The Longevity Blood Panel: What Peter Attia and Bryan Johnson Test

The longevity medicine revolution has moved beyond counting calories or hitting step goals. Peter Attia's framework for understanding lab tests focuses on atherosclerosis, cancer, Alzheimer's disease, and the physical body, while Bryan Johnson tracks 11 biomarkers religiously to stay biologically young and delay death. What started as biohacker curiosity has evolved into a science-backed approach to extending not just lifespan, but healthspan.

The difference between standard wellness panels and longevity medicine? "Normal" laboratory ranges differ fundamentally from "optimal" ranges for health and longevity. Reference ranges are statistical constructs based on population data: including unhealthy individuals: and indicate values unlikely to cause immediate disease, not values that support maximal healthspan.

This isn't about chasing perfect numbers. It's about understanding your body's trajectory decades before symptoms appear and having the data to change course.

The Core Metabolic Triad: Blood Sugar, Insulin, and A1C

"Metabolic health really matters. It is the common thread that links all of these chronic diseases," says Peter Attia. Both longevity pioneers prioritize metabolic biomarkers because insulin resistance underlies most age-related diseases.

Bryan Johnson tracks A1C as a long-term blood sugar marker (3-month average) where elevated levels correlate with higher mortality, cardiovascular risk, cancer, and dementia. He also monitors insulin as an early marker of insulin resistance that often goes abnormal before glucose.

Attia emphasizes OGTT with insulin measurements for a deeper dive into metabolic function. In his book, Attia highlights OGTT as a particularly important test he gives patients to assess their metabolic health.

The key insight? Elevated fasting insulin with normal glucose tells you insulin resistance is developing before it shows up as hyperglycemia. This early warning system allows intervention years before diabetes develops.

For optimal longevity, target HbA1c ≤5.4% (optimal 4.8-5.2%) and fasting insulin in the range of 2, 5 μIU/mL. An A1C test and insulin test can reveal metabolic dysfunction long before traditional glucose markers change.

Advanced Lipid Assessment: ApoB and Lp(a)

Attia argues that the standard cholesterol panel is "far too oversimplified, especially with its conventional labeling of 'good' and 'bad' cholesterol." He argues that apoB and Lp(a) tests are infinitely more valuable.

ApoB is one of the most robust predictors of cardiovascular risk, superior to LDL cholesterol because it counts the number of atherogenic particles, not just the cholesterol they carry. Apolipoprotein B is the protein tag on every cholesterol-carrying particle that can lodge in artery walls; LDL, VLDL, IDL, and Lp(a). Each particle has one ApoB; count ApoB, and you know exactly how many of these particles are in circulation.

This distinction matters more than most people realize. It's common in individuals with insulin resistance or elevated triglycerides, where LDL particles carry less cholesterol but exist in higher numbers. ApoB often provides a more accurate reflection of particle number and cardiovascular risk, especially when lipid markers are discordant.

Lipoprotein(a) is genetically determined and largely unresponsive to lifestyle, but it's a strong independent risk factor for cardiovascular disease and should be measured at least once. Lipoprotein(a) is a genetically set risk amplifier: sticky particles that accelerate plaque. Knowing your Lp(a) is like knowing a headwind exists even when the road seems flat.

Target ApoB <90 mg/dL for cardiovascular health. A comprehensive lipid panel that includes these advanced markers provides far more actionable information than traditional cholesterol testing.

Inflammation: The Silent Fire of Aging

Attia considers inflammation one of the three key contributors to CVD, alongside lipoproteins and endothelial dysfunction. That's why he highly recommends looking into inflammation markers early on.

Among Attia's "honorable mentions" are Hcy, hs-CRP, oxLDL, and oxPL, fibrinogen, Lp-PLA2, ADMA and SDMA as really helpful markers to know. Hs-CRP predicts cardiovascular events and all-cause mortality, but it's a nonspecific marker. Elevated hs-CRP can reflect anything from chronic infection to autoimmune disease to metabolic dysfunction, so it must be interpreted in context.

Chronic, low-grade inflammation accelerates ageing by nudging tissues toward fibrosis, insulin resistance, and impaired repair. For longevity optimization, target hs-CRP <1.0 mg/L for inflammation control.

A CRP test can reveal systemic inflammation that may be silently accelerating aging processes throughout your body.

Organ Function: Liver and Kidney Health

Both experts recognize that organ function deteriorates gradually with age, making early detection crucial for intervention. Peter emphasizes that when it comes to liver health, "normal" is not the same as "healthy" and offers even lower ranges to indicate a risk of liver disease earlier.

Liver disease is the only major disease where death rates are rising. Liver disease deaths have quadrupled since the 70s, while death rates for heart and lung conditions have decreased. Chronic kidney disease (CKD) stage 3-5 is also rising. It's expected to increase by 8.3% between 2011 and 2036.

Optimal liver function markers include ALT levels well below the standard "normal" range. Target eGFR >90 mL/min/1.73m² for kidney function. A liver panel and kidney panel can detect dysfunction years before symptoms develop.

The Underestimated Marker: Homocysteine

Homocysteine may be an overlooked critical yet underrated biomarker that can significantly impact long-term wellbeing. Homocysteine levels provide a window into your body's metabolic processes and cardiovascular health. Elevated homocysteine is linked to increased risks of heart disease, dementia, and other age-related diseases.

The reasons for these risks include the direct damage that homocysteine can inflict on blood vessels as well as its ability to promote inflammation and oxidative stress throughout the body. High levels can reveal B vitamin deficiencies, kidney problems, genetic variations, or increased risk for cognitive decline.

For longevity, target homocysteine <10 μmol/L. According to most medical experts, a homocysteine level between 5 to 15 umol/L is considered healthy for most adults. Levels in this range are associated with a lower risk of health conditions like heart disease, dementia, and stroke as you age.

A homocysteine test is particularly valuable because it responds reliably to B vitamin supplementation, making it trackable for optimization.

Bryan Johnson's Biomarker Protocol

Bryan Johnson's biomarker protocol isn't just a personal experiment. It's a roadmap for what proactive health should look like in the 21st century: data-driven, aggressive, and personalized.

Bryan Johnson's core blood biomarkers: ApoB, Lp(a), hs-CRP, HbA1c, full lipid panel, CBC, metabolic panel, liver enzymes, kidney function, vitamin D, B12, ferritin, and iron: are all available in a single lab visit. His advanced panel provides 108 biomarkers with actionable insights to support data-driven health decisions and lifestyle changes.

Johnson's DunedinPACE score: which measures the rate of aging: is approximately 0.69, meaning he is aging at 69% of the normal rate, demonstrating the potential of comprehensive biomarker tracking.

Interpreting Your Results: Patterns Matter

Many people have multiple biomarkers in the normal range but far from optimal: these suboptimal values predict future disease risk and accelerated aging decades in advance. Focus on patterns and clusters: insulin resistance typically presents as elevated fasting insulin, rising HbA1c (even if still <5.7%), high triglycerides, low HDL, elevated ApoB, and increased hs-CRP.

Look for concordance across systems. High ApoB with high hs-CRP is different from high ApoB with low hs-CRP. Elevated triglycerides with high insulin means a different mechanism than isolated high Lp(a). Patterns write the plan, not single numbers.

Biomarker testing is the highest-ROI part of the protocol. Knowing your biomarkers lets you catch cardiovascular, metabolic, and kidney problems decades before symptoms appear.

The Democratization of Longevity Medicine

The most impactful part of Bryan Johnson's protocol isn't the gene therapy or the $25,000 stem cell injections: it's the regular biomarker monitoring. Most of the protocol's value comes from knowing your numbers and building the right habits. The exotic therapies are the most expensive part: and the least evidence-backed.

The reality is that comprehensive biomarker testing has become accessible. Bryan Johnson's core blood biomarkers are all available in a single lab visit. You don't need millions to access the same foundational tests that guide longevity protocols.

What matters most is consistent tracking over time, understanding optimal ranges rather than just "normal" ranges, and using the data to make informed lifestyle changes. The goal isn't perfect lab reports; it's a long, event-free life where your body ages slowly and maintains function.

Unlike traditional healthcare that waits for disease to develop, longevity medicine uses biomarkers as an early warning system. You can order comprehensive panels without a doctor visit, receive results privately, and use the data to optimize your health trajectory. The future of medicine is proactive, personalized, and in your hands.