April 22, 2025 • 58 mins
As research lead for the nutrition and metabolic health company Health Via Modern Nutrition (HVMA), Latt Mansor knows more than most people about what it takes to stay fit and healthy. Still, he struggled to lose fat pounds and worried about his heart health. So, Dr. Comite invited him to come to Comite Center for a blood draw, evaluation, and recommendations for interventions based on her analysis. In this episode, Dr. Mansor returns to the center to review the results of his year-long experience as a precision medicine patient and learn how he reversed the risks that were leading him toward the cardiovascular trouble that killed his father.
You’ll learn…
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What is “reactive hypoglycemia” and why having high insulin is dangerous even if your HbA1C number is low.
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Why insulin, the fat-storage hormone, makes it so difficult to shed fat mass.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello and welcome to Healthy Longevity.
I am Florence Cometay, CEO and founder of the Cometay Center for Precision Medicine andHealthy Longevity with offices here in New York City, Palo Alto, and Miami Beach.
I'm really excited about today's guest, Dr.
Lat Mansor.
Latt is a research lead at HVMN, Health Via Modern Nutrition.
(00:23):
That's a cool name.
A performance nutrition and metabolic health company.
He has a PhD in physiology, anatomy, and genetics.
Not quite the overachiever, right?
From the University of Oxford.
I first met Lat about a year and a half ago on his podcast by the same name, Health ViaModern Nutrition, and I enjoyed doing his podcast so much that when he started telling me
(00:48):
about his family history and high risk of early death from heart attack and stroke, I wasinterested in sharing my
data with him, which told him that it's very hard on that track when you're 30, it's morelike you're an older person.
I'm going say that over again.
He first told me about his family history and early death from heart attack and stroke,not only in his father, but in a half brother as well, and also related to his father.
(01:15):
And I got intrigued because we've been seeing that prototype in different types ofindividuals, different ethnicities, different backgrounds, Eastern Asian, as well as
Ashkenazi Jewish.
Latt himself is a mixture.
I'll let him tell you a little bit about himself.
But he was facing some personal health challenges, which included the fact that it wasdifficult, even though he worked out and ate right, to lose fat.
(01:39):
And he wanted to learn more about my approach in precision medicine for longevity.
So he shared his health story in a little more detail and the results of his labs andbiomarkers.
And I recommended a series of interventions.
And today we have the privilege of reviewing Latt's outcomes and hearing
how he spent the last year in terms of that experience and wants to share it with all ourlisteners.
(02:02):
So welcome, Lat.
It's pleasure to have you here.
Thank you very much for having me and you have changed my life forever basically.
And you have been also so, so generous and I can't be thankful enough for all the thingsthat you have given me and advise and care and you have shown how personalized medicine or
(02:24):
precision medicine makes such a big difference because everyone's genetic makeup isdifferent.
And you show the utmost care for every single patient of yours, which I have so muchrespect for given how busy your schedule is.
And I know, you you travel a lot and you speak a lot at conferences, and yet you, youstill take time to review your patient's data and your, blood markers and all that.
(02:46):
So I'm very excited today to talk about my journey in the past year, what I've achievedwith Florence and all this amazing stuff that you're doing.
team was also great because everybody was engaged, but thank you for saying that.
That was very kind of you.
And especially coming from someone who's a scientist and understands that while the way wesleep, exercise, maybe do restorative practices makes a huge difference in expression of
(03:12):
genes, it's really the genetic makeup that drives who we are.
And by understanding who we are at a very cellular, basic level, we can actually changeour health destiny.
We can own the way we travel through life.
Who wants to get a heart attack in your 40s or 50s or pass away in your 60s when to melife is half lived?
You really want to try to make it to 120 if you can.
(03:35):
with high quality life on top of that.
Exactly.
So let's turn a little bit to your background because I know at Oxford your researchfocused on the metabolism of type 2 diabetes or diabetes in general and the heart in terms
of diabetic heart in terms of getting enough oxygen and staying healthy.
So what led you to that particular area of research?
(03:57):
Oh, um, so growing up in Malaysia, my mom's side has very high prevalence of diabetes andobesity.
And as you said earlier, my late dad actually passed away when I was 17 from stroke at theage of 63.
And a few years prior to that, had a cardiovascular, he had a myocardial infarction andheart attack and had an open heart surgery.
He survived that.
(04:18):
And then he had a stroke and then unfortunately he did not survive that.
So going into my PhD application, I was always, you know, been interested incardiovascular science.
And it just so happened that the lab that I applied to in Oxford, it's called the cardiacmetabolism research group.
And they also, you know, on top of understanding the metabolism of the heart, they alsojust got a new fellow who got
(04:47):
funding from the British Heart Foundation as well as Diabetes UK to really look into theconnection between diabetes and cardiovascular disease.
Because as we know, if you have diabetes, your risk of getting a heart attack is much,much higher.
And even if you survive the heart attack, you are at risk of heart failure afterwards.
(05:07):
So that was what drove me because I'm essentially the product of the genetic of increasedrisk of diabetes.
with the increased risk of cardiovascular disease.
So that's myself and I want to learn more about the disease, but ultimately it's a selfishreason of me wanting to learn about my own heart metabolism and what I can do to avoid
(05:28):
that outcome.
That's admirable and also exactly why I went into this field because it always concernedme that when we work in medicine so hard, in conventional medicine, it's all about
reactive disease.
It's reacting to disease and somebody has to present with disease and then we jump allover it in a very good way.
(05:49):
But as you said, once you're on this treadmill of chronic disease or acute diseases likeheart attack and stroke, your days can be numbered but you also don't live a quality life
and it's a burden.
not only to yourself, but people who love you because they want to see you in good healthand it's very hard to turn that around.
So with your family history, and if I recall, half brother as well had heart disease andhas passed away at a pretty young age, we wanted to stop you in those tracks and change
(06:16):
the future health trajectory for you and make sure that you can own heart health, nodiabetes to the rest of your life.
And I think it was a struggle in understanding how to best do that.
Yeah, think, I think growing up, I've always been overweight.
So that was already a struggle to begin with and to top it all off.
and you're going to, you're going to frown at me now because I used to be a smoker, right?
(06:38):
For seven years.
And I gave up smoking when I was 22.
So that was quite a few years ago.
It was in my second year in university.
And then I started exercising.
And that was when I started learning about metabolism and physiology.
And I learned that there are things that we can do to defy.
the outcome that our genetics predetermine us to.
So in that sense, I really went in there and changed my life because like, for example, myhalf brother or my dad, they were smokers and they were not living a healthy lifestyle.
(07:08):
And that really propagated the predisposition of what they were given in terms ofgenetics.
But for me, I then learn more about the science of physiology and metabolism andpreventative medicine, especially not reactive medicine.
I'm like, you know what, first of all, my weight has to drop.
Second of all, I need to recomp my body and making sure that my lipids are in check.
(07:33):
And then I have to give up smoking.
Ironically, I didn't give up smoking because I thought of the disease outcome and whatnot.
It was because I started jogging.
started running and I realized those days that I smoked less, I could run further.
Now, mind you, how I started this running journey was very ironic as well because it was,it was in the spring of my second year in university in Nottingham.
(07:56):
was my undergrad.
My housemate, Leanne, she asked me, Hey, lad, do want to go for a run for a jog?
There was a lake around the university and from my house around the lake and back is abouttwo kilometers.
Mind you, I was a heavy smoker, overweight and not very healthy person.
I went running with her and I didn't see myself cause I couldn't see myself, but she toldme I went blue.
(08:18):
I was, she thought I was going to pass out anytime soon, but I made it, well, made ithalfway and then walk back.
But it was, it was.
It was a task.
was a challenging task.
And then I went a couple more times after that.
don't know.
I was a glutton for punishment.
And there was, there was a couple who are probably in their sixties, seventies.
Not only they were running faster than me, they were cheering me on.
(08:41):
were like, you can do it.
I was touched and embarrassed at the same time, because I was, I was 22.
Like how bad can this be?
How bad will it be when I reach 40?
You know, which is this year I'm turning 40, right?
So I'm like.
I can't, I can't let this go on.
So during the summer where everyone went home for summer holiday, I stayed back and workin the local cinema and I decided to go jogging every day.
(09:05):
And what I did was because there were trees around the lake, I would mark the next tree asmy goal, as my destination every time so that I can go a little bit further every time
until I can finish the whole loop.
And without...
two kilometers?
Two kilometers.
Wow.
Yeah, it's not even two miles.
No, it's not.
(09:26):
In the American world.
Yes.
It's like
bit more than a mile.
I could not do it.
I couldn't have finished.
impressive that you set those goals for yourself and actually continue to meet them.
That changed your life.
And another thing what people, what my friends were very surprised about was at that timeI didn't even listen to music.
Like I was just running like without music, just on my own, just getting in my head andthinking about other things.
(09:49):
And, and then before I knew it, after three months of the summer, I, I lost about 20kilos, about 45 pounds.
And I almost looked unhealthy because I lost too much weight too quickly.
And I wasn't
gaining muscle because I wasn't doing resistance training.
And that was also when in the summer when I gave up smoking because I was in South Francefor a course.
It's a biology in space course.
(10:10):
I wanted to do PhD in biology in space initially.
And a Russian lady from the Russian space agency came up to me while I was smoking inbetween the lectures and said to me, give up smoking, save money and buy vodka.
Those were her words.
And I felt like she wanted to tell me something.
So after the lecture, I went up to her.
was like, do you want to tell me something?
Turns out her husband is a lung cancer oncologist and she drew the DNA structure andexplained to me how mutation occurs or how the increased risk of mutation would happen
(10:38):
when you smoke and increased risk of cancer.
And then at that point I realized that knowing that knowledge or having that knowledgemade me a hypocrite if I don't give up smoking because I can't have that knowledge and at
the same time still smoke and endanger myself.
So I gave up cold turkey then and then.
So I started exercising.
(10:58):
it up cold turkey.
That's not easy.
I lots of patients who have, but still, you have to be tough.
Tough in mind, tough in body.
Yes, absolutely.
It wasn't easy.
think, I think for me, the challenge was the social setting because obviously smokers havesmokers, smoker friends.
And when you hang out with smoker friends, you go out to a bar or you go out in a socialsetting.
I had relapsed, um, maybe like six months later and then another six months, I have onecigarette.
(11:23):
And what kept me off of it is the next day.
My throat hurts.
I, when I go, you know, for a jog, I was wheezing.
the effect was almost immediate.
And that physical suffering was what reminded me why I stopped in the first place.
So that was what kept me away from it.
And now I almost developed an allergy towards cigarette smoke, actually, because my momstill smokes, unfortunately.
(11:49):
She gave up and then she picked it up again.
So when I went back home in Malaysia, and if I'm in her vicinity when she smokes, I almostfind it very difficult to breathe.
Yeah.
Well, in a way, you're lucky that as a very young guy at 22, you kind of saw the writingon the wall and it was put up in front of you by this Russian physician or scientist.
(12:10):
And that you have physical manifestations of discomfort when you smoked instead of gettingthe pluses of a lot of people say it's creative, it gives them something to do.
You have a lot of friends who are hard not to relapse when everyone around you is smokingand you're breathing the very air, which is second hand or third hand.
So you did yourself a favor, your body did, you were getting strong messages.
But it wasn't easy being you because most of us take for granted our health and ourbodies, but being born with a metabolic type syndrome that puts you into an early
(12:40):
potential death.
of cardiovascular disease is a burden and that's the kind of burden that I'd like torelieve people of.
I'd like people to understand that even at 20 or 30, making that change will make a hugedifference in the rest of their life.
So this was very interesting because you jumped right into physiology, which I was goingto ask about.
Sorry, I chopped the gun.
(13:01):
health history and your own family history and why you wanted to explore precisionmedicine in terms of a proactive approach to longevity.
And overall, you're still a really young man.
You're turning, only turning 40 this year.
So when's your birthday?
So we have six more months, right?
Just about.
And you're a world expert in physiology and metabolism and consult with elite sport,military personnel, clinical and research organizations.
(13:26):
What is HVMN do and what is your role at the company?
How do you translate that given your background?
Sure.
So HVMN, it's essentially a health supplement company and our main product, our flagshipproduct is exogenous ketones.
So I think we need to probably explain what ketones are.
know, ketone 101.
(13:47):
So ketones are essentially fuel that your body creates and it's not a new molecule, it'snot a new drug.
It's something that our own bodies will create naturally.
Our DNA is programmed to...
to produce ketones and metabolize ketones.
But it only happens when your body is really low on sugar and glycogen because theincrease in insulin, when you have sugar in your body, it stops or inhibit ketone
(14:13):
production.
And the reason why ketones are being produced is because when you are low on sugar, yourbrain primarily consumes sugar.
But when the sugar is low, your brain still needs to work and it needs to work 24 seven.
So fatty acids gets converted into ketones because fatty acids
as a big molecule cannot bypass the blood-brain barrier.
So ketones are smaller and can bypass the barrier and enters the brain and provide energyfor the brain.
(14:37):
And right now in this modern society, most people achieve that by going on either ketodiet or intermittent fasting.
Our company creates exogenous ketones, which is an external source of ketone where you candirectly drink shots like this.
When you are not in ketosis, when you have sugar in your body, you can't produce ketones.
So this basically bypass your physiological state.
(14:58):
So even if you have glucose, you can have access to ketones now by just directly drinkingit.
Now, the caveat is you are not in perpetual ketosis like you would if you're on aketogenic diet, for example, you need to top it up if you, if you want more ketones, but
that is what our company.
does.
And as for my role in the company, as a research lead, I oversee all of the science, thepublications, the collaborations with clinicians, with research institutions, with
(15:26):
athletes, and really advise our athletes, our professional athletic teams around the worldon the protocol, on the dosage, on what we know so far of the scientific literature, and
really withhold the integrity of science.
which I think not many nutrition company really pays close attention to.
(15:47):
It's hard work and I think it takes a lot of energy and resources to do so.
So tell me with that in mind, so you take exogenous ketones, ketones not made by your bodynaturally through fatty acid kind of metabolism, how does it work when you still have
glucose in your body?
Like where's the, is there a competitiveness?
Can people lose weight on taking exogenous ketones?
(16:07):
Is that just one side effect or not even present in some folks?
How does exogenous ketones actually?
That's a great question because now for the first time in human history, we are creating aphysiological state that was never there before because you don't, you won't have high
glucose and high ketones.
So what happens in the body?
Right.
That's a super great question because what we have seen then, is that when ketones arepresent, ketones are preferentially taken up in certain organs, especially like the brain
(16:36):
and the heart.
They even created a tracer using a labeled.
butyhydroxybutyrate, which is the main ketone form, the heart takes out the ketones soquickly.
And in fact, we have a couple of clinical trials right now looking at heart failurepatients.
There is a huge clinical trial in Denmark right now that we're collaborating with.
They're putting 250 heart failure patients on ketone IQ for one month and looking at theresults.
(16:59):
Just one dose of ketone IQ, they saw an increase in improvement in stroke volume, ejectionfraction.
and cardiac output, just one dose.
So after 30 days, I really, really hope that we see even bigger, more significant results.
So in terms of competition, what we have seen, University of British Columbia publishedseveral papers in healthy individuals, obese individuals, and diabetic individuals that
(17:23):
across the board, when you take exogenous ketones, your blood glucose actually drops.
And their hypothesis is that gluconeogenesis gets
downregulated and gluconeogenesis for those of you who do not know is a process wherebyour body creates new glucose molecules from non-glucose sources such as proteins and fatty
acids and all that.
So they saw a drop in blood glucose level.
(17:44):
So in that sense, I think it's not so much of a competition, but more so that your bodyrecognizes that ketone is an efficient fuel and you have enough fuel for your body.
Therefore you are halting the creation of glucose molecule.
so that now you can use up the ketones first and then later on you can create the glucoseagain.
(18:04):
And we also have seen in athletic performance, these participants have double the sourcesof fuel essentially.
So you can have a dual fuel system.
And as a result, we saw a glycogen sparing effect where these runners and triathletes areessentially sparing their glycogen so that they can go further.
just so they have the ketones running simultaneous with glucose in their body, but theypreferentially use ketones and then they revert to the glycogenesis when they need it.
(18:34):
So it extends their ability to work out and maybe win the race and however they'reapproaching it.
And this is these, these findings are in individuals who are not on keto diet, right?
So they have glucose for those who are on ketogenic diet.
What we have seen is that having exogenous ketones also up regulate ketone relatedenzymes.
(18:56):
So enzymes that convert beta hydroxybutyrate to acetyl CoA that feeds directly into thecrap cycle and create ATP, which is the energy currency in the cell.
Got it.
So even if you're eating a regular diet or carefully eating a regular diet, you addketones like in this heart failure study.
Is it a daily ketone dose that you're getting at any certain time of day?
(19:18):
three times a day at about 0.3 gram per kilogram of body weight.
So that can make a difference for a lot of folks.
So let's hope these studies go really well.
I me secretly, sort of wish ketones were there when my dad had to go through thosecardiovascular events and who knows, maybe he could have still be alive today.
(19:39):
So I think part of me is hoping that this could help the other lads out there who stillhave their dads who are facing high risk of cardiovascular disease.
I wish the same thing and I have similar feelings because the work I got into was drivenby my father when I graduated medical school.
He said, okay, tell me now my brilliant daughter, because I had just graduated YaleMedical School.
(20:00):
He said, how do I stay healthy?
And I remember looking at him and saying, I don't have a clue.
Like I learned about disease, but not about health.
And I think it's at me along my life's work.
And I look back sometimes and wish what I had learned over the last 10 years or so couldhave made even more of a difference.
I was lucky.
I had my dad into his 90s.
And both my dad and mom, who just recently passed away at 102, both of them outlived alltheir siblings.
(20:25):
And I think in part because of the kind of care they got from my twin sister, who's also aphysician, and myself, there's a number of us in the family.
And you speak about overachiever.
This is the family.
So, yeah, so I can completely relate to that because it affected me in exactly the sameway.
But I was lucky enough to have my dad and my mom for many, many years and they werefascinated by the work we do.
(20:47):
It's fascinating journey you've had and obviously you've radically changed the way youlive life, but still when we met, which was a couple years ago, so you were in your late
30s, you were still struggling.
You couldn't get to the goals you wanted.
You wanted to lose more fat mass, but you wanted to maintain muscle.
You wanted to change your body composition.
And you wanted to know that you could live life to the fullest.
And we identified several areas that really needed more deep attention beyond just habits,perhaps supplements or medication, something that's frequently necessary in order to
(21:16):
change your gene destiny.
We don't want your destiny to be where you're wired in your blueprint.
We want to be able to tinker with it in a very careful way that works with yourphysiology.
And that's what we were able to do.
If you want to elaborate on those questions at the time.
Yeah, to put it in perspective, I was gyming four or five times a week.
(21:37):
was lifting weights and I was lifting heavier and heavier progressive load.
That's what people say.
And to a point where I would injure myself and then I'll, you know, step back and then goback on that and that cycle.
And I was eating low carb diet.
wasn't like overeating.
I wasn't eating out a lot.
was cooking my own food, but I was still struggling at about like 26 % body fat.
(21:57):
And I, I couldn't figure out why, right?
And
Um, and then I spoke to Florence and during our podcast and, and she told me about thework that she does.
I'm like, that would be amazing if I could.
And Florence was generous enough to ask me to come in and let's figure out together what,what is going on and what's wrong.
And yeah, because I think a lot of people can relate cause it's not that people lack thedetermination.
(22:22):
It's not that people lack the drive.
Like people are going to the gym.
People are trying to exercise, but it is the lack of results showing.
in combination with the instant gratification of social media that drives people orhampers people's determination in the long run.
I think people are disappointed that they do, they feel like they do everything right.
(22:43):
And particularly people as they enter their 30s and life gets busy, they're wondering whythe weight sticks around, why they go, might go to the gym, they might make time even to
go to the gym and eat right.
But the story is deeper than that.
The story delves deep into your own system at the cellular level, metabolically.
Your body is changing, your hormones are declining.
Testosterone as one key variable declines by one to three percent a year in all of us, menand women.
(23:09):
We women have some testosterone too, not as much as men, but we have some.
And as that happens, the way we lay down muscle, the way we put on weight, the managementof sugar, cholesterol, all of the factors that lead to diseases of aging, or what I used
to actually always label disorders of aging.
It was apparent to me a long time ago that if we could stop and reverse aging, we couldkeep your health at a physiological place like the 20s, 25 to 30, where it was a great
(23:38):
time to like turn around the track you were on, where you were headed when you were older.
And if we could do that, it didn't mean that aging was bad.
You wanted to chronologically age.
You don't want to stop that piece of it.
You don't want to be Benjamin Button's necessarily.
But what you want is to own your health for the
of your life.
So we dug into the story your biomarker showed us.
So we collected a bunch of biomarkers, looked at your carbohydrate metabolism inconjunction with your continuous glucose monitor.
(24:06):
So we're able to see how sugar rose and fell for you.
what your cholesterol or lipid profile looked like, and all of that told us why you werestill struggling.
No matter the best life you could live, it wouldn't have changed the trajectory of yourhealth in as big a way as you wanted to.
And this is the most comprehensive blood biomarkers tests I've ever done.
(24:29):
You know, my first time doing glucose tolerance tests.
You know, it was, it was a challenge getting all the, you know, blood that I needed togive, but it was definitely worth it.
I've learned so much.
I've achieved so much.
Yeah, so we did a few specialty tests, but we started with a baseline fasting testingwhere it showed that your fasting glucose and fasting insulin was higher than we wanted it
(24:52):
to be.
And we look at averages, and in your case, your average wasn't too bad, something calledhemoglobin A1C.
It's an average of 100 days of glucose sugar measurements.
But because you went high and you went low, the average looks pretty good.
I'm in the same category, actually.
I have very high insulin, but my averages always look good because you're
ruling out the highs and lows when you look at an average.
(25:14):
That only makes sense, right?
In fact, what we see on commercials now, when you see a commercial that says it's great tohave a hemoglobin A1C under 7, truth be told, under 7 you're still diabetes.
You still have diabetes.
And you're a diabetic at 6.5 or what.
I was going to say, isn't it like 6.4, 6.5?
you're a pre-diabetic at 5.7 to 6.4.
(25:37):
So our goal always with folks is to get it below five, but that doesn't tell the wholestory.
And when we do what we call a oral glucose tolerance test, which a lot of women get whilethey're pregnant, and it's abnormal, and we find that in a lot of women, because just
about every single one of us...
has issues with sugar that only worsen when we get older and hormones change and our bodychanges.
(26:03):
And to me it's because...
It's rather ubiquitous and it's Darwinian.
Survival depends on our being able to put down fat during good times and then live off ourown body during lean times.
So that our ancestors survived during bad times because they could, their genes survived.
The ones that couldn't do that died.
Genes aren't passed down, right?
(26:23):
And from those cavemen who didn't make it through the winter.
Well, they're gone.
So we inherit genes of our ancestors that say, why the eating's good, and pack it awaybecause there'll be a time when it's winter and you can't get food, you can't hunt food,
you can't pull food off trees or plants.
And that's what I think is happening in today's world, and the access to food is just onevery corner.
(26:46):
There was no cycle of fed and famished and there's always abundance of food andavailability and accessibility to food and especially processed food where you have very
dense calorie, calorific foods in a small portion.
Yeah, and lots of corn fructose and sugar.
You have it in drinks that we drink.
(27:08):
You have it in food that we eat from different restaurants.
And finding out how that works with your body is a secret to me.
It's a game changer of the continuous glucose monitor.
Because in your case, when we looked at that deeper dive and you took a swig of purecarbs, your sugar actually never went above 99, which is quite low.
But your insulin went to over 40, and that's quite high.
(27:30):
So you didn't have the right
balance and that's genetically driven.
There is nothing you could really do if you don't know that, you don't know where to gowith it.
And is that what they what they call reactive hypoglycemia?
Yes, in a way it's reactive hypoglycemia because you can eat and your sugar might go upinto an okay range.
In you it does, which is a little unusual actually.
Most people overshoot.
(27:50):
You don't.
you go up and then all of a sudden your insulin follows and your sugar is already droppedbut your insulin is in your body and it makes you reactive.
Your sugar goes too low, you can feel jittery, you can get hangry, you can feel likesleepy.
And so there's a whole bunch of kind of symptoms that people know and they say, I'm noteating enough, I gotta grab a donut and a cup of coffee at 10 o'clock because at eight
(28:15):
they had a banana and a brand muffin thinking,
it's all healthy, but that's all carbs.
Yeah.
And this is me putting my physiologist hat on and thinking about what could that, whateverthat Florence just explained, that could lead to me not being able to lose fat.
So if you think about it, even if my glucose was already down, my insulin stayed up andinsulin is an anabolic hormone.
(28:40):
So it encourages storage of fuel, of substrates, of resources.
And fat is one of the more abundant resources that we
store our substrates or our fuel in.
So maybe that is what's driving a lot of fat storage and make it harder for me to losethat fat percentage.
(29:00):
Thanks
Absolutely, I think you explained it beautifully for you.
Now everybody's different though.
I'm completely different story.
so even fasting for you and other ways that you attempted to lose that fat was just notpossible for you.
You were in a conundrum.
And that's where intervening really makes a difference.
Because when you know the data, which is the way I think of precision, and then you canapply it personally to each unique human being, even if you're an identical twin, my twin
(29:27):
and I express things
differently because we've lived in different life paths.
Even in utero when we separate, we implant in different places so we're not born exactlythe same.
We haven't lived that exact same presence and genes can turn on and off in the body as weknow it.
So out of all those interventions that we have done for me, what do you think drove, isthere a specific intervention that we did that drove the insulin to be more normal that
(29:52):
allowed me to achieve the results I have right now?
I think hormones made a big difference for you.
We know as people age, as I mentioned earlier, that our hormones begin to change anddecline.
Now women know it well because they have something.
you know, to hang their hat on with menstrual cycles and periods every month or, you know,close to that.
Men don't have that as a clue because male hormonal cycles are really more like everythree months where testosterone can go up and down within a three month period, it
(30:20):
triggers, but the other hormones that go up and down from the brain that relate to howmuch testosterone you secrete affect how much you secrete of testosterone, how much you
produce, and how that affects laying down muscle.
So it becomes harder
and harder for men like you in their 30s to get enough muscle.
And then you need to marry that to eating enough protein and doing enough resistancetraining.
(30:44):
And you had some of that in there, like the resistance training, but you didn't have therest of it.
And genetically, you were driven to kind of, it was a kind of lose-lose proposition foryou unless there could be interventions that would work.
And that's the way we think.
That's a great way of thinking.
That's the knowledge that Florence has.
what makes like Comitee Precision Medical Center, like Precision Medicine Center, theunique part of what you provide.
(31:09):
It's basically whatever that's in your brain.
connect the dots.
Yeah.
Then interpret it and integrate everything together so that we can come up with insightsand interventions that will make a difference for each human being.
Absolutely.
One thing as well I noticed, because you mentioned fasting, like even during the year, Ihave encountered plateaus before.
(31:31):
What I found is fasting for 36 hours almost resets the clock for me that allow me to breakthat plateau.
So I'll have calorie deficit and no matter how consistent, even for a week, like my weightwill stay the same and then I'll fast for 36 hours and then I'll have the exact same
calorie count.
And then my weight will start going down again.
(31:51):
Will it be sustainable?
that more testing will be needed.
I am planning to do a couple of more times just to test whenever I encounter plateaus.
But then again, I only encounter plateaus every few months.
So definitely need more data on that.
did phenomenally well when you stuck with our routine.
think because you couldn't help yourself as a researcher and a scientist, you starteddabbling in changes.
(32:13):
And as a result, some of your biomarkers didn't go in the direction we needed to when wemeasured it.
We let you know that.
But the goals were still met.
So that was amazing.
I do want to point out, because your initial blood work also showed poor lipid metabolism,that there were real changes there.
And there, we looked at a number of supplements that we thought would be
ideal for you.
(32:33):
I believe you started on an Omega and also a lipid lowering supplement and that had asignificant impact on the way your lipids looked ultimately because you started
in the right direction, you started dropping and you dropped from a cholesterol riskratio, which I consider one of the top five biomarkers to look at.
It was 4.8, which is more than two times what we think is optimal.
(32:58):
It should be closer to two and you dropped at the lowest point to 3.2.
So we were very pleased.
There's still some room to go.
As well your...
Good cholesterol went from 46 to 59.
And good cholesterol or HDL, which is the high density lipoprotein, are predictive oflongevity.
So you really moved pretty far there, and we were really happy with those results as well.
(33:21):
I think overall, your bad cholesterol, which was LDL or low density lipoprotein, went fromclose to 200 to dropping almost by half to 110.
So we were really pleased with that.
Yeah.
And I think the last telehealth appointment I had, the doctor here told me that hesuggested I go on statin as well.
(33:44):
And I did some research and think about it.
I one of the things I want to ask you about today is actually, you know, what you thinklike I actually I'm thinking maybe it's a good time to start on statin.
It is.
I think that's the next step for you.
I like it when we can see a response to supplements, but if truth be told, I think ofsupplements as drugs that a drug company didn't get their hands on, sort of what you're
(34:05):
doing with ketones.
But if you can prove the safety of it and there's data for both the supplements, just thatthere is for like a statin, both of them are needed.
And so some people can do well with a supplement, but other people may need a medication.
And that just means it's a company who poured a lot of money into it and is now selling
it as a prescription.
Yes, that would be advisable.
(34:26):
The other thing that would be really useful for you would be to look at the amount ofcalcium deposits in your heart, which is hard hardening.
So that's okay as an indicator of your future risk, but there's also soft plaque or softstenosis, and that is seen through a CTA or a computerized tomography angiography where
(34:47):
dye is put in contrast, and it can light up these areas of
soft plaque, whether they block the coronary arteries or they're in the wall of thearteries so they narrow it.
That's also important because that's all reversible.
And if we can read that in you, you would benefit because you know what the focus is.
And why that's important for a lot of folks, we hear people getting a heart attack anddying suddenly, even young folks, right?
(35:12):
That's because they might have very high gray lesions that feed the entire heart from themain artery that goes into the heart.
And once that's
obstructed, they can't get oxygen to their heart, if no one's around to resuscitate them,they're going to die.
Do you guys provide that?
We don't because it's an advanced specialized machinery.
You have to go to a radiology department and you need to get a prescription for that.
(35:35):
Unfortunately, it's not usually covered by insurance, but it's a well worth theinvestment.
Now, I like to note though that in young people, I caution them that they may want to getlife insurance before that because if those data are available, it can jeopardize how the
degree of life insurance is awarded.
And so we've worked with a lot of people over the years and we're cautious about thetesting we do because getting results of those tests can undermine your ability to get
(36:05):
life insurance in the way you might want.
That's a great advice.
people don't care, but other people do.
There's even a fancier test now that we really like that uses artificial intelligence orAI to look within the walls of the artery, and that we do as well, because that tells us a
lot more, and then we compare it over time to show response and to show that people areimproving and that soft plaque is melting away.
(36:29):
Wow, so out of curiosity, how much would these tests cost out of pocket?
Usually, because there's a lot of competition now and a lot of centers are doing them, youcan get the test for somewhere around a thousand or fifteen hundred.
So they're not inexpensive, obviously, but they may be well worth the investment.
And you would recommend people who are at high risk like myself do it once every how manyyears.
(36:55):
Yeah, so it's a little variable again for the unique individual, depends what we find atthe beginning.
Some people have a calcium score of zero, others have a calcium score of 2,000, andeverybody else is in between.
And the higher the calcium score in a way can protect you from future heart attack,because once that plaque is solid, it doesn't cause a heart attack.
On the other hand, it also obscures the visibility of the coronary arteries, so you can'ttell where the soft plaque is.
(37:21):
So anything in between is a predictor of
The calcium score will tell us what the risk might be and getting the soft plaque wouldgive us more answers.
Looking inside the wall is the next step and that you do maybe every two, three, up tofive years.
I think those at higher risk, someone like you, I would get life insurance in order and ifit's necessary you might not feel like you need it and then get the test within the next
(37:47):
year or two.
40 is a good time to take a look, a deeper look, particularly in light of your ownpersonal
family history, your father and your brother definitely started with disease in their 40s,know, maybe even earlier, but for sure in their 40s because they both passed away in early
60s.
they didn't have Dr.
Florence Comitee in their lives.
very kind of you.
All right, let's move to something else called fiber scan, your liver function.
(38:11):
You had slightly elevated fat in your liver.
So despite the fact that you were working so hard on every life front, like habits, yoursleep, your food, your exercise, you had some invasion of fat, which is not a good sign.
Again, it's completely reversible.
So you felt that maybe you could tackle the alcohol in your life.
wasn't that you were drinking a ton, but you looked at it as potentially playing a
(38:35):
and I think you reduced your alcohol.
Yeah, mean, don't drink much.
I just don't see the point.
Some people do it for social reasons, which I understand, but I don't see the point ofover consumption to a point of intoxication anymore.
I mean, those were the college days, the college days.
you know what mean?
Right.
Did it affect other parts of your life by reducing alcohol?
(38:55):
No, did not.
think, I think people, especially, I think one very important thing when you give upcertain habits like smoking or alcohol, whatever, it is very important to surround
yourself with friends and families who can support that lifestyle rather than theopposite, where they would pressure you into that lifestyle.
(39:16):
aren't you having a drink?
Exactly.
I think I'm very fortunate and grateful that I've got friends who would respect that andthey're yeah, that's fine.
If don't drink this, have a juice or have a water and we'll still have a good time.
It's the conversation and the company.
Exactly and if you are at cocktail parties where it may feel a little odd not to have aglass in your hand what I do most of the time is I get some club soda and people disturb
(39:42):
me I'm like this is my vodka and club soda.
It's exactly a line
yeah, exactly.
So we also took a look at your B vitamins.
And there you aren't doing too badly.
Your B12 was in the 800s, I believe, and your folate was about 20.
They weren't activated agents, but it's not clear that you needed it.
If you don't have MTHFR, then you don't need activated or methyl groups attached to the Bsto get it to work in your body.
(40:09):
That's what MTHFR does.
It interferes with methylation.
And so for some of us like me, I really need that.
And it's pretty common.
It's about 24 % of the population.
have that.
And if you have that and you don't take adequate activated B's, you can get deep veinthrombosis, emboli to the lungs, you can also have early heart attack, and sudden sensory
(40:29):
neuro hearing loss.
And so it's not uncommon.
I've saved many people's hearing and stopped the risk of deep vein thrombosis byrecognizing those factors in people.
And again, this is the emphasis on precision medicine because I was taking multivitaminbefore I met Florence and I thought that would be enough.
But then when the blood, when the blood results came out, you know, they are very specificvitamins and minerals that I'm deficient in that I didn't even know.
(40:57):
Right.
Right.
And, and, and, and Florence would give specific advice of specific supplement, like shesaid, activated vitamin B rather than non-activated and like all those little,
details, it's what's needed to address your personal health.
And because each of one of us is unique, but that's why I think of it as precision becausewe want personalized Should be taken for granted in medicine But unfortunately most of the
(41:22):
data and researchers done in thousands if not millions of people and so you're looking ataverages But no one's average and no one's exactly the same if identical twins aren't
exactly the same You can't claim that for anyone else, but you did really well and your Dimproved dramatically I would just I would just make sure our listeners are also aware
that with D vitamin if they're
history of kidney stones in the family, in the family or in yourself, you want to take alower dose of D vitamins.
(41:47):
You don't want to take the usual dose we use is about 5,000 a day along with vitamin K2because we want to channel that calcium into bone not into the heart or prostate or
breast.
And so that's another hack that really makes a difference for folks.
So magnesium is probably the most essential element.
It's present in every interaction, almost in the body, more than 300, several hundred.
(42:11):
It also is so important for the GI tract to work well.
ability to sleep.
You need it in your brain, so you have to use a certain kind of magnesium to cross theblood-brain barrier like magnesium trienate.
But the combination of magnesium for different folks is, again, an art in terms ofunderstanding your story and how you're living life.
One of the particular interesting things I find out about magnesium is that we have genesthat don't—there are some folks who have genes that don't allow them to absorb oral
(42:40):
magnesium.
So in that case, we look for creams.
or we advise baths at night with Epsom salt that have magnesium in it, and it also helpswith sleep.
Does magnesium affect absorption of vitamin D?
Not in what we've seen.
No.
Magnesium, can take it any time of day or night.
We, in fact, encourage people to take it at night because of the calm and because it helpswith sleep and because of the GI tract effect.
(43:04):
So if constipation is an issue, it frees up the gut.
And sometimes people feel that's the most important thing we've ever done for them becausethe agony of having your belly feeling like it's tied in knots all the time and not
regularly, you know, going to the bathroom is a hard thing for some folks.
not to, that's a pun, I guess.
Your uric acid, which is also a sign of your body's use of purines, was also somewhathigh, and that would lead to gout.
(43:29):
So gouty arthritis is a particular condition that is also genetically, you have apropensity for.
It goes along with cardio metabolic disease, as you've expressed and your familyexpresses, but there, there's actually very simple directives that you could do.
First of all, you could cut out foods that have high
typically thought of as the diet of kings, steak, red meat, shrimp and shellfish, redwine.
(43:53):
Smelly cheeses.
We have a lot of folks who are off to Italy and then they say we know can we get sometreatment so that I don't get a gout attack because they're gonna drink wine and they're
gonna eat cheese.
But in your case you lowered your uric acid from six and a half to five, which isoutstanding.
We like to keep it five or less.
We don't want to see it creeping up towards seven or eight.
And you were about six and a half.
(44:15):
Makes sense?
Okay, and we would probably want to increase the tort cherry based on your last blooddraw.
Your uric acid was creeping up a little bit.
You also underwent what we call the endurance test, the VO2 max, which we look at as avery particular way to predict, almost like we had a crystal ball of your future health
and longevity.
So when we improve your ability to run on a treadmill, like for seven minutes and breathethrough that mask, which no one finds very much fun, we actually decrease morbidity and
(44:44):
mortality by 12 % over a decade as you increase your score by three to three and a halfpoints.
And I think your score started
at about 35 and a half and went up to over 41, 41.7.
So I can do the math correctly there.
That's 6.2.
So you increased and improved your survival by reducing your risk of death and disease by24 % over the next decade.
(45:11):
So you are, definition, in much better shape than your father was at the same age, notjust because of lifestyle, but because of all the other interventions.
Of course, not sm-
and doing all the good things you're doing are going to help tremendously.
But getting to the deeper levels, reason for being the cellular level, made a hugedifference because we don't see these changes unless we induce interventions that can make
(45:35):
that happen.
Make sense?
Yeah.
So what is your current workout regimen?
How does that work for you?
current workout has been the same.
I do four days of lifting and then on the other rest days, I do sort of active rests whereI would just go on either machine, a cardio machine or outside walking for, you know, 45
to an hour for sort of cardio zone two and doing 10,000 steps per day.
(45:59):
And about once a week, I would do high intensity interval training, which in thebeginning, when I first started with
Commitee Precision Medicine Center, I was doing 6.5 miles per hour.
was my sprint.
And now I could do 10 miles per hour.
So that was definitely a stark improvement that was very significant, both objectively andsubjectively for me to, and it does some, I guess it's the dopamine, you know, when you
(46:27):
know that you're able to run that fast and not dying and
repeated five times, you know, over one minute and then showing the result of the VO2 max.
The objective changes.
So here's what you've done for yourself.
The heart actually works in ways that when it's called upon to give you a power thrust.
(46:48):
It's difficult.
so, HIIT, or High Intensity Interval Training, actually ensures that your heart can becalled on to work when you need it suddenly.
And those are the vulnerable times for folks, because those are the times that you can geta heart attack.
So it's that HIIT that you added to your regimen that has done a remarkable job ofimproving your VO2 endurance.
(47:10):
Also, we want other stages of exercise, and it sounds like you're pretty well covered atthis point, and I would encourage you to continue that.
I'm going to briefly talk about testosterone because it's a little complicated to describein you.
I will say that when you started with us, your testosterone was half of what we'd like itto be.
It was about in the 80s.
That's free testosterone.
(47:31):
A lot of times men will have excellent total testosterone, like their scores will even bea thousand or more.
But what happens is that some of that, if not most of it, is tied up in proteins in thebody.
So it's not free to act.
So we look for free testosterone that's above 180.
We want that to be available to all the cells of the body because testosterone is not justabout sexual activity or libido.
(47:53):
It's actually very important for energy, to maintain muscle, to also maintain memory andcognition and the heart.
Think of it, the heart's a muscle.
Of course you need testosterone for the heart.
And that's why it's, we usually
start there.
In your case, we gave you a peptide called HCG or human chorionic anetropin, sometimesthought of as a fertility injection, because in men it stimulates the physiological
(48:19):
production of testosterone from the testicles.
I think you were interested in experimenting a bit, and so when we went back and forthwhile your three testosterone improved, it didn't quite get to the level we wanted it to,
but we weren't sure what you were doing with the HCG.
I was doing a CG for a very consistent six months at least for the first six months and.
and injecting at least twice a week because you had also reduced the injection at somepoint to once a week and that is actually undermines it.
(48:47):
Your testosterone would drop with that because the body depends on this regular signalsand twice a week is the minimum.
Three times a week is sometimes necessary for someone within your prototype.
Your family history, your story, the way you're living life demands testosterone at anactually younger age than a lot of men.
Yeah, no, I have been doing twice a week, but I think we reduced, we halved the dose afterthe first month because we were seeing too high of a result, too much of a result of the
(49:18):
muscle mass and all that.
And that was when I was advised to halve it for the six months.
Possibly too because from a financial point of view you can't pay for HCG and sotestosterone you can get covered.
HCG you can't.
The reason we like it but realize it might not be realistic for everyone.
Yes, let's talk about that.
Let's, let's get FDA to actually like, you know, give this a pass so that, you know,insurance can cover it or like make it cheaper so that, you know, compounding pharmacies
(49:46):
can, can make it at scale.
Cause it does help people.
Definitely.
Well, your testosterone improved by 25%.
It went to close to 100 from 80.
We were very excited about that.
But I think in looking at various choices, it wasn't ideal.
Right now, I understand you're taking testosterone in a pill form, which is interesting.
(50:06):
Sometimes men need higher doses with a pill form.
But it's a new development, and I think it's quite exciting in that way.
Okay, the exciting, more exciting part for you, or fantastic part, is you were able toactually maintain your muscle mass and lose fat.
And you had an incredible story there, I know you shared it with me earlier, where yourchange over time, because you were measuring your own body composition at home with the
(50:33):
scale that we recommended, the in-body scale, and we asked you if you were interested inpurchasing it.
It is not...
It cost a few hundred dollars, like think 300 and something, change, but it's well worththe investment because then you can see not just one number on a scale, but rather follow
your body's makeup.
And that's much more critical because you can have folks who look fantastic on theoutside, but have 40 % body fat.
(50:58):
They just model fat well.
And then you can have other folks who look very muscular and do great, but maybe thebalance quite isn't there.
And you want that balance and you want enough muscle.
The ideal way to live life and protect your health for longevity is to have muscle andmaintain it and have enough fat.
You don't want too little fat either.
(51:19):
So you want the right balance between fat and muscle and water.
And you managed to get there quite beautifully when you started your initial...
weight was 181 pounds and you dropped to 159, which is incredible over a period of oneyear from December 2023 to December 2024.
(51:40):
Your skeletal muscle mass was maintained.
You started at about 75 and you ended up a little over 76, which is great because you werelosing fat the whole time you
on calorie deficit.
Exactly.
Your body fat mass went from 48 to 26, which again, incredible, And your percent body fatwent from 26.6, which was a little higher than optimal given that you were in your 30s.
(52:06):
We like to see it a little bit less than 20.
And you dropped since then in that one year to 16.3%.
Congratulations.
Thank you.
fantastic.
Thank you to you.
Well, we had to be in partnership.
If you hadn't done the part you needed to do, this wouldn't have happened.
Your visceral fat, is a very important area.
We talk about visceral fat around the belly and what the fat we see around organs and it'svery dangerous fat and you manage to go from what we consider Okay, which is just under a
(52:36):
hundred you about ninety four percent to fifty six percent, which is phenomenal So you'vereally dropped a lot of the fat that interferes with organ function leads to Diagnosis
inflammation and dementia.
So you that was a fancy
I think I'll leave it there, but because you were able to maintain so much along the wayand do numbers speak for themselves.
(52:58):
Yes, and I'm so proud of what I've achieved, but I couldn't have gotten there without you,Florence.
And I'm so honored to be able to share this story here today too.
And just in case you guys need it, yes, I authorize the sharing of my health data, becauseI think if this can help one extra person and help you with your work, I couldn't be more
(53:20):
grateful.
It's an honor even if you save just one life and you've done that just by your changes.
Hopefully will trigger other people, our listeners to say, wow, if he can do it, I can doit.
Particularly the moving story of you're running around that track and seeing an oldercouple encouraging you and then you invested yourself in it and that's what has to happen.
(53:40):
So I'm thrilled.
think one of the nicest things we saw in your body composition is in that grading scorewhen you start out as a C,
it means that your body weight and body fat mass is too high and the muscle dips in.
So that's like a C.
But you went from a C to an I to a D.
So an I is, okay, you're on your way, everything's even, but you actually get the bestgrade here if you get a D.
(54:06):
And you ended up with a D, so we're very proud of you.
Not if I'm Asian parent.
scores.
I know.
Absolutely.
Okay.
So let's move on to the fact that you're now incredibly well and you have enough energy topop from state to state.
You're on all these podcasts to talk about the benefit of ketones and also to share yourown story.
(54:30):
You have to feel great about your progress.
And what if anything did you learn this past year?
What
would you want to share in a meaningful way?
You've shared so much, of course, already.
But what do your listeners hear from you about what they might do?
Where should they start?
What should they do?
two things I want to share.
One is knowledge is power, especially knowledge about your own body.
(54:53):
Knowing what is going on, especially when you hit a wall is so, powerful.
And having experts such as Dr.
Florence Comet here, advising you on what your bloods actually show.
That was a game changer for me.
The second advice I want to share is that while you are on this journey, it is called ajourney.
It is not a snapshot.
(55:14):
It's a journey about consistency and you just have to trust the process and keep going.
And throughout that journey, you will face dips, will face walls, plateaus.
It is important for us to be able to pick us back up and keep going.
Because only then I saw results.
I have had plateaus for three months straight without having any dip in my weight.
(55:37):
And I don't know what was going on.
And I'm like, Florence.
I'm taking every supplement you recommended.
I'm doing all these injections for my testosterone.
My weight is just not going down no matter how little I eat.
And then one day I wake up, just went bam, one pound a day for like a week.
So you never know how your body react to certain interventions because it is never linear.
(55:58):
It is a process where you will go past a threshold and your body will start reacting andbe responsive to it.
So trust that process.
Yeah, that's beautifully said because you're right, we're not machines.
We wax and wane, life has its own forces and intent for us.
But if we stick with it, the results are always there.
Well, thank you so much, Let.
(56:19):
It's been a pleasure speaking with you.
And I'd love to have you back to update our listeners because I think they want to seewhere you go with your health journey and achieving your health goals with all the
knowledge you have both in training and expertise from school and all your degrees, aswell as to chat about it.
mutual interest in this field of precision medicine and healthy longevity.
(56:40):
Yeah, I'm excited.
I'm honored to be here and I finally get to see your New York office.
I'm really, really honored.
And yeah, I would love to come back, especially, you know, if I look younger at the age of45.
I'm sure people think you look younger now.
You do, you look fantastic.
You're all cut in angles and that wasn't quite the case when you started.
(57:00):
It wasn't that you didn't look good, but now you look amazing.
Thank you so much.
And you were saying you haven't been thanked so much on a podcast like this.
amazing.
I'm gonna replay it for my family, for everybody here.
I want everyone to hear it.
No.
You should.
You should because, my parents always taught me to be grateful and have gratitude.
And it is one of the factors, one of the main aspects for people to be happy, Be grateful.
(57:23):
And you are definitely one of the greatest thing that happened to me last year,understanding my health and making changes towards a healthier, towards the end of my
life.
So I, it's only natural.
Well, thank you.
And I am actually also very grateful.
I try to wake up every day and think about something I'm grateful for and give gratitudeto my mentors who really allowed me to get to where I am, to my parents who supported me
(57:50):
through every thick and thin, and also to my patients.
Because the data that you benefited from came out of the last 20 years of actually settingit up in a protocol scientific driven way to be able to extrapolate what was unique for
each person.
and how to apply an N of 1 approach, which doesn't exist in medicine because most ofmedicine is testing in huge groups of people and then treating everyone like they're the
(58:14):
same, like average.
But in any case, to my audience, thank you for tuning in.
I welcome you to come back next time on Healthy Longevity with Florence Cometae.
Hello and welcome to Healthy Longevity.
I am Florence Cometay, CEO and founder of the Cometay Center for Precision Medicine andHealthy Longevity with offices here in New York City, Palo Alto, and Miami Beach.
I'm really excited about today's guest, Dr.
Lat Mansor.
Latt is a research lead at HVMN, Health Via Modern Nutrition.
(00:23):
That's a cool name.
A performance nutrition and metabolic health company.
He has a PhD in physiology, anatomy, and genetics.
Not quite the overachiever, right?
From the University of Oxford.
I first met Lat about a year and a half ago on his podcast by the same name, Health ViaModern Nutrition, and I enjoyed doing his podcast so much that when he started telling me
(00:48):
about his family history and high risk of early death from heart attack and stroke, I wasinterested in sharing my
data with him, which told him that it's very hard on that track when you're 30, it's morelike you're an older person.
I'm going say that over again.
He first told me about his family history and early death from heart attack and stroke,not only in his father, but in a half brother as well, and also related to his father.
(01:15):
And I got intrigued because we've been seeing that prototype in different types ofindividuals, different ethnicities, different backgrounds, Eastern Asian, as well as
Ashkenazi Jewish.
Latt himself is a mixture.
I'll let him tell you a little bit about himself.
But he was facing some personal health challenges, which included the fact that it wasdifficult, even though he worked out and ate right, to lose fat.
(01:39):
And he wanted to learn more about my approach in precision medicine for longevity.
So he shared his health story in a little more detail and the results of his labs andbiomarkers.
And I recommended a series of interventions.
And today we have the privilege of reviewing Latt's outcomes and hearing
how he spent the last year in terms of that experience and wants to share it with all ourlisteners.
(02:02):
So welcome, Lat.
It's pleasure to have you here.
Thank you very much for having me and you have changed my life forever basically.
And you have been also so, so generous and I can't be thankful enough for all the thingsthat you have given me and advise and care and you have shown how personalized medicine or
(02:24):
precision medicine makes such a big difference because everyone's genetic makeup isdifferent.
And you show the utmost care for every single patient of yours, which I have so muchrespect for given how busy your schedule is.
And I know, you you travel a lot and you speak a lot at conferences, and yet you, youstill take time to review your patient's data and your, blood markers and all that.
(02:46):
So I'm very excited today to talk about my journey in the past year, what I've achievedwith Florence and all this amazing stuff that you're doing.
team was also great because everybody was engaged, but thank you for saying that.
That was very kind of you.
And especially coming from someone who's a scientist and understands that while the way wesleep, exercise, maybe do restorative practices makes a huge difference in expression of
(03:12):
genes, it's really the genetic makeup that drives who we are.
And by understanding who we are at a very cellular, basic level, we can actually changeour health destiny.
We can own the way we travel through life.
Who wants to get a heart attack in your 40s or 50s or pass away in your 60s when to melife is half lived?
You really want to try to make it to 120 if you can.
(03:35):
with high quality life on top of that.
Exactly.
So let's turn a little bit to your background because I know at Oxford your researchfocused on the metabolism of type 2 diabetes or diabetes in general and the heart in terms
of diabetic heart in terms of getting enough oxygen and staying healthy.
So what led you to that particular area of research?
(03:57):
Oh, um, so growing up in Malaysia, my mom's side has very high prevalence of diabetes andobesity.
And as you said earlier, my late dad actually passed away when I was 17 from stroke at theage of 63.
And a few years prior to that, had a cardiovascular, he had a myocardial infarction andheart attack and had an open heart surgery.
He survived that.
(04:18):
And then he had a stroke and then unfortunately he did not survive that.
So going into my PhD application, I was always, you know, been interested incardiovascular science.
And it just so happened that the lab that I applied to in Oxford, it's called the cardiacmetabolism research group.
And they also, you know, on top of understanding the metabolism of the heart, they alsojust got a new fellow who got
(04:47):
funding from the British Heart Foundation as well as Diabetes UK to really look into theconnection between diabetes and cardiovascular disease.
Because as we know, if you have diabetes, your risk of getting a heart attack is much,much higher.
And even if you survive the heart attack, you are at risk of heart failure afterwards.
(05:07):
So that was what drove me because I'm essentially the product of the genetic of increasedrisk of diabetes.
with the increased risk of cardiovascular disease.
So that's myself and I want to learn more about the disease, but ultimately it's a selfishreason of me wanting to learn about my own heart metabolism and what I can do to avoid
(05:28):
that outcome.
That's admirable and also exactly why I went into this field because it always concernedme that when we work in medicine so hard, in conventional medicine, it's all about
reactive disease.
It's reacting to disease and somebody has to present with disease and then we jump allover it in a very good way.
(05:49):
But as you said, once you're on this treadmill of chronic disease or acute diseases likeheart attack and stroke, your days can be numbered but you also don't live a quality life
and it's a burden.
not only to yourself, but people who love you because they want to see you in good healthand it's very hard to turn that around.
So with your family history, and if I recall, half brother as well had heart disease andhas passed away at a pretty young age, we wanted to stop you in those tracks and change
(06:16):
the future health trajectory for you and make sure that you can own heart health, nodiabetes to the rest of your life.
And I think it was a struggle in understanding how to best do that.
Yeah, think, I think growing up, I've always been overweight.
So that was already a struggle to begin with and to top it all off.
and you're going to, you're going to frown at me now because I used to be a smoker, right?
(06:38):
For seven years.
And I gave up smoking when I was 22.
So that was quite a few years ago.
It was in my second year in university.
And then I started exercising.
And that was when I started learning about metabolism and physiology.
And I learned that there are things that we can do to defy.
the outcome that our genetics predetermine us to.
So in that sense, I really went in there and changed my life because like, for example, myhalf brother or my dad, they were smokers and they were not living a healthy lifestyle.
(07:08):
And that really propagated the predisposition of what they were given in terms ofgenetics.
But for me, I then learn more about the science of physiology and metabolism andpreventative medicine, especially not reactive medicine.
I'm like, you know what, first of all, my weight has to drop.
Second of all, I need to recomp my body and making sure that my lipids are in check.
(07:33):
And then I have to give up smoking.
Ironically, I didn't give up smoking because I thought of the disease outcome and whatnot.
It was because I started jogging.
started running and I realized those days that I smoked less, I could run further.
Now, mind you, how I started this running journey was very ironic as well because it was,it was in the spring of my second year in university in Nottingham.
(07:56):
was my undergrad.
My housemate, Leanne, she asked me, Hey, lad, do want to go for a run for a jog?
There was a lake around the university and from my house around the lake and back is abouttwo kilometers.
Mind you, I was a heavy smoker, overweight and not very healthy person.
I went running with her and I didn't see myself cause I couldn't see myself, but she toldme I went blue.
(08:18):
I was, she thought I was going to pass out anytime soon, but I made it, well, made ithalfway and then walk back.
But it was, it was.
It was a task.
was a challenging task.
And then I went a couple more times after that.
don't know.
I was a glutton for punishment.
And there was, there was a couple who are probably in their sixties, seventies.
Not only they were running faster than me, they were cheering me on.
(08:41):
were like, you can do it.
I was touched and embarrassed at the same time, because I was, I was 22.
Like how bad can this be?
How bad will it be when I reach 40?
You know, which is this year I'm turning 40, right?
So I'm like.
I can't, I can't let this go on.
So during the summer where everyone went home for summer holiday, I stayed back and workin the local cinema and I decided to go jogging every day.
(09:05):
And what I did was because there were trees around the lake, I would mark the next tree asmy goal, as my destination every time so that I can go a little bit further every time
until I can finish the whole loop.
And without...
two kilometers?
Two kilometers.
Wow.
Yeah, it's not even two miles.
No, it's not.
(09:26):
In the American world.
Yes.
It's like
bit more than a mile.
I could not do it.
I couldn't have finished.
impressive that you set those goals for yourself and actually continue to meet them.
That changed your life.
And another thing what people, what my friends were very surprised about was at that timeI didn't even listen to music.
Like I was just running like without music, just on my own, just getting in my head andthinking about other things.
(09:49):
And, and then before I knew it, after three months of the summer, I, I lost about 20kilos, about 45 pounds.
And I almost looked unhealthy because I lost too much weight too quickly.
And I wasn't
gaining muscle because I wasn't doing resistance training.
And that was also when in the summer when I gave up smoking because I was in South Francefor a course.
It's a biology in space course.
(10:10):
I wanted to do PhD in biology in space initially.
And a Russian lady from the Russian space agency came up to me while I was smoking inbetween the lectures and said to me, give up smoking, save money and buy vodka.
Those were her words.
And I felt like she wanted to tell me something.
So after the lecture, I went up to her.
was like, do you want to tell me something?
Turns out her husband is a lung cancer oncologist and she drew the DNA structure andexplained to me how mutation occurs or how the increased risk of mutation would happen
(10:38):
when you smoke and increased risk of cancer.
And then at that point I realized that knowing that knowledge or having that knowledgemade me a hypocrite if I don't give up smoking because I can't have that knowledge and at
the same time still smoke and endanger myself.
So I gave up cold turkey then and then.
So I started exercising.
(10:58):
it up cold turkey.
That's not easy.
I lots of patients who have, but still, you have to be tough.
Tough in mind, tough in body.
Yes, absolutely.
It wasn't easy.
think, I think for me, the challenge was the social setting because obviously smokers havesmokers, smoker friends.
And when you hang out with smoker friends, you go out to a bar or you go out in a socialsetting.
I had relapsed, um, maybe like six months later and then another six months, I have onecigarette.
(11:23):
And what kept me off of it is the next day.
My throat hurts.
I, when I go, you know, for a jog, I was wheezing.
the effect was almost immediate.
And that physical suffering was what reminded me why I stopped in the first place.
So that was what kept me away from it.
And now I almost developed an allergy towards cigarette smoke, actually, because my momstill smokes, unfortunately.
(11:49):
She gave up and then she picked it up again.
So when I went back home in Malaysia, and if I'm in her vicinity when she smokes, I almostfind it very difficult to breathe.
Yeah.
Well, in a way, you're lucky that as a very young guy at 22, you kind of saw the writingon the wall and it was put up in front of you by this Russian physician or scientist.
(12:10):
And that you have physical manifestations of discomfort when you smoked instead of gettingthe pluses of a lot of people say it's creative, it gives them something to do.
You have a lot of friends who are hard not to relapse when everyone around you is smokingand you're breathing the very air, which is second hand or third hand.
So you did yourself a favor, your body did, you were getting strong messages.
But it wasn't easy being you because most of us take for granted our health and ourbodies, but being born with a metabolic type syndrome that puts you into an early
(12:40):
potential death.
of cardiovascular disease is a burden and that's the kind of burden that I'd like torelieve people of.
I'd like people to understand that even at 20 or 30, making that change will make a hugedifference in the rest of their life.
So this was very interesting because you jumped right into physiology, which I was goingto ask about.
Sorry, I chopped the gun.
(13:01):
health history and your own family history and why you wanted to explore precisionmedicine in terms of a proactive approach to longevity.
And overall, you're still a really young man.
You're turning, only turning 40 this year.
So when's your birthday?
So we have six more months, right?
Just about.
And you're a world expert in physiology and metabolism and consult with elite sport,military personnel, clinical and research organizations.
(13:26):
What is HVMN do and what is your role at the company?
How do you translate that given your background?
Sure.
So HVMN, it's essentially a health supplement company and our main product, our flagshipproduct is exogenous ketones.
So I think we need to probably explain what ketones are.
know, ketone 101.
(13:47):
So ketones are essentially fuel that your body creates and it's not a new molecule, it'snot a new drug.
It's something that our own bodies will create naturally.
Our DNA is programmed to...
to produce ketones and metabolize ketones.
But it only happens when your body is really low on sugar and glycogen because theincrease in insulin, when you have sugar in your body, it stops or inhibit ketone
(14:13):
production.
And the reason why ketones are being produced is because when you are low on sugar, yourbrain primarily consumes sugar.
But when the sugar is low, your brain still needs to work and it needs to work 24 seven.
So fatty acids gets converted into ketones because fatty acids
as a big molecule cannot bypass the blood-brain barrier.
So ketones are smaller and can bypass the barrier and enters the brain and provide energyfor the brain.
(14:37):
And right now in this modern society, most people achieve that by going on either ketodiet or intermittent fasting.
Our company creates exogenous ketones, which is an external source of ketone where you candirectly drink shots like this.
When you are not in ketosis, when you have sugar in your body, you can't produce ketones.
So this basically bypass your physiological state.
(14:58):
So even if you have glucose, you can have access to ketones now by just directly drinkingit.
Now, the caveat is you are not in perpetual ketosis like you would if you're on aketogenic diet, for example, you need to top it up if you, if you want more ketones, but
that is what our company.
does.
And as for my role in the company, as a research lead, I oversee all of the science, thepublications, the collaborations with clinicians, with research institutions, with
(15:26):
athletes, and really advise our athletes, our professional athletic teams around the worldon the protocol, on the dosage, on what we know so far of the scientific literature, and
really withhold the integrity of science.
which I think not many nutrition company really pays close attention to.
(15:47):
It's hard work and I think it takes a lot of energy and resources to do so.
So tell me with that in mind, so you take exogenous ketones, ketones not made by your bodynaturally through fatty acid kind of metabolism, how does it work when you still have
glucose in your body?
Like where's the, is there a competitiveness?
Can people lose weight on taking exogenous ketones?
(16:07):
Is that just one side effect or not even present in some folks?
How does exogenous ketones actually?
That's a great question because now for the first time in human history, we are creating aphysiological state that was never there before because you don't, you won't have high
glucose and high ketones.
So what happens in the body?
Right.
That's a super great question because what we have seen then, is that when ketones arepresent, ketones are preferentially taken up in certain organs, especially like the brain
(16:36):
and the heart.
They even created a tracer using a labeled.
butyhydroxybutyrate, which is the main ketone form, the heart takes out the ketones soquickly.
And in fact, we have a couple of clinical trials right now looking at heart failurepatients.
There is a huge clinical trial in Denmark right now that we're collaborating with.
They're putting 250 heart failure patients on ketone IQ for one month and looking at theresults.
(16:59):
Just one dose of ketone IQ, they saw an increase in improvement in stroke volume, ejectionfraction.
and cardiac output, just one dose.
So after 30 days, I really, really hope that we see even bigger, more significant results.
So in terms of competition, what we have seen, University of British Columbia publishedseveral papers in healthy individuals, obese individuals, and diabetic individuals that
(17:23):
across the board, when you take exogenous ketones, your blood glucose actually drops.
And their hypothesis is that gluconeogenesis gets
downregulated and gluconeogenesis for those of you who do not know is a process wherebyour body creates new glucose molecules from non-glucose sources such as proteins and fatty
acids and all that.
So they saw a drop in blood glucose level.
(17:44):
So in that sense, I think it's not so much of a competition, but more so that your bodyrecognizes that ketone is an efficient fuel and you have enough fuel for your body.
Therefore you are halting the creation of glucose molecule.
so that now you can use up the ketones first and then later on you can create the glucoseagain.
(18:04):
And we also have seen in athletic performance, these participants have double the sourcesof fuel essentially.
So you can have a dual fuel system.
And as a result, we saw a glycogen sparing effect where these runners and triathletes areessentially sparing their glycogen so that they can go further.
just so they have the ketones running simultaneous with glucose in their body, but theypreferentially use ketones and then they revert to the glycogenesis when they need it.
(18:34):
So it extends their ability to work out and maybe win the race and however they'reapproaching it.
And this is these, these findings are in individuals who are not on keto diet, right?
So they have glucose for those who are on ketogenic diet.
What we have seen is that having exogenous ketones also up regulate ketone relatedenzymes.
(18:56):
So enzymes that convert beta hydroxybutyrate to acetyl CoA that feeds directly into thecrap cycle and create ATP, which is the energy currency in the cell.
Got it.
So even if you're eating a regular diet or carefully eating a regular diet, you addketones like in this heart failure study.
Is it a daily ketone dose that you're getting at any certain time of day?
(19:18):
three times a day at about 0.3 gram per kilogram of body weight.
So that can make a difference for a lot of folks.
So let's hope these studies go really well.
I me secretly, sort of wish ketones were there when my dad had to go through thosecardiovascular events and who knows, maybe he could have still be alive today.
(19:39):
So I think part of me is hoping that this could help the other lads out there who stillhave their dads who are facing high risk of cardiovascular disease.
I wish the same thing and I have similar feelings because the work I got into was drivenby my father when I graduated medical school.
He said, okay, tell me now my brilliant daughter, because I had just graduated YaleMedical School.
(20:00):
He said, how do I stay healthy?
And I remember looking at him and saying, I don't have a clue.
Like I learned about disease, but not about health.
And I think it's at me along my life's work.
And I look back sometimes and wish what I had learned over the last 10 years or so couldhave made even more of a difference.
I was lucky.
I had my dad into his 90s.
And both my dad and mom, who just recently passed away at 102, both of them outlived alltheir siblings.
(20:25):
And I think in part because of the kind of care they got from my twin sister, who's also aphysician, and myself, there's a number of us in the family.
And you speak about overachiever.
This is the family.
So, yeah, so I can completely relate to that because it affected me in exactly the sameway.
But I was lucky enough to have my dad and my mom for many, many years and they werefascinated by the work we do.
(20:47):
It's fascinating journey you've had and obviously you've radically changed the way youlive life, but still when we met, which was a couple years ago, so you were in your late
30s, you were still struggling.
You couldn't get to the goals you wanted.
You wanted to lose more fat mass, but you wanted to maintain muscle.
You wanted to change your body composition.
And you wanted to know that you could live life to the fullest.
And we identified several areas that really needed more deep attention beyond just habits,perhaps supplements or medication, something that's frequently necessary in order to
(21:16):
change your gene destiny.
We don't want your destiny to be where you're wired in your blueprint.
We want to be able to tinker with it in a very careful way that works with yourphysiology.
And that's what we were able to do.
If you want to elaborate on those questions at the time.
Yeah, to put it in perspective, I was gyming four or five times a week.
(21:37):
was lifting weights and I was lifting heavier and heavier progressive load.
That's what people say.
And to a point where I would injure myself and then I'll, you know, step back and then goback on that and that cycle.
And I was eating low carb diet.
wasn't like overeating.
I wasn't eating out a lot.
was cooking my own food, but I was still struggling at about like 26 % body fat.
(21:57):
And I, I couldn't figure out why, right?
And
Um, and then I spoke to Florence and during our podcast and, and she told me about thework that she does.
I'm like, that would be amazing if I could.
And Florence was generous enough to ask me to come in and let's figure out together what,what is going on and what's wrong.
And yeah, because I think a lot of people can relate cause it's not that people lack thedetermination.
(22:22):
It's not that people lack the drive.
Like people are going to the gym.
People are trying to exercise, but it is the lack of results showing.
in combination with the instant gratification of social media that drives people orhampers people's determination in the long run.
I think people are disappointed that they do, they feel like they do everything right.
(22:43):
And particularly people as they enter their 30s and life gets busy, they're wondering whythe weight sticks around, why they go, might go to the gym, they might make time even to
go to the gym and eat right.
But the story is deeper than that.
The story delves deep into your own system at the cellular level, metabolically.
Your body is changing, your hormones are declining.
Testosterone as one key variable declines by one to three percent a year in all of us, menand women.
(23:09):
We women have some testosterone too, not as much as men, but we have some.
And as that happens, the way we lay down muscle, the way we put on weight, the managementof sugar, cholesterol, all of the factors that lead to diseases of aging, or what I used
to actually always label disorders of aging.
It was apparent to me a long time ago that if we could stop and reverse aging, we couldkeep your health at a physiological place like the 20s, 25 to 30, where it was a great
(23:38):
time to like turn around the track you were on, where you were headed when you were older.
And if we could do that, it didn't mean that aging was bad.
You wanted to chronologically age.
You don't want to stop that piece of it.
You don't want to be Benjamin Button's necessarily.
But what you want is to own your health for the
of your life.
So we dug into the story your biomarker showed us.
So we collected a bunch of biomarkers, looked at your carbohydrate metabolism inconjunction with your continuous glucose monitor.
(24:06):
So we're able to see how sugar rose and fell for you.
what your cholesterol or lipid profile looked like, and all of that told us why you werestill struggling.
No matter the best life you could live, it wouldn't have changed the trajectory of yourhealth in as big a way as you wanted to.
And this is the most comprehensive blood biomarkers tests I've ever done.
(24:29):
You know, my first time doing glucose tolerance tests.
You know, it was, it was a challenge getting all the, you know, blood that I needed togive, but it was definitely worth it.
I've learned so much.
I've achieved so much.
Yeah, so we did a few specialty tests, but we started with a baseline fasting testingwhere it showed that your fasting glucose and fasting insulin was higher than we wanted it
(24:52):
to be.
And we look at averages, and in your case, your average wasn't too bad, something calledhemoglobin A1C.
It's an average of 100 days of glucose sugar measurements.
But because you went high and you went low, the average looks pretty good.
I'm in the same category, actually.
I have very high insulin, but my averages always look good because you're
ruling out the highs and lows when you look at an average.
(25:14):
That only makes sense, right?
In fact, what we see on commercials now, when you see a commercial that says it's great tohave a hemoglobin A1C under 7, truth be told, under 7 you're still diabetes.
You still have diabetes.
And you're a diabetic at 6.5 or what.
I was going to say, isn't it like 6.4, 6.5?
you're a pre-diabetic at 5.7 to 6.4.
(25:37):
So our goal always with folks is to get it below five, but that doesn't tell the wholestory.
And when we do what we call a oral glucose tolerance test, which a lot of women get whilethey're pregnant, and it's abnormal, and we find that in a lot of women, because just
about every single one of us...
has issues with sugar that only worsen when we get older and hormones change and our bodychanges.
(26:03):
And to me it's because...
It's rather ubiquitous and it's Darwinian.
Survival depends on our being able to put down fat during good times and then live off ourown body during lean times.
So that our ancestors survived during bad times because they could, their genes survived.
The ones that couldn't do that died.
Genes aren't passed down, right?
(26:23):
And from those cavemen who didn't make it through the winter.
Well, they're gone.
So we inherit genes of our ancestors that say, why the eating's good, and pack it awaybecause there'll be a time when it's winter and you can't get food, you can't hunt food,
you can't pull food off trees or plants.
And that's what I think is happening in today's world, and the access to food is just onevery corner.
(26:46):
There was no cycle of fed and famished and there's always abundance of food andavailability and accessibility to food and especially processed food where you have very
dense calorie, calorific foods in a small portion.
Yeah, and lots of corn fructose and sugar.
You have it in drinks that we drink.
(27:08):
You have it in food that we eat from different restaurants.
And finding out how that works with your body is a secret to me.
It's a game changer of the continuous glucose monitor.
Because in your case, when we looked at that deeper dive and you took a swig of purecarbs, your sugar actually never went above 99, which is quite low.
But your insulin went to over 40, and that's quite high.
(27:30):
So you didn't have the right
balance and that's genetically driven.
There is nothing you could really do if you don't know that, you don't know where to gowith it.
And is that what they what they call reactive hypoglycemia?
Yes, in a way it's reactive hypoglycemia because you can eat and your sugar might go upinto an okay range.
In you it does, which is a little unusual actually.
Most people overshoot.
(27:50):
You don't.
you go up and then all of a sudden your insulin follows and your sugar is already droppedbut your insulin is in your body and it makes you reactive.
Your sugar goes too low, you can feel jittery, you can get hangry, you can feel likesleepy.
And so there's a whole bunch of kind of symptoms that people know and they say, I'm noteating enough, I gotta grab a donut and a cup of coffee at 10 o'clock because at eight
(28:15):
they had a banana and a brand muffin thinking,
it's all healthy, but that's all carbs.
Yeah.
And this is me putting my physiologist hat on and thinking about what could that, whateverthat Florence just explained, that could lead to me not being able to lose fat.
So if you think about it, even if my glucose was already down, my insulin stayed up andinsulin is an anabolic hormone.
(28:40):
So it encourages storage of fuel, of substrates, of resources.
And fat is one of the more abundant resources that we
store our substrates or our fuel in.
So maybe that is what's driving a lot of fat storage and make it harder for me to losethat fat percentage.
(29:00):
Thanks
Absolutely, I think you explained it beautifully for you.
Now everybody's different though.
I'm completely different story.
so even fasting for you and other ways that you attempted to lose that fat was just notpossible for you.
You were in a conundrum.
And that's where intervening really makes a difference.
Because when you know the data, which is the way I think of precision, and then you canapply it personally to each unique human being, even if you're an identical twin, my twin
(29:27):
and I express things
differently because we've lived in different life paths.
Even in utero when we separate, we implant in different places so we're not born exactlythe same.
We haven't lived that exact same presence and genes can turn on and off in the body as weknow it.
So out of all those interventions that we have done for me, what do you think drove, isthere a specific intervention that we did that drove the insulin to be more normal that
(29:52):
allowed me to achieve the results I have right now?
I think hormones made a big difference for you.
We know as people age, as I mentioned earlier, that our hormones begin to change anddecline.
Now women know it well because they have something.
you know, to hang their hat on with menstrual cycles and periods every month or, you know,close to that.
Men don't have that as a clue because male hormonal cycles are really more like everythree months where testosterone can go up and down within a three month period, it
(30:20):
triggers, but the other hormones that go up and down from the brain that relate to howmuch testosterone you secrete affect how much you secrete of testosterone, how much you
produce, and how that affects laying down muscle.
So it becomes harder
and harder for men like you in their 30s to get enough muscle.
And then you need to marry that to eating enough protein and doing enough resistancetraining.
(30:44):
And you had some of that in there, like the resistance training, but you didn't have therest of it.
And genetically, you were driven to kind of, it was a kind of lose-lose proposition foryou unless there could be interventions that would work.
And that's the way we think.
That's a great way of thinking.
That's the knowledge that Florence has.
what makes like Comitee Precision Medical Center, like Precision Medicine Center, theunique part of what you provide.
(31:09):
It's basically whatever that's in your brain.
connect the dots.
Yeah.
Then interpret it and integrate everything together so that we can come up with insightsand interventions that will make a difference for each human being.
Absolutely.
One thing as well I noticed, because you mentioned fasting, like even during the year, Ihave encountered plateaus before.
(31:31):
What I found is fasting for 36 hours almost resets the clock for me that allow me to breakthat plateau.
So I'll have calorie deficit and no matter how consistent, even for a week, like my weightwill stay the same and then I'll fast for 36 hours and then I'll have the exact same
calorie count.
And then my weight will start going down again.
(31:51):
Will it be sustainable?
that more testing will be needed.
I am planning to do a couple of more times just to test whenever I encounter plateaus.
But then again, I only encounter plateaus every few months.
So definitely need more data on that.
did phenomenally well when you stuck with our routine.
think because you couldn't help yourself as a researcher and a scientist, you starteddabbling in changes.
(32:13):
And as a result, some of your biomarkers didn't go in the direction we needed to when wemeasured it.
We let you know that.
But the goals were still met.
So that was amazing.
I do want to point out, because your initial blood work also showed poor lipid metabolism,that there were real changes there.
And there, we looked at a number of supplements that we thought would be
ideal for you.
(32:33):
I believe you started on an Omega and also a lipid lowering supplement and that had asignificant impact on the way your lipids looked ultimately because you started
in the right direction, you started dropping and you dropped from a cholesterol riskratio, which I consider one of the top five biomarkers to look at.
It was 4.8, which is more than two times what we think is optimal.
(32:58):
It should be closer to two and you dropped at the lowest point to 3.2.
So we were very pleased.
There's still some room to go.
As well your...
Good cholesterol went from 46 to 59.
And good cholesterol or HDL, which is the high density lipoprotein, are predictive oflongevity.
So you really moved pretty far there, and we were really happy with those results as well.
(33:21):
I think overall, your bad cholesterol, which was LDL or low density lipoprotein, went fromclose to 200 to dropping almost by half to 110.
So we were really pleased with that.
Yeah.
And I think the last telehealth appointment I had, the doctor here told me that hesuggested I go on statin as well.
(33:44):
And I did some research and think about it.
I one of the things I want to ask you about today is actually, you know, what you thinklike I actually I'm thinking maybe it's a good time to start on statin.
It is.
I think that's the next step for you.
I like it when we can see a response to supplements, but if truth be told, I think ofsupplements as drugs that a drug company didn't get their hands on, sort of what you're
(34:05):
doing with ketones.
But if you can prove the safety of it and there's data for both the supplements, just thatthere is for like a statin, both of them are needed.
And so some people can do well with a supplement, but other people may need a medication.
And that just means it's a company who poured a lot of money into it and is now selling
it as a prescription.
Yes, that would be advisable.
(34:26):
The other thing that would be really useful for you would be to look at the amount ofcalcium deposits in your heart, which is hard hardening.
So that's okay as an indicator of your future risk, but there's also soft plaque or softstenosis, and that is seen through a CTA or a computerized tomography angiography where
(34:47):
dye is put in contrast, and it can light up these areas of
soft plaque, whether they block the coronary arteries or they're in the wall of thearteries so they narrow it.
That's also important because that's all reversible.
And if we can read that in you, you would benefit because you know what the focus is.
And why that's important for a lot of folks, we hear people getting a heart attack anddying suddenly, even young folks, right?
(35:12):
That's because they might have very high gray lesions that feed the entire heart from themain artery that goes into the heart.
And once that's
obstructed, they can't get oxygen to their heart, if no one's around to resuscitate them,they're going to die.
Do you guys provide that?
We don't because it's an advanced specialized machinery.
You have to go to a radiology department and you need to get a prescription for that.
(35:35):
Unfortunately, it's not usually covered by insurance, but it's a well worth theinvestment.
Now, I like to note though that in young people, I caution them that they may want to getlife insurance before that because if those data are available, it can jeopardize how the
degree of life insurance is awarded.
And so we've worked with a lot of people over the years and we're cautious about thetesting we do because getting results of those tests can undermine your ability to get
(36:05):
life insurance in the way you might want.
That's a great advice.
people don't care, but other people do.
There's even a fancier test now that we really like that uses artificial intelligence orAI to look within the walls of the artery, and that we do as well, because that tells us a
lot more, and then we compare it over time to show response and to show that people areimproving and that soft plaque is melting away.
(36:29):
Wow, so out of curiosity, how much would these tests cost out of pocket?
Usually, because there's a lot of competition now and a lot of centers are doing them, youcan get the test for somewhere around a thousand or fifteen hundred.
So they're not inexpensive, obviously, but they may be well worth the investment.
And you would recommend people who are at high risk like myself do it once every how manyyears.
(36:55):
Yeah, so it's a little variable again for the unique individual, depends what we find atthe beginning.
Some people have a calcium score of zero, others have a calcium score of 2,000, andeverybody else is in between.
And the higher the calcium score in a way can protect you from future heart attack,because once that plaque is solid, it doesn't cause a heart attack.
On the other hand, it also obscures the visibility of the coronary arteries, so you can'ttell where the soft plaque is.
(37:21):
So anything in between is a predictor of
The calcium score will tell us what the risk might be and getting the soft plaque wouldgive us more answers.
Looking inside the wall is the next step and that you do maybe every two, three, up tofive years.
I think those at higher risk, someone like you, I would get life insurance in order and ifit's necessary you might not feel like you need it and then get the test within the next
(37:47):
year or two.
40 is a good time to take a look, a deeper look, particularly in light of your ownpersonal
family history, your father and your brother definitely started with disease in their 40s,know, maybe even earlier, but for sure in their 40s because they both passed away in early
60s.
they didn't have Dr.
Florence Comitee in their lives.
very kind of you.
All right, let's move to something else called fiber scan, your liver function.
(38:11):
You had slightly elevated fat in your liver.
So despite the fact that you were working so hard on every life front, like habits, yoursleep, your food, your exercise, you had some invasion of fat, which is not a good sign.
Again, it's completely reversible.
So you felt that maybe you could tackle the alcohol in your life.
wasn't that you were drinking a ton, but you looked at it as potentially playing a
(38:35):
and I think you reduced your alcohol.
Yeah, mean, don't drink much.
I just don't see the point.
Some people do it for social reasons, which I understand, but I don't see the point ofover consumption to a point of intoxication anymore.
I mean, those were the college days, the college days.
you know what mean?
Right.
Did it affect other parts of your life by reducing alcohol?
(38:55):
No, did not.
think, I think people, especially, I think one very important thing when you give upcertain habits like smoking or alcohol, whatever, it is very important to surround
yourself with friends and families who can support that lifestyle rather than theopposite, where they would pressure you into that lifestyle.
(39:16):
aren't you having a drink?
Exactly.
I think I'm very fortunate and grateful that I've got friends who would respect that andthey're yeah, that's fine.
If don't drink this, have a juice or have a water and we'll still have a good time.
It's the conversation and the company.
Exactly and if you are at cocktail parties where it may feel a little odd not to have aglass in your hand what I do most of the time is I get some club soda and people disturb
(39:42):
me I'm like this is my vodka and club soda.
It's exactly a line
yeah, exactly.
So we also took a look at your B vitamins.
And there you aren't doing too badly.
Your B12 was in the 800s, I believe, and your folate was about 20.
They weren't activated agents, but it's not clear that you needed it.
If you don't have MTHFR, then you don't need activated or methyl groups attached to the Bsto get it to work in your body.
(40:09):
That's what MTHFR does.
It interferes with methylation.
And so for some of us like me, I really need that.
And it's pretty common.
It's about 24 % of the population.
have that.
And if you have that and you don't take adequate activated B's, you can get deep veinthrombosis, emboli to the lungs, you can also have early heart attack, and sudden sensory
(40:29):
neuro hearing loss.
And so it's not uncommon.
I've saved many people's hearing and stopped the risk of deep vein thrombosis byrecognizing those factors in people.
And again, this is the emphasis on precision medicine because I was taking multivitaminbefore I met Florence and I thought that would be enough.
But then when the blood, when the blood results came out, you know, they are very specificvitamins and minerals that I'm deficient in that I didn't even know.
(40:57):
Right.
Right.
And, and, and, and Florence would give specific advice of specific supplement, like shesaid, activated vitamin B rather than non-activated and like all those little,
details, it's what's needed to address your personal health.
And because each of one of us is unique, but that's why I think of it as precision becausewe want personalized Should be taken for granted in medicine But unfortunately most of the
(41:22):
data and researchers done in thousands if not millions of people and so you're looking ataverages But no one's average and no one's exactly the same if identical twins aren't
exactly the same You can't claim that for anyone else, but you did really well and your Dimproved dramatically I would just I would just make sure our listeners are also aware
that with D vitamin if they're
history of kidney stones in the family, in the family or in yourself, you want to take alower dose of D vitamins.
(41:47):
You don't want to take the usual dose we use is about 5,000 a day along with vitamin K2because we want to channel that calcium into bone not into the heart or prostate or
breast.
And so that's another hack that really makes a difference for folks.
So magnesium is probably the most essential element.
It's present in every interaction, almost in the body, more than 300, several hundred.
(42:11):
It also is so important for the GI tract to work well.
ability to sleep.
You need it in your brain, so you have to use a certain kind of magnesium to cross theblood-brain barrier like magnesium trienate.
But the combination of magnesium for different folks is, again, an art in terms ofunderstanding your story and how you're living life.
One of the particular interesting things I find out about magnesium is that we have genesthat don't—there are some folks who have genes that don't allow them to absorb oral
(42:40):
magnesium.
So in that case, we look for creams.
or we advise baths at night with Epsom salt that have magnesium in it, and it also helpswith sleep.
Does magnesium affect absorption of vitamin D?
Not in what we've seen.
No.
Magnesium, can take it any time of day or night.
We, in fact, encourage people to take it at night because of the calm and because it helpswith sleep and because of the GI tract effect.
(43:04):
So if constipation is an issue, it frees up the gut.
And sometimes people feel that's the most important thing we've ever done for them becausethe agony of having your belly feeling like it's tied in knots all the time and not
regularly, you know, going to the bathroom is a hard thing for some folks.
not to, that's a pun, I guess.
Your uric acid, which is also a sign of your body's use of purines, was also somewhathigh, and that would lead to gout.
(43:29):
So gouty arthritis is a particular condition that is also genetically, you have apropensity for.
It goes along with cardio metabolic disease, as you've expressed and your familyexpresses, but there, there's actually very simple directives that you could do.
First of all, you could cut out foods that have high
typically thought of as the diet of kings, steak, red meat, shrimp and shellfish, redwine.
(43:53):
Smelly cheeses.
We have a lot of folks who are off to Italy and then they say we know can we get sometreatment so that I don't get a gout attack because they're gonna drink wine and they're
gonna eat cheese.
But in your case you lowered your uric acid from six and a half to five, which isoutstanding.
We like to keep it five or less.
We don't want to see it creeping up towards seven or eight.
And you were about six and a half.
(44:15):
Makes sense?
Okay, and we would probably want to increase the tort cherry based on your last blooddraw.
Your uric acid was creeping up a little bit.
You also underwent what we call the endurance test, the VO2 max, which we look at as avery particular way to predict, almost like we had a crystal ball of your future health
and longevity.
So when we improve your ability to run on a treadmill, like for seven minutes and breathethrough that mask, which no one finds very much fun, we actually decrease morbidity and
(44:44):
mortality by 12 % over a decade as you increase your score by three to three and a halfpoints.
And I think your score started
at about 35 and a half and went up to over 41, 41.7.
So I can do the math correctly there.
That's 6.2.
So you increased and improved your survival by reducing your risk of death and disease by24 % over the next decade.
(45:11):
So you are, definition, in much better shape than your father was at the same age, notjust because of lifestyle, but because of all the other interventions.
Of course, not sm-
and doing all the good things you're doing are going to help tremendously.
But getting to the deeper levels, reason for being the cellular level, made a hugedifference because we don't see these changes unless we induce interventions that can make
(45:35):
that happen.
Make sense?
Yeah.
So what is your current workout regimen?
How does that work for you?
current workout has been the same.
I do four days of lifting and then on the other rest days, I do sort of active rests whereI would just go on either machine, a cardio machine or outside walking for, you know, 45
to an hour for sort of cardio zone two and doing 10,000 steps per day.
(45:59):
And about once a week, I would do high intensity interval training, which in thebeginning, when I first started with
Commitee Precision Medicine Center, I was doing 6.5 miles per hour.
was my sprint.
And now I could do 10 miles per hour.
So that was definitely a stark improvement that was very significant, both objectively andsubjectively for me to, and it does some, I guess it's the dopamine, you know, when you
(46:27):
know that you're able to run that fast and not dying and
repeated five times, you know, over one minute and then showing the result of the VO2 max.
The objective changes.
So here's what you've done for yourself.
The heart actually works in ways that when it's called upon to give you a power thrust.
(46:48):
It's difficult.
so, HIIT, or High Intensity Interval Training, actually ensures that your heart can becalled on to work when you need it suddenly.
And those are the vulnerable times for folks, because those are the times that you can geta heart attack.
So it's that HIIT that you added to your regimen that has done a remarkable job ofimproving your VO2 endurance.
(47:10):
Also, we want other stages of exercise, and it sounds like you're pretty well covered atthis point, and I would encourage you to continue that.
I'm going to briefly talk about testosterone because it's a little complicated to describein you.
I will say that when you started with us, your testosterone was half of what we'd like itto be.
It was about in the 80s.
That's free testosterone.
(47:31):
A lot of times men will have excellent total testosterone, like their scores will even bea thousand or more.
But what happens is that some of that, if not most of it, is tied up in proteins in thebody.
So it's not free to act.
So we look for free testosterone that's above 180.
We want that to be available to all the cells of the body because testosterone is not justabout sexual activity or libido.
(47:53):
It's actually very important for energy, to maintain muscle, to also maintain memory andcognition and the heart.
Think of it, the heart's a muscle.
Of course you need testosterone for the heart.
And that's why it's, we usually
start there.
In your case, we gave you a peptide called HCG or human chorionic anetropin, sometimesthought of as a fertility injection, because in men it stimulates the physiological
(48:19):
production of testosterone from the testicles.
I think you were interested in experimenting a bit, and so when we went back and forthwhile your three testosterone improved, it didn't quite get to the level we wanted it to,
but we weren't sure what you were doing with the HCG.
I was doing a CG for a very consistent six months at least for the first six months and.
and injecting at least twice a week because you had also reduced the injection at somepoint to once a week and that is actually undermines it.
(48:47):
Your testosterone would drop with that because the body depends on this regular signalsand twice a week is the minimum.
Three times a week is sometimes necessary for someone within your prototype.
Your family history, your story, the way you're living life demands testosterone at anactually younger age than a lot of men.
Yeah, no, I have been doing twice a week, but I think we reduced, we halved the dose afterthe first month because we were seeing too high of a result, too much of a result of the
(49:18):
muscle mass and all that.
And that was when I was advised to halve it for the six months.
Possibly too because from a financial point of view you can't pay for HCG and sotestosterone you can get covered.
HCG you can't.
The reason we like it but realize it might not be realistic for everyone.
Yes, let's talk about that.
Let's, let's get FDA to actually like, you know, give this a pass so that, you know,insurance can cover it or like make it cheaper so that, you know, compounding pharmacies
(49:46):
can, can make it at scale.
Cause it does help people.
Definitely.
Well, your testosterone improved by 25%.
It went to close to 100 from 80.
We were very excited about that.
But I think in looking at various choices, it wasn't ideal.
Right now, I understand you're taking testosterone in a pill form, which is interesting.
(50:06):
Sometimes men need higher doses with a pill form.
But it's a new development, and I think it's quite exciting in that way.
Okay, the exciting, more exciting part for you, or fantastic part, is you were able toactually maintain your muscle mass and lose fat.
And you had an incredible story there, I know you shared it with me earlier, where yourchange over time, because you were measuring your own body composition at home with the
(50:33):
scale that we recommended, the in-body scale, and we asked you if you were interested inpurchasing it.
It is not...
It cost a few hundred dollars, like think 300 and something, change, but it's well worththe investment because then you can see not just one number on a scale, but rather follow
your body's makeup.
And that's much more critical because you can have folks who look fantastic on theoutside, but have 40 % body fat.
(50:58):
They just model fat well.
And then you can have other folks who look very muscular and do great, but maybe thebalance quite isn't there.
And you want that balance and you want enough muscle.
The ideal way to live life and protect your health for longevity is to have muscle andmaintain it and have enough fat.
You don't want too little fat either.
(51:19):
So you want the right balance between fat and muscle and water.
And you managed to get there quite beautifully when you started your initial...
weight was 181 pounds and you dropped to 159, which is incredible over a period of oneyear from December 2023 to December 2024.
(51:40):
Your skeletal muscle mass was maintained.
You started at about 75 and you ended up a little over 76, which is great because you werelosing fat the whole time you
on calorie deficit.
Exactly.
Your body fat mass went from 48 to 26, which again, incredible, And your percent body fatwent from 26.6, which was a little higher than optimal given that you were in your 30s.
(52:06):
We like to see it a little bit less than 20.
And you dropped since then in that one year to 16.3%.
Congratulations.
Thank you.
fantastic.
Thank you to you.
Well, we had to be in partnership.
If you hadn't done the part you needed to do, this wouldn't have happened.
Your visceral fat, is a very important area.
We talk about visceral fat around the belly and what the fat we see around organs and it'svery dangerous fat and you manage to go from what we consider Okay, which is just under a
(52:36):
hundred you about ninety four percent to fifty six percent, which is phenomenal So you'vereally dropped a lot of the fat that interferes with organ function leads to Diagnosis
inflammation and dementia.
So you that was a fancy
I think I'll leave it there, but because you were able to maintain so much along the wayand do numbers speak for themselves.
(52:58):
Yes, and I'm so proud of what I've achieved, but I couldn't have gotten there without you,Florence.
And I'm so honored to be able to share this story here today too.
And just in case you guys need it, yes, I authorize the sharing of my health data, becauseI think if this can help one extra person and help you with your work, I couldn't be more
(53:20):
grateful.
It's an honor even if you save just one life and you've done that just by your changes.
Hopefully will trigger other people, our listeners to say, wow, if he can do it, I can doit.
Particularly the moving story of you're running around that track and seeing an oldercouple encouraging you and then you invested yourself in it and that's what has to happen.
(53:40):
So I'm thrilled.
think one of the nicest things we saw in your body composition is in that grading scorewhen you start out as a C,
it means that your body weight and body fat mass is too high and the muscle dips in.
So that's like a C.
But you went from a C to an I to a D.
So an I is, okay, you're on your way, everything's even, but you actually get the bestgrade here if you get a D.
(54:06):
And you ended up with a D, so we're very proud of you.
Not if I'm Asian parent.
scores.
I know.
Absolutely.
Okay.
So let's move on to the fact that you're now incredibly well and you have enough energy topop from state to state.
You're on all these podcasts to talk about the benefit of ketones and also to share yourown story.
(54:30):
You have to feel great about your progress.
And what if anything did you learn this past year?
What
would you want to share in a meaningful way?
You've shared so much, of course, already.
But what do your listeners hear from you about what they might do?
Where should they start?
What should they do?
two things I want to share.
One is knowledge is power, especially knowledge about your own body.
(54:53):
Knowing what is going on, especially when you hit a wall is so, powerful.
And having experts such as Dr.
Florence Comet here, advising you on what your bloods actually show.
That was a game changer for me.
The second advice I want to share is that while you are on this journey, it is called ajourney.
It is not a snapshot.
(55:14):
It's a journey about consistency and you just have to trust the process and keep going.
And throughout that journey, you will face dips, will face walls, plateaus.
It is important for us to be able to pick us back up and keep going.
Because only then I saw results.
I have had plateaus for three months straight without having any dip in my weight.
(55:37):
And I don't know what was going on.
And I'm like, Florence.
I'm taking every supplement you recommended.
I'm doing all these injections for my testosterone.
My weight is just not going down no matter how little I eat.
And then one day I wake up, just went bam, one pound a day for like a week.
So you never know how your body react to certain interventions because it is never linear.
(55:58):
It is a process where you will go past a threshold and your body will start reacting andbe responsive to it.
So trust that process.
Yeah, that's beautifully said because you're right, we're not machines.
We wax and wane, life has its own forces and intent for us.
But if we stick with it, the results are always there.
Well, thank you so much, Let.
(56:19):
It's been a pleasure speaking with you.
And I'd love to have you back to update our listeners because I think they want to seewhere you go with your health journey and achieving your health goals with all the
knowledge you have both in training and expertise from school and all your degrees, aswell as to chat about it.
mutual interest in this field of precision medicine and healthy longevity.
(56:40):
Yeah, I'm excited.
I'm honored to be here and I finally get to see your New York office.
I'm really, really honored.
And yeah, I would love to come back, especially, you know, if I look younger at the age of45.
I'm sure people think you look younger now.
You do, you look fantastic.
You're all cut in angles and that wasn't quite the case when you started.
(57:00):
It wasn't that you didn't look good, but now you look amazing.
Thank you so much.
And you were saying you haven't been thanked so much on a podcast like this.
amazing.
I'm gonna replay it for my family, for everybody here.
I want everyone to hear it.
No.
You should.
You should because, my parents always taught me to be grateful and have gratitude.
And it is one of the factors, one of the main aspects for people to be happy, Be grateful.
(57:23):
And you are definitely one of the greatest thing that happened to me last year,understanding my health and making changes towards a healthier, towards the end of my
life.
So I, it's only natural.
Well, thank you.
And I am actually also very grateful.
I try to wake up every day and think about something I'm grateful for and give gratitudeto my mentors who really allowed me to get to where I am, to my parents who supported me
(57:50):
through every thick and thin, and also to my patients.
Because the data that you benefited from came out of the last 20 years of actually settingit up in a protocol scientific driven way to be able to extrapolate what was unique for
each person.
and how to apply an N of 1 approach, which doesn't exist in medicine because most ofmedicine is testing in huge groups of people and then treating everyone like they're the
(58:14):
same, like average.
But in any case, to my audience, thank you for tuning in.
I welcome you to come back next time on Healthy Longevity with Florence Cometae.
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