For executives · The Bio-Audit
The one dependency nobody puts through diligence.
A forensic read on whether your biology is giving you room to operate, or quietly working against you. Measured, not guessed at, and written up in plain English.
The gap
You put all aspects of business through diligence. The finances, the contracts, the operations, the cybersecurity. Never the person the whole thing depends on.
Every material risk in a business gets examined by somebody whose job it is to examine it. One does not. The physiology of the individual whose judgment, stamina and continued presence the whole thing runs on has never been measured, and nobody has ever asked to see it.
23%
of UK SMEs would stop trading within a month of losing a key person. Scottish Widows, 2026
26%
would close immediately if the owner were incapacitated. Legal & General
Nothing
is what most of them spend on measuring the risk their key-person cover insures
"Sudden" is usually the last day of something old
By the time a heart attack announces itself, the disease behind it is often decades old. The event is sudden. What produced it was not.
There is a window, and you cannot feel it
Between the point a problem becomes detectable and the point it becomes a failure there is a long interval. It runs for years, it is silent, and feeling well is not evidence that it is still open.
Performance goes first, and it gets explained away
You read the same paper three times and none of it goes in. You wake at four with work already in your head. It gets put down to age or a bad quarter, because no measurement exists that would say otherwise.
The cover is bought. Nothing is maintained
No business insures a machine and then never services it or watches what it is producing. That is exactly what happens to the person the whole thing runs on.
The Bio-Audit is that due diligence.
Where you actually stand, what is limiting you now, what is building quietly, and what to do about each one in order. It tells you where you are while there is still room to act.
What sits under performance
Strategy is the software. Biology is the hardware it runs on.
Biological capacity sits at the base, the cognitive capability it powers above that, the leadership performance that runs on that, and the enterprise outcomes at the top. Each layer rests on the one beneath it.
When the base degrades, everything above it degrades with it, and no amount of skill or effort at the top compensates for a system running below capacity. That is what makes this both a business question and a personal one.
Already on the balance sheet, unpriced
The cover is bought and the exposure behind it has never been measured. The fee buys a measurement of a risk the business is already paying to insure.
A quarter without them costs more than the audit
Put a number on that person being absent for three months, then set it against the fee. It is arithmetic rather than persuasion.
Capacity is an operating cost nobody has costed
If something reversible is taking their afternoons, the business has been paying for it every week with no line item anywhere. Finding it is cheap.
What gets measured
Four systems, and the one thing underneath them.
Metabolic capacity
Whether your energy holds through the afternoon, or drops and takes your judgment with it. Fasting insulin moves years before glucose does and almost nobody measures it, which is why this is where the earliest and most reversible findings sit.
Cardiovascular reserve
How much work you can do, how fast you recover, and the state of the arteries carrying blood to your brain. ApoB counts the particles that do the damage rather than the cholesterol they carry, which is how a well-looked-after person with a normal cholesterol result gets told every year that everything is fine.
Endocrine regulation
The stress axis, thyroid and sex hormones. This is what sustained load has already cost you, and it separates someone who is tired from someone whose regulation has stopped keeping up.
Cognitive function
Attention, working memory and executive function, tested rather than asked about. Most people assume a bad afternoon is a thinking problem. Testing it alongside the other three is what tells you whether it is.
And recovery, underneath all four.
Fourteen nights of sleep, overnight heart rate variability and resting heart rate. Recovery is not a fifth system, because it is the condition every other one's improvement depends on. Nothing above it moves far while it is short.
The full measured set, marker by marker
Metabolic capacity. Fasting insulin and HOMA-IR, fasting glucose and HbA1c, triglycerides and liver function. Fourteen days of continuous glucose, read against your working day rather than against an average. Waist to height and body fat measured by ultrasound, with the Fatty Liver Index for steatosis and FIB-4 for fibrosis, which between them answer what a scan largely could not.
Cardiovascular reserve. ApoB, Lp(a) and the full lipid panel. hs-CRP and homocysteine. A 12-lead ECG and blood pressure on both arms. The carotid arteries imaged for thickening and plaque. Oxygen uptake measured at every stage rather than predicted, with the threshold read from expired gas and VO2 max estimated with a range.
Endocrine regulation. Thyroid in full, TSH with fT4 and fT3. Total testosterone with SHBG, and free testosterone calculated from the two rather than estimated by index. Cortisol measured twice over, and this is the part worth reading twice. A morning serum draw gives the total, which is the figure with the established relationship to adrenal disease. Then four saliva samples on one nominated day inside the fortnight give the free hormone and, with it, the shape: the rise after waking, the fall across the day, and whether the afternoon flattens out. The two answer different questions and neither replaces the other. Because the sleep monitor is already recording on that date, the times you wrote down are checked against the time you actually woke, while you are still in the room. Almost nobody running salivary cortisol has anything to check it against.
Cognitive function. A battery across attention, working memory, processing speed and executive function, done in the room on the day. And what feeds it: omega-3 index, homocysteine, and iron studied properly. Ferritin with transferrin saturation, because ferritin alone cannot separate iron deficiency from inflammation, and neither can see overload. The three together read as a pattern, which is how iron loading gets found in a man in his forties whose fatigue, aching joints and raised liver enzymes have been put down to drink.
Recovery, which sits under all four. Fourteen nights of sleep duration, efficiency, timing and regularity, overnight heart rate variability, and resting heart rate. Recovery is not scored as a system of its own, because it is the condition every other system's improvement depends on.
Also measured. Grip strength, gait speed, sit-to-stand, single-leg balance with your eyes closed, full blood count and kidney function.
Why these
Every measurement earns its place, or it isn't ordered.
Every test clears two questions before it goes on the standard set.
- Is there good evidence behind it?
- Will the result change what we do?
Everything on the Bio-Audit list has cleared both. Anything that clears only one is not on it.
The list moves when the evidence moves. It is reviewed once a year and dated, so what went on it and what came off it are both a matter of record rather than a matter of opinion.
The list is a starting point, not a limit. If your history or your examination gives a reason for a test that is not on it, we do that test. You are told what it is, why it matters and what it costs before anything is booked, and it passes to you at exactly what it costs me.
What you walk away with
A position, and what to do about it.
Not a folder of results with a green tick against most lines. A written read on four systems, in plain English, and an hour with me going through it properly.
Where you actually stand
Four systems, read against the load your role is putting on them rather than against a population average. Sitting inside the normal range is not the same finding as being well.
What is working against you
The findings that change a decision, separated from the ones that are interesting and change nothing. Most reports never make that separation, which is why they get filed.
What to change first, and only that
There is always one constraint doing most of the damage. You get that one, with what to do about it, how hard and for how long. Fixing it is what reveals the next, so what you leave with is a short list you will actually finish rather than a programme you abandon in March.
How you will know it worked
Every action carries a marker, a target and a date, so the plan is something you can check rather than something you have to believe. Feeling better is not the test.
How it runs
Fourteen days of measurement. Three hours of your time.
What you are buying is a fortnight of your working life, measured. The visit itself takes two to three hours, and the fortnight runs in the background before it.
Fourteen days
In the background
The sleep monitor, the glucose sensor and a small collection pack arrive once your date is fixed, and both devices run through an ordinary working fortnight before we meet. The pack holds the saliva tubes for the cortisol day and a urine pot for the morning itself. Wearing the devices is most of the job. There are four saliva samples to take on one day I nominate, and the urine sample on the morning we meet. Nothing else about your fortnight should change, because the fortnight is only worth reading if you carry on as normal.
Two to three hours
The assessment
At your office or your home, at a time that suits. It covers the bloods, a full examination, the functional testing, the ultrasound and the cognitive battery. Your fortnight of data is in front of me while we talk, so I can ask you about what is in it there and then.
A day of mine
The reading and the writing
Fourteen nights of sleep and heart rate variability, a fortnight of continuous glucose read against your working day, the panel, the imaging and the cognitive battery, put together into one position rather than five reports.
One hour
Going through it
The report in front of both of us, in plain English: where you stand, what to change first, what to watch, and the markers that will show it is working.
What I bring
The lab comes to you. All of it.
There is no clinic and no waiting room. I bring the whole assessment to your office or your home, so the only time it costs you is the time you spend with me.
The sleep monitor is yours to keep.
Before you decide
Read a real one before you buy one.
Everything on this page is a promise about a document, so here is the document. A full worked report, eight pages, composed from several assessments and identifying nobody.
All four systems written up, findings and reasoning both, the constraint identified and what to do about it first, and the markers set for the next reading.
Confidentiality
Your results go to you. Nobody else, ever.
I report to you and to nobody else. No result, no finding, no summary and no record of attendance goes to your company, your board, your insurer or anyone else, including whoever arranged it. The risk belongs to the business. The report belongs to you.
What happens to it afterwards is yours to decide, in writing, and you say exactly what goes and to whom.
- Nothing at all. This is the default, and it needs no decision from you.
- A line to a chair or a co-founder. Enough for them to know what they need to know, and no more.
- A copy to your NHS GP, for their records.
- Or you bring it to me. If you would rather the plan was run than filed, practice membership is where the report gets acted on through the year by the doctor who wrote it.
The fee
What it costs.
The Bio-Audit
£4,500 each for two or three directors, £4,000 each from four.
- The whole assessment, the written report, and an hour going through it, so you leave knowing where you stand and what to change first rather than holding a document
- A fortnight of continuous measurement taken while you carry on exactly as normal, so what gets read is your working life rather than one morning of it
- The markers a standard screen leaves off, so a risk is found while it is still cheap to change
- Cognition measured rather than guessed at, so you know whether a bad afternoon is a thinking problem or a fuel problem
- Where there is more than one of you, a single day at your offices, and each report goes to the individual it belongs to and nobody else, including whoever arranged it
Running several people across one day is one journey instead of several, and the saving is passed on.
Can the company pay for it?
Yes, and a statutory exemption usually means no tax on you and no National Insurance on the company. I am a doctor rather than your accountant, so ask yours to confirm it for your circumstances.
After the audit
After the report, if you want it watched.
The audit is a one-off and it stands on its own. You get the report, the hour going through it, and a plan you can run yourself.
If you'd rather it was watched than filed, that's what membership is for. One doctor who knows you and your numbers, measures them again through the year, and acts when something moves.
Overwatch sits on top of membership, for people who want the audit's own four systems kept under review, cognition included.
Both are on the membership page, and both are a conversation for after the report rather than before it.
Questions
The ones people actually ask.
What happens on the call?
You talk and I listen. What the role is asking of you, what has changed in the last couple of years, how you sleep, and what runs in your family and at what age it showed up. Twenty minutes, and it costs nothing.
At the end I tell you whether the audit would find you anything you do not already know. If the answer is no, I say so and we stop there.
What if you find something abnormal?
Most abnormal results are not dangerous and not urgent. They are findings that need something done about them, and finding them early is the whole point of looking. Fatty liver reverses. Plaque can be stopped from growing. Raised particle counts come down.
So the report does not stop at the finding. I tell you what it means, what changes it, and over what timescale: what to do, how hard, for how long, and what to stop as well as what to start.
A genuine red flag, the sort that needs seeing quickly, is uncommon in a well person. If one appears I say so on the day rather than in a report a week later, and I arrange what needs arranging, privately or on the NHS as makes sense. Nothing found here commits you to anything further with me.
Is this the same as your Assessment?
No. They answer different questions.
The Assessment answers whether anything is building that you cannot feel yet. You find out what is most likely to shorten your life, or take the quality out of the back half of it, while there is still time for it to be cheap to change. You leave with a plan for the next ten years.
The Bio-Audit answers whether your biology is keeping up with what you are asking of it now. You find out why the afternoons go, what the short nights are actually costing you, and whether the way you have felt for the last two years is the workload or something underneath it that can be measured and moved. You leave knowing the one thing to change first.
If the question is what might be building, take the Assessment. If it is what is limiting you now, take this.
Is it confidential from my NHS GP too?
Yes, unless you ask me to write to them, and that is your call.
Worth knowing what the letter achieves. Anything crossing an NHS threshold gets picked up and managed properly. Most of what this report finds does not cross one, so there is no pathway to put it on and no ten minutes long enough to work through it, and that part gets filed. Running the plan is either you or a doctor you pay.
Start with a conversation.
What the role is asking of you, what has changed, and a straight answer about whether the audit would tell you anything you do not already know. No cost, and no obligation to go further.