InsideTracker blood test: 36 biomarkers

SHBG levels may help explain symptoms related to hormone imbalances even when total hormone levels appear normal. Understanding SHBG can provide a more complete picture of hormonal health. Consult your healthcare provider to interpret results.

TSH is widely considered the most sensitive initial screening test for thyroid disorders. Even subtle changes in thyroid function may be reflected in TSH levels before other thyroid markers become abnormal. Your healthcare provider may use TSH as a starting point for comprehensive thyroid evaluation.

ALT levels provide important insight into liver function. Elevated levels may indicate conditions such as hepatitis, fatty liver disease, or medication-related liver damage. Early detection of elevated ALT can help identify liver problems before symptoms develop, allowing for timely intervention and lifestyle modifications.

Of all the values in a lipid panel, LDL has the strongest causal link with atherosclerosis. Every LDL particle carries one apolipoprotein B, enters the artery wall and can lodge there. The more of those particles pass through over decades, the more plaque builds up. That is why lowering a raised LDL is the best-evidenced way to reduce the risk of a heart attack and a stroke. The most important sentence on this page, however, is not about high or low but about for whom. The 3.0 mmol/l upper limit on your report is a reference interval: it describes what is common in the population. It is not a goal. Guidelines tie the goal to your risk. <table><thead><tr><th>Situation</th><th>Guideline LDL goal</th></tr></thead><tbody><tr><td>Established cardiovascular disease, up to age 70 (Dutch CVRM guideline)</td><td>below 1.8 mmol/l</td></tr><tr><td>High or very high risk, or diabetes or chronic kidney disease, up to age 70 (CVRM)</td><td>below 2.6 mmol/l</td></tr><tr><td>Very high risk (ESC/EAS 2019)</td><td>below 1.4 mmol/l</td></tr><tr><td>High risk (ESC/EAS 2019)</td><td>below 1.8 mmol/l</td></tr><tr><td>Moderate risk (ESC/EAS 2019)</td><td>below 2.6 mmol/l</td></tr><tr><td>Low risk (ESC/EAS 2019)</td><td>below 3.0 mmol/l</td></tr></tbody></table> The consequence is sharp. An LDL of 2.8 mmol/l sits neatly inside the reference interval on the printout, while that same 2.8 is clearly too high for someone who has had a heart attack. Conversely, an LDL of 3.2 in a thirty-year-old with no other risk factors leads to a very different conversation than in a sixty-year-old who smokes, has diabetes and has high blood pressure. Your risk category, built from age, blood pressure, smoking, diabetes, kidney function, family history and existing cardiovascular disease, is what decides what your number means. Above seventy, LDL lowering is not routinely started in people without cardiovascular disease. A second situation deserves attention. A strongly raised LDL in someone who takes no lipid-lowering medication, particularly alongside early cardiovascular disease in close relatives, is a reason for a doctor to look into whether familial hypercholesterolaemia may be present. That inherited condition affects roughly 1 in 250 to 300 people and remains under-diagnosed in the Netherlands. A blood value does not make that diagnosis and cannot make it: the conversation belongs with your doctor, who also looks at your family and your history. The sensible reading rule, then, is that a single LDL number without a risk profile says little. Place the result alongside your HDL, your triglycerides, your non-HDL cholesterol and your blood pressure, and assess it together with a doctor.

GGT is considered the most sensitive enzymatic indicator of bile duct problems. Elevated levels may suggest bile duct obstruction, liver inflammation, or chronic alcohol use, often before other liver enzymes become abnormal. Because GGT responds quickly to alcohol intake, it is frequently used to monitor alcohol-related liver damage. Tracking GGT over time can provide valuable insight into the effectiveness of lifestyle changes and treatment.

Cortisol imbalances may indicate adrenal dysfunction or chronic stress. Persistently elevated levels could suggest increased cardiovascular and metabolic risk. Low levels may point to adrenal insufficiency. Consult your healthcare provider for interpretation.

DHEA-S levels decline significantly with age and low values could suggest adrenal insufficiency or premature ageing. High levels may indicate adrenal overactivity or other hormonal conditions. Consult your healthcare provider for interpretation.

Estradiol influences bone health, mood regulation, and reproductive function. Imbalanced levels could suggest conditions affecting fertility, menstrual regularity, or overall hormonal health. Discussing your results with a healthcare provider may help identify underlying causes and appropriate next steps.

Free testosterone drives muscle development, energy levels, mood, and sexual function. Even when total testosterone appears normal, low free testosterone could suggest functional deficiency. Discussing your results with a healthcare provider may help identify whether further evaluation is warranted.

Testosterone plays a fundamental role in many bodily functions for both sexes. Imbalances could potentially affect energy, mood, body composition, and reproductive health. Your healthcare provider can help evaluate your levels in the context of your overall health.

Folate is considered vital for DNA synthesis, red blood cell formation, and proper neural tube development during pregnancy. Low levels may be associated with anaemia, fatigue, and increased cardiovascular risk. Your healthcare provider can advise on appropriate levels.

Vitamin B12 is believed to be vital for healthy nerve cells, red blood cell formation, and DNA synthesis. Low levels may be associated with anaemia, fatigue, and neurological symptoms. Early detection through testing may help prevent long-term complications.

Calcium balance is critical for bone health, heart function, and muscle contraction. Abnormal levels may be associated with bone disorders, parathyroid conditions, or kidney problems. Consult your healthcare provider for personalised advice.

Iron is essential for oxygen transport, energy production, and immune function. Ferritin testing helps detect iron deficiency before anaemia develops, or iron overload which can damage organs. Consult your healthcare provider for personalised advice.

Iron is vital for producing red blood cells and carrying oxygen. Both low and high levels can affect your health. Serum iron is best interpreted alongside ferritin and TIBC for a complete picture. Consult your healthcare provider.

Magnesium supports heart rhythm, muscle relaxation, nerve signalling, and bone health. Deficiency is common and may be associated with muscle cramps, fatigue, and cardiovascular issues. Consult your healthcare provider for personalised advice.

Standard serum magnesium tests may appear normal even when intracellular levels are depleted. This test can reveal hidden deficiencies that affect energy production, muscle function, and nerve signalling. Consult your healthcare provider for advice.

Potassium is critical for maintaining heart rhythm, blood pressure regulation, and proper muscle function. Both low and high levels can be dangerous and may require medical attention. Consult your healthcare provider for interpretation.

Monitoring progesterone is important because it may confirm ovulation, help evaluate menstrual cycle health, and support early pregnancy assessment. Abnormal levels could suggest luteal phase deficiency, anovulation, or other reproductive concerns.

Sodium balance is essential for proper nerve transmission, muscle contraction, and blood pressure regulation. Significant imbalances can affect brain function and require medical attention. Consult your healthcare provider for guidance.

Transferrin levels help determine whether your body is getting enough iron and transporting it effectively. Abnormal levels may indicate iron deficiency, overload, liver disease, or chronic conditions. Consult your healthcare provider for interpretation.

CRP is a sensitive indicator of inflammation. Monitoring can help track infections, autoimmune conditions, and post-surgical recovery. Chronically elevated CRP may be associated with increased health risks. Consult your healthcare provider.

Fasting glucose is a cornerstone of metabolic health assessment. Elevated levels may indicate pre-diabetes or diabetes, while very low levels can also be clinically significant. Consult your healthcare provider for interpretation.

HbA1c provides a long-term view of blood sugar control, unlike fasting glucose which reflects a single point in time. It is essential for diabetes diagnosis and management. Consult your healthcare provider.

ApoB may be a stronger predictor of cardiovascular events than LDL cholesterol because it counts all atherogenic particles, not just cholesterol content. Elevated ApoB may increase risk even when LDL appears normal. Consult your healthcare provider.

Almost every page about HDL says the same thing: HDL is the good cholesterol, and the higher the better. Both halves of that sentence are wrong, which is exactly why this is the most important section on this page. <strong>Higher is not always better.</strong> The relationship between HDL and all-cause mortality is not a straight line but a U. In two large Danish population studies, together more than 116,000 men and women, the lowest mortality sat at an HDL of roughly 1.9 mmol/l in men and roughly 2.4 mmol/l in women. Above that, the curve turns: men with an HDL of 3.0 mmol/l or more had roughly twice the mortality, women from 3.5 mmol/l upwards around one and a half times. An extremely high HDL is therefore not a certificate of health, and it deserves a conversation with your doctor rather than congratulations. <strong>HDL is a gauge, not a dial.</strong> If a high HDL protects, then raising HDL ought to help. That has been tried extensively and it did not work. Drugs that inhibit the CETP transfer protein raised HDL by tens of percent and did not reduce heart attacks; the first in that class actually caused more deaths. Niacin raised HDL, but added no benefit on top of a statin and did add side effects. Genetic research points the same way: people who naturally carry a variant that raises HDL do not have a lower risk of myocardial infarction because of it, while that does hold for LDL-lowering variants. What does that mean? That a low HDL is not a cause, but a signal. HDL is low because something else is going on: visceral fat, insulin resistance, smoking, too little movement, or high triglycerides. Those are the factors that carry the risk. Fixating on the HDL number means treating the thermometer instead of the fever. <strong>So what do you do with it.</strong> Use HDL as context for the rest of your panel. A low HDL alongside high triglycerides and a raised fasting glucose together sketch a metabolic pattern that genuinely does carry risk. A low HDL also raises the cholesterol/HDL ratio, which is used in Dutch risk tables. But the values that predict risk most sharply are LDL, non-HDL cholesterol and ApoB, the number of risk-carrying particles. Your HDL says nothing about those. And finally: there is no target value for HDL. Your doctor does not set an HDL goal the way they set one for LDL, because no treatment has been shown to lower your risk by raising HDL.

Total cholesterol is a basic screening marker for cardiovascular risk. However, the breakdown into HDL, LDL, and triglycerides provides more actionable information. Consult your healthcare provider for interpretation.

Albumin is important for maintaining blood volume, transporting substances, and reflecting overall health status. Low levels may indicate liver disease, kidney disease, or malnutrition. Consult your healthcare provider.

AST levels provide important information about the health of your liver, heart, and muscles. Elevated levels may be associated with conditions such as hepatitis, cirrhosis, heart attack, or muscle injury. When evaluated alongside ALT, the AST:ALT ratio can help your healthcare provider identify the underlying cause of liver enzyme elevation. An AST:ALT ratio greater than 2:1, for instance, may suggest alcohol-related liver damage.

Adequate vitamin D levels are essential for strong bones, a well-functioning immune system, and overall well-being. Low levels may be associated with an increased risk of bone disorders, mood changes, and weakened immunity. Consult your healthcare provider for personalised advice.

Fasting insulin can detect insulin resistance years before diabetes develops. Early detection allows for lifestyle interventions that may prevent progression. Consult your healthcare provider for personalised advice.

The differential count helps healthcare providers pinpoint the nature of immune responses. For example, elevated neutrophils may suggest a bacterial infection, while increased eosinophils can indicate allergies or parasitic infections. It is a critical tool for diagnosing and monitoring many conditions.

CK is a reliable indicator of muscle damage. While elevated levels can follow intense exercise, persistently high levels may indicate conditions such as rhabdomyolysis, myocarditis, or muscular dystrophy. Monitoring CK helps distinguish normal post-exercise elevation from clinically significant muscle injury.

Transferrin saturation is one of the most informative markers for assessing iron balance. Because it reacts before your red blood cells change, it can help identify iron deficiency early, often together with a low <a href="/en/biomarkers/ferritin">ferritin</a>. A low saturation typically fits iron deficiency, blood loss or increased demand. A high saturation can point to iron overload, as in the hereditary condition haemochromatosis, where the body absorbs and stores too much iron. Because a single value shifts with meals, iron supplements and the time of day, the saturation is best read together with your ferritin and repeated when needed rather than judged on one measurement.

Elevated triglycerides may contribute to atherosclerosis and are a component of metabolic syndrome. They are often elevated alongside insulin resistance. Consult your healthcare provider.