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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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February 16, 2009

Dear Mark: Blood Markers

By Mark Sisson
68 Comments

Dear Mark,

Could you write an article on blood “markers” (cholesterols, triglycerides, blood sugar and … C-reactive protein)??? What are they?  How can they be monitored and managed? Thanks mucho!  Can’t wait for your book.

Thanks to Rob for the question today. Blood markers are essentially detectable and measurable substances in the blood. Their interpretations are based on the levels found and their correlations with disease or other health concerns the medical/research community has assigned to these substances. A blood workup can vary and run into the hundreds of markers, but (for today at least) let me focus on the key categories Rob mentioned.

The logical first set of readings is, of course, the cholesterol set (total, HDL, LDL, triglycerides) – a.k.a. lipid profile. It’s the one everyone gets (and insurance pays for) because the medical establishment continues to put more emphasis on cholesterol over many other heart health factors. The “total cholesterol” is calculated as the full amount of cholesterol (represented as mg/dL) being carted around in the blood by the various lipoprotein particles. In and of itself, it offers little information about heart risk or desirable/undesirable lipid profile.

The HDL particles (high-density lipoproteins) transport cholesterol from the body’s tissues to the liver, where it gets excreted through bile. A higher HDL is seen as favorable, but a more specific measure most doctors look for now is the HDL/LDL ratio. On the other end of picture is LDL (low-density lipoproteins), which transfers “new” cholesterol from the liver to the body’s tissues where it can be used for all manner of vital cell building and functioning. While HDL is often called the “good” cholesterol and LDL the “bad” cholesterol, they’re both really just two ends of the body’s self-regulatory lipid processing system. Finally, triglycerides are another form that fat takes as it travels to the body’s tissues through the bloodstream.

Now let’s get the chart on the table and then dissect. The American Heart Association offers the following recommendations for lipid profile measures:

HDL: “normal” readings vary between 40-50 mg/dL for men and 50-60 mg/dL for women; above 60 mg/dL considered “protective”

LDL: less than 130 mg/dL considered good; less than 100 considered “optimal”

Triglycerides: less than 150 mg/dL considered “normal”

Total Cholesterol (add 1/5 triglyceride measure to LDL and HDL numbers): under 200 mg/dL considered “desirable”

As for the HDL/LDL ratio, between a .3 and .4 (or higher) is generally seen as desirable.

Scalpel, please? First off, most people get their cholesterol profiles done every five years (what most insurance pays for (especially for younger folks) unless they’re currently diagnosed with heart disease or labeled “at risk.” Your lipid profile is much more flexible than a five-year window suggests. Even a few weeks (or, in some cases, a few days) will alter numbers substantially. In other words, a single reading is a snapshot and that’s about it. Nonetheless, let’s see what we can salvage.

First let me take on triglycerides. I think this measure gets short shrift. While the other lipid measures, I’ve said before, can act as red herrings, this marker can be telling in and of itself and is very often linked to other “bad” lipoprotein readings – low HDL and high LDL, including high VLDL (very low density lipoproteins – bigger, more pillowy particles that are largely composed of triglycerides). High triglycerides are considered a “lifestyle” measure and strongly correspond with a high carb diet, smoking and low physical activity. They correlate with not only an increased risk of heart disease in general but inflammation and insulin resistance. Another reason lipid analysis cannot stand on its own….

Another point? LDL and HDL measures are only the tip of the iceberg. These lipoproteins, usually measured as single categories, actually contain particles of varying size and alleged corresponding detriment. Smaller particles, many experts suggest, are more risky or at least less desirable. In essence, smaller HDL particles are less protective, and smaller LDLs are believed to be bigger contributors to artery plaque. And guess what kind of diet fuels high numbers of smaller low density lipoproteins? Not saturated fat, but… (drum roll) All together now: a high carb diet! Surprise, surprise….

It’s important to mention that a relatively small but increasing number of medical specialists would say that the traditional lipoprotein blood tests may not be the best way to measure your lipid profile. Better testing, many believe, can be achieved with other lipoprotein analysis tests such as liquid chromatography, Gel Electropheresis (GGE), density gradient centrifugation or NMR (Nuclear Magnetic Resonance). These techniques provide more detailed analysis of actual lipoprotein subfractions and can offer a fuller picture of particle size breakdowns.

We could talk forever and a day about lipids, but there are so many other nifty blood markers to discuss. Onward, shall we? Now for a favorite category of blood markers: blood sugar. We’ll include glucose and A1C levels here. A simple blood glucose test is usually administered after an 8 hour fast. A blood sample is taken to measure fasting glucose levels, or sometimes a fasting reading is followed by an oral glucose tolerance test (OGTT), in which the person drinks a glucose solution and has his/her glucose levels subsequently tested at given time intervals to see how well the body “processes” the sugar. The American Diabetes Association offers the following guidelines for glucose testing levels:

Fasting Glucose
70-99 mg/dL (3.9-5.5 mmol/L) considered “normal”
100-125 mg/dL (5.6-6.9 mmol/L) considered “impaired”
126+ mg/dL(7.0 mmol/L) suggests diabetes if measured on more than one occasion

OGTT (values not valid during pregnancy)
(As measured 2 hours following intake of 75 gram glucose solution)
<140 mg/dL (7.8 mmol/L) considered “normal”
140-200 mg/dL (7.8 to 11.1 mmol/L) considered “impaired”
200+ mg/dL (11.1+ mmol/L) suggests diabetes if measured on more than one occasion

Beyond standard glucose readings, A1C measures represent “longer term” glucose levels. Last year we reported on a New Zealand study involving 47,000 people (without diabetes) that correlated higher blood sugar levels (as measured by A1C levels) with greater mortality risk in the 4-year study window. (Causes of death: “endocrine, nutritional, metabolic, and immunity disorders” as well as “diseases of the circulatory system.”) The correlation of higher A1C levels with higher mortality risk was observed in A1C values that many hospitals consider the “normal” range. The initial “reference category” for the study was between 4.0 and 5.0%, and the highest category was 7.0% and higher, (7.0% marking a threshold defined by several health organizations including the American Diabetes Association). “Healthy” A1C readings are commonly interpreted between 4-6%, but the lower end of that range is preferable.

Finally, tests for inflammation markers like C-reactive protein are becoming more common. (I’d suggest including it in a blood workup for heart health or asking your doctor about it if you’re concerned about systemic inflammation or the possibility of an autoimmune disorder.) CRP, as it’s known, is produced by the liver and is generally only seen in trace amounts with blood tests. Its presence in the blood can be associated with infection or with systemic inflammation caused by various medical conditions, pregnancy or certain medications.

To help assess heart disease risk, the hs-CRP (highly sensitive test) is by far the better test. Though there’s some disagreement on a professional level and inconsistency in labs regarding “normal” levels, the American Heart Association offers the following guidelines for hs-CRP interpretation.

  • < 1.0 mg/L suggests “low risk” of  cardiovascular disease
  • Between 1.0 mg/L and 3.0 mg/L suggests “average risk”
  • > 3.0 mg/L suggest “high risk”

There are, indeed, other more newly recognized blood markers for inflammation out there (such as resistin, a strong biomarker for heart failure), but an hs-CRP is likely the one your doctor is most familiar with and your insurance most likely to pay for if you’re just looking for a general health overview and don’t show specific risk factors. If test results show reason for concern, your doctor can always order more specialized tests.

As mentioned, the list of blood marker tests is a mile long, and these few options are simply among the most common you’ll see. This overview is just the tip of the iceberg, I know, and I might come back to the subject in future posts if folks are interested. For now, let me say this about blood workups in general. Though the numbers might seem telling, they usually mean little in and of themselves or may indicate something seemingly unrelated (i.e. not what they talk about on the Pharma commercials). Cholesterol levels, for example, are influenced by everything from hypothyroidism to birth control pill use. Medications like anti-depressants and some blood pressure prescriptions can elevate glucose levels. An hs-CRP test can be influenced by something as mundane as a recent hard workout. And even among the most common tests, there’s sometimes an appreciable difference between one lab’s results and another’s testing the same sample (look for an upcoming post on that soon).

A blood workup can give you some hard evidence to work with in assessing your health, but you’ll need a good discussion with a doctor you trust who knows your background (with perhaps some second opinions/perspectives from other practitioners and sometimes even a bit of your own digging) to connect the dots and make sense of where your numbers come from. Whether you’re investigating the possibility of a particular condition or sketching an overview of your general health, by far the longer but more important stage of the game will be piecing it all together. There might be a number of paths suggested by the tests, or they may suggest nothing when you know in your gut that something is awry. Blood markers are tools, to be sure, but the full story behind them is seldom as black and white as the numbers on the page.

Have your thoughts to add? Thanks as always for your questions and comments. Keep ‘em coming!

Further Reading:

New Biomarker for Heart Failure

The Role of Lean Muscle Mass and Organ Reserve in Aging

Hormones and Heart Disease

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68 Comments on "Dear Mark: Blood Markers"

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Grok
Grok
7 years 7 months ago

Nice article, Mark.

A few typos you might correct:

Magnetic, not Nuclear Magnesium Resonance
A1C, not AIC (you’ve got that only in 1 place, it’s right in others)

Holly
Holly
7 years 7 months ago

Thanks for the explanation. I’ll definitely be asking for further tests during my next blood work-up… not that the Primal Blueprint hasn’t put all of my levels in the “optimal/normal” spectrum!

Son of Grok
7 years 7 months ago

Great right up mark. i am all too familiar with the lipid profile as i used to need them regularly. I had an HDL below twenty which really threw off my ratio even though my LDL was in the 80’s. It took only 2 months of being primal to get my HDl back up in the 40’s while keeping my LDL in the 80’s. Good Stuff

The SoG

nonegiven
nonegiven
7 years 7 months ago

They don’t figure total cholesterol that way, they measure it directly, along with HDL and triglycerides. LDL is usually estimated by that formula rather than by direct measure.
total cholesterol – HDL – (triglycerides/5) = LDL

SuperMike
SuperMike
7 years 7 months ago

Thanks for this post. I have a couple of questions from my blood work done last summer after two years of being primal.

This is the way mine read:

CHOLESTEROL 145.00
DHDL 69.0 (flagged as high)
LDL 70.0
TRIGLYCERIDES 30.0
C/H RATIO 2.1 (flagged as low) Is this the LDL/HDL ratio?

And my fasting glucose was 109.0 (flagged as high)

My question is, “Why the flags?”

Rob
Rob
7 years 7 months ago

A high carbohydrate diet is not the only thing that adversely affects triglycerides and lipoproteins you know; in fact, it would seem that the rise of n-6 polyunsaturated fats are more to blame if anything, though carbohydrates are certainly a factor. You can easily see the trend lines if you graph out the data on this.

Snappydog
7 years 7 months ago

Following the American Diabetic Association guidelines (which I did for 7 years) I would probably be dead or living with the consequences of high blood sugars in 10 years. (The ADA recommends 200gms carbs/day). I went primal/low-carb (50 gm/day), and 4-5 days of resistance training a week a little over a year ago. I dropped 95 pounds almost effortlessly, my A1c went from 7.5% to 5% and my total cholesterol dropped from a high of 331 to normal range. All this happened within 10 months of the changes in diet.

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[…] done or will be getting it done soon, you gotta take a look at this to understand what all those blood test markers really mean. February 16, 2009 | Filed Under […]

Rob
Rob
7 years 7 months ago

Wow, I feel so very special today – an MDA post from a question that I asked.

Thanks Mark & crew,
Rob (not the same “Rob” as above)

Dr. Corey R. Duvall
7 years 7 months ago
A solid understanding of stress physiology lends a solid, unifying theory to these blood-markers. The sympathetic nervous system is commonly known as the “fight or flight” system. Speaking evolutionarily, when we saw a tiger we needed to either fight or escape and our body has adapted a way to make that most effective. This physiology mirrors chronic disease. Cholesterol production rises: LDL cholesterol is a potent clotting factor. If we are attacked we should damn well be able to clot our blood. Triglycerides increase: we need energy in the muscles to get us away from danger. Insulin resistance increases: We… Read more »
Danielle T
7 years 7 months ago
Thanks Dr. Duvall for the informative post. Any suggested reading to learn more about stress physiology? I used to be so stressed. I used to just be awake all night worrying about things, heart pounding. I thought it was work-related stress, but I now understand it was the MSG and chemicals in processed food causing physical reactions, general poor nutrition and lack of exercise. There’s always SOMETHING there to worry about and if conditions are right, it can manifest itself in extremely negative ways. Now things just don’t bother me as much–and seldom do they mess with my sleep. Excercise… Read more »
zbiggy
zbiggy
7 years 7 months ago
SuperMike, my suggestion on “why the flags” is that so high HDL as yours is rarely seen, hence it drops out of normal range (but in a positive way – nothing to worry about). > C/H RATIO 2.1 (flagged as low) Is this the LDL/HDL ratio? no, it’s total – to – HDL ratio your LDL/HDL is about 1.0 (very desirable in the light of Mark’s > And my fasting glucose was 109.0 (flagged as high) this is due to your low level of insulin – most people got it below 100 because they have insulin in their blood, you… Read more »
Steve
Steve
7 years 7 months ago

Mark,
I’m a bit confused. Are you saying that a high VLDL is good or bad? What is considered an appropriate VLDL measurement?

Dr. Corey R. Duvall
7 years 7 months ago
Danielle T: Unfortunately I do not have any “good” reads on this. I have looked, not hard, for entertaining and substantial compilations and they are not present. What I have read is largely scientific journals. Doing a search on Pubmed.com for stress physiology and any aspect you are interested about should give you some good info. Most of the information I have gathered requires sifting for the good stuff. I believe people pay for diplomas and certifications, but their education is up to them. As such, you too can educate yourself largely for free. All it takes is time. A… Read more »
Daniel
7 years 7 months ago

very interesting article… really enjoyed it. I think i’m relatively clued up on nutrtion but this definitely ads to my knowledge

Mark Sisson
7 years 7 months ago
SuperMike, zbiggy did a good job of answering (sorry I couldn’t get to this sooner). Yeah, your numbers are great and “to be expected” from what I see. I love it that the lab will put ranges, and when you are out of the range on the “good” side, they still flag it as abnormal. It’s sorta like the BMI charts that suggest that if I put on ten more pounds of muscle, my skinny ass will be classified as “overweight”! Furthermore, it might be interesting to borrow a friends glucose monitor (I know we all have friends with t2!)… Read more »
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[…] “Blood Markers” Published in: […]

Trinkwasser
Trinkwasser
7 years 7 months ago

Couple of good sources concerning lab tests

http://www.labtestsonline.org/index.html

http://www.labtestsonline.org.uk/

Availability in the UK is often limited by accountants, I have to bribe the vampire to get a Full Lipid Panel containing useful information (trigs/HDL ratio is a marker of insulin resistance and also cardiovascular risk) they want to use the cheaper but pointless TChol. Doctor looks the other way as she gets the (usually excellent) results without getting blamed for wasting money

A Primal Type diet decimated my trigs (literally) and doubled HDL. This simply wouldn’t have showed in the TChol numbers.

Helen Kennaway
Helen Kennaway
7 years 7 months ago

Please can you help me? I went to the doctor as a lay person with lower abdominal pain 5 weeks ago and was told my Markers were well up, instead of 3-4 they were 200. ESR not normal either. I am confused, no other explanation given! I have had breast cancer treated 5 years ago but this visit had not been feeling well for a few days only. Please can you explain in simple terms what the figures are and the scale used?
Thank you so much,
Helen Kennaway.

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[…] animals as much as a whopping 60 percent. Some weeks back Mark offered up a rundown of common blood markers. Triglycerides, he proposed, are too often given short shrift in the whole cholesterol […]

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[…] obsessive-compulsive desire to reach a certain arbitrary weight, lean muscle mass and healthy body markers be damned. Don’t obsess over a number! Listen to your body. If you subscribe to the Primal way of […]

Nancy Loetterle
Nancy Loetterle
6 years 11 months ago

I was just notified by my doctor that
they wanted me to see an oncoloty doctor.
I have lost 6 pints of blooe in the last
6 months and my hemo. is 9.4,Red blood
cellw 3.7 and my Hemo-something or other
is 29.3. Needless to say I am looking
into the subject. If you can help me
understand what they are trying to say
I would appreciate your comments.
Sincerely,
Nancy Loetterle

Jeanine
Jeanine
6 years 7 months ago
Dear Mark, I am an avid primal follower, an elite endurance athlete and a biochemist (only mentioning this so you know a bit of my background in asking my question. I have what might be a unique question…. I had my fasting blood work done the day after Valentine’s day. That is significant because I just so happened to go off the primal wagon on Valentine’s day and had some wine and chocolate. My blood work the following morning showed my fasting glucose was high. The doctor wanted me to reschedule my blood work (either because she thought I ate… Read more »
Mark Sisson
6 years 6 months ago

Jeanine, if you are eating Primal and exercising as an elite athlete, it’s unlikely you have serious BG issues. I’d need to know exact numbers to comment further, though. You can send them to me at the contact info on this site if you wish.

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6 years 7 months ago

[…] Blood Test Markers – HDL, LDL, Triglycerides, Fasting Glucose? What do all the numbers on your blood test mean, and what are they worth? This post explains. […]

Larry Githens
Larry Githens
6 years 3 months ago
Dear Mark I’ve been a Type II Diabetic for a number of years. I am now 71. My A1C about 6 months ago (Dec ’09) was 8.2. I got my A1C results back for June 25th..they were 6.5!! Doctor is amazed. He wants me to keep doing what I’m doing which is the Primal plan. I’ve been doing Primal since January of 2010. Stopped eating bread, gains, bad carps, etc. eating good protein and carbs. Lost about 5-8 pounds. now 185. What in your eating plan is giving me such a great A1C for a diabetic?
Mark Sisson
6 years 3 months ago

Nice work, Larry. A1C is a measurement of the average amount of sugar in your bloodstream over the past 120 days. When you have less glucose floating around, as you do on a PB eating strategy, less of it gets “stuck” to hemoglobin. Lower A1C means your risk for heart disease and a number of diabetes-related conditions is now lower. Keep up the great work.

CSJ
CSJ
6 years 2 months ago

Hold the phone. We don’t necessarily want low LDL levels, do we? I mean, that would mean low pattern A LDLs as well, then isn’t it kinda saying that our liver can’t deliver cholesterol efficiently because there’s a shortage of LDLs? Couldn’t one argue that the LDL reading is completely irrelevant unless you had your blood analyzed on a machine that can differentiate between pattern A and pattern B LDLs?

Ashley
Ashley
5 years 11 months ago

I’m rather befuddled by the Pattern A versus Pattern B.

My VLDL is 11 (range 10 – 120). This means that my VLDL is low. What pattern does this indicate? The printout doesn’t say anything about a “pattern.”

Ashley
Ashley
5 years 11 months ago

I’ll add that the total cholesterol was 204 (HDL = 95, LDL calc = 95) and the triglycerides were 54.

Mark Sisson
5 years 11 months ago

@Ashley, with an HDL of 95 and trigs of 45, I’d say you have impressively great numbers. Don’t sweat it. But I’m not a doctor and this is just a comment on your comment 😉

Ashley
Ashley
5 years 11 months ago

Thanks mark! I’ll update my post if I learn anything new. Have been loving your recipes!!

Ashley
Ashley
5 years 8 months ago

Hi Mark,
Just wanted to follow up on this. I had new bloodwork done since the last report (since I’ve started the primal/paleo lifestyle in earnest), and the CRP dropped from 3.7 to 1.1, the trigs from 54 to 31, the total cholesterol from 204 to 185, LDL from 95 to 85, HDL stayed at 98, VLDL dropped from 11 to 5. The primal style is clearly working for me! Subbing out tons of fruit and incorporating a nightly 85% dark chocolate bar hasn’t seemed to have hurt me at all. Thanks Mark, for all that you do!
Cheers,
Ashley

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[…] the higher your HDL the better.) My LDL (I’m not calling it “bad” because, as Mark points out, both HDL and LDL serve vital purposes in our bodies and we need both) is 92. For good health […]

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[…] It’s interesting, but not really that surprising, that the intervention didn’t affect lipid numbers. LDL, HDL, and triglycerides remained pretty much the same across both groups. The heaviest impact […]

Mark Sisson
5 years 8 months ago

That’s what I’m talkin’ about, Ashley….

Dave
Dave
5 years 7 months ago

Hi
Just had a blood test, here are the reults:

Total Cholesterol 8.1 mmol(313)
HDL 2.5 mmol(96)
LDL 5.9 mmol(228)
Trigs 0.87

My LDL seems high, any thoughts anyone?

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[…] that they cause us harm, but I find it very interesting that in animal studies the bodies’ lipid clearance mechanisms are upregulated whenever oxidized fats come on the […]

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[…] serum lipid stability. It either reduces markers of oxidative stress or increases the resistance of lipids against oxidizing. And in the studies that showed no benefit, there were also no negatives. It was […]

kerry
kerry
4 years 9 months ago
I have booked into the doctor to get some blood work done. My CW partner is insisting that if I’m going to cut out a whole bunch of food groups, then I should monitor and watch for negative indicators. That’s fine, makes sense, and I maybe able to convince him to join the Primal way. (only problem is I’ve always had excellent blood pressure and cholesterol, so he won’t be convinced its the diet doing great things). Anyway, the real reason for this post is to get a list of tests that I can ask my doctor for. Nothing too… Read more »
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[…] serum lipid stability. It either reduces markers of oxidative stress or increases the resistance of lipids against oxidizing. And in the studies that showed no benefit, there were also no negatives. It was […]

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[…] different types of lipoproteins. They’re not actually cholesterol. I discussed this briefly a couple years back, and there’s always Griff’s big primer in the forum, so take the time to go check out […]

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4 years 8 months ago

[…] was sixteen years old (you can tell), but the results are what matter (read some success stories). Blood test results don’t lie, and a common criticism of the Atkins diet – its strict limit on vegetables – […]

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[…] the certainty?  But I’ll mention it to the dr, like I already want to get blood work and cholesterol tests, maybe add the celiac antibodies one as well if she thinks it’s worthwhile.  One thing that […]

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4 years 1 month ago

[…] It’s interesting, but not really that surprising, that the intervention didn’t affect lipid numbers. LDL, HDL, and triglycerides remained pretty much the same across both groups. The heaviest impact […]

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[…] finally, the blood test you just got was a snapshot in time. Far more troublesome would be an upward trend of CRP, or a […]

trackback
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[…] the higher your HDL the better.) My LDL (I’m not calling it “bad” because, as Mark points out, both HDL and LDL serve vital purposes in our bodies and we need both) is 92. For good health […]

trackback

[…] the higher your HDL the better.) My LDL (I’m not calling it “bad” because, as Mark points out, both HDL and LDL serve vital purposes in our bodies and we need both) is 92. For good health […]

trackback

[…] the higher your HDL the better.) My LDL (I’m not calling it “bad” because, as Mark points out, both HDL and LDL serve vital purposes in our bodies and we need both) is 92. For good health […]

Lisa
Lisa
3 years 5 months ago

I know that it’s been a long time since anyone commented on this article, but I have a question. I’m interested in monitoring my blood glucose and cholesterol levels on a regular basis during an n=1 experiment. I’d prefer not to shell out $100+ every time I want to have my blood tested. Has anyone used an at-home cholesterol test kit? I know it’s probably not as reliable as one done in a lab. Also, how about a blood glucose meter? Is it worth purchasing either of these tools? Thanks!

trackback
3 years 1 month ago

[…] – a large part  of your story. That said, know  the numbers you should prioritize. Bond over lab sheets. Talk  technical stuff where it’s […]

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2 years 8 months ago

[…] like the energy and vigor to tackle this year? What do you wish were possible for your body, your blood markers, your life satisfaction? That vision you conjured – you deserve it. Why would you accept anything […]

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[…] I see a patient with the symptoms of chronic inflammation, we first get their blood work done, to see what their lipid profile can tell us. A high number of LDLs in the blood suggests […]

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