What's in a Lipid Panel? Looking Below the Surface.

(This is not medical advice. Consult your physician for medical advice. For reference only.)

Lipid panels have come a long way. It used to just be that if your cholesterol was over 200, it was high, and if it wasn't you were good! Now, you get 5 numbers in your lipid panel, and they can tell you a lot about your metabolic health now, and even predict the future, if you know how to look!

I highly recommend that you take matters into your own hands when it comes to your lipid panel. The "normal" ranges on the computer are a "one size fits all" and that is not good enough for a variable that can can, well, vary, so widely. Moreover, the numbers may fall within the "reference range" but still give important information. They should also be interpreted in the clinical context of your other cardiovascular risk factors, which the computer can not do. While your physician is an important resource, medicine tends to be more "reactive" than "proactive", so you may get a letter that your results are "normal", which they might be, but we can dig a little deeper here.

There are three main numbers in your lipid panel, and two ratios, so five numbers that I recommend examining. Here they are:

LDL: Low density lipoprotein, AKA: "lousy" cholesterol.

HDL: High density lipoprotein, AKA "healthy" cholesterol.

Triglycerides: fatty acids to transfer adipose between fat stores and the liver

Cholesterol/HDL ratio: the ratio of total cholesterol to HDL

Triglyceride/HDL ratio: the ratio of triglycerides to HDL

Now, log into your patient portal and pull up your latest result; what should you look for with each of these?

LDL: This directly correlates with the risk of atherosclerosis and therefore heart attacks, strokes, and other vascular disease. So, as you can imagine, with LDL, the lower the better. Ideal is under 70, great is under 100, acceptable is under 130, moderately elevated is under 160, and severely elevated is over 160. Now, if you have a high risk of cardiovascular disease, then you want your LDL under 70 and should take a "statin" no matter what your LDL is, as long as you do not have a contraindication. If you are low risk for cardiovascular disease, you may not need a "statin" unless your LDL is as high as 190.

HDL: This inversely correlates with cardiovascular disease, meaning that if you have a low "good" cholesterol, it is just as bad as having a high "bad" cholesterol. One pitfall is that the reference ranges on lab tests are not gender specific, but HDL levels are. For females, a level under 50 is a marker for higher risk, and will show as "normal". For men, a level under 40 is higher risk. HDL is difficult to improve. Things like niacin and fish oil have been tried, but the results are disappointing. But, it is not known if a low HDL is a marker of increase cardiovascular disease or a cause. A low HDL can portend the development of Type 2 Diabetes Mellitus. It seems exercise may be good for a low HDL. I like to think that "sweat is your HDL rising," but that's just me! Do not be discouraged if your HDL has been low for a long time, and don't give up. I do see HDL increase with significant weight loss and exercise increase!

Cholesterol/HDL ratio: this is a marker of cardiovascular disease that may be more sensitive than a simple LDL or HDL. A normal level is below 3.5. A level higher than this is correlated with a higher cardiovascular disease. This ratio is helpful because you can have a normal LDL and a normal HDL and an abnormal Cholesterol/HDL ratio and vice versa. If you have a high LDL and a high HDL, then your ratio may be low risk.

Triglycerides - this parameter most directly relate to excess adiposity, fat cell dysfunction, high blood sugar, and the risk of Type 2 Diabetes Mellitus. This number is not really affected by the traditional medication for "high cholesterol," so lowering it is all lifestyle, diet, exercise, avoiding excess alcohol, and reaching a healthier body weight if it is high. Studies show that the typical American diet is currently 51% carbohydrates, many of them ultra-processed. Many people think they are not eating "sugar" but they are eating processed carbohydrates, and if your triglycerides are over 100-150, you may be developing insulin resistance, high insulin, and be going down the road toward Type 2 Diabetes Mellitus, fatty liver and associated conditions.

Triglyceride/HDL ratio: this is my favorite "pearl" from a lipid panel that is the most underutilized. It may predict the development of Type 2 Diabetes and give you 10 years warning. If your ratio is over 2.5, that may be a marker of insulin resistance, which can lead to increased visceral adiposity, fatty liver, and Type 2 Diabetes. Since 1 in 6 Americans has Type 2 Diabetes, wouldn't it be nice to know if you were going to be one of them before it happened so you could prevent it? Well, the information may be right there in your lipid panel. No insulin level or A1c needed. Be sure to fast properly for this test- 10 hours with no food or beverage, including coffee!

These numbers can give you important data on our metabolic health and are probably sitting in your inbox! They are usually highly dependent on lifestyle to a degree. For those of you for who you have genetically unfavorable cholesterol, be sure to consider treatment or further risk stratification in addition to lifestyle measures for cardiovascular risk reduction. You can have the best of both worlds!

Take Back Your Health!

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