Tests to Ask For

The cheapest, broadest first look. It counts red cells, white cells, and platelets.

What it can show: anemia, oversized red blood cells, low platelets, low white cells, signs of infection or bleeding.

What it points to next: enlarged red cells send you to B12, folate, and liver testing. Low platelets send you to a liver panel and an abdominal ultrasound. Anemia sends you to iron studies and, if you are over fifty or have blood in the stool, a colonoscopy.

One draw that covers liver enzymes, kidney function, blood sugar, and electrolytes at once. If you only get one test, get this one.

What it can show: raised liver enzymes, poor kidney filtration, high blood sugar, low potassium or magnesium, low protein.

What it points to next: almost everything below. Abnormal liver numbers go to the liver panel, abnormal kidney numbers to the kidney profile, high glucose to A1c and insulin.

The test most directly aimed at drinking damage. Measures ALT, AST, ALP, bilirubin, and albumin.

What it can show: inflammation, fatty liver, alcoholic hepatitis, and how well the liver is still doing its job. An AST roughly twice the ALT is a pattern doctors associate with alcohol.

What it points to next: abnormal results go to an abdominal ultrasound or FibroScan to look for scarring, a GGT to confirm the alcohol pattern, and clotting studies (INR) to check the liver's synthetic function. Hepatitis B and C screening belongs here too — they compound alcohol damage badly and are treatable.

Quest liver function panel

Kidneys fail quietly. There is usually no pain until a great deal of function is gone.

What it can show: creatinine, eGFR, and BUN — how well the kidneys are filtering. Years of dehydration, high blood pressure, and painkillers take a toll.

What it points to next: a reduced eGFR goes to a urine albumin test, a kidney ultrasound, and a blood pressure workup. It also changes which medications are safe for you, so every doctor you see needs the number.

Quest kidney profile

Heavy drinking suppresses testosterone. The symptoms — exhaustion, no motivation, low mood, muscle loss, low libido — look exactly like depression or like early sobriety, which is why it goes unfound for years.

What it can show: total and free testosterone, and the pituitary hormones that drive them.

What it points to next: low testosterone goes to LH and FSH to work out whether the problem is the testicles or the pituitary, plus prolactin, thyroid, and a morning repeat draw — levels swing through the day, so one low result is not a diagnosis. Levels often recover on their own with months of sobriety, so do not rush to treatment.

Quest men's hormone panel

Alcohol is sugar, and a damaged pancreas stops managing it.

What it can show: hemoglobin A1c gives a three-month average; fasting glucose and fasting insulin together show insulin resistance well before diabetes appears.

What it points to next: a raised A1c goes to a glucose tolerance test and a diabetic eye and foot exam. If blood sugar is high and you have digestive symptoms, ask specifically about pancreatic diabetes — it is treated differently from ordinary type 2.

Alcohol relaxes the airway and wrecks sleep architecture. Untreated apnea causes brain fog, memory loss, and low mood that look identical to alcohol damage — and unlike much of that damage, apnea is very treatable.

What it can show: how many times an hour you stop breathing, and how far your oxygen drops.

What it points to next: a home test is enough to start; a lab study follows if it is unclear. A positive result goes to CPAP, and often to a cardiology referral, since apnea drives high blood pressure and atrial fibrillation. See an internal medicine physician, a primary care physician, or a pulmonologist.

Worth ruling out early because thyroid problems mimic almost everything else on this page: fatigue, weight change, low mood, slow thinking, tremor, feeling cold.

What it can show: TSH, free T4, and free T3.

What it points to next: an abnormal TSH goes to thyroid antibodies and, if there is a lump, a thyroid ultrasound.

Alcohol both displaces food and blocks absorption. These deficiencies cause real neurological damage, and they are cheap to find and cheap to fix.

What it can show: B1 (thiamine), B12, folate, vitamin D, magnesium, and iron.

What it points to next: low thiamine is urgent — it is the deficiency behind Wernicke's encephalopathy, and it is treated immediately rather than investigated slowly. Low B12 or folate goes back to the CBC for oversized red cells. Low vitamin D goes to a bone density scan.

Start with a blood pressure check and a lipid panel, which are cheap and tell you a lot.

What it can show: high blood pressure, cholesterol, and on an EKG, an irregular rhythm.

What it points to next: an irregular pulse goes to an EKG and possibly a monitor worn for a few days to catch atrial fibrillation. Breathlessness, swollen ankles, or a weak heart sound goes to an echocardiogram to measure how well the heart muscle is pumping.

Ask for this if you get upper abdominal pain that bores through to the back, or greasy stools that float.

What it can show: lipase and amylase catch acute inflammation; a stool elastase test shows whether the pancreas is still making digestive enzymes.

What it points to next: abnormal results go to a CT or MRI of the abdomen to look for chronic damage, and to enzyme replacement if elastase is low.

For numbness, burning feet, weak grip, or unsteadiness.

What it can show: a nerve conduction study and EMG measure how well the nerves are actually carrying signal, and how much has been lost.

What it points to next: confirmed neuropathy sends you back to thiamine and B12 levels, blood sugar, and thyroid — all correctable causes worth excluding before anyone calls it permanent alcohol damage.

Easy to skip and easy to regret. Drinking, poor nutrition, and low testosterone all strip bone, and the first sign is usually a fracture.

What it can show: osteopenia and osteoporosis, well before anything breaks.

What it points to next: low density goes to vitamin D, calcium, and testosterone levels, and to treatment that can halt further loss. Deep hip or groin pain when you put weight on it needs an MRI rather than a DEXA — that is a different problem.

Not one test but a conversation. Drinking raises the risk of cancers of the mouth, throat, voice box, esophagus, liver, colon, and breast, and these are survivable when found early.

What it can show: a colonoscopy, a mammogram, a dental and throat exam, and liver imaging where cirrhosis is present.

What it points to next: tell the doctor your drinking history plainly, because the screening schedule they recommend depends on it. If you smoked as well, say so — the two together multiply risk rather than add to it.

Go through a doctor first if you can. Ordered that way the tests are usually covered by insurance, the results go in your record, and somebody qualified reads them and acts on them. The links on this page are to a service that lets you order some panels directly and pay out of pocket. That is worth knowing about if you have no insurance, or if shame is stopping you from making the appointment — a result in your hand is sometimes what finally gets you through the door.

It is not the better option, though. Nobody chases you about a bad direct-order result. If you order your own, take the results to a physician.

That fear is normal and it is the reason a lot of us waited years. What I found is that not knowing was worse than knowing. Most of what turns up is either reversible or treatable, and the damage that is permanent still stops spreading the day you stop drinking. Nothing on a test result is made worse by finding it early.

Yes. It changes which tests they order, how they read the results, and which medications are safe to give you. Doctors are not there to judge the number, and an honest history is the difference between finding a problem and missing it. If you are newly sober, tell them that too — withdrawal and early sobriety change some results on their own.