189. Dr. Florence Comite: The 5 Biomarkers That Predict How You'll Age

What if aging isn't something you simply accept - but something you can measure, predict, and even reverse? Most of us are told our lab work is "normal," yet chronic disease often develops silently for years before symptoms appear. Dr. Florence Comite, one of the world's leading pioneers in precision medicine, is explaining why conventional medicine often misses the earliest signs of diesease- and how personalized data can completely change your health trajectory. Drawing from more than three decades of experience at Yale, the National Institutes of Health, and her own precision medicine practice, Dr. Comite shares how treating every patient as an "N-of-1" allows her to identify hidden risks years before they become heart disease, diabetes, osteoporosis, dementia, or hormonal decline. Together, they explore the biomarkers that matter most, the surprising role of insulin resistance in nearly every chronic illness, and why your genes are far less predictive than the choices you make every day. If you've ever wondered whether it's possible to stay stronger, sharper, and healthier as you age, this conversation offers a practical roadmap backed by decades of research and real-world clinical results. In this episode, you'll learn: Why precision medicine is replacing the outdated one-size-fits-all approach The seven biological patterns of aging-and how to identify your own The biomarkers that reveal disease years before symptoms appear Why fasting insulin may be one of the most important tests your doctor isn't ordering How continuous glucose monitors uncover hidden metabolic dysfunction The truth about testosterone and estrogen optimization for both men and women How to reverse muscle loss and protect your bone density as you age Why standard thyroid testing often misses underlying dysfunction The daily habits that create exponential improvements in long-term health How to build a personalized longevity strategy based on your own biology-not population averages Your biology is unique - your approach to aging should be too. Learn More About Dr. Shah: Website: drshah.com https://www.drshah.com Clinic: next-health.com https://www.next-health.com Instagram: @extend_podcast and @darshanshahmd Learn more about Dr. Florence Comite: Website: florencecomite.com https://florencecomite.com Instagram: @drflorencecomite Book: theinvinciblebook.com https://www.theinvinciblebook.com/ Thank You To Our Sponsors: Next Health Longevity Summit: Head to next-health.com/summit https://www.next-health.com/summit to secure your spot at the first ever Next Health Longevity Summit in Nashville on 9/12. Our speakers include Dr. Shah, Dr. Jeremy London, Dr. Louisa Nicola, Dr. Vonda Wright and many more! This will be one day packed with activities like blood tests, recovery modalities, IV's and brands we love that will completely change the way you think about health. Momentous: Head to livemomentous.com https://livemomentous.com and use code DRSHAH for up to 35% off your first order! IM8: Try IM8 today with a 30-day money back guarantee. Get 10% off your first order with code DRSHAH at im8health.com/drshah https://im8health.com/pages/drshah

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Darshan Shah?

  Before we get started with this episode, I'd like to invite all of you to the first ever Next Health Longevity Summit, happening in Nashville, Tennessee, at the Conrad Hotel on Saturday, September 12, 2026. This is an all-day summit where you're going to be hearing from some of the best speakers in longevity medicine, including Dr. Vonda Wright, Dr. Luisa Nicola, many of the podcast guests that you've heard here on the Extend Podcast, and of course, I'm going to be there, curating the entire day. We also have incredible vendors coming, so you can try the latest technologies in health, wellness, and longevity. Go to next-health.com/summit and buy your ticket today. We only have 400 spots and they're

• 0:40Dr. Darshan Shah?

  going quickly. That's next-health.com/summit. I look forward to seeing you all there.

• 0:48Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 1:34Dr. Darshan Shah?

  Welcome to Extend, the podcast dedicated to helping you live a longer and healthier life. Today, we have an absolute pioneer in longevity medicine joining us, Dr. Florence Comiteé. Dr. Comiteé is a true OG in the field. She's been practicing precision medicine in reversing the disorders of aging for over 30 years, long before longevity became a mainstream topic. A clinical investigator trained at Yale and at NIH, she founded the Comiteé Center for Precision Medicine and Health in Manhattan and Miami Beach. She's also the author of a groundbreaking book, Invincible: The 10 Best Habits to Own Your Genetic Destiny, Live Better, and Longer. Dr. Comiteé challenges the one-size-fits-all

• 2:16Dr. Darshan Shah?

  approach to medicine, emphasizing individual data and biomarkers. She will share her unique perspective on our genetics, environment, and personalized protocols, including her insights into the seven patterns of aging and critical biomarkers like free testosterone and fasting insulin can empower us to own our health destiny and thrive well into being over 100 years old. Get ready to rethink everything you thought you knew about aging.

• 2:50Dr. Darshan Shah?

  Florence, I'm so glad we finally got to do this together.

• 2:52Speaker 01

  You do.

• 2:53Dr. Darshan Shah?

  You are a busy woman. You are everywhere.

• 2:55Speaker 01

  I can say the same. You are everywhere.

• 2:58Dr. Darshan Shah?

  We both. I got to know you from the longevity doctors group, where we have a large collective, a thousand longevity doctors that collaborate all the time on various topics in longevity, and you're one of the most prolific voices there. You've been doing longevity medicine way before anyone else has been doing it. 30, 30 years, almost?

• 3:17Speaker 01

  I've been coined the OG or original gangster.

• 3:20Dr. Darshan Shah?

  Yeah, you are the original gangster.

• 3:21Speaker 01

  Yeah, I was lonely for about 20 years. Nobody even knew what it was.

• 3:25Dr. Darshan Shah?

  And you have a practice in Manhattan?

• 3:27Speaker 01

  I do. Manhattan, Palo Alto, and Miami Beach.

• 3:29Dr. Darshan Shah?

  Wow, so you do have a lot of practice.

• 3:31Speaker 01

  Yeah, but it's grounded in medical science and precision medicine to really predict and detect people's future health trajectory and reverse it, so they don't get diabetes or dementia or anything in between, because I consider those all disorders of aging. So if you can stop aging, it's where I began about 30 years ago, noticing that you're the healthiest between 25 and 30, and then you go downhill and you're 30. So I gave a journal club at Yale. In addition to that, I'm an N of, I think of N of one individuals, and coined that because I'm an identical twin, and I knew that even my twin and I are different. So if we're different, everybody has to be different, and mainly, we practice reactive, one-size-fits-all medicine.

• 4:12Dr. Darshan Shah?

  Yeah, we do. Yeah, it's, it's really amazing to me how this whole medical industry develops, saying like, if you have this marker, then you need this. And it's the same for everybody. And you know through your 30 years of experience that that's not true. Every patient is completely individual.

• 4:30Speaker 01

  Yeah, they can express things differently. And I think my background as a clinical investigator, because I trained both at Yale and NIH, allowed me to create a going-forward prospective analysis. So I collected data, so we have proof of concept and scientific basis for why we identify what's going on in you versus me, and what to do to reverse it. And it's sometimes the exact opposite for different people.

• 4:53Dr. Darshan Shah?

  Right, right. That's pretty powerful. It's the exact opposite. I mean, people need that different methodologies. That one thing could work on someone and absolutely not work, or even be worse for somebody.

• 5:05Speaker 01

  Exactly. Well, I'll even use my twin and I. She can be on metformin and I can't take it. We both have some degree of insulin resistance. I can't tolerate it, but she does great with it. So there are differences, even though we have identical genes. So figuring out how your health story factors in, and what the data and biomarkers say, is a particular core value that we bring to the table.

• 5:26Dr. Darshan Shah?

  Yeah. You know, I was going to talk to you a little bit about genetics, because you went through the entire, kind of, you know, I'm doing air quotes, genetics revolution, right? Where we thought for a while genetics was the answer to everything, and that thought process has changed now in medicine. How do you think about genetics, and how much of genetics is actually a piece of the overall equation? And how should we be using genetics now in modern longevity medicine?

• 5:49Speaker 01

  So I started this because I think genetics is the heart and soul. And actually, there's data recently in huge set of identical twins, showing that instead of the 35% of, you know, the title where the line, genetics loads the gun and environment pulls the trigger, and it's 35, 65, I've always seen it to be far greater than that. And the newest data says it's somewhere around 55%, north of 55%.

• 6:13Dr. Darshan Shah?

  Wow.

• 6:13Speaker 01

  But here's the tip-off, and why my book is Invincible: Defy Your Genetic Destiny to Live Better Longer. So we're all have, we all have genes that don't usually change, or DNA is programmed. But the way the program works varies in different people. That's why my twin and I, with the same genetic makeup, can do different things, can like different, we have different taste buds. I can live on sushi and sashimi, and she doesn't take fish. So I have a high mercury, she doesn't. And that affects your body in lots of ways. And it's true for each one of us. I actually think genetics is the core differentiator, but it's not inevitable. Like, most people think chronic aging, you're going to get disease regardless, and we are living longer. So there are a lot of sick people. That's what we need to stop in its tracks, and have people own their health

• 6:57Speaker 01

  destiny in a way that reverses disease. So for example, I diagnose diabetes, prediabetes, pre-pre-diabetes, starting even in children. But reversing it meant that I don't have to put anyone on insulin. Like, the balancing act is reversing disease to me, or heart disease, same thing. So once you know all the variables, and you actually can look at the total system of human being, you can actually put them on a path where they can stay in optimal health till 120, in my view.

• 7:25Dr. Darshan Shah?

  Wow. And so with genetics being a larger piece of the equation, I think what you're talking about is using environment to turn on and off the right genes?

• 7:33Speaker 01

  Environment, and broadly interpreted, not just exposure to plastic, and how you eat and don't have processed food, and don't have ultra-processed food, how you work out, how you sleep, but also using modalities that we now have at our fingertips. Of course, one that's well-known to everybody is GLP-1s, peptides, which I've actually, as an endocrinologist, worked with for 21 years. It's been, it brought to the market in 2005 with one that you had to take before eating.

• 7:59Dr. Darshan Shah?

  Which one?

• 7:59Speaker 01

  Bieta. And then in 2009 was Victosan. After that, a whole slew of them started coming through. The best one began with Ozempic, but they all had value. I turned around metabolic syndrome and aging in people who have food hunger, or born genetically programmed to just crave carbs. And you wouldn't believe, I mean, from Oprah on out, I mean, I've even seen supermodels in that same situation who have to suffer because they have that food hunger. So all of these changes has radically changed the way we think about aging, because I believe you don't have to get sick. If you own a lot of these kind of changes, and you're willing to invest in a health portfolio, the way we think about a financial portfolio, you would hopefully live till at least 100, and even longer,

• 8:44Speaker 01

  in great shape.

• 8:45Dr. Darshan Shah?

  That's such good news to hear. And, you know, from all your experience, like, you have thousands of patients that you've worked with, you've come up with, there's actually seven patterns of aging that you write about in the Invincible book, right?

• 8:59Speaker 01

  Yes.

• 9:00Dr. Darshan Shah?

  And so I think that's really important for people to know, that most people out there have fallen into one of these seven patterns. And if you can figure out which pattern you're falling into, you can really apply the right therapies that work for you.

• 9:13Speaker 01

  Absolutely. And, and the way we did create it is because while we think women are underserved, in my view, men are underserved too. Having two sons and a husband, I want men to be just as healthy, and they don't live as long as women. And why is that? So no one's actually questioned that. We've done a lot of work in large organs, like the heart for men, and not in women. In women, we focus on hormones and reproductive system. So in order to be equitable, there's a chapter on perimenopause and menopause, but equally a chapter on periandropause and andropause, which is something I started working with decades ago, that people are just beginning to understand. And it's not just all about testosterone. But the other chapters affect all of us. It's about a metabolism disorder, what I think of as a disorder of carbohydrate metabolism, also known as

• 9:58Speaker 01

  diabetes. But diabetes underpins every chronic disease we know, from dementia to osteoporosis, because insulin resistance, inflammation, high and low sugars are damaging to the whole body, because we need sugar for every cell. But that's why when you get diabetes, it affects every cell.

• 10:15Dr. Darshan Shah?

  Right.

• 10:21Dr. Darshan Shah?

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• 11:03Dr. Darshan Shah?

  and you'll get up to 35% off your first order using the code DrShaw.

• 11:12Dr. Darshan Shah?

  And so you mentioned carbohydrate metabolism issues, right? You mentioned andropause, menopause.

• 11:17Speaker 01

  Exactly.

• 11:18Dr. Darshan Shah?

  Do you consider those one of the seven mechanisms?

• 11:20Speaker 01

  Yes, so those are three.

• 11:21Dr. Darshan Shah?

  Hormonal changes, right?

• 11:22Speaker 01

  So there's carbohydrate, yes. So there's a chapter on disorder of carbohydrate metabolism. It speaks to how much insight you can get from wearables, in particular, CGM.

• 11:32Dr. Darshan Shah?

  CGMs, right?

• 11:33Speaker 01

  CGM, right. Continuous glucose monitor. Along, because then you get exactly what you're doing that creates highs and lows. Like if I use me as an example, my hemoglobin A1C, which is an average of 100 days of sugar, has always been superb. It's been under five, but I went very high and very low. So the average looked good. As soon as I found out I was insulin resistant years ago, I started doing something about it. And there's so much you could do. So now I don't have insulin resistance. My hemoglobin A1C was at last count 4.6. My glucose still runs a little high because each of us inherited genes that dictate survival. Otherwise, we wouldn't have made it past cavemen, cave women. Because you have to live off your body in bad times.

• 12:17Speaker 01

  You can't do that if you can't. Exactly. But in today's world, they undermine us because we have all these genes and they're all different in different types of populations and people. But those genes mean that we put weight around our middle as we age. We lose testosterone because we're living longer, right? Where so testosterone starts falling in our 30s. Other hormones start shifting. We lose bone, we get heart disease. So another chapter is on heart disease, cardiovascular disease, bone and sarcopenia and osteoporosis, which is low muscle and bone deficits where you fracture. You can fracture your hip, your spine, shrink, your wrist. And that happens in women and men. So 25% of men and women will become osteoporotic.

• 13:02Speaker 01

  But all of that is actually reversible and you can stop it in its tracks.

• 13:06Dr. Darshan Shah?

  Yeah. You know, with the topic of CGMs and carbohydrate metabolism issues, I think you mentioned something really important, hemoglobin A1C. I think a lot of people get a false sense of comfort with hemoglobin A1C. And then we measure the fasting insulin and it's really high. And I think, you know, I think you mentioned there's five biomarkers that you really want to make sure that you have on your patients. And fasting insulin or fasting glucose is another one of those, right?

• 13:32Speaker 01

  So for years, I set it up. I look at hundreds, if not thousands of biomarkers on all levels, from the immune system to nutrition, to telomeres, to DNA. We do a lot of genetic testing too. But we start with biomarkers, which you can get everywhere now. You know, you can even self order it or come to Nextel or wherever you want to go. But we also, very importantly, look at how they weigh on an individual. And what turned out from my research over the years, when I looked at it prospectively, because you know, in medicine, you can't just say it's your opinion. You want to have proof of concept. So I knew retrospectively, being trained at Yale and NIH, that I would want to publish and show the differences. So what happened is after years of looking at it,

• 14:13Speaker 01

  it was key that five biomarkers, fasting sugar or glucose, hemoglobin A1C, the average of 100 days, and fasting insulin as three that were critical, as well as cholesterol risk ratio, which is total cholesterol divided by HDL, and free testosterone, not total, tell amazing story for each person. And I have yet to meet, in the thousands of people I've measured over the years, anybody who had optimal levels in all of those five areas. So it predicts the path you're on. It tells us what disease you're at risk for or what's emerged. And if you know your health story, if you kind of have a way to dig into your family history, it even adds more. So it's not just the chief complaint, you know, coming into an ER, which was your background, and then reporting in, in today's world,

• 14:58Speaker 01

  I don't feel well. But rather, in the healthiest of states where you think you're fine and you can look fine and everything can test fine, there's still Alzheimer's, there's still heart disease. So why? And that is the question I set out to answer.

• 15:11Dr. Darshan Shah?

  Wow. So you know, you mentioned free testosterone as being a number to follow. Is that true for men and women?

• 15:16Speaker 01

  It is. So of course, men have multiples of what we women have. But what a lot of people don't know, and it's not even approved, but I've been using it personally for years and prescribing it for years, is that we have more testosterone circulating than estrogen at any given time. We make it both from the ovaries as women and from the adrenals. Men make it from the adrenals and their testicles. And men age in a different way hormonally. So what happens is testosterone falls in men and women in our 30s. And that begins the decline. You can't put on muscle, you can't package away glucose or sugar into muscle when you don't have muscle. And that's where resistance exercise, making sure you eat enough protein, fixing your testosterone, looking at your carbohydrate metabolism. After all, the heart's a muscle. So you think of cardiovascular disease, you want to support it.

• 16:01Speaker 01

  But inevitably, remember, before antibiotics, the, you know, age, life expectancy was much lower than it was at the turn of the last century. And now we've increased it dramatically. And I think this century is going to be the next step. So looking at all of those factors, particularly testosterone, is an important variable to consider.

• 16:22Dr. Darshan Shah?

  For men and women, so.

• 16:23Speaker 01

  Men and women.

• 16:23Dr. Darshan Shah?

  So if a man or a woman has a low free testosterone level, you mentioned a few things that they can do as far as resistance exercise goes, et cetera. But are you an advocate of hormone replacement therapy for this?

• 16:36Speaker 01

  I'm an advocate of hormones, but decades ago, I dropped replacement therapy because I'm not Mother Nature. So what I, the way I look at it through the lens of a clinical investigator, it's how do I optimize hormone but look at risk benefit? I'll give you a specific example. So there are women who've had breast cancer and afraid of estrogen, even though there really isn't direct evidence that estrogen causes breast cancer. In fact, on the contrary. But they don't want to be on estrogen, but they're suffering. And I had many women at Women's Health at Yale and subsequently in New York at the Comite Center, who didn't want to live life. They lost their jobs, they didn't feel good, they had no libido was the least of it. No energy, they didn't be, they weren't interested in anything because all their hormones were stripped. And I set up a protocol to use testosterone in women many moons ago

• 17:21Speaker 01

  that now Sloan is using in the same way. So that if you're a survivor of breast cancer, but you want to have a quality of life and put on muscle, you can take testosterone. Now, you may want to block the conversion to estrogen, which we do in men a lot. But you don't really have to because I haven't seen a lot of women make so much estrogen from testosterone. They're sort of siblings, so you can. But yes, it's made a world of difference. And now it's pretty ubiquitous, even though there's no approval. I personally have been on testosterone for 30 years as a cream because I knew at the time I started Women's Health that I had a maternal aunt, my mother's sister, and a paternal aunt who both, their osteoporosis led to their dying. One was collapsing, couldn't breathe and didn't have room to expand her lungs.

• 18:06Speaker 01

  And the other one had a combination of other issues with scoliosis. And so I didn't want to go down that path. And my father had more severe osteoporosis than my mother. That's another misunderstood thing for men. They get osteoporosis exactly the same numbers, just starts 10 years later. So going back to that, I said, you know, I don't want to go down there. And I knew already my bone density was not optimal. So I started taking cream and my bones have stayed perfectly fine. My identical twin started taking the cream. So it's like anecdotal, but one to one experiment. Half the time I did, about 10, 15 years ago. And she has early osteoporosis. So we want to reverse that. And the good news is nowadays, there's so much you could do to reverse chronic disease.

• 18:47Dr. Darshan Shah?

  Yeah, yeah. And you know, to hear that even osteoporosis is reversible, that's huge because I think that a lot of women, they think that, you know, once they get diagnosed with it, it's the end of story, right?

• 18:57Speaker 01

  Yeah, and they're diagnosed too late. I think that's the biggest conundrum we face. The reason I started the work I did is I could see in a 30-year young person, but even in the children, in children and in 20-something, because I was lucky enough to be trained in several areas of endocrine, pediatric, adult, gynecology and andrology, which is reproductive endocrine, in that it starts, you can see it young. That's where the genes play a role. So if you have a family, for example, and we have two that are almost identical. One is, the person, the father is Mexican, the mother is English, German. The other one, the father is Iraqi and Moroccan and the mother is also English and German. One lives in Israel and one lives in Palo Alto, in Silicon Valley. They have three children and one of the children in each family,

• 19:40Speaker 01

  the oldest daughter, has metabolic syndrome. So even as a child overweight, crave carbs. And so the changes you can make to change the course of their life in terms of happiness, because it just gets worse as they get older. So there's so much that's almost miraculous to me. Still, I don't know what I don't know. So there's a lot to learn.

• 19:59Dr. Darshan Shah?

  There definitely is.

• 20:04Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones, and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IM-8. IM-8 powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92-ingredient formula designed specifically for cellular health and longevity.

• 20:49Dr. Darshan Shah?

  I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IM-8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IM-8 had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately.

• 21:35Dr. Darshan Shah?

  You don't have to be one of them. Try IM-8. I actually have a discount secured for you if you go to drshah.com/ima or go to im8health.com/discount/drschah and you can get 20% off with my discount code, Dr. Shaw. You can also find the link below.

• 21:56Dr. Darshan Shah?

  I'd love to touch on some of the other aspects of aging. So, you know, we talked about a few of them. I think thyroid disease was another one. That's something that's, in my opinion, not talked about enough. A lot of people don't even get it tested. They don't realize that they've been living with this for years and years. Tell us your perspective on thyroid disease.

• 22:14Speaker 01

  I couldn't agree more. So I would say about 80% of people, and aging plays a role, actually have insufficient thyroid function.

• 22:21Dr. Darshan Shah?

  80%.

• 22:22Speaker 01

  80%. And the reason for it is, when you said they don't get tested, many people, including OB-GYN internists, will get a TSH, or thyroid stimulating hormone.

• 22:31Dr. Darshan Shah?

  Right.

• 22:32Speaker 01

  Which is signals from the pituitary gland.

• 22:34Dr. Darshan Shah?

  And by the way, they don't get that until someone's experiencing a lot of symptoms.

• 22:38Speaker 01

  Sometimes it's, you're right, in general, but it isn't an uncommon test because when anyone complains of loss of energy, fatigue, changes in hair or skin, usually thyroid comes to mind because metabolism and thyroid, they used to use thyroid to help people lose weight, right? Beat up your metabolism.

• 22:54Dr. Darshan Shah?

  That's true.

• 22:55Speaker 01

  But what happens is, what's covered is the TSH. And TSH is a huge range from 0.45 to 4.5. So if it comes anywhere in that range, there's no reflex to free T3 and free T4. And they can be anywhere. They can be high, low, right in the middle. And so we find by getting those three tests and looking at that relationship, and there's a chapter in Invincible all about thyroid, you can figure out where you stand. Because a lot of the symptoms that men and women experience as they hit 30, 40s and beyond is similar to thyroid, you know, decreased thyroid function or increased thyroid function. And so by understanding where you fit, it doesn't mean you're not going to be periandropausal as a man or perimenopausal.

• 23:39Speaker 01

  But how do you pull out the various indicators so that you can make a difference in someone's life with actionable interventions?

• 23:47Dr. Darshan Shah?

  Where do you see the TSH number being optimal? What numbers do you like to keep people at?

• 23:52Speaker 01

  They can be anywhere. I don't, I think the assay is not ideal. I think the assay can run low, can run high, and I've questioned and queried labs about that. I really target free T3 to be at least three and free T4 to be at least one.

• 24:06Dr. Darshan Shah?

  Excellent.

• 24:07Speaker 01

  And by keeping it in that kind of sweet spot, or a little bit higher, we can judge accordingly. If a person has a pretty high TSH, like over five, in the endocrine community, and that's usually Hashimoto's thyroiditis, we want to suppress it even if the thyroid function is normal. We don't think it's a good idea to have autoantibodies. In fact, somebody we both know of, at least you may know him, is Brian Johnson.

• 24:30Dr. Darshan Shah?

  Of course.

• 24:31Speaker 01

  He just complained about having autoimmune disease of his stomach, thinks it's because of his bad lifestyle and sugar. But in fact, he had Hashimoto's thyroiditis many years ago. And it's a similar disease where you get autoimmune dysfunction, and it's not uncommon to affect multiple organs.

• 24:48Dr. Darshan Shah?

  Right.

• 24:48Speaker 01

  So that is something we should be aware of. But I've diagnosed so many people living a poor quality of life with low thyroid, and that causes weight gain, problems with your heart, bones, muscles, brain. Thyroid is critical to lay down brain in utero and also then to keep it strong throughout life. And the heart, if you have too high a thyroid, you can trigger atrial fibrillation, irregular heartbeats, and then that can go on to strokes and emboli.

• 25:13Dr. Darshan Shah?

  That's true. Yeah, it's something that everyone should have checked. I'm loving that you gave us, you know, the free T3 and free T4 numbers because, number one, insist on getting those checked, and then those are the numbers that you want to kind of aim for.

• 25:25Speaker 01

  Yeah, so it brings me back to your earlier question, which I'm not sure I answered in full, about why I don't call it hormone replacement therapy.

• 25:31Dr. Darshan Shah?

  Yes.

• 25:31Speaker 01

  I have coined the term optimizing hormones for years. In fact, the first book I wrote in 2013 for men was Keep It Up, The Power of Precision Medicine. It's to reverse low T and stay healthy for life. And so the reason I say optimize is what you want to look at is the individual or you think of as the N of one with precision, with data beneath the surface, get their story, and then optimize. But optimization for one person is not necessarily right for the other. And so as an investigator, the way I judged and what came out in the book is what's risk benefit? Like for some person, for some people, certain interventions could be a risk. And for others, those same interventions could be a benefit.

• 26:14Dr. Darshan Shah?

  Sure.

• 26:15Speaker 01

  There are people, for example, who have super high lipids, but they have Teflon arteries. And so if you think about a statin, sure, you might consider it if they have a risk of dementia or Alzheimer's because that could be where the cholesterol is affecting their brain, or they have high sugar. But not everybody. So you can use the data to determine what is the right path from a risk benefit point of view.

• 26:38Dr. Darshan Shah?

  Is neurodegenerative changes, is that another one of the seven methods of aging?

• 26:43Speaker 01

  Yes, so there's a chapter on dementia, which is way beyond just Alzheimer's. I think we tend to throw a lot of people who have trouble with age and memory cognition as if they have Alzheimer's or Alzheimer's dementia, when really thyroid, high blood pressure, vascular changes, injuries, as you know, if you probably know the classical football players or hockey players who deteriorate because their brains have been jostled too much with concussions. It's very delicate. And to be able to manage that effectively, you need to make sure metabolically your electrolytes are within a good range, which isn't common. Actually, sodium starts decreasing with age. And that can be a problem in terms of cognition and memory.

• 27:23Dr. Darshan Shah?

  Yeah, so it's important for people to get tested for all of these different aspects.

• 27:27Speaker 01

  Absolutely.

• 27:28Dr. Darshan Shah?

  And then understand what pattern of aging is going on with them.

• 27:32Speaker 01

  What's the risks that they face? And then back it up with some testing, particularly wearing a continuous glucose monitor, getting at least to start with the five biomarkers of true aging. It may go on from there. Like if there's a family history of Alzheimer's or other conditions, like we spoke about, like osteoporosis, getting both a DEXA to look at your bones directly, starting in your 20s even, and getting testing like ApoE4 and other markers of risk of Alzheimer's and lipid disorders could be added. But to start with a very basic approach, because simply by correcting your sugar metabolism, a lot of these disorders of aging are minimized and reversed. And then you can go on from there, but baby steps are fine.

• 28:14Dr. Darshan Shah?

  Right, right. I think it's a, you know, continual focus, like you're talking about, like taking baby steps every single day, every week, every month, that adds up over time to reversing of chronic disease versus like trying to turn it around once you've been diagnosed with it way too late.

• 28:29Speaker 01

  Yeah, and we even, I mean, we do that even. Originally, I started with people who were like midlife, 30s to 60s. We've seen people from 10 years old to 90s because I did a fair amount of peptide work in children and adults early in my career, and I continue to use peptides. But I think if you can do that, you're really going to see change and you're really going to own that change. Looking at your own health story is also a vital piece of it. Owning some of that because I don't think there are enough clinicians or doctors or places that people can go or people can afford to get this kind of help. And that's part of the reason I wanted to get out there, what my research and proof of concept has shown in people.

• 29:09Dr. Darshan Shah?

  I love it, yeah. For people that don't have access to maybe your Manhattan Longevity Clinic, they can pick up your book and really get the playbook.

• 29:17Speaker 01

  Yeah, exactly. That's what it's been called. And actually, one of the thing you said, I use the term a lot because I love his book, James Clear, Atomic Habits of Longevity, because it's compounding these small baby steps and changes on a day-to-day basis that adds up to far more than trying to make a mega change. So I encourage people to experiment, but test before and after. Take a look at what's happening. That's why wearing a CGM, figuring out what's going on. Maybe it's certain kinds of foods, stress, lack of sleep is causing your sugar to be high or very low. We've actually just had a patient, I've had several of them over the years, who just had a baby boy, beautiful baby boy. She came to me about a year ago and she was all signed up for IVF. And I was seeing her father, who's from Silicon Valley.

• 30:02Speaker 01

  I started seeing her in New York and he begged me to see her because it's been a year and she couldn't get pregnant. And after doing the oral glucose tolerance test and looking at her numbers and wearing a CGM, and the oral glucose tolerance test tells us, a lot of pregnant women, you know, do it. It tells us, you know, how your sugars behave and not necessarily insulin for the ones that are done during pregnancy, but we do insulin too at every point for three hours that we draw. And I basically saw nothing really going on in her system or her partners. And I said, why don't we try to, her sugars ran very low. She was too careful, which I've seen a lot. So you get poor outcomes in IVF in pregnancy. And within that month, she got pregnant and she didn't have to do IVF. So she just had a beautiful baby boy.

• 30:45Dr. Darshan Shah?

  That's amazing. What a great story.

• 30:47Speaker 01

  So it's not just aging. It's like, how do you get your system to function as optimally as possible for life? And if you do that, you're investing and compounding the kind of changes that keep you living hopefully till like 120 in great shape, not on a porch or in a wheelchair or with a stroke or with fractures, hunched over. That is not a quality of life for most of us.

• 31:10Dr. Darshan Shah?

  Right. And I think, you know, to your point about that fertility story, starting way, way sooner than most people think about starting, even, you know, as you're going through the childbearing years and even before that, it's the sooner you start, the better.

• 31:23Speaker 01

  Yeah, I couldn't agree more. In fact, we started with precision medicine and all the different types of medicine I practiced, even though I was initially called concierge. And I used to really dislike that because concierge medicine is great, but it's like you get more time for more money. And in my case, I was thinking about a whole new field if it would work out, right? And to your point, if you start, we start way too late. You can't start when you have a heart attack or diabetes. You've built that disease over decades. So by looking and peering into the system, beginning in your 30s for sure, when a lot of us don't have that same kind of get up and go and energy, we're raising a family, we're working hard, we have aging parents, we're caught in the middle.

• 32:05Speaker 01

  But by investigating, we see that you can trigger things like, and look at things like your B vitamins, your D vitamins, all of that are critically important to the way you live.

• 32:15Dr. Darshan Shah?

  Right. I fully agree. And I'm so excited that you put all of this incredible knowledge that you've accumulated and shared into a book so you can share it even further. Where can people buy Invincible?

• 32:25Speaker 01

  Everywhere the books are sold, basically. I like to support independent bookstores. I know you bought one right away when it was a promotion. So thank you. It means a lot to me because I do want to get the word out. And I also wrote the book in a way that is referenced. So there's scientific literature that backs up. It's not just my opinion. It's what's been proven and what you can bring to the table. So independent bookstores, Amazon, of course, Barnes and Nobles. Get one for yourself and then give a gift of life to friends and family. Like it's, I think it's appropriate for every special occasion.

• 32:55Dr. Darshan Shah?

  Fully agreed, fully agreed. If more people gifted books like Invincible, so much more good would come out of it.

• 33:02Speaker 01

  And not only in the book form, but I actually did the audio too, which I really love. So I've had people contact me and say, it feels like you're right in my ear. Cause I am in there right next to me. And that, that makes me feel good because I went out of my way to do it. I really liked doing it. It was a lot of work, but it was fun. I had great people helping me. And so I was very, you know, grateful. And I think for some people, like my husband doesn't read books, hardcover books too much, but he listens to everything on Apple or audio or Spotify.

• 33:29Dr. Darshan Shah?

  Oh, I love it. I'm so excited that you came on the podcast to do this with me. I'm so excited for my audience to be introduced to your book and just meeting you as well. So where can people find more content from you? Do you have an Instagram?

• 33:43Speaker 01

  So they can go to our website and see how we think if they want. It's comitémd.com. And then I'm on every social media. So the handle for Instagram, for example, is at DrFlorenceComité.

• 33:55Dr. Darshan Shah?

  Got it.

• 33:55Speaker 01

  Facebook, I'm on Tik Tok, I'm on Twitter, on LinkedIn as Florence Comité. So I think my name, I've only found one other person in the world with the exact same name from France. So it's not very common and I think you'll be able to tell a difference. But this particular person is really interesting. She's a fitness person.

• 34:12Dr. Darshan Shah?

  Oh, no way.

• 34:13Speaker 01

  So I read all about her and I'm like, wow, and maybe we are connected.

• 34:16Dr. Darshan Shah?

  That's awesome.

• 34:17Speaker 01

  No, but this was great fun. And I know we didn't have a lot of time, but I felt like we touched on a lot of things.

• 34:23Dr. Darshan Shah?

  I think we, I think we got the gist about why we should read this book. So I really appreciate you doing this. Thank you for coming on today.

• 34:29Speaker 01

  I appreciate it and I hope we can return it and return the favor. I'd love to see you either in New York or we can do it virtually and hopefully successfully.

• 34:37Dr. Darshan Shah?

  I will be there for sure.

• 34:38Speaker 01

  All right. Well, thank you so much. I appreciate it.

• 34:44Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.