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11 Critical Health Tests Your Annual Physical May Be Missing

October 11, 2026

You go in for your annual physical. Your doctor orders bloodwork. A few days later, the results appear in your portal.

Everything is “normal.”

Great news, right?

Maybe. 

But there’s a problem: Most standard checkups measure only a narrow slice of what’s happening inside your body. They’re good at identifying obvious disease. They’re much less useful for spotting the subtle shifts that can begin years—or even decades—before a diagnosis like heart disease, diabetes, dementia, or autoimmune disease becomes official. 

Increasingly, though, we can measure those shifts. 

That’s why I believe we need to move beyond simply asking whether our baseline numbers are “normal.” We need to ask: 

• If we’re measuring the right things in the first place
  
  
• What values are truly “optimal” for long-term health (not just “good enough” for now) 
  
  
• What the pattern of our numbers tells us about where our health is headed

Here are 11 tests your annual checkup is likely missing—and the ones I highly recommend asking your physician to include. 

And I’m not exaggerating when I say that this single request is one of the highest-impact conversations many people will ever have with their primary care physician.

1. Apolipoprotein B (ApoB)

Your standard lipid panel tells you how much cholesterol is carried inside certain particles. ApoB tells you how many potentially plaque-forming particles are actually circulating in your blood.

That distinction matters because cardiovascular risk is driven in large part by the number of these particles entering the artery wall. Your ApoB number predicts cardiovascular risk more accurately than the LDL cholesterol you actually get. 

Optimal: <80 mg/dL; <60 mg/dL for people at high cardiovascular risk

2. Lipoprotein(a) (Lp(a))

Lp(a) is an inherited cardiovascular risk factor that affects roughly 20% of people. Because your level is largely genetically determined, you generally only need to establish it once—yet many people go their entire lives without knowing theirs.

Optimal: <50 mg/dL

3. Fasting Insulin

Fasting glucose can look perfectly fine while insulin climbs unnoticed in the background.

That’s why fasting insulin is so valuable: It can reveal declining insulin sensitivity years before blood sugar becomes abnormal. Insulin resistance is deeply connected to metabolic disease, cardiovascular disease, fatty liver, and cognitive decline.

Optimal: <5 µIU/mL 

4. High-Sensitivity C-Reactive Protein (hs-CRP)

Chronic, low-grade inflammation can damage blood vessels and tissues throughout your body without causing obvious symptoms. Elevated levels predict cardiovascular events, cancer, neurodegeneration, and all-cause mortality.

Hs-CRP gives you a window into that inflammatory burden. The higher it stays over time, the more reason there is to investigate what may be driving inflammation. (See my FREE guide, The Inflammation Fix, to learn five powerful nutrition strategies to calm chronic inflammation.)  

Optimal: <1.0 mg/L 

5. Hemoglobin A1c (HbA1c)

A fasting glucose test tells you what your blood sugar is doing at one moment. HbA1c gives you a much broader picture by estimating your average blood sugar over roughly three months. That makes it useful for detecting metabolic changes that a single fasting glucose reading can miss. Yet, it’s often ordered only after fasting glucose has already become abnormal. 

Optimal: 4.8–5.5%

6. Homocysteine

Homocysteine is an amino acid produced during methylation, an essential biochemical process your body performs constantly.

When homocysteine rises, it can signal problems involving nutrients such as folate and B12. Elevated levels are associated with cardiovascular and cognitive disease.

Optimal: 6–8 µmol/L

7. Omega-3 Index

You can eat fish or take fish oil and assume you’re getting enough omega-3 fats. But why guess?

The omega-3 index measures the percentage of EPA and DHA actually incorporated into your red blood cell membranes. In other words, it tells you something about your omega-3 status inside the body—not simply what you consumed. 

I consider this one of the strongest mortality predictors in medicine.

Optimal: ≥8% 

8. Vitamin D

Vitamin D plays important roles in bone health, immune function, hormone signaling, muscle function, and many other biological processes.

Even though most people have insufficient levels, it’s often only run upon request. And, your results might fall within a “normal” laboratory reference range without reaching the range I consider optimal for health.

Optimal: 50–80 ng/mL

9. Ferritin

A complete blood count can tell you whether you have anemia. Ferritin, on the other hand, measures your iron stores—and you can have inadequate stores long before anemia appears.

Ferritin stores are especially important to look at for menstruating women, in whom low ferritin can be an overlooked contributor to fatigue.

The other extreme matters, too: Very high ferritin can be a signal of inflammation or iron overload.

Optimal: 45–150 ng/mL for women; 100–300 ng/mL for men

10. Thyroid Antibodies

Most routine thyroid testing begins—and sometimes ends—with TSH.

But autoimmune thyroid disease can start long before TSH becomes abnormal. Thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies (TgAb) can reveal that immune activity earlier.

Optimal TPO: <9 IU/mL

Optimal TgAb: ≤1 IU/mL

11. Coronary Calcium Scoring or Coronary CT Angiography

This last one isn’t a blood test. But in the right person, cardiovascular imaging can provide information bloodwork simply can’t.

A coronary artery calcium (CAC) scan measures calcified plaque inside your coronary arteries. A score of zero is associated with low cardiovascular risk, while increasing scores indicate increasing plaque burden.

An AI-enhanced coronary CT angiogram (CCTA) can go further by visualizing both calcified and softer plaque that a calcium scan may miss.

The question is no longer only, “What do my cholesterol numbers suggest?” We can sometimes look directly at what’s happening inside the arteries.

Don’t Just Collect Numbers. Look for Patterns.

A single lab result is a snapshot. The power comes in looking at how these markers change over time, relate to one another, and fit with your symptoms, family history, lifestyle, and other health data.

At your next physical, bring this list and ask your doctor which of these tests make sense for you. Alternatively, take testing into your own hands now through Function Health. Then, save your results and follow the trends over time. 

Because the earlier you can see where your biology is heading, the more opportunity you have to change the direction.

Want the Full Roadmap? 

The right lab tests can reveal a remarkable amount about your health, but knowing what to measure is just the beginning. An even bigger opportunity lies in learning how your body works and what it needs to feel strong, function optimally, and age well over time.

That’s why I wrote 100: How to Live 100 Healthy Years. 

I designed it to be the owner’s manual for your body that most of us were never given—a practical guide to understanding your biomarkers, recognizing early warning signs, and seeing how your metabolism, heart, brain, gut, hormones, immune system, and more all work together as a single, interconnected system. 

This book is where you’ll learn to become the CEO of your own health—and discover exactly how to stop waiting for disease and, instead, actively create health. 

Pre-order your copy of 100: How to Live 100 Healthy Years now.