To know if we are improving our metabolic health, we must measure it.  Fortunately, we have some targets we can measure to see how well we are progressing. These are of course not the only important markers of good health–your doctor will request many more at your annual physical—but if these are off, we know we have improvements to make.

Before listing these recommended labs, a word about the “normal” ranges is in order. The ranges for most lab tests are determined by testing random samplings of supposedly healthy adults. But there are a great many American adults who haven’t been diagnosed with a disease that nevertheless can’t be said to be metabolically healthy.

In short, “average,” in most cases, is not good.

For example, the range for triglycerides is 50 to 150 (lower is better).

That doesn’t mean that if you have a triglyceride level of 149 you are fine and at 151 you are in trouble. Given the state of metabolic health among American adults, we don’t want to be average. We should try to get to the good side of average (e.g., below average for triglycerides; above average for HDL).

NOTE: Most lab ranges are determined this way, but there are exceptions. Total and LDL cholesterol ranges have been adjusted down to what the health authorities think they should be.

For the measurements below, our targets should be not just in the normal range, but at least in the “good” category. These measurements and lab tests should be taken periodically to track our progress toward metabolic health.

Waist circumference: A waist circumference greater than 40 inches for men or 35 inches for women is a marker for metabolic syndrome. Those needing to lose weight and improve body composition should measure the waist regularly.

Triglycerides: Lower is better; normal range is 50-150. Above 150 is a marker for metabolic syndrome. Good would be under 100; ideal would be under 70. This test is part of the lipid panel in your yearly physical.

You can also get a lipid panel test at walkinlab.com for $28 dollars.

HDL cholesterol (HDL-C): Higher is better. Normal range is 40-72. Below 40 is considered a marker for metabolic syndrome. Above 60 would be considered good; ideal would be above 70 (for HDL, being above the normal range is a good thing). This test is also part of a standard lipid panel.

Triglycerides/HDL ratio: Lower is better. This is HDL divided by triglycerides. (e.g., TG=140; HDL=45; 140/45=3.11). Anything under 4.0 is considered normal, but again, much lower is better. Around 1 is considered ideal. This ratio is considered by many researchers the best lab marker for heart disease risk.

A1c: This test measures how much of your hemoglobin (a blood protein) has been glycated over the previous three months, which correlates to your average blood glucose level. Normal is below 5.7 (above that is prediabetes; 6.5 and above is type 2 diabetes). Ideal would be 5 or below. This test costs $28 at Walkinlab.com. (Some doctors order this as part of the physical; some do not).

Blood pressure: 120 over 80 is considered normal; 130 over 90 is considered elevated; anything over that is considered high. Elevated blood pressure is a marker for metabolic syndrome. It is a good idea to purchase your own blood pressure monitor at the drugstore so you can track it. Instructions for properly taking your blood pressure can be found here.

Fasting insulin: This measures the insulin levels in your blood after fasting overnight. It is key in identifying insulin resistance. Anything over 15 (in microunits/mL) is likely insulin resistance; under 10 is considered good, and under 6 is ideal. This is a very important metric that is not generally tested as part of our annual physical. Our A1c and fasting glucose may be fine, but if it takes a lot of insulin to keep it fine that means we are insulin resistant. By checking fasting insulin, we could identify insulin resistance years or decades before it progresses to type 2 diabetes. This test costs $28 at walkinlab.com.