Keto, gluten-free, paleo, plant-based—the number of specialized diets that have entered the world of fitness has continued to increase year after year. Yet, at its core, each of these diets can be whittled down to their components: protein, starch, fruits/vegetables, dairy, and of course, the oft-avoided fat—or, as its other name, lipids. The word “lipid” can include fats, oils, waxes, and certain types of hormones. In terms of health maintenance, the lipids measured in the blood are cholesterol, triglycerides, and lipoproteins. While this sounds like a complicated process—and it is!—we will break down the key facts on lipid counts and how lipid levels fit into your body composition goals.
What Are Lipids?
Lipids are molecules that are insoluble in water, most often found in fatty acids, oils, waxes, etc. Lipids travel in the bloodstream in multiple forms. In this article, we will focus on HDL, LDL, and lipoproteins. Lipoproteins are lipids combined with protein to form macromolecules that are the primary transporter for lipid molecules in the body. HDL and LDL are both forms of lipoproteins.
What Are The Difference Between HDL and LDL
HDL, which stands for high-density lipoprotein, is often referred to as the “good” cholesterol. LDL, or low-density lipoprotein, is frequently viewed as “bad” cholesterol.
As in life, things aren’t always that simple. But HDL indeed carries cholesterol to your liver. The liver is like the clearinghouse of your body; it can get rid of drugs, toxins, and even fat. Cholesterol that goes there is more likely to be removed instead of building up in your bloodstream and causing problems later on.
Unfortunately, the liver only removes a small percentage of cholesterol; HDL carries anywhere from ¼ to ⅓ of blood cholesterol. LDL, on the other hand, transports cholesterol straight to your arteries or larger blood vessels. Here, cholesterol can build up in arteries and cause atherosclerosis, which is plaque accumulation in the vessels. Arterial plaque accumulation can place you at risk of several cardiac diseases.
To remember that HDL is the “generally good” form of cholesterol, you can remember that H is for Healthy. One other way to remember this is that H is for High. The ideal is to have higher forms of HDL (compared to LDL).
How Lipids Are Measured
How do you even know how many of these you have floating in your bloodstream? The most straightforward way is to get the numbers from the source: your blood. Your healthcare provider may refer to this as a “complete cholesterol panel” or a “lipid panel”. Both essentially mean the same thing—a way to measure different levels of each of these molecules in your blood via a simple blood draw.
The current recommendations from the CDC are to have your cholesterol levels checked approximately once every five years. But this frequency increases if you have a history of health conditions in your family or have high cholesterol. Then, you may have to have it checked more frequently.
In general, these tests are fasting tests, meaning that you shouldn’t eat before having your blood drawn. The purpose is to establish your baseline instead of taking the test right after a meal when your body processes the food, causing the numbers to be in flux.
Triglycerides also often come up on the panel. These lipids are the extra cholesterol lying around from your diet that hasn’t been otherwise used for energy or transported elsewhere. It’s a form of fatty acid storage, usually housed in adipocytes or fat cells. Triglycerides can be converted into energy and used when you exercise.
The Meaning of Lipid Count
Lipid count is important for your overall health maintenance, as it gives a sense of your cardiovascular health. It also can be a crucial factor in diagnoses like hyperlipidemia. Breaking down this very long and complicated word, “hyperlipidemia” is a diagnosis for an increase in any of the types of lipids tested on the blood screen. Hyperlipidemia can also be made more focused, like hypercholesterolemia, specific to total cholesterol.
It’s also crucial to know lipid count for its role in chronic health conditions, especially in cardiovascular health. The main factors to think about here are metabolic syndrome, which we’ve written about previously, as well as hypertension, diabetes, and coronary artery disease. Without going too much into the nitty-gritty, chronically high levels of lipids in the bloodstream can build up in the arteries, contributing to and exacerbating a range of heart conditions.
What is a “Normal” Lipid Count?
The standard or normal ranges for lipid count will differ depending on your age, sex, and health history. Generally speaking:
- Total cholesterol less than 200 mg/dL is the goal
- LDL less than 100 mg/dL
- HDL of 60 mg/dL or higher
- Triglycerides of equal to or less than 150 mg/dL
Once more, these values change depending on multiple factors and may not necessarily be the same for every person, at every time in their lives. It is important to note that a higher HDL is protective, whereas lower LDL and triglycerides are closer to the goal.
Lipid count is also relevant to the interpretation of body composition tools. Lipid count has a positive correlation with total body fat, particularly pronounced at the extremes of body composition (<5% or >95% of the standard). One research study found that serum lipid counts were more consistently associated with total body fat than BMI. Given the etiology of lipids and that a sizable component of lipid count is housed in fat cells in the body, this makes sense. But it is still vital to understand this as we move away from viewing BMI as the end-all, be-all in fitness and more towards using more advanced and sophisticated tools to understand how our body moves and functions.
Lipids and Body Composition
A core part of body composition is providing a route for intervention to help you achieve your fitness goals. Lipids can play a role here, as well. For cardiovascular health and body composition optimization, increasing HDL while decreasing LDL should be a priority. As discussed earlier, HDL is protective because it carries cholesterol to be eliminated, whereas LDL contributes to fatty build-up in the arteries. To address the root cause of body composition, you can focus on these two, and here is how.
As in many things in fitness, there are two main routes of intervention: diet and exercise. Both can contribute to reducing total cholesterol levels. Earlier intervention is better, but you can reduce cholesterol levels at any stage of life or any stage of your fitness journey. The interventions are simple: diet modifications and the addition of aerobic exercise.
For diet, a lipid-optimal plate emphasizes healthy fats in moderation while minimizing foods that contribute to high triglyceride count. Two diets aligned with this category are the Mediterranean diet and the DASH Diet. The Mediterranean diet has received more press in recent years, but the DASH diet is equally effective. Both diets encourage a high intake of fruits, vegetables, whole grains, fat-free dairy products, vegetable oils, seeds, nuts, and lean protein, such as salmon or chicken breast. One perfect example of an optimal snack would be avocado toast on whole wheat bread: delicious, nutritious, and lipid-optimal.
There is also early research on how to focus on specific diet interventions. One recent study showed that a high-calcium diet was associated with favorable lipid profile and body composition measures. Specifically, daily calcium intake was negatively correlated with total cholesterol and LDL cholesterol values, even after accounting for individual variation in body composition markers like waist circumference.
The study above suggests that meeting goals for calcium intake can decrease levels of total and LDL cholesterol. For more information on optimizing your vitamin and minerals intake, speak to your primary healthcare provider.
Exercise is also so crucial for affecting lipid counts and body composition. Studies show that daily exercise results in HDL improvements, as well as improvement in body composition measures. Cardiovascular aerobic exercise like jogging is often the most effective. A form of exercise that fits the best into your lifestyle and goals is the most critical factor when deciding a routine for you.
A priority for interventions is to reduce body fat percentage without sacrificing muscle mass. One study explored this by comparing various diets in middle-aged men and following for various outcomes measures related to cardiovascular health and fitness. This study found in this population that the hypocaloric, low-energy moderate carbohydrate diet was associated with improvements in lipid count and body composition measures, without a resultant decrease in muscle mass. Specifically, LDL and triglycerides had decreased post-intervention.
For all of the above results, it’s important to remember that diet and exercise changes will vary depending on age and past medical history. It’s vital to consult with a healthcare provider before beginning one of these diets or lifestyle changes.
Tying It All Together
Lipid count is the number of HDL, LDL, lipoproteins, and triglycerides found in your bloodstream, measured through a blood test, often referred to as a lipid panel. Lipid panels provide a measure for how much free fat there is in the bloodstream and especially for conditions associated with changes in body composition, like metabolic syndrome and cardiovascular disease.
Interventions are simple and focused on diet and exercise. You can optimize your diet to reduce your lipid count, and the Mediterranean and DASH diets are two examples of these. Exercise should be aerobic and frequent. One size does not fit all, and your intervention should be tailor-made for you and your health history.
Monitoring your body composition history can support you in making well-informed health decisions. And as always, consult your physician before making any significant changes to your diet or exercise routine.
Jahnavi Curlin, MD Candidate & Founder, Curlin Communications. Find her on Twitter @jahnavi_curlin and at her website, curlincommunications.com.