Lab Tests - What are 'Healthy' Ranges?

Most 'nutrition' programs are designed solely with weight loss as the goal. Even if successful, they leave people exhausted, hormonally deficient, and primed to revert back to their old selves. While weight loss is indeed a goal for many people, we believe excess weight should not be the diagnosis but a symptom of a more dire metabolic ailment. Healing a malfunctioning metabolism sets the stage for achieving lasting weight loss nearly effortlessly. You can reach your goal weight with astonishingly few hunger pangs while simultaneously improving your hormone levels.

Another disservice from a fixation on weight is a ‘healthy’ BMI doesn’t automatically signal metabolic excellence. Many slim people are often ‘hangry’ before meals, get hit with afternoon drowsiness, or struggle with acne and other skin conditions. Like extra weight, these are all signs of an impaired metabolism.

While we can get a great approximation of your metabolic health merely based on how you’re feeling throughout the day, a simple set of blood work and other tests* can help paint a surprisingly complete metabolic picture.

Unfortunately, the reference ranges that determine if your numbers are ‘healthy’ are typically determined by nothing more than recent averages from the general population. Given that a measly 7% of American adults are truly metabolically healthy, trusting the reference range on any specific test isn’t a great barometer.

Below is what we deem to be the most important basic labs to request and fantastic goals to aim for:

Fasting glucose: < 85 and ideally < 75 

Fasting insulin: < 5 uIU/mL

HOMA-IR: Determines insulin resistance: < 1 would be fabulous! Under 2 is still a celebratory feat.

This requires a fasted insulin test, plus your fasting glucose results. Plug both numbers in here.

Fasting triglycerides: < 100 and ideally < 70

Triglycerides to HDL cholesterol ratio: < 1/1, aka lower than 1

HDL cholesterol: (> 60 for men, > 65 for women) 

CAC (Coronary Artery Calcium): Measures arterial calcium buildup and indicates cardiovascular disease risk, 0. Note: CAC reveals calcified plaque, which takes a long time to form. A '0' for anybody under ~ 55 doesn't signify no risk. About around age 60, a CAC becomes a much better predictor of risk.

CIMT (Carotid Intima-Media Thickness): Measures both soft and calcified plaque, and is relatively inexpensive. There are variations in how technicians read these tests and lack precision at very low levels of plaque.

CTCA (CT Coronary Angiogram): The gold standard in measuring soft plaque buildup, however they are very expensive and rarely covered by insurance. CIMT is, in our opinion, a very good middle ground. As always, this is not medical advice and you should talk with your doctor about all imaging options.

Hemoglobin A1C: < 5.3%

Blood Pressure: < 120/80 & > 90/60

Additional Notes on cholesterol:

• LDL cholesterol alone provides little indication on cardiovascular risk (in certain populations, higher levels are actually associated with better health outcomes). ApoB is a better test for cardiovascular disease risk, but still somewhat reductionist.

• Lp(a) is another advanced test to determine CVD risk. Lp(a) is a molecule similar to LDL with addition of a 'tail'. Lp(a) increases blood clotting - evolutionarily helpful in the case of significant injury, but possibly detrimental for those at risk of CVD. Lp(a) is largely genetically determined, though lifestyle and diet can decrease the clotting potency of Lp(a) present.

• Lipoprotein fractionation is one of the most advanced cholesterol tests. It provides info on the sizes present in your bloodstream of each lipoprotein type.

*You can likely ask to include most of these tests during an annual physical, which should be covered under most insurance plans. The advanced tests and imaging will be separate and probably out-of-pocket.