Labs to Check Once in a Lifetime vs. Every Year

Regular lab testing is a key component of optimizing health and preventing disease.

However, not all tests need to be performed annually. Some labs provide foundational information about your body that only needs to be assessed once (unless specific concerns arise), while others offer insight into ongoing physiological changes and should be checked yearly. Below is a guide to help you understand the difference between these categories.

Once-in-a-Lifetime Labs

These tests assess long-term or unchanging markers and can help identify potential risks or predispositions.

Genetic Testing

Tests like 23andMe, MTHFR, or advanced genetic panels (e.g., nutrigenomics or pharmacogenomics) provide insights into genetic predispositions for nutrient metabolism, detoxification, chronic disease risk, and more. Since your DNA doesn’t change, these tests only need to be done once.

Heavy Metal Testing (Baseline)

A one-time test to evaluate accumulated exposure to heavy metals like lead, mercury, and cadmium can be helpful for understanding past exposures. Retesting is only necessary if there’s an acute exposure or new symptoms arise.

ApoE Genotyping

This test reveals your genetic risk for Alzheimer’s disease and cardiovascular conditions. There can be clinical implications with each subtype. Knowing your ApoE status is foundational for tailoring diet and lifestyle.

Lipoprotein A

Lp(a) is a combination of a low-density lipoprotein (LDL) particle and apolipoprotein(a) connected by a disulfide bond. Its levels are primarily determined by genetics and vary among individuals. Elevated Lp(a) is associated with a higher risk of cardiovascular diseases, including coronary artery disease and stroke. While not routinely measured in clinical practice, Lp(a) can provide valuable insights into cardiovascular risk. Research is ongoing to further understand its effects on cardiovascular health.

Annual/Routine Labs to Follow:

These labs help track your ongoing health and detect changes that may indicate early signs of dysfunction or disease.

Comprehensive Metabolic Panel (CMP)

Tracks markers like kidney function, liver enzymes, and electrolytes to ensure your metabolic processes are functioning properly.

Complete Blood Count (CBC)

Provides information about red and white blood cell health, anemia, and immune function.

Lipid Panel with Particle Number/Fractionation, APO-B

In addition to cholesterol levels, triglycerides, and other markers of cardiovascular risk, an advanced lipid panel includes testing for particle numbers and patterns, providing detailed insights into lipid levels. Elevated levels of APO-B are often associated with an increased number of atherogenic lipoprotein particles (iLDL, vLDL, LDL), which can lead to higher cholesterol levels and a greater likelihood of plaque formation in arteries

Fasting Insulin, HbA1c, and Fasting Glucose, HOMA-IR score

Key for assessing metabolic health, particularly concerning diabetes and insulin resistance. Together, these tests help diagnose and manage metabolic conditions, assess diabetes risk, evaluate treatment effectiveness, and guide lifestyle recommendations. Understanding these biomarkers is essential for maintaining optimal health and preventing chronic diseases related to insulin resistance.

Thyroid Function Tests (TSH, Free T4, Free T3, Thyroid Antibodies)

Ensures optimal thyroid function and identifies conditions like hypothyroidism or Hashimoto’s, which can often be subclinical or undetected for several years prior to causing symptoms.

Vitamin D Level

Monitor this essential hormone for immune health, bone health, and overall well-being.

Inflammatory Markers

Tests like HS-CRP/CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) track systemic inflammation, which can signal chronic disease risk.

Homocysteine Levels

Tracks methylation and cardiovascular health. Understanding the factors that contribute to elevated homocysteine levels and taking proactive steps to address them can significantly reduce the risk of health complications.

Hormone Panel

Annual tracking of sex hormones (e.g., estrogen, progesterone, testosterone), cortisol, and DHEA is useful for managing stress, energy levels, and hormonal balance.

Gut Health and Microbiome Testing

While a full microbiome analysis isn’t necessary annually, checking for gut inflammation (e.g., calprotectin) or imbalances periodically can guide interventions.

Liver Health (GGT)

A sensitive marker of liver health that can detect early signs of dysfunction related to toxins or metabolic syndrome.

Why Functional Medicine Emphasizes Customized Testing

In functional medicine, the decision to test and retest labs is highly personalized. Annual tests focus on tracking changes and catching subtle shifts before they progress into diagnosable diseases. On the other hand, once-in-a-lifetime labs provide a roadmap for your genetic and baseline health risks, enabling you to make targeted lifestyle changes. By combining these approaches, functional medicine offers a proactive, individualized approach to long-term health.