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Tracking Biomarkers: What to Measure and Why


Article at a Glance

  • Chronic and degenerative diseases accelerate aging and present the greatest threat to longevity.
  • Give yourself the opportunity to identify and address warning signs of accelerated aging.
  • Such warning signs are usually much easier to address when identified early.

Assuming you look both ways when you cross the street, drive cautiously, and wear your seatbelt, chronic and degenerative disease is the greatest threat to you living a long and vibrant life.

If you think you may be too young or too healthy to be concerned about degenerative diseases, think again. Most chronic diseases take years, if not decades to develop, which means the initial stages of chronic degenerative disease may be brewing in your body at this very moment.

Fortunately, most chronic diseases can be prevented through proper lifestyle habits, and the sooner you take action, the better. So instead of developing a false sense of invincibility based on what you can “get away” with as a thirtysomething, consider this stage of your life as an opportunity to identify and address concerns that might otherwise translate into a compromised and regretful future.

To help you sustain a high quality of life for as long as possible, this article describes five foundational aspects of disease prevention, including tracking biomarkers and how best to measure them.

tracking biomarkers nutritional status

1. Nutritional Status

Following a diet consisting of high-quality food does not guarantee optimal nutrient intake. Monitoring nutrient status provides the information needed to adjust such a diet to more effectively support your health and vitality. Although nutrient status can be assessed through biomarkers measured in blood, simply tracking dietary intake is a much more practical approach.

Accurately tracking dietary intake requires a food scale and nutrition software. Until recently, the only nutrition tracking software available was very expensive. Today, there is Cronometer, which is a free website and app that you can use to track your vitamin, mineral, macronutrient, and calorie intakes. To get the best representation of your nutrient intake, track periodically throughout the year, and include at least three typical days each time you track.

Although the emphasis here is on micronutrient tracking, macronutrients and calories are important as well. In regard to disease prevention, carbohydrate intake, particularly refined carbohydrates, is especially relevant given the large quantities consumed by most Americans. Excessive carbohydrate intake predisposes to insulin resistance, which is the focus of the next section.

Physician Suggestions

Dr. Bruce Ames, a scientist at Children’s Hospital Oakland Research Institute, has proposed a “triage” theory describing how subclinical micronutrient inadequacies accelerate aging and development of chronic disease. When availability of an essential nutrient is limited, the body will spare the nutrient for vital processes, thereby impairing less critical processes, such as DNA repair, heme synthesis (needed for oxygen transport in the blood), antioxidant defense, and mitochondrial ATP production [R]. While these processes are not critical for immediate survival, they are undoubtedly critical for sustaining a high quality of life.

Dr. Terry Wahls, a physician and professor at the University of Iowa Carver College of Medicine, has developed a research-based protocol similar in concept to the triage theory. Her protocol, largely focused on maximization of micronutrient intake through whole foods [R], has put her own case of late-stage multiple sclerosis into remission and has also helped many of her patients. You can watch her TED Talk to see how her micronutrient-focused protocol enabled her to reclaim life and trade her wheelchair for a bicycle.

2. Insulin Sensitivity

The primary function of insulin is to induce cellular glucose uptake. Insulin resistance is a condition in which cells, particularly in muscle and the liver (but also elsewhere), become less responsive to this signaling. This condition is characteristic of metabolic syndrome and diabetes and predisposes to a wide variety of other age-associated diseases, including cardiovascular disease [R], neurodegenerative diseases [R], and cancer [R].

Given that more than half (52%) of the American population is estimated to be diabetic or pre-diabetic [R], insulin resistance is a significant concern. Although prevalence drops to 33% when only considering those between the ages of 20-44 years, this is still an alarmingly high prevalence for a condition that is largely preventable through lifestyle habits.

During the early stages of insulin resistance, the body produces additional insulin to counteract the decrease in cellular responsiveness. As such, an elevation of fasting insulin will manifest earlier than an elevation of fasting glucose, making insulin a more sensitive marker for metabolic health.

You can have your fasting insulin measured through your physician or a direct-to-consumer lab service such as DirectLabs. Although there is no standard for optimal fasting insulin, 5 uIU/mL and above is considered indicative of insulin resistance [R].

Another option to assess your insulin sensitivity is to ask your physician for a 2-hour glucose tolerance test. You could even do this test yourself if you are confident in your ability to safely use a glucose meter. Simply test your glucose in half-hour or hour increments following a meal. Glucose levels should ideally not exceed 120 mg/dL at any point [R].

tracking biomarkers insulin

3. Chronic Inflammation

Inflammation is involved in the progression of many age-associated diseases [R] and is arguably the broadest predictor of accelerated aging. C-reactive protein (CRP) is an acute-phase reactant involved in the inflammatory process and is the most commonly used marker for general inflammation, regardless of age. In fact, CRP can be predictive of future concern as early as childhood [R].

Similar to fasting insulin, you can ask your physician to test your CRP or have it done yourself through a direct-to-consumer lab service. Be sure to order the high-sensitivity version of the test (hsCRP). A value less than 0.7 mg/L is considered ideal, and 1.0 mg/L or greater is indicative of excessive inflammation [R].

Keep in mind that since CRP is a generic marker, it will be elevated when you are sick or injured or during any other cause of acute inflammation. If your test results seem abnormally high, re-test after waiting for any potential causes of acute inflammation to resolve.

4. Sleep

tracking biomarkers sleep

Relative to diet and exercise, the importance of sleep for sustaining a high quality of life is often underestimated. In addition to preventing you from feeling sharp and energetic, a lack of sleep causes insulin resistance and inflammation [R]. From what we’ve covered above, you should realize that this translates to accelerated aging and increased disease risk.

While we are fortunate that affordable technology is now available for home-based sleep tracking, the accuracy of this technology is still up for debate. The most feature-rich and well-tested platforms appear to be the WHOOP band and the Oura ring.

While for years the focus has been on the quantity of sleep that’s considered healthy, the newest research shows that the quality of sleep matters just as much if not more [R].  So if you wake up from a full night of sleep not feeling refreshed, knowing the length of time you spend in each sleep stage (which the above tools will show you) can help you determine why. Furthermore, paying attention to changes in your sleep patterns can help you identify how various aspects of your lifestyle influence your sleep.

5. Heart Rate Variability

As a representation of nervous system balance, heart rate variability (HRV) is a valuable indicator of recovery and readiness. Heart rate is increased by the sympathetic nervous system, which controls responses to physical and psychological stressors. In contrast, heart rate is decreased by the parasympathetic nervous system, which controls activities that occur during rest. The variability of time between heartbeats is indicative of the balance between these two branches of the nervous system and, in turn, whether the body is in a state of rest or distress.

Although there are a variety of ways to measure HRV, two important considerations for choosing a tracking device are convenience and capacity to measure other relevant markers. The previously mentioned Oura ring and WHOOP band each measure HRV. An advantage of these platforms is that they do so automatically while you sleep. This convenience will help assure that you continue tracking. In addition, these devices combine HRV scores with sleep data and other markers to give you an overall assessment of your readiness for physical activity.

HRV varies considerably by person and testing methodology. Therefore, there is no standardized range, and the best way to use the data is to look for patterns of change. Doing so will help you learn how various aspects of your lifestyle influence your recovery. Adjusting your activity level accordingly will help you avoid the injuries and persistent fatigue that often result from excessive exercise.

tracking biomarkers heart rate variability


Although the prevalence of chronic disease is increasing in young people, most chronic disease does not generally manifest until the fifth decade. As such, being proactive about your health puts you a step ahead, but also requires that you dig deeper to find possible warning signs.

Taking action to address early warning signs of dysfunction can help you extend your youthful-feeling years!

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