Biomarkers

A type of white blood cell (granulocyte) that alerts the body to infection by secreting immune substances that influence inflammation and coagulation. In tissues they are referred to as mast cells. These specialised immune cells play an important role in inflammation and prevention of clotting in inflamed tissues. Levels may indicate inflammation, intestinal parasites, infection, endocrine dysfunction or hypothyroidism.

A type of white blood cell (granulocyte) that alerts the body to infection by secreting immune substances that influence inflammation and coagulation. In tissues they are referred to as mast cells. These specialised immune cells play an important role in inflammation and prevention of clotting in inflamed tissues. Levels may indicate inflammation, intestinal parasites, infection, endocrine dysfunction, or hypothyroidism.

A type of white blood cell (granulocyte) that secretes important immune substances that influence the inflammatory response. These specialised immune cells are primarily involved in allergic reactions and in host defense against parasitic infection. Levels may indicate intestinal parasites, food/environmental allergies or sensitivities, chronic stress or atopic conditions.

A type of white blood cell (granulocyte) that secretes important immune substances that influence the inflammatory response. These specialised immune cells are primarily involved in allergic reactions and in host defense against parasitic infection. Levels may indicate intestinal parasites, food/environmental allergies or sensitivities, chronic stress or atopic conditions.

A measure of the percentage of blood volume that consists of red blood cells in a given percentage of centrifuged red blood. Levels may indicate dehydration, malabsorption, asthma, adrenal dysfunction, blood loss, gastric inflammation, thymus hypofunction, liver disease, hypothyroidism, or nutrient deficiencies or anaemia from iron, B12, Folate, B6, and need for Vitamin C.

An iron-containing metalloprotein that transports oxygen from the lungs to the rest of the body. Levels may indicate anaemia from Iron, Copper, B6, Folate, dehydration, poor oxygen deliverability, adrenal dysfunction, blood loss, gastric inflammation, intestinal parasites, malabsorption.

A group of specialised immune cells consisting of B cells, T cells and NK cells that work together to defend the body against pathogens and cancer cells. Levels may indicate acute or chronic viral or bacterial infection, inflammation, toxicity, oxidative stress, anaemia, hypothyroidism, asthma or chronic stress.

A group of specialised immune cells consisting of B cells, T cells and NK cells that work together to defend the body against pathogens and cancer cells. Levels may indicate acute or chronic viral or bacterial infection, inflammation, toxicity, oxidative stress, anaemia, hypothyroidism, asthma or chronic stress.

MCH is a measure of the average weight of haemoglobin per red blood cell. Levels may indicate hypochlorhydria, heavy metals, blood loss, anaemia, nutrient deficiencies or alcohol consumption, need for B12, Folate, B6, Iron, Vitamin C.

MCHC is a measure of the average concentration of haemoglobin in red blood cells. Levels may indicate hypochlorhydria, heavy metals, blood loss, anaemia, nutrient deficiencies or alcohol consumption. Need for B12, Folate, B6, Iron.

Mean Corpuscular Volume is an estimate of the average size (volume) of red blood cells. Levels may indicate hypochlorhydria, heavy metals, blood loss, anaemia, nutrient deficiencies or alcohol consumption. Need for B12, Folate, B6, Iron, Vitamin C.

Phagocytic cells that are part of the body’s second line of defense against infection. These are the precursor to macrophages. These specialised cells travel to the site of infection to destroy cancer cells, pathogens and remove dead cells or damaged tissue. Levels may indicate the late stages of an infection, intestinal parasites, liver dysfunction or BPH.

Phagocytic cells that are part of the body’s second line of defense against infection. These are the precursor to macrophages. These specialised cells travel to the site of infection to destroy cancer cells, pathogens and remove dead cells or damaged tissue. Levels may indicate the late stages of an infection, intestinal parasites, liver dysfunction or BPH.

A measure of the average size of platelets in the blood. Levels may indicate increased platelet production, vascular disease, certain cancers, type 2 diabetes, Hashimoto’s thyroiditis, aplastic anaemia or cytotoxic drug therapy.

Used to identify viral and bacterial infection. Also used to identify inflammatory processes and metabolic dysfunctions occurring in the body. 

The most abundant white blood cell in the body responsible for neutralising pathogens via phagocytosis and unlike other granulocytes, can travel through tight junctions that line blood vessel walls to enter tissues. Levels may indicate acute or chronic viral or bacterial infections, intestinal parasites, chronic stress or inflammation.

The most abundant white blood cell in the body responsible for neutralising pathogens via phagocytosis and unlike other granulocytes, can travel through tight junctions that line blood vessel walls to enter tissues. Levels may indicate acute or chronic viral or bacterial infections, intestinal parasites, chronic stress or inflammation.

Small, anucleated cell fragments involved in clotting, vascular integrity and vasoconstriction. Levels may indicate atherosclerosis, oxidative stress, inflammation, heavy metals, infection, several types of anaemia, blood loss or certain cancers.

A measure of the amount of RBC’s within the blood. RBC’s carry oxygen from the lungs to bodily tissues and transfer carbon dioxide from the tissues to the lungs. Levels may indicate nutrient deficiencies including Vitamins C, B12 and folate, anaemia ie B12, iron, Folate, Copper, dehydration and stress.

Red Blood Cell Distribution Width (RDW) is a measure of the amount of variation in the size of red blood cells. Levels may indicate malabsorption, nutrient deficiencies including Iron, B12 and folate, anaemia, intestinal bleeding, inflammation.

Reticulocytes are newly formed and immature red blood cells that are produced in the bone marrow. They are reported as a percentage of total Red Blood Cells and can be used as an indicator or an individual’s ability to produce RBCs. Levels are used to assess the bone marrow’s response to anaemia and the effects of supplementation in the case of B12, B6 and Folate anaemias.

A measure of total white blood cells in the blood. White blood cells are specialised cells of the immune system that fight infection and defend against pathogens such as viruses, bacteria and parasites. They also produce antibodies and memory cells to create immunity against future infection. Levels can indicate chronic viral or bacterial infection. Pancreatic insufficiency, stress.

Protein hormone produced in the bone cells (osteoblasts). Binds calcium and is involved in bone regeneration and formation. Once released into the blood can act like a hormone and has direct effects i.e. it affects the beta cells of the pancreas and in turn can increase insulin production. In the fats cells increases the production of adiponectin which in turn increases the sensitivity to insulin. In muscles cells it promotes energy availability and is involved in exercise capacity. In the testes it stimulates testosterone synthesis and is involved therefore in male fertility as it is involved in testosterone production

An estimation of acid-base balance in the blood. Bicarbonate helps to maintain electrical neutrality and plays an important role in transporting CO2 to the lungs and kidneys for excretion. Levels may indicate hypochlorhydria, digestive dysfunction, poor diet, metabolic alkalosis or acidosis, respiratory alkalosis or acidosis or Thiamine deficiency.

A negatively charged (anion) electrolyte located in extracellular fluid that is needed for stomach acid production, maintaining electrical neutrality and pH balance. Along with sodium, chloride helps to regulate normal levels of water in the body. Levels may indicate metabolic acidosis or alkalosis, adrenal hyperfunction / stress or hypochlorhydria.

The main cation electrolyte is located primarily in the intra-cellular fluid with only a small amount found in the plasma, though the relationship is proportionate. Potassium is involved in muscle contraction, nerve conduction, osmotic pressure, pH balance and cellular transport via the sodium-potassium pump. Levels may indicate cellular damage, adrenal dysfunction, tissue destruction acid base balance, insulin dysregulation, dehydration, kidney dysfunction or dehydration.

A positively charged (cation) electrolyte located primarily in the extracellular fluid necessary for muscle contraction, nutrient absorption, neurological functioning and maintaining pH balance and osmotic pressure. Levels may indicate adrenal dysfunction, kidney dysfunction or dehydration.

A measure of the ratio of sodium to potassium in the blood. Levels may indicate excessive sodium intake, poor diet, hypertension or cardiovascular disease, chronic or acute stress levels

A digestive enzyme produced in the salivary glands and the pancreas that helps the body to digest and absorb carbohydrates. Levels may indicate pancreatic insufficiency, digestive dysfunction, pancreatitis.

Also known as DAO. Used in the assessment of histamine intolerance which can be caused by the deficiency of DAO or an imbalance between histamine and DAO.

Glucose 6 Phosphate Dehydrogenase. An enzyme that catalyses the energy (glucose to pyruvate) producing pathway that supplies reducing energy by maintaining the level of NADPH by reducing NADP to NADPH and compound essential in the biosynthesis of fatty acids, via the liver adipose tissue mammary glands and adrenals. Has an important role in erythrocyte functions Levels are used to determine potential haemolytic anaemia. Haemolysis can be set off by certain triggers including pathogens. Via NADPH it plays an essential role in the Glutathione recycling pathway, low levels show a potential propensity to oxidative stress and acts a protective agent for protecting erythrocytes against oxidative stress and removal of hydrogen peroxide.

A chemical produced by the enzymatic action of histadine. It released by mast cells in response to an allergic immune response. Causes smooth vessels to dilate and activates cells that are involved in irritability and pain responses. Has neurotransmitter roles and is involved in Hydrochloric acid secretion. Used in assessing allergic responses and mast cell activation.

A digestive enzyme produced by the pancreas that helps the body to digest and absorb fats. Levels may indicate pancreatitis, pancreatic sufficiency, gallbladder dysfunction, kidney disease or peptic ulcers.

An important antioxidant enzyme that catalyses the conversion of the damaging superoxide radical (produced during normal cellular respiration and energy production) into molecular oxygen and hydrogen peroxide. Different isoforms of the enzyme use zinc/copper, iron, manganese and nickel as cofactors. 

Low levels are linked to increased oxidative stress and the development of inflammatory conditions. 

Adiponectin is an adipokine protein and hormone which is mainly released from fat cells – although levels are inversely proportional to the amount of body fat.

It has anti-inflammatory effects in macrophages, endothelial tissue, epithelial tissue and muscle cells and it consequently has important cardiovascular and pulmonary protective effects. Adiponectin also increases insulin sensitivity.

Higher than normal levels of adiponectin are associated with being underweight, anorexia nervosa and difficulty gaining weight.

Low levels are linked to obesity, lipodystrophy, insulin resistance, increased risk of diabetes and cardiovascular disease.

Anti-Mullerian Hormone levels are differentiated by sex and age. It is used as a biomarker for fertility assessment.  AMH provides a guide to ovarian reserve and can help identify women who may need to consider freezing their eggs or should be trying for conception sooner rather than later. It is also useful as a biomarker in the assessment of PCOS

Known as ‘the stress hormone’ this steroid hormone plays an essential role in helping the body respond to stress, and regulates a wide range of body processes, including metabolism and immune response. This test helps identify degrees of stress levels, diagnose adrenal glands dysfunction, and disorders such as underactive, or damaged adrenal glands due to insufficient or excessive cortisol production.

The hormone Dehydroepiandrosterone (DHEA) is an important precursor to hormones such as the sex hormones progesterone, testosterone and the oestrogens. It is produced predominantly in the adrenal glands and is involved in the Fight or Flight stress response to resume a calm state after perceived danger/stress has passed. As the most abundant circulating steroid in the body, it has an influence on over 150 known repair functions in both the body and brain. Increased or decreased levels may lead to many common conditions in the endocrine, immune, cardiovascular, hormonal, and nervous systems.

Dihydrotestosterone (DHT) is a male sex hormone (androgen). Androgens are endogenous steroid hormones consisting of DHEA, Androstenedione, testosterone and DHT. DHT is the most potent hormone amongst the androgens and because it is not converted to estrogen, it is considered to be a pure androgen. It is created from testosterone via the action of the enzyme 5alpha-reductase and is produced in the prostate gland, adrenal glands, liver, brain, and hair follicles. Its action is related to tissue in which it is produced. It is a more potent hormone than testosterone (approx. 1% circulated feely as unbound), it has a slow dissociation (approx. 5x less than testosterone) and long half-life (2x affinity to the androgen receptors).

During development and adult life in men, it promotes prostate growth, activity of the sebaceous glands, male pattern baldness and the development of characteristics that are typically associated with men (body hair, muscle growth, and a deep voice). In women DHT levels are associated with issues including hirsutism, amenorrhea, and increased acne.

Used to identify the ratio between progesterone and oestrogen on day 21 of the female cycle as part of a fertility investigation.

Synthesised from cholesterol, this steroid hormone is produced in the ovaries of premenopausal women, where it acts as a powerful reproductive hormone and is highest during ovulation and lowest during menstruation. As the main hormone of the three naturally produced oestrogens, it is also produced in the testes of men, but in smaller amounts. In both sexes, oestradiol is made in significantly reduced amounts by the brain, fat tissue, and in the walls of the blood vessels.

Controlled by hormones produced in the pituitary gland, hypothalamus, and ovaries or testes. FSH regulates various hormonal functions in men and women, where insufficient levels in either sex can give rise to infertility. It also controls oestrogen secretion, where it rises during the first half of the menstrual cycle, and decreases after ovulation. This test helps to identify irregular menstrual periods, as well as women who are struggling to get pregnant, going through menopause, or have symptoms of ovarian disease.

In men, the hormones testosterone and inhibin control FSH production. It stimulates sperm production and testicular growth and can help to identify symptoms of testicular disease.

Similar in structure to insulin, insulin-like growth factor-1 plays a prominent role in the regulation of immunity and inflammation, and an essential role in regulating endocrine growth and development. It works together with the growth hormone (GH) and stimulates the liver to produce IGF-1 which reproduces, and regenerates cells and promotes growth and development. Another important function is to strengthen tissues, thereby improving bone density and building muscle, and promoting healing.

Leptin is secreted by adipocytes and has a dual role, acting as both a hormone and pro-inflammatory adipokine. It plays a key role in energy homeostasis (via receptors in the hypothalamus), by suppressing food intake and increasing energy expenditure, and it therefore acts as a negative feedback regulator of adiposity.

Although leptin levels are higher in obesity, high levels are often accompanied by leptin resistance in the hypothalamus, resulting in symptoms of low leptin.

Low levels (which are rare and usually congenital) are linked to increased appetite, poor satiety, rapid weight gain and difficulty losing weight plus decreased levels of reproductive, thyroid and adrenal hormones. Low levels have also been linked to increased risk of osteoporosis, frequent infections, hyperinsulinaemia, dyslipidaemia and non-alcoholic fatty liver disease.

Similarly, raised levels are linked to obesity, hypothyroidism, fatigue, diabetes, poor appetite regulation, fatty liver disease, cardiovascular disease, depression and poor cognition. Raised levels have also been linked to the development of autoimmunity, possibly through differential effects on T cells.

Luteinizing hormone – is one of the main hormones that plays a major role in controlling the reproductive system in both men and women. In men, LH signals the testes to produce testosterone, which in turn, stimulates sperm production. In women, LH performs different roles at different stages of the menstrual cycle. Initially to produce the female sex hormone estradiol. Latterly LH stimulates the production of progesterone, which is required to support the early stages of pregnancy, if fertilization occurs. Used in the assessment of amenorrhea, irregular menstrual periods infertility, lack of ovulation, and identify polycystic ovary syndrome (PCOS).

Released from the parathyroid glands, this hormone works with the hormone ‘calcitonin’, to help control calcium and phosphorus levels in the blood, and lower calcium levels when they get too high. It plays a crucial role in the breakdown and formation of bone.

Progesterone is a steroid hormone released in the ovary. In women, it plays important roles in regulating the menstrual cycle and reproduction, by helping to prepare the body for pregnancy, and maintain the early stages of pregnancy. In men, progesterone is involved in the development of sperm, and is produced at a much lower level than in women. It can help diagnose a failing pregnancy, determine the cause of infertility, or diagnose the cause of abnormal uterine bleeding, as well as adrenal diseases such as congenital adrenal hyperplasia.

Prolactin is a hormone produced in the pituitary gland, and plays a key role in fertility, reproduction, and the stimulation of breast milk production. It is also involved in regulating the immune system, suppressing the stress response, creating and activating new neurons, and stimulating motherly (maternal) behaviour. Men and non-pregnant women generally have low levels of prolactin. In women, prolactin tests help diagnose the causes of absent or irregular menstruation, spontaneous or abnormal breast milk flow or other unexplained discharges. In men, they can help diagnose erectile dysfunction or loss of sex drive (libido).

This protein is produced by the liver, controlled by sex hormones, thyroid hormones, insulin, and dietary factors and binds to sex hormones – testosterone, DHT (dihydrotestosterone), and oestrogen (estradiol). It helps transport them in the blood. SHBG levels, which change with age, vary between men and women, and can help control the levels of androgens and oestrogens in the body. It can help to determine testosterone levels in the blood, since around 40-60% of total testosterone is bound to SHBG in men.

Bioavailable testosterone levels, which peak in the early morning, represent the amount of free testosterone and the testosterone bound to albumin (but not SHBG). Unlike the over 50% of testosterone bound to SHBG which is strongly attached, testosterone bound to albumin is weakly attached and easily able to detach and become free testosterone. It is called “bioavailable” because it is easily “available” to be used by cells. All three types of testosterone (Total, Bioavailable and Free) decline with age in both men and women after peaking in the late 20s. Because SHBG binds up more testosterone as we age, bioavailable testosterone levels decline even more than total testosterone levels. This is of concern because low testosterone levels are associated with heart disease risk factors. It is useful to test free testosterone levels in men and women who have symptoms of low testosterone but have normal total testosterone levels and can also be used to identify Andropause (the male equivalent to the female menopause) which is a collection of symptoms including fatigue and decreased libido in middle-aged men that is due to the age-related testosterone decline.

Free testosterone (approximately 2-3%) is the portion of testosterone that is not bound to any proteins in the blood and is “free” to enter the cells and exert biological effects. 33-54% percent is weakly bound to albumin (called BIOAVAILABLE), with the rest bound to SHBG (44-65%).

This test measures the amount of both testosterones bound to proteins (sex hormone-binding globulin and albumin) and free (not bound to any proteins) testosterone in the blood.

Testosterone is a hormone mainly produced by the testes in men, or ovaries in women. Testosterone’s diverse range of effects on many different organs and tissues includes bone health building and maintaining muscle mass and strength; increasing lean body mass and fat loss; increasing red blood cell production; improving libido and sexual function, increasing sperm production, regulating mood, brain function and memory.

Carcinoembryonic Antigens are proteins produced by certain types of cancer cells eg bowel, liver, lung, breast, pancreatic, stomach and ovarian.  

They may also be detected in non-cancerous conditions including liver disease and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). 

Complement Factor C3 is Important for the body’s immune function and response to inflammation. The main function is to destroy bacteria and viruses. C3 Levels are also used to identify low levels of immune function as well as the identification of autoimmune disease like Lupus, chronic inflammation, diabetes, metabolic syndrome, fatty liver, and CVD.

Complement Factor C4 is Important for the body’s immune function and response to inflammation originating from the HLA system. The main function is as a marker to connect the recognition pathways of the antibody antigen complexes to the effector proteins of the innate immune response system to mark and destroy pathogens, immune complexes and dying cells. Levels are used to determine SLE (Lupus), inflammation and risks of inflammatory nature including metabolic syndrome and CVD.

Antibody responses IgG and IgM to Epstein Barr virus

Type 1 diabetes investigation or latent autoimmune adult diabetes. GAD enzyme is required for the healthy function of the pancreas. The presence of Glutamic Acid Decarboxylase Autoantibodies indicates Type 1 diabetes. Can be used to assess if gestational diabetes is type 1. Also, can indicate neurological disorders. Consider in relation to gluten sensitivity and coeliac disease

High levels of gastric parietal antibodies are associated with autoimmune gastritis and may also precede the development of pernicious anaemia.  

The antibodies are produced against the parietal enzyme hydrogen potassium ATPase. 

A measure of antibodies (infection fighting cells) to H Pylori bacteria. Levels may indicate exposure to H Pylori infection

IgG, IgM and IgE are all B cell secreted antibodies measured in this panel. They are part of the gamma portion of the blood protein globulins and determine the different immune responses depending on the antibody. They are produced in response to pathogens and act as a marking or identifying line of defense. IgE binds to allergens and produces response to allergic signals indicating histamine and mast cell degradation and is involved in parasitic infections like helminths. IgM is responsible for pathogen elimination in the early stages of humoral activity before there is sufficient IgG. IgG has 4 forms and provides the majority of antibody responses to pathogens, it is the only antibody that can cross the placental barrier.

IL-6 is a cytokine that can be used as a marker of immune system activation. Released from macrophages, levels may be raised with inflammation, infection, autoimmune disease, cardiovascular disease, stroke, diabetes and some cancers. High levels may also be seen after recent exercise (see below) 

As part of the NFkB inflammatory signalling pathway, IL-6 is rapidly and transiently released in response to infection or injury and stimulates the synthesis of acute phase proteins and the production of neutrophils. In addition, it downregulates regulatory T cells and activates the growth of B cells. 

In contrast, it also has an anti-inflammatory role when released from muscle cells during exercise. The resulting signalling cascade is different from the inflammatory macrophage pathway. 

Antibodies against intrinsic factor cause impairment of the absorption of vitamin B12 from the digestive tract and may ultimately lead to the development of pernicious anaemia.

Examines the levels of specific blood proteins the Globulins. These are divided into Albumin as well as Alpha 1, Alpha 2, Beta, and Gamma globulins, Alpha 1 responds to acute phase inflammation and includes thyroid binding globulin and alpha 1 antitrypsin. Alpha 2 includes ceruloplasmin and the A2 component increases in acute phases ie. a marker for inflammation. Beta globulins are essentially transport proteins and include SHBG and transferrin. Gamma globulins are predominantly immunoglobulins or antibodies involved in immune function and autoimmunity. Globulin levels are used to ascertain thyroid function, diabetes, anaemia, liver dysfunctions, immune and autoimmune issues and nutrient absorption issues.

A zinc dependent enzyme, Alkaline phosphatase, is made of isoenzymes, each one relating to the tissues they are found including liver, bone, intestine, and placenta. Through electrophoresis the percentage present of each fraction can be determined. Levels are used to determine cancerous or benign liver conditions, liver bone intestinal conditions with or without an increase in ALP.

A measure of a liver produced protein that increases with inflammation. It may also increase following infection, a heart attack, surgery or trauma. Levels may indicate acute inflammation, and diets with too much fat or high GI carbohydrates.

During inflammation, leukocyte mediated damage to blood vessel walls can lead to vasculitis with activation of the coagulation cascade and thrombus formation. Fibrinolysis of the clot’s releases D-dimer protein fragments into the bloodstream. D-dimer may therefore be used to track inflammation and blood vessel damage in inflammatory conditions. 

Raised levels may be associated with recent injury or surgery, vasculitis, pregnancy, heart disease or infection. 

The rate of sedimentation of red blood cells in anti-coagulated blood in one hour. Levels may indicate tissue destruction, inflammation, and may indicate in certain cases presence of pathogens.

A measure of the ratio of fatty acids in the blood. This test and report are a measurement and report on the levels of omega 3, 6, 5, 7 and 9 fatty acids as well as saturated and trans along with ratios and indexes. Levels may indicate deficiencies, needs and excess, assessment for dietary malabsorption, as well as indicating inflammation and cardiovascular disease risk.

A soluble liver produced protein that is broken down to produce fibrin which is necessary for clot formation. Levels may indicate hypercoagulation, inflammation, trauma, infections, cancer, cardiovascular disease or increased risk of stroke and liver function.

An amino acid produced through methionine metabolism. This methylation process involves Vitamins B6, B12 and folate as well as zinc and co-factors including magnesium and tri methyl glycine all required in the recycling of methionine to homocysteine and back again. Levels may indicate needs in these nutrients, oxidative stress or metabolic syndrome, risks of Alzheimer’s, CVD risks. Depression, dementia, Parkinson’s, oxidative stress, poor detoxification, IBD.

A highly sensitive measure of CRP, a protein in the blood that increases with inflammation.

Fractions of LDH (Lactate dehydrogenase) are isoenzymes that are expressed in various blood tissues throughout the body – namely the lungs, heart, blood cells, the brain, lungs, kidneys, placenta, pancreas liver, and muscle. Different isoenzymes are released during tissue damage, and assessment of these can help pinpoint the area of tissue destruction

A measure of the amount of iron stored in the body. The most sensitive test to assess iron deficiency. Levels may indicate haemochromatosis, excess iron intake, inflammation, oxidative stress, liver dysfunction, excessive blood loss or iron deficiency anaemia.

A measure of iron bound to transferrin and serum proteins. It represents 1/3 of the total iron binding capacity of transferrin. 70% of iron is bound to haemoglobin. On its own, it is a relatively poor marker of iron status. Levels may indicate haemochromatosis, haemolytic anaemia, liver damage, hypochlorhydria, Vit B6 deficiency, poor iron intake or absorption, blood loss, chronic disease, pathogen infection, progesterone birth control pills.

An estimation of the iron-binding capacity of transferrin. Levels may indicate iron deficiency anaemia, internal blood loss, haemochromatosis, protein malnutrition or malabsorption, pregnancy, chronic infection, or liver dysfunction.

An estimation of the iron-binding capacity of transferrin. Levels may indicate iron deficiency anaemia, internal blood loss, haemochromatosis, protein malnutrition or malabsorption, pregnancy, chronic infection or liver dysfunction.

A measure of the protein in the blood that binds to iron and transports it through the body. Levels may indicate iron deficiency anaemia, infection, protein malnutrition or malabsorption. Produced in the liver levels can indicate iron capacity, inflammation as well as liver function.

A measure of how much serum iron is bound to transferrin. Levels may indicate haemochromatosis, nutrient deficiency anaemias, tissue inflammation, protein malnutrition or malabsorption.

A measure of the portion of iron binding sites on transferrin that are not occupied by iron. UIBC is often measured along with iron and total iron-binding capacity (TIBC) to determine various iron disorders. Levels may indicate haemochromatosis, poor iron intake, blood loss or pregnancy, hypochlorhydria, cobalamin deficiency.

A byproduct generated from normal muscle metabolism through the action of creatine kinase on creatine the muscle fuel. It is filtered through the kidneys for excretion in the urine. Levels may indicate kidney dysfunction, dehydration, excessive muscle breakdown, increased muscle mass, prostate dysfunction, hyperthyroidism and potential methylation issues.

A calculated estimate of kidney glomerular filtration rate function. Subject to age gender, race and creatinine levels in the blood. Levels may indicate kidney dysfunction.

A waste product generated in the liver due to the breakdown of dietary protein; it is filtered through the kidneys for excretion in the urine. Levels may indicate dehydration, malabsorption, pancreatic insufficiency, hypochlorhydria, kidney dysfunction, high protein intake, fatty liver, catabolic stress (adrenal), inadequate protein intake or protein malabsorption, liver disease, also consider increased need to excrete ammonia and consider pathogens.

A measure of the ratio between BUN and Creatinine levels in the blood and is used to assess renal function.

Used a coronary biomarker. Levels are used to assess risks and trends to coronary artery disease, atherosclerosis, CVD, myocardial infarction, and stroke.

Apo A is a constituent of HDL and assists in the binding of cholesterol and fats transport from blood vessels and cells preventing plaque formation. It has a role in cognitive function, in the immune system as an agent against pathogens and detoxifies bacterial toxins. Used as a predictor for CVD and inflammation.

Apolipoprotein B is the backbone of LDL, and is part of the delivery system to deliver cholesterol from the liver. A main contributor to atherosclerosis and heart disease. Linked to immune function and is a measure of CVD risk. Levels are linked with obesity, hypothyroidism, insulin resistance and diabetes. Risk factors also include Alzheimer’s, cognitive function, heart disease and possibly cancer.

A steroid found in all cells and plasma. Cholesterol is an essential lipid that is obtained through diet and produced in the liver. It is essential for life but can be harmful if levels are too high. It helps to form cell membranes and is used in the production of hormones, vitamin D and bile salts. Levels may indicate oxidative stress, inflammation, insulin resistance, blood glucose dysregulation, poor thyroid function, magnesium deficiency, dehydration, liver or kidney dysfunction or familial hypercholesterolemia., heavy metal load, adrenal sufficiency, gallbladder function.

A better marker to assess CVD risk than cholesterol in its own.

A measure of a type of lipoprotein that transports cholesterol from the bloodstream to the liver to be excreted in bile; HDL transports cholesterol to the adrenals, ovaries and testes where it is converted into steroid hormones. HDL is considered beneficial. Levels may indicate cardiovascular disease., autoimmune processes, metabolic syndrome, fatty liver etc.

A CVD risk assessment marker. 

A measure of a type of lipoprotein that transports cholesterol from the liver to various tissues in the body. Elevated levels can cause fatty deposits to accumulate in the arteries increasing the risk for atherosclerosis and cardiovascular disease. Levels are measured to assess risks of the aforementioned as well as metabolic syndrome, oxidative stress and fatty liver.

Made in the liver comprising of LDL, Apolipoprotein B and apolipoprotein(a). (note not to be confused with Apo A). It is an independent marker and levels are largely dependent on genetic propensity. It is used to assess CVD risk, heart disease and stroke.

Measures the amount of lipoprotein associated phospholipase in the blood. Primarily associated with LDL which carried the Lp-PLA2 to the coronary artery walls activating an immune response making plaque. Levels are associated with increased risk of heart attack and stroke and is an excellent coronary marker

Used as a CVD risk assessor. This measure the level of cholesterol that is not carried HDL. Levels can indicate an increased CBD risk, oxidative stress , fatty liver, diabetes, metabolic syndrome, poor dietary regimes.

A type of lipid primarily obtained through diet and from the conversion of excess dietary calories into fat for storage. Levels may indicate excess CHO intake and an increased risk for cardiovascular disease, biliary and liver dysfunction, autoimmune processes, metabolic syndrome, insulin resistance, poor fat processing, hypo and hyper-thryoidism.

Used in identifying trends to insulin resistance. Type 2 diabetes and risks of CVD.

A measure of a type of lipoprotein VLDL-C that is produced in the liver and carries triglycerides and cholesterol throughout the body. Elevated levels can cause fatty deposits to accumulate in the arteries increasing the risk for atherosclerosis and cardiovascular disease.

A zinc dependent enzyme, the major function of Alkaline Phosphatase, is to protect your intestinal tract against bacteria, aid in digestion, breakdown fats and some B vitamins, and promote bone formation. As its name suggests it depends on an alkaline environment and is found in all tissues in the human body, but mostly in bones, kidneys, liver, intestines, and placenta. Levels are used to assess zinc need, liver function, Vitamin C need or biliary obstruction as well as bone turnover.

An enzyme found primarily in the liver, with small amounts in the heart, muscles, and kidneys. Levels may indicate liver disease, biliary issues, pancreatitis or alcoholism, fatty liver, need for B6.

An intracellular enzyme found primarily in the liver and heart and to a lesser extent in skeletal muscle, kidneys and lungs. It is released into the bloodstream due to cellular or tissue damage. Levels may indicate cardiovascular disease, liver disease, alcoholism, hypothyroidism, viral infection with EBV or CMV, muscle injury or acute pancreatitis, need for B6.

Assess liver function and progression of liver disease. Levels are used to assess Vitamin B6 sufficiency, liver dysfunction, muscle damage biliary obstruction, alcoholic liver disease, also consider hepatitis, insulin resistance, NAFLD.

A measure of bilirubin that has been conjugated ie. made water soluble in the liver so it can be excreted in the bile. Levels may indicate liver dysfunction or biliary tract obstruction.

A measure of the protein (albumin) bound bilirubin that circulates in the blood on its way to the liver, from the breakdown of red blood cells Levels may indicate increased red blood cell destruction. (haemolysis) and Gilbert’s Syndrome.

A marker comprising the total of direct (conjugated) and indirect bilirubin. Formed from the breakdown of haemoglobin from red blood cells at the spleen and bone marrow. May be elevated due to excess red blood cell destruction, liver dysfunction, oxidative stress bile duct obstruction, Gilbert’s Syndrome or zinc deficiency, oxidative stress, heavy metal load.

An enzyme mainly found in the liver. Some production from kidney, prostate and pancreas, Levels may indicate liver or biliary obstruction, alcohol excessive use, Pancreatitis, pancreatic insufficiency, need for Vitamin B6 and magnesium

LDH (Lactate Dehydrogenase) Measures the level of enzyme. LDH plays a part in energy (carbohydrate) production referring to the reversible lactate to pyruvate pathway. Levels can relate to issues with the 5 main tissues it is found in (see LDH Isoenzymes) and glycemic management,

Represents the difference between the electrolyte cations (positive) and the anions (negative). Used for identifying needs for vitamin B1 and acid base states, indicates trends to metabolic acidosis and alkalosis.

Groups of enzymes that play a large role in energy production and found in tissues that use lots of energy i.e. heart, skeletal muscle and the brain. Levels are used to assess damage from the heart (MI), skeletal muscle damage and breakdown, brain damage, and muscle atrophy

Produced as the end product of purine breakdown. It is predominantly excreted via the kidneys Failure to excrete or overproduction can be implicated in kidney stones and gout. Used in assessing risks of gout atherosclerosis, oxidative stress, arthritis, kidney function, intestinal permeability, methylation function, detoxification issues.

The most abundant metal and in the earth’s crust. Widely used in manufacturing, health and beauty products including antiperspirants, and lipsticks as well as edible cake decorations and more. Exposure is common and excess is detrimental to health and wellbeing and long term exposure and overload to excretory processes can lead to increased levels and elevated risks of toxicity as well as increasing cognitive risks including Alzheimer’s and Dementia as well as associations with anaemia, and bone strength reduction.

Arsenic is a neurotoxic and carcinogenic metal that is inhibitory to enzymes involved in energy production.  

Environmental exposures may be from volcanic ash, metal smelting, pesticides, contaminated water and foods grown in contaminated water and soil (eg rice). 

Raised serum levels may reflect a recent exposure. 

45% of calcium is inactive and bound to albumin, of the rest 45% is free and active. The calcium test measures total calcium. Calcium an alkali earth metal is essential for muscle contraction, oocyte activations, bone and dental health, blood clotting, nerve impulse transmission, heartbeat regulation and intracellular fluid balance. Levels are used to assess calcium sufficiency, parathyroid function, hydrochloric acid, tissue cell damage, thyroid function, vitamin D sufficiency, Osteoporosis, acid base balance, ovarian function.

Used to assess Vitamin D sufficiency, protein deficiency or loss, calcium insufficiency.

A determinant in the assessment of metabolic acidosis or alkalosis. Can be used to identify trends to sympathetic or parasympathetic states.

Affects levels of insulin carbohydrate fat and protein levels. Used in supplemental form to assist CH2O metabolism. Note Cr exists in 2 forms Cr (VI) which is toxic and enters the red blood cells and Cr (III). Plasma test measures total Cr and to ID Cr (VI) it will be necessary to measure RBC Cr levels

Used as a marker to identify skin health, mental health, toxicity esp. estrogen and clearance of, heart disease risk, diabetes bone loss and immune function. Used to assess copper sufficiency, inflammation and presence of inflammatory diseases, Levels used to assess needs for copper, zinc, anaemia, immune function, inflammatory conditions, PMS, pathogen infection, adrenal insufficiency.

Lead is a neurotoxic heavy metal. Environmental exposures are commonly through fossil fuels, cosmetics, lead paint and pipes in old houses (although this is now less common). 

Raised serum levels may reflect a recent exposure. 

Lead exposure can cause anaemia, weakness, kidney and brain damage. 

A more accurate measure of magnesium can be obtained via red blood cells which contain 2 – 3x more Mg than serum. Mg is a mineral necessary for energy production, muscle contraction, nerve function, maintenance of strong bones, carbohydrate and protein metabolism, and over 300 enzymatic processes in the body. It is obtained through diet and is absorbed in the small intestine and colon. Levels may indicate deficiency due to malabsorption or gastrointestinal disorders.

A measure of magnesium in the blood. Mg is a mineral necessary for energy production, muscle contraction, nerve function, maintenance of strong bones, protein and carbohydrate metabolism and over 300 enzymatic processes in the body. It is obtained through the diet and is absorbed in the small intestine and colon. Levels may indicate a deficiency due to malabsorption or digestive disorders.

Mercury is a neurotoxic heavy metal. Environmental exposures are commonly through dental amalgams, vaccines, occupational exposures or seafood. 

Raised serum levels may reflect a recent exposure. 

A measure of inorganic phosphate in the blood. Phosphates combine with calcium to form bones and teeth, are required for nerve and muscle function, energy production and maintaining the body’s pH balance. Levels may indicate vit D toxicity or deficiency, hypoparathyroidism, kidney dysfunction. elevated insulin, high CHO intake, diarrhoea, poor protein digestion or malabsorption.

Zinc is not stored in the body and dietary intake is essential. Zinc is involved in over 300 enzyme functions. Including the metabolism and function of carbohydrates, proteins and fats. As well involved in immune function, skin health and healing and senses of taste and smell amongst many. Levels are used to assess zinc status at Red Blood Cell level, hydrochloric acid production, male fertility, inflammation, copper status amongst many.

An essential micronutrient. As soils become depleted dietary intake has fallen, and the need to assess increases. Essential for thyroid T4 to T3 conversion, protects LDL from oxidation. Levels used to assess immune function, inflammation, heart disease risk and reproduction capacity esp. male fertility, Protective effect against some cancers.

Zinc is not stored in the body and dietary intake is essential. Zinc is involved in over 300 enzyme functions. Including the metabolism and function of carbohydrates, proteins and fats. As well involved in immune function, skin health and healing and senses of taste and smell amongst many. Levels are used to assess zinc status at a serum level, hydrochloric acid production, male fertility, inflammation, copper status amongst many.

An important cellular and mitochondrial antioxidant involved in the quenching of both oxygen and nitrogen free radicals, it also has a role to play in recycling vitamins C and E within the cell.   

It is involved in the phase II detoxification of heavy metals and POPs and production of prostaglandins and leukotrienes.  

Composed of three peptides (cysteine, glycine and glutamic acid) de novo synthesis within the cell is primarily limited by the availability of the amino acid cysteine. 

Low levels are associated with the development of a range of chronic diseases such as neurodegenerative diseases, CVD, hypertension, liver disease, COPD, asthma and autoimmune disease as well as loss of function with aging. 

Prostate specific antigen (PSA) is a protein that is made in the prostate in two forms – complexed and free. Complexed PSA is bound to other proteins, while free PSA is not bound to anything. Total PSA tests are mainly used to screen for prostate cancer; however, it is not specific enough to diagnose prostate cancer on its own. Free PSA tests can help men with slightly high total PSA levels to help determine whether they should get a prostate biopsy. Prostate tumors normally produce complexed PSA, while normal prostate cells produce free PSA. Free PSA tests are used to find the PSA free/total ratio. A high ratio means that you do not need a prostate biopsy.

The free prostate-specific antigen (PSA) test is used to measure the level of unbound PSA in the blood, which can be helpful to assess prostate dysfunction, inflammation of the prostate or cancer. Elevated levels of PSA free are associated with Benign Prostatic Hypertrophy. Decreased levels of PSA are associated with an increased risk of prostatic inflammation of cancer.

Prostate specific antigen (PSA) is a protein that is made in the prostate in two forms – complexed and free. Complexed PSA is bound to other proteins, while free PSA is not bound to anything. Total PSA tests are mainly used to screen for prostate cancer; however, it is not specific enough to diagnose prostate cancer on its own. Free PSA tests can help men with slightly high total PSA levels to help determine whether or not they should get a prostate biopsy. Prostate tumors normally produce complexed PSA, while normal prostate cells produce free PSA. Free PSA tests are used to find the PSA free/total ratio. A high ratio means that you do not need a prostate biopsy.

The most abundant plasma protein in serum produced by the liver. It contributes to plasma osmotic gradient, transports nutrients, hormones and other substances in the blood and is needed for tissue maintenance and repair. Levels may indicate dehydration, hydrochloric acid insufficiency, oxidative stress, free radical activity, Vitamin C need, infection, inflammation, liver, or kidney disease.

A measure of the ratio of albumin to globulin in the blood. Levels may indicate dehydration, liver or kidney dysfunction, hypothyroidism, adrenal dysfunction, or immune activation, can also be considered in assessing a hyper coagulative state “sticky blood”. 

The activated partial thromboplastin clotting time measures how long it takes blood to form a clot. 

Used in conjunction with other clotting tests such as prothrombin, it mainly indicates how well the intrinsic clotting pathway and the common final pathway are working. 

Copper transport protein binds 95% of circulating copper. Interacts with 120 other proteins. Is an acute phase protein and responds to inflammation and inflammatory diseases. Used to assess copper sufficiency, inflammation needs for copper, zinc, anaemia, toxicity, and immune function. Is also used as an Alzheimer’s risk marker, Parkinson’s, Iron status, obesity, and liver damage.

A plasma protein with different subtypes produced by the liver and immune system. Some transport nutrients and some, called Immunoglobulins, help to fight infection. Levels may indicate digestive inflammation, immune insufficiency, Gastritis, Cancer, liver damage, heavy metals, chemical toxicity, immune activation including parasites, elevated oestrogen, Haemolytic Anaemia.

The international normalised ratio is a measure of blood clotting function and is based on prothrombin time. 

Poor clotting may result in a bleeding disorder such as unexplained heavy menstrual periods in women, bruising easily or frequent heavy nosebleeds. 

Overzealous clotting may result in increased risk of thrombus formation such as DVT. 

Prothrombin is a protein produced by the liver. It is an important clotting factor. 

The test measures blood clotting time and is often used to monitor the effect of blood thinners such as warfarin or to evaluate liver disease. It reflects the extrinsic pathway and the common coagulation pathway. 

The result is often expressed as the international normalised ratio which expresses the prothrombin time as a ratio against the standard ‘normal’ prothrombin time. 

The sum of total proteins, ie. comprised of albumin and globulin totals in the blood. Levels may indicate dehydration, malnutrition, amino acid need, inflammatory conditions, hypochlorhydria, kidney or liver disease.

To assist in the evaluation of trends to insulin resistance and metabolic syndrome. Levels are used to indicate ageing, metabolic health, insulin resistance, NAFLD metabolic syndrome CVD risk and trends.

A byproduct of proinsulin production by the pancreas. Proinsulin splits into Insulin and C-Peptide. Unlike Insulin which is cleared in a variable manner c-peptide is cleared at a constant rate making it a more dependable measure of Insulin production. Levels indicate how much Insulin is being produced and indicates blood sugar dysregulation including Type 1 and 2 diabetes.

A calculated value based on HbA1C values giving the average glucose reading over the past 60 to 90 days, it very useful to assist in the prediction of values over time

A measure of glycated protein formed between glucose and albumin and is a marker for glucose control over the past 2 to 3 weeks. Levels may indicate blood sugar dysregulation.

The main energy source of the body. Controlled by hormones including Insulin and Glucagon. Poorly controlled levels are associated with Diabetes, insulin resistance. Inflammatory processes including Metabolic Syndrome and Hypoglycaemia.

Haemoglobin A1C measures the amount of glucose that combines with Haemoglobin (glycosylation) over the life of the red blood cells i.e. approximately 90 days. Levels therefore can identify long term glucose management and control as well as Hypoglycaemia. Unlike a fasting glucose test this marker does require fasting.

A fasting insulin test identifies the level of insulin after an 8 to 12 hour fast. Insulin is a pancreatic hormone released to manage the process of glucose being transported into the cells for energy production purposes. Levels are associated with Insulin resistance, Diabetes, Metabolic Syndrome, inflammation, Obesity, lipid management and risks of CVD.

The portion of triiodothyronine (T3) that is not bound and represents approximately 10% of circulating T3 in the blood. T3 is converted from T4 and the majority occurs in the liver and kidneys. The conversion process is dependent on Selenium and bile levels. Levels can be used to assess Hypo and hyper thyroid status, T4 to T4 conversion efficacy, Selenium sufficiency, and Iodine sufficiency.

Less than 0.05% of Total Thyroxine (T4) is free or unbound. The hormone is made in the thyroid gland and is the precursor to T3. Production of T4 is dependent on levels of iodine, co factors like B6, Biopterin, Copper, Zinc, Vitamins B2, B3 and A. Considered by mainstream when combined with TSH to be the gold standard for assessing thyroid function., Levels are assessed to identify thyroid status (hypo and hyper), Iodine sufficiency as well as protein status and liver function.

Used to assess thyroid hormone conversion, stress, elevated cortisol.

Considered to be the metabolic brake to counteract the effects of the metabolic accelerator that is T3. Levels are used to identify possible diabetes, effects of fasting, heavy metals, inflammatory, pathogen effects, inflammatory cytokines like IL6 and TN-Alpha, also an indicator of stress.

Considered to be the metabolic brake to counteract the effects of the metabolic accelerator that is T3. Levels are used to identify possible diabetes, effects of fasting, heavy metals, inflammatory, pathogen effects, inflammatory cytokines like IL6 and TN-Alpha, also an indicator of stress.

A marker to determine how much active T4 is available ie how well the thyroid is functioning. Used to determine hypo and hyper thyroid status.

Also known as TG Abs. Used to determine if there is a thyroid autoimmune dysfunction ie Hashimoto’s (Hypo) or Graves (hyper) where the thyroglobulin in the thyroid is attacked.

Aka TBG Made in the liver. TBG is a protein that binds and carries T4 and T3 in the blood. There are also other proteins that carry thyroid hormones ie Albumin and Transthyretin. Especially useful where T4 and T3 don’t have accompanying thyroid symptoms as levels can also be related to oestrogen, corticosteroids, and liver function.

Also known as TPO. TPO is a thyroid gland produced enzyme that attaches the Iodine molecule to tyrosine to make T4. Levels are used to determine an autoimmune thyroid condition – Hashimoto’s.

Represents the total of free and bound T3 in the blood, represents approximately 90% of T3. A small percentage is made directly in the thyroid gland and rest predominantly made in the liver and kidney by the conversion of T4 to T3. Levels are used to determine T4 conversion syndrome, Euthyroid sick syndrome, Selenium and Iodine sufficiency and Hyperthyroidism.

Major thyroid hormone secreted by the thyroid gland and subject to appropriate levels of Biopterin, Vitamins B6, B2, A, B3 and C as well as sufficient Copper and Zinc. Total T4 represents over 99.5% of the total thyroid hormone available. Levels can help determine, thyroid status (hypo or hyper), Iodine sufficiency,

Thyroid Stimulating Hormone is secreted from the anterior pituitary gland and levels are based on a negative feedback loop to signal to the thyroid gland whether to release more Thyroxine or stop releasing. Conventionally along with free T4 the combination is considered the gold standard for assessing thyroid status. Levels are also affected by heavy metal burdens including Aluminium.

Also known as TRAbs. Measure the number of antibodies produced antagonistically against the thyroid stimulating receptor. These receptors signal the thyroid to produce thyroid hormones and autoimmune conditions cause the receptors to malfunction. Levels are used to determine Graves’ disease (hyperthyroid 90%) and also can be indicated in Hashimoto’s (hypothyroid 10%).

Also known as holotranscobalamin also see Vitamin B12. Active B12 accounts for approximately 10 to 20% of total B12 levels. Considered to be a more sensitive marker than serum B12 as it degrades faster than serum B12 with a short life span making it a more sensitive indicator or B12 deficiency.

See Folate. Red cell folate is considered to be a measure for intracellular sufficiency.

A measure of the total amount of folate in the serum. Folate is needed to make red and white blood cells in the bone marrow, convert carbohydrates into energy, and produce DNA and RNA. Adequate intake is extremely important during periods of rapid growth such as pregnancy, infancy, and adolescence. Levels may indicate dietary insufficiency, malabsorption or anaemia, methylation status, anaemia. Consider links to biopterin pathways and links to neurotransmitters like dopamine and serotonin etc.

Vitamin A: 

The test measures serum retinol levels. 

Vitamin A can be derived through the diet as the preformed retinol and retinyl esters in animal products and also as the precursor beta-carotene in plant foods. A percentage of the population (studies suggest this may be as high as 45%) are however, unable to convert beta-carotene efficiently into vitamin A. 

Vitamin A is needed for eye health and also stimulates the growth and activity of white blood cells. It is important for maintaining healthy mucosal surfaces and has a role in bone remodelling and the control of cell division during reproduction. 

High levels are toxic. 

Mild insufficiency is associated with fatigue, susceptibility to infections and infertility. 

Severe deficiency is associated with extreme dry eyes (that can lead to blindness if untreated) night blindness, patches on the whites of the eye, dry skin or hair. 

Thiamine is an essential water-soluble vitamin that is involved in carbohydrate metabolism and energy production. It is also plays an important role in the central nervous system through regulation of chloride channels and is needed for synthesis (and possibly release) of acetylcholine. 

Low levels are associated with alcohol intake, fatigue, weakness, cardiac arrhythmias, confusion, memory loss, neuropathy, depression, weight loss, pain and ataxia among other things.  

Severe deficiency is known as the condition beriberi. 

A measure of the total amount of B12 in the serum. B12 is essential in methylation, important for the nervous system and for red blood cell production. Levels may indicate low dietary intake, malabsorption, Hypochlorhydria, autoimmunity, Anaemia or excessive alcohol intake

Riboflavin’s main significance is around its essential role in the formation of the two coenzymes: flavin mononeucleotide (FMN); and flavin dinucleotide (FAD). These coenzymes are involved in energy production, phase 1 detoxification via cytochrome P450 enzymes, lipid metabolism and antioxidant protection as a consequence of the role of FAD in the recycling of glutathione via glutathione reductase. It is this latter reaction that is utilised during the assay for riboflavin. 

Low levels are associated with fatigue, swollen throat, blurred vision, depression, liver degeneration, glossitis, anaemia, hair loss, skin cracks and dermatitis around the mouth. 

Niacin is a water-soluble vitamin used to form the coenzymes: nicotine adenine dinucleotide (NADH) and its ionized form (NAD+); and nicotine adenine dinucleotide phosphate (NADPH) and its ionized form (NADP+). These cofactors are used in many important redox and non-redox reactions throughout the body including energy production. 

Severe niacin deficiency causes the condition pellagra. 

Low levels are associated with fatigue, depression, memory loss, headache, hallucinations and diarrhoea. 

Pantothenic acid is a water-soluble vitamin. It is a precursor for CoenzymeA which is involved in synthesis of steroid hormones, essential fatty acids, acetylcholine and melatonin.  

Low levels are associated with fatigue, headaches, irritability, sleep disturbance, muscle cramps, burning or numbness in extremities. 

Vitamin B6 is needed as a cofactor in approximately 100 enzyme reactions in the body. Of these, amino transfer and decarboxylation reactions (needed for production of serotonin from tryptophan) are possibly the most prominent. It is needed for gluconeogenesis and also modulates steroid hormone activity through binding to hormone receptors. 

Low levels are associated with skin rashes, cracked and sore lips, glossitis, mood changes, weak immune system, fatigue, tingling in extremities, seizures, high homocysteine. 

Biotin is important for several carboxylation enzymes – including pyruvate carboxylase involved in energy metabolism, and acetyl CoA carboxylase in fatty acid synthesis. 

Low levels are associated with alopecia, dry brittle nails and hair, scaly dermatitis, nausea, depression, hallucinations, muscle pain and localised paraesthesia. Cradle cap in babies is thought to be caused by low biotin – possibly because of the role biotin plays in fatty acid synthesis. 

A measure of Vitamin C (Ascorbic acid) in the serum. Vitamin C is obtained through diet and helps to maintain connective tissue, skin and bones. It is also a powerful antioxidant. Levels may indicate deficiency.

A measure of the level of 25 (OH) D in the blood. Vitamin D is essential for bone health, brain health and immune function. Levels may indicate a deficiency due to inadequate exposure to sunlight, genetics, insufficient dietary intake, or toxicity due to excessive supplementation; and can be associated with risks of Cancer, Hypertension, chronic pain and inflammation, Diabetes and Depression.

Vitamin E is a fat-soluble vitamin consisting of 8 different vitamers. Four of the vitamers are tocopherols and 4 are tocotrienols.  

The principal function of vitamin E is as an antioxidant to prevent peroxidation of unsaturated fatty acids within the cell membrane. It also protects vitamin A and can increase its storage. Once oxidised, vitamin E can itself be regenerated by vitamin C. 

Low levels are associated with muscle pain and weakness, numbness and tingling, vision problems, coordination problems, poor immunity.