How to Read a Blood Test Report: A Beginner’s Guide to Key Health Indicators

You get your blood work back. No flags. No "H" (High) or "L" (Low). Your doctor gives you a thumbs up and says, "Everything looks normal. See you next year."

Yet, you feel tired. You have brain fog. You can’t lose that last bit of fat.

Here is the uncomfortable truth: "Normal" is not healthy.

Reference ranges are based on the statistical average of the population visiting that lab. In modern society, the average person is metabolically dysfunctional, inflamed, and pre-diabetic. If you are "in range," you are simply average among sick people.

We don’t want average. We want optimal.

I’ve spent years analyzing my own blood work and comparing it against longevity data. Here is how to read your report like a biohacker, not a passive patient.

Before we look at specific markers, understand the mechanism of the lab report.

A reference range is usually a bell curve (standard deviation) of the people who took that test. It does not define "biological health." It defines "statistical normality."

• The "Normal" Approach: "My ALT (liver enzyme) is 39. The cutoff is 40. I’m fine."
• The Optimized Approach: "My ALT is 39. That indicates low-grade liver stress. Optimal is under 20. I need to fix this."

The gap between Normal and Optimal is where chronic disease festers for decades before a doctor is allowed to prescribe medication.

Most reports give you Fasting Blood Glucose (FBG) and maybe HbA1c. These are lagging indicators. By the time these are high, your metabolic engine has been broken for years.

The Missing Metric: Insulin

Your glucose might be perfect (4.9 mmol/L or 88 mg/dL), but your pancreas might be pumping out massive amounts of insulin to keep it there. This is silent insulin resistance.

If your doctor didn't order Fasting Insulin, ask for it.

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Metabolic Optimization Protocol

Standard Advice:

• Fasting Glucose: < 6.1 mmol/L (< 110 mg/dL)
• HbA1c: < 5.7%

The Biohacker Target:

• Fasting Glucose: 3.9–4.7 mmol/L (70–85 mg/dL).
• HbA1c: 4.5% – 5.0%. (Above 5.2% correlates with brain shrinkage in some studies).
• Fasting Insulin: 2–5 uIU/mL. (If > 10, you are insulin resistant regardless of glucose).

The Calculation: Calculate your HOMA-IR (Glucose x Insulin / constant).

• Score < 1.0 = Insulin Sensitive (Goal)
• Score > 2.0 = Early Insulin Resistance

If your doctor panics because your Total Cholesterol (TC) is high, but doesn't look at the context, find a new doctor. TC is a useless metric on its own.

We need to look at particle quality and ratios.

The Triglyceride / HDL Ratio

This is the single most powerful predictor of heart disease risk on a standard panel. It acts as a proxy for LDL particle size.

• High Ratio = Small, dense LDL (dangerous).
• Low Ratio = Large, buoyant LDL (mostly harmless).

ApoB (Apolipoprotein B)

Standard LDL-C measures the weight of cholesterol. ApoB measures the number of particles. Particle count drives risk, not weight. If you can afford the extra $20, test ApoB.

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Lipid Optimization Protocol

Standard Advice:

• Total Cholesterol: < 5.2 mmol/L (< 200 mg/dL)
• LDL: "Lower is better"

The Biohacker Target:

• Triglycerides: < 1.0 mmol/L (< 90 mg/dL). Ideally < 0.8 mmol/L.
• HDL: > 1.3 mmol/L (> 50 mg/dL).
• Trig/HDL Ratio: Aim for < 1.0 (in molar units) or < 2.0 (in mg/dL units).
• ApoB: < 80 mg/dL (Aggressive target: < 60 mg/dL).

Your liver filters toxins and regulates energy. When it's stressed, enzymes leak into the blood.

The standard ranges for ALT and AST are laughably wide (often up to 40 or 50 U/L). This range has crept up over the years as the population has become fatter and developed more fatty liver disease.

GGT (Gamma-Glutamyl Transferase)

Often ignored, GGT is a marker of oxidative stress and glutathione demand. If this is high, your body is rusting from the inside out.

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Liver Optimization Protocol

Standard Advice:

• ALT / AST: 0–40 U/L
• GGT: 0–60 U/L

The Biohacker Target:

• ALT: 10–25 U/L. (If > 30, investigate alcohol, fructose intake, or visceral fat).
• AST: 10–25 U/L.
• GGT: < 20 U/L.

Chronic low-grade inflammation drives aging, heart disease, and neurodegeneration. Most basic panels check WBC (White Blood Cells), but that only catches acute infection.

You need hs-CRP (High-Sensitivity C-Reactive Protein).

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Inflammation Protocol

Standard Advice:

• CRP: < 10 mg/L (Checks for acute infection/trauma)

The Biohacker Target:

• hs-CRP: < 1.0 mg/L.
• If you are consistently between 1.0 and 3.0, you have systemic inflammation. Look at gut health, stress, or hidden dental infections.
• Ferritin: Check this too. High ferritin is often not just "good iron stores," but a marker of liver inflammation.

Context matters. Here are two scenarios where I often see panic, but the physiology explains it:

1. The Athlete's Kidney: If you lift heavy weights or eat high protein, your BUN and Creatinine might be slightly elevated. This pushes your eGFR (kidney filtration score) down.

   • The Fix: If you are muscular, check Cystatin C instead of Creatinine for a true kidney function score.

2. The Lean Mass Hyper-Responder: Some people on low-carb/keto diets see LDL skyrocket while Triglycerides drop and HDL soars.

   • The Context: If Trigs are low and HDL is high, the cardiovascular risk of high LDL is debated and likely lower than standard models suggest. Don't panic, but track ApoB and Calcium Score (CAC).

Don't let a "normal" lab report lull you into a false sense of security.

1. Demand the Data: Add Fasting Insulin, ApoB, and hs-CRP to your next request.
2. Tighten the Ranges: Use the "Biohacker Targets" above, not the lab's reference column.
3. Track the Trend: A single data point is noise. A trend is a signal. Use a spreadsheet.

Health isn't about avoiding the "H" flag on a piece of paper. It's about optimizing the biology behind the numbers.