← Smart Girl Dumb Questions
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- [00:00]
A
Can I live forever? And would my healthcare be better if I were richer? This is Smart Girl Dumb Questions. I'm Neymar Raza and today my guest is Dr. Florence Comite, a Yale trained endocrinologist, a longevity expert, and an author behind the forthcoming book Invincible. Are We Invincible? We can be Smart girl dumb questions. Dr. Comite provides personalized precision medicine to CEOs, to founders, to athletes, to artists, and recently to me in her generous time as I was doing research for this episode. It's such, such a pleasure to have you. What is an endocrinologist?
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B
Endocrinologist really deals with hormones and metabolism and affects the whole system from mind and body. The body is complicated and all the glands of the body, from the thyroid, the brain, is involved too with neuroendocrine modulators, pancreas, the adrenal glands, the ovaries, of course, the testes, and in the brain, the hypothalamus and pituitaries.
- [00:55]
A
I'd never heard of someone having an endocrinologist until about 15 years ago. I started knowing all of these people who had endocrinologists. It became like the thing that everybody was after. Was there some kind of discovery that our endocrine system is like a core regulating system? That happened more recently or.
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B
Medicine has been fairly siloed. So everybody's been in their own space until very recently when it's been recognized that the thigh bone's connected to the, you know, hip bone. You remember that song from nursery school?
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A
And it is.
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B
We affect. In fact, we have a mini brain in our gut. So the hormones that are so popular now, the peptide hormones, Ozempic and Manjaro, are actually produced in some fashion from our brain and in our gut.
- [01:37]
A
Say that again.
- [01:38]
B
So the brain produces is a part of the brain called the hypothalamus. And the arcuate nucleus of the hypothalamus controls emotion, controls desire, and produces a lot of these hormones that regulate who we are. And the GLP1s like Ozempic and others are actually produced in the gut as well as the brain.
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A
Okay, they're already being produced in the gut.
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B
Yeah, they're already being produced in the gut.
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A
And so when you take Ozempic. If you take Ozempic. I don't yet take Ozempic, though. I asked you if I should microdose Ozempic and you've withheld it from me.
- [02:06]
B
I didn't withheld it. I think it deserves a deeper conversation. But I do know that what we are using, when we use GLP1s. We are actually exaggerating a response in our body that is a natural physiological response.
- [02:19]
A
That's so interesting to know because I've always wondered how these GLP1s are convincing our brain, for example, that we're full. And that seemed something very artificial.
- [02:28]
B
I'll use me as an example. I test all of it. So I started using GLP1s back in 2005 when they were first brought to market. Called Byeta. It was a version of it that had to be used right before you ate, like within an hour of eating.
- [02:41]
A
And when you were using it, I mean, you're for people that are just listening and not watching on YouTube or Spotify. You are very slender.
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B
Yeah. So it isn't just for weight loss. It actually affects the entire body and every organ system. And it's inflammation, really that's beyond inflammation. It's malfunction. Like sometimes we don't function perfectly and as we age, things deteriorate and it helps support and, you know, kind of in a direct way and indirect way, stop the aging factors that affect us negatively.
- [03:10]
A
I am so happy to see you in a podcast studio instead of your office, because I've been to your office now a couple of times. It is actually a stunning office, but most of the time I've had a lot of blood drawn there and I'm like very squeamish about that. Just so my audience understands. The way that you and I got introduced was that about six months ago I had this question of why are all the longevity experts that I'm seeing really male? For the most part. And so I started asking my friends, do we know female longevity doctors? And I found out that several of my friends go to Dr. Florence Comita. And these are men, these are women. But a lot of people have been going to you. So I was like, is this even something that I could access? And you generously have kind of given me a view into the intake process.
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B
Yes.
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A
And you also have a very research based approach to what you do.
- [03:56]
B
Yes. So back about 25, 30 years ago, I realized that we start deteriorating in our 30s and it's largely aging. I didn't even think of diseases like heart disease or stroke or Alzheimer's as diseases. I thought of them as disorders of aging because we're living longer, but our bodies don't really keep up. Neither do our minds necessarily.
- [04:16]
A
What is the difference between a disease and a disorder?
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B
To me, a disorder can be stopped. You can intervene in a way if you have insights and say, listen, you don't need those symptoms to emerge. How do we stop that from emerging? How do we reverse biological aging so that we can keep people healthy and alive and vibrant? And with the jode de vie for till 120, that was really my goal. Keeping people biologically younger, as young as 25 or 30, while they age chronologically, because that we don't stop.
- [04:45]
A
So is aging a disease?
- [04:47]
B
I know there's a lot of talk about that and agreement, disagreement. Same thing about personalized medicine and precision medicine, which is interesting. I don't consider aging a disease. I actually think aging is a gift. If we live long enough, it's wonderful. We get to experience all the joy that life has to offer. There's also trauma, always. But I do think that aging changes our body and the way we function, and we don't function as well. So we don't want to live long with a stroke or be debilitated or have dementia. That would not be fun. That would not be a reason to live long. I certainly don't want to live that way. On the other hand, I also want to enjoy life to the fullest. So I couldn't really do all the things that, for example, Brian Johnson does to live life. It's overwhelming, and it's not necessarily a fit for each one of us.
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A
So, okay, you. Let's talk about the kind of. We're going to get to Brian Johnson, because I have a question about him. Do you know him?
- [05:37]
B
I know of him, and I was invited to participate in some of his programs. But it really. It wasn't exactly a fit for me. And I'll take it back to the research question. My world was clinical research. So when I went to Yale Medical School, I went there because they had a requirement that you had to do research. And I've always won awards for research, whether they were in mice, rats, or humans. I ended up working largely in humans at the National Institutes of Health and Child Health and Human Development. So the design of my center is collecting all that blood work, looking at biomarkers, and connecting them to the insights and ultimately making decisions about interventions that are specific to you as a human being and how your body is functioning.
- [06:18]
A
And that was what was so interesting because you have this whole theory of n of 1 precision medicine and healthy longevity. That's what you talk about, right? That's the tag. Exactly. So let's define each of those things. What is n of 1?
- [06:33]
B
N of 1 is really doing a clinical analysis of a singular person instead of millions of people in an evidence based trial, which is fabulous. You get some data out of it. But largely that data in conventional medicine is a one size fits all. And then everyone gets treated as if they're the same. Obviously, you and I are not the same. Even my identical twin and I are not identical. And so I knew that we started as the same cells, we divided at some point in utero, and yet we have different likes and dislikes. And we are different in terms of body and mind. Like, I could live on sushi and sashimi. And she doesn't eat fish. She's a fabulous gardener. And I kill plants. Basically.
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A
I'm not good for save humans kill plants. That's your.
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B
That should be on the card.
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A
So. But this n of 1. So you thought about this as growing up as an identical twin.
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B
You're.
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A
We are each individual. And the best comparator to myself is not somebody else or some average population, but myself over time.
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B
Right. So you take evidence, which is done in millions of people, and most of conventional medicine also is reactive. You get six, everyone jumps all over you. And we do a great job with that. But what I was dreaming of was a proactive approach. How do we actually. If we can detect changes below the surface at the cellular level, or in your metabolism, how do we reverse that? So you don't get sick, you don't get old. You basically maintain your great health until you go to sleep one night, your cells are tired and you don't wake up at 100, 120, 150. That was always where I started.
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A
Is that how people die? Their cells are tired and they don't wake up?
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B
I think you can. A lot of people dream of going to bed one night and just not waking up. Like when you have suffering, always enjoying life, being able to play with your great great grandchildren or do whatever work you love. Like this. Right. Wouldn't that be fun if you could maintain your vibrancy and there's no reason you can't.
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A
We're gonna get to healthy longevity in a second. But you have a twin who's older, you or your identical twin biologically.
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B
I love that question. Now, I didn't love it as a child cause she always trumped me. But she's older. I'm five minutes younger.
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A
You're five minutes younger. But what about your, like, true age, your biological age?
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B
So that's a good question. Yes, we're pretty similar there. We do very different things. For example, we both have insulin resistance. She can take metformin. I can't. I can't tolerate it. Because of my GI tract, she's had gallbladder issues. I have none. So there's a lot distinct differences. Even though some people think I'm her and some people think she's me, but she's a smarter one because she became a dermatologist.
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A
Oh, why is that smarter?
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B
Because on the outside you can look great. My mother used to say that to me, why don't you go see your sister? And I'm like, I'm healthier on the inside.
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A
But you can be like, my endocrine system looks amazing. And just wait till you see my gut.
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B
And then the other thing that happened when we designed what we designed in going forward so good doctors will treat a patient and each patient in a personal way and do what's right for them. How do we tinker and fine tune it with interventions that are specific to you and to me? It's in the numbers and the way you live life, which I consider your health story.
- [09:33]
A
One of my friends who's a patient of yours as well said to me that he thinks you have a beautiful mind kind of approach to medicine, which is that there's not a structure. You're not just looking and diagnosing on the basis of the charts, but you're having a sense of someone's health, vitality, really, a sense of all these numbers over time, and you kind of make some mathematical sense of them in your mind.
- [09:53]
B
It's intangible. To me, it was like easy to just look across systems from everything from the way the heart functioned, cholesterol, sugar, to hormones, to the way you lived life, how you slept, what you ate. There's never enough time in regular conventional medicine to do that. And it's always been my dream to democratize it. So I want to do that too, because it isn't an easy thing to pay for something like this. Insurance doesn't cover it, and things of that nature.
- [10:19]
A
So I guess two questions for people listening to this. One is how expensive is this kind of proactive preventative medicine?
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B
The high end could be $200,000, $300,000 a year. And that doesn't even have to include supplements or medication that you might have to pay out of pocket for in part testing, diagnostics. All of it can add up quite a bit.
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A
And are rich people, like, healthier when they come in?
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B
No, not necessarily. You think you might have the best care. That's the biggest, I think, issue in medicine and healthcare and why maybe digital health has not quite succeeded. Why forward, you know, folded and modern age? Because it's very hard. What we do is not applicable in an easy way. If you reverse biological aging beginning as early in life as possible, but certainly 30s, you'd be able to hold on to your health for the rest of your life. So it's extending your health span to meet your lifespan. I'm not God, if there is a God. I can't tell you how long you're gonna live, but I can say I want to keep you healthy for the rest of your life and hopefully you live longer.
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A
Is what Brian Johnson does healthy longevity from his lens?
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B
Probably because what he's doing is figuring out for himself what he needs.
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A
It seems wild. I mean, forget it's personal life aside, but just what he's doing. He's taking so many things. It's not scientific. Right. It's really hard to know what's working or not. And for people who are not familiar with Brian Johnson, maybe just tell people who Brian Johnson is. Yeah.
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B
So Brian Johnson came on the scene about a year or two ago. He's a very well known venture person who's been very successful in that regard. I think he created and brought to market Braintree, which was bought by PayPal.
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A
PayPal, yeah. And he's been in this health space for a long time.
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B
And I think he did it for personal reasons. I think he's very open about the fact that he was depressed, he felt like he was aging quickly, he wasn't enjoying life. And so he went ahead on this mega course to do everything and anything. And he's evolved along the way. He's changed some of the things. He takes dozens and dozens of pills. I think he basically takes pills all day long and for meals mostly. I couldn't live if I had to live that way. I wouldn't want to live a long
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A
life to be peptides. Like, is there like blood? Kind of.
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B
He does testing all the time. I think he's monitored and he's monitored by, you know, doctors, I would hope, and other clinicians who could judge and measure things like his erections at night. Basically he talks about that, that he goes to sleep. I think that it's fine for him. I'm not sure if he's having erections at night. Yeah, he measures how often he has erections.
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A
Is that a sign of health?
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B
It can be, yes. Not necessarily. I don't know enough about him personally to tell you, but it is true that men as they age don't get the same number of erections they used to when they were 18 or in their 20s. So 20s is the prime time of life. As you hit your 30s, you think you're busy, you're doing a lot of things. Your career is taking off, maybe taking care of a family or your parents even, who are aging not well. And you begin to decline. And so there's always a good time to do it. But yes, you rise to your peak, which includes erections in your 20s.
- [13:21]
A
Yeah, that's definitely a type of peak. Okay, enough about Brian Johnson's erections, thank God. Can you become younger as you get older? Like, is that. Or is that just Leonardo DiCaprio who turned 50 and told us he feels emotionally in his 30s?
- [13:33]
B
I think it's a lot of us. So using me again as an example and lots of my patients, a few years ago, I did therapeutic plasma exchange, which cleans your serum, basically your plasma. So you keep your red blood cells. You put your plasma, the yellow stuff, through a machine, and it gets rid of all these excitable cells that are not good for us. They're called senescent cells. They go to sleep. They can'. But the thing they really do that's damaging is they hurt the cells next to them. Cause they're inflamed or they're not healthy. And they're actually a nickname for them is zombie cells. So when I had that done to me, and I did it about five years ago after three treatments once a month, and I followed it very carefully, did blood tests before and after. In fact, I made myself anemic because of that. But my biological age reversed by 15 years.
- [14:20]
A
By 15 years. 15 years. And by the way, we're not promoting any of these for anybody listening. This is just like. This is something that you have done for yourself as a medical professional under
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B
the advice of the acute plasma exchange or plasmapheresis is young blood for old blood in a different way. So actually we don't have to bring Brian Johnson back into it, but he does this.
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A
That's what I meant by the bloodline.
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B
He used to do it by getting his son's blood.
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A
Yes.
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B
Then he switched it to the way I always thought was even healthier. I don't like getting other people's products or blood products. They don't think, even if it's a relative. And sometimes there's reactions. So what we did is we cleaned the plasma, which is a kind of diagnostic and therapeutic approach to people who have high cholesterol, for example. They've been doing this for decades. Apheresis, you just clean the blood through a certain filter.
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A
How long has this Been around plasma,
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B
been around this type of approach, not the young blood for old blood, which has been around for probably 15 to 20 years, but much longer than that to clean lipids out of your system or cholesterol.
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A
It's like, how long?
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B
Probably at least 30, 40 years, maybe more.
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A
And how often does one who does it do it?
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B
So if you're doing it for aging, once a month or twice a month in the same week for like three months, and then you can wait years to do it again. And how does it cost so good that they do it very often? It can vary in cost from like a couple of thousand for each treatment to 12,15,000 a treatment, depending on what happens.
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A
So if you're doing a few of these in a couple of months, you're talking about probably $100,000 of a few
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B
in a few months. Like to do an initial treatment costs about 30 to 35,000.
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A
Okay.
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B
Because you're doing one a month for three months in a row, and you'll see a change.
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A
And you couldn't achieve the same result by just like, eating clean for six.
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B
Here's the fallacy about lifestyle and doing everything perfectly. And I just had this conversation with someone in my office this morning. It's a no, you can't win. There are very few people. Having seen thousands of people, I even have couples. There are two that recently that come to mind. They're in amazing shape. One couple is in their 60s, the other is in their 40s. They try to do everything right. The younger couple, she was a ballerina, He's a exercise enthusiast. They both look great on the outside. Their in body looks great. They eat clean, they do everything right. But inside, there's disease brewing in the older couple. One has Alzheimer's and The other had two sisters that died of sudden heart attacks in their 50s. So our genes dictate a lot more than we know, but we can modify.
- [16:47]
A
Okay, but there are certain ages that no matter what happens, like, you get older, there are these peak ages. Like I read 44 is one of them. Is that right? What are the peak ages that, like, where your body, just irrespective of what you do, is just gonna change?
- [17:00]
B
Okay, so your body is constantly changing, even from childhood to 20s to 30s. I think of it as each decade of life. But there's recent work by Michael Snyder, who happens to be a patient of mine and openly related to us so that I can talk about him. He's head of Personalized and Precision Medicine or Genomic Medicine at Stanford. And what he Reported recently is that there are distinct changes in your epigenetics at 44 and 60.
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A
Well, I'm not looking forward to 44.
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B
Well, maybe we don't let you get there.
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A
Yeah, exactly. I'll just stay before.
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B
In a good way.
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A
Yes. Yeah, I was gonna say that seems threatening. Dr. Comatik.
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B
No.
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A
Okay. So basically, for this N of one medicine to work for one to become invincible, part of the early part of the process is like getting a baseline of who you are and what you are. And I came into your office and did this. I had a lot of blood work done. I had, at the same time, incidentally, had a prenuvo full body scan done with. With brain volume analysis and a full MRI of my body that you also could look at. But you wouldn't have done that.
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B
Not right up front. I think that it's appropriate for certain people and maybe people who are curious about what's going on in their body. The downside to it is when something shows up that you're not happy about, it can be devastating to start, and you have to manage it. And sometimes we've had to send people for biopsies and a workup. It may turn out to be nothing. And in some cases, your life is saved if you find cancer, Right? If you find it at a very early stage. One of my patients was telling me, another one who's associated openly with us, Brack and Darrell, who runs vfc, Vanity Fair corporations. He told me about a friend who was convinced to go undergo a pernuvo by his wife. And he turned out to have a type of prostate cancer. And there is a very rare type of prostate cancer where you don't detect changes in the psa. And so his life was saved by that. So people who have family history of pancreatic cancer, that would be an indication to me to encourage somebody to do that.
- [18:58]
A
Yeah. So just so people know, like what I did, just as an example of a person who was trying to figure this out, what is, you know, can I live forever? And what would my healthcare be like if I had all this access and all these riches. I went in to see you and to get a baseline, and this baseline was more robust than any baseline I've ever thought of. To give people a recap, I got. I had already done this prenuva body scan where they had, you know, scanned all of me, done an MRI of my body, done brain volume analysis, drawn some blood, et cetera. I had a series of annual physicals that I brought to you as well. But Then and because I had seen a fertility doctor for, for egg freezing, I had all of that information about my hormones that I also brought in. Then you had me do baseline blood work, these 28 vials. You had me do a physical assessment, a VO2 max, where you had me run and like test my oxygenation levels, basically a grip test where you had me test strength, wear a continuous glucose monitor for weeks to see how my lifestyle and how my sugar levels flowed during the day and what that told us about our lifestyle. You had me do a bone density scan to see how strong or how weak my bones are. You had me do a body composition to see how much fat, how much muscle mass I had if I was skinny fat. You had me do urine test, rectal exam, sorry, tmi. And you also had me doctor a thing I came in where it's like a glucose test where for three hours we drew blood while I drank glucose
- [20:29]
B
and insulin, both in your blood and also using the continuous glucose monitor. You also had a liver scan to see if there was any fat in your liver, because you can look perfect, have muscle, but if there's fat in the liver, it kind of predicts diseases down the line. So that's completely reversible. Very common, but completely reversible.
- [20:47]
A
So in this room with us, there are four other people, producers and stuff. So I'm curious, has anyone ever had this much stuff done in the room? Only somebody that works at the Comate center for precision medicine has that and yourself and myself. But this is really rare to have this much data on yourself. And it's expensive.
- [21:10]
B
It can be, yeah.
- [21:11]
A
When should people get a baseline, if they are to get a baseline?
- [21:16]
B
So that's a great question. And after doing over two decades of designing a protocol that gives me answers and insights, I now know you could drill it down into five biomarkers because for most of us, sometimes too much information is overwhelming. And if you can pick five biomarkers,
- [21:36]
A
like what are the five sugar, glucose,
- [21:39]
B
insulin, pre testosterone, which is a very important factor, hemoglobin A1C, which tells you your average sugar for 100 days and, and cholesterol risk ratio, which is your total cholesterol over your good or hdl, high density, lipoprotein. You have insights into almost every way of functioning in your body. So that is what I advocate now because we want it to scale and that's what I hope everybody can get to.
- [22:05]
A
And these indicators, these five biomarkers, which is wild to hear, five biomarkers, because you definitely took a lot of blood from me, you guys.
- [22:12]
B
Well, because thousands of biomarkers, what we wanted to learn. Think of this as an N of one research study in individuals where we were able now to track people, get that initial data, figure out those insights, and decide what are the right interventions for you.
- [22:26]
A
Right. No, of course.
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B
You mentioned my mind before and how I see all these numbers in a unique way. So I knew I had a different kind of way of looking at it. After a few years of talking to my doctor colleagues and then wondering what I was doing and laughing at me, I knew at some point this had to go to the computer or AI. And that's where we are now, because everything cross reacts. But by figuring that out, we can extrapolate from all these tests that we did and help everybody figure out where they start. And that's really where we should head now.
- [22:58]
A
And are these five biomarkers covered by insurance? Like, could anyone go into their doctor if they have insurance?
- [23:04]
B
I would think so. I couldn't commit to that. But yes, these are standard. Most doctors do not draw a free testosterone or a insulin. The other thing that most doctors don't do is encourage you to use a continuous glucose monitor. But if there was one, game changer over the last 20 years when I started this work, that alone changed the way we can take care of you, because you can now know what your body is doing 247 if you want. And you can make realistic changes to keep yourself healthy for life.
- [23:37]
A
But like with all of this stuff, there's CGMs, there's Oura rings, but like, it could be overwhelming.
- [23:42]
B
This amount is overwhelming. Let me be clear. Like, for some people, it's too much. And so each one of us is different. We have to decide to what extent do we really want to understand if we don't sleep well? Some people are desperate. Having an Oura ring or an apple watch or a whoop or a Garmin, those would all make a huge difference in your life. Because there are things that happen during sleep, like sleep and muscle are probably two of the most important aspects of keeping your health. Besides sugar. Your brain gets washed kind of. It's called a glymphatic system, where during deep sleep, you kind of clean your brain, you restore your brain, you restore the immune system, and without good sleep, you're compromising your life.
- [24:20]
A
Is it possible that, like, someone could be sleeping eight hours a night, but they're really not sleeping at all?
- [24:25]
B
Or they're only. Absolutely. We have people who sleep 14 hours a night and don't get any deep sleep. So we look to change the patterns of sleep. It's not just the number of hours, it's the quality of sleep. Do you get deep sleep if you're a person who sleeps two hours and most of it's deep sleep? And we have patients who are actors, for example, and they're bicoastal, and they sleep very little. They're on the plane all the time. But they get great deep sleep. They have the energy to do what they're doing. REM sleep you need for creativity. So that's the dreaming. That's the sleep where you dream and then there's light sleep and other various stages without quality sleep for a long time. And again, I tested this on myself too. When I stopped, I got four hours of sleep a night and my biological age reversed in the opposite direction.
- [25:10]
A
Oh, gosh. So you're 15 years younger and you screwed it up.
- [25:13]
B
Yes, you're competent, but I can come back. So the good news is I can go either way.
- [25:17]
A
So you didn't answer my question though. At what age should we get a baseline?
- [25:20]
B
Ideally, you get a baseline in your 20s, when you're optimal. The reality is you feel like you're gonna live forever. In your 20s, you don't think about mortality usually. So really the 30s, when the body begins to change, it's always great to see somebody who has trends. Like when you brought in your data from other doctors, it was great. Cause we could see what changed over time.
- [25:39]
A
Right? Although I came in my 20s. I'm kidding.
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C
I did not.
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B
Were you even 20? I wasn't sure exactly.
- [25:45]
A
Your new book, Invincible, is structured around you call seven patterns of aging. So I want to ask you, what are the seven patterns of aging? And first, let's list them out, and then we'll go break down each one.
- [25:56]
B
Okay, so first is carbohydrate metabolism, which is sugar, glucose, and how that affects your body. The second is cardiovascular disease. The third is thyroid disorders. The fourth is menopause and perimenopause. The fifth is andropause and periandropause for men.
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A
Okay, we're going to go into that.
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B
The sixth is sarcopenia and osteoporosis, loss of muscle and bone. And the seventh is brain, the brain fog and dementia and aging.
- [26:24]
A
Okay, when you say seven patterns of aging, you see, these seven systems in the body are what tell us how we're going to age.
- [26:31]
B
And it actually starts with what are you at risk for? Like, where are the areas that you could use? Very aggressive proactive interventions, whether they're lifestyle or they're peptides, or they're supplements, or they're even medication to stop you evolving in the way that your genes are dictating. How do we do what we call epigenetic switches to make the genes different, to express the genes in a slightly different way? Epigenetic means epigenetic is. It overlays genetics. There are switches that turn on and off that you can help change by the way you live life, the choices you make.
- [27:09]
A
But they're very encoded. Right. Our epigenetics are often like inherited over.
- [27:13]
B
They can be inherited, but they're also open to change. As opposed to your genes, Your DNA never changes. So getting DNA testing that is, you know, you'll stay the same the rest of your life. But what we hope to change is by targeting certain parts of the genome, the DNA, by epigenetic switches that exist within it. Like I mentioned Michael Snyder earlier, right. He found out when he got the flu, he became diabetic, which is very common, because when people get sick, it's very hard for them to fight being sick when they're diabetic.
- [27:45]
A
The flu didn't cause diabetes. It just led to his diagnosis.
- [27:48]
B
It led his epigenetics. It caused the epigenetic change in his gene to express diabetes. Really? Yes. It's what happens in pregnant women who have. They have oral glucose tolerance tests. It can be a half an hour, it could be three hours. And that's when they see, because you're vulnerable, you have stresses on your body. You're carrying a baby, one or two, whatever. And if your body responds as if you're pre diabetic or diabetic, that's a sign that you're absolutely gonna be a diabetic because you're expressing it. And it affects the infant and the mother. So that's why OBGYNs intervene. If that is seen during pregnancy.
- [28:21]
A
You had me take that test as well.
- [28:22]
B
I did.
- [28:27]
A
So I wanna ask you, what are the seven patterns of aging? So let's start with number one. Glucose. This carbohydrate metabolism, your first pattern of aging. You have this theory that we're all a little diabetic or that we're all going to be diabetic. It's just a matter of if it will happen in your lifetime or not. Right. Is that true?
- [28:45]
B
It probably happens in all our lifetimes, if we live long enough. For some of us, absolutely. It's a survival journey. There are many genes that cause diabetes, all different combinations, all different types of ways we handle sugar. And that's because our ancestors had to live through lean times, starting with cavemen, right? There were winters that were rough, and if you couldn't put fat on your body, you didn't survive. So the genes that we got passed down to us, whether it was from the famine or the holocaust, were genes that made it clear that it was easy to put on weight. So when food is everywhere and it's processed food, maybe not so good for you. You're gonna gain weight, you're gonna get diabetic. So you' living through fat and lean times. So in the old days, it was a survival technique. Now it's a disease, and it causes and leads to almost every disorder of aging.
- [29:32]
A
Okay. Sad vascular system number two, heart disease.
- [29:37]
B
So heart disease, we hear about all the time. Heart attacks and strokes, they're ubiquitous. In fact, if you have a sugar disorder, you're as likely to get a heart attack as if you've already had a heart attack. That's how sugar affects the heart as well. But heart attack is the vascular system. Can your arteries get plugged up with cholesterol? Are there issues that affect inflammation? Is it your immune system? Is it not enough? Certain vitamins, like B vitamins? I think of it as more systematic. So it affects the vascular system from the heart to the brain, because the
- [30:07]
A
brain is also vascular.
- [30:08]
B
Of course, the brain is vascular means blood flow, vessels. Right?
- [30:12]
A
Okay. I actually forgot. In all my baseline studies, I also had a cardio CT scan to see if there was any.
- [30:19]
B
And cardiac house. They'll look at CT calcium as well. It's a CT calcium and it's a CT angiogram.
- [30:25]
A
And I felt really good because I had zero percent calcification or plaque. But then it turns out most people have that.
- [30:31]
B
No, that's not quite true. Most people don't have zero percent. In fact, the reason we're so focused on heart disease in this day and age is during Vietnam, they did autopsies on these young guys who died at 18, and they already found plaque. You can actually see disease in children who take Accutane if they have a response to lipid to taking Accutane, and their cholesterol goes up, which is something that's monitored using Accutane. That's a diagnostic test for future heart disease. So it was very. It was, you know, Vietnam happened, you know, decades ago, and that's where it started looking.
- [31:04]
A
And is it from the stress that they had plaque? Do we have a theory?
- [31:07]
C
No.
- [31:07]
B
It's from diet. The way you live life and genes.
- [31:11]
A
Okay.
- [31:11]
B
Smoking is. Is a piece of it as well. Plaque is reversible. I've had patients who were headed to the cath lab and headed to getting a bypass or a stent, and we completely reverse it. So having a calcium score of 0. I'm not sure if you want to hear this, but it turns out if you do AI and you look within the wall of the heart and the wall of the arteries, 25% of people already have inflammation within the wall. It might not be plugged up, but inflammation in the wall is actually a lot more common in women. And a lot of times our are different because of that. But it can also explode and cause a heart attack.
- [31:48]
A
Women have heart attacks often. I've actually, unfortunately, lost a friend to a heart attack who's just a few years older. To me, she had not even turned 41. And at the time, like, I was surprised by how many women get heart attacks and how often the symptoms of a heart attack go undiagnosed in women. Why is that?
- [32:08]
B
Yeah, so first of all, women are diagnosed later in life because we have more estrogen. Estrogen protects the heart. So for the heart and the brain, we're somewhat more protected. About 10 years. Men start getting heart attacks in their 30s. We get in the 40s. And when studies are done, they're done in much older women who are not healthy. So they don't look at the baseline treatment. There was a trial that was done called the Women's Health Initiative at the NIH that actually just got reversed because the outcome was putting a black box on hormones. I don't know if you're aware of it, but November 10th, they removed that black box for estrogen and progesterone.
- [32:41]
A
This has been a huge conversation around hormone placement therapy. And, okay, we had a conversation with Tamsen Fadal about this, and there had been this study that linked hormone replacement therapy in women who had menopause with breast cancer. A study that was then debunked. But the debunking never got the coverage of the initial study.
- [33:00]
B
But we do get heart disease. We catch up with men, they catch up with us with osteoporosis. They get osteoporosis later than we do because they have higher testosterone.
- [33:09]
A
So, okay, the third system is metabolism, and this is related to the thyroid.
- [33:13]
B
Right?
- [33:13]
A
Right.
- [33:14]
B
So the thyroid controls a lot of your brain in terms of memory and cognition, your heart in terms of rhythm, your menstrual cycle. In women, if you have. It's sort of the opposite of what you might Think if you have too much thyroid, your menstrual cycle may be light or actually not occur. You might not ovulate. If you have too little thyroid, you might have heavy and irregular menses. So there's a lot. Muscle and bone are connected to thyroid as well.
- [33:39]
A
Okay. And then the fourth and fifth were essentially around hormonal changes, menopause and perimenopause in women, and then andropause and perianthropause in men, which is not a term that I hear a lot of.
- [33:54]
B
So explain what those are in women. Our ovaries basically stop producing any eggs. We don't have the ability. We use them all up. In fact, when we're born, we have fewer eggs than in utero. So that continues. And there are some studies that look at drugs like rapamycin that might delay that use of eggs. So we hit a wall. In General, it's about 50, but I just saw recent women. A woman who is 58 and still cycling and ovulating and can get pregnant. And in some women, it can start as early as 38.
- [34:24]
A
And so was she on rhypomycin?
- [34:26]
B
No, she wasn't on anything. She just naturally made that way. Genetically. She does have signs and evidence in her family history of genes which occur in Ashkenazi Jews, that for longevity, that these are people that might live till 110, 120.
- [34:42]
A
Wow.
- [34:43]
B
So she has cousins that have that. And I suspect she might have inherited it. But that's a separate issue in men. Their testes continue to function, just not well. What happens is initially, testosterone falls, but their brain doesn't notice. And as men never know, compared to the 20s, when they notice it all the time, or starting in their teens to their 20s, the testosterone starts circulating and it's lower levels, less of an amplitude, less frequent. And the brain says, okay, that's fine, you're getting old. We don't want older people around to reproduce. Right. And so you can stimulate male testosterone very easily using peptides, which is what I've done for decades. At some point, the testes don't respond real well and they might need testosterone. We women will always need the hormones because their ovaries just stop producing hormones.
- [35:33]
A
Okay, so is Brian Johnson's nighttime erection indicator a good leading indicator of his andropause function?
- [35:43]
B
I can't tell you what he actually does, although I think he's published it, but I haven't read any specifics where I can interpret myself down that rabbit hole. But, yes, it could be a Sign that he's improving. Particularly if they're measuring what he's doing now to what he was doing before they did any interventions.
- [36:00]
A
Because for women, like, we have a monthly indicator of what's going on in our body through our cycle. Or not, if you don't get your period. But with men, they have no sense of this.
- [36:10]
B
Exactly. They have a hundred day cycle, about a three month cycle of how they produce sperm and how they produce hormones, testosterone. There are two distinct cells in the testes that do one of each. And they can continue doing this even as they age. That's why men can father children without any help. In their 70s, 80s.
- [36:28]
A
Al Pacino, Robert De Niro.
- [36:29]
B
Exactly. Yeah.
- [36:31]
A
Well, I mean, they had some help from like 20 to 30 something year old women.
- [36:34]
B
Exactly. So they knew relationships. And I'm convinced that's what the midlife crisis is about. But men start declining and they need to prove that they want to be on their A game, in the bedroom, in the boardroom. And so buying a Porsche, a red Porsche or having an affair helps them, you know, perform.
- [36:53]
A
That's why I don't even think Leonardo DiCaprio's in his 30s. I think he's actually 20, 26. He maxes out there.
- [36:59]
B
27 is really the age. I was just at a finance meeting speaking at Barron's and I went to one of the sports sections where they're talking about supporting people who had kids going out for Division 1 or then professional sports. And one of the things she said is that we know these kids peak at 27. What can we do to make sure that they hold on to what they've been given so that they're comfortable for the rest of their life and healthy? So I heard that. And I know that happens in medicine. There was a big article in New York Times about that too. For Dieter, the former captain of the Yankees.
- [37:32]
A
Okay. Oh, Derek Cheter.
- [37:34]
B
Derek Cheter, right.
- [37:35]
A
Oh my God. I know more about sports than one person in the world. And it's my doctor. This is great.
- [37:40]
B
So they talk about that all the time. They talk about it for the Olympics too.
- [37:45]
A
Yeah. I think this idea of peaking is. I mean, a colleague of mine when I was at the Times had a story on why women are getting faster with age, running faster with age. So there's all kinds of theories about this. Okay. Running down. So we've done glucose, vascular system, thyroid,
- [38:00]
B
the hormones, perimenopause and menopause, periandropause and andropause. And there are distinct differences between the Two segments, like when you finally get into andropause or when you finally get into menopause. It's very different than peri. In periandropause, your body's going through changes all the time. So when women, it can start in their 30s or their 40s, it can last 10 years. It can also last a month. So you can go from having cycles every single month to having no cycles and you're done. But in most women, it's a few months or a few years of a Runway.
- [38:30]
A
Yes, exactly.
- [38:31]
B
That's a good way to think of it, the Runway. And then you stop and you don't cycle anymore. So by definition, menopause is no menstrual cycle for a year.
- [38:39]
A
Okay, the last two, muscle and brain. So let's talk about muscle first.
- [38:44]
B
Muscle declines. A lot of people now say that muscle is the coin of longevity and protecting your muscle. And moving is probably only second to sleep in terms of how it makes you healthy. Right? So moving, doing resistance training or an exercise, that weight bearing will help us keep muscle. You need to eat enough protein. You need to have your hormones also managed. So those are the minimal things we could do to maximize our health.
- [39:10]
A
And there's obsession with protein right now for this reason.
- [39:13]
B
And you need protein to put on muscle. So you need at least a gram per kilogram, which is a gram per two pounds. But if you work out a lot, you want twice as much. And by putting on muscle, which you need if you're skinny fat, because muscle protects our health, I want to correct something that is out there too. You need fat also. You do not want to have what's called cacao, where you lose fat and you lose muscle. Because with end stage cancer, we know what that looks like. We know what end stage AIDS looks like. These are folks that have lost fat and muscle. And in fact, most women and men over the age of 70 get too thin because it's harder to put on. You don't have muscle and you may look great. You may be what we call skinny fat, which means you don't have enough muscle. You may be 40% fat and you want to be more like 20% or less, but you model for fat well. So there's a bunch of women like that. There's a prototype of women.
- [40:01]
A
And what's the percentage fat that you want to have as a woman, especially in your first.
- [40:04]
B
It varies probably over your lifetime, but depending on the sports you do, the way you live life, probably no less than 15%. And if you can keep it in the teens, that's.
- [40:14]
A
That's a good place to be in your first holidays. 15 to 20 is good.
- [40:17]
B
Yeah, 15 to 20 is good. 10 to 15 is better, is probably good, but less than 10, I think it's hard to maintain body function. You know, you lose your cycle and other things. And bone is part of that, too, because muscle supports bone. But we all become osteopenic. That's why we break bones. We get Carlis fractures of the wrist if we fall off a bike and use our wrists. And that's an indicator of osteopenia, low bone. And then osteoporosis is loss of bone. We can prevent all of that. There's treatments nowadays that reverse it completely. So bone and muscle go together, and then brain. So the brain is, I think, a territory that is the most fascinating and the most frustrating at the same time. There's so much we can do now to protect our brain. We all hear how Alzheimer's is an epidemic, and it is. And I think it's because we are living longer and things go awry. But there's lots of fascinating research and work out there that we're beginning to do. That's one of the reasons we recommend therapeutic plasma exchange for people who can do it. But there's lots of supplements and medications that are coming along that can change the way we present. In terms of brain health, are there
- [41:22]
A
certain diseases that we look at right now that will be solved in the next 20 years? Just giving. It's Alzheimer's.
- [41:27]
B
Alzheimer's, yes.
- [41:28]
A
And are there things.
- [41:29]
B
I think we're solving them now. I've seen data that's amazing. In fact, I'm going to be working with the doctors coming to New York and do things like insert exosomes or parts of the gene material, genetic material that's in stem cells, to fix the brain. So we can first measure it and say, okay, this is the risk. This is where you fall on this spectrum. How much should we do to aggressively keep you, your brain, as healthy as ever when you're 1% hundred?
- [41:57]
A
Are these things like experimental trials? Are they clinical? Are they regulated by the fda?
- [42:02]
B
They're all of the above. So there are some that are absolutely, you know, trials and research. There's a molecule called TB006 that you can only use if you're an investigator. We're doing some of that work. It reverses a molecule called galactin, which we measure. And galactin's a sign of poor health, too. But there are other that doctors and clinicians are allowed to treat a patient if they think they can get them better. Because most of the studies that were done were done in men, for example. So treating women and children would be very difficult if we couldn't apply what we thought would be good medicine for a person.
- [42:41]
A
Right. You'll have to investigate. So the one thing that I thought, maybe when you look at the Harvard Longevity Study or others, one of the things that they found was that the quality of your relationships determines the quality of your life. Something that my friend Esther Perel says a lot as well. Is relationship relevant to any of these seven patterns of aging?
- [43:00]
B
They're relevant to all of them. So when I talk to a person who wants to come in and I describe what we do, and I wanna make sure that they understand the detail. Cause it was so new when I started it. Nobody was doing it at all. Precision medicine didn't exist. Neither did longevity. But I wanted to change the course of what we were doing. Okay. And so I asked them about their relationships within their family, within their friends, their brothers and sisters, cousins, indirectly, the way a physician does. You know, tell me something. How close you know, where's your family live and where are you from? And when I hear somebody who has a lot of anger and dislike and has no friends, it's a danger signal. Is it the only danger signal? No. I'm not a believer in this. Like, one thing you fix and you'll be fine. I think there are priorities of what you could do. But having relationships and having friends and staying close, even when things might be difficult, is a sign of growth and development and openness, I believe. And it's important for all of us.
- [43:59]
A
Yeah. And I imagine, like, relationships also, how
- [44:01]
C
healthy the people around you are have,
- [44:04]
A
you know, impacts on your habit formation and your overall health as well.
- [44:07]
B
There's a study that shows women with metastatic breast cancer who joined a group. There are studies by a doctor out of Stanford who I knew his father actually was the father of hypnosis. But this particular doctor showed that women who had metastatic breast cancer would live 18 months longer if they were part of. They got together in a group setting and shared their concerns. And there are studies from Penn and elsewhere that show if you have a heart attack and you go home to an animal, you're gonna live the longest. If you go home to a partner, you're gonna live next long. But if you go home alone, you're gonna die sooner.
- [44:39]
A
Wow. An animal is better than a partner.
- [44:41]
B
Yes.
- [44:42]
A
Oh, wow.
- [44:42]
B
Hopefully
- [44:45]
A
they don't have to get Your
- [44:46]
B
dog, get your cat, get your hamster, whatever it is.
- [44:48]
C
Yeah.
- [44:49]
A
I've always felt like a good indicator of health is also like having a good emergency contact. Someone that's reliable, but also someone who can be a patient advocate for you in the event of. Of illness.
- [44:58]
B
I agree. And I think in the conventional medicine world, or if you're faced with a decision that's difficult, bringing along someone who's your advocate, be they a family member or a good friend, or even somebody who you trust, you know, is really a smart thing to do.
- [45:13]
A
So for each of these seven patterns of aging, I wanna know one thing that everybody listening right now could do today to help them prevent this pattern of aging.
- [45:22]
B
Move and put on muscle. So that's probably movement and muscle. And I couldn't do one thing. So movement, muscle and sleep, but in that order.
- [45:31]
A
Movement, muscle. But I was gonna say there's not one thing for glucose, one thing for vascular. It's all intertwined.
- [45:36]
B
And does that help?
- [45:38]
A
That helps. That's great. Can I. I mean, it's funny, we're talking about so much of health, and one of the things that, you know, we talk about people getting younger as they get older, et cetera, but then there are these shocks to the system, like cancer. And I have been so scared of seeing people in their 30s around me getting cancer. I now have had friends in their late 30s and early 40s almost every year, being diagnosed for the last five years, every fall, invariably someone calls me up who's like, you know, maybe 37, 38, 39, 40, 41, 42, saying, hey, I just got diagnosed. Diagnosis. And we see that young cancer rates are up across America. What do you think that's about?
- [46:26]
B
I think it's about three things. We've changed our microbiome so we don't have certain bugs in our system that probably helped us. For example, H. Pylori was wiped out because it caused stomach cancer late in life. It causes esophageal cancer. If you don't have any H. Pylori in your gut. And it used to be passed down from parents to children by oral fecal contact. Secondly, it's.
- [46:48]
A
Wait, what?
- [46:50]
B
Like little children. It would be. H. Pylori would be in the microbiome of the feces. So it would be. So diaper changing, diaper changing, things like that.
- [46:58]
A
Why were they oral touching them?
- [47:00]
B
Because you're sucking fingers. You're doing lots of other things. If you're not completely sterile, which we're not. I got it.
- [47:05]
A
Okay.
- [47:05]
B
Do you know that 99% of our body is made up of bugs other than us genetically, we are like only a small percentage of our body. We have bugs everywhere that range from bacteria to viruses to fungi. You never heard that? You know of the microbiome?
- [47:19]
A
No. And I feel like I grew up in Asia and Africa, so I feel like I have a very good immune system. Maybe I'm 99%.
- [47:23]
B
You have those microbiomes and it changes with countries and where you are.
- [47:27]
A
Yeah.
- [47:27]
B
So. Yes.
- [47:28]
A
Oh, wow.
- [47:29]
B
Yeah.
- [47:29]
A
Okay. So that's a whole other topic. Okay, sorry. That just really threw me. Oral fecal contact between babies and mothers. Okay.
- [47:34]
B
So I think. And it made younger people get, like, for example, esophageal cancer in their 30s and 40s. And I've known people who died from it as opposed to stomach cancer in their 80s or 90s, because the H. Pylori, the balance in our microbiome and our system is critically important.
- [47:49]
A
Okay, so that's number one, you said the microbiome.
- [47:51]
B
Number two, we're eating the wrong kinds of food. All the food, even food that comes straight from the ground, is usually put in a cold storage room, like apples, for, you know, to bring them to market when you need them. So we're not going out and picking the food. We eat at right peakness. The soil is not even fantastic. There are chemicals. There are things that our body isn't ready to process. Plastics. You've heard that, right? It's everywhere. It's even in our brain. So how do we get rid of plastics? Some of the things we do are aimed at lowering the plastic levels in our body and using different kinds of utensils and things that are not plastic less or titanium, things of that nature.
- [48:28]
A
And a third.
- [48:29]
B
And number three, I don't think we have answers. Like, I think that the biggest part of number three is Covid managed to change our system. And so the CDC has looked at this data, and there's early disease, not just cancer, but heart attacks and other kinds of diseases that are happening at an earlier age because Covid actually has penetrated our cells. And I'd even recognize this in my patient population because of the work we do. We have very healthy people. We get them healthy as fast as possible. But all my colleagues in this industry, many of them see long COVID patients with neurological disorders with cancer, with heart disease. And Covid has played a major role in that, I believe, in today's world.
- [49:10]
A
So there are studies here, like the Cedar study, that showed that. How do you call it?
- [49:16]
B
Myocardial infarction yeah, heart attack.
- [49:18]
A
Heart attack were more common in, like, 30s and 40s, I think, or the studies showed they were more common in people in their 40s, for example, post Covid, than before COVID in the same exact neighborhoods. So is this epigenetic, what you're describing?
- [49:31]
B
Yes, this is a good example of epigenetics.
- [49:33]
A
So the third category is really things that are epigenetic.
- [49:36]
B
Things like plastics, like Covid, like other things we can't always control. But if we can optimize our health to the best of our ability, then we have more of a chance to resist these kinds of infections and diseases.
- [49:50]
A
Do you think that cancer is one of the things that, through artificial intelligence and otherwise and through awareness that we're going to address within my lifetime?
- [49:58]
B
I do think so. I think we're already addressing it with immunological. We've had patients completely cured of, for example, malignant melanoma, which runs in my family. And I had an aunt and a cousin who died of it. One at 70 and one at 40. And it's in my system. I know I have the gene. Right.
- [50:14]
A
There's something called autophagy that people are obsessed with. This idea of, like, killing off the bad cells. Something that happens during sleep, but also during fasting, right?
- [50:21]
B
Yes. It depends on the person's makeup. Not everyone can fast sometimes. You have genes that say you can fast all you want and won't do anything. But fasting itself for some people is like a cleanse, and they can do it. TPE does that. That's the cells I talk about, the senescent cells as opposed to killer cells.
- [50:38]
A
So you talked about moving muscle and sleep. So we're gonna get moving out of here pretty soon. I have one last question to ask you, which is a question, smart girl. Dumb questions. You're so smart about many things and obviously about your field. What is something that you, Dr. Florence Comitay, are dumb about?
- [50:57]
B
I don't know why time passes faster and speeds up as you get older. It's really a strange phenomenon. But I remember being a child and feeling like summer lasted forever. And now, in a blink of eye, the year is done. Another year has gone by, and I don't understand that. I wish I understood more about the passage of time. That would be fascinating.
- [51:17]
A
Oh, I love that. I wonder if it's also relative, like you. When you're a kid, you have nothing to compare it to.
- [51:21]
B
So, like, maybe, but it just a sense of. Do you remember being a kid and being at the beach or hanging out didn't it feel like those days lasted forever?
- [51:30]
A
Yeah. Now everything's.
- [51:31]
B
And now you get a week or two weeks and it's like gone immediately. It's like.
- [51:36]
A
I love that question. Okay, we're gonna think about it. Maybe we can figure it out. Maybe we're just gonna wonder about it. Thank you so much, Dr. Comte. Where can people find you if they'd like to find more information? Fantastic.
- [51:46]
B
Dr. Florence Kamate in terms of Instagram and also LinkedIn online, it's comite md.com.
- [51:54]
A
yeah. And then your forthcoming book coming out in April, Invincible. And we can all be Leo DiCaprio and are in our 30s, emotional.
- [52:00]
B
Or even better, maybe don't even aim it.
- [52:03]
A
We can be Leo DiCaprio's girlfriend. That's the goal. All right, thank you so much, Dr. Comitano.
- [52:08]
B
Thank you.
- [52:08]
A
Great. All right, I'm gonna have to have more follow up appointments with Dr. Kamate,
- [52:16]
C
who has been so generous with her time with me.
- [52:18]
A
You know, I started this episode feeling
- [52:20]
C
really smart about my own body.
- [52:21]
A
I had all this data that I've been armed with through this kind of
- [52:23]
C
precision medicine approach, but I think I was really dumb about the disconnect between certain things. I assume there's this correlation between how rich you are and how healthy you
- [52:33]
A
are, how skinny you are and how
- [52:35]
C
healthy you are, how you know. But some so much is not seen. What I really appreciate about Dr. Comite's work is the analysis that she does in this kind of beautiful mindy way to understand what's going on in our own bodies. And I think if there's a way to create that at scale and an affordable basis for many people to get, say these five biomarkers, really track them over time, get your own baseline and pursue them. I think that is a really good, hopeful view of the world. And I love what she said about healthy longevity, about the idea of kind of growing old and going peacefully in
- [53:13]
A
your sleep, which I think is how
- [53:14]
C
a lot of us aspire to go and not the way a lot of us go.
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A
Anyways, I learned a lot. I have tons more questions.
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C
So I think I have to do a whole like, can I live Forever? Series and definitely have to do a why are people getting Cancer so Young?
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A
Series.
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C
It is heartbreaking to see. And I just actually came back from Mexico ago where I celebrated the survival of one of my best friends, Federica, who was diagnosed with acute myeloid leukemia at 38. And she is now a year out from her transplant and she's cancer free. And it's amazing. And so, you know, I just hope modern medicine is going to move us along and that our healthcare systems and our own awareness is going to propel us to better health care for each
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A
of us in the future. But anyways, I want to know what you learned. Send me a note.
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C
I'm naimaraza101mail.com. You can drop them in comments below.
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A
Thank you for tuning in.
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C
That's it for this episode of Smart Girl Dumb Questions. This episode was produced with Desta Wonderad of Wonder Studios and Melissa Gibson. It was edited by Darlene Chiem and
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engineered and mixed by Johnny Simon.
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I'm your host, Na Raza, and I want to give special thanks to Healy Cruz and Holly Thiel and to David
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A
Khan, who does our music. See you next week on Smart Girl Dumb Questions. Ra.