The standard annual physical exists to catch disease. It checks that your cholesterol isn't lethal, your blood pressure isn't dangerous, your glucose isn't diabetic.
It is not designed to detect what's happening to a 38-year-old founder who's been sleeping six hours a night for four years while running two companies across time zones.
These are different problems. They require different tests.
Here's the specific panel I run every six months — 11 markers — and why each one matters for people who have been performing at high levels for years.
A conventional blood panel is designed around disease thresholds. If you're below the threshold, you're "normal." If you're above it, there's a problem to treat.
This framework is useful for sick people. It's nearly useless for detecting the slow, subclinical dysfunction that characterizes high-performance burnout.
Your doctor will see a fasting glucose of 99 mg/dL and tell you you're fine. Your fasting insulin of 12 µIU/mL — a more sensitive early indicator of insulin resistance — won't be ordered, because it's not on the standard panel.
Your cortisol will be checked as a single morning measurement. The fact that your cortisol curve is completely flat — no spike, no drop, just a gray plateau all day — won't be visible from that test.
Your hs-CRP of 2.1 mg/L will be noted as "borderline" and left alone. The fact that chronic inflammation at this level is associated with accelerated epigenetic aging won't come up.
To understand what chronic high performance has done to your biology, you need a different set of questions.
What it measures: Your biological age, derived from methylation patterns across your DNA.
Why it matters: This is the summary statistic. Everything else tells you why the number is what it is. TruAge also gives you DunedinPACE — your current rate of aging — which is the metric most responsive to intervention.
Target: Biological age ≤ chronological age. DunedinPACE ≤ 1.0.
Cost/access: ~$350 mail-in blood kit, no prescription required.
What it measures: The rate at which your DNA methylation is changing, as a ratio to the average population. Included in TruAge.
Why it matters: If your biological age is 32 and your chronological age is 30, you could have reached 32 slowly and be decelerating, or you could be accelerating toward 35 fast. DunedinPACE tells you which. A score of 1.09 would mean you're aging 9% faster than average; a 0.9 would mean 10% slower.
Target: ≤ 0.95.
What it measures: Systemic inflammation. Specifically, liver production of CRP in response to inflammatory cytokines.
Why it matters: Chronic stress is an inflammatory state. hs-CRP above 1.5 mg/L indicates your immune system is in low-grade chronic activation — burning resources, disrupting sleep quality, and accelerating methylation aging via the inflammaging pathway.
Target: < 1.0 mg/L (< 0.5 is optimal).
Note: hs-CRP is not the same as standard CRP. Make sure you order the high-sensitivity version.
What it measures: Baseline insulin when no glucose is present. Reflects cellular insulin sensitivity.
Why it matters: Fasting glucose alone misses early insulin resistance. Fasting insulin of 10–15 µIU/mL indicates the pancreas is working harder to maintain normal glucose — meaning cells are becoming resistant. Chronic cortisol is the primary driver in founders who eat reasonably well. This is the test that reveals it.
Target: < 5 µIU/mL (< 8 is acceptable).
What it measures: Calculated from fasting glucose and fasting insulin. Formula: (fasting insulin × fasting glucose) / 405.
Why it matters: More sensitive than either marker alone. HOMA-IR above 1.5 indicates insulin resistance. Above 2.0 is significant. Many founders with "normal" glucose and "borderline" insulin have a HOMA-IR well above 2.0.
Target: < 1.0.
What it measures: Cortisol at 4 time points: waking, 30 minutes post-waking, midday, evening. Maps your diurnal cortisol pattern.
Why it matters: A single morning serum cortisol tells you almost nothing. The curve tells you everything. Healthy pattern: steep rise at waking, gradual decline through the day, near-zero by evening. Chronic stress pattern: flat plateau, suppressed morning spike, elevated evening.
Target: Morning peak > 15 µg/dL with clear decline to < 3 µg/dL by evening.
Access: Dried urine test through DUTCH or salivary panels through various functional labs.
What it measures: Heart rate variability — the millisecond variation between heartbeats. Reflects autonomic nervous system tone and recovery capacity.
Why it matters: HRV is the most sensitive real-time proxy for your nervous system's resilience. A suppressed HRV means your sympathetic nervous system is chronically dominant — you're never fully recovering between stressors. For F/36, average HRV is around 42 ms. Founders often run 15–30% below this.
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Book a Discovery Call →Target: Trending upward with appropriate age/sex norms (use Oura or similar to track 30-day average).
What it measures: A pro-inflammatory cytokine produced by immune cells. More upstream than hs-CRP.
Why it matters: IL-6 rises before hs-CRP does. If your hs-CRP is borderline, IL-6 may already be significantly elevated — you're upstream of the inflammation cascade. Also directly associated with accelerated biological aging via its effects on methylation.
Target: < 3.0 pg/mL.
What it measures: The ratio of omega-6 to omega-3 fatty acids in your red blood cells.
Why it matters: The modern diet creates an omega-6/omega-3 ratio of 15:1 to 20:1. Optimal for longevity is 4:1 or below. High omega-6 is pro-inflammatory. This ratio is one of the most modifiable inflammatory drivers — it responds meaningfully within weeks of dietary intervention. Most high-performers eating even reasonably well are far above target.
Target: Omega-3 Index ≥ 8%. Omega-6/Omega-3 ratio ≤ 4:1.
What it measures: Thyroid function — specifically, whether conversion of T4 to active T3 is adequate.
Why it matters: Chronic stress suppresses T4→T3 conversion (reverse T3 syndrome), even when TSH looks "normal." Symptoms: fatigue, slow metabolism, cold intolerance, poor recovery from exercise. Often missed because TSH alone looks fine. Ask specifically for free T3.
Target: Free T3 in upper third of reference range. TSH 1.0–2.0 mIU/L.
What it measures: Sex hormone levels and binding.
Why it matters: Chronic cortisol directly suppresses sex hormone production (cortisol steals precursors via the "pregnenolone steal"). In men over 35: total testosterone < 500 ng/dL in a high-performer is a red flag. In women: estradiol cycling may be suppressed subclinically. Free testosterone (not just total) is more useful.
Target (men): Total T > 600 ng/dL. Free T in upper third of age-appropriate range.
Most of these markers can be ordered through:
- Marek Diagnostics or Ulta Lab Tests — direct-to-consumer, no doctor required, nationwide US
- Function Health (annual membership, comprehensive panel)
- InsideTracker (consumer-facing, good visualization)
- A functional medicine physician who can order a full panel
The epigenetic age test (TruDiagnostic) is ordered separately through their website.
Budget: $400–800 for the full panel depending on source.
The numbers are only useful if you have a protocol to respond to them.
This is the gap I built KINS to close. Most people who get these tests sit with the results for months — understanding something is off, but not knowing specifically what to do, or not having an environment where doing it is structurally possible.
The 14-Day Deep Reset at KINS begins with this panel on arrival. The protocol for your 14 days is built around your specific numbers. The departure test — DunedinPACE, hs-CRP, fasting insulin, HRV — shows what moved.
That's the feedback loop that makes the testing matter.
Without it, you have information without a system. With it, you have a starting point for the next 6 months of biological improvement.
Get the panel. Know your numbers. Build the protocol around what they show.