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Primary care, the way it's built in this country, was never designed to keep you
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healthy.
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It was designed really to manage once you're already sick.
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Now, that's not a conspiracy.
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It's not malpractice.
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It's really just math.
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Fifteen minutes, a panel that hasn't changed in over twenty years, a reimbursement model that
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pays for prescription, not a conversation, and the result is predictable.
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You turn 40, then 50, and somewhere in there, your chart starts filling up with refills,
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statins, maybe metformin.
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Nobody sat you down and asked why these things are happening.
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Welcome to Health Decoded, your number one source for real health information with your
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host, doctor Alessi and Matt Tack.
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Welcome back to Health Decoded.
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I'm your host, doctor Alessi, founder of Ascend Functional Health.
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And if you only ever listen to one episode of this show, just make it this one Because
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everything else that I've covered, the biomarkers that you're in your annual physical
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skips, the reason that your last three doctors couldn't fix what was actually wrong with you,
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the concept of cash pay medicine not being the luxury that you wanted it to be.
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All of this sits downstream from one central idea.
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Primary care, the way it's built in this country, was never designed to keep you
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healthy.
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It was designed really to manage once you're already sick.
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Now, that's not a conspiracy.
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It's not malpractice.
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It's really just math.
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Fifteen minutes, a panel that hasn't changed in over twenty years, a reimbursement model that
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pays for prescription, not a conversation, and the result is predictable.
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You turn 40, then 50, and somewhere in there, your chart starts filling up with refills,
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statins, maybe metformin, something for blood pressure.
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Nobody sat you down and asked why these things are happening.
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They just started managing you based on numbers.
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And so, I actually wanna make a case today, plainly, and with the proper information for a
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different model.
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Not functional medicine as some add on that you get after everything else fails you.
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Not functional medicine as the backup plan, but functional medicine as your actual primary
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care, the front door, the place where prevention happens before you ever need a
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prescription pad.
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If you've listened to this show before, you know that I've talked about biomarkers, about
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why standard testing misses things, about clinical failures.
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Today is gonna be different.
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Today isn't about a symptom or a marker, it's about an entire model.
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What primary care is supposed to be doing for you, and why almost none of it actually does.
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Everything else we've covered fits underneath this.
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So, let's just get into the topic here.
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Here's what nobody explains to you, okay?
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Primary care in the insurance based system isn't built around you.
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It's built around a volume, a set number.
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The average primary care visit in this country runs somewhere between thirteen and eighteen
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minutes.
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In that window, your doctor has to review your chart, address whatever brought you in, order
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anything that's urgent, refill anything that needs refilling, and document enough to justify
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why they're billing codes to a payer who is auditing every minute of that visit after the
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fact.
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There's no structural room in that window for the answering the question why.
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Why is your fasting insulin creeping up year over year?
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Even if your doctor genuinely wanted to have that conversation with you, there's no wiggle
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room built in for thinking outside of the box.
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So the system does what any system under those constraints does.
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It optimizes for the fastest legible action.
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The fastest legible action, almost always, is a prescription.
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Now, because your doctor's lazy or doesn't care about you, I think majority of doctors actually
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genuinely care.
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The overwhelming majority of primary care physicians that I've worked alongside are
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actually exhausted, overbooked, and carrying patient panels in the thousands, and genuinely
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doing their best inside a structure that was never built for root cause work.
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The prescription is the tool that the system hands them.
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It's the tool that they've been trained to use.
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So the prescription is what gets used.
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Think about what that means compounding over a couple of decades.
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Your fasting glucose drifts up a little every year.
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92, then 96, then 101.
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Nobody flags this pattern until you cross that arbitrary line into prediabetic, and even the
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intervention is usually a follow-up in six months, not a conversation about the fifteen
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years of gradually rising insulin resistance that got you there in the first place.
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Your blood pressure maybe has been creeping up from 118 to 128 to 138 across your thirties and
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forties.
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At some point, again, you cross this arbitrary threshold that basically on a chart, and the
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answer to that is a pill.
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Not to look at your sleep architecture, maybe your stress load, maybe your mental health,
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maybe your sodium to potassium ratio, or the visceral fat around your organs that's been
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quietly accumulating while your scale weight still looks fine.
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None of that happens because standard care doesn't understand that root cause matters.
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Every physician learns pathophysiology.
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It happens because the system isn't built to pay for the time that root cause work actually
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takes.
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You cannot run an elimination protocol in fifteen minutes.
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You cannot review four months of continuous glucose data, map a hormone panel against a
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symptom timeline, or unwind a decade of HPA axis dysfunction in a visit built for Medicaid
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refill and acute complaints.
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The visit length isn't an accident of scheduling.
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It's the design constraint that determines everything downstream of it, including which
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tool was going to get reached for first.
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Here's the version of this that maybe hits differently.
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If you're running a company or sitting inside a senior operating role or you're some high level
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performer, you would never let a critical system in your business get monitored only when
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it throws an error.
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You have dashboards.
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You have KPIs, leading indicators.
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You catch these drifts in a supply chain, a burn rate, a churn curve, long before it
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becomes a crisis.
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Because waiting for the lagging indicator to fire is how companies die.
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Think of it in a more simple example.
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The check engine light in your car going off.
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You take it in when that check engine light comes off.
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That's the symptom.
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Now, if you just wait for the car to break down, that's not being preventative.
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That's waiting for disease, injury, crisis, before taking action.
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And yet, the majority of people that I sit across with, they from have more
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instrumentation on their quarterly numbers than they do on their own metabolic health.
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Not because they don't value it, but because the default healthcare model has never really
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offered them a leading indicator.
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It offers a physical once a year that checks whether you've already broken something or not.
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And if you're managing a chronic condition, you've lived the other side of this same gap.
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You've had labs come back normal, while you feel measurably worse every single year.
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That's not you imagining it, and it's not in your head.
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It's because normal on a standard panel is a population reference range, not a marker of
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your actual function.
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It's because normal on a standard panel is a population reference range, not a marker of
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your actual function.
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And nobody in a fifteen minute visit has the time or the tools to ask what your normal used
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to look like before things started sliding or to look for the 12 markers outside the standard
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panel that would actually explain what you're feeling.
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This is the gap.
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Not a villain, not a conspiracy, a structural economic based gap between what primary care
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was built to do and what actually keeps a person out of the pharmacy aisle for the next
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thirty years.
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Once you see the gap clearly, once this clicks, the next question really answers itself.
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What would a model built to close it actually look like?
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That's what we call functional medicine, as the actual front door.
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So, what does it look like to build primary care around prevention instead of management?
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This is where functional medicine stops being the thing you try after everything else fails,
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and becomes what it should have been from the start.
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Your front door into the healthcare system.
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Not a specialty referral three years and four prescriptions too late.
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Mechanically, the difference comes down to three things.
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Time, data, and sequencing.
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Time first.
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A functional medicine intake is not fifteen minutes.
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On average, I spend sixty to ninety minutes, sometimes longer, across multiple visits
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because the entire model depends on actually understanding you as a whole system before
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anything gets ordered.
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Your family history, childhood patterns, possible trauma, things that maybe
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psychologically have happened, your sleep architecture across the past several years,
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your stress loads, and how it's changed with your career and family, The actual timeline of
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when your symptoms began relative to specific life events, not just how long has this been
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going on.
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You cannot find a root cause in a rushed conversation.
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Root cause work is deliberately slow on the front end so that everything after it, such as
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testing, interventions, and the results move faster and more precisely than the trial and
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error approach that we see in standard medicine.
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Second, data.
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We're not working off the same eight marker panel that you've had every year since college.
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Fasting insulin, not just fasting glucose, because insulin resistance shows up in the
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insulin number five to ten years before it shows up in your glucose number.
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HSCRP, if you've ever listened to the show, I talk about this all the time, for vascular
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inflammation.
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This is often elevated years before it can manifest as a cardiac event.
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A full thyroid panel, TSH, free T3, free T4, reverse T3, and antibodies.
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Instead of just TSH, does the thyroid work, in isolation, which misses a meaningful share of
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actual thyroid dysfunction.
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Comprehensive and full sex and adrenal hormone mapping, gut function, microbiome markers,
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micronutrient status.
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The question we're asking isn't, are you sick?
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It's where is your physiology trending, and how far upstream can we catch it before diagnosis
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becomes a thing.
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And the third piece is sequencing.
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And this is the piece that standard care is structurally incapable of.
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Regardless of any individual physician's intent or skill level, we address root cause before we
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reach for suppression.
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If your fasting insulin is climbing, the first move isn't a medication that lowers the glucose
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number while the underlying insulin resistance keeps progressing quietly underneath.
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It's not even gonna be a supplement.
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Not even gonna just take a natural medicine approach.
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The first move is identifying why insulin resistance is developing in the first place.
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Sleep debt, chronic cortisol elevation, a buildup of visceral fat around your organs,
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meal timing and composition, declines in muscle mass, and intervening at that level.
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Sometimes medication is still the right tool.
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Sometimes supplementation is the right tool, and we use it when we need to.
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But it becomes a deliberate decision made with full information, not just a reflexive default
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because it's the only lever that we had time to pull in a fifteen minute visit.
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This is what primary care should mean.
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Not the specialist you eventually see after the diagnosis already landed.
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Not the functional clinic that you stumbled on over Facebook after conventional medicine has
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run out of ideas.
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This should be the place you start before there's anything left to manage.
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So one objection that I hear, and I hear this constantly, so let me just address it rather
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than dance around it or pretend this doesn't exist.
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People say this sounds like it's gonna take a lot more time and cost a lot more money than
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what I'm doing right now.
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And both of those things are probably true, and I won't pretend otherwise.
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A ninety minute intake does cost more time upfront than a fifteen minute visit.
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That's just true.
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Comprehensive testing does cost more than the eight markers that you get on a panel.
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That's also true.
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But if you've listened to the economic conversation that we had a few weeks back, you
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know why I don't shy away from that.
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Because cost more upfront and cost more are two different things, and standard care only wins
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on the first one.
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The real comparison isn't this year's testing bill against this year's co pay.
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It's this year's testing bill against thirty years of prescriptions, dose escalation,
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secondary medications to manage the side effects of the first ones, and the medical
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costs of whatever eventually develops because you did not address the root cause in the first
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place.
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And that's the concept between cost and investment.
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Functional medicine, preventive care is an investment, not a cost.
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Medications every year for the rest of your life, that's a cost.
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That's something you don't wanna pay for.
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Prevention can be expensive today, but cheap over a lifetime.
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Management is probably cheaper today, but becomes extraordinarily expensive over a
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lifetime, and not just financially, but in the things you have to give up, in the time lost,
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all of that.
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And almost nobody does that math until they're the one living on the inside of it.
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It's rare that somebody nowadays is gonna make that decision until they felt the repercussions
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of that, unfortunately.
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And so, sorry, I got a little heated there.
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This, functionally, is what we built Ascend Total Care to be.
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Not some add on membership, not just some concierge upgrade that you bolt on to the same
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fifteen minute model.
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This is a genuine replacement for what your primary care relationship should have been
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doing all along.
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Comprehensive testing on the front end, direct access to your care team as things move and
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change, and a relationship built around catching drift years before it comes a
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diagnosis instead of managing this diagnosis for the rest of your life.
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And the most pressing piece is staying preventative.
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It's not just a one time event.
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So it's built on lifestyle medicine, and real patient education as ongoing staples of the
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program.
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Not just a binder you get on day one, and you never open it again.
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Because the whole point is that you understand your own physiology well enough to actually run
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it yourself between visits.
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If any part of what I just described sounds like something you've been missing from your
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own care, it's worth the conversation.
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There's no pressure or sales pitch, just an honest look at where you actually stand.
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Now, I wanna walk you through kind of a composite case here.
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This is a blend of patterns that I see constantly across this patient population.
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Not this isn't just one person's actual chart, so I can't be specific about the mechanism
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without, you know, infringing on anyone's privacy.
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And again, kind of a disclaimer here, this is a case a composite illustration built from
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patterns.
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This is not an actual case.
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I'm describing a process here, not promising any results, not prescribing any medications.
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I'm not making any recommendations here.
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You obviously need to have your own information, your own evaluation done for any
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of this to to apply.
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Again, just a composite illustration here.
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Picture a 47 year old, fasting glucose is sitting in the low hundreds, not technically
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diabetic, but high enough that the standard visit will flag pre diabetic, and schedule a
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recheck in six months.
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Blood pressure, around 134 over 86, Borderline enough that a lot of primary care physicians
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would open up the conversation about a low dose ACE inhibitor at the next visit if that number
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doesn't come down.
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LDL cholesterol, elevated enough that the standard next step per most conventional
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guidelines is a con a discussion about a statin medication.
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On this trajectory this person is on, they are roughly twelve to eighteen months and three
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separate prescriptions away from a chart that gets labeled well managed for the next thirty
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years.
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Now flip that script.
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Here's what a root cause intake find instead.
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On the very first visit, fasting insulin nearly triple where it should be.
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The earliest most sensitive marker actually for developing insulin resistance and a marker that
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essentially never gets ordered on the standard panel.
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A cortisol pattern that's flattened across the day instead of showing the healthy morning
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peak.
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This is consistent with years of poor sleep, chronic low grade stress, all very plausible
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giving a demanding role and a habit of treating five and a half years with five hours of sleep
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as a badge of discipline rather than a warning sign.
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Visceral fat elevated on a body composition scan, even though the scale weight itself looks
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entirely unremarkable and would have never really triggered a conversation on its own.
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None of the three numbers on the standard panel, those are glucose, blood pressure, and
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LDL, are actually even the problem.
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They are downstream symptoms of one upstream pattern.
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Chronic stress, insufficient sleep, and rising insulin resistance that has compounded quietly
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for probably a decade before any of those numbers actually cross a threshold that would
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be diagnostic.
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I hope you're understanding the picture here.
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And so the intervention itself isn't really exotic.
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It's not anything extreme.
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Sequencing protein and fiber at meals to blunt that glucose and insulin spike.
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Optimizing sleep, a protocol built around actual circadian rhythm and an anchor,
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consistent wake up time, consistent morning light exposure, a wind down routine, not just
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generic instructions, like try to get more rest.
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Targeted resistance training to rebuild muscle mass as a metabolic reserve, because muscle is
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one of the most effective insulin sensitizing tissues in the body.
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Direct work on the cortisol pattern itself, because you can't out diet or out workout a
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nervous system that is stuck in a fight or flight response.
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None of that I just described requires a prescription, but all of it addresses the
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actual mechanism that was left alone and going to eventually require prescription.
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Worked through consistently over a period of months, this is the kind of pattern where we
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frequently see fasting insulin begin to normalize, blood pressure settle into a range
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that no longer will trigger the medical conversation, and an LDL that improves, enough
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to meaningfully change the overall cardiovascular risk calculation.
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Sometimes removing the near term need for medication that was on the immediate horizon.
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Sometimes even reducing someone's dose requirements for patients who are already on
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something, and working with their physician to reassess.
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I want to be precise here because this matters more than almost anything else I'll say today.
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This is not the outcome for every patient.
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It's not a guarantee.
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Some people, because of possible genetic predisposition, family history, or how far a
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condition has already progressed before we see them, they may need medication regardless of
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how well the root cause gets addressed.
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And in those cases, medication is the correct tool, not a failure of the process.
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The point of this was never to never take medication.
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The point is that almost nobody is ever given the chance to find out whether they need it in
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the first place.
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And that's what integrative health is as well, working alongside your physicians to understand
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that, hey, you're on this medication, something that you do need because things have gotten to
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that point.
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How can we address other things that are gonna likely pop up?
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How can we prevent secondary medication use due to the side effects of the primary medication
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use?
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That's the important piece.
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And now, before we get to why this matters, let me give you something practical, and then we'll
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wrap this up.
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A handful of signals that, in my experience, show up years before anything crosses the
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diagnostic line on a standard panel.
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Not a diagnosis, just a pattern worth paying attention to.
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Things to look out for, energy that dips hard in the early to mid afternoon, regardless of
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how much you slept the night before.
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That's frequently an early signature of blood sugar dysregulation.
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Your body swinging through a glucose and insulin spike and crash cycle that hasn't yet
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shown up as abnormal fasting number, because fasting glucose is often the last thing that
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moves.
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Waking up at two or three in the morning wired, unable to fall back asleep for twenty, thirty
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minutes, even though you fell asleep fine.
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That's a classic cortisol disruption pattern.
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A nervous system that hasn't learned to fully stand down, showing up in your sleep
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architecture.
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This is years before it shows up as a diagnosable condition.
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Weight that's stable on a scale, but a waistline that keeps creeping or clothes are
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fitting differently through the midsection specifically.
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That's often visceral fat accumulating around your organs while your total body weight stays
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flat.
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This is one of the more dangerous patterns precisely because it's invisible on the one
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number that most people actually track, which is a weight on a scale.
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Another one is brain fog.
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Slower mental gear shift by mid afternoon.
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You think you're just getting older, or I'm just kinda tired.
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Sometimes it might be age, but far more often in the patients we see, it's some combination
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of blood sugar swings, thyroid dysfunction, and really, that a normal panel just will not
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catch, or will call fine.
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As well as the sleep quality that never gets deep enough to actually restore you.
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None of these things on their own mean something is seriously wrong.
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But if two or three of them have been quietly true for you for the last several years, that's
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not just getting older.
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And it's not just something you should wait on until it becomes a number.
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You know, that's exactly the window where root cause work has the most leverage.
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Because nothing has fully tripped yet, however, you're starting to feel those symptoms, those
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check engine lights come on.
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Time to address.
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So, if you're a high performer, if you're running a company, or you're operating at some
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high level, here's the number that should genuinely bother you.
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It isn't the medication itself, it's the trajectory.
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One prescription at 45 statistically predicts more prescriptions by 55, and more again by '65
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because the underlying pattern that produced the first one was never addressed, only
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suppressed.
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And it kept quietly compounding underneath the medication the entire time.
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That's not just a future health cost sitting somewhere down the road.
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That's a compounding tax on your energy, your recovery, capacity, your cognitive sharpness,
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landing in exactly the years where you're supposed to be operating at your peak.
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You would never accept that kind of unaddressed structural debt anywhere in your life, in your
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financial life, in your business.
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There's no good reason to accept it in the one system, your own physiology, that every other
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part of your performance actually depends on.
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I think about executives that I work with who came in already on some low dose statin, or an
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early blood pressure medication convinced that that ship had sailed.
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The medication was just the cost of being 50 and successful.
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In more cases than not, once we address what was actually driving the numbers, the
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conversation with their own physician shifted from let's increase my dose to let's see if we
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can get off this at all.
00:23:52
That's not a guarantee.
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Please don't take it that way.
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And I said that plainly a few minutes ago, but it's a conversation almost nobody gets to have.
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Because almost nobody ever looks upstream on the prescription in the first place.
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And the truth is almost nobody advocates for themself.
00:24:08
The doctor tells them what to do, and they do it.
00:24:10
Nobody thinks outside the box for themself, or says, is there another way?
00:24:14
And that's what I'm here for, really.
00:24:16
As a doctor, I'm an educator.
00:24:18
My job is to do no harm.
00:24:20
So, I need to tell you that you need to be an advocate for yourself.
00:24:24
If settling for medication to manage disease is what you actually want, do it.
00:24:30
Perfect.
00:24:31
That's you advocating.
00:24:33
But, if that's something that doesn't sit well with you, and you want other options, you're
00:24:37
just not sure what they are, advocate for yourself.
00:24:40
Learn.
00:24:40
Explore.
00:24:41
Get educated.
00:24:42
Talk to somebody else.
00:24:44
Because if you've spent years managing a chronic condition, here's what I want you to
00:24:48
hear underneath everything I said today.
00:24:50
The goal was never less pills as some kind of trophy to hold up.
00:24:54
The goal is getting your actual function back, Energy, mental clarity.
00:24:58
The version of you that existed before this slow accumulation of symptoms quietly became
00:25:03
your new normal.
00:25:05
The version of you you stop noticing because it happens so gradually.
00:25:09
For a lot of people, needing fewer prescriptions ends up being a side effect of
00:25:13
that broader shift.
00:25:15
Great.
00:25:15
But it's not the point of it.
00:25:17
I'm not here to get people off meds, but if that happens, fantastic.
00:25:20
It's a meaningful side effect worth naming because every medication you genuinely no
00:25:25
longer need is one less thing your body has to process every single day.
00:25:29
One less interaction to manage across everything else you're taking.
00:25:32
And one more piece of real evidence that you actually address the root cause instead of just
00:25:37
muted it.
00:25:39
Do this for me.
00:25:40
Picture yourself at 60.
00:25:42
In one version, the default version, the one that most people slide into without ever really
00:25:47
choosing, you're on the trajectory most people end up on.
00:25:50
Three, four, maybe five medications, each one added a few years apart from the last.
00:25:55
Each one managing a number instead of a cause.
00:25:59
Because nobody along the way ever sat you down and asked why the numbers kept moving so fast
00:26:03
in the first place.
00:26:05
In the other version, you're the person whose labs make your friends' doctors pause and
00:26:10
comment on how remarkable they are for your age.
00:26:13
Not because you're lucky, because of your genetics, but because somewhere in your
00:26:16
forties, you stopped accepting that we'll just manage it is the only option on the table.
00:26:23
And you started asking yourself why.
00:26:25
Why is this actually happening?
00:26:26
Why do I feel this way?
00:26:28
Why are my markers trending in this direction?
00:26:31
That second version is what primary care should have been offering you the entire time.
00:26:37
And it's what we built Ascend Total Care to actually deliver.
00:26:41
Comprehensive testing that goes past your standard panel, real root cause investigation,
00:26:46
and a care team that treats prevention as their primary job, not the upsell tacked on to the
00:26:51
end of a visit.
00:26:52
Lifestyle medicine, patient education sit at the center of that, not the periphery, because
00:26:57
the goal was never to make you dependent on doctors for thirty years of visits.
00:27:02
It's to hand you the tools, and the actual understanding of your own physiology, so that
00:27:07
staying preventative becomes something that you can carry yourself with us as the backstop, not
00:27:12
the crutch.
00:27:14
If today's episode described a gap that you've been quietly feeling for years, but you could
00:27:18
never quite put it into words, the next step is pretty simple.
00:27:21
Book a discovery call with my team.
00:27:23
We'll look at where you actually stand right now, no obligation attached, and we'll figure
00:27:28
out together whether this is the front door into your own health that you've been missing.
00:27:32
If not, at least we get to have a conversation, and you can learn something.
00:27:37
That's the case.
00:27:38
Laid out as plainly as I can make it.
00:27:40
Not functional medicine as the alternative, but not functional medicine as the thing you try
00:27:45
after everything else has failed.
00:27:47
Functional medicine as primary care, the way primary care should have worked from the very
00:27:52
beginning.
00:27:53
Again, if this is something that hits home for you, share this with someone who needs to hear
00:27:58
this message.
00:27:59
That's the only way that we're able to spread the positivity of what we're doing and not just
00:28:03
us, but in general.
00:28:05
Functional medicine, not just standard primary wait for things to go wrong medicine.
00:28:11
Please follow the show, like the show.
00:28:13
That's how we grow.
00:28:14
That's how we're able to help more people.
00:28:16
Again, if this is something you need help with or someone you know, book an appointment.
00:28:20
I'm happy to talk through this with you.
00:28:22
I'm doctor Lesse, and I look forward to seeing you on the next episode.
00:28:27
Thank you for tuning in to Health Decoded, where we break down the truth about all things
00:28:32
health and empower you to take charge of your well-being.
00:28:36
If you found value in today's episode, please subscribe, leave a review, and share it with
00:28:41
someone who needs to hear this.
00:28:43
For more resources, personalized support, or to have your questions answered live on the show,
00:28:48
visit Ascend Functional Health and head to the contact page to connect with us directly.
00:28:53
Until next time, stay curious, stay empowered, and remember, your health is in your hands.