Medically reviewed by Shane D. Naidoo, MD
Medical Director, TrufaMED Urgent Care & Concierge Medicine
Board-Certified, Emergency Medicine
Last reviewed: May 2026
Peter Attia is the most-cited longevity physician of the last decade. Outlive, his 2023 book, has sold millions of copies. The Drive podcast publishes deep clinical interviews on the same topics. His patient-facing practice, Early Medical, runs annual lab panels that go several layers deeper than the standard primary-care visit.
The framework’s core insight is that the markers physicians have used for decades to screen for disease are not the same markers needed to identify and prevent disease early. ApoB, Lp(a), oral glucose tolerance, full thyroid panels, advanced inflammation markers, and full hormone panels are not exotic. They are the panel that any patient seriously interested in long-term cardiovascular, metabolic, and cognitive health should be running. Most are not.
This is the panel, the targets, and how to run it at TrufaMED in Miami.
The cardiovascular block: ApoB, Lp(a), advanced lipids
ApoB. Apolipoprotein B is the protein that wraps every atherogenic lipoprotein particle in the blood. One ApoB per particle. ApoB therefore counts particles directly, while LDL cholesterol estimates the cholesterol content carried by those particles. Two patients with identical LDL can have very different ApoB and very different cardiovascular risk.
The Attia framework treats ApoB as the single best blood marker for cardiovascular risk. Targets:
- Below 60 mg/dL for the general adult population
- 20 to 40 mg/dL for patients with elevated Lp(a), family history of early cardiovascular disease, or evidence of existing plaque
The “normal” range on most lab reports is much higher than these targets, which is why a normal ApoB on the printout can still be a clinically suboptimal value in this framework.
Lp(a). Lipoprotein(a) is largely genetic and does not change with diet or standard lipid medications. The Attia framing: test it once. The result is your lifetime number. High Lp(a) often justifies more aggressive ApoB lowering and earlier preventive intervention. Low Lp(a) is a relief.
Advanced lipid panel. Particle counts (LDL-P, HDL-P), particle size, and triglyceride-to-HDL ratio. These add detail when ApoB is borderline or when the lipid pattern is mixed.
The metabolic block: insulin, OGTT, HbA1c
HbA1c rises late. By the time HbA1c crosses 5.7 percent, insulin resistance has typically been driving the system for years. The Attia framework runs metabolic markers in series:
- Fasting glucose and fasting insulin, calculate HOMA-IR for an early insulin resistance signal
- Oral glucose tolerance test (OGTT) with paired insulin measurements at 30, 60, 120 minutes, the most sensitive early test for impaired glucose disposal
- HbA1c, the late marker, but still part of the panel
- Triglycerides and triglyceride-to-HDL ratio, supportive metabolic markers
Catching insulin resistance early is one of the framework’s central wins. Most primary-care visits skip this entirely.
The full thyroid axis
TSH alone is not enough. The Attia panel runs:
- TSH (the screen)
- Free T4 (the storage form)
- Free T3 (the active form)
- Reverse T3 (the under-conversion marker)
- TPO and thyroglobulin antibodies (autoimmune thyroid disease screen)
A patient with normal TSH but elevated reverse T3 and positive TPO antibodies has a different problem than the screening test alone shows. Same logic as covered in our normal-labs workup.
The hormone block
For men: total testosterone, free testosterone, estradiol, SHBG, LH, FSH, prolactin. For women: estradiol, progesterone, FSH, LH (cycle-day dependent for cycling women), total and free testosterone, DHEA-S, SHBG, with morning cortisol on the adrenal axis. The framework treats hormone optimization as a clinical judgment call: thresholds for intervention are individualized, fertility planning is non-optional in men considering TRT, and the modern HRT landscape for women is very different from the early-2000s era of clinical caution.
This block has substantial overlap with our testosterone lab workup coverage of the Huberman framing on the same panel.
Inflammation, methylation, and nutrients
- hsCRP, high-sensitivity C-reactive protein, the inflammatory marker the standard panel does not include
- Homocysteine, methylation marker; elevation points to B12, folate, or B6 deficiency, or MTHFR-related variation
- Vitamin D (25-OH), many adults are functionally deficient regardless of where the lab marks the cutoff
- B12 with methylmalonic acid where indicated
- Ferritin and iron saturation, fatigue, hair loss, and exercise intolerance often trace to ferritin even when hemoglobin is normal
- Omega-3 index, elective; useful for patients optimizing cardiovascular risk
The liver, kidney, and cancer screening blocks
The framework rounds out with standard liver enzymes (ALT, AST, GGT), kidney function (creatinine, BUN, eGFR), and age-appropriate cancer screening: PSA in men, mammography and cervical screening in women, colonoscopy on the standard schedule, with consideration of advanced imaging (CT coronary calcium, abdominal MRI) where the framework calls for it.
How often to run the panel
- Annual baseline for most adults
- Every 6 months for patients actively working on metabolic health, lipid management, or hormone optimization
- 4 to 8 weeks after starting any intervention, first re-check; most laboratory changes are measurable in this window
- Symptom-driven re-check at any time the picture changes
Running the panel at TrufaMED
The TrufaMED workflow:
- Baseline visit, fasting morning draw, on-site collection. Most basic markers run on-site through our lab; specialty markers (ApoB, Lp(a), advanced lipid particle counts, OGTT with insulin curves, expanded thyroid panels, hormone panels) return in 2 to 7 business days through reference labs.
- Results consultation, physician interpretation of the full panel against your symptom history, family history, and goals. We compare values to the framework targets and identify the actionable findings.
- Written plan, every patient leaves with a written summary, a specific intervention list, and a re-check date on the calendar before the visit ends. Testing without a plan is just data.
- Follow-up, 4 to 8 weeks for any new intervention; 6 months for stable optimization; annual for maintenance.
For patients who want this on a longitudinal basis with direct physician access between visits, our concierge medicine program (VIP, Family+, Signature) folds the full panel into a structured framework. For patients who want to run the panel once and decide from there, a single initial visit through urgent care or telehealth is the entry point.
What we will not do
We will not run every test on every patient. We will not chase markers with weak evidence and high false-positive rates. We will not prescribe long compounded protocols based on a single anecdotal study. We will not promise outcomes. The honest version of this work, the version Attia consistently models, is more humble than the marketing version.
We also will not tell patients their labs are “normal” when the deeper question has not been asked. The whole point of running the panel is to ask the deeper question.
Frequently asked questions
Who is Peter Attia and what is his lab framework?
Peter Attia, MD, is a Stanford-trained physician focused on longevity medicine, the author of Outlive, host of The Drive podcast, and the founder of Early Medical (formerly Outlier MD). His lab framework emphasizes early identification of cardiovascular and metabolic dysfunction. TrufaMED is not affiliated with Dr. Attia or Early Medical.
What does the framework include that a standard panel does not?
ApoB, Lp(a), OGTT, fasting insulin, HOMA-IR, full thyroid (free T4, free T3, reverse T3, antibodies), hsCRP, homocysteine, full hormone panels, vitamin D, B12 with methylmalonic acid where indicated, and ferritin with iron studies.
Why does Attia emphasize ApoB?
ApoB measures the number of atherogenic lipoprotein particles directly. Two patients with the same LDL can have very different ApoB and very different cardiovascular risk.
What ApoB targets does the framework recommend?
Below 60 mg/dL for the general population, 20 to 40 mg/dL for patients with elevated Lp(a), family history of early cardiovascular disease, or existing plaque.
Why test Lp(a) only once?
Lp(a) is largely genetic and does not change with diet or standard medications. A single result gives you the lifetime number.
How often should the full panel be run?
Annual baseline for most adults. Every 6 months for patients actively optimizing. 4 to 8 weeks after starting any intervention.
What are the seven categories of markers?
Cardiovascular, metabolic, liver, kidney, hormones, nutrients, and cancer screening.
Does TrufaMED run the full panel?
Yes. Through concierge medicine as a structured longitudinal program, or as a single visit through urgent care or telehealth.
Will insurance cover it?
Some markers, sometimes. Standard markers with documented indication are usually covered. Less common markers may be partially covered or self-pay. We verify before any non-standard test is ordered.
How does this compare to the ‘Normal Labs But Still Sick’ workup?
Substantial overlap. The Attia framework focuses on the asymptomatic optimizing patient; the Normal Labs framework focuses on the symptomatic patient who has been told everything is normal. Same categories, different reasons to run them.
How do I act on the results?
Every patient leaves with a written summary, a specific intervention list, and a re-check date before the visit ends. Testing without a plan is just data.
Where can I schedule the panel?
The concierge medicine page on trufamed.com has details on the tiers. Single-visit panels are available through urgent care or telehealth. Call (305) 537-6396.
Schedule a baseline panel
If running a comprehensive baseline once a year (or every 6 months when actively optimizing) is on your radar, the next step is an initial visit. TrufaMED concierge medicine runs the full panel with physician interpretation and a written follow-up plan. Patients who want a single panel without membership can run the same workup as a one-time visit. Call (305) 537-6396 to schedule.