Advanced Blood Work Guide: How to Read and Optimize Your Biomarkers for Longevity

Beyond “Normal” — The Optimal Range

Your doctor runs a blood panel and says, “Everything’s normal.” You feel relieved—but should you be?

Here’s the problem:

“Normal” is based on population averages—not optimal health
Reference ranges often include sick people
Being “in range” doesn’t mean you’re optimized for longevity

Example:

Fasting glucose:
- “Normal” range: 70-99 mg/dL
- But 95 mg/dL is already pre-diabetic territory
- Optimal for longevity: 70-85 mg/dL

The truth: There’s a difference between “not sick” and “optimized for performance and longevity.”

This guide teaches you:

What biomarkers to test (comprehensive panel)
How to interpret results (optimal vs. normal)
Root causes of suboptimal levels
Actionable strategies to improve every marker

Part 1: The Longevity Blood Panel

What to Test (Core Panel)

1. Metabolic Health

Fasting glucose
Fasting insulin
HbA1c (glycated hemoglobin)
Triglycerides
HDL cholesterol
ApoB (apolipoprotein B)

2. Inflammation

hs-CRP (high-sensitivity C-reactive protein)
Homocysteine
Fibrinogen (optional)

3. Cardiovascular Risk

ApoB (most important)
LDL particle number (LDL-P or NMR LipoProfile)
Lp(a) - Lipoprotein(a)
Omega-3 Index

4. Hormones (Men)

Total testosterone
Free testosterone
SHBG (sex hormone binding globulin)
Estradiol (E2)
DHEA-S
Cortisol (AM)

5. Thyroid Function

TSH (thyroid-stimulating hormone)
Free T3
Free T4
Reverse T3 (if symptoms present)

6. Liver & Kidney Function

ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
GGT (gamma-glutamyl transferase)
eGFR (estimated glomerular filtration rate)
Creatinine

7. Vitamins & Minerals

Vitamin D (25-hydroxyvitamin D)
Vitamin B12
Folate
Magnesium (RBC magnesium, not serum)
Iron panel (ferritin, TIBC, serum iron)

8. Advanced (Optional)

IGF-1: Growth hormone proxy
Uric acid: Metabolic health, gout risk
Leukocyte telomere length: Biological age (expensive, limited utility)

Where to Get Tested

Option 1: Through Your Doctor

Annual physical exam (basic panel)
Insurance may cover
Limited (won’t include advanced markers like ApoB, insulin)

Option 2: Direct-to-Consumer Labs

PrivateMDLabs (nationwide, affordable)
UltaLab Tests
Quest/LabCorp (walk-in, no doctor needed)
Cost: $150-500 for comprehensive panel

Option 3: Longevity-Focused Services

InsideTracker ($589): Blood test + AI-driven recommendations
Function Health ($499/year): Quarterly testing + tracking
Marek Health (subscription): TRT/longevity clinic with regular testing

Frequency:

Baseline: Once to establish levels
Active optimization: Every 3-6 months
Maintenance: Annually (or biannually)

Part 2: Metabolic Health Biomarkers

1. Fasting Glucose

What it measures: Blood sugar after an overnight fast (8-12 hours)

Reference range: 70-99 mg/dL

Optimal range: 70-85 mg/dL

Interpretation:

< 70: Possible hypoglycemia (check insulin, cortisol)
70-85: Optimal (low risk of diabetes, longevity-associated)
86-99: Elevated (pre-diabetic territory, insulin resistance developing)
100-125: Pre-diabetes (high risk of Type 2 diabetes)
≥ 126: Diabetes (on two separate tests)

How to improve:

Lose body fat (especially visceral fat)
Intermittent fasting (16:8 or OMAD)
Low-carb diet (< 100g carbs/day if insulin resistant)
Exercise: Zone 2 cardio + resistance training
Supplements: Berberine (500mg 3x/day), Chromium, Alpha-lipoic acid

2. Fasting Insulin

What it measures: Baseline insulin levels (markers of insulin resistance)

Reference range: 2-25 µIU/mL (varies by lab)

Optimal range: < 5 µIU/mL

Interpretation:

< 3: Very low (possibly too low if fasting glucose is also low)
3-5: Optimal (excellent insulin sensitivity)
6-10: Moderate (room for improvement)
> 10: Insulin resistance (high risk of metabolic syndrome)

Why it’s critical:

Fasting insulin is a better predictor of metabolic health than glucose
You can have “normal” glucose with elevated insulin (your pancreas is working overtime)

How to improve:

Same as glucose (weight loss, fasting, low-carb, exercise)
Metformin: 500-1000mg daily (requires prescription)

3. HbA1c (Glycated Hemoglobin)

What it measures: 3-month average blood sugar (% of red blood cells with glucose attached)

Reference range: < 5.7%

Optimal range: < 5.2%

Interpretation:

< 5.0%: Excellent
5.0-5.2%: Optimal
5.3-5.6%: Elevated (early insulin resistance)
5.7-6.4%: Pre-diabetes
≥ 6.5%: Diabetes

How to improve:

Same as glucose and insulin
Takes 3 months to see changes (reflects RBC lifespan)

4. Triglycerides

What it measures: Fat in the blood (marker of metabolic health)

Reference range: < 150 mg/dL

Optimal range: < 70 mg/dL

Interpretation:

< 70: Optimal (longevity-associated)
70-100: Good
100-150: Elevated (insulin resistance, excess carbs)
> 150: High (metabolic syndrome, high cardiovascular risk)

Root causes:

Excess dietary carbs (especially sugar, refined carbs)
Alcohol consumption
Insulin resistance

How to improve:

Reduce carbs (especially sugar, fructose)
Eliminate alcohol
Omega-3 supplementation: 2-4g EPA/DHA daily
Exercise: Cardio + strength training

5. HDL Cholesterol (“Good” Cholesterol)

What it measures: High-density lipoprotein (removes cholesterol from arteries)

Reference range: > 40 mg/dL (men)

Optimal range: 50-80 mg/dL

Interpretation:

< 40: Low (increased cardiovascular risk)
40-50: Moderate
50-80: Optimal
> 80: Very high (usually genetic, check for dysfunction)

How to improve:

Exercise (especially HIIT and strength training)
Omega-3s: 2-4g daily
Moderate alcohol (1 drink/day—but alcohol has other downsides)
Niacin (Vitamin B3): 500-2000mg (causes flushing, consult doctor)

6. ApoB (Apolipoprotein B)

What it measures: Number of atherogenic (artery-damaging) particles

Why it’s THE most important lipid marker:

Each LDL, VLDL, and Lp(a) particle contains ONE ApoB protein
ApoB = total number of “bad” particles
More predictive of heart disease than LDL cholesterol

Reference range: < 100 mg/dL

Optimal range: < 60 mg/dL (longevity-focused)

Interpretation:

< 60: Optimal (very low CVD risk)
60-80: Good
80-100: Elevated (moderate risk)
> 100: High (significant cardiovascular risk)

How to improve:

Lose body fat
Low-carb diet (reduces VLDL particles)
Omega-3s: 2-4g daily
Niacin: 500-2000mg (lowers ApoB)
Statins (if extremely high and other interventions fail)

Part 3: Inflammation Biomarkers

1. hs-CRP (High-Sensitivity C-Reactive Protein)

What it measures: Systemic inflammation (liver produces CRP in response to inflammation)

Reference range: < 3.0 mg/L

Optimal range: < 0.5 mg/L

Interpretation:

< 0.5: Optimal (low inflammation)
0.5-1.0: Low-moderate
1.0-3.0: Moderate (chronic inflammation)
> 3.0: High (significant inflammation, check for infection or autoimmune disease)

Why it matters:

Chronic inflammation drives aging (“inflammaging”)
Elevated hs-CRP predicts heart disease, stroke, Alzheimer’s

Root causes:

Obesity (fat tissue is inflammatory)
Poor diet (sugar, seed oils, processed foods)
Gut dysbiosis (leaky gut → endotoxins in blood)
Chronic stress
Lack of sleep

How to improve:

Lose body fat
Anti-inflammatory diet: Omega-3s, polyphenols, vegetables
Eliminate: Sugar, seed oils, processed foods
Exercise: Zone 2 cardio
Supplements: Omega-3 (2-4g), Curcumin (500-1000mg), NAC (600mg)

2. Homocysteine

What it measures: Amino acid byproduct (marker of methylation and inflammation)

Reference range: 5-15 µmol/L

Optimal range: < 7 µmol/L

Interpretation:

< 7: Optimal
7-10: Acceptable
10-15: Elevated (increased CVD risk, cognitive decline)
> 15: High (serious risk)

Root causes:

B-vitamin deficiencies: B12, B6, Folate
Genetic mutation (MTHFR gene—impairs folate metabolism)

How to improve:

Methylated B-Complex:
- Methylfolate (L-5-MTHF): 1mg
- Methylcobalamin (B12): 1mg
- P-5-P (B6): 50mg
TMG (Trimethylglycine): 500-1000mg

Part 4: Cardiovascular Biomarkers

1. Lp(a) - Lipoprotein(a)

What it measures: Genetic cardiovascular risk factor

Reference range: < 30 nmol/L (or < 14 mg/dL)

Optimal range: < 10 nmol/L

Interpretation:

< 10: Low risk
10-30: Moderate
30-50: High
> 50: Very high (3-4x increased heart attack risk)

Why it’s unique:

Genetically determined (you inherit this from parents)
Does NOT respond to diet or exercise
Test once (it doesn’t change over time)

How to “manage” (you can’t lower it, but you can mitigate risk):

Aggressively manage other risk factors: ApoB, blood pressure, inflammation
Omega-3s: May reduce oxidation of Lp(a)
Niacin: May lower Lp(a) by 20-30% (controversial)
PCSK9 inhibitors (statins don’t work for Lp(a))

2. Omega-3 Index

What it measures: % of red blood cell membranes composed of EPA + DHA

Reference range: N/A

Optimal range: ≥ 8%

Interpretation:

< 4%: Very low (high cardiovascular risk)
4-8%: Suboptimal
≥ 8%: Cardioprotective (longevity-associated)

How to improve:

Eat fatty fish: Salmon, sardines, mackerel (3-4x/week)
Supplement: 2-4g EPA/DHA daily
Retest in 3-6 months

Part 5: Hormone Biomarkers (Men)

1. Total Testosterone

Reference range: 300-1000 ng/dL

Optimal range (men 40+): 600-900 ng/dL

Interpretation:

< 300: Clinical hypogonadism (consider TRT)
300-500: Low-normal (optimize naturally)
500-700: Mid-range
700-1000: Optimal
> 1000: Suspect exogenous testosterone or tumor

How to optimize:

See dedicated testosterone optimization article
Key strategies: Sleep, strength training, body fat < 15%, micronutrients (Zinc, Vitamin D, Boron)

2. Free Testosterone

Reference range: 9-30 pg/mL

Optimal range: Top 25% for your age

Why it’s more important than total:

Only free testosterone is biologically active
Total testosterone can be “normal” while free is low (due to high SHBG)

3. Estradiol (E2)

Reference range (men): 10-40 pg/mL

Optimal range: 20-30 pg/mL

Interpretation:

< 10: Too low (joint pain, low libido, brain fog)
10-20: Low-normal
20-30: Optimal
> 40: High (gynecomastia, water retention, mood issues)

How to manage high estradiol:

Lose body fat (aromatase in fat converts testosterone → estrogen)
DIM (Diindolylmethane): 200mg daily
Cruciferous vegetables: Broccoli, cauliflower
Aromatase inhibitors (if on TRT and estrogen is extremely high)

Part 6: Thyroid Biomarkers

1. TSH (Thyroid-Stimulating Hormone)

Reference range: 0.4-4.0 μIU/mL

Optimal range: 1.0-2.0 μIU/mL

Interpretation:

< 0.4: Hyperthyroid (overactive thyroid)
0.4-1.0: Low-normal
1.0-2.0: Optimal
2.0-4.0: Subclinical hypothyroidism (sluggish thyroid)
> 4.0: Hypothyroidism

How to improve (if elevated TSH):

Check Free T3, Free T4, Reverse T3, TPO antibodies (full thyroid panel)
Iodine: 150-300mcg daily (if deficient)
Selenium: 200mcg daily (supports T4 → T3 conversion)
Avoid: Gluten (if Hashimoto’s), soy, excessive raw cruciferous vegetables

2. Free T3 (Active Thyroid Hormone)

Reference range: 2.3-4.2 pg/mL

Optimal range: Top 50% of range (3.2-4.2 pg/mL)

Why it matters:

T3 is the ACTIVE thyroid hormone (T4 is converted to T3)
Low Free T3 = fatigue, weight gain, brain fog

Part 7: Liver & Kidney Function

1. ALT (Alanine Aminotransferase)

Reference range: 7-56 U/L

Optimal range: < 20 U/L

Interpretation:

< 20: Optimal
20-40: Elevated (fatty liver, inflammation)
> 40: Significant liver damage

How to improve:

Lose body fat (reverse fatty liver)
Eliminate alcohol
Milk thistle: 300mg daily (liver support)
NAC (N-Acetyl Cysteine): 600-1200mg daily

2. eGFR (Estimated Glomerular Filtration Rate)

What it measures: Kidney function (how well kidneys filter waste)

Reference range: > 90 mL/min/1.73m²

Optimal range: > 90

Interpretation:

> 90: Normal
60-89: Mild kidney dysfunction
30-59: Moderate kidney disease
< 30: Severe kidney disease

How to protect:

Hydrate (8-10 glasses water/day)
Control blood pressure
Avoid NSAIDs (ibuprofen damages kidneys)
Limit protein (if kidney disease present—consult nephrologist)

Part 8: Vitamins & Minerals

1. Vitamin D (25-hydroxyvitamin D)

Reference range: 30-100 ng/mL

Optimal range: 50-80 ng/mL

Interpretation:

< 20: Deficient (bone loss, immune dysfunction)
20-30: Insufficient
30-50: Adequate
50-80: Optimal (longevity-associated)
> 100: Too high (potential toxicity)

How to optimize:

Supplement: 5000-10,000 IU daily (test every 3-6 months)
Sunlight: 15-30 min daily (midday, without sunscreen on arms/legs)
Take with fat (vitamin D is fat-soluble)
Add Vitamin K2: 200mcg (prevents calcium from depositing in arteries)

2. Ferritin (Iron Storage)

Reference range: 12-300 ng/mL (men)

Optimal range: 50-100 ng/mL

Interpretation:

< 30: Iron deficiency (fatigue, hair loss, brain fog)
30-50: Low-normal
50-100: Optimal
100-300: Elevated (oxidative stress, inflammation)
> 300: Very high (possible hemochromatosis—genetic iron overload)

How to manage:

If low: Iron supplementation (25mg elemental iron, with Vitamin C for absorption)
If high: Blood donation every 8-12 weeks

Part 9: Putting It All Together

The Optimal Blood Panel Summary

Marker	Optimal Range
Fasting Glucose	70-85 mg/dL
Fasting Insulin	< 5 µIU/mL
HbA1c	< 5.2%
Triglycerides	< 70 mg/dL
HDL	50-80 mg/dL
ApoB	< 60 mg/dL
hs-CRP	< 0.5 mg/L
Homocysteine	< 7 µmol/L
Total Testosterone	700-900 ng/dL
Free Testosterone	Top 25%
Estradiol (men)	20-30 pg/mL
TSH	1.0-2.0 μIU/mL
ALT	< 20 U/L
Vitamin D	50-80 ng/mL
Omega-3 Index	≥ 8%

Part 10: Action Plan

Your 90-Day Biomarker Optimization

Day 1-7: Baseline Testing

Order comprehensive panel
Get tested (fasted, morning)

Day 8-90: Interventions

Sleep: 7-9 hours/night
Exercise: Strength training 3-4x/week + Zone 2 cardio
Diet: High protein, vegetables, healthy fats. Eliminate sugar, seed oils.
Supplements: Omega-3, Vitamin D, Magnesium, Zinc

Day 90: Retest

Compare to baseline
Double down on what worked
Adjust what didn’t

Conclusion: Data-Driven Longevity

“You can’t manage what you don’t measure.”

Getting optimal bloodwork isn’t about vanity—it’s about living longer, with more vitality.

The hierarchy:

Test: Get baseline biomarkers
Interpret: Use optimal ranges (not just “normal”)
Intervene: Diet, exercise, sleep, supplements
Retest: Track progress every 3-6 months
Iterate: Refine based on results

Your biomarkers are a real-time scoreboard for how well you’re aging.

Start testing. Start optimizing. Start living longer.