The standard annual physical was designed to detect disease, not to optimise health or predict longevity. Its laboratory component, CBC, basic metabolic panel, lipid panel, TSH, reflects that design intent. These tests answer the question: "Is anything acutely wrong?" They are poorly suited to answering the questions that actually matter to high performers and longevity-focused individuals: "Where am I heading, and how fast?"
The seven markers below are not exotic. They are available through any major commercial laboratory. Most are covered by insurance for patients with appropriate risk factors. What they share is a stronger relationship with long-term outcomes than the tests that reliably appear on your annual panel, and a systematic absence from most primary care orders.
The 7 Markers
The single most important marker missing from standard panels. A fasting insulin above 10 µIU/mL in the presence of normal fasting glucose indicates compensated insulin resistance: a state that may persist for ten to fifteen years before glucose rises. The intervention window is wide. The detection requires ordering one additional test that costs less than twenty dollars.
Standard lipid panels measure LDL cholesterol: an estimate of cholesterol content in LDL particles. ApoB measures the number of atherogenic particles directly, since each LDL, VLDL, and IDL particle carries exactly one ApoB molecule. Particle number is a stronger predictor of cardiovascular risk than particle cholesterol content. A patient can have a normal LDL-C with a significantly elevated ApoB. The elevated ApoB is what drives atherosclerosis.
Lp(a) is an LDL-like particle with a highly atherogenic and prothrombotic structure. It is primarily genetically determined and does not respond significantly to lifestyle modification, which is precisely why it needs to be known. Approximately 20% of the population carries elevated Lp(a) and does not know it. It needs to be measured once in a lifetime and factored into cardiovascular risk calculations permanently.
Standard CRP detects acute inflammation. High-sensitivity CRP detects the low-grade chronic inflammation that underlies cardiovascular disease, metabolic dysfunction, cognitive decline, and accelerated ageing. An hsCRP consistently above 1.0 mg/L warrants investigation of source. Above 3.0 mg/L represents meaningfully elevated cardiovascular risk independent of lipid levels.
Elevated homocysteine is an independent risk factor for cardiovascular disease, stroke, and cognitive decline. It is also highly actionable. Elevated levels frequently respond to targeted B-vitamin supplementation (B12, B6, folate, and methylated forms where MTHFR variants are present). A fasting homocysteine above 10 µmol/L warrants intervention. Most clinicians do not order it unless prompted by specific risk factors.
IGF-1 is the primary mediator of growth hormone's anabolic effects and serves as the best available proxy for GH status in clinical practice. Age-related GH decline is reflected in falling IGF-1 levels, and IGF-1 below the optimal range correlates with reduced lean muscle mass, increased adiposity, impaired recovery, and cognitive changes. It establishes a baseline for GH optimisation discussions and tracks response to intervention.
Vitamin D deficiency is the most common nutritional insufficiency in developed countries and one of the most consequential. Levels below 30 ng/mL impair immune function, increase cardiovascular risk, reduce bone density, and are associated with depression, fatigue, and cognitive decline. The optimal functional range for performance and longevity is 50–80 ng/mL. Standard panels rarely include it unless specifically requested.
"The standard panel was designed to catch disease. These seven markers are designed to prevent it. That is an entirely different clinical objective. And it requires different tests."
Dr. Nicole Srednicki, clinical practice
How to Use This Information
These markers should be contextualised, not acted upon in isolation. An elevated ApoB in a patient with optimal metabolic health, excellent fitness, and no family history of cardiovascular disease carries different clinical weight than the same number in a patient with insulin resistance and a sedentary lifestyle. The markers inform a risk picture. They do not replace clinical judgement.
What they do, reliably, is expand the risk picture beyond what a standard panel can see. At Ultra Healthy Human, all seven are included in our initial comprehensive workup. They form the baseline against which we track patient progress and calibrate intervention intensity over time.
Get the complete picture
Our initial workup includes all seven markers above, alongside our expanded metabolic and cardiovascular panel. We do not wait for disease to appear. We build the most complete picture of where you are and where you are heading, then act on what we find.