Know your numbers

ApoB

Apolipoprotein B

Counts the particles that can lodge in artery walls (LDL, VLDL and Lp(a)); each carries one ApoB. A more direct read on artery-clogging particle number than LDL cholesterol.

Sorrell MD target

<80 mg/dL

Report Card full marks

≤60 mg/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with less saturated fat, more soluble fiber, losing excess body fat and, when needed, statins, ezetimibe or PCSK9 inhibitors. Insulin resistance and an underactive thyroid push it up.

Check yours in the Lab Decoder Score it in the Report Card ApoB vs LDL: when they disagree Why normal cholesterol isn't enough

LDL cholesterol

LDL-C

The cholesterol carried inside LDL particles: the headline number on a standard lipid panel. It can understate risk when triglycerides are high, which is where ApoB helps.

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≤70 mg/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Moves with the same levers as ApoB: diet quality, body fat and lipid-lowering medication. Inherited high cholesterol can keep it high despite a good diet.

Score it in the Report Card ApoB vs LDL: when they disagree

Non-HDL cholesterol

Non-HDL-C

Total cholesterol minus HDL: the cholesterol in every artery-clogging particle. It works on a non-fasting sample and tracks ApoB more closely than LDL-C does.

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≤100 mg/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with the same changes that lower ApoB and triglycerides.

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Lp(a)

Lipoprotein(a)

An LDL-like particle with an extra protein attached, set mostly by your genes. High levels raise the risk of heart attack, stroke and aortic valve disease, and a routine lipid panel doesn't show it.

Sorrell MD target

<30 mg/dL (<75 nmol/L)

Report Card full marks

≤75 nmol/L

Evidence tier

A (A strongest, D weakest)

What moves it. Diet and exercise barely change it, so one measurement in adulthood is usually enough. When it is high, the plan works harder on ApoB, blood pressure and other risks; therapies aimed at Lp(a) itself are in clinical trials.

Check yours in the Lab Decoder Score it in the Report Card Lipoprotein(a): the test nobody ordered

Triglycerides

TG, fasting

Fat circulating in the blood, much of it made by the liver from carbohydrate and alcohol. High fasting levels often signal insulin resistance.

Sorrell MD target

<100 mg/dL

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≤80 mg/dL

Evidence tier

B (A strongest, D weakest)

What moves it. Fall with less sugar, refined carbohydrate and alcohol, losing excess weight, regular exercise and omega-3s. Rise with insulin resistance, alcohol, an underactive thyroid and some medications.

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HDL cholesterol

HDL-C

The cholesterol in HDL particles. Low HDL is a marker of insulin resistance and higher risk; very high HDL is not extra protective.

Sorrell MD target

Not low (low is <40 mg/dL in men, <50 in women)

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Men 50–90 mg/dL · women 60–100 mg/dL

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with exercise, weight loss and quitting smoking; falls with insulin resistance, inactivity and anabolic steroids. Raising HDL with drugs has not lowered heart risk in trials.

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Triglyceride : HDL ratio

TG/HDL

Triglycerides divided by HDL. A free, simple proxy for insulin resistance and small, dense LDL particles.

Sorrell MD target

<1.5 (mg/dL units)

Report Card full marks

≤1.2

Evidence tier

B (A strongest, D weakest)

What moves it. Improves as triglycerides fall and HDL rises: fewer refined carbohydrates and less alcohol, more activity, and losing visceral fat.

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Coronary calcium score

CAC, Agatston score

A low-dose CT scan that measures calcified plaque in the heart's arteries. Zero means no detectable calcified plaque; higher scores mean more plaque and higher risk.

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0, meaning no detectable calcified plaque

Evidence tier

A (A strongest, D weakest)

What moves it. It shows plaque that already exists, so it rarely falls, and statins can nudge it up as plaque stabilizes. The goal is slowing progression by treating ApoB, blood pressure, blood sugar and smoking.

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Blood pressure

Systolic / diastolic

The pressure in your arteries as the heart beats (systolic) and rests between beats (diastolic). An average of several readings, or a week of home readings, beats a single office check.

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≤115/75 mmHg (average of several readings)

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with less sodium and alcohol, more potassium-rich foods, weight loss, aerobic exercise, better sleep, treating sleep apnea and, when needed, medication.

Score it in the Report Card

Resting heart rate

RHR

Beats per minute at full rest, best taken on waking or overnight by a wearable. Lower generally reflects better aerobic fitness.

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≤55 bpm

Evidence tier

B (A strongest, D weakest)

What moves it. Falls with endurance training; rises with poor sleep, alcohol, illness, dehydration, stress and stimulants.

Score it in the Report Card Zone 2 heart rate

Homocysteine

Hcy

An amino acid that builds up when the folate, B12 and B6 pathways fall short or kidney function declines. Higher levels are linked to stroke, heart disease and cognitive decline.

Sorrell MD target

<8 µmol/L

Report Card full marks

≤8 µmol/L

Evidence tier

C (A strongest, D weakest)

What moves it. Usually falls with enough folate, B12 and B6. Rises with low B-vitamin status, reduced kidney function, an underactive thyroid and some medications.

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Omega-3 index

EPA + DHA in red cells

The share of EPA and DHA in your red blood cell membranes, a three-to-four-month average of omega-3 intake. Higher levels track with lower cardiovascular risk.

Sorrell MD target

>8%

Report Card full marks

≥8%

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with fatty fish (salmon, sardines, mackerel) at least twice a week or with fish-oil supplements, and takes three to four months to settle at a new level.

Check yours in the Lab Decoder Score it in the Report Card The omega-3 index test

HbA1c

Hemoglobin A1c

The share of hemoglobin with glucose attached: roughly a three-month average of blood sugar. 5.7–6.4% is the prediabetes range; 6.5% or higher is the diabetes range.

Sorrell MD target

<5.7%

Report Card full marks

≤5.2%

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with weight loss, exercise (a walk after meals helps), fewer refined carbohydrates, better sleep and medications such as metformin or GLP-1s. Anemia, blood loss or a transfusion can make it read falsely.

Check yours in the Lab Decoder Score it in the Report Card Insulin resistance: a silent epidemic

Fasting glucose

FBG

Blood sugar after an overnight fast. It often stays normal for years while insulin quietly rises to hold it there.

Sorrell MD target

70–84 mg/dL

Report Card full marks

72–86 mg/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Improves with the same levers as HbA1c. Poor sleep, acute stress, illness and steroid medicines push it up for a while.

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Fasting insulin

How much insulin it takes to hold your fasting blood sugar steady. It rises years before glucose does, which makes it one of the earliest signs of insulin resistance.

Sorrell MD target

<6 µIU/mL

Report Card full marks

≤5 µIU/mL

Evidence tier

B (A strongest, D weakest)

What moves it. Falls with losing visceral fat, resistance and aerobic training, fewer refined carbohydrates, better sleep and, when needed, medication.

Check yours in the Lab Decoder Score it in the Report Card How to reverse insulin resistance

HOMA-IR

Insulin resistance index

A calculation from fasting glucose and fasting insulin (glucose × insulin ÷ 405 in U.S. units) that estimates insulin resistance. It is an estimate, not a diagnosis on its own.

Sorrell MD target

<1.5

Report Card full marks

≤1

Evidence tier

B (A strongest, D weakest)

What moves it. Moves with fasting insulin and glucose: lose visceral fat, build muscle, sleep well and keep refined carbohydrates in check.

Check yours in the Lab Decoder Score it in the Report Card The HOMA-IR test

C-peptide

Fasting C-peptide

Released in equal amounts with the insulin your pancreas makes, so it shows insulin output even when you take insulin. High suggests insulin resistance; low suggests the pancreas is struggling.

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0.8–1.8 ng/mL

Evidence tier

C (A strongest, D weakest)

What moves it. Falls as insulin resistance improves; reduced kidney function raises it.

Score it in the Report Card The C-peptide test

Uric acid

Urate

A waste product of purine breakdown. High levels cause gout and track with insulin resistance, high blood pressure and kidney disease.

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Men 3.5–5.5 mg/dL · women 2.5–4.5 mg/dL

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with fructose and sugary drinks, alcohol (especially beer), organ meats, dehydration, insulin resistance and some diuretics; falls with weight loss and, when needed, medication.

Score it in the Report Card

hs-CRP

High-sensitivity C-reactive protein

A liver protein that rises with inflammation. Above 2 mg/L adds to cardiovascular risk; above 10 usually means a recent infection or injury, so it should be repeated.

Sorrell MD target

<1 mg/L

Report Card full marks

≤0.5 mg/L

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with weight loss, exercise, better sleep, not smoking, good gum health and treating the source of inflammation; statins lower it too. A cold or a very hard workout can raise it for days.

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Visceral fat (DEXA)

VAT area

The fat packed around your organs, measured as an area on a DEXA scan. It drives insulin resistance, fatty liver and heart risk far more than fat under the skin.

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Men ≤50 cm² · women ≤40 cm²

Evidence tier

A (A strongest, D weakest)

What moves it. Responds well to moderate and vigorous exercise, a calorie deficit, less alcohol and refined carbohydrate, better sleep and GLP-1 therapy.

Score it in the Report Card DEXA scans for body composition

Body fat percentage

DEXA total body fat

Total fat as a share of body weight. DEXA separates fat from muscle and bone, which makes it far more informative than BMI.

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Men 10–18% · women 18–26%

Evidence tier

B (A strongest, D weakest)

What moves it. Falls with a modest calorie deficit plus resistance training and enough protein, which protects muscle while the fat comes off.

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Appendicular lean mass index

ALMI

Muscle in your arms and legs divided by height squared, from DEXA. Low values define sarcopenia and predict frailty and earlier death.

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Men ≥8.5 kg/m² · women ≥7 kg/m²

Evidence tier

A (A strongest, D weakest)

What moves it. Rises with progressive resistance training and enough protein. Falls with inactivity, low protein intake, age and rapid weight loss, including on GLP-1s.

Score it in the Report Card GLP-1 muscle loss: what to do

Waist-to-height ratio

WHtR

Waist circumference at the navel divided by height. A waist under half your height is the common screening cut-off; it tracks visceral fat better than BMI.

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≤0.45

Evidence tier

A (A strongest, D weakest)

What moves it. Shrinks as visceral fat comes off: exercise, diet quality, less alcohol and better sleep.

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VO₂max

Maximal oxygen uptake

The most oxygen your body can use in all-out exercise, measured on a treadmill or bike test or estimated by a wearable. The strongest single fitness predictor of longevity.

Report Card full marks

≥97.7th percentile for age and sex (elite; the 50th still earns 75 points)

Evidence tier

A (A strongest, D weakest)

What moves it. Rises with steady zone 2 endurance work plus one or two weekly sessions of hard intervals; falls with inactivity and age.

Score it in the Report Card VO₂max and grip strength predict lifespan

Grip strength

Hand dynamometer

The best of three squeezes on a hand dynamometer. A quick stand-in for whole-body strength that predicts disability and mortality.

Report Card full marks

Men ≥50 kg · women ≥35 kg

Evidence tier

A (A strongest, D weakest)

What moves it. Rises with resistance training, especially pulling and carrying; falls with inactivity and muscle loss.

Score it in the Report Card VO₂max and grip strength predict lifespan

eGFR

Estimated glomerular filtration rate

Your kidneys' estimated filtering capacity, calculated from blood creatinine, age and sex. Very muscular people can read falsely low; adding cystatin C sharpens the estimate.

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95–130 mL/min/1.73 m²

Evidence tier

A (A strongest, D weakest)

What moves it. Protected by controlling blood pressure and blood sugar and avoiding regular NSAID use. Hard training, creatine supplements and a big meat meal raise creatinine and can lower the estimate without real kidney harm.

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Urine albumin-to-creatinine ratio

UACR, microalbumin

Albumin leaking into the urine, adjusted for concentration. Above 30 mg/g signals kidney and blood-vessel damage, often years before eGFR falls.

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≤7 mg/g

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with blood-pressure and blood-sugar control; ACE inhibitors, ARBs, SGLT2 inhibitors and GLP-1s lower it. Hard exercise, fever or a urinary infection can raise a single sample.

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ALT

Alanine aminotransferase

A liver enzyme released when liver cells are under stress. Mild elevations most often come from fatty liver; alcohol, medications and hepatitis are other causes.

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Men ≤20 U/L · women ≤16 U/L

Evidence tier

B (A strongest, D weakest)

What moves it. Falls with weight loss, less alcohol and sugar, and exercise. A hard workout can raise it for a few days because muscle releases it too.

Score it in the Report Card Semaglutide and fatty liver (MASH)

GGT

Gamma-glutamyl transferase

A liver enzyme that rises with alcohol, fatty liver and bile-duct problems. Even within the normal range, higher GGT tracks with cardiometabolic risk.

Report Card full marks

Men ≤22 U/L · women ≤16 U/L

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with less alcohol, weight loss and better metabolic health; some medications raise it.

Score it in the Report Card

FIB-4

Liver fibrosis index

A score built from age, AST, ALT and platelets that estimates liver scarring. Under 1.3 suggests low risk; 2.67 or higher usually calls for elastography.

Report Card full marks

≤1

Evidence tier

A (A strongest, D weakest)

What moves it. Age raises it by design. Treating fatty liver (weight loss, exercise, less alcohol, blood-sugar control) lowers the risk it estimates.

Score it in the Report Card FIB-4 first for fatty liver

Ferritin

Iron stores

The body's iron-storage protein. Low ferritin means depleted iron; high ferritin can mean iron overload, but it also rises with inflammation, fatty liver and alcohol.

Sorrell MD target

50–150 ng/mL

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Men 50–150 ng/mL · women 40–150 ng/mL

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with iron-rich food or supplements and with inflammation; falls with blood loss, heavy periods, blood donation and heavy endurance training.

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Hemoglobin

Hgb

The oxygen-carrying protein in red blood cells. Low means anemia; high can come from testosterone therapy, smoking, sleep apnea or dehydration.

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Men 14–16.5 g/dL · women 12.5–15.5 g/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Rises when low iron, B12 or folate is corrected and with testosterone therapy; falls with blood loss, iron deficiency and chronic disease.

Score it in the Report Card

RDW

Red cell distribution width

How much your red blood cells vary in size. A high RDW can flag iron, B12 or folate deficiency, and it independently predicts mortality.

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≤12.8%

Evidence tier

A (A strongest, D weakest)

What moves it. Normalizes as nutrient deficiencies are corrected; inflammation and chronic disease can keep it high.

Score it in the Report Card

TSH

Thyroid-stimulating hormone

The pituitary signal telling the thyroid how hard to work. High TSH usually means an underactive thyroid; low TSH an overactive one or too much thyroid medication.

Report Card full marks

0.5–2 mIU/L

Evidence tier

A (A strongest, D weakest)

What moves it. Shifts with thyroid disease (often autoimmune), iodine status, illness, pregnancy and thyroid medication. Biotin supplements can skew the test, so pause them for two days beforehand.

Check yours in the Lab Decoder Score it in the Report Card Subclinical hypothyroidism High TPO antibodies

Free T3

Triiodothyronine

The active thyroid hormone available to your tissues. The Lab Decoder reads it alongside your resting metabolic rate.

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3–4 pg/mL

Evidence tier

C (A strongest, D weakest)

What moves it. Depends on thyroid output and conversion from T4; falls with significant calorie restriction, illness and overtraining.

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Total testosterone

The main androgen in men and an important hormone in women, best drawn in the morning. Low testosterone is defined by symptoms plus repeated low levels, not one number.

Sorrell MD target

Men 531–916 ng/dL · women 25–57 ng/dL

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Men 500–900 ng/dL

Evidence tier

A (A strongest, D weakest)

What moves it. Rises with weight loss, better sleep, treating sleep apnea and resistance training; falls with obesity, poor sleep, opioids, heavy drinking and illness. Testosterone therapy raises it but suppresses sperm production.

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Free testosterone

Calculated or by dialysis

The share of testosterone not bound to SHBG or albumin, so available to tissues. Best calculated from total testosterone, SHBG and albumin, or measured by equilibrium dialysis.

Sorrell MD target

Men 134–230 pg/mL · women 2.5–7.3 pg/mL

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Men ≥110 pg/mL

Evidence tier

B (A strongest, D weakest)

What moves it. Moves with total testosterone and opposite to SHBG, so anything that raises SHBG (age, thyroid excess, oral estrogen) lowers it.

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SHBG

Sex hormone-binding globulin

The protein that carries testosterone and estradiol in the blood. Low SHBG is a marker of insulin resistance; high SHBG leaves less free hormone available.

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25–50 nmol/L

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with age, oral estrogen, an overactive thyroid and very low-calorie diets; falls with insulin resistance, obesity and androgen use.

Score it in the Report Card

DHEA-S

Dehydroepiandrosterone sulfate

An adrenal hormone that declines steadily with age and feeds into testosterone and estrogen production.

Sorrell MD target

Men 300–500 µg/dL · women 150–350 µg/dL

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≥60th percentile for age and sex

Evidence tier

B (A strongest, D weakest)

What moves it. Falls with age and chronic stress. DHEA supplements raise it, but should be supervised because they can raise androgens and estrogens.

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Estradiol

E2

The main estrogen. In women it supports bone, brain, skin and blood vessels; in men it is made mostly from testosterone and supports bone and libido.

Sorrell MD target

Postmenopausal women: 60–90 pg/mL

Report Card full marks

Men 20–40 pg/mL

Evidence tier

B (A strongest, D weakest)

What moves it. In women it falls at menopause and rises with hormone therapy; in men it rises with body fat and testosterone therapy.

Check yours in the Lab Decoder Score it in the Report Card Testosterone with menopause HRT

Vitamin D (25-OH)

25-hydroxyvitamin D

The storage form of vitamin D, reflecting sun exposure and supplements. Needed for bone, muscle and immune function.

Sorrell MD target

70–90 ng/mL

Report Card full marks

70–90 ng/mL

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with sun and vitamin D3 supplements (best absorbed with a meal containing fat); falls in winter and with darker skin, obesity and poor absorption. Very high levels can raise blood calcium.

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Vitamin B12

Cobalamin

Needed for nerves, red blood cells and clearing homocysteine. A low-normal level can still be functionally low; methylmalonic acid confirms it.

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≥500 pg/mL

Evidence tier

B (A strongest, D weakest)

What moves it. Rises with animal foods or supplements; falls with plant-only diets, metformin, acid-suppressing medicines and lower stomach acid with age.

Score it in the Report Card

Apnea-hypopnea index

AHI, sleep apnea

Breathing pauses and shallow breaths per hour of sleep, from a sleep study. 5–14 is mild, 15–29 moderate and 30 or more severe sleep apnea.

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≤5 events/hour

Evidence tier

A (A strongest, D weakest)

What moves it. Falls with CPAP or an oral appliance, weight loss (including GLP-1 therapy), side sleeping and avoiding alcohol and sedatives near bedtime.

Score it in the Report Card Why you wake up at 3am