What We Measure

Section 1

Blood and haematology

The foundation. Oxygen carrying, immune cell populations, and the cell-size variability that quietly predicts long-term outcomes.

RDW is already measured in every routine blood count and is almost never discussed. It is an independent predictor of all-cause mortality. We interpret it.

Section 2

Core chemistry and electrolytes

Section 3

Cardiovascular — lipids, lipoproteins and arteries

Three parts: the particles circulating in your blood, the inflammatory activity within the artery wall, and what your arteries have actually become. Most programmes measure only the first.

Cholesterol tells you about risk. Carotid imaging and arterial stiffness tell you what has already happened to your arteries. We measure both, and they frequently disagree.

Section 4

Metabolic and glycaemic

Blood sugar is the last thing to go wrong. Insulin is the first. We measure the whole sequence, dynamically, over two weeks — not with a single fasting number.

You receive the graphs. The two-hour insulin curve and your fourteen-day glucose traces are given to you as plots, meal by meal and night by night, not summarised into a single number. This is the part of the assessment patients change their behaviour from — a table of values rarely moves anyone, and a picture of what happened to their blood sugar after a specific dinner reliably does.

Fasting insulin is the most informative inexpensive blood test most people have never had. Insulin resistance is detectable years — often a decade — before blood sugar becomes abnormal. The paired OGTT catches it earlier still, and the fourteen-day monitor shows you what your own meals actually do.

Section 5

Kidney function

Creatinine alone is distorted by muscle mass — it overestimates kidney function in people with little muscle and underestimates it in people with a lot. Cystatin C is not affected by muscle. In an athletic population, the two together are the only honest answer, and cystatin C is an independent mortality predictor in its own right.

Section 6

Liver and digestive

Section 7

Inflammation and immune function

Chronic low-grade inflammation is the common pathway linking cardiovascular disease, metabolic disease and cognitive decline. It is measurable, and largely modifiable.

A frank note on the last two groups. High-sensitivity CRP and GlycA change with what you do — weight, sleep, alcohol, fitness, dental health — and we can act on them. Interleukin-6 and TNF-alpha are genuine measures of inflammatory signalling, but there is no specific intervention that targets them outside of drug therapy for diagnosed disease. We include them at the Plus tier because the longitudinal trend is informative, and we say clearly what they cannot yet tell you.

Coeliac screening is reported under Liver and Digestive (§6). Autoimmune serology — ANA, rheumatoid factor, anti-CCP — is ordered only where symptoms or examination give a specific reason, and is listed under Further Testing (§18); ordering it in people without symptoms produces false positives at a rate that causes real harm.

Section 8

Thyroid

A single TSH is the standard of care and is often adequate. It is also the reason thyroid problems get missed in people whose TSH sits inside the reference range while their free hormones do not.

Selenium and iodine status are reported under Nutrients (§10) and read into the thyroid assessment. Thyroid ultrasound is not part of the programme: scanning thyroids in people without symptoms finds nodules in roughly half of them, almost none of which matter, and it is a well-documented driver of overdiagnosis. We image the thyroid only where examination or bloodwork gives a specific reason.

A note on reverse T3. It is widely marketed and weakly evidenced — there is no established treatment threshold and no trial showing that acting on it improves anything. We include it at the Plus tier because patients ask for it and because the longitudinal trend is occasionally informative, and we will tell you frankly that it should not drive a treatment decision.

Section 9

Hormones — sex, adrenal and growth

Measured by mass spectrometry wherever accuracy at low concentrations matters, which is most of the time. Immunoassay is adequate for a testosterone in a young man and unreliable for an oestradiol in a postmenopausal woman.

Where hormone measurement leads. Measuring these markers frequently opens a conversation about treatment — testosterone therapy, menopausal hormone therapy, thyroid replacement. All are legitimate medicine with real evidence behind them, and all require a proper clinical assessment rather than a number on a page. We will discuss what your results mean and what the evidence supports. We do not treat a laboratory value in isolation, and we do not describe hormone therapy as optimisation or anti-ageing.

Section 10

Nutrients and fatty acids

Serum B12 is frequently normal in people who are functionally deficient — it measures what is circulating, not what is reaching the cell. Methylmalonic acid resolves the ambiguity, so we run both from the start rather than waiting for a borderline result and calling you back.

Serum magnesium and red cell magnesium answer different questions. Less than one percent of body magnesium is in serum, so a normal serum level tells you very little. Red cell magnesium is closer to tissue status, though it is still an imperfect proxy — and we will say so rather than treating either number as definitive.

Section 11

Cardiorespiratory fitness

Measured directly with breath-by-breath gas exchange, rather than estimated from heart rate.

A treadmill stress test asks whether your heart is diseased. A maximal VO₂max test with gas exchange measures how well your entire cardiorespiratory system works, produces the exact heart-rate zones your training should use, and is among the strongest predictors of remaining lifespan available in medicine. These are not the same test, and the difference is the equipment.

Section 12

Respiratory

Section 13

Body composition

Section 14

Bone

Section 15

Muscle, strength and physical function

Grip strength and walking speed cost almost nothing to measure and predict mortality more powerfully than most of what appears on an expensive panel. They are omitted almost everywhere because they are not billable elsewhere and not impressive to look at.

Section 16

Cognition, senses and sleep

Hearing loss is one of the largest modifiable dementia risk factors identified to date. Reduced sense of smell can precede neurodegenerative change by years. Both take minutes to measure. Neither is on a standard executive health panel.

Section 17

Cancer screening

Screening decisions are made with you, not for you. Guideline-based screening is coordinated with the provincial programmes so nothing is duplicated. Whole-body imaging is available to every patient who wants it, with a full discussion of what it can and cannot find beforehand.

What a whole-body MRI does and does not do. It is very good at showing anatomy — masses, structural change, joint and spinal pathology — without any radiation exposure. It does not detect every cancer, and some common ones, including many breast, lung and colon cancers, are better found by the dedicated screening tests below. It also finds incidental abnormalities in a substantial proportion of healthy people, most of which turn out to be harmless but some of which lead to further imaging, biopsy or specialist referral. We will discuss this with you before you book, and we will manage anything found rather than handing you a report and leaving you to it.

Section 18

Further testing, where your results indicate it

Not included by default. Ordered only when something in the assessment above gives a specific reason, priced individually, and discussed with you before anything is booked.

• Two-hour glucose tolerance test with paired insulin
• Coronary artery calcium score
• CT coronary angiography with flow analysis
• Liver elastography
• Targeted ultrasound
• 24-hour blood pressure monitoring
• Extended cardiac rhythm monitoring
• High-sensitivity troponin
• Faecal calprotectin
• H. pylori testing
• Four-point cortisol curve
• Urinary hormone metabolites
• Breath testing
• Blood heavy metals where exposure history warrants
• Pharmacogenomic testing
• ApoE genotyping with counselling
• Hereditary cancer genetics referral

Section 19

Optional research-tier measures — Continuum Plus

Offered with a clear explanation of their limits. These are longitudinal trackers, not diagnostic tests: a single result means very little, and only the trajectory across repeated measurement carries signal. We will say so before you order one.

• Epigenetic age panel
• Proteomic organ-age profile
• NMR metabolomic profile
• Glycomic inflammatory age