You are putting yourself at risk if you are not asking your doctor for these tests every year.

Monitoring the progression of your health with blood work each year is extremely easy and vitally important. However, the typical yearly physical is NOT a comprehensive look at your health, and it rarely prevents chronic illness.

Recommended Annual Blood Tests Your Doctor Should Be Ordering

Therefore, it is very important that you take preventive health measures into your own hands.

These five lab tests should be a crucial piece of your annual physical, and here’s what you need to know about them:

#1  Vitamin D

The Harvard School of Public Health estimates that 1 billion people worldwide have inadequate levels of vitamin D in their blood. It is estimated that that number becomes almost 50% of the world’s population if you include those in the suboptimal range.

Why is it important?

Having a deficiency of this super nutrient has been linked to osteoporosis, increased fracture risk, cancer, autoimmune dysfunction, cardiovascular disease, multiple sclerosis, lowered resistance to the common cold and seasonal flu, type 1 diabetes, and hypertension. 

Therefore, Vitamin D levels may just be the most important preventive lab measurement. Based on the current research, I recommend a target Vitamin 25D level of 30-50 ng/mL for most people.

#2  The 2-hour post-meal glucose 

Although a fasting glucose is usually included in a basic blood workup, a far more useful marker is the 2-hour post meal glucose. This helps you to determine the amount of time that your blood sugar spends elevated over the level known to cause the complications such as diabetes and heart disease.

Why is it important?

The food that we eat is eventually broken down into glucose, which is the sugar that circulates in your blood that provides your body’s cells with energy. Although glucose is crucial for providing energy, when it remains in the blood stream for too long it can damage the blood vessels and lead to cardiovascular disease.  

After monitoring hundreds of patient’s blood sugars each year, I have come to the conclusion that the American Diabetes Association (ADA) blood sugar targets are too high! 

If you are interested in optimal health and longevity, your ranges should be:

Fasting blood sugar 75-90 mg/dL (ADA recommends <99)

2-hour post-meal blood glucose <120 mg/dL (ADA recommends <140)

*This test can easily be performed from home with a cheap drug store blood sugar monitor or get this one delivered for free from Amazon!

#3  A complete thyroid work-up

Chances are, if you’ve had your thyroid tested recently, a lab marker called TSH was tested. The problem is, the thyroid hormone undergoes a complex cascade of steps before it is active and available to every cell of the body. 

Did you know that it is possible to have normal TSH blood levels but still experience the symptoms of a poorly functioning thyroid?

Why is it important?

Thyroid disorders are on the rise. More than twelve percent of the U.S. population will develop a thyroid disorder in their lifetime, and up to 60 percent are unaware of their disease! One in eight women will develop a thyroid disorder in her lifetime.

A more complete thyroid screening includes:

1. TSH (thyroid stimulating hormone)

2. free T4

3. free T3

4. TBG (thyroid binding globulin)

5. T3 uptake

6. For those with an autoimmune disease or family history of thyroid disease, also include: TPO antibodies and anti-thyroglobulin antibodies.

#4  Screen yourself for a B12 deficiency

It is common for someone following a vegan or vegetarian diet to be low in vitamin B12. But, you can eat meat and still be deficient! 

Additional factors putting you at risk for low B12 absorption are digestive disorders, diabetes, taking proton pump inhibitors or acid blocking medications, and being older than 60 years old.

A review of 3,000 men and women in the ongoing Framingham Offspring Study found that 39 percent had B12 levels in the suboptimal range which are levels that can result in neurological symptoms!

Why is it important?

B12 deficiency causes a type of anemia that can result in neurological symptoms such as walking and balance disturbances, memory loss, cognitive decline, confusion, and dementia. B12 deficiency has also been linked to infertility, autoimmune disease, and autism spectrum disorders!

What is a good B12 level?

Currently the accepted deficiency level is 148pg/mL. However, Japan and Europe have their lower limit at 500-550pg/mL. I also recommend a level greater than 500pg/mL. 

If you suspect you have a B12 deficiency, an even more sensitive marker to include in your testing is methylmalonic acid (MMA).

#5  Take your cholesterol test one step further

It is not enough to just know your total cholesterol, HDL, LDL, and VLDL levels. It is also important to test inflammation markers such as c reactive protein and homocysteine.

The addition of these two tests will help to give you a much clearer picture of your cardiovascular risk.


A good annual physical should help you to catch the disease process early. 

But a great annual physical should help you to identify these areas of imbalance and give you the lifestyle and diet recommendations to reverse poor health.

Requesting the above tests from your doctor is the first step in helping you to get more from your annual physical.


This article was originally published on Eat, Live, Life.

Click here to see other articles I have written for this great website spreading the news of all things health & wellness.

    6 replies to "The 5 lab tests your doctor should be ordering every year (but isn’t)"

    • Elana

      This post about labs is so true! I’m one of Alexis’ clients, and the lab work I did with her FINALLY showed all of the issues that I was having–on paper! It made it so much easier for me to address my medical concerns. Previously, Western doctors had only told me that there was nothing that could be done for my medical problems, that they were “chronic” and therefore permanent and unchangeable.

      In the last 6 months that I have been working with Alexis, I have seen marked improvement in my levels via blood work as well as felt worlds better on a day to day basis. Thanks to Alexis I feel in control of my health and body in a way that I hadn’t for years. The blood work holds the truth 🙂

    • Allie

      So should I be cynically blaming pharmaceutical and insurance lobbyists for the differences between the U.S. recommended intakes/deficiency standards and those favored by you/other countries? Or is there some other reason that you differ from the ADA re: blood glucose levels and why you and Japan/Europe differ re: B12 deficiency levels?

      • Dr. Alexis Shields

        Well, in part. However the answer is a bit more complicated in that it also involves how “normal” ranges are determined and what “normal” actually means. So each range is derived from tests done on 95% of a healthy, a.k.a. normal, target population for that specific lab. Which is why ranges differ slightly from lab to lab given differences in testing equipment, procedures, and the health of the target population itself. So you have to ask yourself, when the majority of people going into a lab to get blood work done are sick, do these people truly represent a healthy target population? Another problem lies with the interpretation of the results. For example, if someone has a Total cholesterol of 200mg/dL. This is considered normal for some labs. However, a cholesterol of 201mg/dL is all the sudden not normal and could lead to the recommendation of a drug. So you can literally be told “you are normal, come back next year” or “this is abnormal, you need drugs”, over 1 point. So- within most lab ranges there are healthy “optimal” ranges. And when you are outside of these optimal ranges, measures should be taken with diet & lifestyle to prevent worsening. Essentially, the blood work is a window into the inner workings of your body, and it shows imbalances WAY before you are outside of most lab ranges. However, most doctors are not taught how to see these patterns in blood work, or the lifestyle modifications that work to reverse them. It’s all about drugs. If it doesn’t yet require a drug, well then you are just fine. Come back when it does. It is not necessarily that the current lab ranges are wrong, they are just focused on something different. Disease. And disease processes. Whereas, I am more concerned with health. And maintaining health for that individual. So it requires looking at the blood in a different way. I have not done extensive research into these claims, but it has also been said that lab ranges have been changed slightly over time (with a push from drug companies), so that more people qualify for a particular medication (aka cholesterol lowering drugs). I’ll have to look more in to the roots of this claim. However, if it true then… ugh.

        • Allie

          Thanks dude.

    • lemon gloria

      That was really interesting and informative. Thanks, Alexis!

    • XXX

      Dear Dr,

      I am 46 years old now. My previous family Dr was checking glucose level for the last 14 years. I moved to different city and my primary Dr also changed. Now this new Dr refused to check my glucose level for this year. He is saying my glucose number is stable for the last 2 years. Is this correct?. When I ask him to test it again, he is threatening that I have psychiatric issues and he will me to psychiatric . What should I do now?. Please advise me. Thank you!.

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