Every scientific term you've seen in your lab results and wanted to understand, all in one place.
Blood urea nitrogen measures how well your kidneys are working to filter blood and is an indicator of kidney health. High levels of urea nitrogen indicate that your kidneys may not be functioning well and can result from complications due to diabetes, high blood pressure, kidney stones, kidney infections, autoimmune disease, congestive heart failure, or dehydration.
Blood urea nitrogen is used to test how well your kidneys are working. Urea is a waste product produced by the liver, filtered out of the blood by the kidneys, and removed from the body in urine.
The amount of urea nitrogen in your bloodstream, in conjunction with other biomarkers, can be used as an indicator of kidney health. High levels of urea nitrogen indicate that your kidneys may not be functioning well to filter your blood.
Age and sex are factors that can affect blood urea levels. Women and children tend to have lower blood urea levels, and all individuals tend to have rising blood urea levels as they age. Women may have lower blood urea levels during the second or third trimester of their pregnancies.
You should consider a blood urea nitrogen test if your healthcare professional believes you have kidney disease or if your kidney function needs to be assessed due to chronic conditions, including diabetes and high blood pressure¹. Symptoms of kidney disease include changes to urinary function, swelling in your limbs, muscle cramps, nausea and vomiting, loss of appetite, and fatigue². It can also be used, in conjunction with other blood tests, to help diagnose other diseases, including liver damage, urinary tract obstruction, congestive heart failure, and bleeding in the GI tract.
Since kidney damage can result in elevated levels of creatinine, testing this biomarker should also be considered. See creatinine for more information.
Additional testing of kidney function may be needed if your blood urea nitrogen levels are abnormal.
The American Board of Internal Medicine considers the reference range for blood urea nitrogen to be 8–20 mg/dL³, but this may be affected by your age and is dependent on the lab you use for your test.¹
While an elevated level usually indicates poor kidney function, it can also be due to other conditions, including dehydration, obstruction of the urinary tract, congestive heart failure, and bleeding in the GI tract.
Elevated blood urea nitrogen can result from complications related to diabetes or high blood pressure, conditions that block the flow of urine, such as kidney stones, or damage to your kidneys from an infection or autoimmune disease. Additionally, factors that cause decreased blood flow to the kidneys, such as congestive heart failure or dehydration, may cause elevated blood urea nitrogen levels. To find the root cause of your elevated blood urea level, additional testing will be required.
Low levels of blood urea nitrogen can indicate a low-protein diet, severe liver damage, or malnutrition.
Staying hydrated and consuming less protein can help lower blood urea nitrogen levels.
4q25, 9p21, KIF6, APOE, Haptoglobin
The cardiogenetics panel is used to identify specific regions of your genetic profile associated with increased risk of cardiovascular disease. The results of this test can be used by healthcare professionals to create a treatment plan to complement your genetic risk factors.
The cardiogenetics panel is used to identify specific regions of your genetic profile associated with an increased risk for cardiovascular disease. By analyzing the DNA of these regions, we are able to identify variants associated with this risk.
Variants are alternate sequences that differ from the normal DNA sequence. Carrying a risk variant does not mean you will necessarily suffer from cardiovascular disease; it means your risk is increased compared to someone who carries no copies of the risk variant. The results of this test can be used by healthcare professionals to create a treatment plan to complement your genetic risk factors.
The panel tests genetic variants in 5 regions:
Having the variant of 4q25 may increase your risk of atrial fibrillation, which causes an irregular heartbeat and risk of stroke¹.
Depending on which variants of region 9p21 you carry, you may have an increased risk of coronary artery disease²,³.
Those with the variant of KIF6 who are treated with statins have a lower risk of cardiovascular disease⁴.
Having the variant of APOE may increase your risk of Type III hyperlipoproteinemia, which prevents your body from correctly metabolizing fats. This can lead to atherosclerosis (a buildup of fats in your blood vessels), potentially increasing your risk of coronary artery disease and blood clots⁵.
Your chances of having heart disease or a stroke depends, in part, on which haptoglobin variant you have. This is especially true for those with diabetes, for whom cardiovascular disease is a major cause of death. Those with the Hp2-2 genotype and diabetes have a 500% greater risk of heart attack or stroke than those with the Hp1-1 genotype.
Since your DNA can’t be changed, you will always carry any genetic variant that affects your risk for cardiovascular disease. The good news is you can lower your risk for heart disease through lifestyle changes, including not smoking, exercising regularly, eating a healthy diet, and avoiding excess weight⁶.
tTG IgA , tTG IgG, DGP IgA, DGP IgG
Screening these 4 key autoantibody biomarkers allows you to know how your body reacts to gluten and whether you have celiac disease. For those with celiac disease, continued testing is also an excellent way to monitor your progress toward healing.
Antibodies are part of your immune system that identify and help eliminate foreign invaders in your body, like a virus. Autoantibodies—sometimes mistakenly produced by the immune system—attack your own tissues. This can lead to autoimmune disorders, such as celiac disease.
Celiac disease is a genetic, autoimmune disease characterized by inflammation of the small intestines when someone eats gluten, a protein found in wheat and other grains. Autoantibodies mistakenly identify gluten as foreign and attack the small intestine where it is present. The damage can cause abdominal pain, diarrhea, and failure to absorb nutrients from food. Your risk for having celiac disease increases if you have a family history of celiac disease, have an autoimmune disorder, such as thyroid disease or type 1 diabetes, or have some other genetic disorder, such as Down Syndrome or Turner Syndrome.
Testing 4 key antibody biomarkers, including the gold standard tTG-IgA, allows you to know how your body reacts to gluten and whether you have celiac disease. This test detects the presence of 4 autoantibody biomarkers associated with celiac disease: the tissue transglutaminase (tTG) antibodies tTG IgA and tTG IgG; and the deamidated gliadin peptide (DGP) antibodies DGP IgA and DGP IgG. It can be used to both screen for celiac disease and monitor your disease progression in response to dietary changes.
The results of this test alone will not provide enough information for healthcare professionals to definitively diagnose whether you have celiac disease. Follow-up tests, including an upper endoscopy and biopsy, are necessary to identify the cause of any symptoms you are experiencing.
Celiac disease non-profit Beyond Celiac recommends that people get tested for celiac disease if they have symptoms of celiac disease, have a first-degree relative with celiac disease, or have an associated autoimmune condition, such as type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, and selective IgA deficiency¹,². Symptoms of celiac disease include chronic diarrhea, bloating, abdominal pain, or other digestive problems that last for more than two weeks³. Celiac disease can also cause an itchy, blistering skin rash (called Dermatitis Herpetiformis) with or without digestive symptoms. It is important to continue on a gluten-containing diet until you have been screened and tested for celiac disease.
Any result that is above these cutoff values is considered a positive result for each respective biomarker:
If this is your first test for celiac disease, the tTG IgA biomarker a verymost important indicator. A positive result is a strong indicator and, the more elevated the level, the likelier you are to have celiac disease.
A positive celiac disease screening test is only the beginning of your diagnosis. A positive serology (blood) test might indicate that you need to have an upper endoscopy and biopsy to confirm a celiac disease diagnosis. You should bring your celiac disease screening test results to a gastroenterologist for further celiac disease testing.
When monitoring your celiac disease, the interpretation of biomarker levels must be done in relation to your baseline levels. For example, if you began a gluten-free diet with antibodies >10 times more elevated than the cutoff listed above, it is acceptable to still have an elevated level after 3–4 months, as long as it has decreased. It's important to monitor your follow-up blood work with your gastroenterologist.
Any result that is below these cutoff values is considered a negative result for each respective biomarker:
Currently, the only way to treat and manage celiac disease is to follow a strict, lifelong gluten-free diet. Your diet should be devoid of any foods that contain gluten.
imaware thanks Beyond Celiac for advancing celiac disease research.
LDL, HDL, total cholesterol, triglycerides
The lipid panel of biomarkers provides information about your current cholesterol profile and triglyceride levels. Together, these provide a comprehensive view of your cardiovascular health that can help assess your risk for cardiovascular disease.
Cholesterol is used by the body to create hormones, support the structure of cells, and protect nerves. It is produced by your liver and obtained from eating animal products, such as meat, cheese, and egg yolks.
The cholesterol panel of biomarkers is used to help assess cardiovascular health. High cholesterol levels are associated with plaque production in the arteries, which increases the risk of cardiovascular disease.
LDL is a molecule that carries cholesterol in the bloodstream to cells throughout the body, including the cells lining our blood vessels. It is known as “bad cholesterol” because it contributes to the buildup of plaque in blood vessels. The greater your level of LDL, the greater your risk of cardiovascular diseases.
HDL is known as “good cholesterol” because it lowers overall cholesterol levels. It does this by transporting cholesterol from cells back to the liver to be expelled from the body. The more HDL you have in your body, the lower your risk of cardiovascular diseases.
Total cholesterol gives a reading of the total amount of cholesterol in your blood without differentiating between LDL and HDL. The greater your total total cholesterol level, the greater the risk of cardiovascular diseases.
Triglycerides are the main form of fats in our body and diet. They transport certain vitamins through the body, provide energy, and help insulate and protect cells. Triglycerides are stored in fat cells and they accumulate when you consume more calories than you burn. Having a higher level of triglycerides in your body puts you at greater risk for cardiovascular diseases.
Your risk for high blood cholesterol can be affected by your age, sex, family history and genetics, and ethnicity.
Usually, elevated levels of HDL do not cause symptoms unless they are very high.
The National Heart, Lung, and Blood Institute (NHLBI) recommends that people get a cholesterol screen at ages 9–11, then every 5 years after that¹. Men 45–65 and women 55–65 years of age should be screened every 1–2 years, while anyone over the age of 65 should be tested yearly. Those with heart disease, diabetes, or a family history of high cholesterol should get tested more frequently².
Your healthcare professional may suggest further tests to determine appropriate treatment if you have high cholesterol, including C-reactive protein, lipoprotein(a), and a coronary calcium scan, which can help diagnose atherosclerosis.
The imaware medical advisory board recognizes the following normal levels of each biomarker:
To decrease cholesterol levels, you can quit smoking, exercise regularly, eat a heart-healthy diet, manage your stress, and get enough sleep¹. Your healthcare professional may prescribe statins to reduce your cholesterol level.
Cortisol is the main stress hormone produced by your adrenal glands. Chronic stress can lead to high cortisol levels and is known to affect heart health. The cortisol test measures whether your cortisol levels are high or low, which may be a sign of an adrenal gland condition.
Cortisol is the main stress hormone produced by your adrenal glands and is involved in the “fight or flight” response. It affects energy levels, blood pressure, digestion, and your sleep/wake cycle.
Chronic stress can lead to high cortisol levels and is known to affect heart health¹ and stress is known as a long-term risk factor for high blood pressure or hypertension². Abnormal levels of cortisol—either too high or too low—could indicate Cushing’s syndrome or Addison’s disease. Healthcare professionals may need to conduct additional tests to determine the cause of abnormal levels of cortisol.
The cortisol test measures whether your cortisol levels are high or low, which may be a sign of an adrenal gland condition or that lifestyle changes need to be made.
You should test cortisol levels if you have symptoms of either low or high cortisol. High levels can affect your heart rate and energy levels.
Symptoms of Addison’s disease (low cortisol) include extreme fatigue, weight loss, darkening of the skin, low blood pressure (which may cause fainting), and more³. Levels of ACTH, the hormone that stimulates the production of cortisol, can be either elevated or decreased, depending on the cause of low cortisol⁴. Other tests may be needed to diagnose this disease.
Symptoms of Cushing syndrome (high cortisol) include obesity, high blood pressure, and elevated blood glucose levels⁴.
Reference values vary according to the time of day the test is taken and may vary between labs. Normally, they are highest in the early morning and decrease in the evening.
A person’s normal levels of cortisol can be elevated by acute stress, alcoholism, depression, prescription drugs, pregnancy, and estrogen therapy⁴.
Lower than normal levels of cortisol could be indicative of Addison’s disease, hypopituitarism, or adrenal insufficiency⁴.
The most common cause of elevated cortisol levels in women is a high level of estrogen in the blood due to pregnancy or estrogen therapy⁴. Excess levels of cortisol can also be indicative of Cushing syndrome, which is a rare disorder. The most common cause of Cushing syndrome is the use of corticosteroids⁵, though it can also be caused by overproduction of the hormone ACTH.
Cortisol levels may be lowered by changing the medications you’re taking in consultation with your healthcare professional. If chronic stress is the cause of elevated cortisol, you may benefit from getting adequate sleep, exercising regularly, eating a healthy diet, and reducing the amount of caffeine you drink.
Cotinine is a biomarker to show whether you have been exposed to tobacco smoke recently, either by consuming products containing nicotine or from being exposed to secondhand tobacco smoke.
Cotinine is a metabolite of nicotine, the addictive substance found in tobacco and smoking-cessation products. It is used as a biomarker to indicate whether you have been exposed to nicotine recently.
The more nicotine you have been exposed to, either through consuming products containing nicotine or being exposed to secondhand tobacco smoke, the more cotinine you will have in your body and the higher your levels will be.
Elevated levels of cotinine in your blood may indicate active use of tobacco products, while lower levels may indicate previous use or exposure to secondhand smoke. Your healthcare professional can use the results to test for nicotine poisoning or to prescribe the correct dose of nicotine patches to help you stop smoking. It is also used by insurance companies as part of a health examination before approving a policy.
The following are considered typical blood levels of cotinine¹:
Any amount greater than 10 ng/mL indicates someone is an active smoker. Levels between 1–10 ng/mL indicate you are exposed to heavy amounts of secondhand smoke.
An elevated level of creatinine in your blood may indicate your kidneys are not filtering your blood properly. Your healthcare professional may suggest dietary and lifestyle changes, including not smoking and limiting alcohol consumption, to reduce your creatinine levels.
Creatinine is a breakdown compound produced by working muscles. It is filtered out of the blood by the kidneys, then is released from the body in urine. In a healthy person, the level of creatinine is constant because the kidneys are able to filter it out as it is produced. This makes creatinine a useful biomarker to indicate how well the kidneys are functioning because a buildup of creatinine in your blood may indicate your kidneys are not filtering your blood properly.
Your creatinine levels can be elevated due to complications related to diabetes, medication toxicity, kidney infection, high blood pressure, heart disease, and conditions that block the flow of urine. Your healthcare professional may perform a urine test to confirm your blood levels.
Your level of creatinine depends on your age, ethnicity, gender, and muscle mass.
Your healthcare professional may recommend this test if you have symptoms of kidney disease, have a condition (e.g., diabetes or high blood pressure) that increases your risk of kidney disease, or to check on the effectiveness of treatment for kidney disease.
High levels of creatinine may not result in noticeable symptoms until kidney disease progresses. At that point you might experience swelling, fatigue, changes in urination, loss of appetite, nausea, and itching².
Blood levels of creatinine should be stable and the following ranges are considered normal¹:
Serum creatinine is used to measure the glomerular filtration rate (GFR), which takes into account age and sex when assessing kidney function¹.
Elevated levels of creatinine may indicate poor kidney function and the possibility of kidney disease.
Low levels of creatinine can be associated with low muscle mass due to aging, severe liver disease, or a low-protein diet.
Working with a healthcare professional to address the condition affecting your kidney function may help lower your creatinine levels back to normal. This could include dietary and lifestyle changes, including not smoking and limiting alcohol consumption.
EAG is based on the results of your HbA1c test, which measures the average levels of blood glucose for the past 2–3 months. This information will allow your healthcare professional to make decisions about your diet, lifestyle, and medications to help you control your blood sugar levels better.
EAG is a measurement of your blood sugar over time and helps diabetics understand how well you are managing your blood sugar. It is based on your HbA1c results. While your glucose meter measures your blood sugar at the time of testing, EAG is the average of your blood glucose for the previous 2–3 months. This gives you and your healthcare professional an idea of how well your treatment plant is working to control your blood sugar.
While HbA1c is reported as a percentage, EAG is reported in mg/dL, just like your home-based glucose monitor. This makes it easy to compare results and follow your progress. Just keep in mind that EAG is not the same average that you get from your daily glucose meter readings¹. Diabetics tend to measure blood sugar more often when it is low—upon waking and before eating—whereas EAG is an average of your glucose over the entire day.
See HbA1c for more.
Measuring EAG helps you understand how well you are managing your blood sugar over an extended period of time and can help you confirm your self-test readings. With this information, you can work with your healthcare professional to make decisions about your diet, lifestyle, and medications to help you control your blood sugar levels better.
EAG should be measured to help monitor the progress of your diabetes treatment and to confirm your at-home glucose meter readings. Also, for diabetics, the American Diabetes Association recommends testing your HbA1c at least twice a year to monitor the progress of your treatment².
The imaware medical advisory board recognizes the normal range of EAG as 70–117 mg/dL.
A higher than normal EAG indicates that your blood sugar is not being controlled sufficiently. Knowing this will allow your healthcare professional to alter your treatment plan and suggest lifestyle changes to reduce your risk of complications due to diabetes.
With this information, your healthcare professional can help you make informed decisions about your diet, lifestyle, and medications to help you control your blood sugar level better. This can include regular exercise, a balanced diet with fewer carbs, and getting adequate sleep. Your healthcare professional might also prescribe medications to help regulate your blood glucose level, such as Metformin.
Ferritin levels indicate the amount of iron stored in your body and can reveal whether you have an iron deficiency. You can elevate low iron levels with dietary changes and supplementation.
Iron is an essential part of hemoglobin, which is found in red blood cells and carries oxygen throughout the body. Most of the iron outside of hemoglobin is stored as ferritin, a complex of iron and a protein that can be used to screen for iron deficiency¹. The ferritin test is a specific and sensitive measurement of your iron levels.
Pregnant women, children, and vegetarians have a higher risk of becoming iron deficient. Having an elevated ferritin level is far less common and may be a symptom of liver disease, hyperthyroidism, or infection.
Low iron can cause fatigue, headaches, and dizziness. It also increases your risk of developing anemia, a condition characterized by having too few functional red blood cells².
The imaware medical advisory board recognizes the following as normal levels of ferritin:
Low ferritin is anything below the normal levels:
Low ferritin usually indicates iron deficiency, which can lead to fatigue, headaches, and dizziness. It also increases your risk of developing anemia².
Low iron levels can be elevated by eating iron-rich foods—animal protein, dark green leafy vegetables, and iron-fortified cereals—and by taking an iron supplement. For excess iron levels, healthcare professionals may recommend dietary changes or iron chelation therapy.
Vitamin B9, also called folate, contributes to cell growth and the production of DNA and red blood cells. Folate deficiency may cause anemia and fatigue and is especially important for healthy fetal development.
B vitamins help your body perform a variety of functions, including energy metabolism, creating blood cells, and maintaining brain function. Vitamin B9, also called folate and folic acid, contributes to cell growth and the production of DNA and red blood cells. Lack of folate may cause anemia, one of the symptoms of which is fatigue. Folate is especially important for healthy fetal development.
Those at risk for not getting enough B vitamins in their diet include the elderly who have a poor diet, alcoholics, those with digestive disorders that prevent nutrient absorption, and pregnant women.
This test is advisable if you’re experiencing symptoms of anemia that may be caused by a folate deficiency, which include extreme fatigue, shortness of breath, pale skin, heart palpitations, mental confusion, and more⁴. Since some forms of anemia can be caused by a vitamin B12 deficiency³, it might be advisable to also test levels of this vitamin. Measurement of both of these biomarkers is needed to determine the cause.
Folate levels in blood greater than 4.0 µg/L are considered normal¹.
Folate levels lower than 4.0 µg/L suggest folate deficiency¹.
As approximately 20% of folate comes from the food you eat, low levels are usually due to a lack of folate in the diet. Folate deficiency is most common in pregnant people and alcoholics¹, has been found in patients with psychiatric disorders¹, and is a risk factor for spontaneous abortions².
Most people can get the folate they need from food. You can improve your folate levels by eating food rich in folate, including dark green leafy vegetables, beans, peas, and nuts. It is also found in citrus fruits, bananas, melons, and strawberries. It is recommended that people who plan to get pregnant or are pregnant or breastfeeding take a folic acid supplement.
Blood glucose levels are an important indicator of your cardiovascular health, immunity, and as a screen for whether you have, or might develop, diabetes.
Fasting blood sugar—a test of glucose levels after not eating for a period of at least 8 hours— is useful to determine if you have diabetes or are likely to develop it.
Diabetes is characterized by your body’s insulin response not working properly, either due to not making enough insulin or the cells not responding to the insulin signal. Diabetes causes blood glucose levels to stay elevated for long periods of time after a meal, eventually resulting in damage to the eyes, kidneys, nerves, circulatory system, and other organs.
Additionally, elevated blood glucose levels can cause long-lasting inflammation throughout the body. Chronic inflammation inhibits immunity and can increase your risk of getting infections.
Diabetes increases your risk of heart attack and stroke. This occurs because elevated levels of sugar and insulin in your blood can cause cholesterol to form plaque that shrinks and damages your arteries. Your immune system responds by trying to get rid of the plaque, which is what can cause inflammation and blood clots.
Other than elevated blood sugar, there are usually no symptoms accompanying prediabetes other than, possibly, areas of darkened skin, including on the neck, armpits, elbows, knees, or knuckles¹. Prediabetes can progress to type 2 diabetes, at which point symptoms can include increased thirst, frequent urination, blurred vision¹.
Your healthcare professional may recommend other tests if they suspect type 1 diabetes. This includes a urine test for ketones and tests to detect the presence of autoantibodies. If you’re at risk for gestational diabetes, you may need to take a glucose challenge test and a glucose tolerance test².
The imaware medical advisory board recognizes a fasting blood sugar level of below 100 mg/dL as normal.
The imaware medical advisory board recognizes the following fasting blood sugar levels as high:
You can help your body better regulate the amount of glucose in your blood by exercising regularly, eating a balanced diet with fewer carbs, and getting enough sleep. Your healthcare professional might also prescribe medications to help regulate your blood glucose level, such as Metformin.
Identifying your haptoglobin genotype helps you assess your risk of heart attack and stroke, especially if you have diabetes. Your healthcare professional can use these results to choose a treatment to help lower your risk, including vitamin E therapy.
Haptoglobin (Hp) is a protein involved in recycling essential parts of red blood cells when they die. There are three types of Hp protein and each person produces only one. Your genetics determines which of the three Hp proteins you produce. This is known as your haptoglobin genotype and can be a risk factor for certain diseases.
Your chances of having heart disease or stroke depends, in part, on which Hp genotype you have. This is especially true for those with diabetes, for whom cardiovascular disease is a major cause of death. Those with the Hp2-2 genotype and diabetes have a 500% greater risk of heart attack or stroke than those with the Hp1-1 genotype¹.
This test identifies your Hp genotype. Knowing this helps your healthcare professional choose a treatment to help lower your risk of heart attack or stroke, including vitamin E therapy. Vitamin E therapy decreases the risk of experiencing a cardiovascular event among those with the Hp2-2 genotype and diabetes². However, vitamin E therapy may increase the risk of heart disease among those with the Hp2-1 genotype and diabetes³. This is why it’s so important to know your Hp genotype before you choose an appropriate therapy.
Knowing your haptoglobin genotype can help you and your healthcare professional make treatment choices to reduce your risk of heart attack or stroke, especially if you have diabetes. As your genetics don’t change over the course of your lifetime, you only need to take this test once.
While you can’t change your Hp genotype, you can lower your risk for heart attack and stroke by adopting a lifestyle that includes regular exercise, not smoking, and consuming a heart-healthy diet. This test is especially important for those with diabetes.
The HbA1c test measures your blood glucose levels over the past 2–3 months. The results of this test will help your healthcare professional identify prediabetes, diagnose diabetes, and monitor the effectiveness of your diabetes treatments.
Hemoglobin A1c (HbA1c) is a biomarker that measures the amount of glucose in your blood that is attached to hemoglobin, the molecule in your red blood cells important for carrying oxygen throughout the body. HbA1c gives an average of your blood sugar over the past 2–3 months, providing a snapshot of your ability to maintain healthy blood sugar over time.
Diabetes causes blood glucose levels to stay elevated for long periods of time after a meal, eventually resulting in damage to the eyes, kidneys, nerves, circulatory system, and other organs. Hyperglycemia—the chronic state of having high blood sugar—is also known to adversely affect the immune system¹.
Measuring HbA1c can detect prediabetes, help diagnose diabetes, and be used to monitor the effectiveness of diabetes treatments. The higher your percentage of HbA1c, the greater your blood sugar levels over the past 2–3 months and the greater your risk of having prediabetes or diabetes. Additionally, those with elevated HbA1c and a genetic variant of the haptoglobin protein called Hp2-2 have a significantly increased risk of heart disease². Learn more about haptoglobin.
Other than elevated blood sugar, there are usually no symptoms accompanying prediabetes other than, possibly, areas of darkened skin, including on the neck, armpits, elbows, knees, or knuckles³. Prediabetes can progress to type 2 diabetes, at which point symptoms can include increased thirst, frequent urination, blurred vision³.
If you have prediabetes, it is recommended that you test HbA1c once a year⁴. For diabetics, the American Diabetes Association recommends testing your HbA1c at least twice a year to monitor the progress of your treatment⁵.
The following levels are recognized by the imaware medical advisory board:
The higher your level of HbA1c, the greater your chance of developing type 2 diabetes.
With this information, your healthcare professional can make informed decisions about your diet, lifestyle, and medications to help you control your blood sugar level better. This can include a balanced diet that reduces intake of carbs and sugar-rich foods, regular exercise, and getting enough sleep. Your healthcare professional might also prescribe medications to help regulate your blood glucose level, such as Metformin.
Your body makes C-reactive protein (CRP) in response to inflammation and elevated levels of CRP are associated with an increased risk of heart disease and heart attack. CRP levels can be lowered by lifestyle changes, as well as statin medications.
C-reactive protein (CRP) is a biomarker produced by your liver in response to inflammation, which is a natural process used by your immune system to heal injuries and ward off infections. High-sensitivity CRP (hs-CRP) is one of the biomarker screens used to detect chronic inflammation. Healthcare professionals will use follow-up tests to identify the specific factors affecting your CRP level and to determine the source of the inflammation.
When inflammation becomes chronic, it leads to changes in your blood vessels making them more permeable to fat and cholesterol and leading to the formation of plaque on the blood vessel walls. This is why chronic inflammation can cause atherosclerosis and heart attacks¹ and elevated levels of CRP are associated with an increased risk for cardiovascular disease.
Your healthcare professional may recommend this test to check for inflammation due to an infection, to see if you might have an inflammatory disease such as rheumatoid arthritis, or to gauge your risk for a heart attack. If your level is high, they might recommend further tests to assess your risk for heart disease.
The imaware medical advisory board recognizes a normal level of hs-CRP to be below 3.0 mg/L.
The imaware medical advisory board categorizes the following levels of hs-CRP:
A high level of hs-CRP, i.e., greater than 3 mg/L, indicates acute inflammation and might be a sign of a serious infection, an injury, or chronic disease. Levels in this “red zone'' mean you’re at greater risk for heart disease.
Determining the cause of inflammation is essential to lowering CRP levels, but exercise, refraining from smoking, and consuming a heart-healthy diet can help. CRP levels can also be elevated by inflammation due to infections and autoimmune diseases, such as Crohn’s disease or rheumatoid arthritis. Statin medications can also be used to reduce CRP levels.
Total IgE measures blood levels of antibodies made by your immune system in response to allergens. The presence of IgE antibodies in your blood means you’re more likely to have allergic reactions. Tests for allergen-specific IgE particles are then used to pinpoint the specific substances causing your allergic reactions.
Total IgE measures blood levels of antibodies produced by your immune system in response to allergens.
Immunoglobulin E (IgE) is an antibody that initiates an allergic reaction. When you are exposed to an allergen—a normally non-harmful substance that the immune system assumes is dangerous, like peanuts—your body makes specific IgE antibodies designed to recognize that allergen in the future. Then, when you are re-exposed to the same allergen, your immune system quickly produces a large amount of allergen-specific IgE particles to identify and eliminate the allergen.
The total IgE test detects the presence of IgE antibodies in your blood, indicating an increased likelihood that you will experience allergic reactions. Tests for allergen-specific IgE particles are then used to provide information about the specific substances causing your allergic reactions.
Allergic reactions can range from localized patches of red, itchy skin to anaphylaxis, which involves a sudden drop in blood pressure and difficulty breathing. Allergic reactions can vary widely in both type and severity depending on the person and allergy. The following symptoms are strong indications that you should measure your IgE levels:
Unlike an IgG test (known as a food sensitivity test), which only measures the common antibody immunoglobulin G and doesn't accurately predict specific food allergies, an IgE test focuses on the class of antibody that's directly associated with allergic reactions — giving you much more specific results when it comes to identifying allergic triggers.
Your IgE test results are reported in fluorescent standard units (FSU). A reading lower than 0.01 FSU indicates no detectable IgE. Generally, the higher the level of IgE, the greater the risk that you will experience allergic symptoms. Each potential allergen is in a class based on this level, as below.
While the higher the IgE level, the greater the likelihood you will have allergic symptoms for a particular allergen, even allergens that fall into the lower Classes should be monitored. They can contribute to the cumulative allergen burden, for example during allergy season.
If you have elevated IgE levels for any indoor, outdoor, or food allergies, a board-certified allergist can work with you to create a program that helps to alleviate symptoms. This can include the use of antihistamine and other medications, allergen avoidance and immunotherapy.
Insulin is a hormone that can show how well your body regulates blood sugar levels. Diabetes is a disease characterized by a faulty insulin response, which leads to elevated blood sugar levels over long periods of time.
Insulin is a biomarker that can tell you how well your body’s insulin response is working. It is a hormone released by your pancreas in response to elevated levels of glucose in your blood, usually after a meal. It tells cells to take up glucose to be used later as an energy source. Between meals, when glucose levels are low, the amount of insulin in your blood is expected to be low as well.
Insulin resistance occurs when your cells need more and more insulin over time to absorb glucose from the bloodstream. Eventually this reaches a point when the pancreas cannot produce enough insulin to react to glucose levels. One-third of Americans have insulin resistance, also known as prediabetes¹.
Diabetes is a disease characterized by a faulty insulin response, either due to your pancreas not making enough insulin or your cells being unable to respond to the insulin that is made. These factors can cause blood glucose levels to stay elevated for long periods of time after a meal, eventually resulting in damage to the eyes, kidneys, nerves, circulatory system, and other organs throughout the body.
It is recommended to get an insulin test if you have low blood glucose, if you have diabetes and need to track your production of insulin, or to determine if you have insulin resistance.
Your healthcare professional might recommend an insulin test if you are more likely to develop insulin resistance or diabetes. Risk factors include obesity, being over the age of 45, having a familial history of diabetes, having high blood pressure or abnormal cholesterol levels, and if you’ve had gestational diabetes, heart disease, or a stroke².
Insulin levels measured 2–3 hours after consuming 100 mg of glucose indicate:
*Insulin levels are measured in milli-international units per litre, or mIU/L.
When insulin levels are greater than 100 mIU/L 2–3 hours after consuming 100 mg of glucose, you are insulin resistant and have a higher risk of developing diabetes.
You can possibly decrease insulin resistance by losing weight, eating fewer carbohydrates and sugars, exercising, and getting enough sleep. Even if a test of your blood sugar levels is normal, measuring your insulin levels is an important way to find out if you have insulin resistance.
High levels of lipoprotein(a) can contribute to an increased risk for cardiovascular disease and is not revealed by standard cholesterol tests. Lipoprotein(a) levels are controlled mainly by genetics, rather than diet or lifestyle.
Lipoprotein(a) is a low-density lipoprotein (LDL) that transports cholesterol, fat, and protein in your blood. Having a high level greatly increases your risk for heart disease and stroke. About one in five Americans have an elevated level of lipoprotein(a) that puts them at risk and most (80–90%) of this is inherited at birth.
Even in healthy adults, excess lipoprotein(a) can build up on the walls of the arteries, causing them to narrow and, potentially, block blood flow. This can lead to blood clots, a stroke, or a heart attack.
While there is no consensus on lipoprotein(a) levels, a guideline published by the National Lipid Association notes that normal levels are under 30 mg/dL and recommends considering lipoprotein(a) levels greater than 50 mg/dL as high risk¹.
Elevated levels of lipoprotein(a) can contribute to the buildup of plaque in your arteries and an increased risk of cardiovascular diseases, such as high blood pressure, heart attack, and stroke.
Testing lipoprotein(a) levels can help you assess your risk for heart disease. The test is recommended if you or a family member had a heart attack when young and seemingly healthy, when an immediate family member has hypercholesterolemia, or you have a familial history of elevated lipoprotein(a)¹.
Your level of lipoprotein(a) is controlled mainly by your genetics, meaning you should get tested if you have a family member who died suddenly of a heart attack or stroke—especially when they were young—or who has premature vascular disease or familial hypercholesterolemia.
Currently, there are no treatments aimed at decreasing lipoprotein(a) and statins do not affect it. Individuals with high levels of lipoprotein(a) can manage their risk for contracting cardiovascular diseases by taking medications and making appropriate lifestyle changes to reduce cholesterol levels.
Lp-PLA2 is a biomarker released by immune cells specifically in blood vessels where it causes inflammation. As vascular inflammation is associated with cardiovascular disease, measuring Lp-PLA2 levels is an accurate indicator of the risk of heart disease.
Lp-PLA2 is a biomarker released by immune cells specifically in blood vessels to cause inflammation. As vascular inflammation is associated with cardiovascular disease, measuring Lp-PLA2 levels is an accurate indicator of the risk of heart disease¹.
Normal levels of Lp-PLA2 are below 200 ng/mL².
Levels greater than 200 ng/mL are considered elevated² and indicate that inflammation is likely and increase your risk of atherosclerosis, chronic ischaemic heart disease, and stroke³,⁴. Atherosclerosis is a condition characterized by plaque deposits in your arteries that increases your risk of blood clots. Half of heart attacks occur in people with normal cholesterol levels, making this an important additional test for cardiovascular health.
Your healthcare professional may recommend this test if you have cardiovascular disease or to help assess your risk of cardiovascular disease, especially if you have risk factors such as diabetes, you are a smoker, or you are over the age of 65². Lp-PLA2 can be tested along with other biomarkers, such as C-reactive protein (CRP), to assess your risk for cardiovascular disease. Your healthcare professional may also recommend a cholesterol panel of tests.
To decrease your risk of vascular inflammation and cardiovascular disease, healthcare professionals may recommend you eat less fatty foods, exercise more frequently, stop smoking, and, possibly, take statins, which lower levels of cholesterol in your body. Lp-PLA2 levels can be lowered over the course of weeks or months by addressing risk factors².
Magnesium is a mineral that supports healthy muscles, nerves, heart, and bones. When you don’t have enough, you may experience symptoms like muscle cramps, weakness, or fatigue. Testing your magnesium levels lets you know whether you need to add a supplement to your diet or eat more magnesium-rich foods.
Magnesium is a mineral needed for healthy muscles, nerves, heart, and bones. While most of the magnesium in the body is stored within cells and bones, this test measures the small portion found in your blood.
Magnesium deficiency—called hypomagnesemia—can be caused by malnutrition, excessive alcohol intake, diabetes, chronic diarrhea, or other digestive disorders, such as Crohn’s disease. It can lead to neurological issues, such as migraines, confusion, and depression, and may cause weakness and muscle cramps. In pregnant women, hypomagnesemia is correlated with preeclampsia, leg cramps, and preterm birth¹. Magnesium deficiency also interferes with your ability to use stored vitamin D as magnesium is essential to convert vitamin D to its active form in your body. Severe magnesium deficiency can cause low blood levels of calcium or potassium².
This test is recommended for those who consume less magnesium than the recommended daily allowance (e.g., older adults and alcoholics), have a condition that interferes with the absorption of magnesium (e.g., Crohn’s disease and celiac disease), or have type 2 diabetes, which leads to increased magnesium excretion².
Symptoms of a new magnesium deficiency include loss of appetite, nausea and vomiting, fatigue, and weakness². Among the symptoms of more severe magnesium deficiency are numbness, tingling, muscle contractions and cramps, and seizures.
The normal range for blood magnesium is 1.7–2.2 mg/dL³.
Any result below 1.7 mg/dL is considered low.
You can take a supplement to elevate your magnesium level if you find it is too low. Magnesium is also found in many foods, including leafy green vegetables, bananas, many nuts and seeds, and milk.
An elevated PSA level in the blood is used to identify men at risk of developing prostate cancer. Generally, the higher the level, the greater the risk, but elevated PSA can also be caused by an enlarged prostate, sexual activity, or even riding a bike.
Prostate-specific antigen (PSA) is a protein made in the prostate. PSA levels are often elevated in the blood of men with prostate cancer. The PSA test can also identify non-cancerous conditions, such as prostatitis (prostate inflammation) and benign prostatic hyperplasia (overgrowth of the prostate).
The PSA blood test is often used by healthcare professionals as an initial screen for prostate-related conditions in men over the age of 50, though earlier testing may be advisable for men in high-risk groups such as those with a family history of prostate cancer¹. A PSA test may help detect prostate cancer early in men without any symptoms of the disease, find cancer in those who do have symptoms, and be used to monitor the effectiveness of prostate cancer treatments¹.
While it used to be recommended to men over age 50 to test their PSA yearly, some organizations warn against routine testing due to the need to balance the benefits and risks of screening for prostate cancer². Most organizations recommend discussing the PSA test with your healthcare professional before proceeding.
While there is no normal PSA level, generally, the higher the level, the greater the risk a man has prostate cancer². Most healthcare professionals used to consider a PSA level of 4 ng/mL or lower as normal, though further studies showed some men with PSA levels less than 4 ng/mL can develop prostate cancer³.
An elevated PSA level may warrant follow-up tests, such as a digital rectal exam or urine test, to learn more about the cause. If a healthcare professional suspects prostate cancer, they may recommend additional tests and a prostate biopsy. Elevated levels of PSA can also be caused by an enlarged prostate, exercise, and sexual activity.
CCP IgG, RF IgM, RF IgA
CCP IgG, RF IgM, and RF IgA are important biomarkers for the diagnosis of rheumatoid arthritis. Their presence indicates your body may be undergoing an autoimmune response, which is what causes the aching symptoms in your joints.
Three autoantibody biomarkers are used to test for rheumatoid arthritis, a condition that affects more than 1.5 million Americans¹.
Antibodies are part of your immune system that identify and help eliminate foreign invaders in your body, like a virus. Autoantibodies—sometimes mistakenly produced by the immune system—attack your own tissues. This can lead to autoimmune disorders, such as rheumatoid arthritis.
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation and joint pain, usually starting with small joints in the hands and feet and progressing to other joints.
The rheumatoid arthritis panel detects the presence of 3 autoantibodies that are common in those with rheumatoid arthritis: citrullinated peptide antibody (CCP IgG) and 2 rheumatoid factor (RF) biomarkers, RF IgM and RF IgA. The CCP antibody test is 97% specific for rheumatoid arthritis². Because low levels of RF autoantibodies have been found in those who do not have rheumatoid arthritis, healthcare professionals might test for other biomarkers and take other health information into account before diagnosing rheumatoid arthritis.
You may want to test for rheumatoid arthritis if you begin to experience symptoms of the disease. In the early stages of rheumatoid arthritis, your joints may be painful, warm, or swollen. These symptoms may gradually get worse or come and go over the course of days or weeks. Fatigue is another early symptom of developing rheumatoid arthritis, though it is common to many other conditions as well. As the disease progresses, affected joints will become stiff and exhibit mild to severe pain.
Medications can relieve symptoms and reduce the inflammation and pain associated with rheumatoid arthritis. Other drugs can slow down the progression of the disease. Low-impact exercise and an anti-inflammatory diet rich in whole grains, fruits and vegetables, omega-3 fatty acid-rich foods, and minimizing red meat and dairy can help relieve symptoms.
The thyroid produces 2 hormones—T3 and T4—that manage your metabolism. T3 and T4 levels are used to assess the functioning of your thyroid and pituitary glands and to evaluate the effectiveness of treatments taken to address a thyroid disorder.
The thyroid is a small gland located just below the Adam’s apple that produces hormones to manage your body temperature, energy use, weight, muscle strength, and mood. These hormones are: T3 (triiodothyronine), which contributes to the body’s muscle control, digestion, heart function, and bone health; and T4 (thyroxine), which helps maintain metabolism, mood, and body temperature. Your body can convert T4 to T3 if necessary.
Healthcare professionals use free T3 and T4 levels to assess the functioning of your thyroid and pituitary glands. The pituitary gland is in the brain and manages the production and release of thyroid hormones.
You should test your levels of free T3 and T4 if you begin to feel symptoms associated with hormone imbalance.
If your free T3 and T4 levels are elevated, you might experience:
If your free T3 and T4 levels are low, you might experience:
This test may also be used to help evaluate the effectiveness of treatments taken to address a thyroid disorder.
The normal range for adults for each hormone is¹:
Elevated levels of free T3 and free T4 are associated with an overactive thyroid, which is also called hyperthyroidism. Hyperthyroidism is most commonly caused by Graves’ disease, an autoimmune disorder that causes the immune system to signal the thyroid to produce excess T4 and T3.
Low levels of free T3 and T4 are associated with an underactive thyroid, also known as hypothyroidism. Hypothyroidism is most commonly caused by Hashimoto’s thyroiditis, an autoimmune disorder that leads to chronic inflammation of the thyroid gland, causing it to produce lower quantities of hormones.
If your T3 and T4 levels are low, studies have shown that aerobic exercise increases total blood levels of T3 and T4²,³. Some foods interfere with thyroid function, particularly brassicas, peanuts, and soybeans and should be avoided by those with hypothyroidism⁴. Always consult with your healthcare professional prior to making these lifestyle changes. Medication may be needed to improve thyroid hormones.
Testosterone is the sex hormone that functions in the sexual development of people with testicles. It is the muscle-building hormone, increasing muscle mass in both sexes. Healthcare professionals can use this information to help identify conditions, such as erectile dysfunction and low sex drive.
Testosterone is the sex hormone produced by the testicles and, in smaller amounts, by the ovaries. People with testicles tend to have higher levels of testosterone because it plays a large role in male sexual development. Testosterone is referred to as the muscle-building hormone because it increases muscle mass and bone in both sexes.
Healthcare professionals can use this information to help identify a range of conditions, such as erectile dysfunction and pituitary disorders in those with testicles, and infertility and low sex drive. This test can also be used to monitor testosterone levels of those undergoing hormone replacement therapy.
It is recommended that you test your testosterone levels if you are experiencing symptoms of low testosterone, which include changes in sexual function (e.g., lower sexual desire, fewer spontaneous erections, and infertility), increased body fat, reduced muscle mass, decreased bone density, and emotional changes¹.
The imaware medical advisory board recognizes the following levels for total testosterone for adult men:
At this time, the imaware testosterone test is for use in males only. We look forward to offering a female test soon.
Testosterone levels in people with testicles naturally decrease with age, a process distinct from male hypogonadism, which occurs when the testicles fail to produce testosterone. The risk of male hypogonadism is increased by many conditions, including type 2 diabetes, HIV infection, or if the testicles are removed to treat cancer.
Evidence exists for natural methods that may boost your testosterone levels, including exercising more², getting plenty of good sleep³, reducing stress⁴, and avoiding excessive alcohol⁵. While evidence of causation is unclear, these lifestyle choices have many other health benefits besides potentially increasing your testosterone.
Testosterone-replacement therapy may be a viable option for those with low testosterone.
Thyroid-stimulating hormone (TSH) levels are used to assess your thyroid’s health. Low levels of TSH are indicative of an overactive thyroid, or hyperthyroidism. High TSH levels are indicative of an underactive thyroid, or hypothyroidism.
The thyroid is a small gland located just below the Adam’s apple that produces hormones to manage your body temperature, energy use, weight, muscle strength, and mood. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland in the brain and tells the thyroid how much of these thyroid hormones to release. This means that TSH is a biomarker that can be used to evaluate thyroid health. If your pituitary gland notices that thyroid hormone levels are low, it produces TSH to signal to the thyroid to release more.
A TSH test is used to identify problems with thyroid function and to monitor the effectiveness of treatments for hypothyroidism and hyperthyroidism.
Thyroid problems are linked to both stress and iodine deficiency. It is recommended during pregnancy since about 1 in 500 pregnant women experience hyperthyroidism¹ and both hyper- and hypothyroidism can continue after birth if a woman experienced either during pregnancy.
The imaware medical advisory board recognizes 0.4–4.5 mU/L as the normal range for TSH in blood.
Low levels of TSH may indicate that your thyroid is overactive and produces an excess of thyroid hormones. This is called hyperthyroidism. Hyperthyroidism can lead to anxiety, weight loss, and difficulty sleeping.
High TSH levels may indicate an underactive thyroid, a condition known as hypothyroidism. This may cause hair loss, weight gain, and tiredness.
Those with an underactive thyroid can address their symptoms by taking a pill daily that contains thyroid hormones. Those with hyperthyroidism have many treatment options, including anti-thyroid medications.
B vitamins are required for many functions, including energy metabolism, creating blood cells, and maintaining brain function. Those at risk for not getting enough B vitamins in their diet include the elderly who have a poor diet, alcoholics, those with digestive disorders that prevent nutrient absorption, and pregnant women.
B vitamins help your body perform a variety of functions, including energy metabolism, creating blood cells, and maintaining brain function.
Vitamin B6, also called pyridoxine, helps digest nutrients, create blood cells, and produce signals to allow our brains to function properly. Low levels of vitamin B6 may lead to confusion or depression, a weakened immune system, and anemia. Taking pyridoxine supplements may help address nausea and vomiting in pregnant women¹.
Vitamin B9, also called folate and folic acid, contributes to cell growth and the production of DNA and red blood cells. Lack of folate may cause anemia and fatigue and is especially important for healthy fetal development.
Vitamin B12, also called cobalamin, helps create new red blood cells, breaks down fats and proteins to be used for energy, and maintains brain function. Vitamin B12 deficiency may cause confusion or depression. A long-term deficiency may result in permanent nerve and brain damage.
Those at risk for not getting enough B vitamins in their diet include the elderly who have a poor diet, alcoholics, those with digestive disorders that prevent nutrient absorption, and pregnant women.
Your healthcare professional may recommend testing your levels of B vitamins if you experience symptoms including fatigue, weakness, constipation, loss of appetite, numbness in the hands and feet, confusion, nausea, anemia, skin rashes, heart palpitations, shortness of breath, or open sores in your mouth²,³.
The normal ranges for B vitamins in the blood are as follows:
Those with vitamin B12 levels of 150–400 ng/L are borderline deficient and require further testing to determine the cause⁵.
To address a deficiency of any of the above B vitamins, healthcare professionals may suggest supplements, taken orally or as an injection.
Vitamin D is needed for healthy bones and immunity. Finding out if you have vitamin D deficiency will allow you to adjust your lifestyle and nutrition to increase your level with supplements or by eating more vitamin D-enriched foods.
Vitamin D supports healthy bone density, insulin production, and immune function. While the recommended amount of vitamin D is not generally acquired from the diet, it can be reached through exposure to sunlight and supplementation.
Vitamin D deficiency can lead to increased susceptibility to infection¹. Deficiency usually affects older people who aren’t exposed to enough sunlight or don’t eat vitamin-enriched foods and increases their risk of fractures².
Vitamin D toxicity—called hypervitaminosis D—occurs in those with excess vitamin D in the body but is rare and generally only caused by extreme over-supplementation. It can have serious health effects, such as kidney stones and bone issues.
Testing is recommended for people at risk of vitamin D deficiency, including those with malabsorption conditions, kidney failure, or unusual bone pain or fractures³. If you live in latitudes that have extended periods of limited sunlight, you might want to get your vitamin D levels tested.
As vitamin D is needed to absorb calcium, it may be advisable to also test levels of this nutrient.
The normal range of vitamin D in the blood, as recognized by the imaware medical advisory board, is 25–80 ng/mL.
Finding out if you have vitamin D deficiency will allow you to adjust your lifestyle and nutrition. You can increase your vitamin D level by taking supplements or by consuming more vitamin D-enriched foods.
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