00:00:00
Standard panels are doing exactly the job that they were built to do, which is to catch a
00:00:04
disease.
00:00:05
They were never built to tell you whether you're operating anywhere close to your ceiling
00:00:08
or what diseases may be coming in the future.
00:00:11
So if you walked away from your last physical with a clean bill of health, but you still
00:00:15
don't feel like you're operating at your best, that gap right there is exactly what these
00:00:20
markers are built to close.
00:00:22
Welcome to Health Decoded, your number one source for real health information with your
00:00:27
host, doctor Alessi and Matt Tack.
00:00:33
So you just got your annual physical.
00:00:35
Your blood work came back normal, and your doctor shook your hand and said, see you next
00:00:40
year.
00:00:40
Everything's fine.
00:00:42
But why do you still hit the wall at 2PM every single day?
00:00:46
Why does the recovery from your bad night's sleep take you longer than it used to?
00:00:51
Why is the number on the scale the same as five years ago, but you look and you feel different?
00:00:57
Well, here's the problem, and I wanna be precise about this because this is the whole
00:01:01
episode basically in one sentence.
00:01:03
The standard physical is built to catch disease.
00:01:07
It is not built to measure performance.
00:01:10
And those are two different jobs.
00:01:12
A normal fasting glucose tells your doctor you don't have diabetes right now.
00:01:17
It tells you almost nothing about whether your metabolic engine is running efficiently,
00:01:21
whether you're inflamed, whether your cardiovascular risk is quietly climbing.
00:01:27
The panel your insurance covers is basically a floor.
00:01:30
It's not a ceiling.
00:01:31
And if you're a high performer or someone whose job depends on cognitive output, stamina,
00:01:37
decision making under pressure, the floor is not the number you should be optimizing to.
00:01:42
So today, I'm giving you the five categories of biomarkers that never make it onto a standard
00:01:47
panel, but why each one matters specifically if you're operating an executive level, and what
00:01:53
we actually do with the data once we have it.
00:01:56
This isn't a go ask your doctor list.
00:01:58
This is what we run at Ascend and exactly why we do that.
00:02:02
So let's get right into it.
00:02:04
So start here because this is the clearest example of normal not being optimal.
00:02:10
Lipids.
00:02:11
Your standard lipid panel gives you four numbers.
00:02:14
Basically, total cholesterol, LDL, HDL, and triglycerides.
00:02:19
Your doctor will look at the LDL.
00:02:21
He'll see it's under one thirty, maybe under a 100 if you're being careful, and tell you that
00:02:25
you're fine.
00:02:26
But here's what that panel doesn't tell you.
00:02:29
How many particles are carrying that cholesterol and how small and dense they are.
00:02:34
This matters because cardiovascular risk isn't driven by how much cholesterol is floating in
00:02:39
your blood.
00:02:40
It's driven by how many particles are available to lodge into your arterial walls and start the
00:02:45
inflammatory cascade that eventually becomes plaque.
00:02:49
Think of it less like a fuel gauge and more like a traffic count.
00:02:54
LDL cholesterol tells you the total volume of cargo being shipped.
00:02:57
It doesn't tell you how many trucks are on the road.
00:03:00
You can have a totally normal LDL number and still have a high particle count because your
00:03:05
cholesterol is being packed into large number of small dense particles instead of fewer
00:03:11
larger ones.
00:03:13
So two patients with an identical LDL of one ten can have wildly different actual risk.
00:03:19
One might have 900 particles, the other 1.
00:03:24
Same cargo, total twice the trucks on the road, twice the opportunity for something to go wrong
00:03:30
at an intersection.
00:03:31
So that panel can't tell them apart, but an APOB can.
00:03:36
So APOB, which is apolipoprotein b, is a direct count of the atherogenic particles, LDL, VLDL,
00:03:45
ILDL, LPA, one number, and it is far better predictor of cardiovascular events than LDL
00:03:51
cholesterol alone.
00:03:53
This has been argued in cardiology for over a decade.
00:03:56
It's increasingly recognized as the more accurate measure even if it's still catching on
00:04:02
in mainstream primary care.
00:04:04
But it's still not on the standard panel, and most of you are getting once a year.
00:04:08
So why is that?
00:04:10
And here's why this is specifically important.
00:04:12
If you're running a company or you run a team or you're somebody who needs to perform
00:04:17
cardiovascular events, they do not announce themselves.
00:04:21
And we've all heard stories of people who seemingly are healthy, and their doctors say
00:04:26
they're fine, and then they have a heart attack.
00:04:28
There's no meeting on your calendar for this.
00:04:30
There's not warning sign.
00:04:33
The first sign of a heart attack is often the heart attack itself.
00:04:36
And so the people who show up in the cardiologist's office with an event in their
00:04:40
fifties, they over overwhelmingly, people had what would be called normal cholesterol on
00:04:45
paper the year before.
00:04:47
Not because the disease appeared overnight, but because nobody was measuring the marker that
00:04:51
would actually have shown it developing.
00:04:54
And so if you're an executive, if you're in your forties or fifties with a family, if you
00:04:59
have history of heart disease in your family, or you've had a normal lipid panel for a
00:05:04
decade, and you would, like, actually wanna know your risk, APOB is the single highest
00:05:09
value number that you're not getting.
00:05:11
It actually costs almost nothing to add to a panel.
00:05:14
It's just one more tube of blood.
00:05:17
Run this alongside everything else you're already getting drawn, and it can completely
00:05:20
change the risk picture of your current cholesterol numbers and sometimes reassure you
00:05:25
when the picture looked worse than it is.
00:05:28
Because sometimes doing the opposite, telling you to take action before standard panel would
00:05:33
have said anything.
00:05:34
Okay.
00:05:34
So here's the next one.
00:05:35
This is the one that I want you to pay close attention to because it's the marker most
00:05:39
directly tied to the one thing you're actually probably here for, which is being able to
00:05:43
perform or optimize your health.
00:05:45
So energy, the two PM wall.
00:05:47
Standard panels are gonna check fasting glucose.
00:05:50
That's it.
00:05:51
Glucose is a lagging indicator.
00:05:53
By the time it's elevated, the problem has usually been developing for years.
00:05:57
So here's the mechanism, and I wanna walk through it slowly because once you understand
00:06:01
this, you'll actually never look at normal glucose the same.
00:06:05
When you eat, especially carbohydrate heavy food, your blood sugar rises, and your pancreas
00:06:11
releases insulin to move that glucose out of your bloodstream and into your cells, where it
00:06:16
gets used for fuel.
00:06:18
In a metabolically healthy person, that process is efficient.
00:06:23
A modest amount of insulin does the job.
00:06:25
Glucose comes back down cleanly and the system resets.
00:06:29
In someone who's developing insulin resistance, the cells stop responding as well to insulin
00:06:34
signal.
00:06:35
The receptors on the cell surface become less sensitive.
00:06:39
So the pancreas compensates the only way it knows how, by producing more insulin to force
00:06:44
the same amount of glucose into the cells.
00:06:47
And because that compensation works, at least for a while, glucose stays in normal range.
00:06:53
The extra insulin is doing the heavy lifting.
00:06:55
But you're now running a system under load that used to run without strain, and that
00:07:00
compensation has a cost that doesn't show up on the marker that anyone's actually measuring.
00:07:06
This is why fasting insulin and the calculated ratio, which we call the HOMA IR, which
00:07:12
combines fasting glucose and fasting insulin into a single index, catches the problem years,
00:07:19
sometimes even a decade before glucose does.
00:07:22
Optimal fasting insulin is under eight micro IU per ml.
00:07:27
We regularly see executive high performers, people with no visible weight problem, glucose
00:07:32
sitting at a comfortable 90, with, like, a fasting insulin of, like, 15 or 18, or even
00:07:37
sometimes higher, telling us that their pancreas is working overtime to keep that
00:07:42
glucose looking normal on paper.
00:07:44
But nobody's measuring the thing doing the compensating because it was never part of the
00:07:48
panel.
00:07:49
So here's why this matters.
00:07:51
If you're sitting in back to back meetings, if you live on coffee, if you live on adrenaline,
00:07:56
insulin resistance doesn't just predict future type two diabetes, which is the framing most
00:08:01
people have heard and mentally filed under, like, someday, this is not my problem right
00:08:06
now.
00:08:07
It's directly tied to the energy crash you feel mid afternoon.
00:08:10
The brain fog that you get in a 4PM meeting.
00:08:13
The carb heavy lunch that leaves you foggy and reaching for a second coffee instead of feeling
00:08:18
fueled and sharped.
00:08:20
Your cells, including the ones in your brain, are becoming progressively less efficient at
00:08:25
taking up glucose for fuel.
00:08:27
That's the biology behind the thing you've been talking up to as just stress, or getting older,
00:08:32
or needing more sleep.
00:08:34
It's not that you're undisciplined, and it's not something you're gonna be able to
00:08:38
caffeinate your way out of for a long term.
00:08:40
It's a measurable, correctable metabolic signal that your annual physical never looked for
00:08:46
because it never ran the test that would have found it.
00:08:50
The third thing, inflammation.
00:08:52
And these are the inflammation markers that you can't even feel.
00:08:56
You don't know this is building.
00:08:57
Two markers here in specific, h s c r p, which is high sensitive high sensitivity c reactive
00:09:03
protein, and homocysteine.
00:09:06
Neither hurts.
00:09:07
Neither shows up as a symptom that you would bring to the doctor.
00:09:11
Both are quietly correlated with accelerated cardiovascular and cognitive decline.
00:09:16
So HSCRP is a marker of systemic low grade inflammation, Not the kind of inflammation from
00:09:23
a sprained ankle where you're gonna see it, feel it, watch it resolve in a few weeks.
00:09:28
That it's the kind of smoldering low level inflammation that's going on at all times from
00:09:34
things like visceral fat in the abdominal region, from chronic stress physiology, poor
00:09:40
sleep, gut permeability, or food sensitivity.
00:09:44
Optimal would be under one milligram per liter.
00:09:47
And a lot of healthy executives who are healthy on paper with a good diet, exercise, they have
00:09:53
no obvious red flags, are sitting at around a two or a three or even higher.
00:09:57
And so I wanna spend a minute on why specifically because this is the piece that's
00:10:02
most relevant to you and most commonly missed.
00:10:06
Chronic occupational stress doesn't just feel bad.
00:10:09
It has a direct inflammatory signature.
00:10:11
When cortisol is chronically elevated or elevated at the wrong times of day because
00:10:16
sleep and stress have disrupted your normal rhythm, your immune system's regulatory signals
00:10:21
are gonna become disrupted.
00:10:23
Cortisol is supposed to help keep inflammation in check.
00:10:26
But under chronic stress, the tissues that respond to cortisol become less sensitive to
00:10:30
it.
00:10:31
Similar to what we talked about earlier with insulin resistance a few minutes ago.
00:10:35
Except this time, it's the hormone that's supposed to be dialing inflammation down that
00:10:39
stops getting hurt.
00:10:41
The result is a baseline inflammatory state that has nothing to do with your diet and
00:10:46
everything to do with the way you manage your calendar.
00:10:49
This is the piece that people miss because you can be doing a lot of things right on the
00:10:53
nutrition side and still be inflamed because the driver isn't your food.
00:10:58
It's your cortisol curve and the sleep debt that you've created.
00:11:02
So why does this matter beyond inflammation is bad?
00:11:06
Well, chronic low grade inflammation is now understood to be one of the core mechanisms
00:11:11
behind accelerated vascular aging.
00:11:13
It's actually part of how the arterial plaque forms and progresses, and increasingly, it's
00:11:19
implicated in cognitive decline as well.
00:11:22
Though effects on the blood brain barrier pause.
00:11:27
Jeez Louise.
00:11:30
Unpause.
00:11:31
And increasingly, it's implicated in cognitive decline as well through effects on the blood
00:11:36
brain barrier and neuroinflammatory process that will track with long term changes in
00:11:41
memory and processing speed.
00:11:44
This is a leading indicator.
00:11:46
It's not a symptom you'll notice until the downstream event happens, such as a cardiac
00:11:51
event or the cognitive change, and no one can attribute to just getting older.
00:11:57
The next piece that we talked about was homocysteine, an amino acid byproduct that when
00:12:02
it's elevated is independently associated with cardiovascular risk and is tied to how
00:12:07
efficiently your body is running methylation.
00:12:11
Methylation is a biochemical process that touches an enormous range of downstream
00:12:15
function.
00:12:16
Detoxification pathways, neurotransmitter production, DNA repair.
00:12:21
So elevated homocysteine is often a signal of a b vitamin insufficiency or possibly a genetic
00:12:27
methylation inefficiency, both of which are easily correctable once you know they're there,
00:12:33
and both of which are completely invisible on a standard panel that never checks for them.
00:12:38
Neither of these two markers, HSC or p or homocysteine, will ever generate a symptom that
00:12:43
sends you to urgent care.
00:12:44
That's exactly why they matter because that silent, measurable, pause.
00:12:53
That's exactly why they matter.
00:12:55
Silent, measurable, and by the time they become a felt problem, you've lost the years where
00:13:00
correcting course was easiest and cheapest.
00:13:04
Next, hormones.
00:13:06
If your physical checked hormones at all, it probably checked one number, maybe total
00:13:10
testosterone or estrogen.
00:13:12
That number alone tells you almost nothing useful, and here's why.
00:13:16
Testosterone in your blood exists in two functional states, bound and free.
00:13:22
Bound testosterone is attached to proteins, primarily sex hormone binding globulin, or what
00:13:28
we call SHBG.
00:13:30
And in that bound state, it is not biologically active.
00:13:34
It can't do anything at the receptor level.
00:13:37
What actually matters is free testosterone, the small fraction that's unbound and available to
00:13:42
your tissues.
00:13:44
Along with SHBG itself, estradiol, and in a generally thorough panel, thyroid markers that
00:13:51
go beyond just TSH that include free t three, free t four, because TSH alone can actually
00:13:58
look normal while actual thyroid hormone conversion and availability are impaired.
00:14:04
So a man can have normal total testosterone and functionally low free testosterone because SHBG
00:14:10
is elevated, often driven by factors like chronic stress, liver function, age related
00:14:16
changes, which bind up the hormone that would otherwise be doing the work.
00:14:21
That distinction is the difference between a doctor telling you you're fine, and you
00:14:26
actually knowing why you feel flat, unmotivated, or like your recovery from
00:14:30
training has slowed for no obvious reason.
00:14:33
Then there's body composition, and this is where I wanna correct something almost everyone
00:14:37
gets wrong.
00:14:39
Your weight is not a leading indicator.
00:14:42
Weight is actually a lagging one.
00:14:44
Two people can weigh the same, wear the same size, have a completely different risk profile
00:14:49
depending on where their weight is actually distributed.
00:14:52
This is where a DEXA or dual energy x-ray absorptiometry test earns its place.
00:14:58
It doesn't just give your body fat percentage.
00:15:01
It separates visceral fat, which is around the organs, metabolically active fat that directly
00:15:07
drives inflammation and insulin signaling.
00:15:10
Doesn't distribute it doesn't delineate that from subcutaneous fat, which is the fat under
00:15:15
the skin that is comparatively metabolically, you know, inert.
00:15:20
It also gives you your lean mass, and lean mass is one of the strongest predictors we have of
00:15:25
long term metabolic resilience.
00:15:27
Functional independence, healthy aging, because muscle isn't just about strength, it's your
00:15:32
body's largest reservoir for glucose disposal.
00:15:35
Meaning, the more lean mass directly supports insulin sensitivity that we just talked about a
00:15:41
few minutes ago.
00:15:42
So two executives at the same weight and the same BMI can have wildly different visceral fat
00:15:48
and lean mass numbers, and therefore, wildly different actual risk.
00:15:53
One might be carrying most of that weight as muscle with some moderate visceral fat.
00:15:58
The other person might be at the same number on the scale with high visceral fat and a
00:16:03
comparatively low lean mass.
00:16:05
The scale can't see that difference.
00:16:07
BMI can't read that either.
00:16:09
BMI is just basically a height to weight ratio, by the way, and it has no idea what tissue is
00:16:13
actually making up that weight.
00:16:15
The DEXA scan can see it and see it precisely.
00:16:19
This is the category where most people are surprised because you you could be lifting
00:16:23
three days a week, eating reasonably well, showing a normal BMI, and still be carrying
00:16:28
visceral fat that's driving that exact inflammatory and metabolic picture we just
00:16:34
spent the last few minutes talking about.
00:16:36
It all connects.
00:16:37
None of these four categories are isolated.
00:16:40
They're four windows into the same underlying system.
00:16:44
And now what we actually do with this data is very important because getting a number is
00:16:49
cool, but it's it's pointless unless you know what to do with it.
00:16:53
A number with no action attached to it is just gonna become anxiety.
00:16:57
So let me walk you through how this actually plays out, and I wanna be upfront about
00:17:01
something first.
00:17:02
The case I'm about to describe is a composite.
00:17:05
It's not a specific patient.
00:17:07
It's basically a pattern that we see over and over blended into, like, a single picture, for
00:17:11
example.
00:17:12
And so I'm using it to show you how these pieces connect, not to hand you a protocol for
00:17:17
yourself.
00:17:18
That part still requires actually running your own numbers and having a physician walk through
00:17:23
this with you.
00:17:24
So just to be clear, this is for illustration only.
00:17:26
This is not medical advice for your specific situation.
00:17:30
My listeners know that by now.
00:17:32
Your own protocol would depend entirely on your own labs, history, and an evaluation.
00:17:37
But if any of this sounds like you, the next step would likely be testing, not a self
00:17:41
diagnosis.
00:17:43
So here's a picture.
00:17:44
Picture this.
00:17:44
A mid forties executive person comes in after completely clean annual physical.
00:17:51
My doctor said everything was good.
00:17:53
My glucose is normal.
00:17:54
My cholesterol is acceptable.
00:17:56
The doctor told me he would just report me next year.
00:18:00
But this person has this constant daily wall that they hit around two to 3PM.
00:18:06
They feel like they're not recovering from sleep.
00:18:08
They feel like their weight has slightly been gaining even though they're working out harder
00:18:13
than they have ever before.
00:18:14
On paper, this is fine, but in the room, they don't feel fine.
00:18:18
And so what we do, we run a panel that we talked about.
00:18:21
ApoB comes back elevated, even though their LDL was comfortably sitting in the range of a
00:18:27
standard panel.
00:18:29
The particle count tells a different risk story than the cholesterol number did.
00:18:33
Years of quietly elevated cardiovascular risk that a doctor would have no reason to flag
00:18:37
because the doctor wasn't looking at that in the first place.
00:18:41
Next is a fasting insulin comes back at like a 17.
00:18:44
Glucose was a 91, which would have been completely unremarkable, but the 17 tells us
00:18:49
that the pancreas has been compensating for a while.
00:18:52
That's the mechanism behind that 2PM crash.
00:18:55
The cells are less efficient at taking up glucose, including the brain.
00:18:59
HSCRP comes back at a 2.4, well above the optimal one point o target.
00:19:04
Diet's reasonable.
00:19:06
The driver here is almost always the existing chronic stress, chronic under sleeping, a
00:19:12
stress hormone curve that never fully resets, which drives inflammatory signaling independent
00:19:18
of what's on someone's plate.
00:19:20
And then the DEXA scan shows visceral fat that's elevated.
00:19:24
Lean mass, adequate, but not increasing.
00:19:27
So weight gain that looked minor on the scale is actually concentrated in exactly the tissue
00:19:32
that's most tied to the insulin and inflammation findings from above.
00:19:37
Same root cause, four different numbers.
00:19:39
That's the part I want you to sit with because these four findings aren't four separate
00:19:43
problems.
00:19:44
They're one metabolic picture showing up in four places.
00:19:48
The protocol that follows isn't just fix the APOB, then fix insulin, then fix CRP, as like
00:19:55
four separate projects.
00:19:57
It's targeted resistance training, restructured eating, within a window to rebuild sensitivity
00:20:03
to insulin, which improves the visceral fat picture, which lowers the inflammatory load
00:20:08
alongside specific nutritional support, and where may be warranted direct treatment for the
00:20:14
particle count.
00:20:15
One coordinated protocol because one underlying pattern produced all of the four numbers.
00:20:21
That's the difference between functional medicine and just conventional medicine.
00:20:25
A result with no interpretation attached to it is not useful, no matter how sophisticated the
00:20:30
test that generated it.
00:20:32
A result connected to other three results with a plan built around the pattern instead of each
00:20:37
marker targeted in isolation, that's what changes trajectory.
00:20:42
And I'd point out, none of this required any guessing.
00:20:45
Every step in the protocol maps directly back to a specific number.
00:20:49
That's the whole difference between optimization and generic advice.
00:20:54
Generic advice is eat better, sleep more, manage your stress.
00:20:58
Although that's true, it's basically useless because it doesn't tell you which lever matters
00:21:02
the most for your physiology.
00:21:04
A real panel will tell you exactly where to spend your limited time and attention.
00:21:09
So let's bring it all together.
00:21:11
Five categories that your annual physical almost certainly did not check.
00:21:15
One, advanced lipid markers, specifically APO B, instead of stopping at total cholesterol and
00:21:20
LDL.
00:21:21
Two, fasting insulin and HOMA IR, instead of just glucose.
00:21:27
Three, h s c r p and homocysteine, the inflammation that you can't feel until it's
00:21:32
already cost you some years.
00:21:34
Four, a full hormone panel, not just total testosterone, plus a DEXA scan for real body
00:21:40
composition instead of a number on a scale.
00:21:43
Every one of these is measurable right now with existing validated tests, and none of this is
00:21:49
experimental or fringe.
00:21:51
Every one of these, when it's off, has a specific actionable next step attached to it.
00:21:57
It's not a vague eat better, move more advice that leaves you exactly where you started.
00:22:04
So here's the test I give you to walk away with.
00:22:07
If you've had a physical this year, pull the results back up and ask yourself honestly, did
00:22:11
it check for any of these five?
00:22:13
For almost everyone listening, the answer is probably no.
00:22:16
That's not a failure of your doctor.
00:22:18
Standard panels are doing exactly the job that they were built to do, which is to catch a
00:22:22
disease.
00:22:23
They were never built to tell you whether you're operating anywhere close to your ceiling
00:22:27
or what diseases may be coming in the future.
00:22:30
So if you walked away from your last physical with a clean bill of health, but you still
00:22:34
don't feel like you're operating at your best, that gap right there is exactly what these
00:22:38
markers are built to close.
00:22:41
If you're ever interested, links in the show notes if you wanna see what a comprehensive
00:22:44
panel actually looks like.
00:22:46
Thank you again for tuning in to Health Decoded.
00:22:49
I'm doctor Alessi.
00:22:50
And if this was valuable, please share this with someone who needs to hear it.
00:22:53
That's how we're able to help more people and spread the word of functional health.
00:22:58
Doctor Alessi, I'll see you on the next one.
00:23:02
Thank you for tuning in to Health Decoded, where we break down the truth about all things
00:23:07
health and empower you to take charge of your well-being.
00:23:10
If you found value in today's episode, please subscribe, leave a review, and share it with
00:23:16
someone who needs to hear this.
00:23:18
For more resources, personalized support, or to have your questions answered live on the show,
00:23:23
visit Ascend Functional Health and head to the contact page to connect with us directly.
00:23:27
Until next time, stay curious, stay empowered, and remember your health is in your hands.