#1 Aging Expert: Dementia, Diabetes & Heart Disease Start After 40 When You Ignore This

1. RCDr. Rangan Chatterjee0:00

   Staying youthful, strong, and mentally sharp as you age is the most important investment you can make in yourself and for the people you love. Yet so many accept physical and cognitive decline as unavoidable, doing little to interrupt the hallmarks of aging. If this is the most important investment we can make, why are so few people making it?

2. FCDr. Florence Comite0:29

   I think we don't know enough, and there's nothing in the medical world that actually treats you proactively. It's all about you getting sick, and it's a reactive healthcare system in most places in the world, certainly in the US, and presumably in the UK. So there's no real basis for understanding what you're looking for, what you need to do, not just to prevent disease, but actually proactively reverse it and own your own health destiny.

3. RCDr. Rangan Chatterjee0:56

   Yeah. In your book and your wider work, you talk a lot about this concept of healthy aging. What do you mean or what should we be thinking of as individuals when we think about that term aging?

4. FCDr. Florence Comite1:13

   I think we should be grateful for aging, because if we're not aging, then we've died young. And so I'm not in favor of the term necessarily anti-aging. I'm pro-aging, but pro-aging in fantastic health, so you can live life to the fullest and be vital to the very last moment. More and more of us are living beyond 100. Antibiotics brought that to the 20th century. This century, equivalent to that is GLP-1s, I believe, and we are gonna be living to beyond 100, beyond 122, I believe. But without investing in keeping our body strong, healthy, without heart disease, stroke, dementia, cancer, we're not gonna enjoy those years. So living long without health may not be as much fun as we have had the rest of our lives.

5. RCDr. Rangan Chatterjee2:02

   Yeah. In that same section of the book, you basically reference what you have just been talking about, the kind of aliveness we all want. We want to be biologically youthful, engaged, and healthy, no matter how many candles adorn our birthday cake, which I, I really like, but I wanna talk to you about this concept of biologically youthful because I'm trying to sort of understand in my head the tension that some people may have between growing old gracefully and accepting the aging process at the same time whilst trying to stay biologically youthful. Are those two things in opposition to each other, or is it possible to do both?

6. FCDr. Florence Comite2:48

   Well, my career has been built on it's possible to do exactly that because you do chronologically age. You do get a candle every year. But we allow our bodies to decline because life expectancy before antibiotics was much younger than it is today, and we don't invest in our health in the way we invest in finances to stay a- well and to be able to live well, right? But how-- where do you live? In your body. If you're gonna age, don't you wanna be in charge of all your facilities? Don't you wanna be able to play paddle ball, tennis-

7. RCDr. Rangan Chatterjee3:21

   Mm-hmm

8. FCDr. Florence Comite3:22

   ... any one of the sports, and also dance maybe at your great-granddaughter's wedding, um, and really enjoy everything life has to offer? And there's data and clear-cut studies, published Michael Snyder in Nature, showing that aging happens and poor health begins to be obvious and palpable in the 40s and then again in the 60s. And once you hit 70s, you-- there's a group of people that can go on and continue neurologically sound, but for the most part, we are declining, and in order to not decline, we have to be proactive.

9. RCDr. Rangan Chatterjee3:57

   What would you say are some of the most prevalent myths that exist in society or beliefs that exist out there about the aging process?

10. FCDr. Florence Comite4:06

    The biggest myth is that you can wait. You can wait until you're sick, because we tend to reinforce that. When do we see a physician?

11. RCDr. Rangan Chatterjee4:13

    Mm-hmm.

12. FCDr. Florence Comite4:13

    When does a physician actually start exploring? A lot of physicians feel that by looking at your tests, by understanding what's going on at the cellular level, we can just keep an eye on it, or it's all in the normal range, and both of those statements are outrageously wrong.

13. RCDr. Rangan Chatterjee4:27

    Yeah. The way you write and the things you talk about in terms of how you've practiced for many years resonated so deeply with me, this idea of every patient being an individual, and actually, we need to find the right approach for them, what you, you know, the term you coined, N equals one medicine, right? So I, I really enjoyed that. I enjoyed this idea that there are seven aging patterns that you have recognized, which I'd love to talk about, but also this idea that whatever we're doing, whatever we want in health, ultimately, you've identified five key biomarkers that can give us a representation of how well we're doing. I very much like that approach because I think these days there's so much data out there, and I think it can become very overwhelming. So we'll definitely get to those five key biomarkers shortly. But this idea about aging, you mentioned Michael Schneider's work and what happens at 40 and at 60. I've heard you talk before about this idea that it's in your 30s where people suddenly start to feel things going wrong. Can you elaborate on that a little bit?

14. FCDr. Florence Comite5:42

    Yes. So Abbie Hoffman, I don't know if you recall who he was, uh, it ends at 30, and that's because in our 20s I think we can compensate well. We can burn the candle at both ends. We can ski all day, party all night, and still get up the next day and ski, and we don't pay a huge price for it. But as we enter our 30s, biologically, metabolically, hormonally, our system is changing. It may not change in a way that's palpable. It may not change in a way where symptoms have emerged, but we know that because we know men begin to get heart disease in their late 30s. We know women begin to put on a few pounds around their waist, and we know hormonally it's driven even if you're trying to do everything perfectly. Let's rule out the fact that in our 30s, which u- is used as excuses for the most part, real excuses, we're raising children, we have a busy career, we may have aging parents. We're coping with things, and we c- may not get into the gym. We may not eat correctly. We may not be able to get enough sleep. But if you do all of that, you are still aging, and you're aging in a way metabolically that undermines your health for the future. And by thinking that way, that's the way I began, and looking at where peak health happens, and we know that because of athletes. We know that 27 or 25 to 30 is a perfect time to have children. We're supposed to be optimal. You can still see disease, and you can still assess it in the 20s, even in the teens, and even in children, but where it begins to matter is our 30s because that's when hormones really start to decline, and that's when metabolism changes because hormones are declining, and you can't maintain muscle in the same way even if you do everything you've done before.

15. RCDr. Rangan Chatterjee7:29

    Yeah. This is really interesting that by the time modern medicine gets involved, you are way down the road to getting sick.

16. FCDr. Florence Comite7:41

    Absolutely. In fact, diabetes, heart disease, dementia, that's not overnight. It's not what happens from one week to the next. Your heart attack has been brewing generally under the surface for decades. Insulin resistance is seen decades before florid signs of diabetes-

17. RCDr. Rangan Chatterjee7:59

    Mm

18. FCDr. Florence Comite7:59

    ... whether it's tingling in the feet and hands, whether it's eye disease, kidney disease, any number of issues, and yet we don't look for it until we're aggressively active, we have symptoms, and they've emerged. Because medicine, the way we practice it today, is about disease. It's reactive. So we're 10, 20, 30 years down the line already, and we've been dealing with these conditions under the surface.

19. RCDr. Rangan Chatterjee8:22

    Yeah. Here in the UK, we have the National Health Service, and that has been fantastic for many years, and elements of it continue to be fantastic, but what I don't think there has been is a recognition of what it actually is. It is a disease management service.

20. FCDr. Florence Comite8:48

    Exactly.

21. RCDr. Rangan Chatterjee8:49

    And sometimes it can do that exceptionally well. It is not a health creation service, but also this idea that actually it does prevention is, is unfortunately very, very misplaced because the current NHS's idea of prevention, and I, and I get- I'd love to get your take on this, is once you hit 40, you will be invited in for a very basic blood panel, so lipids, you know, fasting glucose, um, maybe an A1c, an average blood sugar, and a blood pressure reading. If it's deemed normal, not optimal, normal, that's it. You, you just... You, and you have a blood pressure reading. You, you crack on with your life. That, that's prevention done, and if there's a issue there that they pick up, yeah, they might see you again. But I feel it's so dated, but of course, you've been practicing a true preventive model, a true health creation model for several decades now. So firstly, what is your take on what I just said in terms of what you are offered currently in the UK on the National Health Service?

22. FCDr. Florence Comite9:56

    I can't speak intimately to the UK-

23. RCDr. Rangan Chatterjee9:59

    Sure

24. FCDr. Florence Comite9:59

    ... because I'm not as closely knowledgeable as you are with how they operate. I will tell you I've had patients in the UK, and I've had interactions even this week alone as I talk about Invincible and the book that I hope to get in everybody's hands because people have complained to me and said they have symptoms. They have vague symptoms. They're in their 40s, and they're not getting any direction. They've gone to five or more doctors, and no one can help them both figure it out and also put in place ways to stop the diabetes their mother had or the heart attack their father or dementia in their grandfather. And so to me, what I think about is proactive prevention, not just reactive prevention, which is what you described. And a one-time measurement is meaningless because what you have to do is look at trends.

25. RCDr. Rangan Chatterjee10:50

    Yeah.

26. FCDr. Florence Comite10:50

    You're told you're normal, but that normalcy, what so-called normal, is based on a derivative of average of one size fits all in a sick population because there's no telling where those blood results have come from. They're measuring a thousand, even a million people, and the ranges are broad, and you fall anywhere. It's population dynamics. It's not about you, distinctly you, and it's not about the ins and outs of where you go as you travel-

27. RCDr. Rangan Chatterjee11:17

    Mm

28. FCDr. Florence Comite11:17

    ... as you travel in life. And so it is similar in the US. We probably have a little more access. We've lost the art of family medicine-

29. RCDr. Rangan Chatterjee11:27

    Yeah

30. FCDr. Florence Comite11:27

    ... because it's gone. Most people use urgent care. But in the UK, from what I've seen, and I've counseled people about even getting an appointment based on symptoms. I tell them I, I had a young woman in her 20s who worked for me, and she looked incredibly pale. Um, it might have been her complexion, but she was feeling weak and not so well. She could not get an appointment, and I said to her, "Listen, you might wanna tell whoever you need to tell to get an appointment that you feel faint when you get up, when you go from sitting to rising. You feel weak. You feel like, um, you're, um, losing weight, and you need a workup." And so she got an appointment, and the workup consisted of a stethoscope on her chest, and she was told she was fine, and two weeks later she was hospitalized because she was profoundly anemic. And so nobody looked at... I told her the options are anemia, thyroid disease. She was only in her 20s. And so I think less is more in medicine. Like, it is not about searching for abnormalities. It's about looking for how an individual is evolving and particularly looking at an individual, not at the population.

Episode duration: 1:33:33