Doctor Says Optimal Hemoglobin A1C Under 5 Not Current Guidelines
"Hemoglobin A1C, 5, less than 5. The data in the literature that I quote shows hemoglobin A1C of less than 5 is associated with less diabetes and disorders of chronic disease. As hemoglobin A1C creeps up by a tenth of a point, that change is dramatic, and your risk of disease as you age goes up."
About this episode
On this episode of Feel Better Live More, host Dr. Rangan Chatterjee interviewed Dr. Florence Comite, a US endocrinologist and longevity expert with 30 years of clinical experience at Yale and the National Institutes of Health. The conversation centered on Comite's new book Invincible and her paradigm-shifting approach to preventative medicine, which treats patients proactively before disease manifests rather than reactively after diagnosis. Comite revealed that none of her patients have experienced a heart attack while on her protocol, a remarkable claim that underscores her focus on early intervention. The core of her methodology involves tracking five key biomarkers—fasting glucose, hemoglobin A1C, fasting insulin, cholesterol risk ratio, and free testosterone—which she argues can predict and reverse chronic disease decades before symptoms appear. She made the controversial assertion that fasting insulin, a marker almost never checked in routine care, changes decades before diabetes diagnosis and that she has never found a patient with all five biomarkers in optimal range. Comite challenged conventional medicine's reliance on population averages and normal ranges, advocating instead for individualized N=1 medicine that tracks personal trends over time. She argued that virtually everyone will develop carbohydrate metabolism disorders as they age due to declining testosterone and muscle mass, and that lifestyle optimization alone cannot restore hormones to optimal levels. The discussion covered her extensive use of testosterone replacement in both men and women starting in their 30s, including HCG peptide therapy to stimulate natural production, and her advocacy for continuous glucose monitors as essential tools for personalized health data. Comite also critiqued current healthcare systems in both the US and UK as disease-management models rather than health-creation systems, and shared her vision for virtual medicine delivered through apps that provide credentialed, scientific guidance at scale. The episode concluded with her call for individuals to take ownership of their health trajectory by understanding their biomarker trends and making proactive changes to defy their genetic destiny.
Key takeaways
- Dr. Comite stated no patients on her preventative protocol have experienced heart attacks, attributing this to early biomarker intervention.
- Fasting insulin changes decades before diabetes diagnosis but is almost never measured in routine healthcare according to Comite.
- She advocates hemoglobin A1C targets under 5.0, far lower than current guidelines, citing literature linking each tenth-point increase to higher mortality.
- Comite claims lifestyle optimization alone cannot raise testosterone to optimal levels once age-related decline begins in the 30s.
- She has prescribed testosterone to both men and women for 30 years, crediting it with preventing her own osteoporosis over her identical twin.
- Virtually all people will develop carbohydrate metabolism disorders as they age due to declining hormones and muscle mass, she argues.
- Current healthcare in US and UK is reactive disease management, not proactive health creation, requiring a shift to individualized virtual medicine models.