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10 “Hard Truth” Health Indicators 

How many ways do you measure your health?

Our annual physicals are, indeed, essential. They offer us a basic check-in on certain numbers. Nonetheless, there’s so much more to the story than what standard tests gauge that I encourage my clients to look deeper with additional assessments.

When we’re interested in getting a sense of where we’re at health-wise and what kind of progress we’re making (or not making), certain numbers simply tell us more. In some cases, that means more detail around the basics. In other cases, it means examining additional dimensions that conventional screening doesn’t cover.

Many of these added assessments don’t cost anything. In fact, one you can even do before you finish reading this article. Check out ten health indicators that offer a clearer picture of your current health status.

Lifestyle Questionnaire  

It’s my favorite over-the-phone friendly assessment. As simple as it is, your answers to these five questions tell you (and me) quite a bit about the path your health may be on. It goes like this.

In the past seven days, how many days have you…

  • Gotten at least 7 hours of uninterrupted sleep?
  • Eaten at least 5 cups of fresh produce (at least 3 cups of which are non-starchy vegetables)?
  • Consumed at least 2 liters of water?
  • Been physically active for 30 minutes?  
  • Practiced at least 5 minutes of conscious relaxation, meditation, or gratitude?

They’re five simple, telling questions that help you snap the chalk line, so to speak, and give you an overall picture of your daily patterns. If you answered less than four to any of the above questions, you know exactly which lifestyle areas need your added effort. No further testing is needed to get started….

One-Mile Run Time or VO2Peak

Remember the Presidential Physical Fitness program in grade school? I hated the sit-and-reach but loved the one-mile run. I was a top-tier performer then, and I intend to keep it that way because this simple run turns out to be a great predictor of overall mortality risk.

Peak exercise capacity (expressed as METs by most studies) is a better forecast for death risk than overall fitness – even if one has other concerns like body mass index greater than thirty, diabetes, elevated blood pressure or high cholesterol. Within each of those groups, the individuals who could crank out eight METs for 8-12 minutes had about half the relative risk of dying compared to those producing less than five METs. 

If you don’t know your METs, you can figure it out pretty easily if you know your VO2peak.  Divide your VO2peak by 3.5.  Judging by my latest Active Metabolic Assessment, in which my peak oxygen consumption topped out at 52 ml/kg/min or nearly 15METs, I still got it!

Resting Heart Rate and/or Heart Rate Variability

Pretend you passed the first questionnaire with flying colors, and let’s say you’re already physically fit by the standards of peak exercise capacity. You still want to understand why you aren’t losing fat or gaining strength in accordance with what you’d expect. Could it be you’re pushing your body too far past its red line? The total amount of stress accumulating in your body and mind may be standing in the way of positive adaptation.

We can only push our bodies to adapt in a positive way if we’re recovered from the last bout of stress. Resting heart rate (RHR) and Heart Rate Variability (HRV) are arguably the best ways to gauge the body’s day-to-day readiness for more stress. Higher HRV and lower RHR (indicating better recovery or readiness) are significantly correlated with longevity.

Sure, you can pick your workout based on whether or not your muscles are sore, but your nervous system (which ultimately controls RHR and HRV) has the final say in how your body responds to that workout. Pile too much physical stress on top of other life obligations, and you could be in the hurt tank for a few days.

Body Fat / Lean Mass

During every visit, your doctor probably measures your height and weight and then charts your body mass index (BMI) before poking and prodding you. Unfortunately, BMI means very little over time because it isn’t sensitive enough to express the relationship between lean body mass and fat mass. Medical treatment guidelines operate using BMI data, but there is plenty of good evidence supporting more sensitive body composition markers as indicators for optimal health.

The entire health conversation in this country is sadly focused on being lighter rather than leaner. Instead of getting our doctors’ encouragement to lose fat and gain muscle, we are told to lose weight. Rather than celebrating strength gains, we wallow in our own pity when the scale remains stagnant.

When you speak to a Life Time Fitness Professional, you’ll notice they may give very little thought to your weight or BMI but care a whole lot about your body composition (body fat expressed as a percentage of total weight). 

Tom Nikkola, who many of you know from past Flourish editions, has written and presented extensively on the importance of lean mass. For more on how building muscle makes life more awesome, read here, and to find out your own body fat levels, schedule a consultation with a Fitness Professional.

We should all aim to build and maintain substantial muscle tissue to help us reduce our risk of bone loss, falls/fractures, type 2 diabetes and other forms of metabolic meltdown. How do you know if you’re headed for one of these meltdowns? You’ve got to test for them. This goes for lean guys and gals, too.

Unfortunately, annual check-ups oftentimes won’t uncover major concerns until it’s too late – as in, “time for medication” too late with the onset of chronic disease. Standard blood chemistries and basic health measures are meant to be disease screening steps at best (as opposed to a measure of how you compare to your peak potential).

That means there can be unaddressed symptoms and signs that indicate your metabolism is genuinely drifting away from its physiologic potential: your energy has plummeted, physical recovery takes a long time, mental sharpness eludes you, and generally speaking your resiliency to stress is about as strong as a wet paper bag. What could it be? That depends. What are the best assessments to find out? My short list is below.

Nutrient Levels

Nothing drags down mood or immunity quite like low levels of the sunshine vitamin. Beyond vitamin D, however, I recommend people assess other important nutrient indicators. Vitamin D should be tested at least annually and supplemented accordingly in everyone. Anyone with complaints of low energy, low activity tolerance, or trouble losing weight should assess iron levels at least every 6 months. Those with slipping mental performance or concerns over extended soreness ought to think about testing their essential fatty acid levels (mostly to determine omega-3 dosing needs).

Beyond these basic nutrients, there may be more extreme cases in which someone may assess coenzyme Q10 levels, red-blood-cell magnesium or other nutrients for example.

Fasting Insulin Levels

There may not be a better way to head off diabetes and jumpstart fat loss than to understand your glucose and insulin dynamics. You can do this by testing fasting insulin levels. Ideally, the level of this hormone should settle well into single-digit levels after a night of rest.

Some proactive healthcare providers initiate aggressive nutrition and lifestyle change protocols when insulin levels drift into the double digits – and for good reason – as insulin resistance usually develops as a gradual process over 10-30 years before fasting blood sugar levels show abnormalities. Sure, you might have to beg your provider to assess fasting insulin, or you can do it through direct-to-consumer lab testing in most states as well.

Cholesterol Particle Size / Inflammation Markers

Cholesterol is inherently helpful to our bodies. It’s a vital repair substance for our arteries and supports our brain function. Without it, every cell in our bodies would eventually die. In the absence of inflammation, cholesterol cannot be harmful. Just as food quality is likely more important than food quantity (calories), how your body transports cholesterol appears to be more important than the total amount. Standard cholesterol profiles fail to show that level of detail though.

Any individual concerned about his/her cholesterol-inflammation-heart disease risk should monitor cholesterol particle size and particle number as well as inflammation markers on a regular basis. The test of choice to find these would be a Nuclear Magnetic Resonance (NMR) plus high-sensitivity C-reactive protein (CRP-hs) and homocysteine. Using this method may better explain why nearly half the individuals who suffer heart attacks have completely normal cholesterol using standard testing methods. Carrying cholesterol in small, dense particles (as opposed to larger, fluffy particles) makes it easier for the waxy substance to burrow into artery walls and become oxidized, ultimately triggering the immune system to attack the vascular wall to create an irritated plaque-like scar tissue.  

Assuming cholesterol automatically causes heart disease is like blaming firefighters for setting fires. Where there’s a fire, there will always be firefighters, but where there are firefighters, there isn’t always fire.

Thyroid Hormone Levels

Interestingly, high cholesterol levels were once used as a diagnostic measure to determine if someone had underactive thyroid. When overall metabolism slows (characteristic of underactive thyroid hormones), cholesterol metabolism also slows, causing cholesterol levels to rise noticeably.

Now, when people (mostly women, unfortunately) report depression-like symptoms, cold hands and feet, hair loss, brittle fingernails, weight gain or stubborn weight loss, or constipation, they will often have their TSH (Thyroid Stimulating Hormone) screened. Unfortunately, this doesn’t give a comprehensive indication of metabolic function related to all of the thyroid hormones. Too often, TSH is monitored as it slowly creeps up for a few years (while the above symptoms nag the individual in debilitating ways) until it’s high enough to warrant medication.

To head off the lengthy time period of unpleasant symptoms (just as with the insulin resistance and cholesterol-inflammation patterns mentioned), it’s usually better for patients to seek the deepest level of testing up front and request to have their free T4 and free T3 levels tested along with TSH. This way, the thyroid hormone pattern can shed light on more specific nutrition, lifestyle, and supplementation recommendations to compliment or preempt the need for medication in the future.

Free & Total Testosterone

While underactive thyroid may be rare in men, more often men experience their own brand of unhealthy hormonal changes. If you see body fat accumulate not only in the belly but also in the chest area, it may be time to check in on testosterone dynamics.

While it might be interesting to compare your total testosterone levels to those of your buddies, that’s not the whole story. Men looking to maintain top-tier levels of muscle mass and vitality will find it best to monitor their own trends of both total and free (active) testosterone levels over time.

“T” activity doesn’t just dictate muscularity; it also has significant impacts on mood and overall metabolic function, primarily insulin sensitivity. Low testosterone activity may be able to hint at early insulin resistance patterns, especially when trended from early or mid-twenties. Since about one-fourth of men in their late 30s have low testosterone and about one-third of American adults have insulin resistance, there’s a great deal of overlapping lifestyle and metabolic patterns these two conditions share. Test one or test both, but at least test something if you don’t feel like you.


This tenth and final hard truth health measure could have fallen anywhere on this list, but I want to leave you with another easy-to-measure-but-hard-to-maximize metric. Beyond the physical assessments and biochemical screenings, there’s the question of emotional well-being – happiness.

Even people who aren’t setting the curve on earlier tests I mentioned or who have sub-optimal patterns in certain physical areas can still outlive their peers if they meet everyday life with a positive mindset. If we’re truly happy, we have better psychological resilience and mental fortitude to overcome any of these other challenges.

How do you test it? There are all kinds of surveys to screen for depression, and entire lists of happiness questionnaires. However, the best assessment tools might be a pen, a notebook and time for self-reflection. Just as we can track our health measures and physical achievements, we can gauge our personal growth and well-being over time. Likewise, we can gather support for this dimension in our journey as we do for our physical health.

There’s genuine power in clarity – no matter what number or capacity we’re measuring. What we honestly assess is what we’ll most likely invest in. Whatever tests and tools you choose to access, don’t stop seeking the best for yourself! Thanks for reading, everyone.

In health, Paul Kriegler, Corporate Registered Dietitian

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

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