Annual Physical: Does it deliver? An annual physical is a good way to determine if your health is on track. Since an annual physical or wellness exam is covered under the Affordable Care Act, it’s wise to know what is included in the coverage. Your policy or plan will dictate what is allowed. This will depend on your age and risk factors. Any tests ordered have to be justified by clinical findings and an annual physical is not meant to address any new or chronic issues. If your doctor orders anything outside of the coverage parameters, it will not be paid for by insurance.

Typically an annual physical will include a physical exam and some blood tests. If you are over 50 it may include an EKG. As part of the annual physical, the routine blood tests most likely will include:

• Comprehensive Metabolic Profile (CMP) inclusive of liver and kidney function and electrolytes such as sodium and potassium
• Complete Blood Count (CBC) – red blood cell and white blood cell count
• Thyroid Stimulating Hormone (TSH)
• Lipids (cholesterol, HDL, LDL and triglycerides)

The question you should be asking yourself is..

“Is an annual physical adequate to understand the state of your health and is it preventive?” The answer is yes and no. You may discover abnormalities in your liver or kidney function, anemia, blood, thyroid and cholesterol disorders. However, your annual physical is limited to these organ systems and is mostly early detection.

What is missing from your annual physical is early signs of inflammation, oxidation and glycation, which precede the development of metabolic disorders. The Comprehensive Metabolic Panel is not very comprehensive and it will not pick up any hormone abnormalities or early signs of autoimmune disorders. The interpretation of test results is also important since the range of what is considered normal is very wide.

For example:

If your fasting blood sugar is 99 in your annual physical, you are deemed “normal” but if it’s 100-125 you are labeled pre diabetic and if it is greater than 126 you are considered diabetic. Early signs of blood sugar abnormalities start to occur when fasting blood sugar is above 85, yet no one starts the conversation during your annual physical about the consequences or how to manage blood sugar until you are diabetic or in the higher ranges of pre diabetes.  What’s glaringly absent in the annual physical are tests for early signs of metabolic disorders that are the root cause of most illnesses.

• Hemoglobin A1C (HbA1C) is a marker of both oxidation and glycation, which is sugar binding to protein. Many people have normal or pre diabetic fasting blood sugar with an abnormal HbA1C. High HbA1C is an indicator of spikes in blood sugar and changes in the structure of proteins in your body. Ongoing elevations lead to all of the complications of diabetes but at a slower rate. These can be cataracts, cardiovascular disease, dementia, kidney disease and peripheral neuropathy among other things. If this were measured and included in your annual physical, you might be able to take charge of your health before and prevent diabetes and all of its complications.

C- Reactive Protein

C-reactive protein is a marker for inflammation. Which is the root cause of most illness such as allergies, asthma, arthritis, autoimmune disorders, cancer, dementia, diabetes and more. High HbA1C causes oxidation, which accelerates inflammation. If this were measured in your annual physical, you could be counseled on how to lower inflammation with diet, weight loss and supplements.

• Thyroid antibodies are oftentimes the first sign of an autoimmune disorder. If you have one autoimmune disease, you are more likely to develop another. Hashimoto’s thyroiditis is the most common autoimmune disorder; however measuring these antibodies is not part of your annual physical. You would not be diagnosed with this until you are overtly hypothyroid. These antibodies damage your thyroid. If unchecked will necessitate that you be on thyroid medication for the rest of your life. There are many things you can do to modulate your immune system and avoid damaging tissues. Lupus, rheumatoid arthritis, ulcerative colitis, Chron’s, insulin dependent diabetes, multiple sclerosis, vitiligo. Furthermore, celiac are among the many autoimmune diseases that can be modulated with detoxification, stress management, diet and supplements.

Alternatives to an Annual Physical

Your annual physical is missing a lot because you won’t find anything that you don’t look for. Consider having a Comprehensive Executive Physical by an anti aging and functional medicine doctor or a functional medicine consultation. You will find that the thrust of an anti aging and functional medicine evaluation is more comprehensive, preventive and tailored to your individual symptoms, family history and risk factors. A good anti aging and functional medicine physician will add the missing pieces and interpret findings by what is optimal, not the definition of normal which is skewed. Many of these tests are included in panels, which would be covered with a co payment. It is a wise choice to have a deeper look before illness develops. This is true prevention.