Metabolic and Inflammation Panel
Insulin resistance and cardiovascular disease both develop silently for years before any symptom appears. The markers that predict them earliest are almost never run on a standard physical. Your GP orders a lipid panel. They do not order fasting insulin, Lp(a), ApoB, or hs-CRP at a meaningful cutoff. This panel does.
Metabolic markers
Fasting Insulin
ATH optimal
Under 8 uIU/mL
Mainstream
Under 25 uIU/mL
The single most important marker for metabolic health that most GPs never run. Insulin resistance precedes type 2 diabetes by 10 to 15 years and is completely invisible without this test. DiNicolantonio et al. Open Heart 2017 established the case for aggressive insulin testing.
HbA1c
ATH optimal
Under 5.3%
Mainstream
Under 5.7%
3-month glucose average. The gap between 5.3 and 5.7 represents years of preventable metabolic progression.
Fasting Glucose
ATH optimal
70-90 mg/dL
Mainstream
70-99 mg/dL
The mainstream upper limit of 99 already indicates insulin resistance risk in most research on metabolic health.
Uric Acid
ATH optimal
Under 5.5 mg/dL
Mainstream
Under 7.0 mg/dL
Independent cardiovascular and metabolic risk marker. Elevated uric acid is an early sign of metabolic syndrome and is rarely discussed in standard care.
Lp(a)
ATH optimal
Under 30 mg/dL
Mainstream
Under 75 mg/dL
Genetic cardiovascular risk that is not lifestyle-modifiable. You need to know this number because it changes how aggressively you manage every other cardiovascular risk factor.
ApoB
ATH optimal
Under 80 mg/dL
Mainstream
Under 130 mg/dL
Better cardiovascular predictor than LDL-C. ApoB measures particle count. Two people with identical LDL-C can have very different ApoB. The particle number is what damages arterial walls.
ApoA1
ATH optimal
Above 140 mg/dL
Mainstream
Standard reference
The protective lipoprotein marker. Context for the ApoB result. The ratio matters as much as either number alone.
Inflammation
hs-CRP
ATH optimal
Under 1.0 mg/L
Mainstream
Under 3.0 mg/L
High-sensitivity C-reactive protein. The mainstream cutoff of 3.0 mg/L is where elevated cardiovascular risk has already accumulated. ATH optimal of under 1.0 is based on Ridker et al. NEJM 2002 and subsequent replication.
Ferritin
ATH optimal
50-150 ng/mL
Mainstream
12-300 ng/mL
Low ferritin signals iron deficiency before anemia develops. High ferritin is an inflammation signal. The mainstream range is wide enough to miss both problems.
Iron and TIBC
ATH optimal
Context-dependent
Mainstream
Standard reference
Iron saturation gives context to the ferritin result. Necessary to distinguish true iron deficiency from functional iron restriction caused by inflammation.
Key micronutrients
25-OH Vitamin D
ATH optimal
50-80 ng/mL
Mainstream
30-100 ng/mL
The mainstream lower bound of 30 includes people with clinically deficient immune function, bone metabolism, and mood regulation. The research on optimal, including Hollis and Wagner 2011, puts the functional range at 50 to 80.
RBC Magnesium
ATH optimal
5.5-6.8 mg/dL
Mainstream
4.2-6.8 mg/dL
Serum magnesium is almost always normal even when you are clinically depleted. RBC magnesium reflects intracellular status, which is the accurate measure. DiNicolantonio et al. Open Heart 2018 estimated that up to 45 percent of Americans are deficient.