You Feel Fine. But Are You Actually Healthy?

Why your biomarkers matter before symptoms appear

Most of us use how we feel as a measure of how healthy we are.

We wake up, go to work, exercise, spend time with family and get on with our lives. If nothing hurts and our energy feels reasonably good, we assume everything is probably fine.

And often, it is.

But feeling well and being metabolically healthy are not always the same thing.

Some of the most important changes in our health can develop quietly, long before they produce symptoms. High blood pressure, elevated cholesterol and abnormal blood glucose are classic examples. In Singapore, Healthier SG highlights hypertension, diabetes and high cholesterol as conditions that may be "silent" in their early stages.

This raises an important question:

If we cannot always feel what is happening inside our bodies, how do we know what is changing?

One answer lies in our biomarkers.

Your body doesn't always send an early warning

Chronic disease rarely appears overnight. More often, risk accumulates gradually over years through a combination of genetics, ageing, lifestyle, environment and underlying metabolic changes.

The World Health Organization identifies raised blood pressure, elevated blood glucose, abnormal blood lipids and excess body weight as major metabolic risk factors for noncommunicable diseases.

The challenge is that many of these changes don't necessarily make us feel unwell.

You can exercise regularly and have elevated LDL (bad) cholesterol. You can feel energetic and have high blood pressure. You can maintain a relatively stable weight while your glucose regulation gradually changes.

By the time symptoms appear, a biological process may have been developing for some time.

Preventive health therefore looks beyond the question of "How do I feel today?" , and asks a different one, "What is happening beneath the surface?"

Biomarkers give us a window beneath the surface

A biomarker is simply a measurable characteristic of the body that provides information about a biological process or aspect of health.

Some are familiar: blood pressure, cholesterol, blood glucose and HbA1c.

Others can provide additional information about areas such as metabolic health, nutritional status, kidney and liver function, thyroid function or cardiovascular risk when clinically appropriate.

Individually, each number tells us something small.

Together, interpreted in the right context, they can begin to build a picture of what is happening inside the body.

Start with cardiovascular health

Consider cardiovascular disease.

For many people, the first indication of cardiovascular risk isn't chest pain. It may be elevated blood pressure or an abnormal lipid profile discovered during routine screening.

The American Heart Association includes blood pressure, blood lipids and blood glucose alongside body weight, diet, physical activity, sleep and nicotine exposure in its Life's Essential 8 framework for cardiovascular health.

A standard lipid profile may include LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. What we know today is that the standard lipid profile is no longer sufficient and we need to be looking a little deeper at Apolipoprotein B and even Lipoprotein(a) in those individuals with a family history of high cholesterol. Depending on an individual's circumstances, a doctor may consider additional markers to refine cardiovascular risk assessment.

But no single cholesterol result tells the entire story.

Age, blood pressure, smoking, diabetes, family history, medical history and other factors all contribute to overall cardiovascular risk.

The same principle applies when we look at another major area of long-term health: metabolic health.

Then look at how your body is handling energy

Blood glucose gives us information about the amount of glucose circulating in the blood at a particular moment, while HbA1c reflects average glucose exposure over the preceding two to three months.

Both are important markers of metabolic health and are established tests for identifying prediabetes and diabetes.

But there is another part of the story that can provide additional information: insulin.

Insulin is a hormone produced by the pancreas. One of its main jobs is to help move glucose out of the bloodstream and into our cells, where it can be used for energy.

When our cells respond well to insulin, relatively small amounts of insulin can do this job effectively.

When they become less responsive, the pancreas may compensate by producing more insulin to keep blood glucose under control.

This is known as insulin resistance.

Your glucose can look normal while your insulin is working harder

This is an important concept in metabolic health.

Imagine two people who both have a fasting glucose of 5.0 mmol/L.

On the surface, their glucose results look the same.

But one person's body may need considerably more insulin to maintain that glucose level than the other's.

Looking at glucose alone tells us how much glucose is circulating in the blood. Measuring fasting insulin provides additional information about how hard the body is working to keep that glucose under control.

This matters because insulin resistance can develop before someone meets the diagnostic criteria for prediabetes or type 2 diabetes.

For a period of time, the pancreas may be able to compensate by producing more insulin. Blood glucose may therefore remain relatively normal even while the underlying metabolic system is becoming less efficient.

Eventually, if the body's ability to compensate is no longer sufficient, blood glucose may begin to rise.

This is one reason metabolic health is better understood as a continuum rather than simply being divided into "diabetes" and "no diabetes."

What is HOMA-IR?

One way of estimating insulin resistance is through something called HOMA-IR, or Homeostatic Model Assessment of Insulin Resistance.

Despite the complicated name, the principle is relatively simple.

HOMA-IR uses your fasting glucose and fasting insulin together to estimate how resistant your body may be to the effects of insulin.

The model was first described by researchers at the University of Oxford in 1985 and has since been widely used in metabolic research.

In general, a higher HOMA-IR suggests greater insulin resistance.

It can therefore add another layer of information to a metabolic assessment, particularly when considered alongside glucose, HbA1c, triglycerides, HDL cholesterol, blood pressure, waist circumference and body composition.

But HOMA-IR is not a diagnosis by itself.

There is no single universally accepted HOMA-IR cut-off that applies to everyone. Results can vary according to factors including population, ethnicity, laboratory methods and the insulin assay being used.

Fasting insulin and HOMA-IR are therefore best interpreted as part of a broader metabolic picture rather than as standalone measures of whether someone is "healthy" or "insulin resistant."

Why look beyond glucose alone?

The goal isn't to replace glucose or HbA1c.

These remain established tests for screening and diagnosing prediabetes and diabetes. Current guidelines do not recommend fasting insulin or HOMA-IR as routine diagnostic tests for diabetes.

The potential value of fasting insulin is different. It can provide additional insight into how the body is maintaining its glucose levels, particularly when interpreted alongside other signs of metabolic health.

For example, someone may have a normal fasting glucose and HbA1c but also have other features associated with insulin resistance, such as elevated triglycerides, low HDL cholesterol, increased abdominal fat, polycystic ovary syndrome or metabolic dysfunction-associated fatty liver disease.

Looking at these markers together gives us a more complete picture.

Instead of only asking "Is my glucose normal?", we should ask "How efficiently is my body maintaining that glucose level?". That is a much more useful conversation about metabolic health.

And it brings us back to an important principle: a number becomes far more useful when we understand what is happening around it.

Sometimes your numbers explain how you feel

Not every useful biomarker is about predicting future disease.

Sometimes the numbers can help explain what you are experiencing right now.

Fatigue is a good example.

Feeling tired can have dozens of possible causes, from inadequate sleep and psychological stress to illness, nutritional deficiencies and hormonal disorders.

This is where clinically appropriate testing can help narrow the picture.

Iron and ferritin, vitamin B12, folate and vitamin D are examples of markers that may be considered when investigating nutritional status. Thyroid testing may be appropriate in certain clinical circumstances, while kidney and liver markers can provide information about organ function.

The important distinction is that these tests are not diagnoses by themselves.

A low or elevated number is a clue. It needs context. And that brings us to one of the most important principles in health screening.

A number without context is just a number

It can be tempting to open a blood test report and immediately scan for anything marked red, high or low.

But laboratory reference ranges are only part of the story.

Your age, sex, medications, symptoms, family history, lifestyle, medical history and previous results can all influence what a particular result means for you.

Equally, an abnormal result does not automatically mean you have a disease.

Results can be influenced by recent illness, hydration, medications, exercise and other physiological factors. Unexpected findings may need to be repeated or investigated further before conclusions are drawn.

The real value of testing isn't simply receiving a report. It is understanding what the results mean in context.

There is also another piece of context that becomes increasingly valuable over time. Your own history.

One test gives you a snapshot. Your history gives you the story.

Imagine having a blood test today and finding that your LDL (bad) cholesterol falls within the laboratory reference range.

Useful information.

But now imagine having several years of results.

Your LDL cholesterol may technically still sit within the reference range, but perhaps it has been gradually increasing.

That tells you something a single measurement cannot.

So here instead of simply asking "Is this number normal?", you should begin asking "Where is this number heading?"

This is the value of establishing a baseline.

Over time, repeat measurements can help identify whether relevant markers are stable, improving or moving in an unfavorable direction.

It doesn't mean every biomarker needs to be measured repeatedly or frequently. The appropriate tests and intervals depend on age, risk factors, medical history, previous results and clinical guidelines.

But when testing is clinically appropriate, having your own previous results provides another valuable point of comparison. Your baseline allows you to compare yourself not only with a population reference range, but also with your previous self.

That shift from isolated numbers to patterns is where health data becomes much more useful.

But more data isn't always better data

Once we recognise the value of biomarkers, there is an easy trap to fall into:

If some testing is useful, surely more testing must be better.

Not necessarily.

Preventive health should not become a competition to run the greatest number of tests.

Some screening tests have strong evidence supporting their use in particular populations. Others may only be appropriate when an individual's age, symptoms, family history or risk factors justify them.

Testing without a clear clinical rationale can produce false positives, unnecessary investigations, additional cost and anxiety.

Singapore's Ministry of Health makes an important distinction between screening tests recommended at a population level and other tests that should be considered based on individual circumstances.

So the goal isn't to test everything.

The goal is to measure what is meaningful, understand what the results mean, and act when there is something worth changing.

That final part matters most, because Information alone doesn't improve health.

The value of knowing your numbers is what you do next

Imagine discovering that your blood pressure is higher than it should be.

Or that your glucose control and insulin sensitivity appear to be changing.

Or that a nutritional deficiency may be contributing to persistent fatigue.

None of these results is valuable simply because you know the number.

Their value lies in what happens next.

That might mean changing nutrition, increasing physical activity, improving sleep, addressing body composition, correcting a deficiency, discussing medication with your doctor or arranging further investigation.

Sometimes the outcome is simply reassurance: your results look appropriate, there is nothing that requires intervention, and you now have a useful baseline for the future.

This is the fundamental shift from reactive healthcare to proactive health.

Rather than waiting for symptoms to tell us when to pay attention, appropriate screening, clinical interpretation and evidence-based interventions can help us identify what we may be able to influence earlier.

“The goal is to measure what is meaningful, understand what the results mean, and act when there is something worth changing.”

From "What is wrong?" to "What can I influence?"

Traditional healthcare is exceptionally important when we become ill.

Preventive healthcare doesn't replace that.

It adds another question. Instead of only asking "What is wrong?", we should also ask "What can I understand and influence now?"

Knowing your biomarkers cannot predict everything that will happen to your health. A normal health screen doesn't guarantee that disease will never develop, just as an abnormal result does not automatically mean that disease is present.

But appropriate testing can give us information.

Information can identify risk.

Risk can guide action.

And action, taken early enough, may change the trajectory of our health.

Know your numbers. Then know what to do with them.

At Matter, this is how we think about health screening.

Our Comprehensive Health Screen looks across more than 100 biomarkers spanning areas including cardiovascular and metabolic health, blood counts and nutritional markers, kidney and liver function, thyroid function, urine testing and body composition.

But the number of biomarkers isn't the most important part.

The interpretation is.

Results are reviewed with a doctor so that individual numbers can be considered within the wider context of your health, your history and your risk factors.

Ultimately, preventive health isn't about collecting data for the sake of having more data.

It's about turning the right information into meaningful action.

“Measure. Understand. Act. Reassess.”

Measure. Understand. Act. Reassess.

The best time to start paying attention to your health isn't necessarily when something feels wrong.

Sometimes, it's while everything still feels right.