Biomarkers

Biomarkers are biological molecules found in blood, other body fluids, or body tissues that are a sign of a normal or an abnormal health condition or disease.

Biomarkers are grouped in the Longevity Diagnostics Test Panels in relation to their function in the body. By looking at the individual test results and related tests, the risk or presence of cardiovascular disease, dementia, diabetes, cancer, and other major diseases can be assessed. Our risk assessment has the added benefit of putting your laboratory test results in the context of your health history.

Biomarkers Tested

The Longevity Essential Health test panel (Ess) measures 25 biomarkers. The Longevity Advanced Health test panel (Adv) measures 36 biomarkers. The table below shows the biomarkers included in each test panel.

Biomarker Definitions and Reference Ranges

Albumin (Alb)

• Low <3.1 g/dL
• Normal 3.1-5.1 g/dL
• High >5.1 g/dL

Albumin is the major protein in your blood. Low serum levels may indicate liver disease, chronic illness, infections, malnutrition, or excess urinary excretion due to nephrotic syndrome. High serum levels may be due to dehydration and/or diarrhea.(Back)

Alanine Transaminase (ALT)

• Normal <30 U/L
• Borderline 30-120 U/L
• High >120 U/L

ALT is a marker of liver function and liver disease. A borderline value indicates the presences of mild liver disease; a high value potential significant liver disease. The causes of liver disease are listed above, under AST. (Back)

Alkaline Phosphatase (AlkPhos)

• Normal ≤1.26 U/LL
• High >126 U/L

Alkaline phosphatase is a marker of liver and bone disease. High blood levels may be due to significant obstructive liver disease, gallstones, a blockage of the bile duct, infections, pancreatic disease, bone disease including Paget’s disease, or various forms of cancer affecting the bone or liver. The treatment depends on the cause of the elevated level. (Back)

Aspartate Transaminase (AST)

• Normal <30 U/L
• Borderline 30-120 U/L
• High >120 U/L

AST is a marker of liver function and liver disease. A borderline value indicates the presence of mild liver disease. A very high value indicates potential significant liver disease. Common causes of liver disease include chronic alcohol intake, fat accumulation in the liver, gallstones, and certain medications. It can also result from some forms of cancer, various infections including hepatitis, autoimmune disease like primary biliary cirrhosis, and rare genetic disorders such as hemochromatosis. The treatment depends on the cause of the liver disease. (Back)

Bilirubin

• Normal ≤1.2 mg/dL
• High >1.2 mg/dL

A high blood bilirubin level may be due to liver disease, anemia, a drug reaction, or Gilbert’s disease (a benign inherited disorder). (Back)

Blood Urea Nitrogen (BUN)

• Normal ≤26 mg/dL
• High/Increased Risk of Kidney Disease >26 mg/dL

BUN, along with creatinine and estimated glomerular filtration rate, measures kidney function. (Back)

Calcium

• Low <8.6 mg/dL
• Normal 8.6-10.3 mg/dL
• High >10.3 mg/dL

Calcium is a very important measure of kidney and parathyroid function. Abnormal values may indicate the presence of fluid imbalance, kidney disease, or parathyroid disease.

Carbon Dioxide

• Low <20 mmol/L
• Normal 20-32 mmol/L
• High >32 mmol/L

Carbon dioxide is a measure of your lung and kidney function. Abnormal values may indicate the presence of fluid imbalance, kidney disease, or lung disease.

Chloride

• Low <98 mmol/L
• Normal 98-110 mmol/L
• High >110 mmol/L

Chloride is also an important measure of the salt level in your blood. Abnormal values may indicate the presence of fluid imbalance or kidney disease.

Cholesterol, Total

• Optimal <200 mg/dL
• Borderline 200-239 mg/dL
• High ≥240 mg/dL

Total cholesterol is the sum of the cholesterol in all the cholesterol-carrying lipoproteins in your blood. It is important to know not only this value but also how your blood cholesterol is being carried. (Back)

Creatinine

• Males
• Normal ≤1.35 mg/dL
• High <1.35 mg/dL

• Females
• Normal ≤0.97 mg/dL
• High >0.97 mg/dL

Creatinine, along with blood urea nitrogen and estimated glomerular filtration rate, is an excellent measures of kidney function.

Creatine Kinase (CK)

• Males
• Normal <196 U/L
• High 196-1500 U/L
• Very High >1500 U/L

• Females
• Normal <143 U/L
• High 143-1000 U/L
• Very High >1000 U/L

CK is an enzyme found in muscle cells throughout the body. When there is muscle damage, muscle cells leak CK into the blood stream. Elevated CK levels may indicate muscle injury or muscle disease. Very high values signify significant muscle damage and even muscle breakdown.

Estimate Glomerular Filtration Rate (eGFR)

Normal >60 mL/min/1.73 m2	High Risk 30-60 mL/min/1.73 m2
Low/Kidney Disease 15-30 mL/min/1.73 m2	Very Low/Kidney Failure <15 mL/min/1.73 m2

eGFR, along with BUN and creatinine, is an excellent measures of kidney function. eGFR is a calculated value based on your blood creatinine level and your sex. We recommend that you consult with your healthcare provider if your eGFR is low or very low. A very low value indicates the potential need for dialysis or a kidney transplant. (Back)

Folate

• Low <12 ng/mL
• Borderline 12-18 ng/mL
• High >18 ng/mL

Folate, as known as vitamin B9, is essential for normal neurological function and red blood cell metabolism. Low levels have been associated with anemia, elevated serum homocysteine levels, and an increased risk for cardiovascular disease and dementia. While the recommended daily allowance of folate is 400 mcg/day, folate deficiency should be treated with 1000-5000 mg/day (that is, 1-5 mg/day). Hypertensive patients who were treated with folate 2.5 mg/day, vitamin B12 1 mg/day, and vitamin B6 50 mg/day had a 25% decrease in the risk of stroke, compared to placebo. The recommended daily allowance of folate is higher for pregnant and lactating women (600 mcg/day and 500 mcg/day, respectively) and for people who drink alcohol since alcohol impairs folate absorption. (Back)

Globulin

• Low <1.9 g/dL
• Normal 1.9-5.1 g/dL
• High >5.1 g/dL

Globulin is a calculated value, determined by subtracting the concentration of albumin in the blood from the concentration of total protein. Globulin protein contain all the major immunoglobulin proteins that are important for the immune response. Low levels may be due to liver disease, chronic illness, and/or malnutrition. High values may be due to infection, inflammatory disease, immune disorders, and some cancers like multiple myeloma and lymphoma. (Back)

Glucose, Fasting

• Low <65 mg/dL
• Normal 65-100 mg/dL
• Prediabetic 11-125 mg/dL
• Diabetic ≥125 mg/dL

Glucose is the most important short-term energy source for the body. Your fasting blood glucose value is a diagnostic test of your diabetes status. A leading cause of CVD, kidney disease, neuropathy, and blindness, diabetes can be prevented in prediabetic individuals with lifestyle modification (diet and physical activity) and weight loss if indicated. Metformin, pioglitazone, semaglutide, and other medications can be used to treat prediabetes and diabetes. A low fasting blood glucose level indicates excess insulin production or excess diabetes treatment and requires further examination. We recommend that you consult with your healthcare provider if your fasting blood glucose value is low, prediabetic, or diabetic. (Back)

Hematocrit

• Males
• Low <38.6%
• Normal 38.5-50.0%
• High >50%

• Females
• Low <35%
• Normal 35.0-45.0%
• High >45.0%

Hematocrit is a measure of the red blood cell count in your blood. Red blood cells are critical for carrying oxygen to the body tissues. A low level indicates the presence of anemia, which can be due to blood loss, deficiency of iron, vitamin B12, or folate, or chronic disease. A high level may indicate excess red blood cell production due to certain bone disorders. (Back)

Hemoglobin

• Males
• Low <13.8 g/dL
• Normal 13.2-17.1 g/dL
• High >17.1 g/dL

• Females
• Low <11.7 g/dL
• Normal 11.7-15.5 g/dL
• High >15.5 g/dL

Hemoglobin is a measure of the red blood cell count in your blood. Red blood cells are critical for carrying oxygen to your tissues. A low level indicates the presence of anemia, which can be due to blood loss, deficiencies of iron, vitamin B12, or folate, or chronic diseases including kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis. A high level may indicate chronic lung disease, dehydration, heart failure, kidney or liver cancer, or polycythemia vera, a rare type of blood cancer. (Back)

Homocysteine

• Males
• Normal <11.4 µmol/L
• High ≥11.4 µmol/L

• Females
• Normal <10.4 µmol/L
• High ≥10.4 µmol/L

Homocysteine is an amino acid that is converted to methionine (an essential amino acid) and cysteine (an amino acid important for reducing inflammation) by the action of B vitamins, specifically folate, vitamin B6, and vitamin B12. High serum values >14 µmol/L have been associated with an increased risk of cardiovascular disease and dementia. An international consensus conference has recommended that serum homocysteine levels be optimized to <10 µmol/L with vitamin B supplementation (folate at least 0.8 mg/day; vitamin B12 at least 0.5 mg/day; vitamin B6 at least 20 mg/day) to decrease the risk of all-cause dementia, especially in individuals >60 years of age.

High-Density Lipoprotein Cholesterol (HDL-C)

• Males
• Optimal ≥50 mg/dL
• Borderline 40-49 mg/dL
• Low <40 mg/dL

• Females
• Optimal ≥60 mg/dL
• Borderline 50-59 mg/dL
• Low <50 mg/dL

HDL-C, the “good cholesterol”, is the cholesterol carried on protective HDL. HDL-C levels can be increased by sugar restriction, weight loss if indicated, smoking cessation if indicated, and control of fasting triglycerides (≤150 mg/dL and of fasting blood glucose (<125 mg/dL) in individuals with diabetes. (Back)

High sensitivity C-reactive protein (hs-CRP)

• Optimal <1.0 mg/L
• Borderline 1.0-3.0 mg/L
• High CVD Risk >3.0-10.0 mg/L
• Very High CVD Risk >10.0 mg/L

C-reactive protein (CRP) is a measure of the level of inflammation and/or infection in the body. In the Longevity Diagnostics Test Panel, CRP is measured with a high sensitivity assay in order to increase the accuracy of the measurement; the test is, therefore, designated as hs-CRP. CRP values >10.0 mg/L are usually associated with infection or marked inflammatory disease like rheumatoid arthritis. Values >3.0 mg/L are associated with increased cardiovascular disease (CVD) risk. CRP levels can be lowered in the moderate range with weight loss, if indicated, and by statin therapy. Reducing CRP levels to <1.0 mg/L (optimal) and LDL-C levels to <70 mg/dL (optimal) with rosuvastatin 20 mg/day therapy has been shown to lower CVD risk by about 80%, compared to placebo, in individuals with high CRP levels. Omega-3 fatty acids and colchicine (0.6 mg/day) has also been shown to lower CRP and CVD risk.

Lipoprotein(a) (Lp(a))

• Optimal <75 nmol/L
• Moderate CVD Risl 75-125 nmol/L
• High CVD Risk >125 nmol/L

Serum lipoprotein(a) or Lp(a) is a lipoprotein particle circulating in the bloodstream that is similar to the low-density lipoprotein (LDL) particle, except that it has another protein, known as apo(a), attached to it. Lp(a) levels are genetically determined. A high level (>125 nmol/L) has been associated with increased cardiovascular disease (CVD) risk. Patients with elevated levels benefit significantly from low dose aspirin therapy. The treatment for elevated Lp(a) also involves optimizing all other risk factors including blood pressure and blood glucose and LDL-C levels. In individuals with established CVD, the use of a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor like evolocumab or alirocumab is recommended; this therapy lowers Lp(a) by 25-30% and optimizes LDL-C levels.

Low-density Lipoprotein Cholesterol (LDL-C)

• Optimal <70 mg/dL
• Normal <100 mg/dL
• High CVD risk ≥100 mg/dL

Serum low-density lipoprotein cholesterol (LDL-C), frequently called “bad” cholesterol, is the cholesterol carried on atherogenic LDL, the major cholesterol-carrying lipoprotein particle. A high LDL-C blood level is a major cardiovascular disease (CVD) risk factor, especially if it is ≥160 mg/dL. You should aim for a normal value <100 mg/dL and an optimal value <70 mg/dL, especially if you have established CVD (post-heart attack, bypass, angioplasty, or a cardiac calcium score >100) or are at high 10-year risk for CVD (≥7.5%). LDL-C can be optimized with nutritional modification, by restricting meat, dairy fat, and sugar and increasing the intake of fruits, vegetables, and grains. In high-risk individuals or individuals with established CVD, statin therapy (rosuvastatin 5-40 mg/day) and, if necessary, ezetimibe (10 mg/day) or a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor like evolocumab or alirocumab may be needed to decrease LDL-C to <70 mg/dL. Rosuvastatin should be taken along with co-enzyme Q10 200 mg/day to prevent statin-induced muscle problems.

Mean Cell Volume (MCV)

• Low <80 fL
• Normal 80-100 fL
• High >100 fL

Mean cell volume (MCV) measures the mean red cell volume in the bloodstream. If you are anemic, a low MCV may indicate iron deficiency or chronic blood loss or a variety of hemoglobin disorders, a normal MCV may indicate acute blood loss or the anemia of chronic disease; and an elevated MCV may indicate a deficiency of vitamin B12 or folate, liver disease, or a myeloproliferative disorder. Other measures of red blood cell normality include mean cell hemoglobin (MCH); mean cell hemoglobin concentration (MCHC), and red cell distribution width (RDW). These tests are all useful in the diagnosis of anemia and complement MCV.

Mean Platelet Volume (MPV)

• Low <7.5 fL
• Normal 7.5-12.5 fL
• High >12.5 fL

Mean platelet volume (MPV) is a measure of platelet size. A high MPV value with a low platelet count may indicate increased platelet consumption or turnover seen with an enlarged spleen. A low value has been linked to inflammatory bowel disease, chemotherapy, and certain types of anemia.

Non-HDL cholesterol (non-HDL-C)

• Optimal <100 mg/dL
• Normal <130 mg/dL
• High CVD risk ≥130 mg/dL

Non-HDL-C is calculated by subtracting HDL-C from total cholesterol. It represents the sum of the cholesterol in all lipoproteins causing cardiovascular disease (CVD). You should aim for an optimal value (<100 mg/dL), especially if you have established CVD or are at high risk for developing CVD (10-year CVD risk ≥7.5%). Your non-HDL-C blood levels can be optimized in the same way as LDL-C blood levels, by restricting the intake of meat, dairy fat, and sugar and increasing the intake of fruits, vegetables, and grains. In high-risk individuals or individuals with established CVD, statin therapy (rosuvastatin 5-40 mg/day) and, if necessary, ezetimibe (10 mg/day) or a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor like evolocumab or alirocumab may be needed to decrease non-HDL-C levels to <100 mg/dL. Rosuvastatin should be taken along with co-enzyme Q10 200 mg/day to prevent statin-induced muscle problems.

Omega 3 Fatty Acids

• Low <3.7%
• Borderline 3.8-5.4%
• Optimal ≥5.5%

Omega-3 fatty acids include eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA). The Onega-3 Check Test measures the sum of these three fatty acids as a percentage of the concentration of total fatty acids in the blood. Omega 3 fatty acids are important for maintaining the fluidity and function of cell membranes, especially in the brain and the heart. A low blood Omega-3 Fatty Acid Index value has been associated with an increased risk of cardiovascular disease and dementia. Optimal values can be achieved with increased consumption of oily fish in the diet or supplementation with two (2) or more 1 gram omega-3 fish oil capsules per day, and for brain health two (2) 200 mg capsules of oral DHA per day.

Platelet Count

• Low <140 Thousand/µL
• Normal 140-400 Thousand/µL
• High >400 Thousand/µL

Platelets, along with clotting factors, are important for blood clotting. A low platelet count can be due to a variety of causes including an enlarged spleen, viral infections including hepatitis or human immunodeficiency virus (HIV), heavy alcohol consumption, various cancers including leukemia, some types of anemia, chemotherapy drugs, and radiation therapy. An elevated platelet count can be due to infections, iron deficiency, cancer, certain types of anemia, and inflammatory disorders including rheumatoid arthritis, sarcoidosis, and/or inflammatory bowel disease.

Potassium

• Low <3.5 mmol/L
• Normal 3.5-5.3 mmol/L
• High >5.3 mmol/L

Potassium is a very important measure of body health status. Low serum potassium values may be due to excessive alcohol intake, kidney disease, uncontrolled diabetes, diarrhea, diuretic use, excessive laxative use, excessive sweating, folic acid deficiency, primary aldosteronism, certain antibiotics, and vomiting. High serum values may be due to kidney disease, adrenal insufficiency, certain antihypertensive medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers), dehydration, excess potassium supplementation, and uncontrolled diabetes. Occasionally high levels may be due to improper blood collection with excess red cell breakdown (hemolysis). A hemolyzed specimen is usually noted by the laboratory receiving it, and the potassium test may not be performed.

Sodium

• Low <135 mmol/L
• Normal 135-146 mmol/L
• High >146 mmol/L

Sodium is a very important measure of the salt level in your blood. Low values may be due to the use of certain medications (like diuretics and antidepressants), heart, kidney, and liver problems, inappropriate anti-diuretic hormone syndrome, excess fluid intake, amphetamine use, and adrenal insufficiency. High levels may be due to Cushing syndrome, diabetes insipidus, hyperaldosteronism, and significant fluid loss from excessive sweating, diarrhea, or burns. Too much salt or sodium bicarbonate in the diet and certain medicines, including corticosteroids, laxatives, lithium, ibuprofen, and naproxen, can elevate sodium levels.

Thyroid stimulating hormone (TSH)

• Low <0.4 mIU/L
• Normal 0.4.4.5 mIU/L
• High >4.5 mIU/L

Thyroid stimulating hormone (TSH), which is produced in the pituitary gland, is a precise measure of thyroid function. A high value indicates the presence of an underactive thyroid gland (hypothyroidism), while a low value indicates the presence of an overactive thyroid gland (hyperthyroidism). Follow-up testing is recommended for individuals with either of these abnormalities, in order to assess serum levels of the thyroid hormones, specifically total and free T3 and total and free T4, and to ascertain actual thyroid function. Individuals who have a high TSH level and low thyroid hormone levels due to hypothyroidism may require thyroid hormone replacement therapy. Hypothyroidism is very common in the elderly (>10% of the female population; >5% of the male population) and predisposes to elevated LDL-C blood levels.

Total cholesterol (TC)

• Normal <200 mg/dL
• High ≥200 mg/dL

Total cholesterol is the sum of the cholesterol in all the cholesterol-carrying lipoproteins in your blood. It is important to know not only this value but also how your blood cholesterol is being carried on serum lipoproteins.

Total Protein

• Low <6.1 mg/dL
• Normal 6.1-8.1 mg/dL
• High >8.1 mg/dL

Total protein is a measure of the total protein level in your blood. A low serum level may be due to liver disease, chronic illness, malnutrition, decreased protein production, or increased protein loss due to kidney or intestinal disease. High serum levels may be due to infections, amyloidosis, dehydration, hepatitis, HIV/AIDS, monoclonal gammopathy, and/or multiple myeloma.

Triglycerides (TG)

• Normal <150 mg/dL
• High ≥150-500 mg/dL
• Very High >500 mg/dL

Triglyceride (TG), like cholesterol, is a major fat in the bloodstream. A high value is associated with increased cardiovascular disease risk; a very high value, with fatty liver disease and pancreatitis. TG levels can be decreased with weight loss if indicated, restriction of sugars, and control of fasting blood glucose to <125 mg/dL in individuals with diabetes. For people with very high values, despite lifestyle modification, treatment with micronized fenofibrate 200 mg/day and/or omega-3 fatty acids 4-6 one-gram capsules/day will lower TG values significantly. Statin therapy also lowers TG levels.

Uric Acid

• Males
• Normal 4.0-8.0 mg/dL
• High ≤8.0 mg/dL

• Females
• Normal 2.5-7.0 mg/dL
• High ≤7.0 mg/dL

An elevated serum uric acid level has been associated with an increased risk of cardiovascular disease and gout. Not all individuals with high uric acid values will develop gout, and some individuals will develop gout at somewhat lower levels. Individuals with gout can have painful joints, especially in their feet and big toe, and are at increased risk for kidney stones. Individuals with elevated serum uric acid levels should limit their intake of alcoholic beverages and drinks sweetened with fruit sugar (fructose); they should minimize the intake of red meat, especially organ meats like liver. Individuals who have both an elevated uric acid level and attacks of gout are candidates for allopurinol treatment (200-300 mg/day) to lower the blood uric acid level to <6.0 mg/dL and minimize the risk of attacks of gouty arthritis and kidney stones.

Vitamin B12

• Low <200 pg/mL
• Normal 200-1100 pg/mL
• Optimal %gt;700 pg/mL

Vitamin B12 is necessary for normal neurological function and red blood cell metabolism. Low levels have been associated with anemia, elevated serum homocysteine levels, and increased risk for cardiovascular disease and dementia. The recommended daily allowance of vitamin B12 is 2.4 mcg/day. Vitamin B12 deficiency, however, should be treated with 1000 mcg/day (that is, 1 mg/day) to optimize blood levels. Treatment of hypertensive patients with 1 mg/day of vitamin B12 plus 2.5 mg/day of folate and 50 mg/day of vitamin B6 lowered homocysteine levels and the risk of stroke by 25%, compared to placebo.

Vitamin D, 25-OH

• Low <30 ng/mL
• Optimal 30-100 ng/mL
• Optimal %gt;100 ng/mL

Vitamin D plays an important role in bone and cardiovascular health. A daily intake of 600 international units (IU)/day for all adults up to 70 years of age and 800 IU/day for those older than 70 years of age is recommended. Individuals with low levels of vitamin D (<30 ng/mL) should be supplemented with 2,000 IU of vitamin D per day until blood vitamin D levels are in the 30-100 ng/mL range, which is optimal for bone and CVD health, and then supplemented with 800 IU/day to maintain optimal levels.

White Blood Cell Count (WBC)

• Low <3.8 Thousand/µLL
• Normal 3.8-10.8 Thousand/µL
• High ≤10.8 Thousand/µL

White blood cell count is a measure of the level of white blood cells in your bloodstream. White blood cells are very important for combating infection or inflammation. Low levels may be due to chemotherapy, radiation, bone marrow failure, leukemia, lupus erythematosus, rheumatoid arthritis, malnutrition, and certain medications including some antibiotics. High levels may be due to infections, inflammatory or allergic disorders, abnormalities in the bone marrow including leukemia, smoking, and chronic lung disease.