Bloodwork That Matters: A Calm, Non-Hyped Executive Guide
If you search for information about bloodwork online, you’ll find yourself overwhelmed long before you find any real answers.
You’ll see headlines like “Longevity blood testing: 8 biomarkers to check” or “5 Biomarkers Everyone Should Test.” The articles all sound the same, but the companies behind them are easy to spot. They’re selling you test panels, subscription services, and a subtle sense that you’re not doing enough. I call this tactic “panel-panic marketing.” It’s a strategic move designed to exploit your fears and doubts, all to drive more sales.
I’ve been on both sides of this. As a competitive wrestler, I started running bloodwork in my late teens, trying to make weight while keeping my body from falling apart. As a physician, I ordered it for patients. And over all those years, the number of blood panels that actually changed what I did? I can count them on one hand. The rest was curiosity dressed up as diligence.
Let’s look at what’s actually important, what isn’t, and why the real answer is much simpler than what most companies suggest.
Fair warning: this piece uses medical terms and acronyms. I tried to keep the language plain, but some parts get technical. If you hit a term that doesn’t land, there’s a glossary at the end written for people who don’t spend their days reading lab reports.
The FOMO Machine
Some companies now offer 100+ biomarker panels with testing “at least twice a year.” Their editorial teams produce content about “critical markers you’re probably missing.” Most of these articles come from companies whose primary interest is their business, not your biology.
The business model is straightforward: the more tests they sell, the more likely you are to get flagged results, and the more often you’ll come back for more. Your worry is what drives their business.
The Choosing Wisely initiative has explicitly warned against routine blood tests in asymptomatic patients precisely because of the cascading consequences of false positives [1]. Over 80 medical specialty societies signed on to that recommendation. When that many physicians agree on something, it’s worth paying attention.
You won’t hear about Choosing Wisely from wellness companies, because it doesn’t support their message.
The 64% Problem
Even basic statistics show why testing for everything doesn’t make sense.
Every blood test uses reference ranges based on the central 95% of a population. That means even in a perfectly healthy person, each test carries a 2.5% chance of flagging as abnormal at either end. Sounds small. It isn’t.
Run 20 independent tests on a healthy person. The probability of at least one abnormal flag: roughly 64%. Run the kind of 100-marker executive panel wellness companies love to sell? The probability approaches 99% [2].
A flagged result often leads to more tests, imaging, specialist visits, and sometimes even a biopsy. This can mean weeks of unnecessary worry, usually without any real problem.
A 2024 study in Nature showed that individual homeostatic setpoints are far narrower than population reference ranges [3]. Your white blood cell count could swing from your personal 10th to 90th percentile (a massive inflammatory signal if someone were tracking your trend) while sitting comfortably inside the “normal” range on a standard lab report. Population averages mask individual variation. And individual variation is where the actual signal lives.
Challenge: More testing does not mean better health. A 100-marker executive panel statistically yields false positives in healthy individuals. That flag triggers a cascade of follow-up that costs time, money, and peace of mind, usually for nothing. The evidence on this is not ambiguous [1, 2].
It’s like a car alarm that sounds every time something minor happens. Eventually, you stop paying attention, and you might miss something important when it really matters.
One published case study illustrates where this ends: a physically active 39-year-old man had mildly elevated liver enzymes flagged on routine bloodwork. He was referred to a gastroenterologist, underwent repeat labs, and was scheduled for a liver biopsy. When he finally stopped exercising for seven days before the next draw, every value was normalized. The diagnostic pathway never once assessed his exercise habits or muscle biomarkers [4].
I’ve experienced this myself: after a tough training period, I had a flagged result that made me worry for a moment. But when I repeated the test two weeks later, after resting and following the right protocol, everything was normal. This happens more often than most people realize.
The Confounders Nobody Mentions
Even when you do test, your results are often distorted by factors no one warned you about.
Strenuous exercise elevates AST and ALT (commonly called “liver enzymes”) for up to seven days post-exertion. These enzymes are abundant in muscle tissue, not just the liver. One study showed that a single hour of heavy weightlifting in healthy men resulted in significantly elevated AST and ALT levels that persisted for at least a week [5]. Hit the gym on Sunday, draw blood on Wednesday, and your “liver function” can look pathological on paper while your liver is perfectly fine.
Exercise can also spike creatine kinase by thousands of units and transiently raise creatinine, mimicking acute kidney injury in lab results [6]. Testosterone follows a circadian rhythm, peaking around 8 AM and declining throughout the day. A 4 PM draw will give you a misleadingly low number [7]. And vitamin D fluctuates with season and latitude. A February reading in a northern city measures winter, not deficiency [8].
I’ve seen this happen many times. You come back from a work trip, running on just a few hours of sleep. You still make it to the gym early in the morning, because you never skip a workout. Then you go for your blood draw, since rescheduling isn’t an option. The results show high creatinine, flagged ALT, and low testosterone. These numbers don’t reflect your real health, but just reflect what happened in the day and a half before your test.
The Decision Filter
Before we get to what to actually test, sit with one question that will save you more money and anxiety than any panel ever will.
“If this comes back abnormal, what would we do differently?”
If the answer is unclear or nothing would change, then the test is just adding noise. This is the difference between real medical decision-making and commercial wellness.
The Minimal Panel That Actually Matters
What passes that filter, and why.
Blood Pressure. Still the single strongest predictor of cardiovascular events. Clear treatment thresholds. Clear intervention pathways. USPSTF recommends screening all adults 18 and older [9]. If you measure one thing, measure this.
Lipids, plus ApoB. Standard lipid panels give you LDL-C, HDL-C, and triglycerides. Useful. But the addition that matters most: Apolipoprotein B. ApoB directly measures the number of atherogenic particles in your blood, not just the cholesterol they carry. In patients with insulin resistance (high triglycerides, low HDL), LDL-C can look “normal” while particle count is dangerously elevated. The 2024 National Lipid Association Expert Clinical Consensus now explicitly supports ApoB measurement for cardiovascular risk stratification, noting that when ApoB and LDL-C diverge, risk follows ApoB, not LDL-C [10]. One extra line on your lab order. Meaningful additional information.
Add a one-time Lipoprotein(a) measurement. Lp(a) is genetically determined, largely resistant to lifestyle intervention, and elevated levels mandate aggressive management of every other modifiable risk factor. Multiple international guidelines, including the 2024 NLA update, endorse universal or opportunistic screening for Lp(a) [11]. You only need this number once.
HbA1c and Fasting Glucose. Prediabetes (HbA1c 5.7 to 6.4%) is reversible with intervention. That’s the whole point: catching it before medication becomes the only option. The American Diabetes Association recommends screening from age 35, or earlier, for overweight individuals with risk factors [12]. The triglyceride-to-HDL ratio is a useful surrogate for insulin resistance. Below 2.0 suggests good sensitivity. A value above 3.0 correlates with resistance and small, dense LDL [13].
Creatinine and eGFR. Silent kidney decline changes medication decisions and alters cardiovascular risk profiles. KDIGO 2024 guidelines recommend routine eGFR monitoring [14]. One catch: if you carry significant muscle mass, creatinine-based eGFR can underestimate kidney function. Cystatin C resolves this when creatinine is equivocal.
ALT and AST, with FIB-4 Calculation. Your metabolic barometer. But most lab ranges still flag “normal” at 40-50 U/L. Updated AASLD 2023 thresholds are lower: 29 to 33 U/L for men, 19 to 25 U/L for women [15]. FIB-4 (an index combining age, AST, ALT, and platelet count) costs nothing extra and gives you a useful fibrosis risk estimate [16]. Ask your doctor to calculate it.
CBC (Complete Blood Count). Broad baseline for anemia, infection clues, and hematologic red flags. The biggest payoff comes from tracking your personal numbers over time rather than comparing against population averages [3].
Conditional add-ons (only with specific risk context): Urine albumin-to-creatinine ratio if you have diabetes, hypertension, or CKD risk factors [14]. hs-CRP only when it would change a statin decision in an intermediate-risk patient, not as a general “inflammation check” [17]. Ferritin only with anemia or suggestive symptoms, and remember that ferritin rises as an acute-phase reactant, masking true deficiency [18].
What I Skip (And Why)
A quick note before this section. I’m a physician by training, and I know that listing tests to avoid could appear as medical advice. It isn’t. What follows is my own approach, based on current guidelines and study results. Your health context is unique to you. Discuss any testing decisions with your own doctor. My intention is to provide a thinking framework, not a prescription. It’s important to recognize that individuals with chronic conditions or significant family medical histories might require personalized panels tailored to their specific health contexts. Consulting with a healthcare provider is essential for those with unique backgrounds to determine the most appropriate testing approach.
With that said, this is where things get uncomfortable for anyone paying for executive health panels.
Challenge: The Endocrine Society’s 2024 Clinical Practice Guideline now recommends against routine vitamin D screening in healthy adults. The guideline panel, co-sponsored by nine medical societies, found no clinical trial evidence supporting routine 25(OH)D testing in the general population and could not determine a specific blood-level threshold for disease prevention [19]. The large-scale VITAL trial failed to show that screening and targeting specific levels improved outcomes. This is a genuine shift in consensus, and a big one. Most wellness companies will never mention it because testing is how they keep you coming back.
I skip a thyroid screening unless I have symptoms. The USPSTF assigned an “I” (Insufficient Evidence) rating for thyroid screening in asymptomatic adults [20]. If you feel fine, this test adds noise rather than clarity.
I skip tumor marker panels (CA-125, CEA, PSA outside shared decision-making guidelines). These markers lack the specificity for screening in asymptomatic populations and generate false positives that trigger invasive follow-up [21].
I also skip broad inflammation panels, cytokine panels, testosterone “optimization” labs without clinical indication, and micronutrient megapanels without deficiency symptoms.
If your health provider is offering a 100-marker panel with frequent retesting, they’re not focused on your health.. they’re running a business. You don’t have to participate.
Try This Today
1. The 48-Hour Protocol. Before your next draw, prepare with this checklist to streamline the process and your preparation for better adherence:
- Sleep well: Aim for 7-9 hours of quality sleep leading up to your test day.
- No strenuous exercise for 48 hours prior.
- Morning appointment before 10 AM.
- Fast if triglycerides are on the panel.
- Use the same lab for consistency.
- Schedule your appointment to allow for 30 minutes of quiet time on a calm Tuesday morning.
Completing these steps not only helps to ensure accuracy in your results but also turns preparation into an achievable mini-challenge, increasing the likelihood of follow-through on lab day. These steps eliminate the majority of pre-analytical noise that distorts results [5, 6, 7].
2. Add ApoB. Request Apolipoprotein B alongside your standard lipid panel. Most doctors still don’t order it routinely, but the NLA consensus now backs it. It captures atherogenic particle burden that LDL-C misses, especially if you carry metabolic risk factors. One extra line on the lab order [10].
3. The One-Question Filter. At your next appointment, before agreeing to any test, ask your doctor: “If this comes back abnormal, what would we do differently?” If the answer is vague, skip the test.
4. Track Trends, Not Snapshots. Never react to a single abnormal value. Repeat under the same standardized conditions before escalating. A first reading is statistically more likely to show an extreme value (regression to the mean). Two consistent readings under controlled conditions tell you something real. One reading after a red-eye flight tells you nothing.
You don’t need to get bloodwork every few months. One carefully timed and prepared test each cycle, tracking a few key markers over time, is enough. This means less time waiting and fewer unnecessary scares.
The Upward ARC Connection
This newsletter addresses the Activate pillar of the Upward ARC framework. Activation means establishing your biological foundation: movement, sleep, nutrition, light exposure, and knowing where your body actually stands.
Focused, well-interpreted bloodwork is part of that foundation. It gives you a clean baseline that informs everything else in the framework, from how you design Recovery to how you build Capacity over decades.
Getting too much data from oversized panels, inconsistent testing, or single abnormal results can be more misleading than having no data at all.
I’ve been doing my own bloodwork for more than 30 years. I’ve had dozens of panels, and most of them just satisfied my curiosity. Only a few actually led me to make changes, but those few were very important. For example, a symptomatic thyroid test revealed a temporary autoimmune reaction, and a lipid panel combined with elevated blood pressure made me think differently about my family history. The real value wasn’t in how many tests I did, but in knowing which ones mattered, and which ones didn’t.
Stay healthy.
Andre
Glossary
ApoB (Apolipoprotein B). A protein found on “bad” cholesterol particles. Each dangerous particle has exactly one ApoB molecule. Counting ApoB tells you how many harmful particles you have, which is more useful than measuring how much cholesterol those particles carry.
ALT and AST. Two enzymes your body makes. Doctors call them “liver enzymes,” but they also live in your muscles. When muscle tissue breaks down (from exercise, for example), these numbers go up. A high reading can indicate liver trouble or recent exercise.
Atherogenic. Anything that helps build plaque inside your arteries. Plaque narrows blood vessels over time and can cause heart attacks or strokes.
Asymptomatic. Having no symptoms. You feel fine. Nothing hurts. Nothing seems off.
CBC (Complete Blood Count). A basic blood test that counts your red cells, white cells, and platelets. It shows if you’re anemic, fighting an infection, or have a blood disorder.
Circadian rhythm. Your body’s 24-hour internal clock. It controls when certain hormones peak and dip. Testosterone, for example, is highest in the morning and lowest in the late afternoon.
Creatinine. A waste product your muscles make. Your kidneys filter it out. When the kidneys slow down, creatinine builds up in the blood. But heavy exercise also temporarily raises it, which can make a kidney problem look like it’s on paper.
Cystatin C. Another way to check kidney function. Unlike creatinine, it isn’t affected by how much muscle you carry. Useful when creatinine results are confusing.
eGFR (Estimated Glomerular Filtration Rate). A number that estimates how well your kidneys filter blood. Higher is better. Calculated from your creatinine level, age, and sex.
Ferritin. A protein that stores iron. Low ferritin levels can indicate low iron levels. But ferritin also rises when your body is fighting inflammation, so a “normal” reading can hide a real deficiency.
FIB-4. A simple score calculated from four things already on your blood test: your age, AST, ALT, and platelet count. It estimates whether your liver has scarring (fibrosis). No extra blood draw needed.
Fibrosis. Scarring of an organ, usually the liver. Scar tissue replaces healthy tissue over time, reducing the organ’s function.
HbA1c (Glycated Hemoglobin). A blood test that shows your average blood sugar over the past two to three months. Normal is below 5.7%. Between 5.7% and 6.4% means prediabetes. Above 6.5% means diabetes.
HDL (High-Density Lipoprotein). Often called “good” cholesterol. HDL particles help remove cholesterol from your arteries.
hs-CRP (High-Sensitivity C-Reactive Protein). A marker of inflammation in the body. It goes up with infections, hard training, stress, and many other things. Useful in narrow clinical situations, but too noisy as a general screen.
Insulin resistance. When your cells stop responding well to insulin, the hormone that moves sugar from your blood into your cells. Your body makes more insulin to compensate. Over time, this leads to weight gain, high blood sugar, and eventually type 2 diabetes.
LDL (Low-Density Lipoprotein). Often called “bad” cholesterol. LDL particles carry cholesterol into your artery walls, where it builds up as plaque.
Lp(a) (Lipoprotein-a). A type of cholesterol particle determined almost entirely by your genes. You can’t change it with diet or exercise. If it’s high, your doctor needs to be more aggressive about managing everything else.
Prediabetes. The stage before type 2 diabetes. Blood sugar is above normal but not yet in the diabetic range. With changes to diet and exercise, it can be reversed.
Pre-analytical. Everything that happens before the lab analyzes your blood. This includes when you ate, when you exercised, what time of day you drew, how well you slept, and which lab processed the sample. These factors can move your numbers more than your actual health.
PSA (Prostate-Specific Antigen). A protein made by the prostate gland. Elevated levels can indicate prostate cancer, but also infection, enlargement, or recent activity. High false-positive rate in screening.
Reference range. The “normal” range printed on your lab report. It’s based on the middle 95% of a large group. It does not mean that values outside this range are automatically a problem.
Triglycerides. A type of fat in your blood. Your body converts extra calories into triglycerides and stores them in fat cells. High levels are linked to heart disease, especially when combined with low HDL.
USPSTF (U.S. Preventive Services Task Force). An independent group of medical experts that reviews evidence and makes recommendations about screening tests and preventive care. Their letter grades (A, B, C, D, I) tell doctors how strong the evidence is for or against a test.
25(OH)D. The form of vitamin D measured in blood tests. It reflects how much vitamin D your body has stored from sunlight, food, and supplements.
References
[1] Choosing Wisely Canada. (2017). Unnecessary tests and treatments in Canada. Society of General Internal Medicine recommendations.
https://choosingwiselycanada.org
[2] Mold, J. W., & Stein, H. F. (1986). The cascade effect in the clinical care of patients. New England Journal of Medicine, 314(8), 512-514.
[3] Pietzner, M., et al. (2024). Plasma metabolites to profile pathways in noncommunicable disease multimorbidity. Nature Medicine, 30, 1780-1786.
[4] Keenan, J. I., Muir, R. M., Ayre, K., & Baldi, J. C. (2023). Exercise-induced increases in “liver function tests” in a healthy adult male: Is there a knowledge gap in primary care? Journal of Family Medicine and Primary Care, 12(1), 167-170.
[5] Pettersson, J., Hindorf, U., Persson, P., Bengtsson, T., Malmqvist, U., Werkstrom, V., & Ekelund, M. (2008). Muscular exercise can cause highly pathological liver function tests in healthy men. British Journal of Clinical Pharmacology, 65(2), 253-259.
[6] Clarkson, P. M., Kearns, A. K., Rouzier, P., Rubin, R., & Thompson, P. D. (2006). Serum creatine kinase levels and renal function measures in exertional muscle damage. Medicine and Science in Sports and Exercise, 38(4), 623-627.
[7] Bremner, W. J., Vitiello, M. V., & Prinz, P. N. (1983). Loss of circadian rhythmicity in blood testosterone levels with aging in normal men. Journal of Clinical Endocrinology and Metabolism, 56(6), 1278-1281.
[8] Klingberg, E., Olerod, G., Konar, J., Petzold, M., & Hammarsten, O. (2015). Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine, 49(3), 800-808.
[9] U.S. Preventive Services Task Force. (2023). Screening for hypertension in adults: Recommendation statement. JAMA, 330(16), 1570-1579.
[10] Soffer, D. E., Marston, N. A., Maki, K. C., Jacobson, T. A., Bittner, V. A., Pena, J. M., … & Remaley, A. T. (2024). Role of apolipoprotein B in the clinical management of cardiovascular risk in adults: An expert clinical consensus from the National Lipid Association. Journal of Clinical Lipidology, 18(5), e647-e663.
[11] Koschinsky, M. L., Bajaj, A., Boffa, M. B., Dixon, D. L., Ferdinand, K. C., Gidding, S. S., … & Tsimikas, S. (2024). A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. Journal of Clinical Lipidology, 18(3), e308-e319.
[12] American Diabetes Association Professional Practice Committee. (2024). Standards of care in diabetes, 2024. Diabetes Care, 47(Supplement 1), S1-S321.
[13] Salazar, M. R., Carbajal, H. A., Espeche, W. G., Leiva Sisnieguez, C. E., March, C. E., Balbin, E., … & Palma, R. B. (2013). Comparison of the abilities of the plasma triglyceride/high-density lipoprotein cholesterol ratio and the metabolic syndrome to identify insulin resistance. Diabetes and Vascular Disease Research, 10(4), 346-352.
[14] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International, 105(4S), S117-S314.
[15] Kwo, P. Y., Cohen, S. M., & Lim, J. K. (2017). ACG clinical guideline: Evaluation of abnormal liver chemistries. American Journal of Gastroenterology, 112(1), 18-35. [Updated ALT thresholds: Prati, D., et al. (2002). Updated definitions of healthy ranges for serum alanine aminotransferase levels. Annals of Internal Medicine, 137(1), 1-10; AASLD 2023 Practice Guidance on MASLD.]
[16] Sterling, R. K., Lissen, E., Clumeck, N., Sola, R., Correa, M. C., Montaner, J., … & Sulkowski, M. S. (2006). Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology, 43(6), 1317-1325.
[17] Ridker, P. M. (2016). A test in context: High-sensitivity C-reactive protein. Journal of the American College of Cardiology, 67(6), 712-723.
[18] World Health Organization. (2020). WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO.
[19] Demay, M. B., Pittas, A. G., Bikle, D. D., Diab, D. L., Kiely, M. E., Lazaretti-Castro, M., … & McCartney, C. R. (2024). Vitamin D for the prevention of disease: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 109(8), 1907-1947.
[20] U.S. Preventive Services Task Force. (2015). Screening for thyroid dysfunction: Recommendation statement. Annals of Internal Medicine, 162(9), 641-650.
[21] U.S. Preventive Services Task Force. (2018). Screening for ovarian cancer: Recommendation statement. JAMA, 319(6), 588-594.
A note for new readers:
I’m a trained reconstructive facial surgeon, medical doctor, and dentist. Before launching this newsletter, I had a varied career: competitive freestyle wrestler, management consultant (McKinsey), entrepreneur (Zocdoc, Thermondo, and docdre ventures), and corporate executive (Sandoz). Today, I’m a Managing Director and Partner at BCG.
Husband of one. Father of three. Split between Berlin’s urban pulse and our Baltic Sea retreat. I’d rather be moving than sitting. Not just hobbies. Research. My body is my primary laboratory; I’ve been conducting experiments for decades.
If this is your first time here, welcome. I’m excited to share what I’ve learned and will continue to learn with you.
DISCLAIMER:
Let’s get one thing straight: None of this, whether text, graphics, images, or anything else, is medical or health advice. This newsletter is here to inform, educate, and (hopefully) entertain you, not to diagnose or treat you.
Yes, I’m a trained medical doctor and dentist. No, I’m not your doctor. The content here isn’t a replacement for professional medical advice, diagnosis, or treatment.
If you have questions about your health, talk to your physician or a qualified health professional. Don’t ignore their advice or delay getting care because of something you read in The Upward ARC. Be smart. Do your research. And, as always, take care of yourself.