3 Tests to Transform Your Health (and Your Lifespan)

If you are already doing What Everyone Should Be Doing For Their Health and there are still things you want to improve about your current health or that you want to optimize to protect your future health and longevity, it may be time to do some lab testing beyond whatever your doctor orders for you in your checkups.

The problem with this is that there are all kinds of things you could test, and most of the things that actually move the needle beyond the standard of care that the average person gets from mainstream medicine aren’t covered by insurance.

Another problem is that so many labs can be poorly interpreted that it is easy to get misled into making the wrong health decisions.

So how do you juggle decisions of when to test things when you need to balance your budget?

How do you make sure your testing reflects the root cause of your issues and what can be done about them, instead of just telling you whether you have a problem?

And how do you ensure everything gets interpreted properly?

Here we cover the three most important things to test to get game-changing health results.

This is educational in nature and not medical or dietetic advice. See terms for additional and more complete disclaimers.

When Is the Right Time to Test?

The right time to start testing is when you are already doing what you know to be best, and you are still hitting a point where you need further improvement, yet you are at a loss about which decision to make next.

Thus, focus first on What Everyone Should Be Doing For Their Health.

In my Optimization Framework, the next thing to do is assess your progress. If you have a specific problem, address the known low-hanging fruit. That is, try some things that are well known to work for large numbers of other people to see if they also work well for you. If you still need improvement after that, or if you simply want to optimize, you then enter a rigorous optimization cycle that includes comprehensive measurement of everything relevant.

If your goal has highly specific signs of success, and if you have the patience, then you should follow through with any low-hanging fruit, then should start testing once you reach the limits of that approach.

However, if you want faster answers, you can speed ahead to testing once you have made sure you’re mastering the basics.

Nutritional Testing

Making sure you are getting enough of each vitamin and mineral should be the foundation of any testing you do, because everything in your body is either something you ate or something you made from what you ate.

Macronutrients (protein, fat, and carbs) are just as important as micronutrients (vitamins and minerals), but assessing whether you are getting enough protein is fairly straightforward and your body can very flexibly deal with different ratios of fats and carbs and there are no well-validated tests to tell you if you are currently eating too much of one or the other.

By contrast, each vitamin and mineral has a requirement that can be characterized as an population average and some variation around the average where 95% of people will have a requirement within two standard deviations of it. Since 5% of people will be outliers with very different requirements and most people differ from the average, testing the assortment of very well validated markers of nutrient status is the best way to determine whether you are personally meeting your requirement.

The probability you are missing something is high.

When scientists ask people in the United States what they eat, a whopping 93% fail to consume enough of at least one vitamin or mineral [1].

It looks even worse when we break it down by specific nutrients:[2]

• Over 90% of people don’t get enough choline, a nutrient that protects against fatty liver disease and supports learning, memory, and relaxation.

• Over 60% don’t get enough of vitamins K, E, or D, needed for healthy bones and to protect our tissues from wear and tear as we age.

• Over 40% don’t get enough magnesium, needed to fuel every process in the body.

• Over 30% don’t get enough calcium, needed for healthy bones; enough vitamin A, needed for healthy eyes, skin, and sleep; or enough vitamin C, needed to protect against heart disease and cancer.

The best approach to nutritional testing is to use my Comprehensive Nutritional Screening. You then combine this with Testing Nutritional Status: The Ultimate Cheat Sheet for interpretation. If the labs in the comprehensive screening are not available to you, you use the Appendix on page 81 of the Cheat Sheet, which lists the markers you would need to assemble a comprehensive screening from scratch based on the labs that are available to you.

The core of this testing is as follows:

• Serum or plasma concentrations tell you whether a nutrient is present in the diet and being effectively absorbed.

• Intracellular concentrations tell you whether a nutrient is getting into your cells effectively.

• Functional markers tell you whether the nutrient is doing its job.

If you measure functional markers without concentrations, you don’t know if the job isn’t done because there’s no vitamin, because it didn’t make it into the cell, or because there’s another problem. Or, if you have the concentrations but not the functional marker you may verify that there is enough nutrient present but completely miss that there is some other problem such as a genetic impairment that is raising your need for the nutrient. By contrast, if you have all three, you can integrate the information to make a robust conclusion about whether a nutrient’s job is getting done, and, if not, why not and what to do about it.

Glucose, Ketones, and Lactate

I use a NovaBiomedical Lactate Plus for finger-prick lactate, KetoMojo for finger-prick glucose and beta-hydroxybutyrate (ketones) measured at home.

Elevated glucose is considered the hallmark of diabetes, which afflicts over a half billion people worldwide.

This is actually somewhat misleading, because diabetics don’t just have high glucose. They have high ketones, high lactate, high free fatty acids, and high triglycerides too.

Diabetes itself is very unlikely to be a single disease, and is instead a generic hodge podge of hundreds of unique problems in energy metabolism that all converge on a fundamental impairment in effectively turning food energy into cellular energy.

If you find out at an annual checkup that your glucose is high, this tells you that you may be on the path toward this condition, but it doesn’t tell you anything about why or how to change course.

While there are many types of low-hanging fruit that can help, such as optimizing your body composition and exercise program, being able to test your energy metabolites at home allows you to test what they respond to, which then tells you what you can do.

Once you move the measurement from your doctor’s office to your home, you now empower yourself to take charge.

You can run experiments on a daily, weekly, or monthly basis to figure out exactly what is working, discarding the things that don’t work and leaning hard into the things that do.

While continuous glucose monitors (CGMs) are currently trending, until there is a continuous glucose-ketone-lactate meter on the market I advocate using finger prick measurement of glucose, ketones, and lactate simultaneously.

The reason is that ketones and lactate add context to the glucose measurement to help its interpretation. I would rather have fewer measurements with more context and better interpretation than more measurements with less context that are harder to interpret.

CGMs also run the risk of putting way too much focus on postprandial excursions outside the timeframes that are well validated as meaningful and can also facilitate people running away from glucose spikes without giving their bodies time to adapt to varying carb loads, which are very well established to require weeks of adaptation.

For interpreting glucose, ketones, and lactate, use my protocol dedicated to that purpose here:

Mitochondrial Respiratory Chain Testing

As I wrote in Energy Metabolism Governs Everything, every single health issue is profoundly influenced by the ability to produce cellular energy in the form of ATP.

The respiratory chain of the mitochondria is where you use oxygen from the air you breathe to produce 90% of this ATP.

You can think of the mitochondrial respiratory chain as the cell’s power plant. In turn, creatine forms the mitochondria’s energy grid, carrying the energy produced in the mitochondria throughout the cell, and glycolysis forms a local power generator.

Testing the respiratory chain can tell you why your glucose, ketones, or lactate are abnormal.

Those may even be normal, but you might not be making enough ATP to invest in things like utilizing your cholesterol instead of leaving it to run high in your blood; making your gut motile enough and your nutrient absorption efficient enough to have well formed stool instead of constipation or diarrhea; or anabolic tissue synthesis to support healthy skin, bones, teeth, and gums.

It can also explain why you might not be oxidizing NADH, an important energy carrier, which could have many knock-on effects like hurting your activation of vitamin A and thereby making you more vulnerable to getting sick frequently, developing autoimmune disease, and getting cancer.

I developed Mitome to take respiratory chain testing out of the niche field of rare disease diagnosis and reframe it to look for unique idiosyncratic bottlenecks in each person’s respiratory chain. Instead of classifying you as “normal” or “out of range” Mitome is looking for patterns that provide unique insights of how you can best optimize your cellular energy metabolism.

Most importantly, I designed all of the protocols to help you know which nutritional testing you could benefit most from and how you can use glucose, ketones, and lactate to fine-tune the protocol to your own needs.

Many people have asked what the difference is between Mitome and tests such as the Genova ION + 40 or the Mosaic (formerly Great Plains) Organic Acid Test. The ION and OAT contain many markers of the catabolic breakdown of macronutrients that happens inside the mitochondria, but they do not contain any markers of the mitochondrial respiratory chain. When you break down fat, carbohydrate, or protein in these systems, you then deliver the breakdown products to the respiratory chain. If you have a problem in the respiratory chain and in the breakdown of macronutrients, the last thing you want to do is fix the breakdown of macronutrients first, because then you will greatly increase the work you are sending to the impaired respiratory chain.

It’s as if you had traffic jam at point A and point B when everyone is traveling from A to B. The last thing you want to do is resolve the traffic jam at point A while doing nothing to fix it at point B, as you will double or triple the problem at point B and probably 10x or more the accidents and road rage.

You always want to fix a downstream problem before an upstream problem, so that when the upstream point starts flowing freely to the downstream point, the downstream point can handle it.

Mitome tests the most downstream point there is in your mitochondrial energy production, so it represents the point you want to optimize first.

Why These Beat Many Other Tests

Many other tests that conventional or functional medicine focuses on are worth testing, but should be seen as effects rather than causes.

For example, you might want to optimize your cholesterol to optimize your heart disease risk. Before we get into deciding whether we should look at total cholesterol, the total-to-HDL-C ratio, the HDL-C-to-triglyceride ratio, or ApoB, we should first acknowledge the elephant in the room: cholesterol levels are powerfully controlled by thyroid hormone and are mechanistically controlled by the activity of the LDL receptor. In fact, statins work by making your liver cells deficient in cholesterol, which makes them increase the LDL receptor without the need for thyroid hormone to do so.

As I covered in Hormones Are Never In Charge, thyroid hormone is produced in response to hypothalamic ATP content. The LDL receptor itself requires ATP to fuel the motor protein dynamin, which constitutes the molecular motor that moves the LDL receptor into the cell.

Thyroid hormone is influenced by a wide variety of vitamins and minerals. In fact, I have never seen a woman on thyroid hormone who didn’t have low serum iodine, and I find it disturbing that practitioners are prescribing thyroid hormone without measuring iodine status first.

ATP production, too, requires most of the nutrients.

Both thyroid and the LDL receptor together are fundamentally powered by ATP production in the mitochondria. For thyroid hormone, ATP production in the hypothalamus is the driver, and for the LDL receptor, ATP production in the liver is the driver.

As such it makes no sense to go on statins — which themselves are mitochondrial toxins — before optimizing the nutrients you need for thyroid hormone and ATP production and the identification of the idiosyncratic needs of your respiratory chain.

Bonus: Putting Them Into Proper Context

In order to put these into their proper context, you want to run two “bonus tests” at home:

Bonus 1: Self-Rated Health Scores. “What gets measured gets managed.” Don’t get lost in proxy markers. Rate yourself on the health metrics that matter most to you on a scale of 1-5. Make sure your health strategies are improving these and not just the lab numbers. This is the ultimate determinant that you are getting the health results you want.

Bonus 2: Track Your Diet in Cronometer. If you are doing nutritional testing, you will make much better inferences if you characterize the nutrients you are eating. This rounds out the functional markers and concentrations in serum/plasma and cells by showing you whether the nutrients are even in your diet in the first place. Use my Cronometer Guide to get this set up correctly.

Integrating both are covered in my Optimization Framework.

Negotiating Time and Money

If you have unlimited time and money, you should run all of this as a baseline and after each major turning point in the evolution of your health strategy. More data is always better so long as you have trained yourself not to get lost in the weeds or have anxious reactions to data overload.

Most of us need to negotiate the tradeoff, however, and most of us are more limited in one area than the other.

One important point, though, is “I have no time” or “I have no money” often means “this is not important enough to me to spend my time or money on it.” My own experience is that the greatest waste of time and money I’ve ever made has been in putting off testing of this nature. Time spent in less than optimal health means problems compound themselves over time. Better to invest and accumulate compound dividends than to let problems drag on and accumulate compounding debt payments.

With that said, tracking your diet is the most time-intensive step and is the part you can forego if you are trying to save time. I would highly recommend you at least do a rough outline of your diet. For example, go into Cronometer, and in a single day, estimate what you eat in a month. Generate the nutrition report for the month, and you’ll now have a daily average of your nutrient intake for the month. Whenever you change your diet, copy that day to a day in the new month, and edit it a little bit to make it more representative of the new diet. That saves a lot of time over meticulously tracking each morsel of food every day, but it still provides you a general sketch of where your nutrients stand.

If you genuinely have no money to put toward this, you are best to focus on home experiments with affordable foods. For example, how does your self-rated energy respond to increasing the amount of liver or nutritional yeast in your diet or to consuming diets run more on carbohydrate or more on fat?

If you are trying to hit a middle ground on what you spend, I would run my Mitome test and combine it with testing glucose, ketones, and lactate (GKL) for three days in a row at baseline and at the turn of each of your health strategies.

There are two reasons to test Mitome first:

• Since any problem you fix in your energy metabolism eventually dumps on the respiratory chain, the respiratory chain is what you should fix first to enable anything else to be fixed safely.

• I made the protocols with cost-saving people in mind. Rather than telling you that you have to optimize your nutrients first or telling you that you have to do testing afterward, the protocol guides you through how to implement each step while judging its effects with your home testing and rating alone and also tells you when you would be best off running additional nutritional testing alongside that approach. When the protocol recommends testing, it gives you the interpretive framework you need for the recommended tests.

Running the comprehensive testing costs about $2400, so the ability of Mitome to select out the nutritional tests that are most necessary can save money as part of the return on the initial investment into the Mitome test.

The reason to include the GKL is that it adds the highly repeatable pre- and post- home testing to evaluate how your strategies are impacting your energy metabolism. This is critical to tailoring your individualized program.

You get faster insights when you test everything together at every step of your strategy, but if you have more time than money you can invest more time in self-experiments on self-rated endpoints, and if you have more money than time you can focus more on the comprehensive screening + Mitome, with the middle ground being Mitome + GKL.

The light way to use these is to do intermittent testing to evaluate the things you do using a “try it and see if it works” approach.

If your problem or goal is worth the time, or if you are simply obsessed with optimization, you take one of these approaches and then run with it using my Optimization Framework.