Your blood is an incredible substance. Not only does it carry oxygen to every last inch of your body, it also transports hormones, removes waste, kills pathogens and much, much more. But maybe the most powerful thing you can do with your blood is examine the massive amount of information carried in every drop.

Monitoring the progression of your health with blood work each year is extremely easy and vitally important — regular blood health screening can highlight potential problems while they’re still simple to treat.

However, the typical yearly physical is NOT a comprehensive look at your health and it rarely prevents chronic illness, so it’s important for you to take matters into your own hands.

In this article, you’ll find everything you need to request from your doctor each year to make sure you have the best blood test package possible.

Your Annual Wellness Blood Test Should Include…

1. Red blood cells (for oxygen distribution and anemia screening) and white blood cells (for immune function)

Red blood cells (RBCs) are produced in the bone marrow and circulate in the bloodstream to deliver oxygen to your cells. Oxygen molecules attach to a protein called hemoglobin within the RBC. The lifespan of most RBCs is around 120 days, and healthy RBC production requires iron, copper, B12, and folate.

Mean cell volume (MCV) is the size of your RBCs. If your RBCs need iron, they will shrink (low MCV), reducing their ability to effectively deliver oxygen around the body. If your RBCs need B12 or folate they increase in size (high MCV). A deficiency of iron, B12, and folate all lead to the reduced production of RBCs. The size of your red blood cells helps you to determine which nutrients are lacking. This test is key for understanding whether your RBCs are getting the support they need for their critical role in the body.

White blood cells (WBCs) exist in the blood, lymph, and tissues as your body’s natural defense system. They help to protect you against infections and have a role in inflammation and allergies. There are five different types of WBCs, each with a different function: neutrophils, lymphocytes, basophils, eosinophils, and monocytes.

The numbers of each type are relatively stable until a response is needed from your immune system, in which case the relevant WBC will increase in number. Imbalances in the types of WBCs may indicate infection, inflammation, or allergies, and so this test can highlight if your immune system is actively fighting a recent insult or a long-standing health issue.

The lab test that includes your RBCs and WBCs is called the Complete Blood Count (CBC) + Differential.

2. Liver and kidney function (removal of waste, detoxification, and regulation of body fluids)

The liver is responsible for more than 500 vital functions in the body and at any moment it contains about 13% of your total blood volume. All of the blood leaving your stomach and intestines passes through the liver where components are broken down, balanced, recreated, and stored. Chemicals and drugs are broken down into nontoxic forms, and can then be safely excreted by the body.

Bile and cholesterol are manufactured in the liver, and proteins are created to balance your blood volume and the distribution of fluid in your body. These proteins also help to regulate blood clotting and serve to carry hormones, cholesterol, and your immune system around the body. Iron and glucose are stored in the liver to make future red blood cells and energy.

Your kidneys are efficient filters and rid the body of wastes and toxins while preserving vitamins, electrolytes, hormones, and other vital substances. Your kidneys also play an important role in maintaining your blood pressure, promoting red blood cell production, activating vitamin D to promote healthy bones, and balancing body fluids.

Elevated liver enzymes indicate liver disease or dysfunction. Diseased liver cells means that they no longer can carry out their basic functions of detoxification, etc. An example of this is a common condition called fatty liver or non-alcoholic fatty liver disease (NAFLD). This occurs when healthy liver cells are replaced by fat cells due to high triglycerides and the amount of fat surrounding your abdominal organs (visceral fat).

Elevated kidney markers may indicate impaired kidney function or disease. You can not live without the continuous filtration and fluid balancing act of the kidneys. When the kidneys fail to function artificial means of filtration are required such as dialysis.

In the US liver and kidney function is part of the larger test called the Comprehensive Metabolic, which also includes electrolytes, proteins, and glucose. Outside of the US, you would ask for kidney (BUN, creatinine) and liver function tests (alkaline phosphatase, ALT, AST, bilirubin, albumin, total protein).

3. Electrolytes (body pH and enzyme function)

Electrolytes are essential minerals with an electrical charge — sodium, calcium, potassium, chloride, phosphate, and magnesium — that you must get from the food you eat and fluids you drink. They are key to vital processes in the body such as muscle contraction and hydration.

Another one of the main jobs of your kidneys is to maintain the delicate pH balance in the body. The ‘Anion Gap’ is a calculation using sodium, potassium, chloride, bicarbonate and it reflects the balance of acidity and alkalinity within your body. The higher your pH, the more acidic your body, and the lower the pH, the more alkaline.

A pH outside of the range, whether high or low, impacts the speed at which your enzymes can function. This slows down the tens of thousands of chemical reactions that take place every second of every day, which can cause a cascade of problems.

Your pH is impacted by your diet, breathing patterns, stress, medications, and kidney function. The pH in different body tissues impacts the function of your enzymes, which are vital for life and speed up the rate of virtually all of the chemical reactions that take place within your cells.

Measuring the Anion Gap requires each of the electrolytes involved to be measured: sodium, calcium, potassium, chloride, phosphate, magnesium, bicarbonate. Some labs may group them together in various ways. In the US, the electrolytes are included in the above liver and kidney function test called the Comprehensive Metabolic.

4. Blood sugar (glucose, insulin, and hemoglobin A1c levels)

Blood sugar, or glucose, is the sugar found in your blood that comes mainly from the food you eat. Whenever you eat something, your digestive system breaks it down into smaller components, and one of the major components is glucose.

Glucose is our bodies’ primary energy source. It’s a necessary ingredient for maintaining the optimal function of your organs, muscles, and nervous system. If you just ate a meal high in carbohydrates, starch and/or sugar, your blood sugar will rise high over a normal fasting level. If you just had a meal of healthy fats and proteins, your blood sugar will not rise as high.

Blood sugar after meals that is continuously outside of the normal range can lead to major blood vessel and body tissue damage. This damage creates toxic compounds called advanced glycation end products (AGEs), which are biomarkers implicated in aging and the development, or worsening, of many degenerative diseases, such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s disease.

Blood sugar stability and insulin levels throughout the day all impact your overall sense of well-being, ability to heal from illness, future risk of chronic disease, and your longevity. What you eat, how much you move and sleep, and the amount of stress that you are under all impact your daily blood sugar control.

Glucose testing is part of the Comprehensive Metabolic test in the US. In addition, I recommend that you test your insulin and hemoglobin A1c. Outside of the US, you would ask for glucose, insulin, and hemoglobin A1c levels separately.

5. Cardiovascular health screening (Cholesterol/Lipids + Apolipoprotein B)

Your cardiovascular system is made up of your heart and blood vessels and its main job is to transport oxygen, nutrients, and hormones throughout the body. The pattern of blood test results that indicate a healthy cardiovascular system include: healthy levels of both types of cholesterol (not too high or too low), low inflammation, and balanced blood sugar levels.

Your family history, smoking history, blood pressure, diet, fitness, sleep, and response to stress also contribute to your overall cardiovascular risk. In spite of the bad rap for playing a role in heart disease, a healthy balance of cholesterol is also vital to your health and well-being.

These tests are called lipid or cholesterol tests which include total cholesterol, HDL cholesterol, LDL cholesterol, VLDL, and triglycerides. You would also request an Apolipoprotein B test.

6. Inflammation (hs-CRP, homocysteine)

Inflammation is a vital part of your immune system’s response to injury and infection. It is the signal to your immune system that healing and repair are needed, or that defense against things like viruses and bacteria is required.

Inflammation that goes on too long or in the wrong place can lead to certain chronic diseases such as heart disease, diabetes, chronic pain, obesity, dementia, cancer, and autoimmune disease. Your diet choices, a lack of daily movement, inadequate sleep, and a poor response to mental and physical stress all contribute to increased inflammation.

When there is chronic inflammation, hs-CRP and homocysteine levels rise in the bloodstream. These tests indicate whether the concentration of those proteins is within an optimal range or whether the concentration is high enough that inflammation must be present.

Ask for the individual tests for homocysteine and c-reactive protein hs.

7: Thyroid (metabolism)

Your thyroid gland is a bowtie-shaped gland located just below your voicebox. It secretes hormones that affect the speed of your body’s chemical functions, also known as your metabolism or metabolic rate.

Metabolism is the rate that your body expends energy and burns calories, and your thyroid gland creates a whole cascade of hormones that go on to impact every tissue in the body. These include many vital functions such as your heart rate, the rate at which calories are burned, skin maintenance, tissue growth, heat production, fertility, and digestion.

To produce thyroid hormones, your body uses iodine and selenium. Symptoms of underactive thyroid function (hypothyroidism) include low energy, weight gain, cold hands and feet, dry skin, constipation, and low mood. Symptoms of elevated thyroid function (hyperthyroidism) include nervousness, anxiety, irritability, increased sweating, difficulty sleeping, hand tremors, high or low energy, heat intolerance, and heart racing.

This test is the Thyroid stimulating hormone (TSH), Free T3, Free T4.

8. Nutrition blood tests

One of the most common requests I get from new clients is for a nutrition blood test. Sadly there’s no single test that will tell you how good your current nutrition is, and so we need a range of tests that will indicate your dietary intake of macro and micronutrients (vitamin D, iron/ferritin, B12/folate, and magnesium).


If your kidney tests show that creatinine and BUN are low, this may indicate that you are not eating enough dietary protein. Your body needs proteins and amino acids for cellular growth and repair and to produce important molecules in our body – such as enzymes, hormones, neurotransmitters, and antibodies.

Protein is essential for managing fat loss, muscle mass, bone strength, immune system function, and athletic performance and recovery. The basic recommendation for protein intake is 1.2 to 2.4 g/kg (around 0.54-1.1 g/lb) of body mass in generally healthy adults.

Common signs of low protein intake include loss of muscle mass, poor bone health and wound healing, swelling, low mood, frequent illness, weakness and fatigue, frequent hunger, and poor quality hair, skin, and nails.

Dietary Fat and Carbohydrates

If your triglycerides are low, this may indicate that you are not eating enough dietary fat. Healthy fats include olive oil, avocado, coconut, nuts and seeds, eggs, organic butter or ghee, and meat and seafood.

You use fat to support your mood, brain function, metabolism, cell communication, immune system, hormone production, and the absorption of many nutrients (such as vitamins A and D). Eating enough fat helps you to feel full between meals.

If your triglycerides are high this may indicate that your dietary carbohydrates are too high. Foods that contain carbohydrates are grains, vegetables, legumes, fruit, nuts, dairy, and sugars.

All carbs that we eat are broken down at various speeds into sugars and eventually glucose. Simple carbs like baked goods made from refined flour are broken down quickly and lead to a fast blood spike in blood sugar, while complex carbs such as vegetables and beans contain fiber and are broken down more slowly.

Vitamins and Minerals

Vitamins and minerals are needed for normal cell function, growth, and development. If you take supplements with fat-soluble vitamins — vitamins A, D, E, and K — these are best absorbed when taken with food. Fat-soluble vitamins are stored in fat for future use and this is why they can build up to toxic levels. It is important to test your levels of fat-soluble vitamins if you are taking high doses for prolonged periods of time.

There are 9 water-soluble B vitamins and these are not stored in the body (apart from B12 which can be stored for 3 to 5 years in the liver). If you take more B vitamins than the body can use you will get rid of them in urine (resulting in a fluorescent yellow tinge).

Some critical vitamins and minerals to test for include:

  • Vitamin D
  • B12/folate
  • Magnesium
  • Iron/ferritin

To do a basic nutrition blood test you will need all of the following: Vitamin D, iron, ferritin, B12, folate, magnesium, electrolytes, BUN and creatine, and triglycerides.

* * *

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 and prevent the disease process from starting in the first place.

If you would like to order the blood health screening I use with all my clients at a lab near you, just click here. All these tests are included.

Remember that lab reference ranges take their data from the population that visits that particular lab, not from the research that indicates what’s optimal. I rely exclusively on research data, rather than a population’s averages, to assess your blood health, so if you want to take your analysis beyond the information the lab sends back — to see if your results reflect optimal health rather than just a lack of disease — click here to book a consultation.

    6 replies to "Essential Yearly Blood Tests"

    • 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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