Endurance athletes have been using basic blood tests for years. Blood tests provide simple insights into an athlete’s overall wellness and identify red flags. Today, a new breed of biomarker testing offers more than 100+ markers that measure hormone levels, micronutrient status, inflammation, and other indicators.
When experts from different fields interpret this data together, there’s the potential to improve an athlete’s performance and enhance their health. Let’s take a deep dive into this bloodwork-based approach, its benefits, and the experiences of a coach and first-time marathoner.
Putting Physiology Under the Microscope
Before you can follow a personalized optimization plan, you need to get tested.
Traditional blood panels typically asses 20 to 30 markers, and an annual physical may include up to 50. Some companies now offer far more comprehensive testing, analyzing well over 100 biomarkers for a deeper look at health and performance. Some of these companies include:
- Function Health: Co-founded by Dr. Mark Hyman, Function Health tests 160+ markers, including those related to “heart, hormones, thyroid, toxins, metabolic, autoimmunity, stress, nutrients, and more.” Testing is usually completed in 15 minutes in a lab. Function Health’s annual plan is $499.
- Vitality Blueprint: Vitality Blueprint’s standard and elite plans test 85 and 129 biomarkers, respectively. They also offer biomarker patterns to screen for conditions related to performance areas like speed and power, muscle size and strength, and joint health and functional areas such as hydration, inflammation, and cellular health. An algorithm performs 20,000 calculations to analyze test results and generate personalized recommendations. Pricing starts at $500 for one-off testing, with semi-annual or quarterly retesting options.
- Inside Tracker: InsideTracker analyzes 48 biomarkers related to healthspan, the amount of time you can live with full vitality. It produces scores in 10 areas, including heart health, metabolism, and cognition. It then provides recommendations to optimize lifestyle, training, and nutrition. The testing and action plan pricing starts at $489. If you upload your own data, the price drops to $149. Inside Tracker also offers a DNA kit that provides insights into genetic predispositions for 38 wellness traits.
- Arétē (RAPID): There are also more advanced options for people wanting even broader testing and precise programming. The Arétē program from RAPID evaluates over 500 biomarkers via blood, stool, saliva, sweat, and urine testing. It also includes body composition tests, movement assessments, and traditional endurance-related evaluations, such as CO2 tolerance and VO2 max. A one-off fee (price available on request) covers initial and follow-up testing, an individualized plan based on the implications of the results, and working with domain experts to apply and adjust the suggested interventions.
Making Sense of Test Results
Lab results alone aren’t enough; expert interpretation is key to turning data into actionable steps for better health and performance.
With a regular blood panel, a physician utilizes clinical reference ranges for each marker designed to indicate the presence of pathology or raise a red flag for an elevated risk factor. In contrast, the human performance experts behind the latest optimization platforms believe health is not merely the absence of disease.
While most are not medical doctors (except for clinicians at Function Health), these experts believe the future of health and performance lies in individuals proactively taking charge of their well-being, guided by personalized data and expert analysis. It’s a two-part process.
How Biomarker Companies Interpret Results
First, a dedicated lab analyst combs through each result line by line. For RAPID and Vitality Blueprint–both co-founded by Andy Galpin and Dan Garner–each result is compared against performance ranges based on the latest evidence and assessments of elite performers.
InsideTracker provides optimized zones, “rooted in decades of scientific research and are generated based on your age, sex, and activity level, making them unique for you.”
Function Health offers similar “optimal ranges.” All these companies go beyond the scope of simple health screenings, for which ‘normal’ results can be suboptimal.
“The normal range for fasted glucose is 70 to 99, the prediabetic range is 100 to 125, and 126 or above is in the type 2 diabetes range,” explained Dr. Nathan Jenkins, a lab analyst for RAPID who was previously a tenured professor of exercise science. “Most physicians wouldn’t bat an eyelid if someone’s score was between 85 and 99, but we know that for every point above 86, there’s a six percent increase in the risk of developing type 2 diabetes within the next 10 years. So we help our clients get below that 85 threshold.”
Uncovering Anchors that Hold Athletes Back
Once a lab analyst and/or algorithm has finished analyzing an athlete’s data, domain experts in multiple branches of human performance–from psychology to nutrition to sleep and more–combine research insights with their practical experience to further assess the lab results. This allows them to identify what RAPID calls performance anchors.
Dan Garner explained that “A system can only perform to the degree that it is constrained.” Certain factors act like an anchor on a ship, preventing an athlete from progressing beyond a certain point and, in some cases, lowering their response to training stimuli, their ability to process nutrients, and other desired adaptations.
RAPID attributes these limitations to visible and hidden stressors. The former are factors that an athlete might be aware of, such as low energy, chronic stress, and sleep disruptions. Hidden stressors like micronutrient deficiency, bacterial overgrowth, or hormone disruption are less apparent.
Visible and hidden stressors are classified as severe, concerning, sufficient, or optimal, and assigned performance anchors that might be the root causes of the constraints. The data points provided by comprehensive biomarker test results paint a full picture of each athlete’s unique physiology, which informs a bespoke training and lifestyle plan.
Delivering a Comprehensive Wellness Plan
When the interpretation phase is complete, the decoded lab results are presented to the client. This involves sending them a detailed written report with graphs, charts, and color-coding to visualize the data. There are succinct summaries so the athlete can review their physiology at a glance.
RAPID gives scores out of 100 for visible and hidden stressors. Function Health provides a detailed clinician’s summary that is less focused on performance and more on overall well-being. It includes early indicators for hundreds of diseases and recommendations on what to do about them. Vitality Blueprint also offers an online encyclopedia that explains each biomarker and gives tips for optimizing them.
Prosumers who are curious about a certain area (like hormonal, gut, or cardiovascular health),can dive deeper into the data. The most comprehensive platforms also include a video from one of their in-house experts, who explains the constraints that are limiting health or performance and the plan to address them. The main action items are optimization protocols personalized to the individual and grouped into categories, such as nutrition, supplementation, exercise, sleep, and stress.
RAPID’s individualized plan spans eight months, Vitality Blueprint’s and Function Health’s run for six months, and InsideTracker recommends three months of programming between tests.
Using TrainingPeaks to Plan Workouts & Capture Subjective Feedback
InsideTracker, Function Health, and Vitality Blueprint provide a do-it-yourself plan. RAPID assigns a coach to help each athlete put their program into action and adjust interventions as needed. The company partners with several endurance experts, including Florida-based Javier Pineda, who has been guiding runners and triathletes for 25 years. He utilizes the post-testing report to create and implement a plan and tailor it to the athlete’s training, competition, and life goals.
“Once I have an athlete’s RAPID interventions, I use TrainingPeaks to outline their training calendar,” said Javier Pineda. “I also utilize TrainingPeaks to set thresholds and heart rate, power, and pace zones, which helps me create customized workouts. Then they can use the TrainingPeaks app to record their data from each session and add comments so we have subjective information too.”
In addition, Pineda looks at recovery data from the athlete’s wearable device, such as a smartwatch or fitness tracker. This provides more information about non-training activity levels, external stressors, and sleep duration and quality. When combined with insights from TrainingPeaks, these data points inform the weekly meetings that Pineda conducts with every client.
“In my accountability sessions with an athlete, I use all the data consolidated in TrainingPeaks to talk with them about their total training load, intensity and volume, and recovery,” Pineda said. “Then I go back to the action plan that came out of their lab analysis to see how they’re progressing and what we might need to tweak in their upcoming training. I collaborate with a strength coach to make sure they’re doing enough resistance work, which is the X-factor for endurance athletes. Retesting objectively shows how we’re positively impacting their outcomes and what we need to change.”
Case Study: Finishing a First Marathon and Improving Wellbeing
Performance optimization based on extensive lab work isn’t just for elite competitors.
Growing up in Australia, David Burt played just about everything, participating in team sports and individual activities, like running and tennis. But when he moved to the U.S. to advance his business career and then started a family, it was hard for Burt to keep up his sporting hobbies. And once he became a finance executive at Netflix, long workweeks and frequent travel put his health on the back burner.
Realizing that Burt needed a new challenge, a close friend looked into health optimization platforms that used biomarker testing and recommended RAPID. Burt’s initial goals were to improve his overall well-being and race his first IRONMAN triathlon, but when he had to go back to Australia because of a family member’s health issue, he pivoted to completing his first marathon.
How Testing Uncovered Burt’s Performance Limiters
Results from testing over 500 of his biomarkers showed that for Burt to achieve his performance goal, he also needed to work on lifestyle, nutrition, and overall wellness. His hidden stressor score was 62 (the higher the number, the better), so there was a lot of room for improvement.
One area where Burt struggled was nutrition.
“I had no consistency with when I’d eat,” he said. “I didn’t know that this made it more difficult for my body to absorb nutrients. The testing also revealed that I wasn’t hydrating enough.”
Like many athletes, Burt’s lab work showed that he was deficient in vitamin D, which is needed for musculoskeletal health and immune function and magnesium, which is involved in hundreds of bodily processes. Test results also highlighted issues with his microbiome that were linked to ongoing digestive issues and low levels of omega-3 fatty acids.
To solve these challenges, Burt started a tailored plan that incorporated specific whole-food ingredients into meals, such as salmon and leafy greens. To fill the remaining gaps in his nutrition strategy, he also began taking supplements. The timing of nutrition, hydration, and supplementation was scheduled to stabilize his irregular schedule and ensure optimal uptake of fluid and nutrients.
Doubling Down on Recovery and Sleep
Recovery was another performance anchor that Burt didn’t know was keeping him stuck at suboptimal performance and health. “I don’t drink a lot but didn’t recognize how much alcohol was impacting my sleep quality,” he said. “While I get up every day at 5:30 AM, my bedtime was all over the place, which was also compromising my sleep.”
This led to a sleep expert creating a personalized plan that involved Burt going to bed by 9:30 PM nightly, altering his evening routine to reduce alcohol consumption and make it earlier to minimize sleep disruption, and ensuring he followed sleep hygiene tips, such as sleeping in a cold, dark room. Nighttime supplementation with proven ingredients like magnesium L-threonate further supported restful slumber.
Eating, hydrating, and sleeping better enabled Burt to minimize or remove the constraints that had been limiting his potential. “I lost a significant amount of visceral fat, and started feeling a lot healthier,” he said. “My recovery from workouts was much better than when I first started the program. I feel like my sporty, 15-year-old self again, which was one of my goals before starting this program.”
Crossing the Finish Line in Sub-4 Hours
The improvement in how Burt felt wasn’t merely anecdotal. After going through biomarker retesting, he was surprised to see that his hidden stressor score had improved by 19 points. But the real acid test came when he lined up for the 2025 Los Angeles Marathon, his first attempt at racing the distance.
Despite his smartwatch shutting off partway through the race and him celebrating with the well-wishers who’d gathered to cheer him through the last couple of miles, Burt beat his sub-four-hour goal by finishing injury-free in 3:58. This has given him the confidence to lower his PR in future marathons, and to tackle his first full-length Ironman later this year. But perhaps even more important than the race results that his performance optimization plan facilitated is how it improved his quality of life.
“My vitality is night and day different,” Burt said. “Now I have enough energy to complete my endurance training and keep up with my kids, who think I’m the best tag player on the planet. I’m calmer, focused, and more present with my family.”
The latest generation of biomarker-based optimization platforms isn’t a magic bullet and requires user commitment and consistency to make interventions effective. But they do enable athletes to take control of their own health, remove performance barriers, and better understand their unique physiology.
