My doctor told me I was fine.
Standard lipid panel: fine. Fasting glucose: fine. Blood pressure: fine. CBC, thyroid, liver enzymes — all fine. I was in my late thirties, strength training four times a week, eating reasonably well. The bloodwork confirmed what I already suspected: nothing to worry about.
The problem is that “fine” isn’t a health goal. It’s the absence of a diagnosis. And when I started reading about how South Asians differ metabolically from the populations these reference ranges were built on, I wanted actual numbers — not a thumbs up from a system calibrated for someone else’s body.
So I asked my doctor to run a different panel. Not instead of the standard tests — in addition to them. Five markers that almost never get ordered by default.
Here is what I found, and why every desi should know about these five tests.
Why the standard panel isn’t enough for us
There is a well-documented pattern in South Asian health that the standard blood panel is not designed to catch. A few things to understand before we get to the markers:
We develop insulin resistance earlier and at lower body weights than comparable Western populations. A desi at a BMI of 23 can have the metabolic profile of someone at 28 by Western standards. The reference ranges for “healthy” weight were not calibrated on our bodies.
We store fat differently. More visceral fat — the deep abdominal fat around organs — and less subcutaneous fat. Visceral fat is metabolically active in a damaging way: it drives inflammation, raises cortisol, disrupts insulin signalling. You can look lean and have dangerous amounts of it.
We have higher rates of small dense LDL particles — the dangerous subtype of cholesterol that doesn’t appear in a standard lipid panel. The panel gives you a total LDL number. It doesn’t tell you what kind, or how many particles are circulating. A desi with a “normal” LDL could have particle counts that are dangerously elevated.
South Asians have a disproportionately high rate of cardiovascular disease globally — often presenting earlier, and often without the warning signs the standard panel is designed to catch.
The five markers below are how you actually look under the hood.
1. Fasting insulin (and HOMA-IR)
Your doctor almost certainly tests your fasting glucose. They may test your HbA1c. What they almost never test is your fasting insulin — and that is where the story actually starts.
Insulin resistance develops silently, usually over a decade, before it shows up in glucose or HbA1c numbers. Here is how it works: as your cells become less responsive to insulin, your pancreas compensates by producing more of it. Your glucose stays normal — because the extra insulin is keeping it normal — but the amount of insulin required to do that job is climbing steadily. By the time your glucose tips into the pre-diabetic range, your insulin has often been elevated for years.
A fasting insulin test catches this early. A healthy fasting insulin is below 7 µIU/mL. Between 7 and 15 is a warning zone — your body is working harder than it should. Above 15, you are looking at significant insulin resistance, even if your glucose looks clean.
The more useful number is HOMA-IR: a calculated score that combines your fasting glucose and fasting insulin into a single insulin resistance index. Below 1.5 is healthy. Above 2.5 is concerning. Your doctor can calculate it from the same blood draw — they just usually don’t unless you ask.
Mine is 0.3. That means the combination of resistance training, protein-forward eating, and lower refined carbohydrate intake is doing its job. But I had no idea what my insulin looked like for most of my thirties. The test is the only way to know.
2. ApoB
Your standard lipid panel reports total cholesterol, LDL, HDL, and triglycerides. It does not tell you the number of lipoprotein particles carrying cholesterol through your blood — and that number is what actually predicts cardiovascular risk.
ApoB (apolipoprotein B) is a protein that sits on the surface of every dangerous lipoprotein particle — VLDL, IDL, small dense LDL — exactly one molecule per particle. Measuring ApoB gives you a direct count of how many of those particles are circulating. More particles means more opportunity for them to embed in artery walls.
This is the one that matters most for South Asians specifically. We disproportionately tend toward small, dense LDL particles — which are more dangerous than large, buoyant LDL because they penetrate artery walls more easily and resist clearing from the bloodstream longer. Two people with identical LDL readings can have completely different ApoB counts depending on their particle size distribution. The only way to know which one you are is to measure ApoB directly.
The optimal target is below 80 mg/dL. For anyone with cardiovascular risk factors, some clinicians push for below 70.
Mine is 105. That is above optimal — and this is the marker I am actively working to bring down. My LDL from the standard panel looks unremarkable. My ApoB tells a different story. This is exactly the gap the standard panel misses, and exactly why South Asians need to test beyond it.
3. Vitamin D (25-OH)
Studies consistently find that 70–90% of South Asians are vitamin D deficient, regardless of geography. Desis in Mumbai. Desis in London. Desis in California. The melanin in darker skin significantly reduces vitamin D synthesis from sunlight — we need substantially more sun exposure than someone with lighter skin to produce the same amount, and most of us don’t get it regardless of how sunny our city is.
Vitamin D is not just a bone health issue. It is involved in immune function, insulin sensitivity, muscle performance, inflammation regulation, and mood. Low vitamin D is associated with elevated insulin resistance — which, for South Asians, compounds an already elevated risk.
The test is called 25-hydroxyvitamin D, or 25-OH vitamin D. The clinical “normal” floor is 30 ng/mL. Most functional medicine practitioners consider 50–80 ng/mL optimal for metabolic function.
Mine is 66 ng/mL — in the optimal range. I supplement with 5,000 IU daily and have for years. If you are South Asian and have never tested your vitamin D, there is a high probability you are deficient. The test takes thirty seconds and costs almost nothing.
4. hs-CRP
hs-CRP (high-sensitivity C-reactive protein) is a marker of systemic inflammation. Your liver produces CRP in response to inflammatory signals from anywhere in the body. Low-grade chronic inflammation — driven by visceral fat, poor sleep, chronic stress, and ultra-processed food — shows up here before it shows up in most other tests.
Why does this matter metabolically? Because inflammation and insulin resistance are locked in a reinforcing cycle. Visceral fat releases inflammatory cytokines that impair insulin signalling. Elevated insulin promotes further fat storage, particularly visceral fat. hs-CRP gives you an early read on whether that cycle is running in the background.
Target: below 1.0 mg/L is excellent. Below 2.0 is acceptable. Above 3.0 is high risk.
Mine is 0.5 — at the low end of excellent. What I find useful about this marker is how responsive it is to lifestyle changes. Sleep is probably the single biggest lever: a few weeks of consistently poor sleep will move this number in the wrong direction faster than almost anything else I’ve tracked. It’s a useful signal that the system is working, or not.
5. Triglyceride-to-HDL ratio
This one requires no additional test — you already have the inputs from a standard lipid panel. Divide your triglycerides by your HDL. That ratio is arguably the best single proxy for insulin resistance and cardiovascular risk that doesn’t require expensive testing.
Target: below 2.0 is good. Below 1.5 is excellent. Above 3.0 is a problem. Above 5.0 is serious.
South Asians specifically tend toward high triglycerides and low HDL — a combination called atherogenic dyslipidaemia — even when their LDL looks normal. This pattern is directly linked to insulin resistance and visceral fat accumulation. It is common in our community and consistently underdiagnosed because the standard panel doesn’t explicitly surface the ratio.
My triglycerides are 73, my HDL is 50. Ratio: 1.46 — in the excellent range. The numbers that moved this most for me were resistance training (raises HDL), reducing refined carbohydrates (lowers triglycerides), and improving sleep quality. Not complicated, but the marker has to be visible before you know whether it’s moving.
What to actually do
You don’t need a functional medicine doctor or a concierge GP. You can ask your regular physician directly: “I’d like to add a few markers to my next blood panel.” Most will agree. Some won’t — in which case services like LabCorp and Quest allow direct-to-consumer ordering for less than a typical co-pay.
Here is what to ask for:
- Fasting insulin — ask them to calculate HOMA-IR from this and your fasting glucose
- ApoB
- Vitamin D (25-OH)
- hs-CRP (high sensitivity)
- Standard lipid panel — which you’re likely getting anyway, and which gives you triglycerides and HDL for the ratio
Do this fasted — 12 hours, water only. If the results come back and your doctor says everything is “fine,” ask them for the specific number on each test. “Fine” is not a number. Fine doesn’t tell you that your ApoB is 25 points above optimal, or that your insulin has been quietly climbing for five years.
To be clear on where I stand: four of my five markers are currently in good shape. The ApoB at 105 is the one I am still working on — and knowing that it is elevated is the only reason I am working on it. Without the test, I would have a clean standard panel and no idea.
That is the whole point.
The standard blood panel was built to keep you out of the hospital. These five markers are how you understand what is actually happening in your body before it becomes an emergency. For South Asians — who face higher cardiovascular and metabolic risk than standard reference ranges account for — that understanding is not optional. It is overdue.
