Part 5
The Advanced Testing Menu, Graded
ILLUSTRATION. A forty-page laboratory report lies on the table: hundreds of results, several marked red. The person holding it has spent a week searching each abnormality online. Before discussing another test, the clinician asks which results can change care. A large report can contain very little useful direction.
Clinical scenes in this edition are explicitly labeled illustrations. They describe imagined situations used to explain medical decisions, not documented patients, diagnoses, conversations, or treatment outcomes. They should not be read as evidence that a particular intervention works. Personal recollections are recollections, not medical records.
Evidence grade (draft mapping). 31 questions; a question with mixed evidence counts under each grade.
I use thirteen areas to organize a prevention conversation. They are not thirteen targets that everyone must measure or drive downward. (Part 5, Q65)
- 1.Blood pressure
- 2.LDL cholesterol and, selectively, ApoB
- 3.Lp(a)
- 4.Glucose regulation
- 5.Triglycerides and HDL
- 6.Waist size
- 7.Kidney function
- 8.Liver health
- 9.Fitness
- 10.Strength and balance
- 11.Bone and fracture risk
- 12.Screening and vaccination status
- 13.Medication and supplement review
Heart and blood vessel tests
- 57. Should I have a CT angiogram of my heart arteries, with AI plaque analysis?SOMETIMES. It provides detailed coronary information in selected patients. It has not been proven as a screening test for everyone.FNot demonstrated / insufficientARobust human trials
- 58. What about a carotid ultrasound?SOMETIMES. Seeing plaque in the neck arteries can motivate treatment. Screening everyone for narrowing is not recommended.GGuideline-based / consensus
- 59. Do I need an NMR particle test, or is ApoB enough?ApoB is enough. SKIP the more expensive particle tests.GGuideline-based / consensus
- 60. What about “inflammation panels” with Lp-PLA2, MPO, and oxidized LDL?SKIP. hs-CRP is the only inflammation test with a role in guidelines.FNot demonstrated / insufficient
- 61. Should I treat a high homocysteine?SKIP it as a heart or longevity target. Check it only if B12 or folate deficiency is suspected.ARobust human trials
- 62. Should a healthy person have a stress test, an echocardiogram, or a yearly ECG?Generally no. They are excellent tests for people with symptoms and poor screening tests for people without.GGuideline-based / consensus
- 63. Are there any vascular screening tests that are proven?Yes, one. An ultrasound for abdominal aortic aneurysm in men 65 to 75 who have ever smoked. WORTH IT.ARobust human trials
- 64. Omega-3 index, genetic heart-risk scores, troponin, and BNP?SKIP the first two for now. The last two are useful in specific people.BLimited or small human studies
Metabolic and hormone tests
- 65. What thirteen areas belong in a prevention review?I use thirteen areas to organize a prevention conversation. They are not thirteen targets that everyone must measure or drive downward.JClinical judgment / author synthesis
- 66. Do I need a “full” thyroid panel with reverse T3 and antibodies?SKIP it unless your TSH is abnormal or you have clear symptoms. TSH first is the right approach.GGuideline-based / consensus
- 67. Is “adrenal fatigue” real? What about saliva cortisol tests?Adrenal fatigue is not a recognized medical condition, and the four-point saliva test sold to diagnose it is not validated. SKIP.GGuideline-based / consensus
- 68. My blood work is “normal.” Why am I so tired?A normal blood count does not rule out every cause of fatigue. Ferritin can be useful when iron deficiency is plausible, but the evaluation begins with the history.Grade pending
- 69. What about dried-urine hormone tests?SKIP. Menopause and endocrine societies advise against using urine or saliva hormone tests to guide treatment.GGuideline-based / consensus
- 70. IGF-1, uric acid, cystatin C, and GGT?One of the four is clearly useful.GGuideline-based / consensus
- 71. How should fatty liver be checked?In adults at risk of metabolic liver disease, a staged assessment often begins with routine tests and a fibrosis calculation such as FIB-4. It estimates risk; it does not diagnose scarring by itself.GGuideline-based / consensus
- 72. Are resting metabolic rate tests and body composition scales useful?SOMETIMES for motivation. Neither changes medical care.Grade pending
Functional medicine tests
- 73. Do food sensitivity tests work?No. SKIP. Allergy societies in the United States, Canada, and Europe all recommend against them.GGuideline-based / consensus
- 74. Micronutrient panels?SKIP the $300 to $900 “intracellular” panels. Test the few nutrients that matter, by standard methods, when there is a reason.FNot demonstrated / insufficient
- 75. “Leaky gut,” SIBO breath tests, and organic acid tests?SKIP the first and third. The second has a limited role in people with symptoms.BLimited or small human studies
- 76. Should I be tested for mold toxins or heavy metals?SKIP urine mold tests and “provoked” metal tests. A plain blood test for lead or mercury is valid when there is a real exposure.GGuideline-based / consensus
- 77. What about “toxic burden” panels for plastics, PFAS, and pesticides?SOMETIMES for PFAS, if you have a known exposure. SKIP the broad panels.GGuideline-based / consensus
- 78. Is MTHFR testing useful?No. SKIP. Genetics societies recommend against it.GGuideline-based / consensus
- 79. Hair analysis, live blood analysis, and thermography?SKIP all three.FNot demonstrated / insufficient
Genes, clocks, and scans
- 80. Should I have my whole genome sequenced?SOMETIMES. About 1 person in 30 carries a gene change that would alter their medical care, and most do not know it. The rest of the report is mostly uncertainty.CObservational
- 81. What is pharmacogenomic testing?A test of how your genes affect your response to certain drugs. SOMETIMES, and most useful when you are about to start one of those drugs.Grade pending
- 82. Glycan age, “organ age,” and NAD level tests?SKIP for now. They are interesting research tools without proven uses.BLimited or small human studies
- 83. Brain MRI “volumetrics” and memory testing for healthy people?Routine brain volumetrics are not established screening for healthy people. Assess memory when symptoms, family concerns, or clinical observation suggest a problem.FNot demonstrated / insufficient
- 84. Should a non-smoker get a lung CT?Generally no. Screening is proven only for people with a significant smoking history.FNot demonstrated / insufficient
- 85. Are there cancer blood tests besides Galleri?Yes, and more are coming. None is FDA approved, and none has been shown to reduce cancer deaths.Grade pending
- 86. What is the testing scorecard?Here it is on one page.JClinical judgment / author synthesis