Important lab tests to assess your Metabolic Health!


Have you ever tried to make sense of your routine blood test, only to not understand anything? Most often than not, we are dismissed by the doctor, saying everything looks fine on the blood test, even when we are not feeling at our best.

Read further to understand what the lab results mean, and be empowered to take your health into your own hands.

Most of us get a standard panel of blood tests like CBC, cholesterol, glucose, etc, every year or so. We assume that if any particular result is too high or low, the doctor will let us know. The problem comes in, as most of the time the results are not interpreted well, and a patient is often dismissed by saying, “everything looks good, see you next time”. Maybe some of you may google the number and find out what it means, but even when you do, it’s difficult to know what that high or low number actually means. This is not the path to optimal health.

Learning how to make sense of those numbers could be such an empowering tool for you and your loved ones, to take charge of your own health, address any underlying imbalances in time, and get the help you need before it’s not too late.

In functional medicine, we consider optimal ranges for blood work rather than standard ranges. An optimal range is a much tighter range than the standard one. They are so, because functional medicine works in a way, for the body to have thriving health and to be operating at an optimal level.

It’s also important to understand that none of the blood work markers work in isolation, but represent inter-related systems in your body, and give a lot of meaningful insight into what is happening in the body.

Let’s understand some key lab markers:

Fasting glucose – Blood glucose is a standard screening test for diabetes. It is done by checking blood glucose levels after not having any food for at least eight hours before the test. This test can further be classified into three categories, depending upon the glucose levels: normal, prediabetes, and diabetes. To be considered “normal,” fasting glucose must be under 90 mg/dl. This marker tells us the blood sugar levels which are unaffected by a recent meal.

Optimal levels <90 mg/dl.

Level >100 mg/dl, indicates insulin resistance or prediabetes.

Fasting insulin – this marker shows the level of insulin hormone, unaffected by a recent meal. The body does everything to maintain fasting glucose levels <100 mg/dl, even if it has to pump more insulin, to shuttle more glucose into the cells, and to maintain blood sugar levels. Many traditional doctors do not advocate getting a fasting insulin test, but this marker is a true indicator of prediabetes! One can have elevated levels of fasting insulin and perfect levels of fasting glucose or even post meal glucose. It is a very significant test when considering metabolic health.

Optimal levels: 2-6 iu/dl. Anything above 15 iu/dl, means insulin resistance and risk of metabolic disease.

Hemoglobin A1c – this test measures blood glucose levels over a period of 3 months, by the process of glycation. Glycation is the process by which glucose levels attach to haemoglobin in the red blood cells. This value is expressed as the percentage of haemoglobin molecules that are glycated. This blood marker indicates the presence of excessive sugar in the bloodstream over a period of three months. The fraction of glycated haemoglobin increases in a predictable way and is associated with metabolic diseases. This test, however, has its limitations as it is not a reflection of what’s happening day to day, like glucose variability. It can also be falsely low in some people, indicating hypoglycaemia at night.

Optimal : <5.0%

Normal: <5.7%

Prediabetes: 5.7–6.4%

Diabetes: >6.4%

Post-meal/ postprandial glucose – this test measures the level of glucose post 2 hours of eating meals. Repeated postprandial high levels of glucose are contributors to many metabolic diseases and insulin resistance. A higher blood sugar level over time, damages blood vessels, and can lead to atherosclerosis.

Optimal levels- 110-115 mg/dl 2 hours after meal

LDL-C – Low-density lipoprotein cholesterol is a key marker to access in traditional medicine, as there are drugs like statins designed to deal with it.

LDL-C is not a great predictor of who will suffer a heart attack. More people are suffering heart attacks with lower LDL-Cs than before because the standard test of cholesterol assumes all the LDL particles are the same. But there are two different LDLs, and the lipid profile test measures them together.

The majority (approx. 80%) of circulating LDL species are called large buoyant, or type-A LDL, which are increased by dietary fat consumption. This is the species reduced by eating low-fat diets or taking statins. However, large buoyant LDL molecules are cardio-vascularly neutral – meaning it’s not the particle driving the accumulation of plaque in the arteries leading to heart disease.

There’s a second, less common (only 20%) LDL species called small dense or type-B LDL, and that is predictive of risk for heart attack. The problem is that statins will lower your LDL-C because they are lowering the type-A LDL, but they’re not doing anything to the type-B LDL, which is the problematic particle.

But what causes these small dangerous cholesterol particles? It is the sugar and refined carbohydrates in our diet. Insulin resistance causes these small cholesterol particles to form, and taking statins won’t fix the problem. The NMR (Nuclear magnetic resonance- unavailable in India) test for cholesterol is one of the most essential tests in evaluating the degree of insulin resistance and cardiovascular risk. Smaller particles are dangerous as they damage arteries and put your health at greater risk.

Optimal: <70 mg/dl

Normal: <100 mg/dl

High Risk: >150 mg/dl

HDL-C – High-density lipoproteins are a type of complex molecules made of proteins and fat, that carry cholesterol in the blood. When cholesterol is in an HDL particle, it is sometimes called “good” cholesterol because HDL carries oxidized cholesterol back to the liver (from the tissues), where it is broken down and passed out of the body through waste.

HDL-C removes lipids from cells and blood vessels. A high level is considered protective against heart disease. A low HDL level accelerates the development of atherosclerosis (hardening of the arteries) due to impaired reverse cholesterol transport, and is associated with an increased risk for coronary heart disease.

Increased intake of virgin olive oil, nuts, legumes, whole grains, and fish improves HDL functionality. Blue and red colored plants contain anthocyanins which make positive changes to HDL function. Pomegranate seeds and green tea also have been shown to allow HDL to better transport LDL out of the cells, thereby reducing the risk of HDL dysfunction.

Optimal: >60 mg/dL

Normal: 50–60 mg/dL

Low: <50 mg/dL

High Risk: <40 mg/dL

Triglycerides – A type of lipid stored in fat cells when calories are consumed in excess or unused; mainly carried through the blood by very-low-density lipoproteins (VLDL), which become LDL once they give up their triglycerides.

High levels of triglycerides indicate consumption of a high carbohydrate and high sugar diet, which are the main drivers of metabolic syndrome and insulin resistance. Replacing refined and processed foods with whole unprocessed food, rich in fiber, can help in reducing triglycerides.

Optimal: <100 mg/dL

Normal: 100–150 mg/dL

High Risk: >150 mg/dL

Total Cholesterol – a measure of the total of HDL and LDL cholesterol.

Optimal: < 180 mg/dl.

Standard: 75–169 mg/dL for those age 20 and younger.

100–199 mg/dL for those over age 21.

Triglycerides to HDL ratio – This test is the best way to check for insulin resistance. If the ratio is high, then your risk for a heart attack increases alarmingly. This is because as triglycerides go up, HDL or good cholesterol goes down with insulin resistance. To calculate, just divide your triglyceride number with HDL number to get the ratio.

Optimal- 2:1, Normal- <4:1, Anything above is at high risk.

Hs CRP (High sensitivity C-reactive protein) – A protein made by the liver that rises in blood concentration when you have inflammation.

It is one of the easiest ways to measure hidden inflammation in the body. High CRP levels are found in those with obesity, heart disease, diabetes, Alzheimer’s disease, leaky gut, infection, cancer, sleep disorders (like sleep apnea), and other states of chronic inflammation.

Inflammation is a key driver of metabolic dysfunction, and metabolic dysfunction leads to further inflammation. It’s a vicious cycle!

Ideal: <1.0 mg/L

Average: 1.0–3.0 mg/L

High: 3.0–6.0 mg/L

High Risk: >6.0 mg/L

Although LDL cholesterol (LDL-C) is associated with an increased risk of coronary heart disease, other lipoproteins, and their constituents, apolipoproteins, may play an important role in atherosclerosis and cardiovascular disease. Elevated levels of apolipoprotein (apo) B, a constituent of atherogenic lipoproteins, and reduced levels of apo A-1, a component of anti-atherogenic HDL, are associated with increased cardiac events. Apo B, apo A-1, and the apo B/apo A-1 ratio have been reported as better predictors of cardiovascular events than LDL-C.

Apo A -1

Adult males: 75-160 mg/dL

Adult females: 80-175 mg/dL

Apo B:

Lower risk<100 mg/dl

High risk >110 mg/dl

APO B: APO A- 1:

Lower risk: <0.6

Average risk: 0.6-0.8

Higher Risk: >0.8

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Functional Nutritionist & Functional Medicine Practitioner

Smriti is a leading Health Coach and Functional Medicine Practitioner, based out of Gurgaon, India.