What Your Annual Physical Isn't Telling You

These 5 types of blood tests could reveal more about your health than any 15-minute physical exam.

February 10, 2014


When people visit Dr. Florence Comite, an endocrinologist in Manhattan, they spend two to three hours of filling out health histories and undergoing various types of blood tests—even though most of the doctor's patients think they're perfectly healthy.


The reason: "People think that if they feel OK, they're healthy," she says. And often, they're not, because despite dutifully scheduling annual physicals, most people aren't getting enough or even the right information that alerts them to subtle changes that lead to long-term problems.

Know before you go: Here are 4 Ways to Prep for Your Annual Physical

To find out how truly healthy—or unhealthy—you are, she says, you need accurate measurements of blood sugar, hormones, and inflammation, types of blood tests that not only lay the groundwork for staying healthy for as long as possible, but also indicate diseases that may be brewing (and, therefore, may still be preventable). Unfortunately, your doctor might not order them for you. And if your doc does order them, he or she may not give you an accurate reading.

"These numbers, these metrics we get, are clues as to how well our body is functioning at a deeper, cellular level," and she details all those clues and metrics in her book Keep It Up, which she wrote for men suffering from all those ailments of aging—low energy, low sex drive, and increasing belly fat.

But many of her tips apply to women as well. "You need to own your health, and to do that you need to have metrics and statistics," she says. "And once you get these numbers, you can get out in front of problems like diabetes and heart disease, and prevent them from ever occurring."

#1: Fasting Blood Sugar
A lot of doctors will test your blood sugar levels, Dr. Comite says, "but you should insist on having fasting blood work done." Why? It takes insulin 12 hours to clear your system after you've eaten, and if you have no food in your system, there should be no insulin present. If it is present despite your not having eaten anything for 12 hours, that indicates insulin resistance, she says, a sign you're at risk for diabetes.

#2: Hemoglobin A1c
Hemoglobin A1c is a biomarker that will tell you how well your body metabolizes sugar over time. Sugar adheres to red blood cells, and if your body has a hard time clearing sugar out of your system, your red blood cells will look like they're "sprinkled with powdered sugar," says Dr. Comite. A hemoglobin score of 6 percent means you're diabetic, but if you wait until a fasting blood sugar test diagnoses diabetes, your A1c levels could be as high as 7.5 percent, she says. Getting this test can diagnose "prediabetes," which is considered a score of 5.7 percent, giving you a chance to start to get blood sugar levels under control before the disease gets out of control.

Only 7% of people suffering from prediabetes know it. Do You Have Prediabetes?

#3: Hormone Levels
Hormones protect against a number of midlife health problems, including diabetes, depression, and bone loss. Getting your thyroid levels in check can help stave off fatigue and weight gain, and all of us, even women, should have our testosterone levels checked, advises Dr. Comite. Low testosterone can trigger belly fat production while also inhibiting the formation of muscle tissue, and it makes you tired, to boot. While most doctors order thyroid tests, you'll need to ask your doctor to measure your testosterone, and ask for a "free testosterone" test; "total testosterone" levels include testosterone that's bound up in protein that your body can't access, therefore, it isn't much use.  

#4: C-Reactive Protein (CRP)
It's becoming increasingly clear that heart disease can be caused by more than high cholesterol. Inflammation plays a key role in triggering cardiovascular problems, and CRP is one of the key signs that inflammation has run amok in your body—specifically, in the linings of your blood vessels—leading to plaque buildup and a higher risk of heart disease and stroke. In fact, you can have normal cholesterol levels but a high CRP and still be at risk for those ailments. "Women should know this level most of all," Dr. Comite says, "and it can be a more accurate predictor of heart problems than cholesterol." She suggests asking for a cardiac CRP, also called a high-sensitivity CRP, which specifically addresses inflammation in the blood vessels. Inflammation can be treated with baby aspirin or simple changes to your diet and exercise routine.

If you do have high CRP levels, try these 9 Strategies to Reduce Inflammation

#5: Homocysteine

Homocysteine is an amino acid that damages the lining of the arteries and increases the risk of cardiovascular disease as well as stroke and Alzheimer's disease, says Dr. Comite. Like CRP, homocysteine is a marker of too much inflammation. "If it's too high, it means your body isn't absorbing enough nutrients," she ads, particularly vitamin B12, which can ward off dementia. Vitamin B12 and folic acid are thought to keep homocysteine levels in check, so the solution to curbing homocysteine could be as simple as taking a supplement (vitamin B12 can be difficult to absorb in sufficient quantities from diet alone)—but you won't know you need them if you don't get the test!