The Forgotten Labs: Tests That Could Save You, But Rarely Get Ordered

06-06-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

Many life-saving lab tests—like the homocysteine level—go overlooked in routine care. At HHOM, we go beyond the basics to uncover what your body’s really telling us

The flame begins before the burn

, In quiet cells we rarely learn.

 No pain, no pulse, no outward clue—

But markers rise in blood and clue.

 Prevention whispers where disease will shout,

 If we don’t look within, we go without.

—Dr. Howard Friedman, MD

Most patients assume that if their check-up labs are "normal," they're in the clear. But what if those “normal” labs aren’t telling the full story? That’s where forgotten lab tests come in—underused tools that may reveal inflammation, insulin resistance, or early cardiovascular risk long before symptoms appear. But in my thirty-plus years of practicing medicine—from military hospitals to civilian outpatient clinics—I've seen how wrong that assumption can be. Disease rarely starts overnight. Inflammation builds, metabolism shifts, and systems begin to break down—often silently. These changes are detectable long before symptoms appear, but only if we know where to look.

Unfortunately, many of the most valuable early-warning labs are never ordered during routine visits. In this post, I walk you through several underused but powerful tests that can uncover what standard panels miss—and why they matter for anyone who values prevention over repair.

High-Sensitivity C-Reactive Protein (hs-CRP)

Inflammation is the nexus of nearly all chronic diseases. I’ve written before about internal and external inflammation, as well as the calming power of gratitude. The hs-CRP is the gold standard for measuring internal inflammation. It can predict cardiovascular events, even in people with no symptoms. This simple test measures what we can’t feel yet—low-grade inflammation that, if left unchecked, becomes disease.

Erythrocyte Sedimentation Rate (ESR)

The ESR is another inflammation marker. It is not as specific as CRP, but it remains valuable when tracking autoimmune or chronic inflammatory conditions over time. While CRP may spike quickly, ESR can remain elevated during ongoing, smoldering inflammation.

Fasting Glucose and Hemoglobin A1c (HbA1c)

These tests may catch blood sugar abnormalities before diabetes is diagnosed. Glucose spikes are inflammatory events. Many individuals linger in the pre-diabetic range without knowing it. That’s why early measurement matters. Awareness can guide behavior change and delay or prevent disease.

Fasting Insulin and HOMA-IR: The Silent Metabolic Markers

Insulin resistance precedes most chronic metabolic conditions by years. Yet, fasting insulin is rarely ordered. Chronically high insulin levels (hyperinsulinemia) are pro-inflammatory and pro-atherogenic. They are often the first domino to fall in metabolic dysfunction, leading to visceral fat accumulation, fatty liver, hypertension, type 2 diabetes, Alzheimer’s disease (sometimes called type 3 diabetes), and PCOS.

Fasting insulin ideally measures below 10 uIU/mL. Even more telling is the HOMA-IR (Homeostatic Model Assessment of Insulin Resistance), calculated as:

(Fasting Glucose in mg/dL × Fasting Insulin in uIU/mL) ÷ 405

A result over 2 suggests insulin resistance. The tragedy is that insulin levels often rise 10–15 years before blood sugar does, but by the time elevated glucose is detected, the damage is already well underway.

Homocysteine: The Vascular Canary in the Coal Mine

Homocysteine is an amino acid produced during methionine metabolism. It should be recycled into methionine or converted into cysteine with the help of vitamin B12, B6, and folate. When this process fails, homocysteine builds up.

Elevated homocysteine levels are associated with vascular inflammation, stroke risk, and B-vitamin deficiencies. It may also reflect methylation issues and cardiovascular strain. High levels are linked to endothelial dysfunction, arterial inflammation, and plaque instability—even when cholesterol levels appear normal.

There’s evidence linking elevated homocysteine to dementia, brain atrophy, and neuropathy. B12 and folate deficiencies, often found in alcohol use disorders, contribute to these elevations. While elevated homocysteine doesn’t diagnose a disease, it signals increased risk. Normal levels are below 10–11 µmol/L. Borderline is 11–15 µmol/L. Anything over 15 is considered high risk. Treatment usually includes methylated B-complex vitamins after confirming B12 and folate status.

Vitamin D: Not a Magic Bullet, But Not Irrelevant

Vitamin D plays many roles in the body, particularly in immune modulation. Deficiency has been linked to fatigue, low mood, immune dysfunction, and chronic pain. However, routine high-dose supplementation isn’t supported by current evidence, especially in people with adequate levels (>30 ng/mL).

For those with osteopenia or levels under 20 ng/mL, supplementation may help. Some studies suggest links between low Vitamin D and chronic pain conditions such as fibromyalgia or migraines, possibly due to its role in reducing inflammatory cytokines. There is also speculation about cognitive benefits, but findings remain inconsistent. Repletion may benefit severely deficient older adults, but there is no current recommendation to take Vitamin D solely for memory or brain health.

A Word on Coverage

You may have heard of some of these tests, but you likely haven’t had many of them done. That says more about our system than your health. We don’t have a healthcare system—we have a disease-care system. These tests are often considered "non-essential" or "not routinely indicated" by insurers. But here’s the truth: by the time your labs are bad enough to be covered, the damage is already done. These tests aren’t for watching disease—they’re for preventing it.

Why This Matters at Howard’s House of Medicine

At Howard’s House of Medicine, we don’t wait for disease to show up on a scan or strike with symptoms. We believe prevention is more than a slogan—it’s a commitment to listening, looking deeper, and treating each person as a unique story, not a billing code.

These forgotten labs? They aren’t forgotten here. They’re part of how we practice real medicine—medicine that values subtle shifts, early clues, and the quiet signals before the storm. We understand that the system may not pay for prevention, but the cost of ignoring it is far greater. That’s why we do things differently.

Whether you’re a veteran who gave everything in service, an attorney seeking clarity for a client, or someone simply trying to live longer and stronger—this is what we offer: insight, integrity, and a partner who still believes in the art of medicine.

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions

Q: If my standard labs are normal, why should I ask for additional tests?

A: Most standard labs—like a basic metabolic panel or lipid profile—check for overt abnormalities. But many conditions begin silently, long before standard labs ring alarm bells. Tests like C-reactive protein (CRP), fasting insulin, or homocysteine can detect subtle changes that signal inflammation, metabolic dysfunction, or cardiovascular risk. These “forgotten” labs are not for everyone—but in the right context, they can detect problems before symptoms emerge and allow for earlier, preventive intervention.

Q: Are these advanced tests covered by insurance?

A: Some are, and some are not. Coverage depends on your plan and whether your physician documents a specific medical necessity. For example, vitamin D might be covered if you have osteopenia, but not for general screening. Fasting insulin or hs-CRP might not be covered unless there’s a diagnosis to justify them. Patients should be informed that some of these tests may come with out-of-pocket costs—but many are reasonably priced if ordered through direct-access lab services.

Q: Should I bring these tests up with my doctor, or is that overstepping?

A: Good doctors welcome engaged, informed patients. If you’ve read about a test and think it may apply to you—especially if you have a family history of heart disease, diabetes, or autoimmune conditions—it’s perfectly appropriate to ask. Present it as a question, not a demand: “Would checking my CRP or fasting insulin give us more insight into my health?”That opens a thoughtful dialogue, which is exactly what good preventative care is built on.