themselves in a different light. I think that's important as well.
Florence Comite (31:25)Absolutely, and I think beyond that, one of the reasons I went into this in a serious way about 20 years ago is that I am an identical twin. And so I knew that even my twin and I, I know there's two of me, can you imagine? And she's better than me. She became a dermatologist. And my mother used to say, you got to go see your sister because you know your face. And I'm like, mom, I'm doing health from the inside out.
Dr. Shepherd (31:39)I love it.
(02:28):
you
Florence Comite (31:51)My mom, actually didn't, you know, I wish she's still here. We lost her a couple of years ago. She was 102. And I think the fact that we're living life, she guarded and did everything, you know, she was a model for what she did. It was amazing. And so I think I came by that naturally thinking you can work until you don't want to, you know, and if you keep your health.
Gardening was her go -to exercise and that's hard. I'm a failure as a gardener. My sister is great at it and so, and where so many differences. So that's where I actually began to see this epigenetic difference between identical twins, cause I'd lived it. And I knew that from the beginning, but you can share what looks good, what the data says.
Dr. Shepherd (32:31)Yeah.
Florence Comite (32:36)even though the data to me, which I would base everything on evidence -based medicine, but it's a one size fits all. So unless you can define what I think of as the N of one, which is the core concept, and then how do you implement it in your own life? So it was...
Dr. Shepherd (32:46)Thank you.
Florence Comite (32:52)is the ability to look at these numbers under the surface, even if you were 25 or 30, that had me saying, wait a minute, let me find out about your family history. And
we can see it even earlier. In fact, that's why we found out heart disease starts so young, because it was the Vietnam vets that came home. Unfortunately, they were killed. And when they did autopsies during the war, they realized that they could see plaques at 18. So owning that understanding and connecting the dots from the data to me, to that individual, was critically important. I think of it as the health story.
Dr. Shepherd (33:27)Yeah.
Florence Comite (33:28)So family history to me is as vital as genetics, which is also really important. Have you found that your patients know how their mothers and grandmothers have lived and died? And does that help you guide them in some way into their choices?
Dr. Shepherd (33:32)Yeah.
it absolutely helps how I'm gonna guide them. I think I'm still maybe at 50 -50 of people really knowing their family history. And like, I hear a lot of they know how, but they don't know the why, right? She died at this age because I think it was something, some cancer. Well, which cancer? I'm not sure. You know? So yeah.
Florence Comite (34:08)And also families keep secrets. They don't like sometimes, some families don't like to be thought of as ill.
Dr. Shepherd (34:11)Thank you.
Florence Comite (34:15)And that data that we're now beginning to see is just that much better adding to family history. But I actually changed my vision. Years ago, I used to think of family history as a poor man's genetic test. And now I think it's far richer because it's where genes emerge, where the diseases that run in your family.
Dr. Shepherd (34:14)Yeah.
Great.
Florence Comite (34:35)For example, osteoporosis runs in my family pretty heavily. So from a young age, I've looked at my sons and extended family to show them that, you know, you can't miss, dairy and enough vitamin D is critical. So the children in my family start on vitamin D quite young. And that's one of the things I watch in myself too.
Dr. Shepherd (34:55)I love seeing us work towards in seeing how we know from the data that we're able to extract, whether it's through wearables, whether it's through the testing that we have, that's much more looking at genetic expression and then how to tailor healthcare to someone and allowing them to be their best selves through what they have, like what they're able to provide in their DNA.
Florence Comite (35:17)Exactly. Yes.
Dr. Shepherd (35:19)Yeah, and genetics as well.
(02:49):
Florence Comite (35:20)If somebody just taps you on the shoulder or you go to these studios and do your media and you're interviewed and they say, I have a question for you from the anchor or on a plane, what is the one most important thing they need to be healthy? And if they do to take one step, what would your response be?
Dr. Shepherd (35:38)say the one step is the thing that they can do on their self without me having to be there or any doctor. I would say nutrition and exercise are your kind of fundamental key of life as far as like how you can actually change your health is nutrition and exercise because those are the things that outside of my O .R., outside of my exam room, the things that you can actually take on as your own individual self and really change your life.
Florence Comite (36:07)And to wrap that up, because you said it earlier, so from nutrition, it's focused on protein, the rest will fall into place. And for exercise, a resistance training and strength training above all. Like do aerobics, you need to move always, but you can get that probably in your regular day -to -day life, running around and getting those steps that so many people count nowadays. Do you agree?
Dr. Shepherd (36:12)Thank you.
Right, I absolutely agree.
Florence Comite (36:30)Well, this has been fantastic. I really had fun talking to you as I knew I would, because you're delightful. Yeah, it was so wonderful meeting you. I have to confess you are the top favorite of mine at the meeting, at the longevity meeting. Yes, because you are so approachable and open and kind.
Dr. Shepherd (36:42)Aww, thank you.
Florence Comite (36:46)And I think it's wonderful to be a really wonderful human being on top of being a physician. So thank you for that.
Dr. Shepherd (36:51)Thank you. And thank you for being who you are. And I think that I have learned so much from you and I'm so glad that in our space, we have the ability to be mentors, be colleagues, be friends, and I find that in you.
if people wanted to find me, I think the best place to find me is on Instagram. So my Instagram handle is Jessica Shepherd MD. I love new followers. I love to interact with people. So find me there.
Florence Comite (37:18)we will.
Jessica. It was a pleasure.
Dr. Shepherd (37:20)it's completely fine.
Florence Comite (37:20)thank you for your kindness Take care, Jessica. Bye
Dr. Shepherd (37:22)Okay.
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