BrainStorm
Aging Is Not the Enemy: How Precision Medicine Can Protect Your Brain
Aging Is Not the Enemy: How Precision Medicine Can Protect Your Brain
What if the way we think about aging and dementia is fundamentally wrong? Dr. Florence Comite, precision medicine pioneer and author of Invincible: Defy Your Genetic Destiny to Live Better Longer, joins host Meryl Comer to make the case that cognitive decline is not inevitable. From the difference between biological and chronological age, to the five key biomarkers everyone should know, Dr. Comite offers a science-backed roadmap for protecting your brain and body decades before crisis hits. They discuss the role of hormones in cognitive function, and why dementia risk must be addressed in midlife. Dr. Comite advocates for precision medicine, wearable technology, and personalized lifestyle interventions as tools to delay the point where aging becomes disease. If dementia or cognitive decline is a concern, this conversation is one you can't afford to miss.
Dr. Florence Comite (00:00):
When you hear a doctor say to you, oh, you're within the normal range, it's mostly meaningless because those normal ranges on lab tests are based on large population studies and it includes or people who are already sick. And so they skew the results to have us think, okay, it's fine to be in a normal range, but it really means that your body is declining.
Introduction (00:23):
Welcome to BrainStorm By UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder 24 year caregiver and Emmy award-winning journalist and the author of the New York Times bestseller, slow Dancing With a Stranger.
Meryl Comer (00:42):
This is BrainStorm and I'm Meryl Comer. Today we're joined by Dr. Florence Comite, endocrinologist and longevity expert whose work in precision medicine and healthy aging has pushed the conversation about dementia into far more urgent territory. In her new book, invincible Defy Your Genetic Destiny to live better longer. She challenges the idea that cognitive decline is something we simply accept as we grow older. Instead, she argues that how we age and how we protect our brains is shaped by biology that looks different in women than in men. Dr. Comite, thank you for joining us.
Dr. Florence Comite (01:28):
Thank you for having me. I'm looking forward to the conversation.
Meryl Comer (01:31):
You know, you describe aging as happening in different patterns rather than one uniform process. So what does your framework suggest about the difference between chronological age and biological age?
Dr. Florence Comite (01:45):
So let's start with chronological age. That's basically your birth date. And to the extent that every year we have a new candle on the cake, we get one year more mature. And it varies from person to person as far as what happens biologically, which means that the body has patterns of aging that can even vary within one human body. So for example, if you're doing things that are healthy for you and will offset rapid aging of organs, you might be aging 0.75, like three quarters as you know, fast as chronological aging. So for every year on Earth, your body may only be getting, may be getting may, maybe staying younger year to year. And so effectively when you're 50, maybe you're really 40 internally. And that applies to organs too. So different organs in the body can age differently. You can have a really healthy brain, but maybe your heart isn't as healthy. And I see those patterns express themselves in people very differently, largely driven in part I think by genetics and genetic variants.
Meryl Comer (02:56):
So which lifestyle or metabolic factors most often push people into an accelerated aging before they realize it.
Dr. Florence Comite (03:05):
So everyone is unique and you don't necessarily see these patterns in the mirror. You could look fantastic on the outside and actually even test well in terms of the fact that something called a VO two max, which is endurance on a treadmill and what your heart's doing, your pulmonary system at 50 or 60 can look like a 25 or 30 year young person. But in effect under the surface, at the cellular level, we're declining. And that decline can affect us in a variety of ways. Again, very unique to the individual, but begins to be seen at the cellular level in your thirties.
Meryl Comer (03:45):
I've been all over your book and the Comte Precision Health questionnaire in the appendix pointed to me gaping holes in our system. A fact that only one in five Americans see a doctor on a yearly wellness visit, familial health history that wasn't traditionally shared generationally. It was kept quiet unless something happened. And the other point scream that screams out to me is that normal range is not optimal. And we've been, we've turned it all over to our primary care physicians.
Dr. Florence Comite (04:22):
It is a challenge and not only that, many of us don't have a primary care physician, whether it is an insurance driver or the fact that most physicians now don't go into solo practice the way Dr. Welby did in the past on TV or, and I think that the fact that there are lifestyle options we choose that may undermine our health as well as the genetic propensity to get disease makes it very difficult to have an ongoing dialogue with someone who gets to know you might know your family might be able to focus on why things are going south even without diagnostic tests of the sort we have today. But certainly the tests we have today and the way we can look into the body almost with x-ray vision, looking at biomarkers, looking at MRIs, all the different ways we can test the body, the InBody, which can look at percent body fat muscle, very critical element for longevity and health are just not at our fingertips for most of us. Most of the information is coming through social media and is compromised because it's not really, medically, medicine isn't factored into it. It's medically challenged I think.
Meryl Comer (05:38):
I mean, how do you separate out promising longevity interventions from the hype and what are the basics when it comes to slowing or reversing accelerated aging?
Dr. Florence Comite (05:50):
That's a great question. It's hard for the person on the street to not look at the height 'cause it's all over, right? And I would say look for the credentials. Look at the science, look to see is this person an influencer? Even if it's a trained physician in influencer, are they actually working with patients? Do they know the outcomes of what they're doing? Has there been research that's applied? Real world research even so that you can tell the difference between what might be legitimate and what might be just a fad and a trend. And then don't believe that everything out there is applicable. So for example, even something like intermittent fasting where I think a lot of people enjoy it, think it really helps them with their body and their health. It is not a good thing for all of us. So it's very specific to how we can look at ourselves. And I think that's where the game changes are for this century in that with wearables such as the Apple Watch or the Whoop or the Ora ring and with the ability to even monitor ourselves in terms of our glucose, we can see those changes. We can see what's happening 24 7. Should we be so inclined that may be better insight than what we're getting on social media.
Meryl Comer (07:07):
For those that have dementia in their families, what matters most? The genetics, the biomarkers, the daily habits.
Dr. Florence Comite (07:16):
So we have many, many people who test positive for apo E four homozygote or heterozygote. Many of them have family members and I've taken care of some of them for a decade or two. They have family members. Every single family member as they age be get got Alzheimer's dementia. Now, there's a lot of other reasons for dementia and I'm sure you are well aware that metabolic abnormalities, diabetes that isn't controlled hypertension or high blood pressure, thyroid condition can all lead to difficulty maintaining function in terms of your brain memory and cognition. And so none of the patients I've cared for have even begun to see signs of any of these issues because of the way they can own their own decisions about the habits they have and understand what we can do, including the use of testosterone, which I feel is vital. Testosterone and estrogen are vital for brain function to the extent a person can tolerate it. You have to look at the indications. I would not give every woman estrogen because some women may not tolerate it because of other reasons or if they're concerned because there's breast cancer in the family. But testosterone, I've used it very successfully in some men and women where memory was a huge issue and they had a high risk of Alzheimer's. And I was shocked to find out the change in memory was dramatic, particularly with testosterone. But there are studies that are showing that this is what's going on at the level of the brain.
Meryl Comer (08:57):
You know, it's very disturbing that doctors say, oh you're, you're in the normal range. Come back and see me next year. Yeah, when they're waiting for symptoms instead of treating aging itself as a risk factor.
Dr. Florence Comite (09:10):
You're exactly right. I don't think, I think of aging as a gift to be fair. If we're lucky enough to live a long life to a hundred, 120, how wonderful. Or even 90, right? When I hear people pass away in their eighties, I in seventies and I hear a patient say, oh, they were old already. They were 75. I'm like, 75 is not old. In this day and age, if you can own some of the factors that keep you in great shape, living till a hundred is a real, real absolute. We can do it, we can all, but there's so many people living to a hundred, they don't celebrate it on TV anymore. But it's knowing what are the factors that affect you specifically and what runs in the family. And then working with a medical system that is sick centric, reactive and waits for symptoms.
Dr. Florence Comite (10:00):
So you're a thousand percent right about that. Bringing the attention to yourself and sharing what runs in your family with your doctor and asking your doctor, what can I do today? Whether you are 20, 30, 40, 50 to stop the advances of diseases of aging, which are what we're facing, not aging itself. I'm really one of those who think I'm grateful to be living a long life and I want to live as with as much vitality as possible. Tell your doctor if a family member has dementia, tell your doctor if there's thyroid or osteoporosis. If you're lucky enough to have a doctor that you see on a regular basis, at least yearly. Update them on what's gone on for the elder elders in the family or even people who are younger who may have faced a new disease that they're unaware of. And that's what runs in our genes. So being able to be aware of family history and putting that to work is also a very important component of what I espouse.
Meryl Comer (11:04):
Let me ask you, how often is brain fog, which is not uncommon in women in menopause or perimenopause, an early signal of a deeper aging process that deserves medical attention?
Dr. Florence Comite (11:19):
So I think all of brain fog should be looked at, and I have that in quotes 'cause it's not a clear cut medical diagnosis, but it's a very commonly requested, I need help my brain. I'm fuzzy. I can't keep, I don't remember things. I go into one room. I'm not sure why I am there. Some of that is expected if you're under stress, if you're worried if there's a lot going on. It can even happen at 20 or 30 or 40. I think if the factors are disturbing enough to interrupt what you're doing, even if they're minimal, meaning you weren't like this and why is this happening now, then it deserves to be looking looked at in a deeper way and to do the kinds of tests and measurements. We're getting a better handle on factors like for example, tau two 17 and amyloid ratios to be able to say, you know, there is a decline here.
Dr. Florence Comite (12:12):
There is a number here that isn't as promising. Let's look deeper. Some people will want that, but Merrill, but other people might be scared. So it's weighing those factors. I know I've had patients who weren't happy to hear that they had APO E four. They were quite disturbed and they honestly looked back and said, well why did you do that? Why didn't I know? And even though we prep people to say, listen, this is the kind of information you're going to hear it takes is an adjustment to understanding their limitations. But I think the brain is exposed to a different combination of hormones and metabolites in men and women. 'cause We are not the same. And we could talk about the changes with aging. It's in the book in chapter four and five, menopause in women. If you, you know, you have a partner you care about, that's a male andropause in men. But I think because we're we are seeing different combinations of estrogen, progesterone, and testosterone as well as other hormones, we age differently. Our brain ages differently. And so that's an important component of I think why women tend to have more dementia than men. We don't have to get the disorders that our parents and grandparents have experienced by owning more insight and following and monitoring the kinds of things that change the direction of our health. Personally,
Meryl Comer (13:34):
I loved your positioning that the real goal, it's not the goal to just delay aging, it's to delay the point when aging becomes disease.
Dr. Florence Comite (13:43):
Unlike most physicians, I was lucky enough to be trained across a variety of specialties all in endocrinology, hormones, metabolism. It led me to other areas. But because I also did research and was trained in human research or clinical investigation at the National Institute of Health, I had the benefit of looking at every decade of life and recognizing that we were beginning to go downhill even if we didn't realize it in our thirties. And that's exactly what happened. And so I recognized that if we could look beneath the surface, if we could find out how a person lived life, what I think of as their health story, we could take those factors, marry it and connect the dots to the biomarkers and the findings diagnostically, and then be able to redirect your future health trajectory that is stop the decline, which I think of as disorders of aging, diabetes, heart disease, dementia. All of that is related to the fact that as we're getting older, our body doesn't perform in the same way. And my question was how do we stop ourselves biologically from getting older? How do we keep our the same health that we were able to enjoy most of us in our twenties?
Meryl Comer (14:59):
So walk us through the seven types of aging. You didn't have one broad category. There are seven types. So are the, are these patterns more common than people realize? And what challenges most conventional medicine,
Dr. Florence Comite (15:15):
Because medicine is so complex, we wanted to figure out a way to share the areas that are of most concern to most of us. And by dividing it up into patterns, and it's more than one pattern per person because each of us men and women are going to undergo hormonal and metabolic aging. But men and women do age differently. For men, it's more linear for us women as the ovaries begin to decline and are unable to produce eggs, we hit menopause a year after our last menstrual cycle. So these patterns of aging are far more common than people realize. And it's a challenge to conventional medicine because they don't look at, at aging proactively. They wait for symptoms. They wait for the emergency room to make the department to make a diagnosis of diabetes. In fact, in 80% of the people who have that diagnosis is generally made in an emergency room.
Dr. Florence Comite (16:12):
Whereas in precision medicine, we're looking for the data ahead of time. So the seven areas of patterns that we all need to look at and to see what runs in our family, what may be affecting us already, depending on where we pick up this book <laugh> and how we interpret it. Right. The first and probably the most ubiquitous is a carbohydrate metabolism disorder. That means that we have a problem internally. The problem is dictated by genes and the life we live of, the combination of what glucose does to almost every cell in the body. So diabetes, which we're all familiar with. And we think of that in terms of a sugar disorder actually affects every other cell in the body. It leads to heart disease, stroke, can eye disease or kidney disease. So that's one big topic. Heart disease is the second one because it probably kills more people than every other disorder, like including all the cancers combined.
Dr. Florence Comite (17:12):
The other bookend would be sarcopenia or loss of muscle. And that is tied also to sugar because it's muscle lost as lost as we enter our thirties and forties. That means we don't have a way to shelter sugar and we become weaker. And, and we, it leads to also the fact that many of us, at least 25% of us as we age, will have bone loss or osteopenia and osteoporosis. So that's a pattern that we talk about. And finally, maybe most important from your lens is the dementia, brain fog and metabolic disorders of aging that can affect the brain, including of course, Alzheimer's.
Meryl Comer (17:53):
So you've mentioned the types that are most underdiagnosed. What harm does that do to the patient and how, how do you break it out in terms of age? How do you recover?
Dr. Florence Comite (18:06):
Most of the time the only test that's done is a baseline sugar test. We're not looking for insulin resistance pre-diabetes. We're not looking for the signs and symptoms that we can see decades before. And mostly the, the other side of that issue is the fact that when you hear a doctor say to you, oh, you're within the normal range, it's mostly meaningless because those normal ranges on lab tests are based on large population studies. And it includes, or people who are already sick and who are leaning down in just into declining health. And so they skew the results to have us think, okay, it's fine to be in the normal range, but it really means that your body is declining. It's not optimal. And that's what we need to think about. How do we make things optimal?
Meryl Comer (18:56):
That was so upsetting to me. <Laugh>, the doctor says you're in the normal range and you feel great. And that's not the case, right? It
Dr. Florence Comite (19:05):
Isn't. I'll give you a very specific example 'cause so many people know about GLP ones Ozempic and to raise a peptide. And the reason, if you see these, the dancing commercials, they'll say get your hemoglobin A1C down to seven. Now hemoglobin A1C is an average of a hundred days of your sugar averages mean very little. I for example, had a beautiful average. It was less than five, that's what you want. 5.7 to 6.4 is pre-diabetes and 6.5 and up is diabetes. So getting your numbers down, your hemoglobin A1C to below seven means you could still be a diabetic or a pre-diabetic. It's putting you in the optimal range. That's key. And that means a sugar that measures 70 to 80 when you're fasting insulin that is undetectable when we're fasting. And a hemoglobin A1C that's less than five. And the combination of interpreting how all those three count is really very valuable. And that's not something that's routinely done.
Meryl Comer (20:09):
You know, unfortunately, I think most people end up assuming that aging is only about appearance or energy. So they miss the bigger points that you're making.
Dr. Florence Comite (20:20):
I agree with you and, and energy is a huge factor in aging. In fact, one would believe that with all the prescriptions for testosterone, which is critical to maintain muscle by the way, in women, just like in men, we have more testosterone circulating than estrogen in general. And we continue to make testosterone, but we start slowing down in our thirties just like men. And that's critical for muscle, right? We are in trouble when we can't sustain our body's strength. And in fact, we get into more trouble. It's not just fat, it's, we need more muscle, but we can't, we don't want to lose all the fat on our body too, because that's protective. Those signs of aging at the cellular level is really very critical.
Meryl Comer (21:03):
So we don't want people looking at all these types and becoming overwhelmed because they see themselves pigeonholed in one or two. Which of the seven types are most likely to be reversible with early intervention?
Dr. Florence Comite (21:18):
Well, here's my bias. Every single one of them, okay, I have diagnosed diabetes or pre-diabetes or somebody heading to diabetes in just about everybody. I see even young folks who are like 25 or 30 because we're genetically, we genetically have a predilection to put fat in our body and to hold onto sugar. So the simple ways that people can start by understanding underneath and taking baby steps, which I strongly advocate, is to focus on baby steps. One thing they can do at a time and if they're open to it, wearables can really give us insight into how our body is performing, independent of going to a physician wearing a continuous glucose monitor and looking at what sugar does. In fact, I specifically I'm thinking of one patient who I just said hello to earlier today, who is in amazing shape, absolutely amazing. He performs at the level of a 30-year-old when tested in terms of exercise.
Dr. Florence Comite (22:16):
His percent body fat is less than 10, but his sugar is all over the place and he doesn't get great sleep. He gets almost no deep sleep. And he's in the earliest stages of Alzheimer's that we are reversing. We've been taking care of him about a year or two now, and we're doing everything we can. And it's only by monitoring his own sugar 24 7 using continuous glucose monitor that we were able to show him what sleep was doing to him and what his own genetic makeup was. Now Alzheimer's runs in his family. There was no question about it. But our goal is to not let him slide further to reverse what he's actually seeing in the way he's living.
Meryl Comer (22:54):
So let me ask you, why do you think that brain aging is still so often treated separately from the rest of the body's aging process?
Dr. Florence Comite (23:03):
I think that question applies to everything in medicine and the simplest answer in conventional medicine, we're all slotted into silos. So a cardiologist is going to look at the heart. You tend to get more obvious symptoms from heart disease and from brain disease, I think, and they're not trained to look at that. Neurologists look at the brain, but you're referred to a neurologist when you have symptoms already. We're starting way too late to look at the body as a whole, as a system, as opposed to breaking it down into parts and then going to different specialists that can examine those parts. So we need to start much earlier in life proactively to look and determine what is your makeup, how you're living life to be able to turn that around. So I advocate starting slow, starting with the five biomarkers I mentioned in the book, which is fasting sugar, hemoglobin A1C, and fasting insulin, along with a cholesterol measurement of cholesterol risk ratio, which is the total cholesterol divided by the good cholesterol or HDL and a free testosterone. And those five biomarkers should be in everyone's hands to see what path they're on, what their future health trajectory looks like, so they're not overwhelmed.
Meryl Comer (24:24):
Our guest has been Dr. Florence, her new book, invincible Defy Your Genetic Destiny to live better Longer. Research reminds us that when it comes to dementia, the best time to act is long before first symptoms. And that timeline belongs squarely in midlife because at us against Alzheimer's, our call to action is know your risk, track your brain health, and take action early. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us.
Closing (25:00):
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About This Episode
What if the way we think about aging and dementia is fundamentally wrong? Dr. Florence Comite, precision medicine pioneer and author of Invincible: Defy Your Genetic Destiny to Live Better Longer, joins host Meryl Comer to make the case that cognitive decline is not inevitable. From the difference between biological and chronological age, to the five key biomarkers everyone should know, Dr. Comite offers a science-backed roadmap for protecting your brain and body decades before crisis hits. They discuss the role of hormones in cognitive function, and why dementia risk must be addressed in midlife. Dr. Comite advocates for precision medicine, wearable technology, and personalized lifestyle interventions as tools to delay the point where aging becomes disease. If dementia or cognitive decline is a concern, this conversation is one you can't afford to miss.
Transcript
Dr. Florence Comite (00:00):
When you hear a doctor say to you, oh, you're within the normal range, it's mostly meaningless because those normal ranges on lab tests are based on large population studies and it includes or people who are already sick. And so they skew the results to have us think, okay, it's fine to be in a normal range, but it really means that your body is declining.
Introduction (00:23):
Welcome to BrainStorm By UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder 24 year caregiver and Emmy award-winning journalist and the author of the New York Times bestseller, slow Dancing With a Stranger.
Meryl Comer (00:42):
This is BrainStorm and I'm Meryl Comer. Today we're joined by Dr. Florence Comite, endocrinologist and longevity expert whose work in precision medicine and healthy aging has pushed the conversation about dementia into far more urgent territory. In her new book, invincible Defy Your Genetic Destiny to live better longer. She challenges the idea that cognitive decline is something we simply accept as we grow older. Instead, she argues that how we age and how we protect our brains is shaped by biology that looks different in women than in men. Dr. Comite, thank you for joining us.
Dr. Florence Comite (01:28):
Thank you for having me. I'm looking forward to the conversation.
Meryl Comer (01:31):
You know, you describe aging as happening in different patterns rather than one uniform process. So what does your framework suggest about the difference between chronological age and biological age?
Dr. Florence Comite (01:45):
So let's start with chronological age. That's basically your birth date. And to the extent that every year we have a new candle on the cake, we get one year more mature. And it varies from person to person as far as what happens biologically, which means that the body has patterns of aging that can even vary within one human body. So for example, if you're doing things that are healthy for you and will offset rapid aging of organs, you might be aging 0.75, like three quarters as you know, fast as chronological aging. So for every year on Earth, your body may only be getting, may be getting may, maybe staying younger year to year. And so effectively when you're 50, maybe you're really 40 internally. And that applies to organs too. So different organs in the body can age differently. You can have a really healthy brain, but maybe your heart isn't as healthy. And I see those patterns express themselves in people very differently, largely driven in part I think by genetics and genetic variants.
Meryl Comer (02:56):
So which lifestyle or metabolic factors most often push people into an accelerated aging before they realize it.
Dr. Florence Comite (03:05):
So everyone is unique and you don't necessarily see these patterns in the mirror. You could look fantastic on the outside and actually even test well in terms of the fact that something called a VO two max, which is endurance on a treadmill and what your heart's doing, your pulmonary system at 50 or 60 can look like a 25 or 30 year young person. But in effect under the surface, at the cellular level, we're declining. And that decline can affect us in a variety of ways. Again, very unique to the individual, but begins to be seen at the cellular level in your thirties.
Meryl Comer (03:45):
I've been all over your book and the Comte Precision Health questionnaire in the appendix pointed to me gaping holes in our system. A fact that only one in five Americans see a doctor on a yearly wellness visit, familial health history that wasn't traditionally shared generationally. It was kept quiet unless something happened. And the other point scream that screams out to me is that normal range is not optimal. And we've been, we've turned it all over to our primary care physicians.
Dr. Florence Comite (04:22):
It is a challenge and not only that, many of us don't have a primary care physician, whether it is an insurance driver or the fact that most physicians now don't go into solo practice the way Dr. Welby did in the past on TV or, and I think that the fact that there are lifestyle options we choose that may undermine our health as well as the genetic propensity to get disease makes it very difficult to have an ongoing dialogue with someone who gets to know you might know your family might be able to focus on why things are going south even without diagnostic tests of the sort we have today. But certainly the tests we have today and the way we can look into the body almost with x-ray vision, looking at biomarkers, looking at MRIs, all the different ways we can test the body, the InBody, which can look at percent body fat muscle, very critical element for longevity and health are just not at our fingertips for most of us. Most of the information is coming through social media and is compromised because it's not really, medically, medicine isn't factored into it. It's medically challenged I think.
Meryl Comer (05:38):
I mean, how do you separate out promising longevity interventions from the hype and what are the basics when it comes to slowing or reversing accelerated aging?
Dr. Florence Comite (05:50):
That's a great question. It's hard for the person on the street to not look at the height 'cause it's all over, right? And I would say look for the credentials. Look at the science, look to see is this person an influencer? Even if it's a trained physician in influencer, are they actually working with patients? Do they know the outcomes of what they're doing? Has there been research that's applied? Real world research even so that you can tell the difference between what might be legitimate and what might be just a fad and a trend. And then don't believe that everything out there is applicable. So for example, even something like intermittent fasting where I think a lot of people enjoy it, think it really helps them with their body and their health. It is not a good thing for all of us. So it's very specific to how we can look at ourselves. And I think that's where the game changes are for this century in that with wearables such as the Apple Watch or the Whoop or the Ora ring and with the ability to even monitor ourselves in terms of our glucose, we can see those changes. We can see what's happening 24 7. Should we be so inclined that may be better insight than what we're getting on social media.
Meryl Comer (07:07):
For those that have dementia in their families, what matters most? The genetics, the biomarkers, the daily habits.
Dr. Florence Comite (07:16):
So we have many, many people who test positive for apo E four homozygote or heterozygote. Many of them have family members and I've taken care of some of them for a decade or two. They have family members. Every single family member as they age be get got Alzheimer's dementia. Now, there's a lot of other reasons for dementia and I'm sure you are well aware that metabolic abnormalities, diabetes that isn't controlled hypertension or high blood pressure, thyroid condition can all lead to difficulty maintaining function in terms of your brain memory and cognition. And so none of the patients I've cared for have even begun to see signs of any of these issues because of the way they can own their own decisions about the habits they have and understand what we can do, including the use of testosterone, which I feel is vital. Testosterone and estrogen are vital for brain function to the extent a person can tolerate it. You have to look at the indications. I would not give every woman estrogen because some women may not tolerate it because of other reasons or if they're concerned because there's breast cancer in the family. But testosterone, I've used it very successfully in some men and women where memory was a huge issue and they had a high risk of Alzheimer's. And I was shocked to find out the change in memory was dramatic, particularly with testosterone. But there are studies that are showing that this is what's going on at the level of the brain.
Meryl Comer (08:57):
You know, it's very disturbing that doctors say, oh you're, you're in the normal range. Come back and see me next year. Yeah, when they're waiting for symptoms instead of treating aging itself as a risk factor.
Dr. Florence Comite (09:10):
You're exactly right. I don't think, I think of aging as a gift to be fair. If we're lucky enough to live a long life to a hundred, 120, how wonderful. Or even 90, right? When I hear people pass away in their eighties, I in seventies and I hear a patient say, oh, they were old already. They were 75. I'm like, 75 is not old. In this day and age, if you can own some of the factors that keep you in great shape, living till a hundred is a real, real absolute. We can do it, we can all, but there's so many people living to a hundred, they don't celebrate it on TV anymore. But it's knowing what are the factors that affect you specifically and what runs in the family. And then working with a medical system that is sick centric, reactive and waits for symptoms.
Dr. Florence Comite (10:00):
So you're a thousand percent right about that. Bringing the attention to yourself and sharing what runs in your family with your doctor and asking your doctor, what can I do today? Whether you are 20, 30, 40, 50 to stop the advances of diseases of aging, which are what we're facing, not aging itself. I'm really one of those who think I'm grateful to be living a long life and I want to live as with as much vitality as possible. Tell your doctor if a family member has dementia, tell your doctor if there's thyroid or osteoporosis. If you're lucky enough to have a doctor that you see on a regular basis, at least yearly. Update them on what's gone on for the elder elders in the family or even people who are younger who may have faced a new disease that they're unaware of. And that's what runs in our genes. So being able to be aware of family history and putting that to work is also a very important component of what I espouse.
Meryl Comer (11:04):
Let me ask you, how often is brain fog, which is not uncommon in women in menopause or perimenopause, an early signal of a deeper aging process that deserves medical attention?
Dr. Florence Comite (11:19):
So I think all of brain fog should be looked at, and I have that in quotes 'cause it's not a clear cut medical diagnosis, but it's a very commonly requested, I need help my brain. I'm fuzzy. I can't keep, I don't remember things. I go into one room. I'm not sure why I am there. Some of that is expected if you're under stress, if you're worried if there's a lot going on. It can even happen at 20 or 30 or 40. I think if the factors are disturbing enough to interrupt what you're doing, even if they're minimal, meaning you weren't like this and why is this happening now, then it deserves to be looking looked at in a deeper way and to do the kinds of tests and measurements. We're getting a better handle on factors like for example, tau two 17 and amyloid ratios to be able to say, you know, there is a decline here.
Dr. Florence Comite (12:12):
There is a number here that isn't as promising. Let's look deeper. Some people will want that, but Merrill, but other people might be scared. So it's weighing those factors. I know I've had patients who weren't happy to hear that they had APO E four. They were quite disturbed and they honestly looked back and said, well why did you do that? Why didn't I know? And even though we prep people to say, listen, this is the kind of information you're going to hear it takes is an adjustment to understanding their limitations. But I think the brain is exposed to a different combination of hormones and metabolites in men and women. 'cause We are not the same. And we could talk about the changes with aging. It's in the book in chapter four and five, menopause in women. If you, you know, you have a partner you care about, that's a male andropause in men. But I think because we're we are seeing different combinations of estrogen, progesterone, and testosterone as well as other hormones, we age differently. Our brain ages differently. And so that's an important component of I think why women tend to have more dementia than men. We don't have to get the disorders that our parents and grandparents have experienced by owning more insight and following and monitoring the kinds of things that change the direction of our health. Personally,
Meryl Comer (13:34):
I loved your positioning that the real goal, it's not the goal to just delay aging, it's to delay the point when aging becomes disease.
Dr. Florence Comite (13:43):
Unlike most physicians, I was lucky enough to be trained across a variety of specialties all in endocrinology, hormones, metabolism. It led me to other areas. But because I also did research and was trained in human research or clinical investigation at the National Institute of Health, I had the benefit of looking at every decade of life and recognizing that we were beginning to go downhill even if we didn't realize it in our thirties. And that's exactly what happened. And so I recognized that if we could look beneath the surface, if we could find out how a person lived life, what I think of as their health story, we could take those factors, marry it and connect the dots to the biomarkers and the findings diagnostically, and then be able to redirect your future health trajectory that is stop the decline, which I think of as disorders of aging, diabetes, heart disease, dementia. All of that is related to the fact that as we're getting older, our body doesn't perform in the same way. And my question was how do we stop ourselves biologically from getting older? How do we keep our the same health that we were able to enjoy most of us in our twenties?
Meryl Comer (14:59):
So walk us through the seven types of aging. You didn't have one broad category. There are seven types. So are the, are these patterns more common than people realize? And what challenges most conventional medicine,
Dr. Florence Comite (15:15):
Because medicine is so complex, we wanted to figure out a way to share the areas that are of most concern to most of us. And by dividing it up into patterns, and it's more than one pattern per person because each of us men and women are going to undergo hormonal and metabolic aging. But men and women do age differently. For men, it's more linear for us women as the ovaries begin to decline and are unable to produce eggs, we hit menopause a year after our last menstrual cycle. So these patterns of aging are far more common than people realize. And it's a challenge to conventional medicine because they don't look at, at aging proactively. They wait for symptoms. They wait for the emergency room to make the department to make a diagnosis of diabetes. In fact, in 80% of the people who have that diagnosis is generally made in an emergency room.
Dr. Florence Comite (16:12):
Whereas in precision medicine, we're looking for the data ahead of time. So the seven areas of patterns that we all need to look at and to see what runs in our family, what may be affecting us already, depending on where we pick up this book <laugh> and how we interpret it. Right. The first and probably the most ubiquitous is a carbohydrate metabolism disorder. That means that we have a problem internally. The problem is dictated by genes and the life we live of, the combination of what glucose does to almost every cell in the body. So diabetes, which we're all familiar with. And we think of that in terms of a sugar disorder actually affects every other cell in the body. It leads to heart disease, stroke, can eye disease or kidney disease. So that's one big topic. Heart disease is the second one because it probably kills more people than every other disorder, like including all the cancers combined.
Dr. Florence Comite (17:12):
The other bookend would be sarcopenia or loss of muscle. And that is tied also to sugar because it's muscle lost as lost as we enter our thirties and forties. That means we don't have a way to shelter sugar and we become weaker. And, and we, it leads to also the fact that many of us, at least 25% of us as we age, will have bone loss or osteopenia and osteoporosis. So that's a pattern that we talk about. And finally, maybe most important from your lens is the dementia, brain fog and metabolic disorders of aging that can affect the brain, including of course, Alzheimer's.
Meryl Comer (17:53):
So you've mentioned the types that are most underdiagnosed. What harm does that do to the patient and how, how do you break it out in terms of age? How do you recover?
Dr. Florence Comite (18:06):
Most of the time the only test that's done is a baseline sugar test. We're not looking for insulin resistance pre-diabetes. We're not looking for the signs and symptoms that we can see decades before. And mostly the, the other side of that issue is the fact that when you hear a doctor say to you, oh, you're within the normal range, it's mostly meaningless because those normal ranges on lab tests are based on large population studies. And it includes, or people who are already sick and who are leaning down in just into declining health. And so they skew the results to have us think, okay, it's fine to be in the normal range, but it really means that your body is declining. It's not optimal. And that's what we need to think about. How do we make things optimal?
Meryl Comer (18:56):
That was so upsetting to me. <Laugh>, the doctor says you're in the normal range and you feel great. And that's not the case, right? It
Dr. Florence Comite (19:05):
Isn't. I'll give you a very specific example 'cause so many people know about GLP ones Ozempic and to raise a peptide. And the reason, if you see these, the dancing commercials, they'll say get your hemoglobin A1C down to seven. Now hemoglobin A1C is an average of a hundred days of your sugar averages mean very little. I for example, had a beautiful average. It was less than five, that's what you want. 5.7 to 6.4 is pre-diabetes and 6.5 and up is diabetes. So getting your numbers down, your hemoglobin A1C to below seven means you could still be a diabetic or a pre-diabetic. It's putting you in the optimal range. That's key. And that means a sugar that measures 70 to 80 when you're fasting insulin that is undetectable when we're fasting. And a hemoglobin A1C that's less than five. And the combination of interpreting how all those three count is really very valuable. And that's not something that's routinely done.
Meryl Comer (20:09):
You know, unfortunately, I think most people end up assuming that aging is only about appearance or energy. So they miss the bigger points that you're making.
Dr. Florence Comite (20:20):
I agree with you and, and energy is a huge factor in aging. In fact, one would believe that with all the prescriptions for testosterone, which is critical to maintain muscle by the way, in women, just like in men, we have more testosterone circulating than estrogen in general. And we continue to make testosterone, but we start slowing down in our thirties just like men. And that's critical for muscle, right? We are in trouble when we can't sustain our body's strength. And in fact, we get into more trouble. It's not just fat, it's, we need more muscle, but we can't, we don't want to lose all the fat on our body too, because that's protective. Those signs of aging at the cellular level is really very critical.
Meryl Comer (21:03):
So we don't want people looking at all these types and becoming overwhelmed because they see themselves pigeonholed in one or two. Which of the seven types are most likely to be reversible with early intervention?
Dr. Florence Comite (21:18):
Well, here's my bias. Every single one of them, okay, I have diagnosed diabetes or pre-diabetes or somebody heading to diabetes in just about everybody. I see even young folks who are like 25 or 30 because we're genetically, we genetically have a predilection to put fat in our body and to hold onto sugar. So the simple ways that people can start by understanding underneath and taking baby steps, which I strongly advocate, is to focus on baby steps. One thing they can do at a time and if they're open to it, wearables can really give us insight into how our body is performing, independent of going to a physician wearing a continuous glucose monitor and looking at what sugar does. In fact, I specifically I'm thinking of one patient who I just said hello to earlier today, who is in amazing shape, absolutely amazing. He performs at the level of a 30-year-old when tested in terms of exercise.
Dr. Florence Comite (22:16):
His percent body fat is less than 10, but his sugar is all over the place and he doesn't get great sleep. He gets almost no deep sleep. And he's in the earliest stages of Alzheimer's that we are reversing. We've been taking care of him about a year or two now, and we're doing everything we can. And it's only by monitoring his own sugar 24 7 using continuous glucose monitor that we were able to show him what sleep was doing to him and what his own genetic makeup was. Now Alzheimer's runs in his family. There was no question about it. But our goal is to not let him slide further to reverse what he's actually seeing in the way he's living.
Meryl Comer (22:54):
So let me ask you, why do you think that brain aging is still so often treated separately from the rest of the body's aging process?
Dr. Florence Comite (23:03):
I think that question applies to everything in medicine and the simplest answer in conventional medicine, we're all slotted into silos. So a cardiologist is going to look at the heart. You tend to get more obvious symptoms from heart disease and from brain disease, I think, and they're not trained to look at that. Neurologists look at the brain, but you're referred to a neurologist when you have symptoms already. We're starting way too late to look at the body as a whole, as a system, as opposed to breaking it down into parts and then going to different specialists that can examine those parts. So we need to start much earlier in life proactively to look and determine what is your makeup, how you're living life to be able to turn that around. So I advocate starting slow, starting with the five biomarkers I mentioned in the book, which is fasting sugar, hemoglobin A1C, and fasting insulin, along with a cholesterol measurement of cholesterol risk ratio, which is the total cholesterol divided by the good cholesterol or HDL and a free testosterone. And those five biomarkers should be in everyone's hands to see what path they're on, what their future health trajectory looks like, so they're not overwhelmed.
Meryl Comer (24:24):
Our guest has been Dr. Florence, her new book, invincible Defy Your Genetic Destiny to live better Longer. Research reminds us that when it comes to dementia, the best time to act is long before first symptoms. And that timeline belongs squarely in midlife because at us against Alzheimer's, our call to action is know your risk, track your brain health, and take action early. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us.
Closing (25:00):
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