Minding the Borderlands

Mark Koester (@markwkoester) on the art of travel and technology

Biomarkers: Complete List of Most Common Biomarkers and Blood Tests (and Some Lessons Learned)

Ever wondered about those codes in your blood tests? Or ever asked yourself why are you getting these blood tests and not others? Or even gone one step further to ponder: Which blood tests should I get?

After spending a couple years tracking my life and health, I’ve become increasingly focused on the value of blood testing and blood tracking. There are a ton of positive reasons for regular blood testing.

Unfortunately, it’s a confusing space. In studying and thinking about my blood lab results, I struggled to even find a clear single source of information about biomarkers and blood tests today. There are a several sites sharing this blood info, but it’s scattered and misleading. Personally, I have read and reviewed over 400+ pages of articles and research on blood testing as well as a few books too.

For the sake of myself, data analysis and future comparisons, I’ve combined all of this to create my own “awesome” list of biomarkers, blood tests, blood testing companies, and biomarker and blood testing tools and technologies. With the goal of providing both an entry level source about blood biomarkers as well as a deeper “backend” on on-going information about blood testing, I’ve created an Open Source Blood Tests and Biomarker Database to help us understand our blood chemistry and our health based on our blood.

Check it out at: https://github.com/markwk/awesome-biomarkers or scroll to the bottom of the post for a summary.

NOTE: This list is a work-in-progress and meant to be collaborative effort, so feel free to post issues and help make improvements send them back for the community to share.

In this post, I want to share briefly on why I created this project, some lessons learned, and my conclusions. Finally, I’ve included the intro intro to biomarkers and blood testing at the end.

Goals: Why Create an Open Source Database on Blood Tests and Biomarkers?

There are a couple goals of this collaborative list on blood testing and biomarkers.

First, I want to create a simple list of the most important aspects of blood testing, biomarkers and which test should should get. It should be easy to get up-to-speed on biomarkers on your health. Right now it’s quite confusing figuring out your blood chemistry, and as we increasingly need to take ownership of our health outcomes, we need to understand our blood. This post is a starting point for that as well.

Second, I want to create an open source database of blood tests and biomarkers. While there are multiple research projects and some closed databases with tons and tons of biomarkers, I couldn’t find a simple and well-structured list of blood tests, biomarkers and their basic data. This structured database project will provide the names, info, standards, a short description, referenced research and rating on all of the most used and most useful blood tests and biomarkers.

By collaborating on an open source and machine readable database about biomarkers, we provide a better starting point for building health analytics and wellness applications. I strongly believe that this biomarker database and other health metric databases can be used to build the future of heath tracking technologies too, including a personal project I’m building.

Finally, beyond creating the best intro to blood testing and biomarkers and providing a machine-usable database, I hope to also go one step further and create a deeper and more comprehensive database on biomarkers in general. I don’t intend to display active research projects or biomarker discovery, but I hope we can start to take some of the research being done on new biomarkers and blood testing and integrate it too. Not only do these common and most effective matter but so do new ones too.

Lessons Learned on Blood Testing and Biomarkers

From my current list and readings on blood testing and biomarkers, a few high-level points and lessons learned stand out:

  • Tons of Tests: While even in this abbreviated list, there are still a lot of tests to choose from.
  • Some Blood Lab Results Offer Clear Clues to Risk and Health Improvements: I was surprised how many biomarkers in our health can offer a clear clue to something being off in our health, nutrition, etc. For example, Vitamin D and Homocysteine are not included in typical panels but offer a lot of research showing how important these levels are to our risk of disease.
  • Most Blood Biomarkers Don’t Signal a Single Correlation: While in an ideal world, a single marker could be linked to a single correlation. Like X Blood test means Y elevated risk for Z disease. Unfortunately it isn’t that simple, and you need to consider a range of biomarkers and blood test to notice broader implications.
  • Testing All Would Be Expensive: To test all of these 300+ biomarkers would be very expensive. Likely over $1000 or more for a single check.
  • Testing A Subset of Important Biomarkers Can Be Cheap and Meaningful: There are about 30-50 biomarkers that tell us a lot about our health and risk of major diseases. Getting them tested regularly might only cost 50-100 usd, and they can be quite meaningful too.
  • Single Blood Tests Need Followups: The value of a single blood test is difficult to gauge since you need a baseline, an intervention (i.e. something that would affect this reading), and a followup test to confirm whether it worked.
  • Certain Blood Tests Make Sense Regularly, Others Periodically: One day it might be super cheap to get everything tested (and might require only a pinprick of blood), but for now, assuming a budget, it’s likely you’ll need to be selective about which tests to get and when. Fortunately there is enough agreement about tests you might do every several years, some you might do once a year and others maybe 2-3 times per year.

Conclusion: A Lot of Unknowns in the Health Space but Optimistic Builders

Overall, the plan is to continue to work on this list and database of biomarkers and blood tests. I strongly believe that this info should be open source and collaborative. On a personal level I will continue to study and use blood testing as part of my data-driven lifestyle. On a builders level, this is just the first step in the process of building a tool for blood and biomarker tracking, which I hope to share more on soon. (Email me if you’d like to be an early user, share feedback or join in the effort).

From compiling the first version of this list, I’ve come to realize that a lot of unknowns still exist in the health space about using blood testing. This is true of using blood tracking for both diseases and wellness. The realm as a whole is improving. Lots of new companies and applications are emerging. I expect to see more and more powerful ways of using testing and this data to improve health outcomes.

As novice data scientist, I foresee that this data could be taken in aggregate and looked at longitudinally to provide some significant advances in the years to come. By combining machine learning and artificial intelligence with these datasets, our understanding of blood tests and health will improve. Most of the health data we have is on sick people. We will one day be able to use modeling of these blood test results for both healthy and sick patients to guide personalized medicine and performance-oriented healthcare.

For now though I think we can already use blood tests and a basic understanding of the science to guide our health and lifestyle decisions, and in the context of this project, I think we can reach a starting point for the best blood tests panels we should focus on and most people should get.

Complete List of Most Common Biomarkers and Blood Tests

For the latest updates, view this on https://github.com/markwk/awesome-biomarkers

Common Blood Test Panels

  • Complete Blood Count (CBC) with Differential - Measures the numbers and percentages of various blood cell types in a blood sample. CBC is one of the most common tests used to assess and monitor overall health status.
  • Lipids Panel - Tests the fatty substances found in blood, High level of triglycerides and cholesterol are associated with increased risk of heart-related problems.
  • Basic Metabolic Panel (BMP) - Tests electrolyte levels, kidney function, and blood sugar levels. One of the most common tests used by health care providers. Consists of seven or eight biochemical tests. Used to assess and monitor overall health status, response to medication and medical therapies, and indicators of metabolic functioning.
  • Comprehensive Metabolic Panel (CMP) - Tests kidney function, liver function, diabetic and parathyroid status, and electrolyte and fluid balance. The CMP includes a panel of 14 blood tests and is an expanded version of the basic metabolic panel (BMP), which includes liver tests. Also know as Chemical Screen or Complete Metabolic Panel 14 (CMP 14).

Specific Biomarkers and Blood Tests

Complete Blood Count (CBC) Biomarkers:

  1. RBC: Red blood cell count (corpuscles). Red blood cells are made in the bone marrow and broken down in the spleen and liver. May be elevated due to dehydration, high testosterone. May be low due to nutrient deficiencies (iron, Vit B6, Vit B12, folate), kidney dysfunction, chronic inflammation, anemia, blood loss.
  2. Hemoglobin: Delivers oxygen throughout the blood. May be elevated due to dehydration, elevated testosterone, poor oxygen deliverability, thiamin deficiency, insulin resistance. May be deceased due to anemia, liver disease, hypothyroidism, exercise, arginine deficiency, protein deficiency, inflammation nutrient deficiencies (Vit E, magnesium, zinc, copper, selenium, Vit B6, Vit A).
  3. Hematocrit: Percentage of volume of blood composed of red blood cells. May be elevated due to dehydration, elevated testosterone, poor oxygen deliverability, thiamin deficiency, insulin resistance. May be deceased due to anemia, liver disease, hypothyroidism, exercise, arginine deficiency, protein deficiency, inflammation nutrient deficiencies (Vit E, magnesium, zinc, copper, selenium, Vit B6, Vit A).
  4. MCV: Mean Corpuscular Volume. An estimate of the average red blood cell size. May be elevated (“macrocytic”) due to nutrient deficiencies (Vit B12, folate, Vit C), alcohol consumption, thiamin deficiency. May be decreased (“microcytic”) due to iron deficiency, nutrient deficiencies (Vit B6, copper, zinc, Vit A, Vit C).
  5. MCH: Mean Corpuscular Hemoglobin. A measure of the average weight of hemoglobin per red blood cell. May be elevated (“macrocytic”) due to nutrient deficiencies (Vit B12, folate, Vit C), alcohol consumption, thiamin deficiency, and (falsely increased) by hyperlipidemia. May be decreased (“microcytic”) due to iron deficiency, nutrient deficiencies (Vit B6, copper, zinc, Vit A, Vit C).
  6. MCHC: Mean Corpuscular Hemoglobin Concentration. Measures the average concentration of hemoglobin in red blood cells. May be elevated (“macrocytic”) due to nutrient deficiencies (Vit B12, folate, Vit C), alcohol consumption, thiamin deficiency, and (falsely increased) by hyperlipidemia. May be decreased (“microcytic”) due to iron deficiency, nutrient deficiencies (Vit B6, copper, zinc, Vit A, Vit C).
  7. Platelets: Small, anucleated cell fragments in blood that are involved in clotting and important for vascular integrity. May be increased due to iron deficiency anemia, collagen diseases, hemolytic anemia, blood loss, stress, infection, inflammation. May be decreased due to alcoholism, liver dysfunction, viral/bacterial infections, pernicious anemia, bleeding.
  8. MPV: Mean Platelet Volume. Measures the average size of platelets and reflects their function. May be elevated due to increased platelet production, which is often caused by loss or destruction of existing platelets. Elevated MPV can be associated with vascular disease and mortality, some cancers, type 2 diabetes, and Hashimoto’s thyroiditis. MPV may be decreased due to conditions associated with under-production of platelets such as aplastic anemia or cytotoxic drug therapy.
  9. RDW: Red blood cell distribution width. A measurement of the variation in red blood cell size. Typically increased due to nutrient deficiency-related anemias (iron, Vit A, copper, zinc, Vit B6).
  10. Absolute Neutrophils: The most abundant white blood cell type, neutralizes pathogens. May be elevated due to bacterial infection or inflammation. May be decreased due to nutrient deficiencies (copper, B12, folate), elevations in other white blood cells.
  11. Absolute Lymphocytes: White blood cell type including B-cells, T-cells, and Natural Killer Cells. May be elevated due to viral infections, Crohn’s and other autoimmune diseases, hypoadrenalism. May be decreased due to zinc deficiency, elevations in other white blood cells.
  12. Absolute Monocytes: White blood cells that leave the circulation to become macrophages. May be elevated due to inflammation, collagen disease (i.e. Rheumatoid Arthritis), ulcerative colitis, recovery after an infection or trauma.
  13. Absolute Eosinophils: Immune cells that become active in late stage inflammation. May be elevated due to allergies, asthma, parasitic infection, hypoadrenalism, skin diseases such as eczema, ulcerative colitis, Crohn’s, aspirin sensitivity. May be decreased due to elevated cortisol.
  14. Absolute Basophils: White blood cells associated with inflammation and hypersensitivities. May be elevated due to inflammation, allergies, hemolytic anemia, hypothyroidism.

Lipids Panel Biomarkers:

  1. Total Cholesterol: A waxy, fat like substance that travels throughout the body in carrier lipoproteins (HDL, LDL, and VLDL); a precursor to steroid hormones and bile salts. May be elevated due to poor thyroid function, insulin resistance, blood glucose dysregulation, magnesium deficiency, dehydration, kidney disease, familial hypercholesterolemia. May be decreased due to liver dysfunction, oxidative stress, inflammation, malabsorption, anemia.
  2. Triglycerides: Measures blood levels of the major storage form of fat in our bodies; also called triacylglycerols. Must be fasting to be accurate. Implicated in cardiovascular disease. May be elevated due to blood glucose dysregulation, diabetes, hypercaloric diets, poor thyroid function, kidney disease, alcohol consumption. May be decreased due to fat malabsorption, low carbohydrate diets, calorie restriction, potentially autoimmunity.
  3. LDL-C: The amount of cholesterol associated with Low Density Lipoprotein (LDL) particles in the blood. May be elevated due to insulin resistance, blood glucose dysregulation, poor thyroid function, kidney disease, familial hypercholesterolemia. May be low due to liver dysfunction, oxidative stress, malabsorption, anemia.
  4. HDL-C: The amount of cholesterol associated with High Density Lipoprotein (HDL) particles in the blood. May be elevated due to inflammation, oxidative stress, excessive exercise. Low HDL is associated with metabolic syndrome and may be decreased due to insulin resistance, sedentary lifestyle, poor diet quality.

Comprehensive Metabolic Panel (CMP) Biomarkers:

(All includes Lipids Panel: Total Cholesterol, Triglycerides, LDL-C, and HDL-C)

  1. Glucose: Blood sugar concentration; may be elevated due to diabetes type 1 and 2, insulin resistance, increased stress hormones, or an inability to inhibit the liver’s production of glucose, or (if not fasting) ingestion of a high carbohydrate meal.
  2. BUN: Blood Urea Nitrogen. A marker of kidney function. May be elevated due to dehydration, poor kidney function, high protein intake, fatty liver, catabolic stress. May be decreased due to inadequate protein intake or protein malabsorption, liver disease, over hydration, and B6 deficiency.
  3. Creatinine: A byproduct of creatine breakdown. May be increased due to kidney disfunction, dehydration, excessive muscle breakdown or increased muscle mass, hyperthyroidism, high meat intake, ketones. May be decreased due to low muscle mass, poor protein intake or absorption.
  4. Sodium: A positively charged electrolyte, necessary for muscle contraction, nutrient absorption, neurological functioning, pH balance. May be elevated due to dehydration, hyperaldosterone (reabsorption of sodium), excess sodium intake. May be decreased due to elevated serum glucose, low cortisol, glycosuria, ketonuria, hypothyroidism, fluid loss through sweat.
  5. Potassium: A positively charged electrolyte, necessary for muscle contraction, pH balance, nerve signal conduction, and action potentials. May be elevated due to renal failure, hypoaldosterone, acidosis, hemolysis, low insulin, hyperglycemia, exercise. May be decreased due to poor potassium intake, alkalosis, hyperaldosterone, excessive fluid loss, elevated insulin, low magnesium, elevated estrogen, increased catecholamines.
  6. Chloride: A negatively charged electrolyte; important for maintaining cellular equilibrium across cell membranes and for the production of stomach acid. May be elevated due to kidney dysfunction, diarrhea, dehydration, hyperparathyroidism, hyperventilation. May be decreased due to vomiting, respiratory acidosis (hypoventilation), metabolic alkalosis, hypoaldosterone.
  7. Carbon dioxide (CO2): Measures blood bicarbonate and is a surrogate marker for CO2 gas. May be elevated due to vomiting, metabolic alkalosis, respiratory acidosis (hypoventilation). May be decreased due to metabolic acidosis, respiratory alkalosis (hyperventilation).
  8. Uric Acid: End product of DNA purine base metabolism and excretion in the kidneys; may indicate oxidative stress and elevated levels are associated with cardiovascular disease and diabetes. May be elevated due to gout, kidney dysfunction, excess alcohol intake, starvation, extreme calorie restriction, liver dysfunction, hemolytic anemia, excess fructose consumption, fungal infection, ketogenic diet, supplemental niacin, high protein diet, prolonged fasting, supplemental vitamin B3, excess acidity. May be decreased due to nutrient deficiencies (molybdenum, zinc, iron), oxidative stress, low purine intake (vegetarian or vegan), excess alkalinity.
  9. Albumin: The most abundant plasma protein in serum, synthesized in the liver, binds to other compounds in the blood and contributes to the plasma osmotic gradient. May be elevated due to dehydration. May be decreased due to infection, inflammation, liver disease, kidney disease.
  10. Globulin: A plasma protein with different subtypes. May be elevated due to cancer, autoimmunity, elevated estrogen. May be decreased due to hemolytic anemia, nephrosis, compromised immune system.
  11. Calcium: Plays many roles in the body including teeth and bone health, clotting, neurotransmitter function, muscle contraction and enzyme activity. May be elevated due to alkalosis, kidney dysfunction, hyperparathyroidism, cancer, excess Vit D intake, adrenal insufficiency, excess Vit A intake. May be decreased due to poor intake or absorption, hypoparathyroidism, Vit D deficiency, magnesium deficiency.
  12. Phosphorus: A mineral involved in DNA and RNA synthesis, part of ATP, helps activate enzymes. May be elevated due to Vit D toxicity, hypoparathyroidism, kidney dysfunction. May be decreased due to poor absorption, Vit D deficiency, elevated insulin, high carb diets, diarrhea, poor protein digestion.
  13. Alkaline Phosphatase (ALP): An enzyme found in the liver, bone, kidneys, small intestine, and placenta. May be increased due to liver obstruction, cirrhosis, gastrointestinal issues, hyperphosphatemia, hyperparathyroidism. May be decreased due to nutrient deficiencies (zinc, magnesium, and/or Vit C).
  14. Alanine amino transferase (ALT or SGPT): An enzyme found in highest concentrations in the liver but also in smaller amounts in heart, muscle and kidney. May be elevated due to hepatocellular disease, biliary issues, pancreatitis.
  15. Aspartate amino transferase (AST or SGOT): An intracellular enzyme that is usually elevated due to active tissue and cellular destruction. May be elevated due to hepatitis, liver cirrhosis or alcoholism, hypothyroidism. May be decreased due to Vit B6 deficiency, elevated serum nitrogen.
  16. LDH: Lactate dehydrogenase; may be elevated due to liver disease, hypothyroidism, skeletal muscle damage, anemia (hemolytic, pernicious), fractures. May be decreased due to reactive hypoglycemia, insulin resistance, ketosis.
  17. Total Bilirubin: A byproduct of red blood cell breakdown and an important component of bile; functions as an antioxidant. May be elevated due to excess hemolysis, liver dysfunction, bile duct obstruction, Gilbert’s Syndrome. May be decreased due to oxidative stress, zinc deficiency.
  18. GGT: An enzyme found primarily in the liver, kidney, and pancreas. May be elevated due to biliary tree dysfunction, alcoholism, pancreatitis, oxidative stress. May be decreased due to hypothyroidism, magnesium deficiency.
  19. Iron: Measures iron bound to transferrin and represents ~⅓ of the total iron binding capacity of transferrin. By itself, is a relatively poor marker of iron status. May be elevated due to hemochromatosis and other genetic conditions, hemolytic anemia, liver damage, Vit B6 deficiency. May be decreased due to poor iron intake, poor absorption, chronic blood loss, chronic disease or infection, progesterone birth control pills.
  20. TIBC: Measures the iron-binding capacity of transferrin. May be elevated due to iron deficiency, pregnancy, elevated estrogen. May be decreased due to anemia of chronic disease, chronic infection, liver dysfunction.

Additional Common and Recommended Biomarkers:

  • C-Reactive Protein
  • Cortisol
  • DHEA-Sulfate
  • Estimated Glomerular Filtration Rate (eGFR)
  • Estradiol
  • Ferritin: The body’s iron binding protein. May be elevated due to hemochromatosis and other genetic conditions, inflammation, liver damage, hemolytic or sideroblastic anemia. May be decreased due to poor intake, poor absorption, chronic blood loss, chronic disease or infection, progesterone birth control pills.
  • Folate
  • Hemoglobin A1c
  • Homocysteine
  • Progesterone
  • Prostate Specific Ag (PSA)
  • Testosterone
  • Thyroid-Stimulating Hormone
  • Vitamin D, 25-Hydroxy

Misc Blood Tests

  • ABO Grouping (Blood Typing) - Test used for classifying blood types.
  • Antinuclear antibody (ANA) - General test for autoimmune disease
  • Aluminum (Blood) - This blood test measures Aluminum levels. There are concerns that aluminum exposure from either diet or the environment may be related to Alzheimer’s disease.
  • Arsenic (Blood) - This blood test is used to measure Arsenic levels. Arsenic toxicity affects the blood, kidneys, skin, digestive tract and central nervous system.

    Blood Testing Companies

  • Inside Tracker

  • WellnessFX
  • Life Extension

Books

  • Your Blood Never Lies: Author James B. LaValle explains all of the commmon and recommended blood tests, how to read your results, and some of the most recommended interventions with medicine, lifestyle changes and supplements.
  • The Blood Code: Unlock the secrets of your metabolism: Doctor Richard Maurer offers a guide on how to order, read and act upon on your own blood test results and skin-fold caliper measurements. By understanding your metabolic blueprin, you can take the best steps through a tailored diet and exercise to improve your health and wellness.
  • Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Functional Perspective: This manual by Dr Dicken Weatherby and Dr Scott Ferguson presents a diagnostic system of blood chemistry and CBC analysis that focuses on physiological function as a marker of health. Covers of 52 blood tests with optimal and functional values.

Comments