In parts 1 and 2 of this series, we broke down the confusing barrage of acronyms and numbers that are served up to you following your complete blood panel and metabolic panel blood tests. The CBC helps your doctor understand how your blood cells and immune health are doing. The Metabolic Panel helps your doctor check how well your liver, kidneys, and other organs of energy-management are holding up.

Today we’ll cover the final major blood test that most adults get as part of basic health maintenance, the mighty lipid panel.

Unlike the other panels, your lipid panel results are quite straightforward to understand, if you know the basics of cholesterol. Let’s shore up those basics now!

A Series of Tubes

When we walk around the world, doing fancy stuff like using computers and dancing the tango, it’s easy to forget that underneath our skin we’re just a series of mechanical processes. Unlike a human-fabricated machine, our organic processes tend to be wet, slimy, pulsing, and gooey, but they still involve real molecules being moved around to do different things that keep the system intact.

Anytime you have an engineering problem where one thing has to get to another in a chaotic environment, the solution is clear -— build a tube. It’s how subways work, it’s how the internet works, and it’s how your body works.

You have all kinds of tubes running through you, but the most well-known are the arteries that deliver life giving oxygen and nutrients to your cells. Cut off any part of your body from the arterial pipes, and in an hour or so the starved tissue will start to permanently die.

Fortunately, it’s very rare for your blood tubes to get clogged up all at once (although it can happen with blood clots). But over time, just like the pipes in your house’s plumbing, your arteries can start to accumulate detritus on the walls of the tube. This buildup can harden into plaques that narrow the diameter of the tube.

If you’ve ever dealt with old pipes in a home, you’ll have seen the junk that clogs them up isn’t uniformly spread across the pipes. There are choke points where a certain amount of water flow hits a particular angle or bend and over time builds up a layer of crusty grossness. The same is true of your body. People don’t tend to have clogged arteries of the arm or back for example, it’s usually the heart and the brain where the tubes are the most twisty and prone to buildup.

High traffic intersections like this are likely points of plaque buildup.

This is serious business. The leading cause of death worldwide is ischemic heart disease, and number two is stroke, both a byproduct of arteries becoming narrow or blocked. Together, these two problems account for 27% of global deaths. If you go out to dinner with three friends, statistically speaking, narrow, hardened arteries will be the thing that kills one of you.

And what is it that’s clogging up those arterial pipes? It’s billions of tiny droplets of protein and fat called cholesterol. This is why your doctor is so interested in seeing how much cholesterol is floating around your blood -— it’s directly related to your incidence of heart-attack and stroke.

We all know “cholesterol” as this scary, menacing thing in our lives, but believe it or not it wasn’t until the early 1980’s that medical science agreed that it was the lipoprotein cholesterol that was behind hardening of the arteries. And it wasn’t until the 90’s that there was mainstream acceptance of the idea that not all cholesterol was bad. We're still in new territory here, and learning more every year.

The lipid blood test teases apart the different kinds of fat and cholesterol in your blood, and presents them to you in 6 clean metrics. Let’s work through them step by step.

Cholesterol, Total

This is the raw reading of the amount of cholesterol in the blood in milligrams per Deciliter. This is usually a number between 100-350. Anything over 240 is considered too high, and will lead to your doctor recommending diet, exercise, or prescription interventions, depending on your situation.

Back in the 80s you would have gotten this number, and this number only. But we’ve learned a lot about cholesterol since then, and now understand that there are two varieties of it that have different effects on your body. This is the now famous LDL and HDL cholesterol types.

Before we get into LDL and HDL, let’s talk about why your body has cholesterol in it at all. 

Your body needs fats to survive and thrive. Most of the fats that your system uses are fatty acids (long chains of hydrocarbons). These acids will lock into formations of three, forming a triglyceride, which then floats around the body, or is stored in tissues for later use (this is why we get fat when we overeat). You can think of triglycerides as being a lot like a drop of olive oil on your plate. They’re just little droplets of oil, a very simple lipid, but can be used in all kinds of ways. For example:

• You can burn triglycerides for energy when you don’t have any food in your system.
• You can use them to carry proteins and nutrients to different parts of the body (fat-soluble vitamins like A, D, E and K).
• You can use them to create fatty layers around organs, preserving your internal temperature and protecting the cells.

This is why, after total cholesterol, the next item on your lipid test results will be:

Triglycerides

This is the amount of triglyceride packets in milligrams per Deciliter. Your doctor wants to see that you have enough of these fats, but not too many, which would be a symptom of a poor diet or a disease like diabetes or hypothyroidism. 

But sometimes your body needs a fat that’s more than simple oil droplets. It needs lipids that have more structure and chemical interactivity. This is where cholesterol comes in. If fatty acids are like drops of cooking oil, cholesterol is more like a wax. It gets this structure because it’s not a pure lipid but a ball of gummed up proteins and lipids, called a lipoprotein.

The anatomy of a lipoprotein. Triglycerides hang out in the center, while proteins and various chemical stages of cholesterol form the waxy ball. These different molecular structures are able to interact with the body's receptors to use the cholesterol as needed, kind of like a Swiss-army knife with its many different attachments.

Your body can put lipoprotein cholesterol to use in a lot of ways. 

• It’s used in your body’s cell walls, and gives your cells just the right combination of resilient squishiness and structural hardiness. 
• Your liver breaks down cholesterol into bile, which is used to metabolize dietary fat into useful triglycerides.
• Cholesterol is an important component for your body to make its own vitamin D.
• Your body also use cholesterol as a building block for various hormones, including steroids and sex hormones.

In simple terms, you can think of cholesterol as kind of an “intelligent fat”, because the proteins it contains are able to take part in much more complicated and varied chemical interactions than boring old triglycerides. It’s also really important. If you had zero cholesterol, you’d soon be a pile of bones and goo as your cell walls disintegrated.

The factory of the liver builds these little balls of cholesterol and sends them out to the bloodstream to do their work. At first, these balls are more lipids than protein. You can imagine the material as being very soft and pliable, like warm, thin wax. They are low density lipoproteins (LDL).

The problem with these light, fluffy, LDL balls is that when there are too many of them they tend to start accumulating on your arterial walls, forming those plaques which become dangerous as the tubes narrow and restrict blood flow. This is why LDLs are called the “bad cholesterol” (even though they’re a very important part of health). If all these acronyms confuse you, you can remember the “L” in “LDL” can stand for “lousy”.

As LDLs move through your circulatory system, the body takes off triglycerides here and there, and more proteins are added. This results in a higher ratio of proteins to lipids. Proteins are much denser and heavier than lipids, so our little ball of wax is now hard and more rigid. It has become a high density lipoprotein (HDL).

This dense little HDL ball keeps circulating through your systems, and as it bounces along, it does something special. Its proteins are able to pick up and bind loose bits of cholesterol that have gotten stuck to arterial walls. The HDL ball loads up on waste cholesterol and makes its way back to the liver, where the extra cholesterol is dumped back into the factory to make a whole new round of LDL to distribute the next wave of cholesterol around the body.

This is why HDL is called the “good cholesterol”. It literally scrubs your arteries of LDL plaques and recycles them for future use. That is, if there’s enough of it, which is why your doctor wants to see high numbers of HDL in your blood. You can remember the “H” can stand for “helpful.”

This brings us to the next two items on your lipid blood panel, after total cholesterol and triglycerides:

HDL

This is the amount of “helpful” high density lipoprotein in millgrams per Deciliter. A number of 60 or above is good. Below that and your doctor will want you to improve your diet.

LDL

This is how much “lousy” low density lipoprotein is in your blood in milligrams per Decililter. Anything above 130 is borderline, and above 160 is worrisome to your doctor.

On your blood test, you might see that LDL is marked as LDL-D  or LDL-C. LDL-D means “LDL direct” and means the test actually measured how much LDL was in your blood. LDL-C means “LDL calculated” and means that the LDL number was extrapolated from the other numbers in the report rather than being directly measured. Both methods are highly accurate, the only difference is the type of testing equipment your lab used.

Next, you'll see this:

Chol/HDL Ratio

This is your total cholesterol divided by your HDL levels. For example, if your total cholesterol was 150 and your HDL was 50, this number would be 3.0 The higher this number, the more concerned your doctor will be, as you have too little of the helpful cholesterol as a ratio to your total.

Finally, you'll see this on your results:

LDL/HDL Ratio

This is your LDL number divided by your HDL number. It’s a quick way for your doctor to assess how healthy your ratio of bad to good cholesterol is. The lower the number, the better. 

And that’s it! The lipid test is a way for your physician to understand how much fat and cholesterol is in your blood, and what your ratio of good to bad cholesterol is. When someone is overweight, eating poorly, and not exercising, there will be higher triglycerides, higher LDL, and lower HDL. This tells your doctor that your body is probably in the process of forming arterial plaques and that an intervention is warranted.

A good doctor will always prefer that you treat high LDL cholesterol with nutrition and exercise, but since so many patients are unsuccessful in these efforts, they’ll often reach for a prescription solution, usually a statin, which reduces how much cholesterol the liver produces. In later stages of very high cholesterol more intense medicine can be employed, but has more side-effects.

If you want to avoid all that, keeping your cholesterol in check is straightforward.

• Try to get 30 minutes of continuous exercise a day.
• Eat a diet that’s low in saturated fats (reduce dairy, butter, lard, ghee, oils, and animal fats).
• Increase fruit and vegetable intake to boost nutrients and fiber intake. 
• Choose whole grains.
• Don’t drink too much.
• Reduce body fat.
• Don’t smoke. Smoking makes everything worse, including cholesterol.

You’d be surprised how much a fitness intervention can turn around a bad lipid panel result. We’ve seen it hundreds of times with Kenzai trainees. Better cholesterol numbers that put a smile on your doctor’s face are just a few months away!

This concludes our epic run-through of what all those obscure acronyms and numbers mean on your blood panel results. The blood test is a miraculous way to peer into the black box of human physiology, and pinpoint small, easily fixed problems today that would become big, hard-to-treat issues later on. Take advantage of this miracle of modern science and get your blood checked every few years until your mid-40s, and then yearly after that.

Here’s to a healthy result on your next round of panels. The choices you make today will be right there in the numbers, so make good choices now, don’t wait for your doctor to give you a stern conversation after a bad set of blood work. 

If you’re not sure where to start, Kenzai is here to show you how to get all of those metrics pointed in the right direction!

Patrick Reynolds // Kenzai Founder