I Tested My Blood on Day Three at Altitude. This Is the Baseline I Will Be Judged Against

Ladakh field log · Day 3 · Bloodwork
A baseline taken after you have already adapted is worthless. So on my third morning in Leh, before altitude has had time to change anything, I walked into a lab and had my blood drawn.

Everyone in this industry talks about what altitude does to your blood. Almost nobody shows you their own. I am going to, at both ends, from an accredited lab, with the retest booked for September.

This post is the starting line. Print it, screenshot it, hold me to it.

Dr Lal PathLabs, Leh · Collected 27 July 2026, 9:13 AM · Day 3

14.25 g/dL

Haemoglobin. The single number this entire experiment is about. Reference range 13.00 to 17.00.

43.50% PCV

Packed cell volume, with a red cell count of 5.07 million per mm3. These three move together.

The timing is the point. Meaningful blood adaptation to altitude takes weeks, not days. Testing on day three catches me before the adaptation starts, which is the only way the September retest means anything.

In this log

1. Why day three, and not day thirty
2. The three numbers I am actually watching
3. The markers that said I was fit to train
4. What the kidneys and urine said about hydration
5. Metabolic health, and why it matters up here
6. The one result I am still waiting for
7. What to test before you go to altitude
8. Frequently asked questions
9. Sources

Why Day Three, and Not Day Thirty

This is the part most people get wrong, and it is the reason plenty of altitude camps cannot actually prove anything.

If you test your blood after four weeks at altitude and the numbers look good, you have learned nothing. You do not know where you started. The only way to demonstrate that altitude changed something is to measure before it had the chance.

I arrived in Leh on the evening of 25 July. I had blood drawn at 9:13 on the morning of 27 July, roughly 36 hours later. Haematological adaptation to altitude develops over weeks, not hours, which means this panel is close to a clean pre-adaptation picture, taken at the altitude I will be living at.

This is exactly what we do with our residential group. Bloodwork before, bloodwork after, at an accredited lab, interpreted by a doctor and not by us. A programme that only tests you at the end is showing you a photograph and calling it a film.

The Three Numbers I Am Actually Watching

Altitude works, when it works, by pushing your body to carry oxygen more effectively. These are the markers where that shows up.

Marker	27 July, day 3	Reference	What I expect by September
Haemoglobin	14.25 g/dL	13.00 to 17.00	Higher, if adaptation is working
Packed cell volume	43.50%	40.00 to 50.00	Higher
RBC count	5.07 mill/mm3	4.50 to 5.50	Higher
MCV	85.80 fL	83.00 to 101.00	Broadly stable
MCH	28.10 pg	27.00 to 32.00	Broadly stable
MCHC	32.80 g/dL	31.50 to 34.50	Broadly stable
RDW-CV	13.20%	11.60 to 14.00	May rise as new cells are made

I want to be careful here, because this is where altitude marketing usually overreaches. I am not promising you these numbers will rise. I am telling you what I will publish either way. If they move, I will show you. If they do not, I will show you that too, and explain what I think went wrong.

It is also worth saying that a higher haemoglobin is not automatically a better athlete. The landmark research on this found that runners who lived and trained at altitude gained the blood adaptation and still did not run any faster, because training quality at altitude is degraded [2]. The blood is one part of a longer story.

The Markers That Said I Was Fit to Train

Before anything else, a baseline panel answers a simpler question: is there any reason not to train hard at 3,500 metres this month?

No inflammation, no infection

Marker	Result	Reference
Total leukocyte count	5.33 thou/mm3	4.00 to 10.00
Neutrophils	52.48%	40.00 to 80.00
Lymphocytes	36.99%	20.00 to 40.00
Monocytes	7.09%	2.00 to 10.00
Eosinophils	3.10%	1.00 to 6.00
ESR	14 mm/hr	0 to 15
Platelets	230 thou/mm3	150.00 to 410.00

Every value inside range, with no sign of an active infection or unresolved inflammation. That matters more at altitude than at sea level. Poorer general health is an independent risk factor for acute mountain sickness [3], and going up while you are fighting something is a reliable way to lose a week.

Liver handling the training load

Marker	Result	Reference
ALT (SGPT)	32.2 U/L	<49.00
AST (SGOT)	34.3 U/L	15.00 to 40.00
GGTP	28.8 U/L	10.00 to 45.00
Alkaline phosphatase	63.16 U/L	40.00 to 129.00
Total bilirubin	0.45 mg/dL	0.30 to 1.20
Total protein	6.93 g/dL	6.00 to 8.00
Albumin	4.48 g/dL	3.50 to 5.20
A:G ratio	1.83	0.90 to 2.00

Thyroid in range

Marker	Result	Reference
TSH	2.429 µIU/mL	0.34 to 5.60
Free T3	3.54 pg/mL	2.60 to 4.80
Free T4	0.64 ng/dL	0.61 to 1.12

All three inside range, though my free T4 sits near the lower boundary, which I will keep an eye on across the retest rather than read anything into today. Thyroid function is worth having on a baseline for anyone about to spend two months training hard in a cold, high, energy-demanding environment.

What the Kidneys and Urine Said About Hydration

This is the underrated section of any altitude baseline, because dehydration at altitude is common, it arrives quietly, and it wrecks training.

Marker	Result	Reference
Creatinine	1.06 mg/dL	0.62 to 1.17
Estimated GFR	93 mL/min/1.73m2, category G1	>59
Urea	38.23 mg/dL	13.00 to 43.00
Sodium	139.80 mEq/L	136.00 to 145.00
Potassium	4.40 mEq/L	3.50 to 5.10
Chloride	103.50 mEq/L	97.00 to 108.00
Calcium	9.42 mg/dL	8.80 to 10.20
Urine specific gravity	1.010	1.001 to 1.030
Urine protein, glucose, ketones, blood	All negative	Negative

A urine specific gravity of 1.010 sits comfortably in the middle of the range, which says I arrived properly hydrated after two days of driving. Kidney filtration is in the top category. No ketones, meaning I was not running on empty. No protein and no blood in the urine.

For a marker that costs almost nothing to check, that panel tells you a great deal about whether someone is ready for a hard month at 3,500 metres.

One value worth naming honestly. My uric acid came back at 7.13 against a ceiling of 7.20. That is inside the range, but only just, and I would rather point at it now than have someone find it later. It goes on the watch list for the September retest.

Metabolic Health, and Why It Matters Up Here

Marker	Result	Reference
HbA1c	4.7%	4.00 to 5.60
Estimated average glucose	88 mg/dL
Fasting glucose	90.36 mg/dL	70.00 to 100.00
Urine glucose	Negative	Negative

An HbA1c of 4.7% sits near the bottom of the non-diabetic range, with a fasting glucose of 90.36 and no glucose in the urine. That is a clean glycaemic picture, and it is the part of this panel I am most pleased with.

It matters here because carbohydrate becomes a more important fuel at altitude, where oxygen is limited and your body leans harder on the fuel that costs less oxygen to burn. Going into a high altitude block with good glucose handling is a real advantage.

The One Result I Am Still Waiting For

My iron studies and ferritin are still pending, and they may matter more to the next eight weeks than anything already listed above.

Iron is the raw material your body uses to build new red blood cells. If iron stores are low, the adaptation this entire trip is built around will be blunted no matter how well the training goes. You cannot manufacture haemoglobin out of good intentions.

Why we test ferritin before anyone goes to altitude

• Low ferritin caps your adaptation. The stimulus arrives, the substrate is missing, and the response is smaller than it should have been.
• It is common and quiet. Plenty of endurance athletes carry low stores without symptoms obvious enough to notice.
• It is correctable, but not overnight. Which is exactly why it belongs on a test taken before a block, not after it.
• Supplementation is a medical decision. Excess iron is harmful. This is a conversation for your doctor, working from your numbers, not a supplement you add because a coach mentioned it.

I will publish that result when it arrives, whatever it says.

A note on the full panel. This was a complete health check, and it covered more than the markers set out above. Some of those results are still pending and others I am reviewing with a doctor before I write about them properly. I will publish those separately once I have the complete picture and a physician's read, rather than offer you my own interpretation of an unfinished panel.

What to Test Before You Go to Altitude

If you are planning a trek, a race, or a training block above 3,000 metres, this is a reasonable panel to have in hand before you go. Ask your doctor rather than a coach, and go to an accredited lab.

A sensible pre-altitude baseline

• Complete blood count. Haemoglobin, PCV, RBC indices. Your starting point for any adaptation claim, and it also flags anaemia before you go up.
• Ferritin and iron studies. The substrate question. Arguably the single most useful test on this list.
• Kidney function and electrolytes. Creatinine, urea, eGFR, sodium, potassium. Hydration and filtration matter enormously at altitude.
• Fasting glucose and HbA1c. Fuel handling.
• Thyroid profile. Relevant to energy, cold tolerance, and recovery.
• Liver function. General resilience under training load.
• Routine urine examination. Cheap, fast, and surprisingly informative about hydration and kidney health.
• A lipid profile and inflammatory markers. Not about altitude, but if you are having blood drawn anyway, this is the moment.

Then retest the same panel, at the same kind of lab, after the block. That comparison is the only honest way anyone can show you what a programme actually did.

Following the series? Read day two, when my pace collapsed to 10'44" per kilometre, and day three, where I explain why a faster run was not progress.

Frequently Asked Questions

What blood tests should you do before high altitude training?

A complete blood count, ferritin and iron studies, kidney function and electrolytes, fasting glucose and HbA1c, thyroid profile, liver function, and a routine urine examination. Ferritin is the one people most often skip and most often need, because iron is the raw material for building new red blood cells. Ask your doctor which panel suits you and use an accredited lab.

Does haemoglobin increase at high altitude?

Sustained exposure to altitude stimulates erythropoietin release and increased red blood cell production, and haemoglobin and packed cell volume typically rise over weeks. The speed and size of the response varies considerably between individuals, and it depends on having adequate iron stores. It is not instant and it is not guaranteed.

When should you test your blood, before or after an altitude camp?

Both, and the before is the one people skip. A result taken only at the end tells you nothing, because you do not know where you started. I tested on day three, roughly 36 hours after arriving, deliberately before adaptation had time to begin.

Why does ferritin matter for altitude training?

Iron is required to make haemoglobin. If your stores are low, your body cannot fully act on the altitude stimulus, and the adaptation you travelled for is blunted. Low iron stores are common in endurance athletes and often produce no obvious symptoms. Correction takes time, which is why it should be checked before a block rather than after it, and any supplementation should be directed by a doctor.

Can you get a blood test in Leh?

Yes. I used a Dr Lal PathLabs collection centre in Leh on a walk-in basis, with the sample collected at 9:13 AM and the first results issued the same afternoon. Being able to test on arrival and again before departure is one of the practical advantages of running a long block from a town rather than a remote camp.

Is a higher haemoglobin always better for performance?

No. Randomised research on live high, train low found that athletes who lived and trained at altitude gained the blood adaptation but no improvement in race time, because training quality at altitude is degraded. Blood is one input among several, and the adaptation on its own does not make you faster.

Every claim in this log, and where it came from

1. All laboratory values in this article are from the author's own report. Dr Lal PathLabs, collected at the Leh collection centre on 27 July 2026 at 9:13 AM, lab number 527176925, reported the same day. Reference intervals quoted are those printed on the report.
2. Levine BD, Stray-Gundersen J. "Living high-training low": effect of moderate-altitude acclimatization with low-altitude training on performance. Journal of Applied Physiology. 1997;83(1):102-112. Randomised controlled trial, 39 competitive runners, four weeks. The live high, train high group gained red cell mass and VO2max but no improvement in 5 km time. PubMed
3. Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3,658 m above sea level: a cross-sectional study. Reports rapid ascent, poorer general health, and age under 55 as independent risk factors for AMS. PMC
4. Health advisory, District Administration Leh, Union Territory of Ladakh. All arriving tourists must complete at least 48 hours of acclimatisation before travelling to higher altitude areas. leh.nic.in

Niraj Kumar Borah

Founder and head coach of Fitness Bootcamp, a residential health transformation programme running in Rishikesh, Ladakh, Manali, and the north east. Since 2020 he has guided more than 4,600 guests through structured, fully supported transformations.

He has spent four to six months of each year in Ladakh for several years, and has raced the Ladakh Marathon in 2023 and 2024. He is here from July to September 2026, running the routes and testing the acclimatisation protocol our residential group will follow from 16 August, and racing the 11.2 km on 13 September. He publishes his own training and laboratory data, including the results that are not flattering.

Verifiable credentials

• VDOT Certified Distance Running Coach · VDOT O2
• Certified Heart Rate Performance Specialist · NESTA
• Precision Nutrition Level 1 · Precision Nutrition
• Affiliated HYROX Performance Coach · verify on the HYROX register
• Mountaineering, Adventure Course · Jawahar Institute of Mountaineering, J&K
• Ladakh Marathon · 5 km 2023, 11.2 km 2024, racing the 11.2 km on 13 September 2026
• Full background and competition record · read here

The 4-week high altitude endurance programme

28 nights across Leh, Basgo and Nubra Valley. Bloodwork at both ends from an accredited lab, structured heart rate training, safe acclimatisation, and cooked vegetarian meals. There is no payment to apply, and we speak with everyone before confirming a place.

See the programme

This log reports one person's laboratory results and is general educational information, not medical advice. Laboratory values must be interpreted by a qualified doctor in the context of your own history, and reference intervals vary between laboratories and methods. Do not use these figures as a benchmark for your own health, and do not start or change any supplement, including iron, without medical direction. Ascent to high altitude carries real medical risk, including acute mountain sickness and, rarely, high altitude pulmonary or cerebral oedema, which are emergencies. If you have any cardiovascular, respiratory, or haematological condition, are pregnant, or have a history of altitude illness, please speak with your doctor before travelling to altitude. Results collected 27 July 2026 at Dr Lal PathLabs, Leh.