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Every year during my birthday month, I gift myself with a comprehensive battery of labs to stay on top of my health. I think it’s a good idea to be in touch with at least an annual exam, if not something more regular, especially when there are underlying health issues to address.

Several of the tests on the list below are commonly run by most physicians. When you next head to your physician’s office for your annual checkup, you can ask about these 10 essential lab tests to see whether they would be best for you.

This list is not intended to be prescriptive, but as an educational guide to some important tests.

CBC with Diff (Complete Blood Count with Differential)

Most physicians include this test in a routine physical: the complete blood count with differential, or more simply, CBC with diff.

As the name suggests, this test looks at your blood; more specifically, it looks at the different blood cells and components in your blood. This includes:

• Hematocrit
• Hemoglobin
• Platelets: platelet count and possibly the mean platelet volume (MPV) and platelet distribution width (PDW)
• Red blood cells: the count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width, and possibly reticulocyte count
• White blood cells: Neutrophils, lymphocytes, monocytes, basophils, and eosinophils

Why This Test is Important:

Just knowing the information about your blood cells tells you a lot about your general health. Its primary purpose is to screen for blood cancers, infection, and anemia (including iron deficiency and B-vitamin deficiency), but it can also provide information about many other aspects of your health. Generally, abnormal results in this test would lead to additional tests to determine the cause.

Let’s dive a little deeper into some of the individual components of this test and what they tell you about your health:

Although white blood cell count informs the doctor of an acute or chronic infection, it can also be a marker for other diseases. Increased total white blood cell count is a non-specific marker for inflammation, which could be acute or chronic. Increased white blood cell count has been associated with:

• All-cause mortality
• Cardiovascular disease
• Death from cardiovascular disease
• Declined pulmonary function
• Increased odds of reduced kidney function and the development of chronic kidney disease
• Independent risk factor for cancer mortality
• Independent risk factor for NAFLD
• Ischemic stroke
• Metabolic syndrome and
• Poor psychomotor cognitive performance in the elderly

The percentage of the individual type of white blood cells also reveal information about your health:

• Basophils: Increased percentage of basophils is often associated with allergies and skin disorders
• Eosinophils: There is a U-shaped curve, and too few or too many eosinophils correlate to an increased risk of respiratory and skin diseases, including allergenic diseases. There is also an increase in cardiac disease, gastrointestinal disorders, and neurological problems and bladder cancer. Increased numbers of eosinophils, especially when not due to a reaction to an acute situation such as an infection or allergies, may also correlate to hematological malignant diseases, such as chronic lymphatic leukemia or Hodgkin’s lymphoma.
• Lymphocytes: Chronically decreased lymphocyte count is associated with depression.
• Monocytes: A higher percent of monocytes in those with a normal white blood cell count has been shown to be associated with an increased 10-year cardiovascular disease risk.
• Neutrophils: Chronic high numbers of neutrophils have also been associated with an increased risk of cardiovascular disease.

The other markers in the CBC look at red blood cells and platelets. This details whether there may be anemia or other blood-related disorders. Furthermore, RDW has been associated with gastric disease, including gastric ulcers. A higher red blood cell count has been associated with fatty liver disease, diabetic nephropathy in those with type 2 diabetes independent of diabetes duration and glycemic control, and all-cause mortality and mortality in patients with coronary artery disease. Increased hematocrit levels have been associated with increased cardiovascular risk factors and heart disease.

This is just a simplified overview of the many associations that the tests in the CBC with Diff tell doctors, especially doctors trained further in blood chemistry who know to look beyond the basics.

CMP (Complete Metabolic Panel)

Another test frequently run by doctors during an annual physical is the complete metabolic panel (although some doctors may choose to run a basic metabolic panel or BMP instead, which does not include the liver enzymes, proteins or bilirubin).

This panel looks at a variety of key markers of health, including liver and kidney health, acid and base balance, metabolism, electrolyte balance, and waste products.

CMP generally includes:

• Albumin
• ALP (alkaline phosphatase)
• ALT (alanine aminotransferase, you may see it as SGPT)
• AST (aspartate aminotransferase, you may see it as SGOT)
• Bilirubin
• Blood glucose
• BUN (blood urea nitrogen)
• Calcium
• Chloride
• CO2
• Creatine
• Potassium
• Sodium
• Total protein

Why This Test is Important:

This test provides insight into liver and kidney function, as well as your acid-base balance and electrolyte status. An imbalance in your pH may lead to mild metabolic acidosis, which has been linked to a higher risk of diabetes and insulin resistance. Imbalances in electrolytes and pH may also affect heart and muscle contractions, neurological processes, and cellular function. Albumin levels can also provide insight into risk for chronic disease, including cardiovascular disease.

As you can see from this snapshot, there is a lot that this test reveals to doctors, and I have not covered it all. Similar to a CDC test, abnormal findings in this test typically lead to further testing to find the reason behind the abnormal findings.

Hemoglobin A1C (HbA1C), Insulin, and C-Peptide

The next tests on the list provide further information about blood glucose regulation and insulin sensitivity. While the CMP looks at blood sugar, it is beneficial to get a larger picture with HbA1C and serum insulin or c-peptide.

The blood glucose test from the CMP, provides a snapshot of your blood sugar at that moment in time, while HbA1C details blood sugar regulation over a longer time frame for blood sugar by looking at the binding of sugar to hemoglobin over about 3 months.

Many doctors will also use fasting insulin to see how much insulin you are secreting and whether it may point to the potential for insulin resistance. However, a more accurate test for insulin may be c-peptide, a proinsulin cleavage product.

The pancreas secretes c-peptide in a similar amount to insulin, but it has a longer half-life than insulin, making it a potential surrogate marker for insulin levels. It also is not extracted by other organs, which gives a better insight into beta-cell function and endogenous insulin secretion.

Why This Test is Important:

Maintaining optimal blood glucose regulation and insulin sensitivity is important for more than just whether you have diabetes. Poor glucose management and insulin resistance have been associated with:

• Cancer
• Chronic kidney disease
• Chronic liver disease
• Fatty liver
• Heart disease
• Neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease
• PCOS

The association with chronic disease is not just for those with diagnosed diabetes. One study found increased HbA1c correlated to more than 27 different chronic diseases, including acute cerebral infarction, nephrotic syndrome, certain cancers, coronary heart disease, and chronic obstructive pulmonary disease. Increased HbA1C is associated with acute myocardial infarction and long-term mortality, increased risk for all-cause mortality and cardiovascular disease death, even in those not diagnosed with diabetes. It’s also associated with nonalcoholic fatty liver disease independent of other risk factors for NAFLD. This is just a snapshot of the studies demonstrating an association between increased HbA1C levels and chronic disease.

Postprandial glucose rather than fasting glucose may be a better indicator of cardiovascular disease. Increased insulin levels are associated with an increased risk of Barrett’s Esophagus (BE), although there are no significant associations between BE and insulin resistance.

Keeping an eye on your blood sugar regulation can help you identify early whether action needs to be taken to keep your numbers within a healthy range to help reduce the risk of associated diseases.

Vitamin D

It is estimated that more than half of the world’s population has vitamin D insufficiency or deficiency, as defined as a 25(OH)D less than 50 nmol/L, and it is a global public health problem for all ages. Vitamin D is such an important player in health that tracking your status is important.

Although the active form of vitamin D is 1-25(OH)2D3, the standard test for vitamin D levels is serum 25-hydroxyvitamin D, or 25(OH)D, or the precursor to the active form.

Why This Test is Important:

Vitamin D plays a key role in health, and deficiency or insufficiency has been associated with:

• Alzheimer’s disease
• Autoimmune disorders
• Cardiovascular disease
• Metabolic syndrome
• Mortality
• PCOS
• Pregnancy complications, including preeclampsia and gestational diabetes
• Thyroid function

Screening for deficiency or insufficiency can help you catch it early and make changes to your diet and lifestyle and/or supplement accordingly to help reduce the risk of complications associated with vitamin D deficiency and/or insufficiency.

Thyroid panel

Tracking your thyroid function can help you to discover a potential problem in the early stage, and with the wide-reaching function of the thyroid hormones, you want to ensure you had optimal thyroid function throughout your life.

TSH, or thyroid-stimulating hormone, is the hormone secreted by the anterior pituitary gland to tell the thyroid to produce T4 (thyroxine) and T3 (triiodothyronine).

T3 is the active thyroid hormone, which is synthesized from T4 by an action known as deiodinases. Most T3 and T4 are bound, with only a small percentage free to act on the target tissues and tell the hypothalamus and pituitary gland to stop producing TSH in a negative feedback loop.

The most commonly used test for thyroid function is TSH, and may doctors use it alone as the initial screening for thyroid dysfunction, but getting a full thyroid panel provides a more complete picture of thyroid function.

Additional thyroid tests to include are:

• Free T4
• Free T3
• Reverse T3 (RT3)
• Tg (thyroglobulin) antibodies
• TPO (thyroid peroxidase) antibodies
• TR (TSH receptor) antibodies

The antibody tests help determine whether problems with thyroid function is due to an autoimmune disorder, such as Hashimoto’s or Grave’s disease.

Why This Test is Important:

Thyroid dysfunction and subclinical thyroid disease have been found to correlate to an increased risk of:

• Atherosclerosis
• Bipolar disorder
• Bleeding disorders
• Cancer
• Cardiovascular disease
• Chronic kidney disease
• Dementia
• Diabetes
• Hypertension
• Increased lipids
• Mood disorders
• Non-alcoholic fatty liver disease
• Obesity
• Osteoporosis
• Vitamin D deficiency

One study found a correlation between thyroid function and life expectancy. Those in the highest quartile for TSH level had a 1.5 year longer life expectancy compared to those in the lowest range. Those in the highest tertial for FT4 had a life expectancy of 3.7 years less than those in the lowest tertial. This showed that low-normal function of the thyroid led to a higher life expectancy in those with and within non-communicable diseases compared to those with high-normal. Those with the highest FT4 also had 1.17 times higher risk of having a non-communicable disease.

Lipid Panel with Particle Size

Cholesterol and triglycerides are also common tests in many annual physicals, especially for those with a high risk of heart disease. But to get the best picture of your lipid metabolism and its impact on your health, you want to get a full lipid panel that also tells you about particle size.

Although most lipid panels run in standard doctor’s office stick with basic LDL, HDL, total cholesterol, and triglycerides, cholesterol can be split up into even more classifications based on size, density, and apolipoprotein content. Dyslipidemia involving the different size of the LDL particles could lead to it being missed in traditional blood panels that do not look at the particle size.

These subclasses of lipids have distinct properties, which means they have their unique influence on the risk of cardiovascular disease. LDL particles will have at least one apo B molecule to be recognized by the LDL receptors, and this can be used as a marker for how many particles are in the blood. HDL cholesterol, often referred to as the good cholesterol because of its inverse association with cardiovascular disease, will have apo A molecules.

Why This Test is Important:

Increased cholesterol and triglycerides, or dyslipidemia, are associated with atherosclerosis, heart disease, and NAFLD.

Although LDL has been given the nickname “bad cholesterol” and HDL the nickname “good cholesterol,” like with many things in the body, the reality is more complicated than that. Rather than the type of cholesterol, the size and density may play a larger role in the potential for contributing to heart disease and other health problems down the line.

Smaller particles are more likely to make their way into the arterial wall and become oxidized, leading to atherosclerosis. In one in-vitro study, denser LDL particles (1.035 – 1.063 g/ml) had a 1.5 to 1.9 times higher uptake into the arterial tissue compared to the less dense LDL particles (1.019 – 1.035 g/ml).

Small LDL particles are associated with cardiovascular disease, metabolic syndrome and insulin resistance. In one study, small, dense LDL particles were significantly associated with three times greater the risk of myocardial infarction, and this group also had higher levels of triglycerides, very low-density lipoproteins, and intermediate-density lipoproteins, as well as lower levels of HDL cholesterol, which also increase the risk. Another study found that while there was an association with small LDL particle increase and myocardial infarction risk, it was no longer significant once adjusted for triglyceride levels.

Thus, getting a more comprehensive picture of what is going on with the size and density of your lipids may just help you to discover risk factors that you otherwise may have missed with just looking at LDL and HDL.

Iron panel

Iron carries oxygen through the body and plays a role in energy metabolism, as it is necessary for many of the enzymes required in the electron transport chain. It is also a mineral that you don’t want too much of or too little, making it important to track yearly, especially if you are menstruating female or at risk of anemia or hemochromatosis (a condition related to excess iron). While too little iron reduces the ability for transporting oxygen and/or energy metabolism, excess iron can lead to oxidative stress via the Fenton reaction, leading to damage to DNA, lipids, and other cellular components.

A full iron panel includes:

• Iron – the amount of iron in your blood
• Ferritin – the amount of iron stored in your body
• Transferrin – the level of the transport protein for iron in your blood
• Total Iron-binding capacity (TIBC) – the total amount of iron available to be bound by protein
• Unsaturated iron-binding capacity (UIBC) – how much transferrin has not yet been linked with iron

Why This Test is Important:

There is a balance to iron; too much can contribute to symptoms and disease as can too little. Anemia, especially iron-deficient anemia, has a high prevalence (5.6 percent in America) and thus is an important marker to check. Iron-deficiency anemia not only leads to fatigue, weakness, pregnancy complications, poor cognitive and psychomotor development in children, poor health problems, and increased risk of mortality, but it is also associated with thyroid dysfunction, especially when combined with low iodine.

Excess iron is associated with psychiatric disorders, schizophrenia, acute myocardial infarction, liver problems, diabetes, neurodegenerative diseases including Alzheimer’s disease, and cardiovascular disease.

Liver Function Tests (ALT, AST, GGT)

Liver enzyme tests look at three key liver enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). These liver enzymes are widely tested because they are highly sensitive to any dysfunction or damage to the liver.

In addition to its identification as a liver enzyme, GGT is also an enzyme in the catabolism of glutathione and required for glutathione homeostasis, an important antioxidant. Thus, high levels of GGT may indicate oxidative stress and related damage.

Why This Test is Important:

In addition to shedding light on liver health and function, including NAFLD, these tests also show:

• Arterial stiffness (brachial-ankle pulse wave velocity or baPWV is positively associated with AST/ALT ratio)
• Cancer (A meta-analysis found an association between GGT overall cancer risk, especially in site-specific cancers, while ALT had more geographical variations and more risk of digestive cancers)
• Cardiovascular disease and death related to cardiovascular disease
• Dementia (Increased GGT positively associated with cognitive decline and vascular dementia)
• Diabetes, with GGT more strongly associated with the risk of developing diabetes
• Insulin resistance (a high ALT/AST ratio)
• Low ALT is associated with sarcopenia, frailty, disability, mortality, and poor outcomes in the elderly. Increased GGT is associated with sarcopenia.
• Metabolic syndrome (GGT positively associated with metabolic syndrome in children and adolescents)
• Non-monotonic dose-response association between ALT, AST, and GGT with all-cause mortality

While most CMP tests include ALT and AST, you may have to talk to your doctor about also including GGT. GGT adds important information about not just the status of your liver but also other areas of health that ALT and AST do not always have the same association.

Sex Hormones

Sex hormones change throughout life, with the largest alterations during puberty, pregnancy and lactation, and menopause/andropause. Many elements in our environment and lifestyle can impact sex hormones, such as diet, exercise, increased exposure to endocrine-disrupting chemicals such as BPA, and more, which may contribute to acute or chronic health problems.

The common sex hormones to include in a test for everyone are:

• DHEA and DHEA-S
• Estrogen (typically estrone or estradiol)
• Progesterone
• Testosterone

Males should also get their prostate checked, generally with a PSA test.

Why This Test is Important:

Low or high levels of one or more of the sex hormones may indicate reproductive-related disorders, such as

• Age-related hormonal decline (Menopause and andropause)
• Endometriosis
• Erectile dysfunction
• Fibroids
• Infertility in both men and women
• Menstruation problems
• PCOS

Furthermore, imbalances in sex hormones may also play a role in chronic disease, including:

• Autoimmune disorders, such as multiple sclerosis
• Cardiovascular disease, especially in middle-aged women and post-menopausal women
• Chronic headaches and migraines
• Lung diseases, including allergies, asthma, and COPD
• Metabolic syndrome
• Mood disorders, including anxiety
• Neuroinflammation and neurodegenerative diseases, including Alzheimer disease, Parkinson’s disease

By keeping an eye on your sex hormones on an annual basis, you can see if there are fluctuations that may increase your risk of certain symptoms or diseases. There are also tests to go further to help delineate where in hormone metabolism that there are specific issues. Based on findings, you can talk to your doctor about potential diet and lifestyle changes as well as whether any hormone therapy is warranted.

Homocysteine & High-Sensitivity C-Reactive Protein (hs-CRP)

Chronic, systemic inflammation is a risk factor for many chronic diseases, and hs-CRP is one important test to screen for non-specific inflammation, and it has also been shown to be independent risk factors of chronic disease. Another test that also has associations with many chronic diseases is homocysteine. Adding both of these to your annual physical can add additional insight into your risk for developing many of the common chronic diseases.

Why This Test is Important:

Inflammation, as measured by hs-CRP, is associated with:

• All-cause and cardiovascular mortality
• Alzheimer’s disease
• Cardiovascular disease, including ischemic stroke and heart failure
• Diabetes and insulin resistance
• Mild cognitive impairment in diabetic patients
• NAFLD, at least in patients with cardiovascular disease

Higher homocysteine levels are associated with:

• Acute coronary syndrome
• Cardiovascular disease
• Diabetes and gestational diabetes
• Neurodegeneration, dementia, and cognitive impairment, including Alzheimer’s disease meta-analysis
• Osteoporosis

Reducing chronic inflammation may help to mitigate your risk factor for certain chronic diseases. Screening for inflammation on an annual basis can help you see your level, and whether your anti-inflammatory lifestyle and other actions are working, or whether you need to talk to your doctor, nutritionist, and other healthcare practitioners about further actions to take.

Conclusion:

Many of these tests are standard lab panels for annual physicals for most doctors in America, and insurance covers the tests as well. Some of these, such as the full thyroid panel and particle size lipid panel, may not be standard. However, it is worth talking to your doctor about what would be best for you, especially if you have a greater risk for chronic diseases, such as cardiovascular disease, diabetes, and neurological conditions.

Although these tests may be helpful for most people to have on an annual basis to screen for potential disease, there may be other tests that would be beneficial for you specifically. Always talk with your doctor about the best tests for your annual physical.