Basics of Reading your Lipid Panel

The “Good”, the “Bad”,  the Confusing…

Have you ever found yourself a bit puzzled by the results of your lipid panel? You are not alone. It can be a mix of confusing terms and abbreviations. One type is supposed to be high and the other is supposed to be low? One is “good”, and one is “bad”? But then there are triglycerides too, what are those? And do the ratios matter?

This is intended to be a brief reference guide to help remember what these letters and abbreviations are, what your results should ideally be, and why these results matter. If you have your lipid panel in front of you feel free to follow along. But first, it is important to understand what cholesterol is and how it moves around in our body.

What is Cholesterol?

Cholesterol is a fatlike, waxy substance that is essential to life. Our bodies make cholesterol constantly, and it is used to:

1: Create important hormones

2: Create cell membranes

3: Support the endless cellular machinery that makes us tick

Without cholesterol, we would not be able to live.

That said, there is no such thing as “good” or “bad” cholesterol. There is only one type of cholesterol. What matters is what is carrying the cholesterol, as we will find out.

The “boats” that cholesterol rides on:

Cholesterol cannot exist in our blood all by itself. Just as oil and water do not mix, cholesterol and blood do not mix. Therefore, cholesterol must be shuttled around on carrier proteins called lipoproteins.

These different lipoproteins are given names based on their density, and the most common ones measured in our blood are HDL, LDL, and VLDL.

We like to think of lipoproteins as those wooden Viking warships, and the cholesterol are the people stacked neatly inside. Just as sailors need their ship, cholesterol molecules need these lipoproteins for transport. As we will find out, these cholesterol molecules end up in different places in our body based on what type of ship they are riding on. 

HDL Cholesterol

HDL stands for high density lipoprotein. The number you see on your lipid panel, often shown as HDL-C (C standing for cholesterol), is measuring the amount of cholesterol carried in your HDL “boats”.

HDL’s transport cholesterol from your bloodstream back to your liver to be removed from circulation. This is why the cholesterol riding in HDL particles are often called the “good” cholesterol, as they are moving away from the arteries (where we don’t want it accumulating).

You want the amount of cholesterol in your HDL’s to be high, as the cholesterol in these boats generally do not contribute to heart disease and stroke.

What is considered normal:

Most labs denote anything over 39 mg/dL as normal HDL cholesterol.

What you should aim for:

A reasonable goal is to keep your HDL cholesterol above 50 mg/dL. 

Read here to learn more about how to raise your HDL’s.

**Link to “5: Keep your HDL cholesterol high” on Cholesterol page**

LDL Cholesterol

LDL stands for low density lipoprotein. The number you see on your lipid panel, often shown as LDL-C (C standing for cholesterol), is measuring the amount of cholesterol carried in your LDL “boats”.

LDL’s transport cholesterol around your bloodstream and deliver cholesterol to our cells. LDL particles are very large and can carry a large amount of cholesterol.

Over time, LDL’s that are too full of cholesterol begin dropping the cholesterol off in places it doesn’t belong (i.e. blood vessels in the heart and brain), just as a ship would drop off passengers if it is overloaded.

Because of this, you want the amount of cholesterol in your LDL to be low, as the cholesterol in LDL particles plays a pivotal role in the formation of heart disease and stroke. Because of this, LDL cholesterol has become the proverbial “bad” cholesterol.

Read here to learn more about how to lower your LDL’s.

Link to cholesterol page

What is considered normal:

Most labs mark anything under 100 mg/dL as normal LDL cholesterol. If you have a history of a previous heart attack, stroke, or diabetes your doctor will advise you to keep your LDL under 70 mg/dL.

What you should aim for:

This is a complex topic, and we recommend reading our detailed write-up on cholesterol and heart disease to learn more.

VLDL Cholesterol

VLDL stands for very low-density lipoprotein. While VLDL’s do carry some cholesterol, their primary role is to transport triglycerides (more on them below).

That said, the cholesterol within VLDL’s can still end up in the blood vessels in our heart and brain, so we want to keep these low as well.

What is considered normal:

Most labs denote anything between 5-40 mg/dL as normal.

What you should aim for:

Aim to keep your VLDL cholesterol towards the lower end of normal. This is achieved by sticking to the same principles that keep your LDL low.

Triglycerides

When thinking about triglycerides, forget the whole metaphor of ships and sailors above. Triglycerides are their own entity in our blood and are another form of fat that circulates in our blood stream. Triglycerides are different than cholesterol. Triglycerides are used by our body as an energy source and have a different chemical makeup than cholesterol. Our body makes some triglycerides, but a significant portion of triglycerides comes from food (carbs and fat mostly).

Elevated triglycerides in our bloodstream can cause inflammation in our arteries, make our blood thicker, and increase our risk of heart disease and stroke. Even if the rest of your lipid panel looks good, having high triglycerides can put you at risk.

Triglycerides can go up for a number of reasons, but the most common culprits are:

1: Eating more calories than we burn

2: Insulin resistance

What is considered normal:

Most labs set the upper limit of normal at 150 mg/dL. Anything above 400 is considered very high.

What you should aim for:

A good goal is to keep your triglycerides below 100 mg/dL.

Lofty goal:

If you can get your HDL’s and your Triglycerides to be roughly the same number (assuming your triglycerides are below 100), you are really optimized!

Total Cholesterol

Total cholesterol is equal to your HDL + LDL + 20% of your triglycerides. While this number should ideally be below 200, it is by far the least informative of the results on your lipid panel. It is essentially a summary of the 3 most important portions of your lipid panel. While it can provide some information it is more valuable to look at the individual values of LDL, HDL, and triglycerides.

If you have any questions about cholesterol and how to use lifestyle interventions to improve your cholesterol, please reach out to schedule a one-on-one consultation.