Your Health Needs a Road Map, Not a Resolution
- InnerSight AI
- Aug 3
- 8 min read
Kicking off 2026, we used our first episode of the year to step back from any single specialist topic and instead lay out the bigger picture: how we actually think about health, testing and long-term risk with our own clients, and why New Year's resolutions so often fail before February even arrives.
Here's what we've noticed: most people who set a health resolution pick a single target - lose weight, exercise more, cut sugar, without ever really knowing where they stand across the full picture of their health. Without that baseline, it's hard to know what actually matters most for you, specifically. That's the gap we've tried to close by building what we call a "health wallet", a web app that consolidates a client's questionnaires, blood work, fitness testing and body composition data into one place, tracked over time, so people can see their own risk picture the same way we do.
Servicing the Body Like You'd Service a Car
One analogy we come back to again and again: most people service their car on a schedule, without waiting for the brakes to fail. Healthcare, by contrast, tends to be reactive - we wait for something to go wrong, or for worry to set in, before we spend any time or money investigating it.
Here's our honest admission: even after doing hundreds of these health screenings, there's essentially no one who comes through our process without us finding something. It might be small. It might not matter for years. But catching it early, and tracking it is what prevents a minor finding from becoming a major problem down the line. And realistically, meaningful change isn't instant: we've found it takes about 18 months of consistent effort before most people start to see the needle move on their underlying risk markers.
Cholesterol: The Number That Means Almost Nothing on Its Own
A theme we return to constantly is that a total cholesterol number tells you very little. Cholesterol is essential; it's used to build hormones and cell membranes, and it has to be transported around the body inside carrier particles called lipoproteins (the LDL and HDL most people have heard of). Each of those particles carries a marker protein called Apo B.
Two people can have an identical total cholesterol reading, yet one might be carrying that cholesterol in a large number of small, dense particles, while the other carries it in fewer, larger ones. The smaller particles are more likely to penetrate the artery wall and drive plaque formation, so it's the particle count, reflected by Apo B, that actually predicts risk, not the cholesterol concentration itself.
One important clarification we make with every client: a fingerprick cholesterol test (the kind often used in workplace wellness screenings) does not measure Apo B; a proper venous blood draw is required. The target we aim for is an Apo B around 0.75, notably lower than the threshold South African labs currently flag as abnormal (1.2), reflecting our more conservative, prevention-focused approach. And crucially, even a reassuring finding, llike a calcium score of zero on a CT scan, isn't a reason to stop monitoring altogether; we treat markers like Apo B as things that need to be re-checked over time, since they tend to worsen with age if left unaddressed.
The broader point we try to drive home: cardiovascular events like heart attacks and strokes don't start on the day they happen - the underlying disease process typically begins developing 10 to 20 years earlier. That's precisely why we believe younger people are the ones who could benefit most from early intervention, even though they're the least likely to have these values tested or treated under typical medical practice.
Lipoprotein(a): The Genetic Risk Factor Almost Nobody Tests For
Another biomarker we consistently see under-tested, even internationally, is lipoprotein(a), or Lp(a). It's a genetic variant affecting roughly one in five people, structurally similar to LDL but with an added component that makes the particle stickier, more prone to entering artery walls, and associated with increased clotting risk (including conditions like deep vein thrombosis).
There's currently no approved treatment to directly lower Lp(a) in South Africa, though options are in development. What testing for it does change is how aggressively we manage other risk factors - a raised Lp(a) shifts someone into a higher overall risk category in our models, which lowers our target for Apo B and often prompts additional testing, such as a coronary calcium scan, that we might otherwise have skipped.
We want to be candid here about the real-world stakes: we've seen clients who received this information, chose not to act on it, and experienced serious cardiac events as a result, while others who intervened early avoided major surgery entirely. Our message is blunt: a normal stress ECG doesn't rule out significant underlying disease, and a "high but stable for years" blood pressure or lipid value isn't reassuring to us, it's a sign of prolonged exposure to risk, which matters more the longer it goes untreated.
CRP: A Marker of Whether the Body Is "Unhappy" Internally
High-sensitivity CRP (C-reactive protein) rounds out our core cardiovascular panel as a marker of background inflammation. Elevated CRP, often driven by things like type 2 diabetes, gout or high blood pressure, doesn't cause disease on its own, but it amplifies existing risk, acting, as we like to put it, like fuel added to a fire. A raised result is a signal for us to dig deeper into what's driving it.
Ferritin: Still One of the Most Commonly Missed Deficiencies
Iron deficiency remains a major, recurring theme in our work, and this episode was no exception. Roughly half of the women and children we see in our regional data have some degree of iron deficiency, and many simply adapt to feeling unwell, assuming that's their normal, until we treat them and they realize how much better they can actually feel.
A key clinical nuance we emphasize: ferritin is a reactive protein, meaning it rises during illness or inflammation, so a "normal" ferritin result taken while someone is unwell, or alongside a raised CRP, can mask a genuine underlying deficiency. We recommend testing ferritin alongside CRP and hemoglobin together, a combination that costs relatively little, so we can interpret the result correctly. We've also come to see lab reference ranges for "normal" ferritin as increasingly outdated; historically a cutoff around 20 was used, but our current thinking, based on the evidence, suggests optimal levels are meaningfully higher, closer to 50–80.
The list of symptoms we associate with iron deficiency is broader than most people expect: headaches, hair loss, brittle nails, anxiety, chest pain, brain fog and notably, a meaningful proportion of children with ADHD-type symptoms who are also iron deficient may see real improvement once we correct that deficiency.
Glucose and Insulin: Catching the Problem Before It's a Problem
We then turned to metabolic health, particularly relevant given recent shifts in dietary guidance moving away from carbohydrates as a nutritional foundation. The key insight we focus on: fasting insulin rises well before fasting glucose does.
Roughly 60–70% of glucose is stored in muscle tissue as glycogen, a process that requires insulin to bind to receptors on muscle cells. Over time, as the body's ability to store glucose in muscle declines, it compensates by producing more insulin to keep blood glucose looking normal, meaning a standard glucose test can look perfectly fine long after the underlying problem has already started. We see this as a largely reversible process if we catch and manage it early through lifestyle changes, and exercise plays a uniquely powerful role in our approach, since muscle contraction opens the same glucose-uptake pathway independent of insulin.
Where fasting insulin isn't available, we consider HbA1c (reflecting average blood glucose over roughly three months) the minimum useful test, though it's worth noting HbA1c can be skewed by iron deficiency, so we keep that context in mind. For clients with a strong family history of diabetes, we'll often add a glucose tolerance test to be sure.
Blood Pressure: We Underestimate This Too
One of the more candid moments we shared in this episode was Shaun's own experience - a borderline blood pressure reading, sustained despite consistent lifestyle interventions, that he was initially reluctant to treat with medication, even as a physician working in this exact field. Current evidence suggests a systolic blood pressure between 120–124 is associated with meaningfully better long-term outcomes than anything above that range, a stricter standard than many of us, including doctors, are used to applying in practice.
The theme of "time under the curve" applies here directly: the longer any of these risk markers - blood pressure, Apo B, inflammation - sit outside a healthy range, the greater the cumulative risk, regardless of how "fine" someone feels day to day. We call hypertension a silent disease for exactly this reason: by the time symptoms like headaches or nosebleeds appear, the exposure window has often already been a long one.
Homocysteine and Omega-3s: The Brain-Health Layer
Rounding out our panel, homocysteine, a breakdown product of the amino acid methionine, is cleared from the body through a B-vitamin-dependent process (B12, B1, B6 and folic acid in particular). Elevated homocysteine is associated with poorer vascular health, and while it can be raised by smoking or excess alcohol, roughly 30% of people carry a genetic variation that simply requires higher B-vitamin intake to manage effectively. The fix, in most cases, is straightforward supplementation.
We address omega-3 status more practically than through direct testing (which remains expensive in South Africa), largely via a simple proxy question we ask every client: how often do you eat fish? Less than twice a week is generally something we flag as insufficient, particularly for anyone with a family history of dementia or signs of systemic inflammation.
Fitness and Muscle: The Metric That Ties Everything Together
VO2 max and strength testing (grip strength, squats, push-ups) round out our picture, alongside body composition scanning that goes well beyond a simple BMI or scale weight - we measure visceral fat and lean muscle mass specifically. The data here is striking: moving from the least fit to the most fit tier of VO2 max is associated with roughly a five-fold difference in all-cause mortality. Similarly, increasing daily step count from around 2,000 to 7,000 has been associated with a 40%+ reduction in all-cause mortality in recent published research.
Muscle mass matters for more than strength alone; since muscle functions as the body's primary glucose storage site, under-muscled clients (rather than simply "overweight" ones) are often the ones we see developing insulin resistance. This is also directly relevant for anyone using newer weight-loss medications like GLP-1/GIP drugs (referenced in the episode as "Munjaro"): we're clear with our clients that muscle loss on these medications isn't inevitable, but avoiding it requires continued resistance training -we won't prescribe medication alone without effort on the client's part.
Our Approach: A Personalized Road Map, Not a Generic Checklist
The core of what we wanted to get across in this episode is less about any single biomarker and more about the system we've built - the understanding that no two people need exactly the same testing or intervention plan. Someone might need more support metabolically, cardiovascularly or simply around body composition and exercise; our role is to figure out which, rather than guess.
We're candid that this addresses a real structural problem we see in healthcare: information asymmetry, where clinicians have access to a person's data and context that the person themselves often doesn't - spread across different specialists' offices, inaccessible when it's actually needed (including, notably, while traveling). Our answer has been to put that data directly into our clients' hands through the app, along with a clear, ongoing action list tied to each abnormal marker, whether that's repeating a test, starting treatment or beginning home monitoring.
Our ideal window for a first comprehensive screen has shifted earlier over time, from the 40s, when most people first start noticing changes in how they feel, to around age 35, well before symptoms typically emerge. But as we're quick to point out from our own experience - one of us turning 52 and feeling better than we did at 35 - it's genuinely never too late to start.
Watch the replay of this episode at the below link:
Innersight Episode 32: Know Your Numbers - Why Health Goals Fail Without a Roadmap
This blog post is not intended as a substitute for the advice of your healthcare provider. No doctor-patient relationship is formed through this content, it is provided for general informational purposes only.
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