014: Vitals - Normal Blood Work but Still Exhausted? 5 Biomarkers Every Woman Over 40 Should Track (My Real Data)

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Written By Alysia Bell

Note: This post contains affiliate links to some of the products I use in the Lab. If you make a purchase through these links, I may earn a small commission at no extra cost to you. I only highlight products that are a core part of my actual routine.

"Normal" Was Never Built for a High-Performing Woman Over 40

If brain fog is interrupting your meetings, you're always tired by 3 PM, and perimenopause weight loss feels impossible no matter how disciplined you are — your "normal" blood work might be the reason why.

Because normal is a population average. It was never built for a high-performing woman over 40.

Here's the executive problem with a standard blood panel: it grades you against general ranges, not optimal ones. "In range" just means not diagnosably broken. That's the biological default.

This post is the executive decision to renegotiate the terms.

Five biomarkers. My real data. Two came back in the black. One flagged outright in the red. One that reads normal but still isn't optimal. And a fifth that's a leading indicator — an early signal every woman over 40 can forecast for, rather than react to. That one isn't a red flag. It's a preview.

By the end, you'll have the exact five numbers to put on the agenda for your next appointment.

The Unfair Advantage: Season 2, Episode 3

This is Episode 3 of The Unfair Advantage — Season 2 of the show. Where Season 1 (the ASSETS series) was the framework, Season 2 is the field data. All experiments. All real numbers. Every Thursday.

In the last two blogs, I wore a continuous glucose monitor (CGM) and audited "healthy" coffee orders and "healthy" foods. Today we go deeper — past the food, past the wearable, and into the blood work. The numbers that tell us what's actually happening underneath the surface.

If we're just meeting, I'm Alysia Bell. I'm 44. I've tracked my macros for nearly 4,000 straight days, I wear an Oura ring 24/7, I use a Hume smart home scale, and I get regular DEXA scans to keep myself honest. I'm not a doctor. I'm an executive who finally decided to run my own body like the most important account I manage.

A quick, important frame before we get into the numbers: everything below is my data. My values, my context, my N-of-1 experiment. The point isn't for you to match my numbers. The point is to show you which conversations are worth having with your own doctor — and why "fine" isn't the finish line.

Biomarker 1: Fasting Insulin — The Number Our CGM Can't Show Us

Many people watch their glucose. We spent the last two blogs on it.

My fasting glucose came back at 88. Perfect. Move on, right?

But glucose is the light on the dashboard. Insulin is what's happening under the hood.

Here's the mechanism most people miss. The body can hold glucose steady for years by quietly pumping out more and more insulin behind the scenes. By the time glucose finally rises on a standard test, the underlying dysfunction may have been accumulating for years.

My fasting insulin came back at 3.1.

There's a one-number score that combines fasting glucose and fasting insulin to assess insulin resistance. It's called HOMA-IR. Mine comes out to 0.67. Most labs won't flag insulin resistance until you're past 2.5 — but optimal is under 1.0. My CGM and fasting glucose told me the surface was calm. HOMA-IR proved the tank underneath is calm too.

And here's why this is the number most tied to the weight that won't move.

Insulin is a storage hormone. When it runs high, the body stays locked in storage mode — holding onto the very fat you may be trying to shed. That perimenopause weight loss stall isn't necessarily a discipline problem. It can be a signal problem.

Glucose is a lagging indicator. Insulin is the leading one. Fix the insulin, and rewrite the future.

Biomarker 2: ApoB — The Cholesterol Number Our Standard Panel Doesn't Even Print

Our standard panel gives us total cholesterol. Mine's 190. Fine. It gives us LDL. Mine's 95. Fine. And we usually stop there.

But LDL measures the weight of our cholesterol. ApoB counts the particles — and it's the particle count that actually drives cardiovascular risk. Two people can have identical LDL and completely different ApoB.

Mine came back at 72 — optimal zone. But I had to specifically ask for it.

Here's the thing about this one: it's the single number on the entire list that we won't feel. No fog. No fatigue. Nothing that nags us between meetings. And that's exactly why it gets skipped.

We audit every line of the budget at work. Almost none of us audit the one number on our own panel that predicts long-term cardiovascular risk best.

If there's a single line I'd add to my own order sheet, it's this one.

LDL is top-line volume. ApoB is the bottom-line liability.

Biomarker 3: hs-CRP — My First Number in the Red

hs-CRP — high-sensitivity C-reactive protein. It measures silent, low-grade inflammation. No symptom we'd point to. Nothing obviously disrupting us at our desk.

Mine came back at 1.4 — above the optimal threshold of below 1.0.

I'll be straight with you, because that's the whole point of this series: I feel like I do everything right, and I STILL have a number pointing at low-grade inflammation.

Here's the part that ties back to how we actually feel. Chronic low-grade inflammation has been linked with the afternoon fatigue and brain fog we keep blaming on a full calendar. Research has associated higher CRP levels with slower processing speed and weaker performance on memory tasks. I want to be careful with the language here — these are associations documented across study populations, not a guarantee of cause and effect in any one person. But the link is worth knowing about.

This is the executive tax — the interest we pay on the stress, the short sleep, and the cortisol of leading everyone else before we lead ourselves.

I'll share the exact lever I'm pulling: omega-3. The research on omega-3s lowering hs-CRP is genuinely strong, so I'm running it as a real N-of-1 experiment. Load omega-3s, retest, and share the updated numbers in a future episode. If it moves, we'll see clear proof in the before-and-after. Receipts, not promises.

Inflammation doesn't send a calendar invite. It just shows up on the balance sheet.

Biomarker 4: The Thyroid + Ferritin Panel — Where "In Range" Hides the Truth

This is the sneakiest one on the list, because every single value is technically normal. And that's exactly the trap.

We check our TSH, see it in range, and close the file. Mine's 3.5 — in range. But optimal for how we actually feel is often cited as under about 2.5.

Then Free T3 — the active hormone, the one that actually does the work — came back at 2.4 against a floor of 2.3. Scraping the bottom of the range.

And ferritin — iron stores, critical if we're lifting heavy in the gym — came back at 23. Normal starts at 16, but functional targets for an active woman are often cited at 50 and up.

This is the one with the cleanest fix in the data. In a randomized controlled trial, non-anemic women with ferritin under 50 who supplemented iron reported measurably less fatigue than the placebo group.

This is the panel hiding behind "I sleep well, I eat well, and I'm still dragging by 3 o'clock with a fog I can't quite think through."

Three green checkmarks on paper — and a woman who could be told everything's fine, all while she feels the drag every single afternoon.

Normal is not optimal. "In range" is where high performers go to feel tired.

Biomarker 5: The Perimenopause Panel (FSH + AMH) — The Leading Indicator

The fifth is the leading indicator. The perimenopause panel. The one many women never get until something already feels off.

FSH — follicle-stimulating hormone — for me came back at 11.

And AMH — the marker of ovarian reserve — came back at 0.14. Nearly empty.

One honesty caveat, because I won't oversell a number: FSH and AMH move with our cycle. So this is a snapshot of a transition, not a fixed verdict. But the direction is the story.

And this is where all three symptoms we opened with converge. Across the menopausal transition, the research documents more frequent reports of brain fog and memory complaints, along with a measurable shift toward abdominal fat and lower daily energy expenditure. The "why won't it move" showing up in the data before it fully shows up in how we feel.

Here's why it's the anchor of the whole season. Almost every symptom women over 40 quietly Google traces back to this one transition.

Perimenopause shows up in our blood work before it shows up in our mirror.

The Executive Read: Five Numbers, One Decision

So there it is. Five numbers.

Two in the black — insulin and ApoB. Two in the red — an inflammation flag I'm addressing with an omega-3 experiment, and a thyroid-and-ferritin panel that reads normal but isn't optimal. And a perimenopause snapshot that works as a leading indicator for what's ahead.

I track everything. And this report still taught me something.

"Fine" isn't a metric we accept in business. It shouldn't be a standard we accept for our own health. Because we don't want our balance sheet — or our biology — in the red.

Labs look for red flags. We're looking for green lights.

That's the bottom line.

Boring + Consistency = Results.

The simple thing — actually ordering the right numbers, reading them against optimal ranges, and retesting after we pull a lever — beats the elaborate thing done occasionally. Every time.

A Few Common Questions (And Honest Answers)

Before we close out, a few questions I hear from women like us - who are managing work, home, and their biology — and wondering why their current routine isn't serving them.

Q1 "Which one should I ask for if my doctor pushes back?"

Personally, I'd start with fasting insulin. It's cheap, it's an early warning, and it goes wrong silently for years before glucose does. If we only win one negotiation at our next appointment, that's the one I'd aim for. A quick note on the doctor conversation itself: I show up with specific asks, not vague requests. "I'd like to add a fasting insulin and an ApoB to my next panel" lands very differently than "can we run more tests." Specificity is respect for their time — and it's how we get to yes.

Q2 "I'm in my 30s. Is it too early for me to care about this?"

The opposite. Every one of these is a trend line. The women who get ahead of their perimenopause symptoms are the ones with baseline data before the transition, so they can track what's changing against a known starting point. The best time to pull these numbers was five years ago. The second-best time is our next physical.

Q3 "Is this going to be expensive? My insurance won't cover 'optimal range' testing."

It varies widely by where we live, our insurance, and whether we use direct-to-consumer lab services. Some of these markers (like a standard lipid panel) are routinely covered; others (like ApoB or fasting insulin) sometimes require us to specifically request them or pay out of pocket. The good news is that several of these are inexpensive when ordered à la carte. Fasting insulin in particular is usually one of the cheapest meaningful tests we can add. If cost is a barrier, I would personally prioritize insulin first, then ApoB, then hs-CRP.

Q4 "What do I actually do with a number that comes back 'not optimal'?"

We bring it to a qualified professional and we make a plan with them — we don't self-treat off a YouTube video or a blog post. My omega-3 experiment for hs-CRP is something I'm running with eyes wide open and my own retest scheduled, and I interact with my doctor regularly; it's not a prescription for you or others. The value of knowing our own numbers isn't that we fix them alone. It's that we walk into our appointment with data, ask better questions, and partner with our medical professional on a plan instead of accepting a general, blanket analysis such as "everything looks fine".

Our Next Move (One Decision in the Next 24 Hours)

Let’s non't try to overhaul our entire lab strategy tomorrow. Let’s be kind to ourselves and consider picking one.

If you've never seen your own numbers, the first move is simply to request a copy of your most recent blood work. Most patient portals let you download it in a couple of minutes. Read it not as pass/fail, but as a starting data set.

If you have your numbers but they've only ever been read against "standard range," the move is to look up the optimal ranges for the markers you already have — and note which ones are technically fine but not actually optimal for how you feel.

If your next physical is coming up, the move is to write down the specific additions you want on the order sheet before you walk in. For example, you could start with fasting insulin. You could add ApoB. You might consider hs-CRP and a ferritin check if afternoon fatigue is your story.

If you're in your 30s and symptom-free, the move may be to establish a baseline now — so that five years from now, you're tracking change against your own data instead of a population average.

One change at a time. Stack the next when you feel ready.

More broadly, if you want to audit your own biology the way I audit mine, the free one-page ASSETS Audit is linked below. Rate yourself across Activity, Strength, Sleep, Equilibrium, Total Energy, and Sustenance. Find your lowest score — that's your red light. The audit gives you one green light move to make in the next 24 hours.

Because you can't lead from empty.

When you're optimized, everyone wins.

Alysia Bell is the founder of All Green Lights CEO. She's tracked her nutrition for ~4,000 consecutive days, wears an OURA ring 24/7, and is currently running Season 2 of the show — The Unfair Advantage — a series of N-of-1 biohacking experiments including continuous glucose monitor data.

Sources referenced: research associating elevated CRP with cognitive processing and memory, research on omega-3 supplementation and hs-CRP reduction, a randomized controlled trial on iron supplementation and fatigue in non-anemic women with low ferritin, and research documenting cognitive and body-composition shifts across the menopausal transition.

FAQ

Q: What's the difference between "normal range" and "optimal range" on blood work?

A: "Normal range" (also called the reference range) is a statistical band derived from a general population — often including many people who are not particularly healthy. Being "in range" means your value falls within what's statistically common, not necessarily what's ideal for energy, longevity, or performance. "Optimal range" refers to the narrower band increasingly associated with lower long-term risk and better day-to-day function. The gap between the two is exactly where a lot of high-performing women get told "everything's fine" while feeling anything but. Always interpret ranges with a qualified clinician who knows your full history.

Q: What is HOMA-IR and why does it matter more than fasting glucose?

A: HOMA-IR is a calculation that combines your fasting glucose and fasting insulin into a single score estimating insulin resistance. It matters because the body can keep glucose looking normal for years by secreting progressively more insulin — meaning an in range fasting glucose can mask developing insulin resistance underneath. HOMA-IR can surface a trend earlier than a glucose test alone. Optimal is generally cited as under 1.0, though interpretation should always happen with your doctor.

Q: Why isn't ApoB on a standard cholesterol panel, and should I ask for it?

A: Standard panels typically report total cholesterol, LDL, HDL, and triglycerides. ApoB — which counts the actual number of atherogenic particles rather than the weight of cholesterol they carry — often has to be requested separately or paid for out of pocket, depending on your insurance and provider. Many lipid specialists now consider ApoB one of the better single predictors of cardiovascular risk. Whether it's right for you is a conversation to have with your physician.

Q: Can supplementing iron really help with fatigue if I'm not anemic?

A: There is randomized controlled trial evidence that non-anemic women with lower ferritin (below 50) who supplemented iron reported less fatigue than those given a placebo. That said — iron supplementation is not something to start on our own. Too much iron is harmful, and the only way to know our ferritin is to test it. If afternoon fatigue is our story and we lift heavy or menstruate, we can ask our doctor to check ferritin specifically (as it's not always included by default) and let the medical professional guide any supplementation.

The N-of-1 Disclaimer:

I am an executive and a mom, not a doctor or medical professional of any sort. The content shared here — including biometric data, protocols, and experiments — is for informational and experimental purposes only. It is a documentation of my personal journey and should not be taken as medical advice. If you have diabetes, prediabetes, or any other metabolic condition, please work with your healthcare provider before making dietary changes or interpreting your own glucose data. Always consult with a qualified healthcare professional before making changes to your health, diet, or supplement routine.

Alysia Bell
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013: Vices - I Wore a CGM and Tested 9 "Healthy" Foods for a Week: The Vegetable That Spiked Me Higher Than Ice Cream