Endocrinologist Florence Comite, MD, doesn't believe we should accept aging as is. She believes any man can restore his body, mind, and energy; prevent disease; and feel strong, confident, and in control once again.
Keep It Up will show you how to quantify your own health and then make key changes that will reduce your belly fat and risk of diabetes, revitalize your sex drive and strengthen your erections, and give you more muscle and greater mental agility. Because testosterone affects all of the above aspects of a man's vitality, Dr. Comite shows readers how the cutting edge science of hormone optimization is an effective way to prevent the disorders of aging.
"Testosterone optimization can absolutely change a man's life," Dr. Comite says. It can reduce fat, build lean muscle and reverse disease but the most important benefit, she says, "is the feeling of being 'recharged'-feeling more focused, more vigorous, more masculine, more alive."
Key chapters in Keep It Up include:
- The Metabolic Tests
- The Hormone Tests
- The Sleep and Stress Connection
- Great Sex, Your Second Act
- Building a High-Performance Body
- The Truth about Hormone Therapies
- Advanced Diagnostics
- The Future of Medicine, Today
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About the Author
Read an Excerpt
THE GAME IS CHANGING
Can your body keep up with what modern culture expects of it as the decades pass?
The realization that I wasn't what I used to be came a couple years ago when I was in the Congo tromping through the jungle. I'm a photographer. Jane Goodall was there, and she's 77 and kicking the [crap] out of the entire crew. All these guys couldn't keep up with her. Throughout my career, I'd always been the strongest guy on my crew. I'd be in Dubai running up a sand dune leaving my younger assistants in the dust. But suddenly that was over for me. I'd lost that. I could feel myself failing. It was horrible. When I got my blood work back from Dr. Comite, my cortisol [stress hormone] levels surprised me. I know what it feels like to be stressed out, but I'd never seen being stressed out illustrated as a number before, chemically. My testosterone levels were low, of course, and whatever improvements I could make to my physical infrastructure through hormone treatment and exercise was my primary concern. I didn't just want to be better. I wanted to be optimal. I'm competing with the best in the world.
I felt results right away. I had more energy, and now Dr. Comite tells me that I've essentially reversed the aging process in most of my measurable tests. Travel is still the biggest obstacle for me. I avoid the junk foods that are easily accessible, like in hotel minibars. Also, I've never had a steady, normal schedule. In my work, I have to keep a second suitcase packed at all times because I don't know when or where I'm going next. So I work very hard to eat right and stay on the program no matter where I am. I rededicated myself to the good things I had already been doing while including the newer ideas from Dr. Comite and her staff, such as adding intervals to my workouts. My God, has that helped me! I am now out on a shoot and not even feeling it.
—VINCENT M., age 53, photographer
The baby boomers have forever changed what a 40-year-old looks like and what he can do with his body. The transformation began in the 1980s, when many people started exercising more and eating better. They also were starting their families later in life. All this got pushed up against the wall of the body's natural slowdown, and the health impact became obvious. It used to be you might live into your fifties, dying from the disorders of aging instead of surviving to deal with their complications. Today, you'll likely live into your eighties, so now the question becomes, How well will you live those added years? How will you sustain health beyond your peak? If life begins at 40, as the saying goes, then we need to make sure the body can keep up.
Here's the problem: Countless men hitting their forties come into my office and tell me that everything seems like it's just grinding down--that their best years are over. If you're feeling that way, and facing four more decades of life, that has serious implications.
Growing older in the current medical climate isn't pretty. It's full of knees that don't work, beer guts that persist even after you stop drinking, a disappearing sex drive, and a steadily weakening of body and mind until some debilitating disease takes you out. It doesn't seem fair or practical. Our quality of life is suffering, and our health care system is crashing because it wastes billions to manage chronic disorders year after year. We have extension of life but not extension of health. I don't want to see folks in the last one, two, three, or even four decades of life having few choices in how they live except to cater to the complications of avoidable diseases.
You will likely live longer thanks to modern medicine, and you too can be like my dad and live to see your nineties. If you take action now, you can age in good health like my father fortunately did. He took the initiative to eat right and exercise. He monitored his health and challenged himself to improve in a way that people usually don't do on their own. My father was the first person to shape my ideas on Precision Medicine. Knowing yourself and taking ownership of your health will help you keep going strong physically, mentally, and socially. Doctors may not always ask the right questions, so it pays to be aware as Livingston Miller's story illustrates.
I'm a trainer, so I eat right and I stay in shape. I've appeared in ads all over New York City for a gym, advertised as the picture of health. I was training Dr. Comite and talked to her about some of the problems I was having--getting dizzy periodically, feeling thirsty all the time, and fainting. I was drinking a lot of fluid and urinating so much that I cut back on water. When I had gone to another doctor, he thought I was dehydrated because of my intense physical activity. He wasn't alarmed by my elevated blood sugar either because I ate five meals a day. I even passed out a few times and was brought to the ER. There, they had no idea what was wrong with me, even with multiple tests, CAT scans, too. My symptoms persisted, and Dr. Comite was hearing my frustration. After another episode when I passed out just after snacking on a protein bar at the end of a long day of golf, I told Dr. Comite, and she got me evaluated right away. When the lab test results came back, I was in for the shock of my life. I was a diabetic. Then I underwent a VO2 assessment, and the findings caused her to suspect that I had had a silent heart attack sometime in the past. Next I underwent a nuclear stress test, which confirmed the muscle damage in the inferior portion of my heart. My cholesterol was 240. I got onto her program, lost 20 £ds, and turned the diabetes around completely with supplements and eating the right food at the right times. I got my cholesterol down and have been repairing the damage from the heart attack.
—LIVINGSTON MILLER, age 59, personal trainer
Livingston's symptoms were classic signs of diabetes. Before I brought him in for testing, I asked him, "Who in your family has diabetes?" His response: "Everyone." That didn't surprise me, and it indicated that I was on the right track. After I ran his blood work and saw his sugar metabolism numbers (see his hemoglobin A1c shown on page 237), my hunch was confirmed. If he had been asked about his family history earlier, the other doctor might not have glossed over his high blood sugar. If doctors had more time with patients, we could get to know them. By asking the right questions, we would be better able to identify such warning signs. That's why you have to know your family's health history and your own health data, a process I'll help guide you through in this book. With this knowledge, you'll be the one to optimize your own health and ensure the quality of your life at any age.
Livingston has done a health 180. What did he change? He's getting adequate sleep; he's practicing stress reduction; he's training properly for his body--significantly cutting back on the resistance training, replacing it with more cardio. He's mostly eating the right food regularly throughout the day and is drinking less wine too; he's taking supplements and even some medications for balance. I have him on a statin for his cholesterol because I want to see it lower than the 180 milligrams per deciliter (mg/dL) he has been able to attain with lifestyle changes. I've also started him on testosterone, which has benefited his metabolism. For Livingston, it's game on. Now he has the chance to keep his edge for the rest of his life. If he stays on track, he will likely be in good health for decades to come, despite having hit a rocky patch in his late forties.
But imagine if Livingston's disorders of aging--heart disease and diabetes-- had gone undetected. His future might have looked as it does for many seniors facing constant hospitalizations, with limited mobility and mental faculties. I don't want this to be the way anyone lives their last years. And it doesn't have to be.
I've been a doctor for 36 years. I studied and taught medicine at Yale Medical School at Yale University, and I've been fortunate to work with some of the brightest minds in the medical world. I'm an endocrinologist, which means I look at communication throughout the body through the interaction of hormones and proteins, these agents in essence determining much of how we think and feel every day and over the course of our lives.
Which 84-Year-Old Do You Want to Be?
I've shrunk to about 100 £ds. I have diabetes and I'm in the hospital after breaking my second hip. I was home for only 3 weeks after the repair of my first hip fracture. My wife and son are by my bedside constantly, and I'm not able to eat much. I'm failing fast, and I feel I'm helpless. After being strong all my life, I never thought I could become so frail.
—SAM, retired electrician
I founded an investment banking firm over 40 years ago, and I never imagined that I would stop working. I wanted to be able to get into the office at least twice a week; still, even that was becoming impossible. It was pretty depressing to feel incapacitated. My available testosterone level was 14, and I was told that was less than you'd find in a boy, not even a teen. I started on testosterone and several supplements, including DHEA (dehydroepiandrosterone), vitamin D, coenzyme Q10. Within a few weeks, I'm not only at the office every day, I'm in the gym every day too. I even wake up with erections. I hadn't seen that action for years! I feel stronger, with more energy. My whole attitude has changed.
—GEORGE, investment banker
I've had the opportunity to study the human body in all its stages: in utero; early childhood; school-age years; the teenage years, when hormaonal surges trigger puberty; the twenties, when the body reaches its physiological and reproductive peak; the thirties, when hormone production begins to shift and dial back; the forties, when physiological and reproductive challenges usually become noticeable; the fifties, when health and disease consequences may develop, the product of unchecked disorders of aging; and the sixties, seventies, and so on.
The usual model has been to try to repair the body's malfunctioning systems and parts with medicine, which commonly shuts down any remaining functionality, creating a lifelong dependency on pharmaceauticals. When you replace thyroid hormone, for example, the thyroid gland stops working, and you are likely to need alternative sources of thyroid hormones for the rest of your life. My passion has been to find a way to help the body regain balance naturally, when possible, to restart sluggish metabolic function while triggering optimal hormonal activity. Lifestyle factors like sleep, stress, sex, nutrition, and exercise all impact the body's operation.
I've done clinical research at both Yale and the National Institutes of Health (NIH) that required thinking about how to help the body do a better job of taking care of itself when something isn't functioning well. My early focus was on pediatrics, specifically puberty that occurs too early, and later I helped develop Women's Health at Yale. My role, at that point, was to serve as a consultant; often many patients were interested in participating in my research trials on hormonal function once they met me. I wasn't a primary care doctor but the person a specialist conferred with when a patient was not making progress, a diagnosis was proving difficult to determine, or alternative management approaches were needed. A gynecologist might send her patient to me, for instance. I would assess the patient's health, make a diagnosis, then make recommendations, some of which may have derived from my research efforts. I acted as a tertiary consultant in many cases in that I conferred with specialists, but I didn't replace them or the primary physicians.
In the 1980s, I began to hear many stories that sounded similar. Women would tell me that they didn't know what was happening to their bodies. They felt lethargic, anxious, and generally just not like themselves. Some of these women were medical researchers and writers who had access to the literature, and they still didn't really know what was wrong. They would tell me: "Nobody seems to be able to answer my questions. I was told it's all in my head." Diagnoses were anything but physical: often empty-nest syndrome, depression, or something similar. Many of these women were given prescriptions for diazepam (Valium) or chlordiazepoxide (Librium). They were told to adopt a puppy. They were told to get over it. These women, baby boomers who were starting to feel the effects of aging, considered these answers unacceptable and kept searching for different solutions.
What became clear to me was that these women weren't being taken seriously and they weren't going to stay silent. They were not like their parents, who would rarely challenge their physician. Plus, they were part of the sandwich generation, raising a family yet also largely responsible for the care of their aging parents, who often were in poor health. They were concerned about following in the same path, adding burdens for their own children in the future.
As an endocrinologist, I knew that their hormones were in transition, declining each year. The cascade was producing a physiological change that was fundamentally transforming their bodies and shaping their minds, attitudes, and energy. Then it clicked: This time in life--menopause, for women--was an unwinding of what had begun to wind up in puberty. This epiphany led me to start down the road of appreciating how we can optimize the body's function to prevent the downward slide that we had assumed was inevitable with age. We could do it by bolstering the body's ability to regain hormonal balance. And if this was true for women, it was probably true for men as well.
Unexpectedly to me, the number one complaint I heard from women over 40 was actually not about their own health or the fact that they had put on a few £ds. It was about the failing health of their husband or male partner-- their man's lack of energy, his weakening of libido. What's more, women were not only complaining about their men, they were losing interest in their partners because of it. The failing health of their husbands was the number one reason many women cited for having affairs.
Table of Contents
Chapter 1 The Game is Changing 1
Chapter 2 Game On! Increasing Health Span 17
Chapter 3 The Metabolic Tests 39
Chapter 4 The Hormone Tests 74
Chapter 5 The Sleep and Stress Connection 100
Chapter 6 Great Sex, Your Second Act 121
Chapter 7 Building a High-Performance Body 138
Chapter 8 Vitamins and Dietary Supplements 165
Chapter 9 The Truth about Hormone Therapies 185
Chapter 10 Advanced Diagnostics 203
Chapter 11 Achieving your Sweet Spot 220
Chapter 12 The Future Of Medicine, Today 249
Appendix: Precision Health Questionnaire 273