7 Longevity Biomarkers to Track

Inline_Longevity_Biomarkers_10.11.17Last year, I wrote about 10 of the most interesting predictors of longevity. Many of them were subjective, but, as we all know, the objective physiological processes that occur in the human body also predict how long we live. Luckily, we can measure most of them. Some are standard at doctor’s checkups. Some require more involved (and expensive) testing. Some you can complete yourself at home with simple household objects.

But if you care at all about how well you’re doing in the longevity game, it’s worth paying attention to some of them.

Triglyceride:HDL Ratio

Also known as the atherogenic index of plasma, a high triglyceride:HDL ratio is one of the best indicators of one’s risk for heart disease. It has the added benefit of also predicting lipoprotein particle size and insulin resistance. These all impact a person’s longevity. It’s difficult to live long when you’re getting heart attacks and your insulin skyrockets if you even glance at a potato.

Sure enough, in elderly women, the T:HDL ratio predicts all-cause mortality (not just cardiovascular mortality).

A ratio of 2 or under is good. Anything above should be addressed before it worsens, and anything above 4 means trouble.

Sex Hormone Status

Our bodies use them to build tissue, build babies, and lead robust meaningful lives. Evolution is mostly concerned with propagation of the species—with reproduction. Some waning is unavoidable with the passage of time, but we shouldn’t accept levels that lower health quality and increase mortality.

In older men, low testosterone is a risk factor for early mortality. Add to that all the other examples of benefits I described in the TRT post.

It’s not just testosterone, and not just in men. Fractures are terrible for longevity, often reducing both quality and quantity of life in the elderly. In both older men and women, low T and low estrogen levels are risk factors for fractures. Sex hormones regulate the body’s response to injuries and burns. The older you get, the deadlier injuries get. A 20-year-old slips and falls and maybe gets a little bruise. If an 80-year-old slips and falls, they might break a hip.

Serum Magnesium

All minerals play important roles in health and longevity. But serum magnesium is the one that shows up time and time again. For instance, serum magnesium predicts insulin sensitivity. In peritoneal dialysis patients, those with low serum magnesium are more likely to be hospitalized. High serum magnesium predicts physical performance and appears protective against muscle-wasting in the elderly.

Plus, magnesium is safe to supplement. There’s little risk of conflict with other minerals.

Omega-6 Content of the Mitochondrial Membranes

As cellular power plants, mitochondria are perhaps the most important organelles in the body. If they don’t work well, we don’t produce ATP, the basic energy currency used by every single tissue, enzyme, endocrine pathway, and organ in the body. We’ll shut down. The aging process, some researchers have proposed, is initiated by the failure of normal mitochondrial function. Living long and living well requires healthy mitochondria.

Healthy mitochondria start with the right building blocks—the right fatty acids in the right proportions. Accumulating evidence suggests that mitochondria with a lot of omega-6 PUFAs are more prone to oxidative stress. A “PUFA-deficiency,” for example, preserves mitochondrial energy metabolism in the presence of ethanol abuse. Sounds like a nice deficiency to have.

Meanwhile, monounsaturated fat is crucial for healthy mitochondria. One of the reasons olive oil and other sources of monounsaturated fat (like avocado oil 0r lard) are so beneficial in aging is that they crowd out the mitochondrial linoleic acid and stave off mitochondrial oxidative stress.

Mitochondrial membrane fatty acid ratio tests aren’t exactly standard at most doctor’s offices. Luckily, simply eating less linoleic acid (especially from refined sources like industrial seed oils) and more omega-3s and monounsaturated fats will give you the best shot at optimal ratios.

Red Blood Cell Fatty Acid Composition

The fatty acids present in the blood are worth examining but offer only a  transient glance at the state of your health. Looking at the fatty acids that make up your red blood cells is more predictive. Generally, a higher proportion of omega-6 linoleic acid is bad for longevity and predicts earlier death and physical and cognitive decline.

The stearic acid/oleic acid ratio is another marker to check. This is called the saturation index, as stearic acid is a saturated fat and oleic a monounsaturated fat. A lower saturation index has been linked to several aging-related diseases, disorders, and declines:

More stearic (saturation) acid is better.

Many studies find correlations between RBC palmitic acid (a saturated fat) and disease, but it’s important to note that RBC palmitic acid is generally not a marker of saturated fat intake. It’s a marker of de novo lipogenesis, the creation of fat from excess carbohydrate.

Like the previous marker, RBC fatty acids aren’t easy to test, but your RBC fat ratios respond quickly to the fats you eat.

Waist Circumference

You might think that this is simple correlation. People with large waists are probably overweight or obese, with all the health issues that stem from those condition. That’s part of it, but waist circumference measures a special type of fat with unique effects on our metabolic health: visceral fat.

Visceral fat, as measured by waist circumference, is highly inflammatory. It secretes inflammatory cytokines like IL-6 which contribute to the type of systemic inflammation that’s at the root of many aging-related diseases.

That’s probably why waist circumference predicts mortality at all levels of BMI, from severely underweight to morbidly obese.

A good rule of thumb is 35 inches and under for men, 32 and under for women. That’s the ideal—something to move toward. Measure at your belly button.

Low Fasting Insulin

In both non-obese and obese people, high fasting insulin levels are associated with a greater risk of cancer mortality. Some have suggested that hyperinsulinemia is just an indictor of insulin resistance, and that insulin resistance and related diseases are the true cause for the link between high fasting insulin and mortality. While the hyperinsulinemic are usually insulin resistant, and this is a major problem, excess levels of insulin itself has deleterious effects.

Insulin helps tissues grow. That’s why bodybuilders often inject it—to increase muscle protein synthesis and stimulate hypertrophy. But insulin can make other things grow, too.

In cancer patients, for example, those who eat the most insulin-producing foods have worse cancer and overall mortality.

In middle aged adults, hyperinsulinemia predicts cancer mortality, even when you control for diabetes, obesity, and metabolic syndrome.

In older adults with type 2 diabetes, insulin use predicts mortality.

Simple Longevity Action Items…

Luckily, much of this biomarker information is actionable. They aren’t all just correlations, or genetic. You can actually improve them by improving how you eat, train, and live.

Avoid industrial seed oils. These are the richest sources of omega-6 fatty acids in the modern diet, and they’re almost always rancid and oxidized. Terrible for your mitochondria and red blood cell fatty acids.

Minimize insulin production. If you’re insulin-resistant (or don’t train hard enough to necessitate the extra glucose), eat low-carb or go keto.

Don’t snack. Better yet, try fasting sometimes or eating in a compressed window. Constant snacking means you’re not burning the fat on your body (especially the waist) and keeps your liver glycogen topped off. If liver glycogen is full, excess carbs will be converted to fat and your RBC saturation index will drop.

Eat your micronutrients and supplement with magnesium. Spend a week tracking your meals to get a sense of what it takes to consume adequate levels of minerals and vitamins. Take a magnesium supplement.

Normalize your hormones. Natural methods first.

There are certainly other biomarkers that predict longevity and long-term health and functionality, but these are some of the most accessible and actionable.

There’s more to come on the longevity issue. For now, start thinking about these biomarkers. How are you doing on them? What can you change?

Thanks for reading, everyone. Take care!


TAGS:  Aging, hormones

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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69 thoughts on “7 Longevity Biomarkers to Track”

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  1. Good post Mark, thanks so much. I’d like to know more about the harmful effects of estrogen. “The influence that estrogen holds over testosterone ideally deserves its own post” Would you please do this soon? Thank you.

  2. The only one of those that I have data for is the Triglyceride:HDL Ratio, and mine is 1.16. Is it worth requesting the others the next time my doctor runs blood tests?

      1. I think Ron was referring to the other markers mentioned in the article, hormone levels, RBC fatty acid ratios, magnesium, insulin etc.

        1. Yes, I was. Thanks for the clarification. The links are very helpful, however!

    1. 1.16 is quite good, your risk for heart disease is very low with a ratio that low.

  3. Mark nice job discussing some of the cutting edge trends on aging markers and then bringing it down to the basics. I appreciate that your advice is very practical for All people athletes, obese, old and young folks. I got out my recent blood work to calculate my tcl/hdl ratio. I have some work to do ?. I first heard of you when I saw you speak at the paleo fx conference in Austin last year. You inspired me to take a chance to start my Men’s Functional and Integrative practice (start Jan 2018). I was inspired by a lot of your failures! Any way I am a big fan of the Primalblueprint. I tell all my ER patients to get the book and marks daily ?.

  4. I recently began reading information from the CIAO Study on longevity and the importance of microcirculation. Very interesting.

  5. Appreciate this post! Would love to see more about insulin resitance and sensitivity and what to. For a normal weight, healthy person like myself — I have a fasting glucose level of 70… But if I “indulge” (which I rarely do), in something like in a couple of gluten-free pizza slices, my blood glucose rises sharply and peaks 170 or 180! I am so lost understanding why my body responds this way but I know it’s causing longevity issues! More info on blood glucose please!

    1. I think gluten free pizza might have a lot more carbs than you would guess. The Udi’s gluten free pizza crust (10 inch pizza) lists 23 grams of carbs per slice, and that’s without any toppings. Two slices, plus toppings, might have you ingesting enough carbs to make a difference in how your body handles the load. In addition, depending on the types of flour used in the crust, you may be dealing with something that is very carb dense. Just my two cents. 🙂

      1. Absolutely, Dana. Gluten-free doesn’t mean carb-free. Plus some of the ingredients used in processed GF foods are pretty darn questionable and probably best avoided.

  6. Mark Sisson saved my life in 2009. Obese, chronic low level body pain. My attention to diet and lifestyle and weight changes over the years, but I always return to Primal basics. I’m 71 and want to stay healthy as long as I can since my genes pretty much guarantee another 20-30 years.

    My last tests were nine months ago. Stunningly good! My weight wasn’t even low then. My Trig/HDL ratio is actually negative! Last spring I started supplementing with L. Reuteri, zinc, and born for, um, “men’s health.” In the last few months, magnesium. Yes indeed, they work. No supplemental testosterone needed.

    I was on Metformin for almost two years. Did you know it actually repairs insulin sensitivity? I stopped taking it. Yet, my FBG is usually is around 85, lower than the 100 of my younger days.

    To amplify on one point, saturated fats not only prevent alcoholic liver disease, they even reverse it! Do a Google/Bing search, a lot of papers on this topic. I’m a heavy drinker and yet my liver enzymes are always excellent.

    My only “beef” with this post is the matter of waist size. When I had a 34″ waist I was skinny. I have read about waist/height ratios, but I think that’s bogus, too. Per the standard (I don’t recall what it is), I was allegedly barely healthy when I was at my prime. I’ve now age shrunk almost two inches, still 6’1″, and by that metric I am now obese. Yes, I do have some subcutaneous, not visceral, fat on my belly, but otherwise I still cut a fine figure in clothes.

    Last night I tried on a suit from 1994, just a tiny bit snugger. I wore it then on a life changing first date. Although Carol and I have long since parted romantically, we are still friends. I saw her in 2009 just before discovering Mark, I was embarrassingly fat. In August, I visited family and her and was able to say, “I weigh the same as I did when we were dating.” She can’t say the same, but she still looks better than almost any other 63 year old woman.

    Sorry for the ego ramble!

    1. I agree that waist circumference isn’t indicative of much. Some people are naturally more straight up and down than others and have never had much of a waist. Also, waist size in a woman often does increase following the birth of one or more children. That doesn’t necessarily mean she’s obese or even overweight. Overall body fat/composition and belly flatness need to be considered–not just waist circumference.

      1. There is definitely a variation in that idea as far as some women are concerned. I am trying to put on weight but have a protruding belly. It was suggested that I actually have a diastasis recti ) whereby the rectus abdominis stomach muscle is stretched during pregnancy and never recovers. The stomach can then protrude giving the appearance of a large amount of visceral fat which may not be true. Apart from surgery closing the gap is difficult and though there are lots of suggestions how to do this by exercise to find this out long after the childbearing years have finished means that the chance of success is negligible. So approach that measurement of health with a touch of scepticism if you have had children. There is a difference between a mound of fate and what is actually a type of hernia which is obvious when palpitated.

        1. Mary that is a good point. Have you seen Katy Bowman’s work? She has a lot of focused movements for working with and reducing the issues associated with diastasis recti? Good luck and be well.

  7. I am a woman. My hip bone at my belly button is bigger than 32 inches. There is no way, without breaking my bones, that my waist at my belly button will ever be 32 inches. My natural waist is a few inches higher than my belly button. Does this mean I’m at death’s door?

    1. Unless your belly hangs below your waist (think flap of fat and skin), no one’s belly button should be level with their hip bones… Something is off

      1. I think she means the top level of the iliac crest. I am short torsoed and have the same issue

    2. I have the same problem. Also, I believe 35 inches for men and 32 for women are based on average height; your waist size should be half your height or less.

    3. Are you definitely measuring at the belly button level; (i.e. between your hips, and lower rib cage) – dont measure at the actual hips.

    4. My natural waist (narrowest part of my torso) is also a little higher than my belly button. This is genetic and certainly not indicative of imminent death. Waist circumference as a measurement of longevity is basically nonsense unless one is both obese and unhealthy in other respects. Even then it’s more correlation than causation. .

  8. Missed serum ferritin and GGT. Those 2 markers are more indicative of mortality than any of the markers mentioned. Of the ones mentioned above I would say fasting insulin probably is the most important.

    1. What is GGT?

      I have been increasingly researching the matter of too much iron causing all kinds of ailments, right up to The Big C. Find the ‘rogue health” website, the guy has a lot of information there and wrote a book, “Dumping Iron.” Cute. Although I’ve given blood for years, I’ve also started taking 81mg aspirin daily. Cuts cancers like the proverbial hot knife in butter. Those who have done so for 5 years or more show a 60% lower prostate cancer rate, with all other cancer types showing close, similar results. It is believed that aspirin achieves this by slight occult bleeding, thus removing the iron overload.

        1. Rob, I had read of that study, but looked at your link. Holy beef steak, a 17:1 difference in heart attacks? And some critic said more work needs to be done? That is not som1.5:1 type of difference which is usually considered to be of statistical significance. This is more than ten times that!

          And, being done in Finland, we know that all of them receive good health care.

          It’s been noted elsewhere that most countries don’t iron fortify their wheat, and iron overload could be part of the reason for the French Pardox. Lots of bread and button, far better health.

    2. Totally agree on serum ferritin being extremely important. Mine was over 400 a year ago and that led to all sorts of problems. I finally figured out what was going on and started donating blood, which did drop my ferritin considerably after a while. Anything over about 200 is definitely too high, and 60-80 is the ideal range. As you say, if ferritin stays high for too long, the excess iron in your system can kill you.

    3. I think iron status is something more people following this lifestyle should look into, particularly since iron antagonists are not high in a primal diet. My ferritin and transferrin saturation are not optimal. Not allowed to give blood however, having been stationed in Germany during the 80s…

      1. Kate – there is some evidence that IP6 might actually reduce ferritin levels over time – you might want to consider it, since you can’t donate blood. IP6 is an iron chelator, but it also chelates some other minerals (like magnesium, possibly), so you want to take it on an empty stomach, so that it doesn’t bind to the minerals in any food you’ve recently ingested. IP6 is made from rice bran, so it’s safe.

        1. Thanks Rob. I did actually try IP6 for a few months over a year ago. My teeth became really sensitive and I chipped a tooth. So I’m a little wary of it.

  9. Thanks Mark. Always a good read. Apart from the laboratory tests everything else as ever is common sense, at least to those who are Paleo aware. We can always do with a reevaluation from time to time however. I’m going to check my magnesium intake, and perhaps eat more fish.
    A footnote: being enthusiastic about living seems important too as an indicator. I’m sometimes bemused when casual acquaintances refer to me as “young fella”.

  10. I have very low testosterone but my only health care provider is the VA..They wont help..is there a safe synthetic booster..thanks

    1. Dane, I tried to make extensive comment on this, including looking form my earlier post above. What I’ve done that took decades off of my “men’s health.” Maybe try PM’ing me?

  11. I always prefer objective markers to subjective ones. Sure, feeling better one day to the next is nice but that doesn’t tell you all that much about how you are doing physically. I love the list you have here – along with the things to try.

    Honestly, simple tips and tricks are often the most powerful.

  12. I have been on a Ketogenic diet for one year now and after six months all of my bio markers were positive!

  13. So, Coconut oil, which I use each morning with butter in my blended coffee is Bad, now? Linoleic acid is the only fatty acid that makes up the polyunsaturated fat content of coconut oil. Linoleic acid is considered to be an essential fatty acid. The body is unable to make essential fatty acids so it is important to get them from food in order for the body to function properly. So Linoleic Acid is no longer good for us?

  14. So, Coconut oil, which I use each morning with butter in my blended coffee is Bad, now? Linoleic acid is the only fatty acid that makes up the polyunsaturated fat content of coconut oil. Linoleic acid is considered to be an essential fatty acid. The body is unable to make essential fatty acids so it is important to get them from food in order for the body to function properly. So Linoleic Acid is no longer good for us? Please reply to this post, not the one below. Thanks

    1. I may be wrong but AFAIK coconut oil is only 2% linoleic.
      2% of a tablespoon – hardly worth worrying about?

    2. Ken, “iron”ically, LA is like iron. You need to consume some, but it quickly goes off the rails and becomes harmful in higher doses. A lot of biological processes are not linear. Stay away from the grain oils and don’t sweat it.

  15. Very good article Mark. For Primal followers who love their meat, perhaps an additional easy to test marker should be considered. IGF-1. Amino acids like Leucine, Isoleucine, Methionine, Tryptophan, stimulates Insulin and IGF-1 more than refined carbohydrates.

  16. Two points:
    Set waist circumference is misleading, because it does not take HEIGHT into account. Waist to height ratio is much better and also seems to predict health better than any other weight marker, including BMI.

    Another point: DONT measure at belly-button level! Belly button is LOWER than the waistline and for women the difference is larger! My belly button is 2 inches lower than my waist! If I measure at belly button I get 4 inches extra, because I have curvy flaring hips.

    The correct place to measure is the very small gap between lowest ribs and hipbone. Another way to find it is to see yourself in the mirror in profile: Bend your back and see the place where your back bends the most, that is where waistline is. And again: For men it is lower tha for women, which anyone who has ever done any drawing of people knows.

    1. LCB, as I pointed out yesterday, even taking height into account, this is a poor metric. IIRC, I think the standard is 2:1, height:waist. Well, at my adult thinnest, very appropriate weight, I barely made the cut. Now I’ve shrunk 1.5″ with age and I’m now theoretically obese. Yes, ideally, I’m losing a final 15 pounds, but I still easily fit into a suit I wore in my glory days in 1994.

  17. Good article, though a bit of clarification is in order. Firstly, when you say that a triglyceride:HDL ratio of 2 or below is good, that is only true if your numbers are given in mg/dl, as is the case in the US and a few other countries. The rest of the world gives these numbers in mmol/l, and because the average molecular mass of triglycerides differs from the molecular mass of cholesterol, this affects the ratio too. Long story short: if your numbers are given in mmol/l, the ideal triglyceride:HDL ratio is 0.84 or below – 2 is actually elevated!

    Secondly, the advice about monitoring serum magnesium is somewhat misguided. The first linked study states that insulin sensitivity is correlated with magnesium intake, not serum magnesium. There was actually no difference between the serum magnesium levels across the low-intake, medium-intake and high-intake groups; but their magnesium *intakes* were indeed correlated with their insulin sensitivity. While a serum magnesium test is cheap, it isn’t that informative. The point is that you need to mind your magnesium intake, not that you need to monitor your serum levels. (If you are interested in your magnesium status, WBC magnesium seems to be a much better indicator, but that test isn’t available everywhere.)

    That said, monitoring a number of longevity biomarkers is a good idea. Periodically doing a complete blood count will reveal a lot about your health, and isn’t that expensive. This is exactly what Michael Lustgarten, Ph. D., a scientist at Tufts University’s Nutrition, Exercise Physiology, and Sarcopenia Laboratory, does. I highly recommend watching one of his short lectures online at

  18. If I understood well, if one should avoid omega-6, he should avoid also olive from olives or eating my beloved olived directly, because they both contain a lot of omega-6 fats.

  19. I like to spend the day after Thanksgiving checking out Black Friday sales, and then that Saturday is reserved to decorate for Christmas.

  20. Great article, but I do NOT want to? at animal products. How to achieve what you’re suggesting without animal products?

  21. Very interesting,good job and thanks for sharing such a good blog. your article is so convincing that I never stop myself to say something about it. You’re doing a great job. Keep it up

  22. Great article! Thanks for sharing! What are your thoughts on the thyroid hormones? Do you think we should measure those as well? I know the thyroid is responsible for metabolism among other important things…

  23. That’s wonderful and helpful article about good knowledge. Thanks for sharing this informative article. I would like to share this to everyone.That’s great article.

  24. These tips are gold Marc! Keep em coming! Gary |https://www.demolitionvancouverbc.com/

  25. This article is very good from the content to the image you have shared. Hope you will share more in the future, giving people more good articles. Thank you and respect you.