[Dr Florence Comite] (0:00 - 0:16)
What happens in our 30s, testosterone as it starts to fall, begins to have an impact on our ability to put down muscle, to lose visceral fat. We can be doing all the same things we've done in life, eating well and working out and sleeping great, and yet we may not feel so great.

[Angela Foster] (0:16 - 0:23)
Dr. Florence Kumite, you are a global authority on healthy longevity. You're the best-selling author of Invincible.

[Dr Florence Comite] (0:23 - 0:36)
By keeping testosterone on board, you're going to maintain muscle, you're going to lose body fat, you're going to lose visceral fat that builds up around the muscles and leads to disease. Testosterone is a vital element to sustaining your health span for life.

[Angela Foster] (0:36 - 0:45)
Do you find that women who use testosterone, could you find it easier to maintain optimal body composition and metabolic health?

[Dr Florence Comite] (0:45 - 0:47)
99.999%, yes.

[Angela Foster] (0:48 - 0:56)
Is there a period of inevitable decline that people will experience at the end? And what we're doing is really trying to shorten that decline period.

[Dr Florence Comite] (0:56 - 1:08)
I don't believe decline is inevitable. The goal is to live till 100 plus and go to sleep one night and we just don't wake up. But we don't suffer, we don't get dementia, we don't get diabetes, we enjoy life to the fullest.

[Angela Foster] (1:08 - 1:23)
And that to me is what I aim for. Dr. Florence Kumite, you are a global authority on healthy longevity. You're the best-selling author of Invincible.

So excited to have you here today. At what age do we reach our peak health and fitness?

[Dr Florence Comite] (1:24 - 2:14)
Peak health really is achieved in men and women in their late 20s. So 25 to 30 is when athletes do the best they can, when having a child is supposed to be the easiest time of life. And really, as we enter our 30s and beyond, our hormonal system, our metabolisms keeps shifting.

And we may or may not realise it because we're so busy with life at that point, whether we have children or moving up in our career or ageing parents or all three, it becomes more challenging. And we usually use external factors to explain why we don't feel maybe as good as we used to feel, why we're more tired, why we don't get as much out of the gym. So that's what we see happening really earlier in life than most people expect, but they don't see real symptoms.

They just don't feel all that they could feel. They don't feel as good as they want to.

[Angela Foster] (2:15 - 2:23)
Is there like an organ or a system within the body, like mitochondria, for example, that's ageing fastest? Is there one that kind of kicks in first?

[Dr Florence Comite] (2:24 - 3:19)
Well, the whole system is unique in each one of us. So I can't say that in any particular case, your system is falling apart, starting with your mitochondria or your lungs or your brain. But having said that, there are actually biological ageing studies that have looked at the system that we measure and look at to say, where are aspects of your system ageing and where should we troubleshoot?

It also comes out of what runs in your family and things you have to cope with. But in general, hormones begin to shift more obviously in the 30s. So testosterone starts decreasing by 1 to 3% in men and women.

And we women have such small amounts of testosterone, but actually much more than oestrogen. So we are used to thinking of oestrogen as the woman's hormone. But it turns out that by orders of magnitude, we have circulating testosterone that is actually greater than the oestrogen.

[Angela Foster] (3:19 - 3:26)
One of the things I've heard you speak about is the link between testosterone and metabolic health. Can you explain more about that?

[Dr Florence Comite] (3:26 - 4:29)
Yeah. So what happens in our 30s, testosterone, as it starts to fall, begins to have an impact on our ability to put down muscle, to lose visceral fat. So we can be doing all the same things we've done in life, like eating well and working out and doing resistance training and sleeping great.

And yet we may not feel so great. We may get aspects of brain fog. We may feel like we're gaining weight and we don't know why.

And that's usually because testosterone begins to decrease. We don't have as much as men. We have a fair amount, but not about a hundredth of what men have.

And as a result, the hormone isn't there to help us put on muscle, maintain fat, good for memory, good for cognition, bones, you name it. Testosterone has a strong role. And I think most women and certainly the doctors that take care of them are not aware of that.

They're not aware of the fact that testosterone plays this amazing role in sustaining our healthful life. And there's a lot of research on that in men and women.

[Angela Foster] (4:30 - 4:43)
It's really interesting, isn't it? Because I think the thing that we hear from women so much, and I remember, you know, saying this myself previously is that sense of, I just don't feel like me anymore. Is that a sign of testosterone declining?

[Dr Florence Comite] (4:43 - 6:22)
It is one of the signs, as well as when testosterone starts changing other beneath the surface, think of it as the cellular level, begins to alter. And as a result, we may not sleep as well. Our bodies may not be ovulating regularly.

I think of myself when I, you know, was in my reproductive years in my thirties, that I kind of knew how to predict each week. Like I would know the week I would feel a little under the weather because I was expecting my period and weeks where I felt on top of my game, right? And I would actually schedule according to that in some fashion, you know, in terms of the workouts I did and the way I approached it.

And then all of a sudden, around 35 to 40, it's maybe premenstrual syndrome meets perimenopause. And there are, in fact, even women who go through menopause as young as 38. You can also be 58.

On average, it's about 50, 50 and a half, meaning your last menstrual cycle happens about a year prior to that. And so, yes, you don't feel like yourself. I remember my neighbour down the street years ago, our sons were best friends, and she called me in a panic one saying she's the most calm person and she taught at the seventh or eighth grade level.

So you're looking at 13, 14 year olds. So you have to be calm. Otherwise, you know, you lose your mind.

And she's like, Diane was her name. I don't know what's happening. I just can't keep my keep it together.

And she was perimenopausal in her early 40s, and it was affecting her sense of well-being, her anxiety, her stress, her sleep, which also feeds the way we want to eat and how well we feel during the day. So all of that contributes to I don't feel like myself.

[Angela Foster] (6:22 - 6:48)
A really common thing that I hear so many women, and again, it's another one I've experienced myself, is just this sense of anxiety that comes out of no way. Don't really know how to explain it. It's not like you're worried about anything in particular, but it's sort of just there are days when you can feel quite anxious.

And I know quite a few women speak about this in my community, which hormone or hormones are related to that sense of anxiety.

[Dr Florence Comite] (6:48 - 8:50)
So when you activate this, the sympathetic system, it's the system that puts you on alert, or the more specific hormone that you might be asking about is cortisol. So cortisol is that fight-flight hormone. So if something's there that scares you, overwhelms you, you think you can't cope with it.

And keep in mind there are external factors. You're raising children. Maybe the school called because there's an issue at school with one of your children.

Your parents are ageing. Maybe they have issues and you're worried about them because they don't live near you. You don't know what's really going on.

It's hard to figure out. You have a job and a career, and you're not sure your boss loves you. And all of that contributes to us feeling this unease.

And if that happens, then cortisol can go up. It's the stress hormone, and it makes you feel like you can't cope. Also, it contributes to increasing sugar, increasing weight around the middle.

And so there are ways to cope with it that are incredible that I have found useful for my patients, for myself. Even just simple breathing exercises where you take deep breaths and you hold it for a bit. Meditation.

Use Heads Up. I think that arose from the UK. It's a wonderful app that I think with very simple moves, you can bring back that calm.

I've even heard a tip from one of my colleagues who I'm very close to who does Qigong. He's from China and he's amazing. And he said, if something feels like it's invading your space and you feel very anxious, put your thumb, and I've read it for other cultures too, put your thumbs inside your palm.

And I said, well, what if you're using your hands? He said, well, then you can try to curl your feet. And I've tried all these things and they actually work.

I think the best way to approach it is to probably do restorative practises like the breathing, like Qigong, like even massage therapy. Meditation is probably the best way to feel like you can get control. And you can meditate anywhere, anytime.

You just have to learn how to do that and what it means.

[Angela Foster] (8:51 - 9:13)
Such good tips. I think the thing is, isn't it, it's that unique time of life, as you say, you've named so many different stressors that women are experiencing and then their hormones are changing. Do you think it's sort of hard to isolate which one is it or is it both?

Do you think there's an element that as your hormones are dropping, it's almost removing some of the buffering of your ability to cope with life's challenges? Yes, definitely.

[Dr Florence Comite] (9:14 - 11:05)
And I think that plays a role in when ovulation doesn't occur on a regular basis. And we don't make progesterone, which also has a calming effect when you ovulate mid cycle. So usually ovulation occurs about two weeks before you're due for your menstrual cycle.

And every decade of life changes that system somewhat. And if that's put off or you just skip a month, you're not making the progesterone. You may not be sleeping as well.

The anxiety ramps up when we're used to this cyclical kind of existence. So, yes. And I also think, you know, life begins to crowd us, right?

In our 20s, we might feel we can live forever. We can burn the candle at both ends. We can ski all day, party all night, still get up the next morning.

And that begins to fade. And I think all of those factors come together so that we have to adjust expectations and maybe accommodate to the extent that we get to sleep a little earlier. We don't accept every party invitation that comes our way.

We learn to control kind of the life our children are living and we get help with our parents. All of those factors, you know, make a difference. Learning to say no as a woman is very hard because women tend to be more of the caretakers.

A lot of the couples I know where the male might work remotely, the woman goes into an office, there's always someone helping at home, whereas a lot of the women stay at home and they're doing their job, whether it's by Zoom or working independently, and they watch the children at the same time and have to accommodate the children. And so there's a distinct gender difference as well. But we women usually figure out a way to make it work.

And we figure out paths around it, I think, because in some ways, we have no choice. So we have to get through it. It makes us stronger.

You know the line, what doesn't kill you, you know, only makes you stronger.

[Angela Foster] (11:05 - 11:14)
And it is true, I think. Yeah, you just get that sense, that sort of feeling of fragmentation, because you're trying to juggle so many things.

[Dr Florence Comite] (11:14 - 15:32)
So you have to protect yourself. So if I were one of those women out there, and I've experienced all of that, let me tell you, all through my life, I've raised two boys, I got divorced when my boys were teens, one was younger, even the other was just a new teen. And juggling it all, I was full time at Yale, I did have some help, I had like an au pair at home, but I was the one driving, I was the one planning their life.

You know, my ex dabbled in it, but really wasn't a presence in the same way. In fact, when I left town for meetings, he would take my au pair. It wasn't part of the deal, but he took her anyway.

I remember the sense of I have to relook at what I'm doing, like taking accounting. And that would help me like if I sat down with some time alone to myself on a weekend, and looked at what was upcoming, how could I make sure I got through the week and still found time for me, whether that was taking a bath, or working out in a different way, or going for a walk with a friend, or meditating, breathing deeply. These were the days before apps, and it was so easy to do that because cell phones became available only in the mid 90s.

And this was in the early, yeah, around the same time. And so it was, you know, it wasn't fun. But you learn how to adapt.

And that's really, I think, what we all have to do in order to live an optimal life. From a technical point of view, there actually are ways to measure what's going on in your body. So there's with wearables.

Now we can see what's happening with our sugar, because cortisol will affect sugar. I know when I wake up in the morning, and I'm under a lot of stress, or I'm not feeling well, my sugar is higher than it should be. When I'm really not well, and I'm sick, in my case, which may be different in your case, my sugar drops really low.

And I can tell. And usually, I wake up, and I don't have to eat for hours. I'm an intermittent faster, because I have the body makeup that allows me to do that.

But only a third of us do. A third of us shouldn't, and a third of us, it has no effect. And so learning what your body is doing under the surface, getting a few biomarkers.

I list five in Invincible that are non-negotiable, because they take a look at what your body is, how your body handles sugar, how your testosterone levels are doing, and also your cholesterol risk ratio, which as I think we alluded to before, as women get older, and oestrogen starts dropping, they can have beautiful lipids, cholesterol before, which is great for the heart and the brain. And yet, that switches as the hormone shift as well. As we lose testosterone, we make more of the bad cholesterol.

And even if we have fantastic good cholesterol, which is the HDL, and you know, in the way we think about it, it doesn't modify the bad cholesterol in the way it needs to. So by getting those few biomarkers, by maybe using wearables, like a continuous glucose monitor, which is now available like over the counter, you don't need a prescription. Have you ever tried one of those?

Using a CGM, yes. I wear it almost all the time. I forget what arm it's on, because I'm a data geek.

So I want to see what's happening. But it's taught me how to keep my sugar in a fairly restricted range, which is going to contribute to optimising my health for life. Because almost every disorder of ageing, and that's how I think of heart disease, I think of brain deterioration, dementia, memory, cognition, osteoporosis is affected by insulin, which is one of the factors in sugar metabolism.

Your sugar affects it all. But it's not like sugar is the enemy. It isn't.

I actually have a sweet tooth. And I, you know, won't skip a dessert if I really like that dessert. I don't eat what I don't like, but if I like it, and just like last week, I gave a fireside chat at a VC function.

And I hadn't really eaten and they had these tiny little creme brulees. And they were so good. I got two of them, but my sugar stayed even.

Because each of us has a different response to food, to activity, to sleep, to exercise. And learning what our body does innately will only help us figure out how we maintain our equanimity, and how we age gracefully and in great shape till at least 100, if not 120 or 150. That's the whole goal to me that you can shape how your genes manifest themselves.

[Angela Foster] (15:33 - 15:53)
If you're getting value from this show, the single best thing you can do to help us keep bringing you the highest calibre guests is to subscribe or follow wherever you listen or watch. It takes 10 seconds, but it genuinely makes a difference to the quality of the guests we bring you week after week. There's so much to unpack there.

I'm going to ask.

[Dr Florence Comite] (15:54 - 15:56)
I hope that wasn't too overwhelming.

[Angela Foster] (15:56 - 16:33)
There's various points I want to break down. The first one was what you just said at the end there around us being able to live well until 120, maybe even 150. I think so many of us have ageing parents who are not doing so well and wonder, what are we protecting here?

So are we able to protect our health span to the point that we can be healthy, healthy, healthy, healthy, and then we're out? Or is there a period of inevitable decline that people will experience at the end? What we're doing is really trying to shorten that decline period, if you like.

[Dr Florence Comite] (16:34 - 17:41)
That's the heart and soul of my book, Invincible. I don't believe decline is inevitable. I do think we've had a great experiment in the great generation that is people born prior to the baby boomers.

46 to 64 is the baby boomers. So prior to that, with the advent of antibiotics, we've now kept people living but in poor health to over 100. We had a show here in the States, a guy named Willard Scott, a reporter who used to wish happy birthday to every individual turning 100.

He had to stop because there were too many, and that's going to continue to climb. But it's really our health span that matters. I had a quote in 2010 in the New York Times Magazine when they were interviewing me about my work, and I said, the goal is to do just what you outlined, to live till 100 plus and go to sleep one night, our body's tired, all the cells are worn out, and we just don't wake up.

But we don't suffer, we don't get dementia, we don't get diabetes, we don't have a heart attack or a stroke, we enjoy life to the fullest, maybe dancing in our great great granddaughter's wedding. And that to me is what I aim for.

[Angela Foster] (17:41 - 17:55)
What you said there was very interesting, how a third of us can fast and it's beneficial, a third of us it seems to have no real benefit, and a third of us should not be fasting. What determines whether we should or shouldn't and whether we'll see a benefit?

[Dr Florence Comite] (17:55 - 21:53)
So it's basically how our body handles sugar, and that goes back to our DNA. Our DNA is really a draft. The way we live life can shape your future health, and that's one of the ways to maintain your health span.

So women who have to eat every three hours, and they usually know because they start fading around three hours, they feel tired or weak or even sleepy, sometimes angry or hangry, which is hungry and angry. It's because their sugar is dropping. They wake up in the morning and they're starving.

So I used to live with somebody at the time when my children were young, and the minute she woke up, she was absolutely ferociously hungry. And yet I, and we both slept well, which is another issue to food, by the way, and how your body maintains it. I could leave the house and not eat until the afternoon, and I was fine.

I might start getting a little headache at like four o'clock in the afternoon after a busy day. And so it turns out with CGMs now, which I didn't realise at the time, because everybody would say breakfast is the most important food, so she'd come after me and say, you're missing breakfast. That's the most important meal of the Turns out that's not quite the case because some of us can maintain our carbohydrate metabolism and our sugar in this vein where we can support ourselves and others cannot.

And you can tell, like in the States, all women when they're pregnant now get a sort of short oral glucose tolerance test where they take a pure carb drink, and then we measure their sugar and their insulin at various intervals. I do it up to three hours because it turns out the women who can't fast are those women who drop below 70 at three hours. So they've taken a pure carb load, and it gets digested very quickly, and their insulin can spike up, which means that's where that urge to eat and that fatigue comes in.

And I can give you specific examples, and they can't last, whereas other people can sustain their sugar. It both has to do with survival, the genes we've inherited to keep us living even during caveman times when there wasn't food in the winter, famine, the Holocaust, the Irish famine. And the people who survived inherited genes that could maintain their health regardless of access to food for long periods.

And the CGM, or the Continuous Glucose Monitor, which in this country you can get over the counter, I think in the UK too, Lingo and Stella, are both very useful in helping you determine what happens when you don't sleep well, what happens when you drink alcohol, what happens when you just have, maybe you think it's healthy, but it's pure carbs, a banana and a bran muffin for breakfast. And then two hours later, you're grabbing a doughnut and a cup of coffee because you're fading. So the way to manage that is not very difficult actually.

And I counsel my patients in this fashion that they should always have a protein at every time they eat. And this is for women who also maintain sugar. It's no different because it keeps your insulin and sugar steady state, matching each other as opposed to spiking high for the sugar.

And then after the sugar starts to drop, your insulin goes up. It happens too fast when you eat a pure carb. So it's best, for example, to have eggs or cottage cheese or some form of apple butter or nut butter is even better.

Oatmeal is a culprit actually. A lot of people think oatmeal is so healthy, but it doesn't have protein. So throw in some seeds or beans or protein, even powder to sustain sugar in an even way, released, and the insulin follows that.

So you don't get that up and down feeling and you don't feel unwell. And so the group of women who really can't fast are the ones that their sugar falls too low after a certain period of time.

[Angela Foster] (21:53 - 22:37)
It's interesting. I find myself in that category, apart from I think if I have not really done any exercise in the morning, then I seem to be able to sustain it. But certainly as soon as I exercise, I'm very hungry and then hungry throughout the day.

But protein, as you say, has made a really big difference to me. You also mentioned around testosterone and women's testosterone shifting from quite a young age, both men and women around 35 to 40. And you spoke there around the link between testosterone, reduced muscle mass and the accumulation of belly fat.

Do you find that women who use testosterone cream, for example, find it easier to maintain optimal body composition and metabolic health?

[Dr Florence Comite] (22:37 - 24:33)
99.999%. Yes. There are very few people I've met and literally can count them. There may be three or four over the thousands I've seen who have a body makeup that even if they're not on any testosterone, they do fine.

They work out hard. Their body composition is good. But the vast majority of us, close to 100%, as close as you can get to 100% without 100, because we don't say that in medicine.

We never say all or nothing because we're all so unique. And that's a different approach that I built into the programme I developed and the research I've done over 30 years. I'll just allude to it, but I can go into it because I'm an identical twin.

So I knew from the beginning that no two people are alike, even an identical twin. Be identical twins because we live different lives. We're in different places.

You can never be in the exact same place, even in utero when you separate, right? Yes. So it's best testosterone.

And I know in the UK, it's very challenging. I've learned from other people who've interviewed me that in order to get testosterone, it has to be based on a very, very poor libido that's negatively affecting your life. What I've said, because I've never seen any downside with testosterone, cream, there are other ways to take it and you just have to manage it with your doctor.

But in the States, there are pellets and there are injections if you want. There's also pills now. So you want to manage those levels.

But by keeping testosterone on board, you're going to maintain muscle. You're going to lose body fat. You're going to lose visceral fat that builds up around the muscles and leads to disease.

And all of this is associated with what I think of as disorders of ageing, diabetes, a heart attack, dementia, osteoporosis, bone loss is affected. So by looking at it through that lens, testosterone is vital element to sustaining your health span for life.

[Angela Foster] (24:34 - 25:01)
I think you can get it here. I certainly have it and it's available privately. But I think on the National Health Service, unfortunately, as you say, it's remarkably difficult to get hold of.

And even a lot of gynaecologists here will say, oh, it's only really for libido, even though I think there was a study back in 2024 that showed actually, it wasn't that it has other impacts. And certainly a lot of women I know talk about the impact on energy, for example, and then the energy for men and women.

[Dr Florence Comite] (25:01 - 27:25)
You think in men, it would be sexual function and you think in women, it would be fat, you know, body fat. That's not the case. And funny the way when I started Women's Health, I thought the women would complain about that, but it was really their husband's lack of sexual ability.

And their putting on weight around the middle was tertiary. Third, energy was number one for both. You just don't feel like you can keep up anymore.

Sometimes you even need naps in the afternoon. Some of that can be undermined by the quality of sleep. And again, you can check your sleep out.

If you wake up after eight, 10 hours, six, eight, 10 hours, and you're not feeling rested, you're not getting quality sleep. So it's not just that quantity, which I think we hear all over eight to 10 hours or six to eight hours, you can actually still make up sleep. So if, let's say during the week, it's very hectic and you have some downtime on the weekend, getting a little, going to sleep earlier, sleeping a little later is also helpful, but sleep undermines your sense of energy too.

But testosterone far and away as a hormone is critical and essential to our keeping our health and avoiding the decline that people think is inevitable, but is not because you can change expression of your genes. So even if diabetes runs in your family, you don't have to become a diabetic. In fact, of the thousands of people I've seen, not one person had optimal sugar metabolism because the way we live life now is that unlike years ago, where it was feast and famine here, you know, there's Uber Eats and you can get whatever you want, whenever you want for most people.

And as a result, we can't control that intake. And so diabetes used to be a survival mechanism. It was great for surviving, but nowadays it undermines our health and undermines our ability to stay healthy as we age without resistance training and exercise testosterone and eating enough protein, which is about a gramme per kilogramme of body weight at a minimum daily, and even up to two grammes per kilogramme of body weight.

If you're someone who works out, you know, to an extreme and you love it, let's say you work out every other day doing some form of resistance and weights. And maybe in between that you're doing aerobic and high intensity interval training. And that combination, you need even more protein.

[Angela Foster] (27:26 - 27:49)
I think that's something a lot of people underestimate. And I know, for example, like when I do my regular DEXAs, you know, I can see sometimes, even though I'm training really hard, I seem to eat, need to eat more protein than you would think. And definitely going to that upper end in order to get results.

But it also as well, like helps with satiety, it helps with blood sugar control, as you were saying, and yeah, helps with our health.

[Dr Florence Comite] (27:50 - 31:07)
It actually muscle burns fat. In fact, there are certain kinds of protein that's even better, like in the States, cottage cheese has casein cheese, as opposed to whey protein. Some people don't want, you know, dairy, you know, protein.

So their plant proteins, I find that to be somewhat problematic for people who are on pure plant diets. Many of them are not healthy under the surface. When I did studies about six years ago, in this particular group of women, two women were pure plant diet, one of them had, they were both thin and they looked good, but they were skinny fat, they didn't have enough muscle.

And they had insomnia and migraine headaches, and they couldn't actually maintain their sugar well. So as soon as they change that up a little bit, they became healthier and healthier. And actually their body composition improved dramatically.

So muscle itself burns fat while you sleep. So I mentioned being an identical twin. So my twin sister now weighs, she's very proud of it, 10 pounds less than me.

And when we were born, she told me that she was longer and thinner, and I was, you know, not, not, you know, the taller, thinner one until puberty. So it's always been, you know, why not, you know, and she is, she's about an inch shorter than me. Maybe that's equal to like 2.2 centimetres. So, you know, a few centimetres shorter than me. Now she's thinner, but she doesn't have the same kind of muscle I do. I have more muscle than she does.

So it's not the number on the scale, but it's the distribution. And many women are what we call skinny fat. They think they're in great shape, but really they have more fat than muscle.

And inside you can see that fat, it can be in the liver. It could be around the visceral organs, like your colon and your intestine, your intestinal tract, your pancreas, your stomach, your spleen, and that's bad fat. So you want to be cognisant of that fact.

So my twin and I are even different that way. We have different desires in terms of food. Like I can live on sushi and sashimi and she doesn't touch fish.

She's an amazing gardener, and I basically kill anything with roots and leaves, not people, but I'm not a gardener. She takes after my mom that way. She likes fruit and vegetables.

She'll make a lot of like baba ghanoush or pasta with eggplant and squash. And while I can eat them, the seeds bother me. So I always get like European or Persian cucumbers.

So I always wondered, and there's other major differences. She had her gallbladder out. My gallbladder is fine, but I have something in my colon, ischemic bowel, which occasionally if I'm dehydrated and under a lot of stress, I can bleed and it can be painful.

She doesn't have anything like that. She can take certain medications and I can't. She's allergic to penicillin and I'm not.

So doing what's right for you individually, not your two best friends, because your best friends may be completely different than you, or even your siblings, as I pointed out, can be very different. It's fascinating with identical twins. Yeah.

Just how different the two of you are. People can't tell us apart. Sometimes in pictures, I can't tell us apart.

So it's not like we don't look alike, we do, but there are aspects that are quite different everywhere from the tip of our head to the bottom of our feet.

[Angela Foster] (31:08 - 32:04)
Just shows how personalised we need to make medicine. Before we dive into the next part of our conversation, I want to take a moment to thank the sponsor of this episode, AlgaeCal. If you're thinking about longevity, it's important to remember that living longer also means keeping your bones strong enough to support the life you want to live.

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If you'd like to learn more or try AlgaeCal Plus for yourself, head to the link in the show notes and you'll get 10% off your first order. You mentioned there are five key biomarkers that we should be looking at to track ageing. What are those five?

[Dr Florence Comite] (32:04 - 36:49)
So the first three really deal with the way our body deals with sugar. It's not the amount of sugar we eat. A lot of people get confused with that and they think, I've cut out sugar, I should be fine.

No, it's the way sugar intersects with our body because of our genetic makeup. And there's ways to work with it. So the first three would be fasting glucose or sugar, haemoglobin A1C, which is an average of less than 100 days of how sugar interacted with your body, and fasting insulin.

And you have certain optimal levels you want to keep them at. You want to keep fasting glucose tightly controlled between 70 and 80. You want haemoglobin A1C to be under five, and you want your fasting insulin to be unmeasurable basically, because you don't need insulin after an overnight fast.

You shouldn't have insulin on board three hours after eating. Your body should be reverting back to a baseline state. You don't need insulin if you don't have food to digest.

And then the other two are a look at the cholesterol. So something called cholesterol risk ratio, which you can extrapolate from a standard lipid test. They give you that number usually because it's total cholesterol divided by the good cholesterol.

You want that under two or under, and free testosterone. And the reason it should be free testosterone is that total testosterone is bound up in proteins in the body. One particular protein is sex steroid binding globulin, and it isn't free to work in your body.

So you need the free testosterone. And you want that to be as minimum of six, depending on the units though. And it could be as high as 30 or even a little bit more, depending on how your body manages it.

And those together can tell, can predict for me where your life is headed, what your health is going to do, what diseases. So my work is predicated on the fact that when I look at numbers, systematically, I can predict, it's almost like having a crystal ball. So I can tell people how to begin to change the path they're on.

And that's what the book does. So if you follow the book, you can see there's seven patterns of ageing. And all of us have at least two because all of us women go through perimenopause and menopause.

We lose all our eggs and that's it. We don't cycle anymore. There's no period.

We women with this kind of predictability can avoid these disorders of ageing and extend our health span for the rest of our life and do what we both hope you and I go to bed one night, we're tired, we're worn out, and we just don't wake up the next morning, but we're not sick. We feel great until the last possible moment. And you think that we could actually feel good until the last moment?

I believe if you follow certain guidelines and you look at the patterns, you can identify what you look like. In fact, I modelled this thinking for a long time. I thought if I was going to write another book, it was going to be about patterns because I remember when there was a book called Colour Me Beautiful years ago, and you had to determine if you were winter, summer, spring, or fall, and those are the colours you should choose.

And now Amazon is doing something called Capsule, where you're supposed to answer a questionnaire, describe the woman you are, and then they define your look. Are you a jock? Are you feminine?

Are you this? Are you that? And it's a way of helping people figure out where they fit into these patterns.

So we all go through menopause as women, men go through andropause, their testosterone lowers, and the rest of their hormonal and metabolic system changes in almost identical fashion, except for them, it's linear, where we women, by the time we're born as newborn babies, we have fewer eggs in our ovary than we did in utero. And every month of life, we lose more and more eggs and accelerates once we start go through menarch, which is our first period. So that begins to pile up.

And when we use up all the eggs, we basically stop cycling. I think you mentioned having Marie Claire Haveron, the narrator. And so I know she's, she's somebody who works in the field, predominantly women's health as an OBGYN, but I'm trained in gynaecology.

In fact, at Yale, I had a triple appointment in gynaecology, adult endocrinology, and paediatric endocrinology. So it was looking at every decade of life, and it helped contribute to my way of thinking and seeing that, you know, menopause was kind of the reverse of puberty. At puberty, we were beginning to come into our own and blossom, and things changed in our body.

And as we go through menopause, there's a reversal of that, but we can actually feel better than ever if we pay attention to the signals our body is sending us.

[Angela Foster] (36:50 - 37:18)
What would you say then, for someone listening to this, so based on that, how we change every decade, how, if we take a woman and her partner, assuming this is just, we'll go with either sex, I think, just to make it more interesting in this example, then we've got both covered, but it could be her brother or friend. So in terms of between a man and a woman, if we go through what's happening in their 30s, 40s, 50s, 60s, what are they experiencing each decade? And how is it different for a man versus a woman?

[Dr Florence Comite] (37:19 - 42:48)
That's a very deep question. We have a few minutes left, but I'll do my best to address at least parts of it. So both men and women really do start shifting in the 30s.

Can you see those changes in children and in 20s? Absolutely. I have, and I know they're there, and I take care of young, some young children for that reason, and people in their 20s, particularly women on birth control pills, because it shuts down testosterone even earlier.

So the weight gain that some women notice associated with birth control pills is because most birth control pills are only oestrogen and progesterone. So in our 30s, women begin to put weight in the middle, the truncal weight. They begin to move towards a body that may have more fat and less muscle.

They can feel fatigued and run down, and they can be challenged in terms of their emotion being a little more emotional, even if they hadn't been before. Their cycles can become irregular. Men don't have cycles, but as their hormones shift, they have less oestrogen than we do.

They have some, but it's much less. They have more heart diseases likely. So if what runs in their family is heart attack and stroke, by the time they hit 35 to 40, they're actually already visibly at risk, both internally and sometimes externally.

So there are tests that the book goes into in the chapter on cardiovascular disease that speaks to that. We women begin losing bones sooner. Generally in our 40s, 30s to 40s, our bones start stabilising.

We're always making bone and losing bones, called formation and resorption. But as we women hit our 35 to 40, we're resorbing more bone than making bone. 25% of women and 25% of men ultimately get osteoporosis, which means shrinkage, buffalo hump, where they're kyphosis, or you see men and women walking around with the walkers.

It's because they can't straighten up. But we women get there sooner. We get collies, fractures of the wrist.

You fall off a bicycle or you fall and you hit your hands first. Your wrist is going to break first. Your spine and your hip follow in decades.

Men have 10 years more of grace because they have more testosterone. So there's differences between men and women. Men age in a more linear fashion, meaning because they have so much more testosterone and they don't have ovaries, they have testes that can be stimulated to make testosterone by peptides, which is some of the work I do.

Again, it's in the book on periandropause and andropause for those women listening who have loved ones who are men, whether they're sons or fathers or partners. And I speak to how a male could be going through andropause, which is the equivalent of menopause in women in their late 30s or their 80s. So they have a more extended period, usually where their body is more responsive.

By the time you hit your 40s, there are studies that show that if you're going to decline and you're not doing anything about it, it's not going to be graceful. That's when disease starts showing up in bulk. And then there's a period of quiescence and again in your 60s.

So I'm sure, you know, people who are 70 who are in terrible shape or people in their 40s and 50s. If you go to a high school reunion or college reunion, I just went to my medical school reunion. I was a bit shocked.

I tried to help my fellow doctors who don't practise proactive medicine. And I did it very carefully because proactive medicine is not what we practise around the world. We practise reactive medicine.

You have to break your wrist or you have to have a heart attack and then everybody jumps all over it. So every decade of life changes. Energy is pretty ubiquitous.

Everybody can experience that, that decline in energy, failure to sleep. I think sleep is one of the most challenging areas for men and women. Most women start complaining of difficulty staying asleep as their hormones start to change in their late 30s, 40s and 50s.

And there are ways to treat it that are game changing. And certainly wearables like besides the continuous glucose monitor, I speak to this in the book, using an Oura Ring or an Apple Watch or a Garmin or Whoop can help you determine, are you actually getting enough deep sleep? One worrisome thing is when people need to sleep 10 or 12 hours.

One of my sons has been like that and it turned out he wasn't getting enough deep sleep. And he found that we did a lot of things to help him. The simplest solution was taping his mouth and he started getting deep sleep.

So there's lots of ways we can help ourselves. We just have to have the data and the knowledge and the desire to look within. And then the book to me, Invincible, will help with the wisdom to be able to put it all together and figure out where things stand.

The book to me is my dream because I want everybody to get the help they need. And doctors don't know this. This is not the training we naturally have.

In our training, it's above all, do no harm. But yet we don't like to experiment. We're not entrepreneurial usually.

I'm an exception and I'm even an exception. That's another difference between my twin and I. She's not.

She's risk averse and I'm not. I was trained as a clinical investigator. So I know how to weigh risk benefit and the book shares that.

So what is best for you may not be best for me, but you have to look at the differences between us. Know your family history. What actually emerges in your family history is brewing in you under the surface.

And all of that adds up.

[Angela Foster] (42:49 - 43:26)
Does that make sense, Angela? It's so, so interesting. It's total sense.

Thank you so much for coming on. And I would encourage everyone to go and get your book, Invincible, because it is such a valuable guide for people. Even for like taking it points to your doctor to discuss the five biomarkers that you've shared and just how to begin that journey.

Because I think what you've done on today's episode is really create a different future for so many people. One that we can truly live our best lives and extend, importantly, our health span. Because let's face it, medicine is going to extend our lifespan either way.

So we may as well take charge of our health span. Where can people find you?

[Dr Florence Comite] (43:26 - 44:09)
Did you ask where you can find me? I love people to follow me. I'm at Dr. D.R. Florence Comité on Insta and Facebook, on LinkedIn at Florence Comité, also on TikTok. And feel free to go to my website, which is www.comitamd.com. You can sign up there for the newsletter and the sub stack, be invincible. And that's the name of the sub stack, I believe.

I would love that. I would love to build a following where people can feel free to ask questions and really get answers because I've lived this field for so long. I can see it all, but we still don't know what we don't know.

So learning and being curious, stay curious to get there.

[Angela Foster] (44:09 - 44:18)
I think what's so amazing is just I can see how much it lights you up and just how much this will help so many people. We just share a very similar mission. Thank you so much.

[Dr Florence Comite] (44:18 - 44:40)
And I hope your health is good. I think I read that you had your own health scare a few years ago, which got you into this podcast. And I'm sure inside you'll do all the right things, but wearables are great if you're excited about it and they don't scare you.

It tells you so much about who you are. Thank you so much for coming on. Thank you for having me.

I had such fun.

Longevity expert Dr Florence Comite joins me to explain why testosterone, not estrogen, drives body composition and ageing in midlife women.

Decline isn't inevitable, it's programmable.

She unpacks why low testosterone is likely behind your belly fat, brain fog and low energy from your 30s on, why only a third of us should fast, and the five biomarkers your doctor probably isn't checking fasting glucose, HbA1c, fasting insulin, cholesterol risk ratio and free testosterone that predict where your health span is headed.

WHAT YOU'LL LEARN

- Why testosterone (which women carry in larger amounts than estrogen) starts declining in your 30s - and how its fall drives the belly fat, brain fog and low energy that leave you feeling not like yourself
- What "I don't feel like myself anymore" is actually signaling beneath the surface
- How cortisol quietly drives the anxiety-out-of-nowhere, the 2am wake-ups and the stubborn weight around your middle
- Why only a third of women should fast, and the 3-hour glucose test that tells you which third you're in
- The five biomarkers your doctor probably isn't checking, and what they reveal about your risk of diabetes, heart disease and where your health span is headed