Interpreting Blood Test Results
Leading up to my trip to Greece where I will race in the Spartan Trifecta World Championships, I had to get a medical release form signed. While I was having this physical done, I asked that I have a blood panel done as well. It has been a few years since I had this done and even all of my efforts to be healthy are no guarantee that something might be going on that I’m unaware of.
The normal panel measures several things. For each one, I'll give my results as compared to the "normal" or "recommended" ranges. This range is a set of values that includes upper and lower limits of a lab test based on a group of otherwise healthy people. When comparing my (or your) results to these ranges, there are a few important things to consider:
- A "normal" result in one lab may be abnormal in another: You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits." While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents used, and analysis techniques. Consequently, for most lab tests, there is no universally applicable reference value.
- A normal result does not promise health: While having all test results within normal limits is certainly a good sign, it's not a guarantee. For many tests, there is a lot of overlap among results from healthy people and those with diseases, so there is still a chance that there could be an undetected problem. Lab test results in some people with disease fall within the reference range, especially in the early stages of a disease.
- An abnormal result does not mean you are sick: A test result outside the reference range may or may not indicate a problem. Since many reference values are based on statistical ranges in healthy people, you may be one of the healthy people outside the statistical range, especially if your value is close to the expected reference range. However, the abnormal value does alert your healthcare provider to a possible problem, especially if your test result is far outside the expected values.
Blood test results generally use the metric system of measurement and various abbreviations, including:
- cmm: cells per cubic millimeter
- arb'U: arbitrary unit
- g/dL: grams per deciliter
- U/L: international units per liter
- mEq/L: milliequivalent per liter
- mg/dL: milligrams per deciliter
- mL: milliliter
- mmol/L: millimoles per liter
- ng/mL: nanograms per milliliter
- pg (picograms): one-trillionth of a gram
Now that we’ve covered all of that, let’s jump in to my results:
Total Cholesterol - 179 mg/dL
The "recommended" range is under 200. Cholesterol is a waxy, fat-like substance produced primarily in the liver. It is used to repair cells, maintain proper hormone levels, vitamin D absorption from the sun, salt and water balance, digestion of fats. It is essential to joint health, hormone regulation, healthy cell membranes, fighting infections, etc. People tend to think of Cholesterol as something bad, but it's essential to a healthy body. Cholesterol is in the body to help, not harm you. Most recent evidence suggests that dietary cholesterol alone (what comes from the food you eat), in the presence of a healthy diet, does not negatively affect blood lipids.
The other part of the lipid panel that gets a lot of attention is the LDL-C.
LDL-Calculated - 94 mg/dL
According to the range listed on my results, anything under 100 is good. But if you notice, the "C" at the end of LDL-C stands for calculated. So your LDL cholesterol is determined using an equation. If you have a higher HDL and lower triglycerides, the calculation will be significantly skewed higher. There is a way to actually measure the number of LDL particles and to distinguish the size of LDL. This requires what is called a NMR Lipoprofile test. You want to see more of the large particles than the small particles. However, if your triglycerides are under 70 and your LDL is over 70, you can assume that most of your LDL is the good kind.
My Lipid Panel measured VLDL, which are the small, dense particles.
VLDV - 9 mg/dL
This is a very small amount of those little guys as anything below 40 is considered good.
So that leads me right into my Triglycerides number.
Triglycerides - 44 mg/dL
Anything under 150 is considered in the good range. I think that lower triglycerides are a much more key marker than total cholesterol and LDL-C. Even though my results said that anything under 150 mg/dL is good, I've heard that under 70 is the optimal number to shoot for. The more unhealthy carbohydrates that you eat, the higher your triglycerides will typically be.
I've skipped over HDL earlier because I wanted to talk about it in conjunction with Triglycerides.
HDL - 76 mg/dL
HDL is what people like to call the "good" kind of cholesterol. Anything at or above 60 mg/dL is considered good. I eat a pretty good amount of saturated fat, but adding even more of these healthy fats will also boost my HDL. When you reduce your triglycerides by cutting the processed carbohydrates in your diet, while consuming more fat to increase your HDL, it’s a fantastic one-two punch. I firmly believe that higher HDL and lower triglycerides are much more indicative of good heart health than the total and LDL cholesterol numbers that most people focus on.
Another number that appeared on my results was CHOL/HDL ratio. This is just the total cholesterol number divided by the HDL number.
CHOL/HDL ratio - 2.3
I don't feel like that total cholesterol number is very important, so this ratio doesn't mean much to me. Even if it was over 3.0, I still wouldn't be worried as long as my HDL was in the 75-100 range.
Triglycerides/HDL Ratio - 0.57
Anything under 1.0 is great!
Now let's move on to minerals.
Sodium - 139 mmol/L
The recommended range is between 136 and 145 mmol/L, so I'm within range. Sodium is both an electrolyte and mineral. It helps keep the water (the amount of fluid inside and outside the body's cells) and electrolyte balance of the body. Sodium is also important in how nerves and muscles work. It is possible to have low sodium levels following physical activity, but for blood taken under non-extreme conditions, a low level of blond sodium is usually due to a condition such as Addison's disease, diarrhea, diuretic administration, or kidney disease. A high blood sodium level is almost always due to dehydration.
Potassium – 5.1 mmol/L
Normal range is between 3.4 and 5.4 mmol/L. Potassium helps keep the water and electrolyte balance of the body and is important in how nerves and muscles work. Potassium levels can be affected by how the kidneys are working, the blood pH, the amount of potassium you eat and hormone levels in the body. A common cause of high levels of Potassium is kidney disease. Low levels can be attributed to diarrhea or dehydration.
Chloride - 104 mmol/L
Normal range is between 98 and 107 mmol/L. Most of the Chloride in the body comes from the salt that you eat. It is absorbed by your intestines when you digest food. Excess chloride leaves the body through urine. Low levels of blood chloride can be caused by low blood sodium, congestive heart failure, chronic lung diseases and loss of acid from the body. High levels usually indicate dehydration, but can also be caused by Cushing syndrome or kidney disease.
Carbon Dioxide - 26 mmol/L
Normal range is between 22 and 29 mmol/L. In the body, most of the CO2 is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level. When bicarbonate levels are higher or lower than normal, it suggests that the body is having trouble maintaining its acid-base balance or that you have upset your electrolyte balance, perhaps by losing or retaining fluid. Both of these imbalances may be due to a wide range of dysfunctions. Low levels can be a warning sign for Addison's disease, diabetic ketoacidosis or Kidney disease. High levels can be cuased by Cushing syndrome, Conn syndrome or lung diseases.
Calcium - 9.0 mg/dL
Normal range is 8.4 to 10.2 mg/dL. Calcium is the most common mineral in the body and one of the most important. The body needs it to build and fix bones and teeth, help nerves work, make muscles squeeze together, help blood clot, and help the heart to work. Almost all of the calcium in the body is stored in bone. Blood calcium levels do not indicate levels of bone calcium but rather how much calcium is circulating in the blood. Normally the level of calcium in the blood is carefully controlled. When blood calcium levels get low (hypocalcemia), the bones release calcium to bring it back to a good blood level. When blood calcium levels get high (hypercalcemia), the extra calcium is stored in the bones or passed out of the body in urine and stool. It is important to get the right amount of calcium in your food because the body loses calcium every day. Foods rich in calcium include dairy products (milk, cheese), eggs, fish, green vegetables, and fruit. Most people who have low or high levels of calcium do not have any symptoms. Calcium levels need to be very high or low to cause symptoms. Some causes of high levels of calcium are hyperthyroidism, sarcoidosis, excess Vitamin D, HIV/AIDS and cancer. Low levels can be caused by liver disease, renal failure or malnutrition.
Anion Gap – 9 (arb'U)
Normal range is between 5 and 13 arb/U. The anion gap measures the difference—or gap—between the negatively charged and positively charged electrolytes in your blood. If the anion gap is too high, your blood is more acidic than normal. If the anion gap is too low, your blood isn't acidic enough.
Total Proteins – 6.9 g/dL
Normal range is 6.3 to 8.2 g/dL. Total protein measurements can reflect nutritional status and may be used to screen for and help diagnose kidney disease or liver disease. A low total protein level can suggest a liver disorder, a kidney disorder, or a disorder in which protein is not digested or absorbed properly. I talked about blood proteins quite a bit in my posts on gluten. A high total protein level may be seen with chronic inflammation or infections such as viral hepatitis or HIV. It also may be associated with bone marrow disorders such as multiple myeloma. It's worth mentioning that a high-protein diet doesn't cause high blood protein. High blood protein is not a specific disease or condition in itself.
My report shows total protein, albumin, globulins, and the calculated ratio of albumin to globulins, termed the A/G ratio. Normally, there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease states affect the relative amounts of albumin and globulin, the A/G ratio may provide a clue as to the cause of the change in protein levels.
Albumin - 4.7 g/dL
Globulin - 2.2 g/dL
A/G Ratio - 2.1
A low A/G ratio (under 1.1) may reflect overproduction of globulins, such as seen in autoimmune diseases, or underproduction of albumin, such as may occur with cirrhosis, or selective loss of albumin from the circulation, as may occur with kidney disease. A high A/G ratio (over 2.5) suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias.
The Liver Panel is used to screen for, detect, evaluate, and monitor acute and chronic liver inflammation (hepatitis), liver disease and/or damage. The liver serves several important functions in the body, including changing nutrients into energy for the body and breaking down toxic substances. The liver panel consists of four tests.
Total Bilirubin - 0.4 mg/dL
Normal Range is between 0.2 and 1.3 mg/dL. Bilirubin is a brownish yellow substance found in bile (helps digest food). It is produced when the liver breaks down old red blood cells. When bilirubin levels are high, the skin and whites of the eyes may appear yellow (jaundice). Jaundice may be caused by liver disease (hepatitis), blood disorders (hemolytic anemia), or blockage of the tubes (bile ducts) that allow bile to pass from the liver to the small intestine. Low levels of bilirubin are not generally a concern and are not monitored.
AST (aspartate aminotransferase) / SGOT - 100 U/L
Normal range is between 15 and 46 U/L. An AST test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. Very high levels of AST (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. Low levels of AST are not a concern. The AST test is usually done at the same time as a test for alanine aminotransferase, or ALT.
ALT (alanine aminotransferase) / SGPT - 104 U/L
Normal range is between 13 and 69 U/L. As with the AST test, ALT is used to identify liver disease, especially cirrhosis and hepatitis caused by alcohol, drugs, or viruses. AST and ALT are considered to be two of the most important tests to detect liver injury, although ALT is more specific to the liver than is AST. In most types of liver diseases, the ALT level is higher than AST, and the AST/ALT ratio will be low (less than 1).
While both my AST and ALT are outside the normal range, levels need to be closer to 1000 U/L before there is concern around serious liver damage. I do not drink alcohol very often and when I do it’s usually just one drink. I am not on any medications either, which can cause long-term liver damage. I did have a beer the night before the bloodwork, so that might have causes the minor elevation. I will likely ask my doctor if another rest is recommend.
ALP (alkaline phosphatase) - 59 U/L
Normal range is between 38 and 126 U/L. The liver makes more ALP than the other organs or the bones. ALP helps break down proteins in the body and exists in different forms, depending on where it originates. Some conditions cause large amounts of ALP in the blood. These conditions include rapid bone growth (during puberty), bone disease (such as Paget's disease or cancer that has spread to the bones), a disease that affects how much calcium is in the blood (hyperparathyroidism), vitamin D deficiency, or damaged liver cells. A deficiency in zinc may cause low ALP levels. Malnutrition or protein deficiency as well as Wilson disease could also be possible causes for lowered ALP. It may also be caused by celiac disease or a deficiency in vitamins and minerals.
Next I'll move on to the Kidney tests. Kidney's not only remove waste products and excess fluid from the body, they regulate of the body's salt, potassium and acid content. The kidneys also produce hormones that affect the function of other organs. So needless to say, these little bean-shaped dudes are very important. The blood tests will show how well your kidneys are doing their job and how quickly the waste is being removed.
BUN (Blood Urea Nitrogen) - 10 mg/dL
Normal range is between 7 and 20 mg/dL. The BUN test is primarily used, along with the creatinine test, to evaluate kidney function in a wide range of circumstances, to help diagnose kidney disease, and to monitor people with acute or chronic kidney dysfunction or failure. If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher. Liver disease or damage can lower your BUN level. BUN levels can increase with the amount of protein in the diet. High-protein diets may cause abnormally high BUN levels while very low-protein diets can cause an abnormally low BUN.
Creatinine – 0.95 mg/dL
Normal range is 0.7 to 1.5 mg/dL. Creatinine is a waste product formed by the breakdown of a substance (creatine) important for converting food into energy (metabolism). The creatinine is filtered out of the blood by the kidneys and then passed out of the body in urine. If the kidneys are damaged and can't function normally, the amount of creatinine in the urine decreases while the amount of creatinine in the blood increases. Low blood levels of creatinine are not common, but they are also not usually a cause for concern. They can be seen with conditions that result in decreased muscle mass. Blood urea nitrogen (BUN) and creatinine tests can be used together to find the BUN-to-creatinine ratio (BUN:creatinine). A BUN-to-creatinine ratio can be used to check for problems, such as dehydration, that may cause abnormal BUN and creatinine levels. My ratio was 10.7 - the normal range is between 10 and 20.
Glucose - 90 mg/dL
Normal range is 74-106 mg/dL. A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Insulin is a hormone that helps your body's cells use the glucose. Insulin is produced in the pancreas and released into the blood when the amount of glucose in the blood rises. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels. There are several different types of blood glucose tests, but the one I had done was a Fasting Blood Glucose (FBG). It measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes. Anything over 126 mg/dL on this FBG test would indicate diabetes. With a family history if diabetes, this is a number that I will always keep a close eye on.
A1C - 5.60%
Normal range is 4.0-6.0%. The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been.
Now that I’m over 40 years old, I will strive to stay as healthy as possible and will continue to have a blood panel done once every year or two to try and catch anything that might be of concern.
If you haven't had a Basic Metabolic Panel (BMP) in the last few years, I would suggest you talk to your healthcare provider about having it done. The results can give your health practitioner important information about the current status of your overall health, including health of the kidneys, blood glucose level, and electrolyte and acid/base balance. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed. The earlier you catch somethings, they better off you are!
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Wishing you optimal health and peak performance,
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