Three sequences, twelve sends

Over the next five days I am going to walk you through five measurements that a standard annual physical usually does not include.

Not because your physician did anything wrong. Because a screening panel is built to answer a narrow question - is any single value outside the population range - and you arrived with a wider one.

Start with the thyroid, since it is the one most of you have had checked.

What was almost certainly run is a TSH. One value, from one axis. What a full panel adds is the rest of that axis, plus antibodies, which a screening number is not asked to report at all.

That distinction matters for a specific reason: a TSH inside range tells you that one string is in tune. It does not tell you what the instrument sounds like.

Tomorrow: the second marker, and the one I most often find missing.

- Dr Ana Reis

Your fasting glucose is probably on a result somewhere, and it probably came back fine.

Fasting insulin usually is not, because it is not part of a standard screening panel. It has to be ordered.

Those two values are read as a pair. One of them does not describe the other, and reading either one alone leaves out what the other was doing at the same moment.

This is the marker I hear the most frustration about, and usually from the women who did everything correctly. Five months of keto. Eleven weeks of fasting windows. Real effort, sustained, with nothing to check it against and no way to correct it when the scale stopped moving.

I am not going to tell you what your insulin is doing. I have not seen it. That is rather the point of this email.

Tomorrow: the third marker, and the one that most often explains why a night looks the way it does.

- Dr Ana Reis

Cortisol has a rhythm across the day. That is not controversial and it is not alternative - it is how the measurement is taught.

What is unusual is measuring it more than once.

A single morning value gives you one point. Several points across one day give you the shape of the curve, and the shape is the part that can be read against everything else on the panel.

I want to be careful here, because this is the marker the wellness industry has done the most damage to. I do not use the phrase you have probably seen attached to it, and I would be cautious of anyone selling you a protocol on the strength of one saliva test and a diagram.

A rhythm is information. It is not a diagnosis and it is not a treatment plan.

Tomorrow: marker four, which takes about thirty seconds to explain.

- Dr Ana Reis

A standard blood count reports whether you are anaemic. It does not report stored iron.

Ferritin does, and it has to be ordered by name.

That is the whole email. I said thirty seconds.

The reason it is on this list is not that ferritin is exotic. It is that it is ordinary, cheap, and routinely absent from the results women bring me - which is a fair summary of this entire five-day sequence.

Tomorrow: the fifth marker, the one-page checklist, and an hour I recorded for the women who reach the end of this list and think, so what do I actually do with that.

- Dr Ana Reis

Marker five is vitamin D, and the reason it is here is unglamorous: it should be read on the same page as the other four, from the same date, rather than recalled from a result taken in a different year.

That is the five. Thyroid with antibodies, fasting insulin with glucose, cortisol rhythm across the day, ferritin, vitamin D.

The checklist below has all of them written the way a lab requisition wants them, so you can ask for the panel by name at your next appointment. Take it. It is yours whether or not we ever speak.

If you got to the end of this and the feeling is less relief than irritation - you now know five things nobody ran and still do not know what they would have said - that is the correct reaction, and it is why I recorded an hour on it.

It is called You Are Not Crazy. You Are Undertested. It is free, it is already recorded, and it covers the part these emails cannot: what the six markers say when they are read together, and why every previous thing you tried was placed ahead of a measurement.

- Dr Ana Reis