Bloodtest Results - Feedback

#1

I just got my newest blood test results back and figured I’d post a two-year comparison. My geographic location limits my testing options a bit, but it’s still a pretty decent spread. I’m looking to optimize my health, so I’d love to hear your take - is there anything you’d keep an eye on or try to improve? I always learn a lot from the folks here, so thanks in advance for the help.
Bloodtest Results - Sheet1.pdf (50.6 KB)

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#2

I take it you’re not in the US, given some of the measurement units I see.

I would focus doing what you can to get LP(a) lower… though I know there is not yet a lot you can do: CVD and high Lp(a) levels and New Lp(a) lowering drug

I would also lower that LDL number to the 30 to 40 range, just to avoid most cardiovascular risk.
Trigerides are also high… definitely need to lower them.
Liver (ALT) measures are a little high.

If possible, try to get a C-reactive protein level test next time.

Generally things look pretty good.

I ran your spreadsheet through Google Gemini with my blood test prompt (I like Peter Attia’s more aggressive targets as he outlines in his Outlive book), and here is what it says: (I also had it convert all measures to USA standard measures, so I could read them more easily).

Comprehensive Blood Analysis: Medicine 3.0 Interpretation

This analysis compares your January 2025 and February 2026 results against standard reference ranges and Dr. Peter Attia’s “Medicine 3.0” optimal targets.

Executive Summary

  • Status: You are metabolically healthy with excellent glucose control and robust testosterone levels.
  • Primary Concern: There has been a significant degradation in your lipid profile (Triglycerides doubled) and liver enzymes (ALT increased) over the last year.
  • Genetic Risk: You have elevated Lipoprotein(a), a genetic risk factor for cardiovascular disease. In Medicine 3.0, this necessitates aggressive management of other lipid markers (ApoB) to offset risk.
  • ApoB: Your ApoB is 63 mg/dL. While “normal” by lab standards, it is slightly above the strict “Attia Optimal” target of <60 mg/dL for someone with elevated Lp(a).

1. Data Comparison & Unit Conversion

Measurements converted to Standard US Units.

Marker Jan '25 Feb '26 Standard Range Attia / Optimal Target Status
Metabolic
HbA1c 4.8% 4.8% < 5.7% < 5.1% :white_check_mark: Optimal
Fasting Glucose 79 mg/dL N/A 70-99 mg/dL 75-85 mg/dL N/A
Lipids (CV Health)
ApoB 67 mg/dL 63 mg/dL < 90 mg/dL < 60 mg/dL :warning: Near Optimal
Lp(a) 103 nmol/L 86 nmol/L < 75 nmol/L < 75 nmol/L :rotating_light: Elevated
Triglycerides 65 mg/dL 125 mg/dL < 150 mg/dL < 80 mg/dL :rotating_light: Degraded
LDL-C 82 mg/dL 82 mg/dL < 100 mg/dL (Focus on ApoB) -
HDL-C 55 mg/dL 51 mg/dL > 40 mg/dL > 50 mg/dL :white_check_mark: Good
Liver & Kidney
ALT (Liver) 20 U/L 33 U/L < 50 U/L < 20-25 U/L :warning: Degraded
Creatinine 0.83 mg/dL 1.07 mg/dL 0.7-1.3 mg/dL Context Dependent :white_check_mark: Normal
eGFR N/A 89 > 60 > 90 :white_check_mark: Good
Hormones
Testosterone (Total) 655 ng/dL 712 ng/dL 264-916 ng/dL 500-800+ ng/dL :white_check_mark: Optimal
SHBG 30 nmol/L 30 nmol/L 16-55 - Normal
TSH 1.63 mIU/L 2.38 mIU/L 0.4-4.5 0.5 - 2.0 :warning: Slight Shift
Nutrients
Vitamin B12 538 pg/mL 512 pg/mL > 200 pg/mL > 500-800 pg/mL :white_check_mark: Good
Ferritin 49 ng/mL 50 ng/mL 30-400 ng/mL 50-100 ng/mL :warning: Low-Normal

2. Deep Dive Analysis

A. Cardiovascular & Lipids (The Critical Area)

This is the most complex area of your report.

  • Lp(a) (Lipoprotein a): You are at 86 nmol/L (approx. 36 mg/dL).

  • The Science: Lp(a) is a genetic particle that is highly atherogenic (causes plaque) and pro-thrombotic (causes clots). Levels are largely set by genetics and do not respond well to diet or statins.

  • Attia Strategy: Since you cannot easily lower Lp(a), you must aggressively lower the other atherogenic particles (ApoB) to reduce overall burden.

  • ApoB (Apolipoprotein B): Your level is 63 mg/dL.

  • The Science: ApoB is the direct measure of all atherogenic particles.

  • Attia Strategy: For someone with elevated Lp(a), Attia typically targets an ApoB of < 60 mg/dL (and sometimes < 40 mg/dL in high-risk secondary prevention). You are very close, but strictly speaking, you are slightly above the “prevention” target for a high-Lp(a) phenotype.

  • Triglycerides: This is the biggest negative change, doubling from 65 (optimal) to 125 mg/dL (suboptimal).

  • Cause: Trigs are highly volatile and driven by recent intake. Common culprits for a sudden spike include: alcohol consumption within 24-48 hours of the test, a high-carbohydrate meal the night before, or reduced insulin sensitivity (though your HbA1c contradicts this).

  • Attia Strategy: Keep this strictly < 100 mg/dL, ideally < 80 mg/dL.

B. Metabolic Health

  • HbA1c (4.8%): This is a standout result. It implies an estimated average glucose of ~91 mg/dL. This places you firmly in the “insulin sensitive” category, which is a massive longevity asset.

C. Liver Function (ALT)

  • ALT (Alanine Aminotransferase): Increased from 20 to 33 U/L.
  • The Science: ALT is an enzyme released when liver cells are stressed. Labs often set the “normal” cutoff at 40 or 50, but Attia argues that anything > 30 is pathological for a male.
  • Context: A jump from 20 to 33 warrants investigation. It is often caused by:
  1. Visceral fat gain (even small amounts).
  2. Alcohol intake.
  3. Supplements (herbal/oral).
  4. Note: Heavy resistance training 24 hours prior to a blood test can transiently elevate ALT/AST due to muscle damage, not liver damage.

D. Hematology & Nutrients

  • Ferritin (50 ng/mL): You are on the “floor” of optimal. While not anemic (Hemoglobin is high at 17.1 g/dL), ferritin below 50 can sometimes impact thyroid function and hair growth.
  • TSH (2.38 mIU/L): This has drifted up from 1.63. While still normal, TSH > 2.0 can sometimes be an early sign that the thyroid is working harder. Attia prefers TSH closer to 1.0-2.0.

3. Optimization Protocols

Objective 1: Crush Triglycerides (Target: < 80 mg/dL)

  • Immediate Action: Audit your carbohydrate and alcohol intake.
  • Protocol:
  • Omega-3s: If not already taking them, consider high-dose EPA/DHA (2-4g/day). This lowers triglycerides and is cardioprotective.
  • Carbohydrate Restriction: Ensure you are not “back-loading” carbs at dinner.
  • Alcohol: If you drink, pause for 14 days and re-test. Alcohol is the most potent driver of acute triglyceride spikes.

Objective 2: Manage Lp(a) Risk via ApoB (Target: < 60 mg/dL)

  • The Strategy: You cannot lower Lp(a) significantly with lifestyle. You must lower ApoB to “make room” for the Lp(a).
  • Diet: Reduce Saturated Fat (SFA) intake. Replace butter/beef fat with Monounsaturated Fats (Olive Oil, Avocado). SFA down-regulates LDL receptors, raising ApoB.
  • Fiber: Increase soluble fiber (psyllium husk, oats) to bind cholesterol in the gut.
  • Pharmacology (Consult your Physician): Attia frequently notes that achieving ApoB < 60 often requires pharmacologic assistance (e.g., low-dose statin or ezetimibe), especially when genetically fighting high Lp(a).

Objective 3: Reset Liver Enzymes (Target: ALT < 25)

  • N-Acetyl Cysteine (NAC): 600-1200mg/day. A precursor to glutathione, this supports liver health and lowers enzymes.
  • Retest Protocol: Ensure no heavy weightlifting for 72 hours before your next blood draw to rule out muscle-damage artifacts.

Objective 4: Monitor Thyroid & Iron

  • Selenium & Zinc: Ensure adequate intake to support T4 to T3 conversion.
  • Iron: Your hemoglobin is high (17.1), likely due to testosterone or altitude/genetics, but your ferritin is low-ish (50). Do not supplement iron without medical guidance, as your Hemoglobin is already at the upper limit (17.5 is the cutoff for polycythemia).

Final Longevity Assessment

You are in the top 10-15% of your age group metabolically (HbA1c) and hormonally (Testosterone). However, your cardiovascular risk profile is “moderate” rather than “low” due to the combination of elevated Lp(a) and the recent spike in Triglycerides.

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#3

The first thing to keep in mind when evaluating your metrics is that two datapoints do not constitute a trend, in spite of an LLM’s suggestions to the contrary. The second thing to keep in mind is that some of these metrics can vary with everyday life events. Was one blood draw the day after vigorous exercise and another three days after? What did you eat the night before? Been consuming a lot of simple carbs lately? How about sleep and stress? Taking the two panels together, and focusing on those that tend not to vary much from test to test, I agree that the first and perhaps only result to put in the back of your mind to address is Lp(a). It may be higher than optimal, and good drugs solely for that are on the way but, more importantly, the two readings should not have been that different. There are other questions, such as NLR (do you have some transient inflammation), but, again, don’t engage in ready/fire/aim. Also, some of these metrics are not the ones of interest. Total testosterone, for example, is mostly of interest only in a nuanced interpretation of free testosterone. Similar issue with thyroid metrics. If I received these results at your age, I would continue on my course of exercise, sleep, diet, supplements, etc., tweaking and improving as we all try to do, but waiting for the results of a third panel. This panel is very much within limits of hundreds i have seen among healthy, long lived people.

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