Peter Attia's Outlive Blood Panel: How to Order Every Test He Recommends Without a Concierge Doctor

Peter Attia changed the conversation about longevity. His book Outlive: The Science and Art of Longevity makes a compelling case that the standard model of medicine, waiting until disease appears and then treating it, is fundamentally backwards. Attia argues that the biggest gains in lifespan and healthspan come from early, aggressive screening: catching metabolic dysfunction, cardiovascular risk, and hormonal decline years or even decades before symptoms show up.

The problem? Attia's framework was built inside a concierge medicine practice that costs thousands of dollars a year. He tells you what to test but never quite explains how to get those tests if your primary care doctor orders a basic metabolic panel once a year and calls it a day. Most physicians are not going to order an ApoB test, a fasting insulin level, or an Lp(a) measurement unless you already have a diagnosed condition. That leaves millions of proactive, health-conscious adults stuck in a gap between knowing what matters and being able to act on it.

This article bridges that gap. Below is every key biomarker Attia recommends, organized into three tiers based on cost and comprehensiveness, along with a straightforward path to ordering them yourself through direct-to-consumer lab testing.

Why Your Annual Physical Falls Short

The standard annual physical has not changed much in decades. Your doctor will likely order a basic metabolic panel, a complete blood count, and maybe a standard lipid panel. These tests are useful for catching acute problems, but they are terrible at catching the slow, silent drivers of chronic disease.

Consider cardiovascular disease, the leading cause of death worldwide. A standard lipid panel measures total cholesterol, LDL, HDL, and triglycerides. That is better than nothing, but Attia and a growing body of cardiovascular researchers argue that LDL cholesterol alone is a crude marker. ApoB, which measures the actual number of atherogenic particles in your bloodstream, is a significantly better predictor of cardiovascular events. Yet most physicians never order it unless a patient already has heart disease.

The same pattern holds for metabolic health. A fasting glucose test can tell you if your blood sugar is elevated right now, but it cannot tell you whether your body is already struggling with insulin resistance, a condition that can precede a diabetes diagnosis by a decade or more. Fasting insulin and HOMA-IR (a calculated ratio of insulin to glucose) catch metabolic dysfunction far earlier than glucose alone. Attia considers these among the most important numbers a person can know, and almost no standard physical includes them.

The Attia Blood Panel: What He Recommends and Why

Attia's biomarker recommendations span several systems. Cardiovascular markers assess heart disease risk at the particle level. Metabolic markers reveal insulin resistance and blood sugar regulation long before they become clinical problems. Hormonal markers track the decline in testosterone, thyroid function, and vitamin D that accelerates aging. Liver markers provide early warning of fatty liver disease, which Attia considers one of the most underdiagnosed conditions in modern medicine.

Here is how to think about building your own panel, organized into three tiers.

Crawl: The Essentials (approximately $150 to $200)

If you do nothing else, start here. These tests cover the most critical blind spots in a standard annual physical.

Lipid Panel: Total cholesterol, LDL, HDL, and triglycerides. The foundation of cardiovascular risk assessment. Not perfect on its own (see ApoB below), but essential baseline data.

Comprehensive Metabolic Panel: Glucose, electrolytes, kidney function, and liver enzymes (ALT, AST) in a single draw. The broadest snapshot of your metabolic and organ health. Available through LevelPanel at our CMP test page.

HbA1c: Measures average blood sugar over the previous two to three months. More informative than a single fasting glucose reading because it captures patterns rather than a snapshot. Attia considers an HbA1c below 5.1% optimal, well below the 5.7% threshold where most doctors start paying attention.

Fasting Insulin: This is the test your doctor almost certainly does not order. Elevated fasting insulin is one of the earliest signals of metabolic dysfunction, often appearing years before glucose begins to rise. When combined with fasting glucose, you can calculate your HOMA-IR score (fasting insulin x fasting glucose / 405), which quantifies your degree of insulin resistance.

This tier costs roughly what you would spend on a nice dinner out, and it gives you more actionable metabolic and cardiovascular data than most annual physicals.

Walk: The Serious Preventive Screen (approximately $300 to $400)

This tier adds the markers that separate standard care from proactive, longevity-focused screening.

ApoB (Apolipoprotein B): Attia calls this the single most important cardiovascular biomarker. ApoB directly measures the number of LDL and other atherogenic particles circulating in your blood. Two people can have identical LDL cholesterol levels but vastly different ApoB counts, and the person with more particles carries more risk. Attia and many lipidologists argue that ApoB should replace LDL cholesterol as the primary target for cardiovascular risk reduction.

Lp(a) (Lipoprotein(a)): A genetically determined cardiovascular risk factor. Your Lp(a) level is largely fixed by your DNA; it does not change much with diet or exercise. That is precisely why Attia recommends testing it once in your life, ideally as early as possible. If your Lp(a) is elevated (above 30 mg/dL by some guidelines, above 50 by others), that information changes how aggressively you and your doctor should approach other modifiable risk factors like ApoB and blood pressure.

Testosterone (Total and Free): Testosterone declines roughly 1% per year after age 30 in men, and the symptoms of low testosterone (fatigue, brain fog, reduced motivation, increased body fat) overlap with so many other conditions that it often goes undiagnosed for years. Women also produce testosterone and can experience symptoms from suboptimal levels. Knowing your baseline is the first step. Order a testosterone panel to establish where you stand.

Thyroid Panel (TSH, Free T3, Free T4): Thyroid hormones regulate metabolism, energy, and body temperature. Subclinical thyroid dysfunction, where TSH is drifting out of range but has not yet triggered a diagnosis, is remarkably common and frequently missed.

Vitamin D (25-Hydroxy): Vitamin D deficiency is one of the most prevalent nutritional deficiencies in the developed world. Attia and many researchers consider levels below 30 ng/mL insufficient and suggest an optimal range of 40 to 60 ng/mL, well above the threshold where most labs flag results as low.

Run: The Concierge-Level Panel (approximately $500 to $700)

This is the comprehensive screen that approximates what you would get in a high-end longevity clinic, at a fraction of the cost. Everything in the Crawl and Walk tiers, plus:

Uric Acid: Elevated uric acid is associated with gout, but emerging research also links it to metabolic syndrome, cardiovascular disease, and kidney disease. Attia tracks it as part of his metabolic health picture.

hsCRP (High-Sensitivity C-Reactive Protein): A marker of systemic inflammation. Chronic low-grade inflammation is implicated in virtually every age-related disease. Knowing your baseline helps you assess whether lifestyle interventions (sleep, exercise, diet, stress management) are having a measurable impact.

Ferritin and Iron Panel: Iron status affects energy, cognitive function, and oxygen delivery to tissues. Both iron deficiency and iron overload (hemochromatosis, which is more common than most people realize) can cause significant health problems.

Complete Blood Count (CBC): Measures red blood cells, white blood cells, and platelets. Provides a general health baseline and can flag issues like anemia, infection, or clotting disorders. Available as a standalone test at our CBC test page.

GGT (Gamma-Glutamyl Transferase): An additional liver marker that Attia considers more sensitive than ALT and AST for detecting early liver stress, particularly from alcohol use or fatty liver disease.

One notable biomarker in Attia's protocol that is not a blood test: DEXA body composition scanning. DEXA measures bone density, lean muscle mass, and visceral fat distribution, all of which Attia considers critical data points for longevity. This requires a visit to a facility with a DEXA scanner and is not available through a standard blood draw, but it is worth pursuing separately if you are serious about building a complete health picture.

How to Actually Order These Tests

If you have never used direct-to-consumer lab testing before, the process is simpler than you might expect. You choose your tests online, place an order, and receive a lab requisition. No doctor visit is required. You then walk into a Quest Diagnostics or Labcorp patient service center near you (there are thousands of locations nationwide), present your requisition, have your blood drawn, and receive your results electronically, typically within a few business days.

The blood draw itself is the same one you would get at any doctor's office. The difference is that you are ordering the tests yourself rather than waiting for a physician to decide which ones you need. You own your results, and you can share them with your doctor, a specialist, or simply use them for your own tracking.

For tests that require fasting (which includes most of the metabolic and cardiovascular markers above), schedule your blood draw for first thing in the morning. Water is fine; avoid food, coffee, and supplements for at least 8 to 12 hours before the draw.

How to Read Your Results: Normal Is Not Optimal

One of Attia's most important arguments is that standard reference ranges are not the same as optimal ranges. Lab reference ranges are derived from the general population, which includes a large number of metabolically unhealthy people. A fasting glucose of 99 mg/dL is technically normal by standard lab criteria. But Attia and other longevity-focused physicians consider that number a warning sign, not a clean bill of health.

The same applies to many other markers. An HbA1c of 5.6% is normal but sits right at the edge of prediabetes. An ApoB of 120 mg/dL is within range at most labs but would prompt treatment in a preventive cardiology practice. A vitamin D level of 31 ng/mL clears the sufficient threshold but falls well short of where most longevity researchers want to see it.

This is not a reason to panic about your results. It is a reason to look at your numbers with more nuance than a simple in range or out of range assessment. Your results report will include standard reference ranges. Use those as a starting point, but consider doing additional reading on optimal ranges for the markers you care about most. Many longevity-focused physicians and researchers have published their preferred targets, and the data is increasingly accessible.

If any of your results are significantly outside the normal range, or if you are unsure how to interpret a particular marker, bring your results to a healthcare provider. Direct-to-consumer testing is a powerful tool for taking ownership of your health data, but it is not a substitute for clinical judgment when something needs attention.

Take Ownership of Your Health Data

Attia's central thesis is that longevity is not passive. It is an active project that requires data, attention, and iteration over time. The first step in that project is knowing your numbers, not the handful your doctor checks once a year, but the full set of biomarkers that reveal what is actually happening inside your body.

You do not need a concierge doctor to get this data. You do not need to wait for your next annual physical and hope your physician orders the right tests. You can order a comprehensive panel today, establish your baseline, and start making informed decisions about your health based on real numbers rather than guesswork.

The tests are available. The science is clear. The only question is whether you are willing to look.