The TL;DR
Regular blood testing is one of the most powerful tools for longevity optimization, enabling early detection of disease, tracking metabolic health, and personalizing interventions. Key biomarkers span lipids (ApoB, LDL-P, triglycerides), metabolic markers (fasting glucose, HbA1c, fasting insulin), inflammation (hs-CRP, homocysteine), hormones (testosterone, estrogen, thyroid panel), and nutrient status (vitamin D, B12, ferritin). Annual comprehensive panels are the minimum; quarterly testing provides optimal data for those actively optimizing. Direct-to-consumer testing services offer more comprehensive panels and detailed insights than traditional healthcare pathways.
Accessibility Level
Level 1 (Foundation): Blood testing provides the objective data foundation for all longevity optimization. Before implementing advanced interventions like supplements, fasting protocols, or pharmacological approaches, establish baseline biomarker data. Testing costs range from minimal (basic panels through insurance) to significant (comprehensive panels through direct-to-consumer services), but the information value is extraordinary.
Why Blood Panels Matter for Longevity
The Case for Biomarker Tracking
Blood biomarkers provide a window into physiological processes invisible to subjective assessment. You can feel healthy while harboring elevated cardiovascular risk, insulin resistance, or chronic inflammation. Many of the conditions that shorten lifespan and healthspan develop silently over years or decades before symptoms emerge (Wang et al., 2011).
The fundamental insight is that what gets measured gets managed. Objective data enables:
- Early detection: Identifying metabolic dysfunction before it progresses to disease
- Personalization: Tailoring interventions to individual physiology rather than population averages
- Optimization tracking: Measuring the effects of lifestyle changes and interventions
- Risk stratification: Understanding personal cardiovascular, metabolic, and disease risk
- Course correction: Adjusting protocols when markers move in unfavorable directions
The Limitations of Standard Medical Care
Traditional healthcare operates on a disease-treatment model rather than an optimization model. Standard annual physicals typically include only basic lipid panels and metabolic markers, with “normal” reference ranges derived from population averages that include unhealthy individuals (Faerch et al., 2016).
Consider that “normal” fasting glucose is defined as below 100 mg/dL, yet research demonstrates that cardiovascular risk begins increasing above 85 mg/dL, and fasting glucose in the 90s predicts future diabetes (Barr et al., 2007). Similarly, standard lipid panels report LDL-C, which is less predictive of cardiovascular events than ApoB or LDL particle number (Sniderman et al., 2011).
Key Insight
Optimal ranges for longevity differ from conventional “normal” ranges. A longevity-focused approach seeks optimal physiological function, not merely absence of diagnosable disease. This requires more comprehensive testing and different interpretive frameworks.
Essential Biomarkers for Longevity
Lipid Panel: Cardiovascular Risk Assessment
Cardiovascular disease remains the leading cause of death globally, and lipid biomarkers are central to risk assessment. However, the standard lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) provides incomplete information.
Standard Markers:
| Marker | Conventional “Normal” | Optimal for Longevity | Significance |
|---|---|---|---|
| Total Cholesterol | <200 mg/dL | Context-dependent | Less useful than component markers |
| LDL-C | <100 mg/dL | <70 mg/dL (high risk) | Standard marker; imperfect surrogate |
| HDL-C | >40 mg/dL (men), >50 (women) | >50-60 mg/dL | Higher generally better; context matters |
| Triglycerides | <150 mg/dL | <100 mg/dL, ideally <70 | Marker of metabolic health |
Advanced Lipid Markers (Recommended):
| Marker | Optimal for Longevity | Significance |
|---|---|---|
| ApoB | <80 mg/dL, ideally <60 | Number of atherogenic particles; superior to LDL-C |
| LDL-P (LDL particle number) | <1000 nmol/L | Direct particle count; more predictive than LDL-C |
| Lp(a) | <30 mg/dL (ideally <10) | Genetically determined; major independent risk factor |
| sdLDL (small dense LDL) | Lower is better | More atherogenic LDL subtype |
| Oxidized LDL | Lower is better | Indicates LDL modification and inflammation |
Why ApoB and LDL-P Matter:
Each atherogenic lipoprotein particle carries one ApoB molecule. Atherosclerosis is driven by the number of particles entering the arterial wall, not the cholesterol they carry. Two individuals with identical LDL-C can have vastly different particle counts and cardiovascular risk (Sniderman et al., 2011). ApoB integrates all atherogenic particles (LDL, VLDL, IDL, Lp(a)) into a single measurement and is recommended by leading cardiologists as the primary lipid target (Ference et al., 2017).
Lp(a): The Hidden Risk Factor
Lp(a) is genetically determined and affects approximately 20% of the population at elevated levels. It is not routinely tested despite being an independent and causal cardiovascular risk factor. Test Lp(a) at least once, as levels remain stable throughout life. Currently, no approved therapies effectively lower Lp(a), though clinical trials are underway (Tsimikas, 2017).
Metabolic Markers: Insulin and Glucose Regulation
Insulin resistance underlies many age-related diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. Metabolic markers reveal dysfunction years before clinical diabetes diagnosis.
| Marker | Conventional “Normal” | Optimal for Longevity | Significance |
|---|---|---|---|
| Fasting Glucose | 70-99 mg/dL | 70-85 mg/dL | Tightly regulated; elevations indicate metabolic stress |
| HbA1c | <5.7% | <5.4%, ideally <5.2% | 2-3 month glucose average; most stable marker |
| Fasting Insulin | 2.6-24.9 uIU/mL (varies) | <5 uIU/mL, ideally <3 | Early insulin resistance indicator; often not measured |
| HOMA-IR | <2.0 | <1.0 | Calculated insulin resistance index |
| C-Peptide | 0.5-2.0 ng/mL | Low-normal range | Insulin production marker |
The Critical Importance of Fasting Insulin:
Fasting insulin is the earliest indicator of metabolic dysfunction, often becoming elevated years before fasting glucose or HbA1c rise. The body compensates for insulin resistance by producing more insulin to maintain normal glucose. By the time glucose elevates, significant metabolic damage has occurred (Reaven, 2005).
Standard medical practice rarely measures fasting insulin in non-diabetics, missing early intervention opportunities. A fasting insulin above 5 uIU/mL suggests insulin resistance, even with normal glucose (Kraft, 1975).
Glucose Variability:
Beyond static markers, glucose variability throughout the day affects metabolic and cardiovascular health. Continuous glucose monitors provide dynamic data that blood tests cannot capture, revealing post-meal glucose excursions and overnight patterns.
Inflammation Markers: Chronic Low-Grade Inflammation
“Inflammaging”---chronic, low-grade inflammation---is a hallmark of aging associated with virtually every age-related disease (Franceschi et al., 2018). Inflammation markers reveal systemic inflammatory burden.
| Marker | Optimal for Longevity | Significance |
|---|---|---|
| hs-CRP | <1.0 mg/L, ideally <0.5 | General inflammation; cardiovascular risk |
| Homocysteine | <10 umol/L, ideally <8 | Cardiovascular and neurological risk; B-vitamin status |
| Fibrinogen | 150-350 mg/dL | Clotting protein; inflammation marker |
| Ferritin | 30-150 ng/mL (men), 20-100 (women) | Iron storage; elevations indicate inflammation |
| ESR | <20 mm/hr | Nonspecific inflammation marker |
| IL-6 | <3.4 pg/mL | Pro-inflammatory cytokine (research marker) |
| TNF-alpha | <8.1 pg/mL | Pro-inflammatory cytokine (research marker) |
hs-CRP (High-Sensitivity C-Reactive Protein):
hs-CRP is the most accessible inflammation marker, produced by the liver in response to systemic inflammation. It independently predicts cardiovascular events and all-cause mortality (Ridker, 2003). Persistent elevation should prompt investigation of underlying causes: dental disease, gut dysfunction, chronic infections, obesity, or autoimmune conditions.
Homocysteine:
Elevated homocysteine damages blood vessels and is associated with cardiovascular disease, cognitive decline, and osteoporosis. It is modifiable through B-vitamin supplementation (B12, folate, B6) and is particularly important for those with MTHFR gene variants (Wald et al., 2002).
Hormones: Endocrine Function and Aging
Hormonal decline is both a marker and driver of aging. Comprehensive hormone testing reveals opportunities for optimization and identifies deficiencies requiring intervention.
Sex Hormones:
| Marker | Optimal Range (Men) | Optimal Range (Women) | Significance |
|---|---|---|---|
| Total Testosterone | 500-900 ng/dL | 15-70 ng/dL | Anabolism, energy, cognition |
| Free Testosterone | 15-25 pg/mL | 1-5 pg/mL | Bioavailable fraction |
| SHBG | 20-50 nmol/L | 40-120 nmol/L | Binds sex hormones; affects free fractions |
| Estradiol | 20-40 pg/mL | Varies by cycle | Cardiovascular, bone, cognitive health |
| Progesterone | 0.3-1.2 ng/mL | Varies by cycle | Cycle-dependent (women) |
| DHEA-S | 200-400 ug/dL | 100-300 ug/dL | Adrenal function; declines with age |
Thyroid Panel:
| Marker | Optimal for Longevity | Significance |
|---|---|---|
| TSH | 0.5-2.5 mIU/L | Central thyroid signal; lower-normal optimal |
| Free T4 | 1.0-1.8 ng/dL | Thyroid hormone production |
| Free T3 | 3.0-4.0 pg/mL | Active thyroid hormone |
| Reverse T3 | <15 ng/dL | Inactive metabolite; elevated in stress |
| Thyroid Antibodies | Negative | TPO and thyroglobulin antibodies indicate autoimmunity |
Other Hormones:
| Marker | Significance |
|---|---|
| Cortisol (AM) | Stress hormone; should peak in morning |
| IGF-1 | Growth signaling; context-dependent optimal |
| Insulin | See metabolic markers above |
| Growth Hormone | Typically requires stimulation testing |
Nutrient and Vitamin Status
Micronutrient deficiencies impair physiological function and accelerate aging. Testing reveals deficiencies common in modern diets.
| Marker | Optimal for Longevity | Significance |
|---|---|---|
| Vitamin D (25-OH) | 40-60 ng/mL | Immune, bone, metabolic health |
| Vitamin B12 | >500 pg/mL | Neurological function; often deficient |
| Folate | >10 ng/mL | Methylation; cardiovascular health |
| RBC Magnesium | 5.0-6.5 mg/dL | Serum magnesium misses intracellular status |
| Ferritin | 30-150 ng/mL (see above) | Iron storage |
| Iron Saturation | 25-35% | Iron availability |
| Zinc | 80-120 ug/dL | Immune function; wound healing |
| Omega-3 Index | >8% | Cardiovascular and neurological health |
Vitamin D:
Vitamin D deficiency is pandemic, affecting an estimated 40% of adults (Holick, 2007). The conventional threshold of 30 ng/mL prevents rickets but may not confer optimal benefits. Evidence suggests 40-60 ng/mL optimizes bone health, immune function, and chronic disease prevention (Holick, 2007). Sunlight exposure is the physiological source, but supplementation is often necessary, particularly at higher latitudes.
Organ Function Markers
Comprehensive panels assess organ function across major systems.
Liver Function:
| Marker | Normal Range | Significance |
|---|---|---|
| ALT | <30 U/L (men), <20 (women) | Liver enzyme; elevations suggest damage or fatty liver |
| AST | <35 U/L | Liver and muscle enzyme |
| GGT | <30 U/L | Liver enzyme; sensitive to alcohol; metabolic marker |
| Albumin | 4.0-5.0 g/dL | Liver synthetic function; nutritional status |
Kidney Function:
| Marker | Optimal Range | Significance |
|---|---|---|
| Creatinine | 0.7-1.2 mg/dL | Kidney filtration; muscle mass affects levels |
| BUN | 10-20 mg/dL | Kidney function; protein intake affects levels |
| eGFR | >90 mL/min/1.73m2 | Estimated kidney filtration rate |
| Cystatin C | 0.6-1.0 mg/L | More accurate GFR estimation than creatinine |
| Microalbumin/Creatinine Ratio | <30 mg/g | Early kidney damage; vascular health |
Complete Blood Count (CBC):
| Marker | Significance |
|---|---|
| Hemoglobin/Hematocrit | Oxygen carrying capacity; anemia assessment |
| WBC (White Blood Cells) | Immune function; infection or inflammation |
| Platelets | Clotting function |
| MCV (Mean Corpuscular Volume) | Red cell size; B12/folate vs. iron deficiency |
| RDW (Red Cell Distribution Width) | Variability in red cell size; mortality predictor |
Advanced and Emerging Markers
Biological Age Testing:
| Test | Methodology | Significance |
|---|---|---|
| Epigenetic Clocks | DNA methylation patterns | Horvath, GrimAge, PhenoAge clocks estimate biological age |
| Telomere Length | PCR or FISH | Cellular aging marker; debated utility |
| Glycan Age | Immunoglobulin glycosylation | Inflammation-related biological age |
Epigenetic clocks, particularly second-generation clocks like GrimAge, show strong correlations with mortality and morbidity risk (Lu et al., 2019). While individual readings are noisy, tracking changes over time may indicate whether interventions are affecting biological aging rate.
Cancer Screening:
| Marker | Significance |
|---|---|
| PSA (men) | Prostate cancer screening (controversial; discuss with physician) |
| AFP | Liver cancer marker |
| CA-125 | Ovarian cancer marker (women with elevated risk) |
| Grail Galleri | Multi-cancer early detection (emerging) |
Testing Frequency
Recommended Testing Cadence
| Population | Minimum | Optimal | Notes |
|---|---|---|---|
| Healthy Adults (25-40) | Annual | Semi-annual | Establishing baselines; less drift expected |
| Adults (40-65) | Annual | Quarterly | More dynamic period; intervention tracking |
| Seniors (65+) | Annual | Semi-annual | Balance frequency against intervention capacity |
| Active Optimizers | Quarterly | Quarterly | Tracking intervention effects |
| Specific Concerns | As needed | Monthly | Monitoring medication changes, addressing abnormalities |
Baseline Testing:
For those new to comprehensive testing, an initial comprehensive panel establishes baselines across all categories. This should occur when healthy and not during acute illness, after unusual stress, or following major dietary changes.
Follow-Up Cadence:
- Stable markers (Lp(a), genetic factors): Once is sufficient; no need to retest
- Slowly changing markers (lipids, HbA1c, hormones): Every 6-12 months
- Responsive markers (fasting insulin, hs-CRP, glucose): Every 3-6 months when actively optimizing
- Intervention tracking: 8-12 weeks after starting new protocols to assess response
Testing Timing
Fast for 12-14 hours before blood draws for accurate fasting glucose, insulin, and lipid measurements. Morning draws (7-9 AM) provide consistent cortisol and hormone readings. Avoid testing after unusual stress, poor sleep, or intense exercise.
How to Get Blood Panels
Through Your Primary Care Physician
The Traditional Route:
Working through your physician remains the most accessible entry point for blood testing, particularly for basic panels.
Advantages:
- Insurance coverage for standard panels and medically indicated tests
- Physician interpretation and follow-up
- Integration with medical records
- Access to prescription-based interventions if abnormalities detected
Challenges:
- Limited panels: Standard physicals include only basic lipid panel, CBC, metabolic panel. Advanced markers like ApoB, fasting insulin, Lp(a), or comprehensive hormones require specific requests
- Physician resistance: Some physicians are reluctant to order “unnecessary” tests for asymptomatic patients, particularly advanced lipid markers or comprehensive hormone panels
- Insurance limitations: Insurers may not cover tests without documented medical necessity; “optimization” is not a diagnosis
- Limited interpretation: Results returned as normal/abnormal based on population reference ranges rather than optimal ranges
- Fragmented data: Results live in medical records without longitudinal tracking or optimization frameworks
Strategy for Working with Physicians:
- Build relationships: Physicians more readily accommodate established patients
- Articulate rationale: Explain family history or specific concerns justifying tests
- Know what to request: Specific CPT codes and test names facilitate orders
- Offer to self-pay: Volunteering to pay out-of-pocket removes insurance objections
- Bring research: Some physicians respond to peer-reviewed literature supporting testing
What to Request Beyond Standard Panels:
- Fasting insulin (not just glucose)
- HbA1c (even without diabetes diagnosis)
- ApoB and Lp(a)
- Full thyroid panel (not just TSH)
- Vitamin D
- hs-CRP
- Complete hormone panel if age 40+
Direct-to-Consumer Testing Services
Direct-to-consumer (DTC) testing services have emerged to fill gaps in traditional healthcare, offering comprehensive panels, detailed interpretation, and longitudinal tracking without physician gatekeeping.
Advantages:
- Comprehensive panels: Tests typically include markers physicians resist ordering
- Detailed interpretation: Results contextualized within optimal ranges, not just population norms
- Longitudinal tracking: Platforms track results over time, showing trends
- Convenience: Order online; visit local lab for draw
- Control: Test what you want, when you want
- Community and coaching: Many services include interpretation support
Considerations:
- Cost: Comprehensive panels range from 500+ out of pocket
- Not insurance-covered: Costs are entirely self-pay
- Physician relationship: DTC testing exists outside medical records; need to share with physician for follow-up
- Quality varies: Service quality, test selection, and interpretation depth differ significantly between providers
Comprehensive Blood Testing Services
Function Health (Recommended)
Function Health represents the premium tier of comprehensive blood testing for longevity optimization.
Overview: Function Health offers the most comprehensive standard panel available, testing over 100 biomarkers spanning all major categories: advanced lipids, metabolic markers, inflammation, hormones, nutrients, organ function, and cancer screening. The platform was designed specifically for longevity optimization and preventive health.
Key Features:
- Comprehensive testing: 100+ biomarkers in standard panel
- Advanced markers included: ApoB, Lp(a), fasting insulin, full thyroid panel, comprehensive hormones, nutrient status
- Clinician-led interpretation: Results reviewed by physicians; recommendations provided
- Longitudinal tracking: Platform displays trends across multiple tests
- Physician network: Option to connect with Function physicians for intervention recommendations
- Testing frequency: Membership includes quarterly testing
Pricing:
- Membership-based model (approximately $499/year)
- Includes two comprehensive panels annually
- Additional tests available
Best For: Those seeking the most comprehensive single testing solution with physician oversight, willing to invest in premium service. Ideal for serious longevity practitioners wanting “one-stop” comprehensive testing.
Website: functionhealth.com
Blueprint (Bryan Johnson)
Blueprint is the testing and protocol service developed by Bryan Johnson, known for his systematic approach to age reversal.
Overview: Blueprint offers biomarker testing as part of a broader protocol system, providing the specific markers Bryan Johnson uses in his own optimization program. The service emphasizes measurable outcomes and protocol adherence.
Key Features:
- Protocol-integrated testing: Tests aligned with Blueprint protocol recommendations
- Focus markers: Biological age testing, speed of aging assessments, cardiovascular and metabolic markers
- Self-experimentation framework: Designed for systematic optimization
- Community: Access to Blueprint community and protocol resources
- Transparency: Bryan Johnson publicly shares his own results and protocols
Pricing:
- Various tiers available
- Testing costs vary by panel selection
Best For: Those interested in following or adapting Bryan Johnson’s systematic approach to optimization. Appeals to those who want structured protocols alongside testing.
Website: blueprint.bryanjohnson.com
InsideTracker
InsideTracker is one of the longest-established DTC blood testing services, founded on sports performance optimization research.
Overview: InsideTracker offers multiple panel tiers with personalized recommendations based on peer-reviewed research. The platform emphasizes actionable interventions and includes optional DNA testing integration.
Key Features:
- Tiered panels: From basic (10 markers) to comprehensive (43+ markers)
- Personalized recommendations: Algorithm-generated food and lifestyle recommendations
- InnerAge calculation: Proprietary biological age estimate based on biomarkers
- DNA integration: Optional genetic testing to personalize recommendations
- Athletic focus: Strong in performance-related markers and recommendations
- Academic foundation: Founded by scientists from MIT, Harvard, and Tufts
Pricing:
- Ultimate panel: ~$589 (43 biomarkers)
- Inner Age panel: ~$199 (key aging markers)
- Various tiers available
Best For: Athletes and performance-oriented individuals; those wanting algorithmic recommendations; those interested in biological age tracking.
Website: insidetracker.com
Marek Health
Marek Health offers comprehensive testing with a focus on hormone optimization and physician-guided care.
Overview: Founded by physicians specializing in hormone optimization, Marek Health provides thorough testing with an emphasis on endocrine function. The service includes physician consultations and can facilitate interventions including hormone replacement therapy.
Key Features:
- Hormone expertise: Particularly comprehensive hormone panels and interpretation
- Physician consultations: Telemedicine appointments with optimization-focused physicians
- Intervention support: Can prescribe and manage hormone optimization protocols
- Male and female optimization: Protocols for both sexes
- Comprehensive metabolic testing: Beyond hormones, includes lipids, metabolic markers, inflammation
Pricing:
- Panel costs vary by comprehensiveness
- Consultation fees additional
- Can facilitate ongoing treatment
Best For: Those specifically interested in hormone optimization; those wanting physician-guided intervention; those seeking telemedicine-based hormone management.
Website: marekhealth.com
Other Notable Services
Quest Diagnostics and Labcorp (Direct Access):
- Major reference laboratories now offer direct-to-consumer ordering
- Wide test menu; a la carte pricing
- No interpretation or optimization framework
- Useful for specific individual tests at lower cost
Ulta Lab Tests:
- A la carte ordering through Labcorp network
- Significant discounts on individual tests
- No interpretation; results only
- Best for targeted testing when you know exactly what you need
Life Extension Foundation:
- Comprehensive panels at reasonable prices
- Includes phone consultation with wellness specialists
- Long-established in longevity space
- Strong for basic comprehensive panels
Genova Diagnostics:
- Specialty testing including advanced hormones, GI health, organic acids
- Typically ordered through practitioners
- Useful for functional medicine-oriented testing
DEXA Scan + Blood Panel Combinations: Some facilities combine DEXA scans with blood panels for integrated metabolic and body composition assessment.
Interpreting Your Results
Beyond Reference Ranges
Standard reference ranges reflect population percentiles, often the 2.5th to 97.5th percentile of tested individuals---including those with undiagnosed disease. For longevity optimization, focus on:
- Optimal ranges: Evidence-based targets for lowest disease risk, not merely “normal”
- Personal trends: Your trajectory over time matters as much as absolute values
- Context: Markers must be interpreted in context of other markers, symptoms, and goals
- Interventions: Identify modifiable factors and track response to changes
Building a Personal Biomarker Dashboard
Create a tracking system (spreadsheet, dedicated app, or service platform) that:
- Records all biomarker values with dates
- Shows trends over time
- Flags values outside optimal ranges
- Notes interventions initiated and their timing
- Correlates lifestyle changes with biomarker shifts
When to Seek Medical Attention
While DTC testing supports optimization, certain findings require prompt medical evaluation:
Red Flags Requiring Physician Evaluation
- Fasting glucose >125 mg/dL (diabetes range)
- HbA1c >6.4% (diabetes range)
- ApoB >130 mg/dL with family history of premature CVD
- hs-CRP >3.0 mg/L persistently
- eGFR <60 (kidney function concern)
- ALT >100 U/L (liver concern)
- TSH >10 or <0.1 (thyroid dysfunction)
- Hemoglobin significantly below range (anemia workup)
- Any cancer markers elevated
- Unexpected significant changes from prior testing
Optimizing Your Biomarkers
Comprehensive guidance on improving specific biomarkers appears in dedicated articles throughout The Longevity Index. Key connections:
Metabolic Health Optimization
- Diet: Foundation for glucose, insulin, and lipid optimization
- Fasting: Powerful tool for insulin sensitivity and metabolic markers
- Exercise: Improves glucose disposal, lipids, and inflammation
Lipid Optimization
- Advanced Lipids: Deep dive on ApoB reduction strategies
- Dietary interventions: Reduce refined carbohydrates, optimize saturated fat intake
- Pharmaceutical options: Statins, PCSK9 inhibitors, ezetimibe (physician-guided)
Inflammation Reduction
- Sleep: Poor sleep elevates inflammatory markers
- Stress Management: Chronic stress drives inflammation
- Anti-inflammatory Nutrition: Omega-3s, polyphenols, fiber
Hormone Optimization
- Sleep: Critical for testosterone and growth hormone
- Resistance Training: Supports anabolic hormone production
- Stress Reduction: Lowers cortisol
- Targeted Supplementation: Vitamin D, zinc, magnesium
Evidence Matrix
| Source | Verdict | Notes |
|---|---|---|
| Peter Attia | Strongly Recommends | Extensive biomarker tracking central to his longevity practice |
| Rhonda Patrick | Strongly Recommends | Regular discussion of optimal ranges and testing |
| David Sinclair | Recommends | Supports comprehensive testing for aging tracking |
| Conventional Medicine | Moderate Support | Supports basic screening; less emphasis on optimization |
| Clinical Evidence | Strong | Individual markers well-validated; comprehensive optimization less studied |
Key Studies:
- Wang et al. (2011): Framingham Risk Score improves with novel biomarkers
- Sniderman et al. (2011): ApoB superior to LDL-C for cardiovascular risk
- Ference et al. (2017): Causal role of LDL in atherosclerosis; lower is better
- Ridker (2003): hs-CRP and cardiovascular risk
- Holick (2007): Vitamin D deficiency prevalence and health implications
- Lu et al. (2019): GrimAge epigenetic clock predicts mortality
Common Pitfalls
Mistakes to Avoid
- Testing without a plan: Random testing without optimization strategy wastes money and causes confusion
- Overreacting to single values: One elevated marker is not a crisis; trends matter more than individual readings
- Ignoring context: Markers must be interpreted together; isolated values mislead
- Not fasting appropriately: Non-fasting samples invalidate lipid and glucose measurements
- Testing during illness or stress: Acute conditions distort many markers
- Fixating on one marker: Optimizing one marker at the expense of others is counterproductive
- Not retesting after interventions: Changes require verification; do not assume success
- Self-treating complex abnormalities: Significant findings require physician guidance
- Expecting instant changes: Many markers shift slowly; patience is required
- Ignoring the basics: No amount of testing replaces foundational lifestyle optimization
Implementation Checklist
Getting Started:
- Choose testing approach (physician, DTC service, or hybrid)
- Schedule first comprehensive panel when healthy (12+ hour fast)
- Create tracking system (spreadsheet or platform)
- Establish baseline across all major categories
Baseline Testing (First Panel):
- Advanced lipid panel (including ApoB, Lp(a))
- Complete metabolic panel with fasting insulin
- HbA1c
- Inflammation markers (hs-CRP, homocysteine)
- Complete thyroid panel
- Comprehensive hormone panel (if age 35+)
- Nutrient status (Vitamin D, B12, ferritin, RBC magnesium)
- CBC with differential
- Liver and kidney function
Ongoing Protocol:
- Quarterly or semi-annual retesting based on optimization activity
- Track trends over time; note interventions
- Share results with physician for abnormalities
- Adjust lifestyle and supplementation based on results
- Annual comprehensive panel minimum
Red Flag Response:
- Significant abnormalities: Schedule physician appointment
- Unexpected changes: Retest to confirm before intervening
- Persistent elevation despite intervention: Seek specialist evaluation
Connected Concepts
Foundational Links
- Diet: Primary lever for metabolic and lipid markers
- Exercise: Improves metabolic health, hormones, and inflammation
- Sleep: Critical for hormones, inflammation, and glucose regulation
- Stress Management: Affects cortisol, inflammation, and metabolic markers
Measurement Links
- Continuous Glucose Monitors: Dynamic glucose data complementing static blood markers
- DEXA Scans: Body composition data to contextualize metabolic markers
- Heart Rate Variability: Autonomic function tracking
- Blood Pressure: Cardiovascular health monitoring
Biomarkers
Optimization Links
- Supplements: Addressing nutrient deficiencies identified by testing
- Fasting: Protocol for metabolic marker optimization
- Advanced Lipids: Comprehensive lipid optimization strategies
Concepts
- Insulin: Central metabolic regulator
- Glucose: Metabolic health marker
- Inflammation: Aging accelerator tracked by blood markers
- IGF-1: Growth signaling and longevity tradeoffs
- Cortisol: Stress hormone assessment
Further Reading
Books:
- “Outlive” by Peter Attia: Comprehensive longevity framework with extensive biomarker discussion
- “Lifespan” by David Sinclair: Context for aging biomarkers and optimization
- “The Longevity Diet” by Valter Longo: Metabolic markers and dietary interventions
Podcasts:
- The Drive (Peter Attia): Deep dives on lipids, metabolic health, and testing
- FoundMyFitness (Rhonda Patrick): Biomarker optimization discussions
- Huberman Lab: Episodes on hormone optimization and metabolic health
Research:
- American College of Cardiology guidelines on lipid management
- Endocrine Society guidelines on hormone optimization
- Peer-reviewed research on individual biomarkers (see References)
References
Barr, E. L., Zimmet, P. Z., Welborn, T. A., Jolley, D., Magliano, D. J., Dunstan, D. W., … & Shaw, J. E. (2007). Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation, 116(2), 151-157.
Faerch, K., Witte, D. R., Tabak, A. G., Perreault, L., Herder, C., Brunner, E. J., … & Vistisen, D. (2016). Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes: a post-hoc analysis of the longitudinal Whitehall II cohort study. The Lancet Diabetes & Endocrinology, 4(7), 582-590.
Ference, B. A., Ginsberg, H. N., Graham, I., Ray, K. K., Packard, C. J., Bruckert, E., … & Catapano, A. L. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal, 38(32), 2459-2472.
Franceschi, C., Garagnani, P., Parini, P., Giuliani, C., & Santoro, A. (2018). Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nature Reviews Endocrinology, 14(10), 576-590.
Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.
Kraft, J. R. (1975). Detection of diabetes mellitus in situ (occult diabetes). Laboratory Medicine, 6(2), 10-22.
Lu, A. T., Quach, A., Wilson, J. G., Reiner, A. P., Aviv, A., Raj, K., … & Horvath, S. (2019). DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging, 11(2), 303-327.
Reaven, G. M. (2005). The insulin resistance syndrome: definition and dietary approaches to treatment. Annual Review of Nutrition, 25, 391-406.
Ridker, P. M. (2003). Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 107(3), 363-369.
Sniderman, A. D., Williams, K., Contois, J. H., Monroe, H. M., McQueen, M. J., de Graaf, J., & Furberg, C. D. (2011). A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circulation: Cardiovascular Quality and Outcomes, 4(3), 337-345.
Tsimikas, S. (2017). A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. Journal of the American College of Cardiology, 69(6), 692-711.
Wald, D. S., Law, M., & Morris, J. K. (2002). Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ, 325(7374), 1202.
Wang, T. J., Gona, P., Larson, M. G., Tofler, G. H., Levy, D., Newton-Cheh, C., … & Vasan, R. S. (2011). Multiple biomarkers for the prediction of first major cardiovascular events and death. New England Journal of Medicine, 355(25), 2631-2639.
Last updated: 2026-01-03