Your GP ran bloods. Everything came back fine.
So why are you still exhausted, carrying weight around the middle, and crashing at 3pm?
Because "fine" on a standard panel and "metabolically healthy" are not the same thing.
Here are the 15 markers I actually look at with founders, and what the numbers need to say.
1. Waist-to-height ratio
Optimal: below 0.5Free. Takes 30 seconds. No blood test needed. Measure your waist in cm and divide by your height in cm.
More predictive of metabolic risk than BMI. A decreasing waist-to-height ratio is often the first sign things are moving in the right direction, usually before the scales shift at all.
A useful companion measure: waist circumference below 94cm for men. If both your ratio and circumference are moving in the right direction, you're heading the right way.
2. Blood pressure
Optimal: below 120/80 mmHgMost people know this one. What most don't know is the difference between "under 140" (what many GPs flag as acceptable) and actually optimal. You want below 120/80.
3. HbA1c
Optimal: below 5.4% (below 36 mmol/mol)Your average blood sugar over the past three months. A lot of founders have had this done and been told it's fine. Sometimes it is. Sometimes it's sitting in pre-diabetic range and nobody has made a point of flagging it.
Pre-diabetic range: 5.7–6.4% (39–47 mmol/mol). That window is where I see most founders sitting when they first come to me.
4. Fasting glucose
Optimal: 4.0–5.3 mmol/LYour blood sugar first thing in the morning before eating. Taken after a 10–12 hour fast, water only. A snapshot of how well your body is managing blood sugar at baseline.
5. Fasting insulin
Optimal: below 6 mIU/LThe one most GPs don't run routinely. Also one of the most important.
Fasting insulin rises years, sometimes a decade, before blood glucose moves. If it's elevated, your body is already working harder than it should to keep blood sugar in range. That's insulin resistance in its early stages. Ask your GP specifically for this one.
6. HOMA-IR
Optimal: below 1.0Calculated from your fasting glucose and fasting insulin together. Not a separate blood test. Gives you an insulin resistance score.
If this number is elevated it explains a lot: why fat loss is difficult, why energy is poor, why belly fat keeps coming back regardless of what you try.
Calculate it here: thebloodcode.com/homa-ir-calculator
7. Fasting triglycerides
Optimal: below 1.0 mmol/L (flag if above 1.7)Fat in the blood. Elevated triglycerides are almost always diet and lifestyle driven: high carb intake, processed food, too little movement. Usually one of the first markers to improve when founders change how they eat.
8. Triglyceride to HDL ratio
Optimal: below 2.0Divide your triglycerides by your HDL cholesterol. One of the strongest available indicators of insulin resistance and cardiovascular risk. Most people have never heard of it.
If you have belly fat, low energy, and this ratio is above 2.0, you now have a clearer picture of why.
Note: calculate using mg/dL values. To convert: TG (mmol/L) x 89 and HDL (mmol/L) x 39, then divide.
9. Liver enzymes (ALT, AST and GGT)
Optimal: all below 30 U/LElevated liver enzymes in an overweight founder almost always mean early fatty liver. Completely reversible with the right changes. Completely ignored, often blamed on alcohol, until the damage accumulates.
10. C-Reactive Protein (hs-CRP)
Optimal: below 1.0 mg/LYour inflammation marker. Chronic low-grade inflammation drives fatigue, brain fog, and fat gain. Cheap and simple. Most GPs will run it without hesitation.
11. Ferritin
Optimal: 30–100 µg/LIron storage and an inflammation marker. Often overlooked. High ferritin in the context of metabolic dysfunction signals inflammation rather than iron excess, and it tends to normalise as metabolic health improves. Low ferritin explains fatigue that doesn't respond to anything else.
12. Vitamin D
Optimal: 75–150 nmol/LRegulates immune function, circadian rhythm, and metabolic health. Deficiency is extremely common, particularly in people who spend most of the day indoors. Low Vitamin D is consistently linked to fatigue, poor sleep, and increased metabolic risk.
13. Homocysteine
Optimal: below 8 µmol/LLinked to cardiovascular risk and cognitive decline. Rarely tested. Often elevated in people eating a poor diet, particularly one low in B vitamins. Worth knowing, easy to improve.
14. Testosterone (men)
Optimal range varies by age: see tables belowLow testosterone in men is increasingly common and increasingly linked to metabolic dysfunction. If you're tired, carrying belly fat, and your drive has dropped, this is worth knowing.
The good news: testosterone responds well to the same things that fix everything else. Better sleep, morning sunlight, resistance training, lower body fat, less processed food.
Total testosterone (nmol/L)
| Age | Optimal |
|---|---|
| Under 25 | 24.0+ |
| 25–34 | 23.0+ |
| 35–44 | 23.0+ |
| 45–54 | 21.0+ |
| 55–64 | 19.5+ |
| 65–74 | 18.5+ |
| 75–84 | 16.5+ |
| 85+ | 13.0+ |
Free testosterone (pmol/L)
| Age | Optimal |
|---|---|
| 20–29 | 387.0+ |
| 30–39 | 331.0+ |
| 40–49 | 307.0+ |
| 50–59 | 270.0+ |
| 60–69 | 243.0+ |
| 70–79 | 213.0+ |
| 80+ | 163.0+ |
Calculate your free testosterone: issam.ch/freetesto.htm
SHBG: Sex Hormone Binding Globulin (nmol/L)
SHBG binds to testosterone and makes it unavailable for the body to use. High SHBG means your total testosterone can look normal on paper while your usable testosterone is low. Worth checking alongside total and free T.
| Age | Average |
|---|---|
| Under 25 | 24.0 |
| 25–34 | 35.5 |
| 35–44 | 40.1 |
| 45–54 | 44.6 |
| 55–64 | 45.5 |
| 65–74 | 48.7 |
| 75–84 | 51.0 |
| 85+ | 65.9 |
15. DEXA scan
Body fat 10–20% (men) · Visceral fat area below 100 cm²The gold standard for body composition. Unlike weight on the scales, a DEXA scan tells you exactly how much of your body is fat, muscle, and bone, and crucially, where the fat is sitting.
Visceral fat (fat stored around the organs) drives insulin resistance, inflammation, and cardiovascular risk in a way that subcutaneous fat does not. You can't see it from the outside, and a DEXA scan is the most accurate way to quantify it.
Not something your GP orders routinely. Available privately at most DEXA scanning clinics. Worth doing once as a baseline, then every 6–12 months if you're actively working on body composition.
What to request at your next GP appointment
Print this list and ask for a fasting blood draw. Fast for 10–12 hours beforehand, water only. Fasting insulin is the one most likely to need a specific request. Most of the others are standard.
- Full Blood Count (FBC)
- Liver Function Tests (LFTs): ALT, AST, GGT
- Urea and Electrolytes (U&Es)
- Fasting Lipids: triglycerides, HDL, LDL
- Fasting Glucose
- HbA1c
- Fasting Insulin: request this specifically
- hs-CRP (high sensitivity C-reactive protein)
- Iron Profile
- Vitamin D (25-OH)
- Homocysteine
- Sex Hormones: total testosterone, free testosterone, SHBG
- Thyroid Function Tests
The pattern I see most often
Founder comes to me. Overweight, low energy, can't shift the belly fat no matter what he tries. Had a blood test. Doctor said everything was fine.
We look at the actual numbers. Fasting insulin elevated. Fasting glucose borderline. HOMA-IR showing early insulin resistance. Triglyceride to HDL ratio above 1.7.
He's not lazy. He's not undisciplined. His metabolism is running in a mode that makes fat loss almost impossible. He had no idea.
Fix the insulin resistance and everything else starts moving.
Want to know what's actually going on with your metabolic health?
The quiz is a useful starting point before you run any bloods. 8 questions, 2 minutes — it'll tell you which area to focus on first.
Take the quiz →Ready to talk now? Book a call instead.
This guide is for educational purposes, designed to help you have a better conversation at your next GP appointment. It does not replace medical advice. Chris Patrick is an AHPRA-registered pharmacist and Primal Health Coach specialising in metabolic health.