Dhru Purohit Show - A Yale Physician Shares The Most Important Biomarkers To Track for Disease Prevention & Living Beyond 100 with Dr. Florence Comite

Episode Date: August 5, 2026

This episode is brought to you by BiOptimizers, Momentous, Cozy Earth, and Bon Charge. Today on The Dhru Purohit Show, Dhru sits down with Dr. Florence Comite to unpack the biggest lessons she's learned from more than three decades at the forefront of personalized medicine. She explains the lifestyle factors that drive heart disease in both men and women, why diabetes is often at the root of cardiovascular disease, and the key biomarkers everyone should monitor early to help prevent chronic illness. Dr. Comite also ranks the most important lifestyle habits for longevity and reveals the hormones that play a critical role in preventing osteoporosis, maintaining strength, and reducing the risk of falls as we age. Dr. Florence Comite is a New York Times bestselling author, Yale-trained clinician-scientist, and one of the world's leading experts in precision medicine and healthy longevity. A former Yale faculty member for 25 years and founder of the nation's first women-only clinic at Yale, she later founded the Comite Center for Precision Medicine & Healthy Longevity, where she pioneered the Nof1™ approach to personalized healthcare. She is the author of Keep It Up and Invincible: Defy Your Genetic Destiny to Live Better Longer, and her research has been published in leading medical journals, including The New England Journal of Medicine and JAMA.  In this episode, Dhru and Dr. Comite dive into: (00:00) Introduction (2:40) Journey into Precision Health & Longevity (6:39) Why Hormonal Shifts Increase the Risk of Heart Disease (12:07) How to Assess Your Risk of Heart Disease (15:27) The Truth About Sugar, Blood Pressure, and Insulin (24:20) Diet vs. Building Muscle: Which Matters More? (31:05) The Five Most Important Biomarkers to Track (33:59) Why Dr. Comite Started Taking Testosterone (38:34) Calcium vs. Vitamin D: What Matters Most? (44:48) Is a DEXA Scan Worth It? (46:45) The Two Habits That Protect Your Healthspan (57:05) Everything You Need to Know About Running (1:00:07) What Are the Optimal ApoB and HDL Levels? (1:07:28) Fasting Insulin vs. A1C (1:09:29) How to Get Enough High-Quality Sleep (1:12:07) Rethinking the Importance of Sleep, Exercise, and Nutrition (1:14:50) GLP-1s: The Antibiotics of the 21st Century (1:17:45) Final Thoughts and Takeaways Also mentioned in this episode: Invincible: Defy Your Genetic Destiny to Live Better, Longer Keep It Up: The Power of Precision Medicine to Conquer Low T and Revitalize Your Life! For more on Dr. Comite, follow her on X/Twitter, Instagram, TikTok, YouTube, LinkedIn, or visit her Website. This episode is brought to you by BiOptimizers, Momentous, Cozy Earth, and Bon Charge. Upgrade your sleep! Head to bioptimizers.com/dhru to take advantage of BioOptimizers ''Back to School, Back to You " sale, happening August 3–16. Get 20% off select products, plus a free tote bag with orders of $99 USD or more. Right now, Momentous is offering our listeners up to 35% off their first order with promo code DHRU. Head to livemomentous.com and use code DHRU for 35% off your first subscription. Right now, get 20% off the Cozy Earth plush towels. Just head over to cozyearth.com/dhru and use code DHRUP. Right now, Bon Charge is offering my community 15% off their Red Light mask. Just go to boncharge.com/dhru and use code DHRU to save 15%. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Disease doesn't happen overnight. Why are we waiting until the last possible moment when it's erupted? Why not start 20, 30, 40, 50 years before when actually you can see signs of it emerging at the cellular level metabolically? Give us a little bit of a teaser here so that people know what these important biomarkers are. As a researcher and a clinician, I was able to design N of one studies where I could look at individuals and see over time what their prototypes were like. Doing so, recognize that there were five key true biomarkers of health. Three of them touch on carbohydrates, a cholesterol risk ratio, and the last one, and this is almost never done, is free testosterone,

in women as well as men. In the case of heart disease, what are some things that people should be doing today? Each one of us is on a path to diabetes. It is the biggest cause of heart attacks. If you're not aggressive about treating these symptoms and signs of disease, that is inevitably in your future, you can't stop it and reverse it. And I believe it is possible because I've done it for years.

What about a Dexa scan? 25% of men and women become osteoporotic. In women, it starts 10 years before men. Dexes are critically important for women and for men. Joining us today is Dr. Florence Comete, a Yale-trained clinician, scientist, and leader in precision medicine. She shares what 30-plus years of clinical experience

have taught her about using biomarkers, hormones and personalized lifestyle strategies to prevent disease before it starts. I believe many people will reach triple digits in excellent health. Some will live to 110 or 120 with sharp memory, strong bodies, and meaningful independence. Talk to me about this quote and idea behind the book, Invincible. What gives you the confidence that that's possible? And then secondarily, what are the top things that are getting in the way of that goal? So first of all, we are already living to three digits.

In fact, there's so many people living till over 100 that Willard Scott on NBC who's doing announce happy birthday couldn't do it. They ran out of space. But the question is we have long life and longevity in some ways due to antibiotics from the last century. But we don't have health span. We don't have health. We can't live in optimal health.

So my work started about 30 plus years ago when I started women's health at Yale and then rapidly went into men's health. And I knew that if we could dig into each person's system, we can help avert and change their health destiny. And if by doing so, looking at their total health picture, something I call the health story, it would make a difference in terms of owning vitality for the rest of their life. You know, I want to jump right in and talk about some of these diseases that we all suffer from. And one of the big ones that's out there, a lot of people listening, you know, my audience is about 75% women. Still to the state, a lot of women actually don't know that heart disease is not just the number one killer. of men, but it's the number and killer of women as well, too. I want to start there. Can you talk

about that a little bit? When I graduated Yale Medical School, I realized that medicine is reactive, not proactive. And at that time, around that time, I was looking at numbers and people and understanding that I could connect numbers through the system. As an endocrinologist, I could read the system because endocrinology and hormones are messengers in the body. And I wondered why we were waiting. And the first woman, for example, I saw at the woman's health initiative, that I started at Yale in 1992, she was telling, she was about 40 and about to start a family. And her mother had died of a massive heart attack in her 60s. And her father was still alive and well after an angioplasty in his 80s. And she said, help me. I don't want to be like my mother.

My mother went to the doctor. Doctor told her she had emptiness syndrome, gave her some librium and valium. And she ended up with a massive heart attack. He was labeling at panic attacks and nerves and emptiness. And I looked at her data and I'm like, well, you're on. track because you have underlying sugar abnormalities or carbohydrate abnormalities. And you had abnormal lipids. And what happens to women as they age and they don't recognize it, even if they've been told their whole young life up until 40s, that their cholesterol looks great. They have great, good cholesterol. But as they hit menopause, hormones change just like they do in men. And so heart disease becomes prevalent, but a little later than in men. In men, because of the different

mix of hormones and molecules in the body, they have heart disease and they can get heart attacks beginning in their 30s. For women, it's more like 40s and up. And so women aren't quite aware still, and that goes back for me over 35 years ago. So the cardiologists were all shocked when I told them that. In fact, there's a story I haven't told in a long time. But when I was studying the field in those years, I remember finding an article about heart disease for women. And it was a meeting that the American Cardiology Association had for the spouses to worry about their husbands with heart disease, not for the women themselves. So women really weren't included in big organ disease. As men aren't included in hormonal issues, it's not just testosterone in men.

It's a lot of other issues. So there's problems in both sides that we kind of ignore until we're faced with it, which recently has become more, everyone's become more aware. You said a couple of things that I want to make sure that we tease out because, you know, You know, your background is in endocrinology. And one of the key ideas inside of this book is that we start aging a lot earlier than people think. And it's all about catching these biomarkers especially that are proxies that show us that we're heading in the wrong direction and that we're on our way to chronic disease. And if we can catch them early, then we have a much better shot of aging well. We don't want to be 80, 90 years old with, you know, dementia and heart disease and cancer and all these other things.

We want to get to these ages, even 110, 120, and be well inside. So from an endocrinologist's perspective, you mentioned two important things that were there, the unique sort of hormonal milieu that's happening and the shifts that happened in the 30s and 40s and 50s that can create or contribute to the cascade in the case of heart disease. So you were mentioning testosterone with men. Give us an example as one of the hormones of how when our testosterone is not optimal, even in our 30s, 40s, 50s for men, how that specifically like mechanistically contributes to heart disease. What do you think supports muscle, testosterone? And so as men and women age into their 30s, and it's not like it isn't present before that. You can see this diseases in children.

Chronic diseases of aging start in childhood and even in utero because it's genetically dictated. In fact, we now know that there's data that shows far more control genetically than lifestyle. You can change the direction of the way you live with lifestyle, medication, supplements, and the expression of genes, but you can't change your genes usually. So when you hit your 30s, your hormones begin to slip 1 to 3% a year. Testosterone starts falling. And if you look at a human's entire system and the way they live life, you can connect the dots, put the pieces together and say, this is the path you're on.

It's quite like a crystal ball to me. So I can look at a whole series of numbers. And in the end, when I started working in Silicon Valley a few years ago, I was told it's a superpower. Until then, I thought every doctor did that. Like, we learn every area just about. And so why don't we see it? But it's not the case. Most people stay in their lane and medicine is kind of siloed into reactive.

So you show up in a doctor's office or in an emergency room with your heart attack. 80% of diabetes is diagnosed in the emergency room when someone's sick and can't recover from an acute illness, like an infection. And why is that? Because disease doesn't happen overnight. Why are we waiting until the last possible moment when it's erupted, basically, we're very sick? Why not start 20, 30, 40, 50 years before when actually you can see signs of it emerging at the cellular level metabolically? So yes, biomarkers are critical if they're tightly woven into the story of your life. So it's who you are. It's the kind of life you've chosen to live or that's imposed on you, whether the way you sleep or don't. Do you get quality sleep, not just the six to eight hours?

What kind of workouts are you doing and are you putting some effort into it? Maybe if you're a gardener or somebody who does a lot of heavy lifting, you don't have to do resistance training, but that helps with aging. The food you eat, you know, how clean is it in terms of processed or ultra-processed food? And all of those factors tie together to create a path to heart disease. or to living well until you're 120. You also had mentioned about women and how, if I understood this correctly, and I think you write about this in the book too, that when women head into paramedopause and then menopause,

their risk of heart disease greatly increases. Is that correct? Can you explain a little bit about why? So estrogen's protective of the heart muscle, and in general, certainly the last 20 years, since the Women's Health Initiative trial at NIH, where they just tested one estrogen and one progesterone, neither of which were great for women.

The estrogen was peremorin. The progesterone was provera. And they were bad for women. The estrogen came from pregnant mares, horses, urine. And so we had a lot of other stuff in it that are good for horses, but not necessarily women. So it sort of tanked the whole field. Millions of women were crying off of hormones, and that just recently got reversed in November, where the black box off of warnings came to be.

But I've never changed the way I treat women because I selected, you know, natural sources of estrogen and used it in such a way that I looked at risk benefit for each person and be able to apply those hormones. So when women as estrogen starts shifting in the 30s and more so in the 40s, when a lot of women are going through perimenopause, even though each woman is unique, just like I am. So the other facet of the work I've done for over 30 years is N of 1. As an identical twin, I knew that my twin sister and I were also very different. And why is that?

We have the same genes, right? We inherited the same patterns, but we live life differently. And so I look at each woman as their own kind of unique being and look at where she's is and where she's headed. So one of the other reasons the woman's health trial at NIH really tanked was that they were studying women in their 60s who already had heart disease and they basically said these hormones contributed to heart disease when really the underlying problem was they had heart disease

and estrogen could have helped them. There's a lot of this confusion in medicine because interpretation isn't always clean. The kind of database you look like may not have been chosen effectively. Same thing in men where they used to say testosterone was dangerous when it was shown in men and women that it actually helps prevent chronic diseases of aging.

So, you know, an important question that you ask in the book when it comes to heart disease is why are we waiting for heart attacks before we get serious about taking charge of our health? And I think that's an important question for a lot of people, and a lot of people who are listening today are saying, okay, if we can catch these diseases early, well before we end up in the emergency room or even die, I think it's like 50% of people have no symptoms for their first heart attack and they just end up. Or no symptoms

that were picked up. No symptoms that were picked up. So in the case of hard disease, where we're starting off first with your invincible framework, what are some things that people should be doing today to assess their risk and know if they're heading in the right direction or not in the right direction. So one of the big areas that I find even trained physicians and clinicians and PhDs, and I have one such person in mind who teaches at Stanford. And he's head of personalized and precision medicine there, genetics in a genetic direction, is that it's not just cholesterol, which you should look at.

Absolutely, and you should look under the surface at things like LP little A and APOB as a stand-in marker for LDL with a bad cholesterol. But sugar, sugar is a big factor in every disease of aging. And the fact is, I used to hate diabetes because I knew what it did to every cell in the body, not just what it does in terms of your eyes and your kidneys and your brain, but it is the biggest cause of heart attacks and equal to somebody will get a heart attack. in the same number of people if you've had a previous heart attack or you have diabetes. And each one of us is on a path to diabetes. Because the genes we've all inherited and they're all different

and they're all a mixture, those genes dictate that we put on fat when we can because we need to live off those genes. Our ancestors survived bad times, like in cavemen, when there was no food and you starved during the winter. If you didn't live through that time or the Holocaust or the Irish famine, your genes weren't inherited. So people who couldn't live those times, we didn't get their genes. We got the genes that said, times are good, put on weight, and then you'll live off of it

during the bad times. But as we age and testosterone falls and we have less muscle, we aren't able to package that sugar. We're unable to manage it. And testosterone, sugar, hormones, sugar, and cholesterol are all factors that need to be studied in each person. And you don't even start with biomarker. You start with what's going on in your family.

Those are the genes that are going to dictate as they emerge what you're going to be dealing with in your future health trajectory. That is where you have to focus. And you can start as young as childhood. In fact, I sometimes would help my sister out and in her office and I would see all these little kids on acutane. And I would get their story, and you know with acutane,

you have to study lipids, cholesterol, right? And I would talk to them because if cholesterol goes too high, you don't want to keep them on that dose of acutane. dose of acutane, you have to adjust things. And I would talk to them about their family history, usually their mom and dad were with them. Inevitably, there was rampant heart disease and stroke and diabetes. And so you could tell, even in a young age, both the numbers and the stories add up. And everyone can do that. Of course, if they're adopted and don't know their biological family or they don't have close relations, which is not a good sign either with their family or friends,

those are factors that you can circumvent. I've had lots of people who don't know much about their family and their earlier years. But by looking at the data, because I'm a data geek, by understanding that data, you can apply it in the same way once you extrapolate from the bigger story. Touching on sugar, because I think that's one of those areas that can be a little bit confusing for people. And the intersection of sugar and hard disease is the idea that elevated and, uh, a blood sugar roller coaster, which a lot of people are on throughout the day, many don't know. You know, they've never worn a CGM. They've never seen it.

His idea that it's multifactorial, like it's glycation inside of the body. It's also sort of stress on the endothelium and contributing to, like, chronic inflammation. Like, what are the things that you're worried about the most when somebody is either pre-diabetic and doesn't know? Or is, you know, even maybe pre-pre-diamatic. diabetic and their sugar is just out of whack. They're just young enough that they can tolerate it and repair. But as they get older, their body doesn't get a chance to repair as easily. So what do you worried the most about sugar when it comes to hard disease? When it comes to sleep, it's not just about hours. It's also about making sure you get the right nutrients to support your sleep. And one of the biggest

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Just go to live momentus.com and use the code Drew, D-H-R-U, for 35% off your first order. That's live-M-M-M-M-M-M-M-E-N-T-O-U-S dot com and use the code D-H-R-U. That's me to save 35% off today. For all the reasons you mentioned. So you could have fooled me because you're playing doctor here, but you mentioned all the critical aspects of what happens with sugar.

First of all, I have studied thousands of people gone on to do, and most of them, an oral glucose tolerance test, which is a three-hour test of how your body does manage a pure dose of sugar. Often pregnant women have to do it. All pregnant women, because it's a stress

around the body. Why do we do that? And why haven't we connected those dots. It's because when you are carrying a baby, you have a stressor, and any stressor will have you mismanaged sugar if you have that tendency. And by the way, I have yet to meet someone who doesn't. So I wrote an op-ed piece back last year talking about how these genes we've inherited to survive also play a negative role as we age and we're living in a land of plentiful food or bad food and processed food, ultra-processed food, because our sugar is on a

roller coaster. And it's not just blood sugar. I actually, the CGM, as you know, the continuous glucose monitor, which I'm wearing right now, I wear it all the time because I'm addicted to numbers. It's on a roller coaster for a reason because we don't manage how we live life. We don't know. We get a blood draw on once a year and the doctor typically will say, your sugar's a little high, let's keep an eye on it. Well, what does that mean? We're going to keep an eye on it until it goes to diabetes. And almost everyone has abnormalities. I have yet to meet some. I have yet to meet someone on the five biomarkers of health that I talk about in the book that has optimal biomarkers. And that's a complicated kind of issue because the labs we have in this world are based on

unhealthy people. You're studying people who have no idea what's going on in their body because of people taking the test to just getting averages and ranges. And so it means very little to you as an individual. That's why studying yourself to the degree you feel comfortable, like you're You mentioned, you know, you test yourself a couple of times a year. You want to see what it's doing. But the more you get that kind of data, the more you can kind of redirect and course correct

what your body is doing. And I can even use myself as an example. For years, my hemoglobin A1C was well under five, which is optimal. So forget 5.4, 3, 6, 7. 5.7 is pre-diabetes, 6.5 in up as a hemoglobin A1C, which we now all know because of Ozempic and the score of seven that you hear in the commercials, OOO-O-O-Zempic, get your number down below seven. You're still a diabetic.

And by having my hemoglobin A1C under five, I was comfortable with that, right? Until I started studying my fasting insulin and my fasting sugar. And I realized my fasting sugar was always a little high. Instead of being between 70 and 80, it was always in the 80s. And when I wasn't well in the 90s and when I was really sick, it actually dropped really low,

all of which I now know because of my CGM. And because I can wake up in the morning, and even if I'm not certain what's going on, those numbers help me figure out and tap into what my body's doing. And over the years, I had course corrected. I realized I had insulin resistance. My insulin was very high when fasting, when you should see no insulin. When you are past three hours of food or overnight fast where most tests get done, your insulin should be unmeasurable, under two.

And instead, the academic world and the, sort of world of labs will say two to five is fine, but there's no reason to have insulin around if you haven't eaten. Even on some of the other well-known labs like Quest, if you read on the bottom, it says it's okay to have an insulin up to 17. Why is that? Because we're basically an unhealthy population and the data we're basing our own needs on is a population-based data, like it's research in populations as opposed to unique human beings. That's CGM and the information you can collect about yourself and if you can interpret it, can set it's so easy. In my case, now my sugar stay tightly between 70 and 120 and I don't work very hard at it.

You can check with my colleagues. I have a sweet tooth. I'll eat ice cream, but a banana will shoot my sugar up sky high. So I find ways, and that's written about Ininvincible, that you can manage that and keep your sugar within that range that you need to keep it. So you don't have sugar floating everywhere in your body, causing inflammation, which insulin contributes to, whether it's dementia, which I'm sure you've heard is thought of as diabetes type 3, or osteoporosis, which insulin has a role in bone resorption, or any one of

the diseases of aging from heart disease to stroke to, of course, diabetes, any one of those diseases is related to sugar and sugar abnormalities. A question that a lot of, you know, experts have proposed on this podcast is that are we putting too much pressure on our diet? to achieve some of these optimal numbers when the truth is that a lot of people actually would have much better blood sugar fasting insulin if they just put on more muscle men and women included and we're just more active than they were because we're so sedentary as a society you know we get worried about a banana you know upping our blood sugar which you know your blood sugar is supposed to respond and

obviously you know bananas are higher sugar in terms of fruit that's there but what are your thoughts about that? Like, are we putting a little bit too much pressure? I'm a huge fan of CGMs. People know on my podcast. I'm an investor in levels. Love, you know, them. They can provide very actual insights.

I think even in the most compliant I've also been, I've never seen my fasting insulin go less than like two, right? That's there. So I don't know if I've ever met anybody that has zero fasting insulin. Less than two is really the closest the assay can get to. So it doesn't say zero, but it's less than two. Okay. So let's go back to that main question that's there.

is that diet is so important. I'm 100% there. Are we putting out an unreasonable goal if we're talking about, and I know you do talk about muscle and the importance of that, but just in the context of this conversation, would a lot more people have better blood sugar and fasting insulin if they didn't put as much pressure in their diet. But if I was my mom listening to something that you just shared right there,

I'd be like, oh, man, freaking out that my diet is not perfect enough. Let me address that. I agree again completely. In fact, when I started this work, I used to think the order of importance was exercise, nutrition, sleep. So let me first start with diet. You can work around almost any kind of diet by starting with intake with protein, fat, and fiber before you dig into carbs because a banana is great. It's a fabulous piece. We have a lot of good minerals and an apple itself has 10,000 ingredients.

So as long as you're eating quality food and you're getting and you're able to absorb and use the nutrients you get, food is critical and it is not the biggest driver. So if you do use a CGM, you will see that sleep is also a huge component. And we get far less sleep, I think, as a society, we all have social jet lag because we're trying to accommodate. I've had patients tell me when they do their intake that they can sleep when they're dead. I'm like, you're going to be dead pretty soon, you know, because sleep is paramount. So everything has to be in balance. And I believe moderation, not deprivation. I wouldn't want your mother to worry because almost any way anyone has eaten, we have been able to help them figure out how to make minor adjustments even and switch up how they do it.

Alcohol could be a big offender of sugar because when you're drinking wine close to bedtime, you're changing the way you both sleep and your hormones get secret. It's not just the circadian rhythm. And so there are multiple factors that are broken down and invincible so people can see what applies to themselves. So there are patterns of aging and patterns you've inherited. So first of all, look around at your own family, if you're lucky enough, you know, to have a family and you can see what's gone on in parents and grandparents, aunts and uncles, cousins, sibs, and then figure out what in your life is going awry. So somebody comes to me, it's not always food.

food. Food is definitely a contributing factor. It's number two for me. Sleep is number one and paramount for everybody and not just for me. And I have my own stories about sleep, which I can share with you too in the context of what changes and why. And exercises last actually. So when people don't sleep enough and don't get quality sleep, they actually start secreting something called Grellin. And Grelin is that grr-hunger hunger thing. And you actually crave bad carbs in the grelin. So can you never eat a donut? Absolutely not. Of course you can have a donut, but do it in moderation. Do it where instead of maybe biting into that donut that you love so much at first, take a couple of nuts or take a piece of cheese or do something that is protein.

Keep trail mix on hand so that you're getting the mix of like nuts and even dark chocolate and, you know, anything you love in it, cranberry, dried cranberries or raisins because there are so many ways instead of thinking in a big picture way of, oh my God, I have to diet, I have to watch every morsel that goes in my mouth. I couldn't live like that. There are people who do. Like Brian Johnson has set a course for himself that I could not live in that world. It would make me insane because I wouldn't be enjoying life and I want to enjoy life. What's the point of living a long life if you can't have fun with it and you can't have vitality and joy and take pleasure? And food is part of pleasure, right? So we work with some famous chefs who also

work with us on this, but I leave it up to each person once we get the understanding of who they are and what their makeup is as to how we're going to make changes. Because if you're Asian versus if you're Hispanic or Mexican, your diet may be completely different, the kinds of foods you eat, and that frames who you are and expression of genes. So we're not going to say, no, you have to leave that all along. Even intermittent fasting, which I know is really hot, and I think you did a nice podcast on that, a third of people, They can fast all they want. It won't change anything.

And a third of us fast, like I'm in that category, I can fast all day and I'm fine. I don't get hungry. My sugar stays fairly balanced. That means I'm a survivor. I come from survivor genes. But there's a third of people who they fast. It's actually dangerous. They can't go beyond three hours without having some form of food to maintain their sugar

and not just blood sugar. The CGM, you know, it rests in the interstitial fluid around the muscle. So sugar goes to every cell in the body. Think of little powdered jelly donuts. And the reason why diabetes causes all these disorders of aging is because they're tackling every cell in the body. They're traveling everywhere, these little red blood cells coated with sugar. So the more sugar they're coated with, which is what the hemoglobin A1C tells us, the more they're going to damage your brain. They're going to damage muscle.

They're going to damage nerves, eyes, kidneys, heart. So I used to teach about diabetes in medical school. And I just used to point out to the Yale medical students that, you know, it's course correcting somebody so that they can live the best life they can, but recognize the impact it can have on their body. And that's where all these wearables are so useful, every single one of them, to the extent somebody wants to experiment with it. You mentioned the five biomarkers. That's, you know, something that's broken down inside the book. But give us a little bit of a teaser here so that people know what these important biomarkers are because they touch on a lot of the things. themes that you've been covering so far? I know the trend nowadays for everyone, whether it's

ORA or the labs themselves or every single company you name, is to get a ton of biomarkers, like hundreds if not thousands. And I personally have done that. I've built the program I built protocol driven. That means it's approved by a university who says you can publish the data. And I did that intentionally because I didn't know whether my theories would pan out. But as a researcher and a clinician, as I was trained at NIH with brilliant mentors, I was a able to design N of one studies where I could look at individuals and see over time what their prototypes were like. And in doing so, recognize that there were five key true biomarkers of health. Three of them touch on carbohydrates, fasting sugar, hemoglobin A1C, which is your average

sugar over the past 100 days, and fasting insulin, which is such an early marker of diabetes and inflammation. I can't believe we don't standardize it in childhood. A cholesterol risk ratio, not because there aren't other particles and tests we should do like APOB or LP LP, A, but in general, that's a commonly done test, and that's the average of total cholesterol divided by HDL or the good cholesterol. And if that average is greater than two, you're going to be at risk. And the last one, and this is almost never done, is free testosterone in women, as well as men because we women have more circulating testosterone than estrogen. And yet nobody thinks about it. We don't even give women testosterone. We suppress them with birth control pills. And I've seen a lot of

young women in their 20s who show up with diabetes and higher risk of diabetes and start putting on weight because they've lost their ability to put on muscle because we're suppressing their release of testosterone. So those are why those five biomarkers, fasting sugar, hemoglobin A1C, fasting insulin, cholesterol risk ratio, and free testosterone, not total, men and women, tell us what is acting in the body. And that's a great place to start. And that's what I really endorse people doing, along with wearing a continuous glucose monitor and seeing what changes happen, getting your own true story, your health story is what the way I think about it,

not just a chief complaint. I don't want to see a person coming in saying, you know, I have an elephant sitting on my chest. and we know they're having a heart attack or they're garbled speech and they have a stroke. I want them to know decades before they get any of those symptoms that they can reverse it and stop it and that's what we do.

I don't have one person on insulin ever. And the reason is I've reversed diabetes for years. So I see it. I see it emerging in people and you can stop it in its tracks and actually reverse it. One quick note about testosterone. I think I heard you say in another interview

You've been on testosterone for now, how many years? 30 years. I started when I started the Women's Health Initiative at Yale. Women's Health at Yale, it was called, actually. I started seeing women because I was in the field of peptides, GNRH analogs, which actually treat women who have infertility, pain, endometriosis fibroids. And I saw these numbers in women, and I was creating sort of an artificial menopause to treat them,

to either get pregnant or to stop their endometriosis and other symptoms. pain and I recognized that I was at high risk because I was studying their bone density and turnover as well. And I recognized they were at high risk because I was putting them into menopause and that's when osteoporosis and bone loss starts happening more. And I had both a maternal aunt and a paternal aunt who died as a result of osteoprocess. In fact, my father had more osteoprocess than my mom, but both of them had it. Can I ask you a just a quick question? When somebody dies of osteoporosis, like what are they actually dying from? So their bones are beginning to collapse in their spine. So in a large effect, it's breathing. Their lungs, they're

collapsing their lung. They're shrinking. They don't have the frame to support breathing. Right. An interesting little tidbit that I saw in my woman's health trials when I was seeing a lot of women then is that women who started saying that they woke up in the morning and they drove their car to work and on the way home, they would have to readjust their mirror because they couldn't see out of it in the same way. Almost always had bone loss already. because they were shrinking. Gravity doesn't help during the day, but that was an early sign.

But every woman and every man, 25% of men and women become osteoporotic. But as I mentioned before, in women, it starts 10 years before men. We get collies fractures of the wrist. If we fall off a bike and we use our wrist or we trip and fall, then we get hip fractures,

and then we get spine shrinkage or chifosis or buffalo hump, which we call it. And if one woman isn't getting it, and she has two other friends, one of those three women will get osteoporosis. Same thing as men, but men have more testosterone. So whereas estrogen and everyone knows estrogen affects bone and it does, testosterone is actually more powerful for bone. And that is why men tend to get heart disease 10 years before women because we have estrogen and that's important for the heart. Whereas we have more estrogen, whereas men have more testosterone so they protect their bones longer.

I hope this isn't overwhelming. No, this is what our audience loves. I describe our audience as professional amateurs. Right? They may not be in medicine. You know, they didn't go to Yale. They didn't teach there. But they are the person in their friend group that is, you know,

staying on top of what's out there. Maybe six years ago they really started to hear that protein was an important part of supporting muscle, which relates to longevity, even for women. And they love to dive deep into this because it feels like a little bit of a master class for them. So I love the details. I'm thrilled because I did. I did this work and I'm still passionate,

as you can tell, despite how much I have to say it, because to me it still hasn't come to fruition and the whole notion of you being unique, knowing I know that in my heart and soul from my twin. I can live on sushi and sashimi. My sister won't eat fish. She's an amazing gardener and I basically murder plants. I keep people alive, but not.

And so it's so important to me because when I started this work, I didn't know where it would end up. But I thought in terms of, have you heard the term, sure, bricks and clicks, that there's bricks and mortar and then there was clicks. And to me, if I could prove the model at the time genetics was emerging, the internet was emerging, that it should be for everyone. I believe everyone should own their own health destiny. And that's why I wrote this book. It wasn't easy to write.

I didn't give up any of my other jobs. And I am an entrepreneur because I create outside the field of medicine. In fact, people laughed at me. I did a journal club around the time of women's health when I was starting the work in longevity and precision medicine. And I was explaining how in your 30s, everything begins to decline. Fertility becomes an issue for women, heart disease in men, women start putting weight around the middle.

And I asked myself, why aren't we looking at that? Why aren't we doing this? And I was just lucky that I was able to see these patterns, which Silicon Valley, called a superpower. And to me, it was easy. It wasn't, and, you know, I could just do it. I didn't think about it. So I figured everyone could do it. I want to double-click on osteoporosis for a second. How important is calcium to the conversation? There are only a handful of brands I've talked about consistently for years and cozy Earth is one of them. So when I heard they were bringing the same premium comfort that we all love beyond the bedroom with their new beach towels,

I got super excited. As a new dad, I'm spending a bunch more time. outside, trying to get my son, that healthy sun exposure, whether it's afternoons by the pool, weekend trip, or just getting out with the family whenever I can. And the beautiful thing about the cozy earth beach towels is that I can take the same comfort that we're used to at home and bring them into these special moments. Now, a couple things about these beach towels. The first thing I notice is how unbelievably plush they feel. We all know those rough, scratchy beach towels that somehow never seem to dry you off. These are the complete opposite of those. They're oversides. incredibly absorbent, and have that same luxurious feel that I've come to expect from everything

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that process is with red and near-infrared light therapy. That's why I've been using bond charges, red light face mask. Red and near-infrared light helps support healthy mitochondrial function in skin cells, giving those cells the energy they need to power your skin's natural repair process. A huge bonus is that it's incredibly easy to use. I'll wear it for 10 to 20 minutes while taking care of baby stuff that I got to do, like washing my son's bottles, catching up on emails, or winding down before bed.

That's another favorite. It's also one of those low effort habits that you can easily fit into your day and feel good about it. And if you've been thinking about trying red light therapy, now is the perfect time. Right now, Bond Charge is offering my community 15% off. Just go to Boncharge.com slash Drew and use the code Drew, D-H-R-U, to get that 15% off. Again, that's Bon, B-O-N, charge, C-H-A-R-G-E.com slash Drew, D-H-R-U to give your skin the recovery support it's been missing. Absolutely not important. In fact, I have never prescribed calcium for a person because it's actually, you don't need it if you have sufficient vitamin D at K2, which I've heard you an earlier podcast talk to someone about that area.

We don't have enough vitamin D. We've lost the ability to actually translate the sun into vitamin D. I've studied lots, thousands, and even the sunbirds who leave for Florida from New York for the winter. If one person had a bump in her vitamin D, I would be shocked. And in fact, what the data shows is the way you can absorb vitamin D from the sun is by living at the equator and going out around noon for about an hour. So if you add the fact that we now use sunscreen, we're not even getting vitamin D. And by the way, it's a misnomer. It isn't a vitamin.

It's a fat-soluble steroid hormone D. It somehow slipped the attention, so we ended up calling it a vitamin. So by taking vitamin D in combination with K2, you're actually, absorbing the calcium you need from your gut because so many foods have calcium and the D needs to transport it and you're transporting it to bone. And the reason for the K2

is that you don't want calcium deposited in breast, prostate, heart and that's why the K2 is really important. And you just, one little caveat, the only person that I've seen get a stone, like, because that is one of the risk if you take too much D. Kidney stones.

Kidney stones. calcium kidney stones. First of all, see if it runs in your family, if it runs in you, and then you just make sure you keep the vitamin D levels more moderate. Like we believe 60, 80, I sometimes have vitamin. My last vitamin D was actually 115, so I cut back on my ergocalciferol, which is a prescription D. And so you just have to be careful in people who are at risk of stone. And the reason I take ergocalciferal and not over-the-counter vitamin D3, so ergalcalcalfyphal is a prescription D. It's like 50,000 international units. The numbers really don't matter. For most people taking 5,000 a day makes sense of over-the-counter, which is D3. But 20% of us can convert the over-the-counter

to the D that we need. So you need to be prescribed ergo-calciferole, which is actually my favorite pill, and I don't love pills because it's this tiny little green, you know, like gel, like tablet that I take once a week. So now I'm cutting it back to every other week because I absorb it really well now. So the idea is that we definitely don't need, from your perspective, supplemental calcium, especially because it comes with consequences of being deposited in the wrong parts of the body, contributing to plaque. But, you know, you should do an audit or take an audit of your diet and make sure you're getting enough whole foods.

In some cases, you know, obviously people who do well with dairy, having dairy as part of it. And then you feel that people would be getting an appropriate amount of calcium. Yes. And if they feel like there's a risk in the family, obviously easy enough nowadays to get a vitamin D level anywhere. You know, you can order it yourself or you can go to any one of these labs, even aura is connected to it, levels, I think does biomarkers now. And you can see if your vitamin D is less than 60, you should be on vitamin D. Again, the caveat, the stones, so then keep it low.

So for most people where stones are not an issue, you can take 5,000 international unit today and then remasure three, six months later to see if you're, you're in the right ballpark. That's the best way to do it. What about a Dexas scan? Is that something for the audience that's listening here that generally has access to a lot of different things? If people, especially women, worried about osteoporosis,

do you recommend a Dexas scan? Full disclosure, I helped bring Whole Logic to market. So that was years ago when I was studying this whole field of using GNRH analogs like Lupron and Neferolin, and they're all used now as standard of care in kids with early puberty, called precocious puberty around the world because it shuts off early puberty.

It also shuts off the ovary for women who are going to undergo IVF. So a lot of that early work was built into what's now standard of care. That was my research. And so I needed to look at bone because I wanted to make sure that the women weren't going to lose bone.

To my surprise, they all had either low bone and not enough bone. And so because a lot of young women in their teens especially avoid dairy, they think it's fat. and they think it's not good for them and it's going to make them fat. So there's a balancing act there. So Dexas are really important, but not to wait until women are menopausal.

And by the way, when I first came to New York, I started sending people to the hospital for special surgery. There was a guy there named Joe Lane who trained me because I used to do bone biopsies and look at bone turnover. It means some of my research at Yale. And he said that no one ever sent men for bone density. But as I mentioned before, my father had severe osteoprosis. fractured his hip. Part of the reason I started testosterone 30 years ago. Today, my bones are pretty strong. They haven't slipped. And my twin sister, identical twin sister, who started testosterone also, but has been on it half the time, has early osteoporosis that we want to reverse. So Dexas

are critically important for women and for men. And in women, I would encourage women to get a Dexia if they could no later than their 30s, even in their 20s. So I think that's. I think that's. It's a critical question. What is the role of an appropriate amount of resistance training, working out, whatever combination, weight training? How important is that to the Osir process conversation? Critically important, but not the only answer. And we see that with GLP-1s, and we see it with ballerinas. So I'll start with GLP-1s.

Everyone's always afraid because you get an ozempic face. Well, my mother years ago, well before GLP-1s were invented, said, if I lose weight, I lose my face because we used to tease her, my sister and I, as she entered her 40s. And she's right, because you lose fat, you lose it from your face predominantly too, right? And so we have lots of people. Recently, I just saw a man who's in his 40s, who always had metabolic syndrome, could not lose weight, struggled.

Before he came to me, he took off six months and tried, went to the gym religiously, did everything right, still couldn't lose weight. he lost 100 pounds in the last year and one pound of muscle, 100 pounds of fat, one pound of muscle because we maintained his hormones correctly and his metabolic status. So resistance exercises become even more important as we age because we need to reinforce and put on muscle. Also, when you work out, you secrete growth hormone. At night when you sleep and when you work out, it triggers growth hormone.

Not testosterone. That's a misnomer. A lot of people will say working out will increase your testosterone. It does not. And there's no supplement I've ever found to increase testosterone. I don't know what other people are saying. And I've read about other supplements, mad goat weed. And there are several others that have talked about extensively.

I've tested all of them. And I don't see any change in muscle and in testosterone. Other things can minimize your testosterone, even as a young man. If you burn the candle at two ends, you're not getting enough sleep. you're too much alcohol. There's other ways because it's a sensitive biomarker that gets released. So as we age, two or three times a week of resistance training, weights, that kind of thing for men and women.

Some aerobic, which you can get in daily activities or you can add it to your, by going to the gym if you want. Swimming is great, but not for osteoporosis because you're not weight-bearing, right? But any kind of, you know, weight-bearing, aerobic-type exercise is going to reinforce your bone. But beware, like, and I'll use ballerinas, and it's been a lot. well-reported, the New England Journal of Medicine by a woman who's a colleague of mine, Michelle Warren, they have the worst osteoporosis and they have terrible fractures. And the reason is they delay puberty and they don't eat well because they need to maintain a certain weight. It's

built in, I think, to their way they live. And as a result, they don't have the right building blocks to make bone. So their hormones are off, their food is off. And so they get all the exercise in the world and right weight bearing and resistance and their bones are weak so it's a balancing act of where you go and what you do so two three times a week resistance training several times a week at least 30 minutes actually ideally right after you eat go for a walk because that will modify much better than waiting an hour and then going for a longer walk can you do a quick walk is data out of Harvard that I just read and reported on where they studied 12 people and they compared eating a meal and doing nothing afterwards,

eating a meal and going for a walk, eating a meal and waiting an hour. And the group that did the best was in the middle because that's when you release the sugar into your system and the insulin. So by modifying that, you're actually going to see change much more quickly. It's interesting you mentioned,

and I'm only bringing this up because my audience there, I'm always sharing my numbers with them, and I write in my newsletter, so they follow along on my different personal experiments that I'm doing. So when I turned 40, I had Dr. Gabriel Lyne on the podcast

and she really kind of convinced me that like I need to double down on, you know, prioritizing muscle. I was very active. I played tennis, other things like that, but I wasn't regularly doing resistance training. At the time, I was using a company Life Force where I would measure my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my, my and other things like that. And my audience knows this because I wrote about this. I went from about low 400s in free testosterone to like mid-sixth hundreds.

And the primary thing that I attributed to was I went from really just occasionally strength training with friends at the gym, like, oh, let's go to I started doing, becoming much more serious about it, getting a trainer, and also prioritizing. like just cardio vascular workouts too for my VO2 max, and I saw this steady increase and they kind of like flattened to around like 600. I always attribute that to being serious about working out, but I'm hearing from you that it might have been something else.

So first of all, that was total testosterone. You don't get a free test. Unless you're a gym rat and you overdose on testosterone, you take mega doses. You don't have a free testosterone of 400 to 600. What's usually the range is for free testosterone? a 25 to a 30 year old where I look at what optimal is because you asked a question about our labs all wrong and the answer is yes they are. The ranges are wrong. They're based on

unhealthy population and it's a population-based number averages and it's one size fits all. But for men, 180 to 250 is ideal. But also you have to calculate that within the kind of per, if you're somebody who's really muscle bound and you always were, then your testosterone may be higher. And they're actually describe communities of people like in finance, for example, who have higher testosterone. People who tend to get bald have higher testosterone because they also manufacture another hormone called DHT that causes hair loss. So 180 to 250. And I'd be happy to look at your numbers and tell you where you were because I love to see trends over time because that, not one absolute set of numbers can change the next day, the next hour. So it has to be compared exactly in the same way.

So that's the kind of protocol I set up so I could tell how people differed from one another, the end of one. So you want to aim for a fasting, and you always want to get at the same time of day. I do fasting always, because I'm looking at insulin and I'm looking at sugar. But if you look at the testosterone,

you want to get at the same time of day. A young boy going through puberty has a free testosterone of 50, and then it starts declining. And actually testosterone tends to go up at night when boys go through puberty. Later on, as your system changes and evolves, the triggers are different and the release of the hormones that make testosterone called LH or lutinizing hormone is what goes up and down. But the amplitude of those waves and the frequency decrease, and that's in the literature for 40, 50 years already.

And so we know that men's testosterone falls. So you were at a time in life where whatever else you were doing, you were probably eating better, you were probably taking in more protein, you were able to build that muscle. your testosterone wasn't in the basement. I couldn't tell you how active it was without knowing what your sex steroid binding globulum was. I could calculate that indirectly, but if you just get your measure of free testosterone, then we would know exactly what's working in your body.

Is any value to total at all since we're talking about it? Not too much, but usually when you get free, you're going to get a total anyway. I have to go back and check. So, yeah, take a look if they did the free. I was eating more protein as well, too. I mean, that was part of the protocol. So you need to eat protein.

I mean, at least one gram, when you mentioned food, I didn't neglected to mention this, but women and men need to have at least one gram per kilogram per body weight. So if you're really working out a lot, I know the term maxing on everything is like popular right now, but I believe in fitting it to that individual, like the individual. So one to two grams per kilogram. So that means if somebody weighs 150 pounds, 75 grams at a minimum a day of protein during, throughout the day.

But going up to 100 or 150 is perfectly fine, particularly if they're working out harder. So we see people who are focused on one thing or the other, like a young guy, 48, who ran to beat the band, and didn't have any muscle. And was at risk for that. His V-O-2 max was fantastic. It was really, he's the highest we see when we study people. He's now in his early 50s, and with one exception, a 23-year-old who had just ridden cross-country, he beats everyone else's VO2. And it's in the 60s, which is almost unheard of.

But he had no muscle. So as we changed his, because he had high risk of heart disease, his aunts and uncles on his mother's side of the family, his mother is a doctor, all had heart disease beginning in their 40s heart attacks. And we've avoided that with him. and he's changed the way he works out. But it's not, you have to look at each individual. I can't emphasize enough the end of one. And you pulled it out in the book when you spoke about one of my early trainers

who had had a silent M.I. And no one figured it out. He had tons of muscle. But he also had too much fat. And he had a high risk. He's Jamaican. He's still my patient since 0.8. And he had a silent M.I.

That no one ever picked up. He used to pass out, didn't know why. And in his case, he had too much. much muscle. He was putting, so sometimes too much muscle puts weight on the heart to pump. It's harder to pump for muscle against muscle than against fat. So you have to have a balancing act. And I have a handful of people who do that because a lot of men in my experience, and I'm generalizing, tend to like the weights more than the aerobic. You're not like, you know, you talked about tennis, which is a great exercise, by the way. And there are studies that say people play tennis live the

longest. It was out of England when they looked at the National Health Service. So tennis, was the sport that made a difference. And that's great for power for the V-O-2. So you probably do well if you get tested for a V-O-2 max. Have you ever been tested? I have been tested. I've talked about this on the podcast, but, you know, you can do it through like a bicycle. You can do it through rowing, which is less common, and you can do it through running.

I did running, and I really hadn't run prior to that in a long time. You know, I did some cross-country when I was in, like, high school. I like sprinting. And then on top of that, I use these barefoot. shoes, Vivo, you know, if you've heard about them, which people tell you, it's like, you shouldn't be using those for running. Yeah. Mine of my friends used it and it wasn't really good for his feet.

I use it on a daily basis. It's amazing, but they're not. Even the brand themselves says, and a lot of barefoot shoes say don't use them for running. They're not meant for that. So I picked the treadmill test and I scored a 43, which is still good, but I had to end early because my knee was totally messed up. And they were like, look, you got to come back. let's get you on the bicycle. On the bike, right. And let's get your true VO2 max.

43. How young were you at the time? I think I was 40 years old when I did. That's excellent, actually. It probably is close to very good even for a 25 to 30 year old because it falls off pretty quickly. We don't see many who have 40 or above, even people who take good care of themselves. So the fact that you do tennis as well had you running around. And I completely identify with your sprinting. Like for years, I would say I have genes that dictate. no marathons. I would never run a marathon. My whole family is known to like short distance and sprinting. In fact, my brother used to be called Comet with the name change because of running, but not long term. And it's hard for the knees. It's hard for other jobs. There's some people

built for that. When I did my own genetics, I found out that I had power genes, but not endurance genes. So I had a good excuse for why I'm never going to run a marathon. It's just not for me. And a lot of us just have nobody really ever taught us how to run correctly. And I know you were in England with my friend Rungan, and, you know, he's talked about how he never was into running and he got a running coach. He's had her on the podcast, and she looked at a lot of his dynamics and were like, you know, your hip is off, this foot is there because you're really tall. He's like six or four or five something, six seven, I think. This is why your dynamics are off a little bit and it's translated into you running this way. And he fixed a lot of those and he ran a couple

marathons, you know, being challenged. Well, you know, I always mention that in the New York marathon, the top three winners in the mail were all from Kenya. And you have to ask yourself, well, what does that tell us? It tells us that both genetically and the inheritance patterns of what you had to do to get to be a Kenyan today who runs means that it selected a bias for the gene variants that allow you to run very, very fast. I mean, can you imagine? I can't even imagine running a marathon in six hours, not two hours. And so when you think of the fact that of all the thousands and thousands of people who run these marathons, it's Kenyans who win, there's a reason for it genetically, and we will uncover that. We just haven't yet. You know, we will find the genes

that make a difference. And probably either with CRISPR, either changing the epigenetic or expression of genes or the genes themselves, we'll make more runners out of maybe me and you. Yeah, who knows? Maybe we'll do some gene editing on you. You'll be 110 and you'll start running marathons. I'm looking forward to it, but not right now. Just continuing on this trend of hard disease and the relationship between heart disease and all these different things. You mentioned in your five biomarkers cholesterol ratio, but also for a lot of the patients that come and see you who want to go above and beyond, you will be looking at things like APOB, right? And so much of, you know, what we're learning about heart disease is that it's not just that hard plaque that shows up,

you know, in your calcium test later on in life. It's this accumulation. of soft plaque that could even start, you know, in your, you know, mid-20s, 30s, from just like very poor lifestyle habits, extreme stress, and then that plaque continuing to get built up over time. So, as I understand, you do look at APOB for your patients. Where do you like that number to be for people, especially if they have a history of heart disease in their family. This episode is brought to you by Accenture.

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The way we all got interested in heart disease began with the war in Vietnam, when they would chip at the sad, you know, the young soldiers who were 1819 and they would do autopsies on them and find that they had significant stenosis and significant plaque, soft plaque, as you describe it. So the way we operate, if someone comes in, and you know, as you mentioned, heart disease is rampant, right, and kills more people than all cancers combined, actually, men and women. And so when we start and we see the standard lipid profile, which gives you total LDL, HDL, HDL, low density, high density, VLDL sometimes, and the cholesterol risk ratio and also non-HDL cholesterol, we look for optimal. Most people do not have optimal. There are groups of people who can look beautiful, particularly young women who are not perimenopausal or menopausal who have very high HDLs.

I have a couple of dozen patients with HDLs of over 100, whereas in most men, you're lucky if your HDL is 50. And there are some men, a few men who have very high issues. It's a sign of longevity, actually. So the next step we would go to if we determine there's risk and the cholesterol risk ratio is over two, which is almost uniform. In fact, if it's under two, I suspect they're on a statin, so we can tell what drugs they're taking.

We will go to a deeper dive and look at particles, And look at APO A, APOB, look at the ratio, look at LP little A. I've done this for years well before it became a known thing that you should search for LP little A. And we also look at the genes that affect that. So there are genetic variants that can also speak to, are you going to have a higher risk? For example, APOE4, which is known to be connected to dementia, is also connected to hyperlipidemia. In fact, we do a test with Boston Heart that digs deeper.

but Mayo does a test, Cleveland Clinic has their test, Quest has a test called Cardio IQ. We do a variety of it because we're cross-checking all the time. And once we see that, we want to get a baseline calcium test. And the reason for the calcium test, even though a lot of people now think it's outdated and you shouldn't do it, to me, it's an indicator of your risk category where you're headed. The good news is when a soft plaque becomes hard plaque with calcium, you don't get a heart attack from the hard plaque. And in almost every person I've treated over the years,

their calcium score goes up as their soft plaque decreases. So we are treating them effectively a combination of the low-hanging fruit like lifestyle, GLP-1s, supplements, and lipid-lowering drugs. It's just a matter of combination. We also go on to encourage people to do a CTA, which is a coronary angiogram, because that will pick up most,

but not all soft plaidivide. And so I'm sure you've heard of clearly. And clearly itself looks behind the wall, in the walls themselves. Because while the plaque could obstruct the arteries themselves, in the wall, it could be narrowing. Because plaque builds up and when it erupts because there's inflammation, or as you mentioned earlier, and there's a test you can do to look at this, there is a buildup of inflammation that affects vessels, right? We look at another biomarker called cardiac CRP or C-reactive protein or high-sensitivity C-reactive protein. They're both the same thing. And that's a way of looking at has the internal, what we call the endothelium or the lining of the vessels been affected by inflammation.

That's an end-stage signal that you're ready inflaming your vessels. And all of that gives us a picture of how to set people straight on their course and reverse heart disease. So I've had plenty of people who've come to me with early heart attacks like in their 40s. In fact, one gentleman comes to mine I write about him in the book. And he had a massive heart attack, anterior wall, which means he wiped out the whole front. Usually you die. Luckily, when he arrested, he was defibrillated back to life. And he's been a patient since 2008.

And in fact, when we do tests of his heart looking at nucleus scans, he doesn't even have a scar anymore. And he's an amazing shape in his 70s. So he was under the care of doctors at Hopkins and really made no progress because I think sometimes we doctors in the reactive conventional world are above all do no harm and we tend to be very cautious about treatment and go slowly and maybe keep people where they are because it's simpler. Whereas to me sometimes do no harm means doing more harm. If you're not aggressive about treating these symptoms and signs of disease that is inevitably in your future, you can't stop it and reverse it. And I believe with my whole heart and soul that it is possible because I've done it. I've done it for years.

As I said before, no one's had another heart attack. I want to knock it. I'm sorry because I am a little suspicious. I don't want to say that without protecting it. And no one's been put on insulin reversing even flagrant diabetics who come in on insulin. We stop it. So I've had a bunch of those. And I'm not talking about type one.

I am talking about type two, but a word on type two, there's many, many, many, many varieties of type two. It's very different, for example, in the Asian population than the Caucasian or Hispanic or Mexican. So in Mexico, they have certain genes that inevitably you're going to be a diabetic. Metabolic syndrome is rampant. Asians look fantastic. I still remember a doctor I took care of from Mayo who came to me after he saw what I did with one of his patients, and he was gorgeous in terms of his body composition, everything else.

He had a hemoglobin A1C of 6.5 and didn't know it. And he was actually a cardiac, you know, he did a lot of research in cardiac surgery. You know, in California, if you have a family history of diabetes, you need to be tested. I think it's kind of a rule in the medical world. You should be tested for your hemoglobin A1C. That's not the case in the rest of the world. And it's very hard to get a doctor to do fasting insulin and hemoglobin A1C and free testosterone. So of the five biomarkers, it may be something that your audience decides and your

listeners, I'm going to go do this for myself. I want to know what my numbers look like. Yeah, super important. And on that note, actually, we've had a couple of other people mentioned the importance of getting fasting insulin, A1C. And I know this because there was a medical doctor who listens to this podcast who posted on social media and said, it's so weird. Like my fasting insulin has been low and it's, you know, I wear a CGM and everything. But my A1C, still is kind of stuck, and I forgot the exact number, but it's like right like borderline of like, you know... 5.7 or a little bit lower, it was like 5.3?

And then I remember looking around because I had something similar, and maybe you can tell us if there's any truth to this. Some people have a situation where their red blood cells just hang around longer, and that can make their A1C, even if their insulin is fantastic, it can make their A1C look like it's artificially higher. Is there any truth to that? I really can't answer that.

I'd have to see the research or if there's any data. I mean, it's interesting. I've not come across that in the thousands I've treated. So I would be more likely, instead of looking for zebra in the room, I would be more likely to think this is more like elephants, where his sugars are vacillating more than he's really aware and that there may be a lack of awareness of that. But again, I can't rule out the fact that there's N of 1

and everybody can have their own situation that you usually find in a number of people once you start looking. For example, I've studied a lot of young men who are around 30 and terrible family history. Also, women have this, but it's more common in men. Terrible family history of early heart attack and stroke where there's death by 60, you know, their parent or grandparent. And their numbers look like they're 20 years older. They have low testosterone. Their cholesterol is off the charts and their insulin is elevated. And their sugar may look good and their hemoglobin A1C maybe 4.9. So think about it. That hemoglobin A1C is an average of 100 days. Unless you're truly committed to wearing a CGM and understanding the fluctuation, because stress can cause sugar to go

up. It's not just food. Sleep, lack of quality sleep. So it's not just six to eight hours. And in fact, if you sleep more than eight hours, 10 or 12, you have to look at the fact, are you getting enough quality sleep? Are you getting enough deep sleep? And most people are not. So there's a whole bunch of factors. I mentioned sleep in myself earlier. I did therapeutic plasma exchange in California. Now we offer it. We work with a company called Circulate, although I think they were just bought, but they're still staying intact. It's run by the CEO is Brad Yote Younger.

You haven't had him on. You might want to. He's great. He's also had other startups before. And when I did therapeutic plasma exchange, which was cleansing my plasma of senescent cells or what we call zombie cells, after the first three months, my biological age, which we also measure, went down by 15 years. So we look at biological age,

the old-fashioned way that Horvac did, Steve Horvac, done in pace, which is rate of aging. Have you ever done any of these tests? I think they've been included in some of the workups that you've had there, yeah. And then I stopped sleeping for the next three months because I created an app that I want, I still believe strongly and I'm headed in that direction.

You stop sleeping? I stopped sleeping more than four hours a night because I was creating an app. I had no time to work on it unless it was between 12. Just working a lot. 12 a.m. and 3 a.m. And I would go to sleep and have like four hours of sleep if I was lucky. I got deep sleep so I could function.

I'm one of those people and I think it's about 50-50 who deviate to deep sleep when I have too little sleep, which is great because it gives you energy. But it wears you down after a while. So most people who have REM only focused, they feel exhausted even if they get hours and hours of sleep. So deep sleep kind of helps you with the energy. REM is more creative. And my biological age rebounded higher than the 15 years after three months.

So I continued to do therapeutic plasm exchange every month with three more months and my biological age rebounded. So sleep is paramount too in that. And so even though you were doing this sort of advanced biohacking thing, therapeutic plasma exchange, just not having sleep aged you in that period of time. It's a de factoorial, and that's why I worry the most about sleep because I think it's something that most people don't have a good handle on. I think you can look at food, which you brought up before, you can look at exercise, you can try to control it. But I think sleep is a great unknown, and unless you know what's going on in your sleep,

how do you address it? It's so important, and that's why you've listed as like, you've reordered it. Can you, again, tell our audience here as we're winding down here. I have a ton of other questions about GLP's, but we'll have to bring you back as a second time. to be honoring. I know you have some other commitments that are there, but reorder, your original order of what you thought was the most important, and now the new order that you're putting out there to folks. So in the past, because this was the emphasis, I think, back a couple of decades ago, it was exercise, food, sleep. And as I began to study each human being and develop my

protocols, I flipped it to sleep, food, exercise. Because sleep trumps food and food trumps exercise, if you will. You can modify much more with sleep and then food and then exercise. What's missing in that equation and is a very important factor is stress and anxiety. And not all of us can control that either. So looking at ways because if you wear a CGM and you're really stressed, I've had endocrinologist colleagues when I started to convince them to try it themselves because usually it was only for diabetics, right? It was great because you didn't have to prick yourself so many times a day. but I started using it in everyone, every single person that I see gets a CGM to start.

They don't have to continue to wear it, but we can judge accordingly. And they called me, one of them called me Beatrice Olson once. She was a colleague at Yale, and she's still in practice. And she said, I can't believe it. I'm prepping here in a hotel room my stress is off the wall because I'm giving grand rounds. And my sugar went up to over 200.

If you ever see a sugar over 200, even in the interstitial fluid around muscle, you're a diabetic by definition. So you don't even have to do an oral glucose tolerance test if you wear the CGM and you test yourself. And so in that case, she had to just get a lot more aggressive about, you know, the lifestyle factors you mentioned. She had to figure out how to manage her stress.

So what she ended up doing, and this is another way to manage high stress and high cortisol because cortisol drive sugar. If you have high cortisol, you're going to put weight around the middle. In fact, a disease called Cushing disease, most people are barrels and they have very thin arms and legs because cortisol puts fat, visceral fat, around your middle. So what she ended up doing because the data was there, and we talked about it, is both

Chi-gong, which is an advanced form of Reiki work to relax and to learn how to self-relax, and also deep meditation. So there's data that shows that if you meditate, you actually turn off the expression of gene that leads to increased cortisol. So she learned how to meditate, and you can even start by doing deep breaths and, you know, breathing exercises, which in my case, it's very hard for me to meditate, but I use the watch, the Apple Watch, to remind me to stop sometimes and take some deep breaths. And that really makes a difference. You've mentioned the term GLPs a few times. And from what I understand a little bit

about your work, is that in your clinic, you're not just using GLPs to deal with obesity, you know, people who have significant weight to lose. You're using it actually as a sort of an independent healing mechanism inside the body. Is that correct understanding? Absolutely, yes. So we use GLP-1s judiciously as it meaningful, but I believe GLP-1s are the antibiotics of the 21st century. Antibiotics that came about, the first person to get it used in America was at Yale.

Her name was Anne. She was the wife of a physician. She was dying from urinary sepsis. And they cycled penicillin through her. This was in the 50s, 1952. So it wasn't that long ago, right? And they were game-changing in terms of why we live longer now. So our life extension happened directly because of antibiotics to begin with in the 20th century.

In the 21st century, GLP-1s have this major impact on the body, both on the brain and in the abdomen, the heart, cancer, you name it. And there's a lot of work going on in academia that's looking at this. I personally in my center have been using GLP1 since the very first one was available called Bayeolm. back in 2005. I remember I test almost everything myself. And as I mentioned, I had insulin resistance and I wanted to see how it worked. I didn't love the fact that if I went out to a restaurant,

I couldn't have the chocolate lava cake because I wasn't hungry and my head didn't want it and my belly didn't want it. So I learned to hold it. But when it became daily or weekly, it was a little harder. So it's been amazing in the changes is induced. It's not a life sentence if you use a GLP1.

The only issue I really have with this, the major issue is it's so ubiquitous. How do you know people are just getting prescriptions for it, whether it's from online companies or from doctors who want to get into the field and may or may not have the depth of knowledge they need to understand its effects? Because it's everything you do has risk and benefits. And I think in my case, I was lucky enough to be trained in clinical investigation. So I think like a researcher.

And I look at each end of one, each person in front of me, as what's the risk and what's the benefit. So what might be right for you might be absolutely the wrong thing for me and even me and my twin sister. For example, she takes metformin and I can't tolerate it. So I've never been able to tolerate it

because I have something called a schema colitis. She doesn't have it. She's had her gallbladder out. My gallbladder is fine. So different stresses in life, different ways you live life, that health story,

which all of us have of our own, is the place to start for each of us to figure out where we're headed and how we can avert chronic disorders of aging, which is also known as diseases. And that would be a gift for every one of us. A lot more for people to dive into. Inside of the book, congratulations.

The book is out there. We have the link in the show notes, Invincible. People can pick up a copy, pick up a copy for your friend or family member, loved one, anybody. It was hard. It was a labor of love because I've always dreamed of making this available to everybody. And so it took a long time much longer than I thought.

Although I did write a book for Men called Keep It Up about this whole field emerging before anyone heard of it in 2013. So if you want a copy of that, I'm happy to gift it to you. Okay, great. We'll link to that as well too. Florence, thank you so much for coming on the podcast for breaking out of these ideas. We're entering into a whole new space instead of health. And the thing is, is that even though we see you popping up on the podcast, you know,

world and circuit now, you've been doing this for such a long time. And that's the wisdom that you've been bringing to this book and your content. And we really appreciate you for it. To me, getting the data and really having proof of concept that you actually can identify and get insights about each person and then apply really personalized, targeted interventions to make a difference for each person was really what I thought was the most important thing to establish scientifically. While you're doing that and so much more, we'll link to all the places where people can follow you

in the book. Thank you for being on the podcast. Well, thank you. This was a very exciting and fun conversation. I appreciate it. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast.

If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send down an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity,

and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says try this.