Take your fitness to the next level with a detailed look at the biomarkers which can help you optimise your training and performance.
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Adrenal hormones
DHEA sulphate
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DHEAS is the sulphated form of DHEA, a hormone which is produced by the adrenal glands and is responsible for male characteristics in both men and women. DHEAS gradually declines from the age of 30 onwards.
Cortisol
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Cortisol is a stress hormone produced by the adrenal glands. It is vital to survival given its role in functions such as immunity, regulating blood pressure and releasing insulin for blood sugar maintenance.
Cholesterol status
Total cholesterol
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Cholesterol is an essential fat (lipid) in the body. Although it has a bad reputation it has some important functions, including building cell membranes and producing a number of essential hormones including testosterone and oestradiol. Cholesterol is manufactured in the liver and also comes from the food we eat. Although there are a number of different types of cholesterol, the two main components of total cholesterol are HDL (high density lipoprotein) which is protective against heart disease and LDL (low density lipoprotein) which, in high levels, can contribute to cardiovascular disease. Your total cholesterol result on its own is of limited value in understanding your risk of heart disease; high levels of HDL cholesterol can cause a raised total cholesterol result but may actually be protective against heart disease. Equally, you can have a normal total cholesterol level but have low levels of protective HDL cholesterol. The most important factors are how much HDL and LDL cholesterol you have, and what proportion of your total cholesterol is made up of protective HDL cholesterol. We give a detailed breakdown of the components of your total cholesterol in the rest of this cholesterol profile.
LDL cholesterol
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LDL cholesterol (low-density lipoprotein) is a molecule made of lipids and proteins which transports cholesterol, triglycerides and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called 'bad cholesterol', can cause fatty deposits to accumulate inside artery walls, potentially leading to atherosclerosis and heart disease.
Non-HDL cholesterol
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Your total cholesterol is broken down into 2 main components; HDL (good) cholesterol and LDL (bad). There are more types of harmful cholesterol in your blood than just LDL - these include VLDL (very low-density lipoproteins) and other lipoproteins which are thought to be even more harmful than LDL cholesterol. Non-HDL cholesterol is calculated by subtracting your HDL cholesterol value from your total cholesterol. It therefore includes all the non-protective and potentially harmful cholesterol in your blood, not just LDL. As such, it is considered to be a better marker for cardiovascular risk than total cholesterol and LDL cholesterol. The recommended level of non-HDL cholesterol is below 4 mmol/L.
HDL cholesterol
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HDL cholesterol (high-density lipoprotein) is a molecule in the body which removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as 'good cholesterol'.
Total cholesterol : HDL
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The cholesterol/HDL ratio is calculated by dividing your total cholesterol value by your HDL cholesterol level. It is used as a measure of cardiovascular risk because it gives a good insight into the proportion of your total cholesterol which is good (i.e. high-density lipoprotein HDL). Heart disease risk tools (such as QRisk) use the cholesterol/HDL ratio to calculate your risk of having a heart attack.
Triglycerides
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Triglycerides are a type of fat (lipid) that circulate in the blood. After you eat, your body converts excess calories (whether from fat or carbohydrates) into triglycerides which are then transported to cells to be stored as fat. Your body then releases triglycerides when required for energy.
Diabetes
HbA1c
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Haemoglobin A1c (HbA1c), also known as glycated haemoglobin, is a longer-term measure of glucose levels in your blood than a simple blood glucose test. Glucose attaches itself to the haemoglobin in your red blood cells, and as your cells live for around 12-16 weeks, it gives us a good indication of the average level of sugar in your blood over a 3-month period.
A raised HbA1c result points to diabetes or an increased risk of developing diabetes, which can have a significant impact on your lifespan and quality of life. Complications of uncontrolled diabetes include heart disease, kidney disease, eye problems, and vascular conditions. It can also contribute to mental health problems. And men with diabetes are three times more likely to have erectile dysfunction. Keeping your HbA1c within a normal range can help you reduce the risk of these conditions.
A raised HbA1c result points to diabetes or an increased risk of developing diabetes, which can have a significant impact on your lifespan and quality of life. Complications of uncontrolled diabetes include heart disease, kidney disease, eye problems, and vascular conditions. It can also contribute to mental health problems. And men with diabetes are three times more likely to have erectile dysfunction. Keeping your HbA1c within a normal range can help you reduce the risk of these conditions.
Hormones
Testosterone
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Testosterone is a hormone that causes male characteristics. For men, it helps to regulate sex drive and has a role in controlling bone mass, fat distribution, muscle mass, strength and the production of red blood cells and sperm. Testosterone is produced in the testicles of men and, in much smaller amounts, in the ovaries of women. Testosterone levels in men naturally decline after the age of 30, although lower than normal levels can occur at any age and can cause low libido, erectile dysfunction, difficulty in gaining and maintaining muscle mass and lack of energy. Although women have much lower amounts of testosterone than men, it is important for much the same reasons, playing a role in libido, the distribution of muscle and fat and the formation of red blood cells. All laboratories will slightly differ in the reference ranges they apply because they are based on the population they are testing. The normal range is set so that 95% of men will fall into it. For greater consistency, we use the guidance from the British Society for Sexual Medicine (BSSM) which advises that low testosterone can be diagnosed when testosterone is consistently below the reference range, and that levels below 12 nmol/L could also be considered low, especially in men who also report symptoms of low testosterone or who have low levels of free testosterone.
Testosterone : cortisol
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The Testosterone/Cortisol (T:C) ratio is a marker which shows promise in assessing whether athletes are recovering well after intense training. Testosterone is an anabolic hormone which helps to build muscle, produce red blood cells and increase aerobic metabolism in muscles. Cortisol is a catabolic hormone working antagonistically with testosterone, inhibiting protein synthesis and blocking anabolic signalling. The T:C ratio is more sensitive to the stresses of training than either measure alone. Over time it can be trended to see how well you are recovering.
Inflammation
hs-CRP
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C-Reactive Protein (CRP) is an inflammation marker used to assess whether there is inflammation in the body - it does not identify where the inflammation is located. High Sensitivity CRP (CRP-hs) is a test used to detect low-level inflammation thought to damage blood vessels which can lead to a heart attack or stroke. When you suffer a serious injury or infection you experience significant inflammation around the site of injury - such as the swelling around a twisted ankle. Any injury like this will cause your CRP-hs to rise.
Iron status
Iron
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Iron is a mineral that is essential for life. It is a component of haemoglobin, a protein in our red blood cells that is responsible for transporting oxygen around our body. If we don't have enough iron, our haemoglobin levels fall and we can't get sufficient oxygen to our cells. This can cause symptoms which include fatigue, dizziness, and shortness of breath. Serum iron is a very transient reading and can be influenced by the amount of iron-rich food in your diet in the days before your blood test. For this reason, iron is rarely looked at on its own, and is interpreted alongside other markers in an iron status test.
TIBC
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Total iron-binding capacity (TIBC) is a measure of the ability of your body to efficiently carry iron through the blood.
Transferrin saturation
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Transferrin is made in the liver and is the major protein in the blood which binds to iron and transports it round the body. This test measures how much this protein is 'saturated' by iron.
Ferritin
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Ferritin is a protein which stores iron in your cells and tissues. Usually, the body incorporates iron into haemoglobin to be transported around the body, but when it has a surplus, it stores the remaining iron in ferritin for later use. Measuring ferritin levels gives us a good indication of the amount of iron stored in your body.
Kidney health
Urea
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Urea is a waste product produced by the body when it breaks down proteins in the liver. Once the urea is made, it is transported to the kidneys, which filter it out of the blood and remove it from the body in the form of urine. Measuring the levels of urea in the blood can therefore reflect how well both the liver and the kidneys, are functioning. It is important to note that even if one kidney is severely damaged but the other is functioning perfectly, results may still return as normal.
Creatinine
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Creatinine is a chemical waste molecule that is generated from normal muscle metabolism. Measurement of this is an indicator of the levels of other waste products in the body. Creatinine is also an accurate marker of kidney function, and may help in diagnosing kidney disease.
eGFR
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The estimated glomerular filtration rate (eGFR) assesses how well the kidneys are working by estimating the amount of blood filtered through the kidneys. The glomeruli are tiny filters in the kidneys responsible for removing waste products. If these filters do not do their job properly, kidney function can be impaired. The eGFR calculation is an estimate of actual glomerular filtration rate, calculated using your age, gender, ethnicity, and serum creatinine levels.
Liver health
Bilirubin
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Bilirubin is a product of the breakdown of haemoglobin from red blood cells. It is removed from the body via the liver, stored and concentrated in the gallbladder and secreted into the bowel. It is removed from your body through urine and faeces. Bilirubin causes the yellowish colour you sometimes see in bruises, due to red blood cells breaking down underneath the skin.
ALP
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Alkaline phosphatase (ALP) is an enzyme found mainly in the liver and bones. Measuring it can indicate ongoing liver, gallbladder or bone disease.
ALT
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Alanine transferase (ALT) is an enzyme which is mostly found in the liver, but is also found in smaller amounts in the heart, muscles and the kidneys. If the liver is damaged, ALT is leaked into to bloodstream. As ALT is predominantly found in the liver, it is usually an accurate marker for liver inflammation and can indicate liver damage caused by alcohol, fatty liver, drugs or viruses (hepatitis).
Gamma GT
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Gamma GT, also known as gamma-glutamyl transferase (GGT), is a liver enzyme which is raised in liver and bile duct diseases. It is used in conjunction with ALP to distinguish between bone or liver disease. Gamma GT is also used to diagnose alcohol abuse as it is raised in 75% of long term drinkers.
Proteins
Total protein
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Total Protein represents the sum of the proteins albumin and globulin in your blood. Albumin and globulin have a range of functions including keeping blood within vessels, transporting nutrients and fighting infection. Abnormal levels can indicate malnutrition as well as a liver or kidney disorder.
Albumin
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Albumin is a protein which is made mainly in the liver. It helps to exert the osmotic pressure which holds water within the blood. It also helps carry nutrients and medications and other substances through the blood and is important for tissue growth and healing. Albumin also carries hormones around the body, therefore measuring the amount of albumin in the blood can help us calculate how much hormone is available to your tissues.
Globulin
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Globulin is an umbrella term for a set of different proteins that the immune system and the liver produce. Certain globulins bind with haemoglobin while others transport metals, such as iron, in the blood. Additionally, there is a certain type of globulin known as an immunoglobulin, (another name for an antibody) which helps to fight infection in the body.
Vitamins
Folate - serum
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Folate is a B vitamin which acts as a coenzyme in the metabolism of amino acids. It is also vital for the synthesis of purines and pyrimidines which are essential for DNA synthesis and red cell formation. Folate is also especially important during the first trimester of pregnancy so if you are thinking of becoming pregnant it is important to make sure your folate levels are normal.
Vitamin B12 - active
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Vitamin B12 is important for production of red blood cells which carry oxygen around the body. B12 is also involved in metabolism and the nervous system and prolonged lack of vitamin B12 may cause nerve damage. Although Vitamin B12 is almost entirely found in animal-based foods, many vegetarian and vegan products, especially plant milks are now fortified with Vitamin B12.
Vitamin D
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Despite its name, vitamin D is actually a hormone that’s produced by your skin when it’s exposed to sunshine. Before your body can use vitamin D produced by sun exposure (known as vitamin D3), it must be converted into another form called 25 hydroxycholecalciferol (25 OH). Vitamin D (25 OH) is the major circulating form of vitamin D, and so your vitamin D (25 OH) level is considered the most accurate indicator of vitamin D supply to your body.
Vitamin D is essential for healthy bones and teeth, as it helps your body absorb calcium. It also plays a role in muscle health, immune function, and mental health.
Low vitamin D symptoms include muscle weakness, mood swings, and fatigue. Many people in the UK have low vitamin D levels, and people with dark skin and people who don’t spend much time outdoors are particularly at risk.
Small amounts of vitamin D can be obtained from food, especially oily fish, eggs, and vitamin-D fortified foods. But if you have a vitamin D deficiency, you’re unlikely to be able to improve your levels by food alone.
Special instructions
How to prepare for your test
Prepare for your Advanced Fitness Blood Test by following these instructions. Take your sample between 6am and 10am. If you have an unusual sleep pattern (eg shift worker) then take this test within 2 hours of waking. Most evidence suggests that DHEAS is unaffected by the menstrual cycle, so taking the test at any point will give you a valid result. However, if you have regular periods and are tracking your results over time, we recommend taking the test between days two and five of your cycle for consistency. Take this test when any symptoms of short-term illness have settled. Avoid heavy exercise for 48 hours beforehand. Avoid fatty foods for eight hours before your test, you do not need to fast. Stay well hydrated before your test. Corticosteroid medication can affect this test, ask your doctor whether to stop before testing. Take your sample at least 24 hours after any vitamin or mineral supplements. Do not take biotin supplements for two days before this test, discuss this with your doctor if it is prescribed. Do not take vitamin B12 for two weeks prior to this test. If your B12 is prescribed ask your doctor whether to stop. Hormonal contraception can affect the results of this test. Taking a break from this and waiting for your periods to restart before your blood test will give more accurate results.
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FAQs
What can I learn from a fitness blood test?
With insights into muscle mass (testosterone), anaemia and low energy (iron status and vitamin B12), as well as stress and over-training (cortisol), you can also check nutritional markers which can affect your training progress. Our profile also includes tests for general health, such as liver and kidney function, cholesterol, and diabetes.
When should take this test?
You can take our test as a snap-shot at any time or take it over a period of time to track your results and help you understand what works for you.
What is a fitness blood test?
Our Advanced Fitness Blood Test is a venous test (which means your blood is taken from a vein in your arm) that offers an advanced understanding of biomarkers that can affect your fitness goals, whether in the gym or on the sports field.
Does this test measure high levels of testosterone?
Most testosterone tests set an upper detection limit of 52 nmol/L. If your result is higher than this, the lab will attempt a second measurement to get an actual reading, providing there is enough sample volume available.