One Longevity Expert Wants You to Get 100 Biomarker Tests Per Year. Stick to These 5 Instead
- By Rebekah Harding
- Fact-checked by Joy Ferguson
- August 4, 2023
I
f you’re like me, you barely remember to schedule your annual physical. Your appointment rolls around, and the doctor orders a few run-of-the-mill lab tests. When the results are sent to your email a couple weeks later, you squint at the long list of numbers and…close tab.
When I found out that physician Mark Hyman, M.D., wants patients to get over 100 biomarker tests per year at his longevity clinic, Function Health, my reaction was somewhere stuck in the intersection of “oh crap, I know nothing about my health,” and, “who the hell has time for that many tests?”
All of us should make time, according to Hyman, who believes that most annual blood tests don’t do a good job of keeping up with the science.
“Let’s talk about your heart. In your annual physical doctors do a standard lipid panel looking at cholesterol and triglycerides to determine if you have an increased risk for heart attack,” Hyman says in a recent Instagram Reel.
He points to emerging research that suggests that biomarkers like apolipoprotein B (ApoB) and lipoprotein (a) may be better indicators of heart attack risk than high cholesterol. According to a study in the journal Metabolites, ApoB levels indicate how many plaque-forming particles are in your arteries, which is independent of how much bad LDL-C cholesterol (the bad kind) you have (1).
Function Health’s telehealth service has become so popular that Instagram users who have signed up for the service report being on a waitlist with an undisclosed timeframe to be seen.
Still, I wondered: Is getting over 100 annual lab tests actually smart—or total overkill? I asked a primary physician and a longevity doctor to find out what biomarkers you should actually get tested annually to optimize your life- and healthspan.
Biomarker Testing at Traditional Annual Physicals
Comprehensive, preventative tests like the ones Hyman touts are rare. Most annual physicals test for fewer than 20 biomarkers, according to Kevin Huffman, D.O., a board-certified bariatric physician and CEO and Founder of AmBari Nutrition, a manufacturer and distributor of high-quality diet and weight loss products. “The most common blood tests your physician is likely to order include a complete blood count (CBC) test or a basic metabolic panel (BMP).”
A CBC test checks 10 different biomarkers pertaining to your red and white blood cells and platelets, says Huffman. This test screens for signs of diseases related to blood cells and helps make sure your cells are functioning optimally.
A basic metabolic panel measures the levels of eight different compounds found in your blood, including glucose (blood sugar), calcium, and sodium. “The levels of these eight compounds gives useful information about the functioning of your metabolism, as well as the state of your body chemistry and its impact on your health,” says Huffman.
Based on any symptoms you come to your doctor with, they may order additional biomarker tests (like thyroid or diabetes screening).
Where Standard Tests Fall Short
“Traditional annual physicals are basically a waste of time. Usually, they’re not doing the important blood work,” says Frank Lipman, M.D., a functional and longevity medicine doctor and founder of Eleven Eleven Wellness Center. But he says concierge longevity clinics that run the same extensive tests on everyone are also “a waste of time if they do not provide thorough, personalized guidance on how to proceed based on an interpretation of the results.”
Lipman frequently tests his patients for more than a hundred biomarkers during their initial visit, including testing for insulin, uric acid and homocysteine levels. Eleven Eleven Wellness’s standard blood test protocol includes an extensive lipid panel that includes particle size and inflammatory markers. The protocol also checks for nutrient levels—like omega-3s and omega-6s, b12, folate, and zinc—and “all the hormones” including testosterone and estrogen.
However, Lipman insists the number of tests is “irrelevant.” It’s what you test for, he says—and how the results are interpreted—that matters.
“[Getting more tests] is what an annual physical will become. Whether it’s a year or 10 years from now—the medical system is slow to catch on—but this is a proper annual physical.”
Huffman agrees that individualization is key.
“Annual blood tests should evolve to include more preventative testing as long as these additional tests have a direct link to the genetic and medical history of each specific patient,” Huffman says. “This way, the annual tests paint a more holistic picture of the patient’s health over the long term, which can lead to more accurate predictions of potential disease as well as implementation of the right preventive interventions.”
How Much Does Longevity Biomarker Testing Cost?
Hyman claims that the level of extensive testing he performs at Function Health could cost more than $15,000 elsewhere. A Function Health membership costs just $499 per year, and includes over 100 lab tests at the beginning of each year, plus a 60+ tests follow-up six months later. They don’t accept insurance.
But that price tag only gets you results and some insights based on those—it doesn’t tell you in detail what to do with them. One of the major reported drawbacks to Function Health’s service is that you will have to take your lab test results elsewhere (like to your primary doctor) to be interpreted further.
“I had these tests done through Dr. Hyman’s program. The most disappointing part of the process….you are on your own to find a Dr to read/explain the results,” one patient commented under a Function Health Instagram post.
Lipman questions this type of hands-off approach to interpreting lab results. “Why would you just do tests and not help people interpret [them]?” He notes you need an expert to interpret test results and make clinical recommendations on treatment, whether that’s lifestyle changes, supplements, or medication.
He says most tests he orders for patients at Eleven Eleven Wellness are covered by insurance (as long as they are available through a clinical laboratory like Quest Diagnostics)—even if they go beyond the typical scope of an annual physical. The outliers: biological age tests and the multi-cancer Galleri test, which will run you about $1000 a piece and aren’t routine tests.
“Most of the important tests are covered,” Lipman says. “And then if people want more—if they want more cancer screening or more heart screening—I can do that if they want.”
Is Longevity Biomarker Testing Worth It?
Is dropping a few hundred dollars on a preventative panel worth it? Huffman and Lipman agree that more tests can yield more insights, but only if the tests are individualized.
“Running over 100 lab tests as part of defensive or preventative medicine is overkill in my opinion,” Huffman says. He also raises concern that “over-testing could lead to overdiagnosis and overtreatment as patients and physicians try to fix the biomarkers that fell in the abnormal range.”
Plus there’s the potential downside of getting over 100 non-personalized biomarker tests each visit: “Making people paranoid about their health,” Huffman says. Even if a biomarker falls out of a normal range, patients may not present with symptoms that require treatment.
“Whether it’s a year or 10 years from now—the medical system is slow to catch on—but this is a proper annual physical.” — Dr. Frank Lipman
5 Tests to Focus On
Whether you’re opting for a concierge service or want to bring up additional testing with your primary physician at your next appointment, it can be tricky to sift through the research on which biomarkers could boost your longevity without a doctorate.
The Drive podcast host—and one of my personal favorite longevity doctors, Peter Attia, M.D.,— shared his top five preventative tests to chat with your physician about. Lipman also tests for these at any initial visit. And Huffman gives them the thumbs up, too.
Lipoprotein (a) (Lp(a)-P)
This test—it’s the one Hyman recommended in his Instagram Reel—checks for your LPA genotype. Certain LPA gene expressions are associated with increased risk for blood vessel diseases, stroke, and heart attack. Attia recommends getting one that tests for lipoprotein (a) mass and particle size.
You only need to get this test done once, since your genetics don’t change. If the test indicates an increased risk, your healthcare provider might suggest losing weight, taking a medication like metformin, or reducing stress.
APOE Gene
Attia explains that your APOE gene is one of the most powerful predictors of whether you have a predisposition to develop Alzheimer’s disease. (It’s the one that revealed Chris Hemsworth has an increased risk of the neurodegenerative disease while filming Limitless.) But while many doctors avoid this test because they believe nothing can be done to prevent Alzheimer’s if you’re already genetically predestined, Attia pushes back.
“I would agree with the logic of said physicians if I thought that there was nothing someone could do to impact their chances of Alzheimer’s disease,” he said on an episode of The Drive. “I think that’s nonsense. I’m in the camp that Alzheimer’s disease is at least somewhat preventable.”
In an episode of The Drive podcast, Attia says that exercising, lowering alcohol consumption, quitting smoking, and getting enough sleep have been linked to lower Alzheimer’s risk—even in people with high genetic risk.
Similarly to lipoprotein (a), this test only needs to be done once.
ApoB
An ApoB test is an important way to measure cardiovascular disease risk in Attia’s book. This test measures ApoB levels, the main protein found in the low-density lipoproteins (LDL). LDL is the “bad cholesterol” that has the potential to damage your heart and arteries in high concentrations.
ApoB should be completed annually. If your levels are high, your doctor may suggest avoiding tobacco, limiting saturated fats, or exercising more.
OGTT with insulin measurements
Oral glucose tolerance tests (referred to as OGTT or GTT) can screen people for diabetes. A fasting blood glucose level of 140-199 mg/dL can signal prediabetes, but 200 mg/dL or higher may be type 2 diabetes, according to the Mayo Clinic.
An OGTT test is a little more involved than a standard A1C glucose test because it requires fasting ahead of time. An A1C test may also have less sensitivity and specificity when diagnosing prediabetes or diabetes, according to some research.
Attia recommends getting an OGTT that measures for both glucose and insulin to determine your risk for diabetes and begin prevention through drugs like metformin, weight management, and a healthy diet.
ALT
Alanine transaminase (ALT) is an enzyme that is released into your blood when your liver is injured or damaged (x). If your ALT levels are high, it indicates that your liver isn’t functioning optimally. That can put you at risk for fatty liver disease as you age.
Attia says that he ignores the current normal reference ranges for ALT for males (as high as 79 U/l at some labs) and likes to see ALT levels under 43 U/I—although he adds that even 38 U/l leaves him “highly alarmed”—due to the rise in fatty liver disease.
Your physician may request an ALT test as part of a routine metabolic panel—especially if you have symptoms like vomiting, dark urine, or swelling in your abdomen.
Hone’s hormone assessment measures 8 biomarkers to help you optimize your health and longevity. You meet with a licensed physician to go over the results and, if you qualify for treatment, discuss your options.
References
1. Behbodikhah, et al (2021). Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target.
