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Evidence-Based Targets

Biomarker Reference

The 20+ biomarkers that actually predict performance, recovery, and healthspan — with optimal ranges, how to test, and what to do with the results. Not clinical reference ranges. Performance targets.

Educational reference only. Optimal ranges listed are performance-oriented targets drawn from high-performance medicine literature — they differ from standard clinical reference ranges. Discuss all results with your physician before making clinical decisions.
Recommended Testing Schedule
QuarterlyHRV trend (via wearable), Resting HR, VO2 Max estimate, Blood pressure
AnnuallyFull metabolic panel: fasting glucose, HbA1c, fasting insulin, triglycerides, ApoB, hsCRP, homocysteine
AnnuallyHormonal: total + free testosterone (morning), morning cortisol
AnnuallyMicronutrients: vitamin D (25-OH), ferritin, RBC magnesium, omega-3 index
Cardiovascular & Autonomic

HRV (RMSSD)

Heart rate variability — the millisecond variation between heartbeats. Reflects autonomic nervous system balance and recovery status.

Suboptimal
<30 ms
Optimal
50–100+ ms
Elite
>100 ms
How to test: Oura Ring, WHOOP, or HRV4Training app (3-min morning capture)
↗ Compare to your own 30-day baseline, not population averages. Trend matters more than absolute number.

Resting Heart Rate

Heart beats per minute at complete rest. Lower values reflect stronger cardiac output and greater aerobic fitness.

Suboptimal
>75 BPM
Optimal
50–65 BPM
Elite
<45 BPM
How to test: Any HRV wearable. Best captured overnight or first thing in the morning.
↗ Each 10 BPM reduction in RHR correlates with ~30% reduction in cardiovascular mortality risk.

VO2 Max

Maximum oxygen consumption during maximal exertion. The single strongest predictor of all-cause mortality in large epidemiological studies.

Suboptimal
<35 (men) / <30 (women)
Optimal
45–55 (men) / 40–50 (women)
Elite
>55 (men) / >50 (women)
How to test: Garmin Fenix (estimate via outdoor run), lab maximal exercise test (most accurate)
↗ Going from the bottom to top quartile of VO2 max has a larger mortality risk reduction than quitting smoking.

Blood Pressure

Systolic over diastolic pressure. Elevated BP silently damages arterial walls, kidneys, and brain over decades.

Suboptimal
>130/85
Optimal
<120/75
Elite
105–115 / 65–72
How to test: Home cuff (Omron), arm position and cuff size matter significantly for accuracy.
↗ Each 10 mmHg reduction in systolic BP reduces stroke risk ~35% and heart attack risk ~25%.
Metabolic Health

Fasting Glucose

Blood sugar after 8+ hours of fasting. Elevated fasting glucose reflects insulin resistance and metabolic dysfunction.

Suboptimal
>100 mg/dL
Optimal
72–90 mg/dL
Elite
70–85 mg/dL
How to test: Standard blood panel (HbA1c always run together). CGM (Levels, NutriSense) shows real-time dynamics.
↗ Fasting glucose of 100–125 is "pre-diabetic" by clinical definition but already associated with elevated cardiovascular risk.

HbA1c

90-day average blood sugar, expressed as a percentage of hemoglobin that is glycated. More reliable than a single fasting glucose reading.

Suboptimal
>5.6%
Optimal
<5.3%
Elite
<5.0%
How to test: Standard blood panel. No fasting required.
↗ Each 1% reduction in HbA1c in diabetics reduces microvascular complications by ~25–35%.

Fasting Insulin

Insulin level after fasting. The most sensitive early marker of insulin resistance — detects problems years before glucose rises.

Suboptimal
>10 μIU/mL
Optimal
<6 μIU/mL
Elite
<4 μIU/mL
How to test: Specific blood panel request — not on standard panels by default. Must request explicitly.
↗ Elevated fasting insulin with normal glucose = early insulin resistance. Caught here, it's reversible with Zone 2 and dietary changes.

Triglycerides

Blood fat levels. Elevated triglycerides reflect excess carbohydrate intake, alcohol, or metabolic dysfunction.

Suboptimal
>150 mg/dL
Optimal
<100 mg/dL
Elite
<75 mg/dL
How to test: Standard lipid panel. Must fast 8–12 hours beforehand.
↗ The triglyceride-to-HDL ratio is a stronger cardiovascular risk predictor than LDL alone. Target ratio: <2.
Hormonal

Total Testosterone (men)

Total circulating testosterone. Critical for muscle protein synthesis, bone density, mood, libido, and motivation.

Suboptimal
<400 ng/dL
Optimal
600–900 ng/dL
Elite
700–1,000 ng/dL
How to test: Morning blood panel (testosterone peaks 7–9am). Always run free testosterone alongside total.
↗ Test results below 10am. Values drop 20–30% by afternoon. Sleep deprivation drops testosterone ~10–15% per night of poor sleep.

Free Testosterone (men)

Bioavailable testosterone not bound to proteins. More predictive of symptoms than total testosterone in many cases.

Suboptimal
<9 pg/mL
Optimal
15–25 pg/mL
Elite
>25 pg/mL
How to test: Equilibrium dialysis method is most accurate. Many labs use calculated free T, which is less reliable.
↗ SHBG (sex hormone binding globulin) increases with age and binds testosterone — high SHBG with normal total T can still produce low free T symptoms.

Morning Cortisol

Primary stress hormone. Peak cortisol 30–45 min after waking (the cortisol awakening response) drives alertness. Chronically elevated cortisol suppresses immunity, testosterone, and recovery.

Suboptimal
<8 or >22 μg/dL
Optimal
10–18 μg/dL
Elite
Well-shaped diurnal curve (high AM, low PM)
How to test: Morning blood panel. 4-point salivary cortisol test shows the full diurnal curve (Genova, DUTCH).
↗ Chronic high stress, poor sleep, and overtraining all dysregulate the diurnal cortisol curve. Low morning cortisol can be as problematic as high.
Micronutrients

Vitamin D (25-OH)

Fat-soluble hormone precursor involved in testosterone production, immune function, calcium metabolism, and sleep quality. Deficiency affects >40% of adults.

Suboptimal
<30 ng/mL
Optimal
40–70 ng/mL
Elite
50–65 ng/mL
How to test: Standard blood panel. Run annually. Test in winter to catch your lowest point.
↗ Supplement D3 with K2 (100mcg MK-7) to direct calcium into bones rather than arterial walls. 2,000–5,000 IU D3 daily for most adults.

Ferritin

Iron storage protein. Too low = fatigue, poor recovery, low VO2 max. Too high = oxidative stress, increased cardiovascular risk.

Suboptimal
<30 or >200 ng/mL
Optimal
50–150 ng/mL
Elite
70–120 ng/mL
How to test: Standard blood panel. Ferritin spikes with inflammation — run CRP alongside for context.
↗ Female athletes are disproportionately at risk for low ferritin. Symptoms appear well before clinical anemia.

Omega-3 Index

EPA + DHA as a percentage of total red blood cell fatty acids. Strong predictor of cardiovascular mortality, independent of other lipid markers.

Suboptimal
<4%
Optimal
>8%
Elite
>10%
How to test: OmegaQuant or SpectraCell dried blood spot test. Not on standard panels — must order separately.
↗ An omega-3 index below 4% carries similar cardiovascular risk to smoking. Most Western diets produce a 3–5% index.

Magnesium (RBC)

Intracellular magnesium involved in 300+ enzymatic reactions including ATP production, muscle contraction, and neurotransmitter synthesis.

Suboptimal
<5.2 mg/dL
Optimal
5.6–6.8 mg/dL
Elite
6.0–6.8 mg/dL
How to test: Specifically request RBC magnesium — serum magnesium is unreliable and doesn't reflect intracellular stores.
↗ Most adults are suboptimal even without clinical deficiency. Magnesium glycinate 400mg before bed is the standard correction protocol.
Inflammation & Longevity

hsCRP (high-sensitivity CRP)

Highly sensitive marker of systemic inflammation. Elevated hsCRP predicts cardiovascular disease, metabolic dysfunction, and accelerated aging.

Suboptimal
>3.0 mg/L
Optimal
<1.0 mg/L
Elite
<0.5 mg/L
How to test: Standard blood panel — specify high-sensitivity (hs) version. Regular CRP is not sensitive enough for monitoring.
↗ Zone 2 exercise, omega-3 supplementation, and sleep quality are the most evidence-based ways to reduce hsCRP.

Homocysteine

Amino acid that damages arterial walls when elevated. Predicts cardiovascular disease, cognitive decline, and stroke — independently of cholesterol.

Suboptimal
>12 μmol/L
Optimal
<8 μmol/L
Elite
<7 μmol/L
How to test: Blood panel. Not on standard panels — must request explicitly.
↗ Elevated homocysteine responds well to B12, B6, and folate. Methylation status affects this marker significantly.

ApoB

The protein coat of all atherogenic lipoprotein particles. Considered the most accurate predictor of cardiovascular risk, superseding LDL in most research.

Suboptimal
>100 mg/dL
Optimal
<80 mg/dL
Elite
<60 mg/dL
How to test: Blood panel — must specifically request ApoB. Not on standard lipid panels.
↗ Two people with identical LDL can have very different ApoB — and very different cardiovascular risk. ApoB is the number that matters.
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