The Skinny on Lipid Panels

Lipid panels are one of the most commonly ordered tests for the average person, even for healthy people of all ages just going in for their annual checkup. It tells you whether you're lifestyle is putting you at risk of chronic or acute cardiovascular disease. Do you need to cut back on saturated fats? Probably. Can you increase your "good" fats? Probably also. Let's start with a look at the different parts of the Lipid Panel and what each one tells us.

Foods to improve your lipid panel!

Parts of a Lipid Panel

Total Cholesterol: Total cholesterol is the sum of all cholesterol fractions in the blood, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL). A desirable level for most adults is less than 200 mg/dL (5.17 mmol/L). Elevated total cholesterol may indicate an increased risk for coronary artery disease, especially if accompanied by a high LDL level or low HDL level. Very low total cholesterol, although uncommon, can be seen in certain chronic illnesses, malnutrition, or hyperthyroidism.

Low-Density Lipoprotein Cholesterol (LDL): Often referred to as “bad cholesterol,” LDL transports cholesterol to tissues, including the arterial walls, where it can contribute to plaque formation. For adults, an optimal LDL level is considered less than 100 mg/dL (2.59 mmol/L). Levels between 130–159 mg/dL (3.37–4.12 mmol/L) are borderline high, and values above 160 mg/dL (4.14 mmol/L) are high. Elevated LDL is a major risk factor for atherosclerosis and ischemic heart disease. Lowering LDL, often through diet, lifestyle changes, and medication, is a primary target in cardiovascular prevention.

Direct or Indirect LDL?

There are two ways that a lab comes up with an LDL number: Direct or Indirect.

Direct LDL is what it sounds like. The LDL is measured directly like any other lab test.

However, indirect LDL is calculated as follows:

Indirect LDL = Total cholesterol - HDL - .2(Triglycerides)

High-Density Lipoprotein Cholesterol (HDL): Known as “good cholesterol,” HDL helps remove cholesterol from the bloodstream by transporting it to the liver for excretion or recycling. For men, a healthy HDL level is 40 mg/dL (1.04 mmol/L) or higher, and for women, 50 mg/dL (1.30 mmol/L) or higher. Higher HDL levels are protective, reducing the risk of heart disease. Low HDL is associated with an increased risk of atherosclerosis, and improving HDL often involves lifestyle modifications such as regular exercise, smoking cessation, and dietary adjustments.

Triglycerides: Triglycerides are the main form of fat stored in the body and are a major energy source. Normal fasting triglyceride levels are below 150 mg/dL (1.7 mmol/L). Levels between 150–199 mg/dL (1.7–2.25 mmol/L) are borderline high, 200–499 mg/dL (2.26–5.64 mmol/L) are high, and 500 mg/dL (5.65 mmol/L) or more are very high. Elevated triglycerides can be caused by excessive caloric intake, obesity, poorly controlled diabetes, hypothyroidism, certain medications, and excessive alcohol use. High triglyceride levels are linked to increased cardiovascular risk and, when extremely high, can precipitate acute pancreatitis. When the blood is drawn and it looks cloudy (see strawberry milkshake), this is usually due to high amounts of triglycerides in the blood.

Foods that lower LDL and raise HDL

Certain foods have been shown to increase high-density lipoprotein (HDL) cholesterol, the “good” cholesterol that helps remove excess cholesterol from the bloodstream and transport it to the liver for excretion. While diet alone may not dramatically raise HDL levels, strategic choices—especially when paired with exercise and weight management—can meaningfully improve HDL function and particle quality.

Fatty Fish and Omega-3-Rich Seafood: Salmon, mackerel, sardines, albacore tuna, and trout are rich in omega-3 fatty acids, which can modestly raise HDL while improving its anti-inflammatory and antioxidant properties. Consuming two servings per week is associated with better HDL function, even if total HDL levels rise only slightly.

Olive Oil and Other Monounsaturated Fat Sources: Extra virgin olive oil, avocados, and certain nuts like almonds, hazelnuts, and pecans are rich in monounsaturated fats, which can raise HDL while lowering LDL and triglycerides. Replacing saturated fats such as butter with these oils is particularly effective.

Nuts and Seeds: Almonds, walnuts, pistachios, flaxseeds, and chia seeds not only support lowering LDL but also promote higher HDL levels, especially when eaten regularly in moderation as part of a balanced diet.

Avocados: Avocados provide both monounsaturated fats and fiber, supporting modest HDL increases while reducing LDL and total cholesterol.

Coconut in Moderation: Virgin coconut oil contains medium-chain triglycerides (MCTs) that may raise HDL cholesterol, although it can also raise LDL. Using it in moderation, and replacing other less healthy fats, can have a net positive effect on HDL.

Berries and Dark-Colored Fruits: Blueberries, blackberries, and other polyphenol-rich fruits can improve HDL’s functional capacity—its ability to remove cholesterol from cells—even if they do not dramatically change the absolute HDL number.

Dark Chocolate and Cocoa: Cocoa flavonoids have been linked to modest HDL increases and improvements in HDL particle function, but the benefit comes from dark chocolate with a high cocoa content (70% or higher) and minimal added sugar.

Soy Products: Soy milk, tofu, edamame, and soy-based protein powders can slightly raise HDL cholesterol, particularly when replacing animal protein sources high in saturated fat.

Legumes: Beans, lentils, and chickpeas provide soluble fiber and plant-based protein, which help improve lipid profiles, including small increases in HDL over time.

Green Tea: While better known for LDL-lowering effects, green tea polyphenols can enhance HDL functionality and support higher HDL levels with regular use.

Get out, get moving if you want to lower that LDL.

How Exercise Affects Lipid Panel Values

Exercise has a measurable and clinically meaningful impact on most components of the lipid panel, and its effects depend on the type, intensity, and duration of physical activity, as well as the individual’s baseline lipid profile, diet, and genetic factors. Regular physical activity can improve both the quantity and quality of lipoproteins, helping to reduce cardiovascular risk beyond what is seen in laboratory values alone.

Effect on HDL Cholesterol: Among all the lipid panel components, HDL cholesterol is the most responsive to regular exercise. Aerobic exercise, in particular, can increase HDL levels by about 5–10 percent, with more pronounced changes in individuals who start with low baseline HDL values. The improvement is partly due to an increase in HDL particle size and functional capacity, enhancing reverse cholesterol transport, where cholesterol is removed from arterial walls and returned to the liver for excretion. High-intensity interval training (HIIT) and longer-duration endurance training appear to yield the greatest benefits for HDL elevation.

Effect on LDL Cholesterol: Exercise alone tends to have modest direct effects on LDL cholesterol levels, often producing small reductions of about 3–6 percent. However, these changes can be more pronounced when exercise is combined with dietary modification and weight loss. Importantly, exercise improves LDL particle size, shifting from small, dense LDL—which is more atherogenic—to larger, less harmful LDL particles. This shift improves cardiovascular risk even if total LDL values change only minimally.

Effect on Triglycerides: Regular aerobic exercise can significantly lower triglyceride levels, with average reductions of 10–20 percent seen in individuals with elevated baseline levels. This effect is due to increased activity of lipoprotein lipase, an enzyme that helps clear triglyceride-rich lipoproteins from the bloodstream. Triglyceride reduction can occur rapidly, often within a few weeks of consistent training, and is most pronounced when exercise leads to energy expenditure of at least 1,200–2,000 kcal per week.

Effect on Total Cholesterol: Total cholesterol changes tend to mirror the combined shifts in LDL and HDL. Increases in HDL and modest decreases in LDL often result in a small net decrease in total cholesterol, though the ratio of total cholesterol to HDL—which is a stronger predictor of cardiovascular risk—often improves substantially.

Overall Impact on Cardiovascular Risk: Beyond numerical changes on the lipid panel, exercise enhances lipid metabolism efficiency, reduces inflammation, and improves endothelial function. Even if LDL or total cholesterol numbers shift only modestly, the overall atheroprotective environment created by regular physical activity reduces cardiovascular morbidity and mortality.

Bigger is not always better, trust us.

Is Obesity Predictive of Lipid Panel Values?

Obesity is strongly predictive of certain patterns in lipid panel values, and this relationship is well-documented in both epidemiological and clinical studies. The connection arises from the metabolic changes that excess adipose tissue causes, particularly in the context of insulin resistance, chronic inflammation, and altered lipid metabolism.

Typical Lipid Panel Patterns in Obesity

In individuals with obesity, especially central (abdominal) obesity, the most common lipid abnormality is a condition known as atherogenic dyslipidemia. This is characterized by moderately elevated triglycerides, low high-density lipoprotein (HDL) cholesterol, and a predominance of small, dense low-density lipoprotein (LDL) particles. Total cholesterol may be normal or only mildly elevated, but the quality and size of lipoproteins—especially LDL—are more atherogenic, increasing cardiovascular risk.

Triglycerides: Elevated triglycerides are one of the most consistent findings in obesity, particularly when accompanied by insulin resistance or metabolic syndrome. Excess adipose tissue releases more free fatty acids into the circulation, which the liver packages into triglyceride-rich very-low-density lipoproteins (VLDL). These higher triglyceride levels often respond to weight loss and improved insulin sensitivity.

HDL Cholesterol: Low HDL is common in obesity, often falling below 40 mg/dL in men and 50 mg/dL in women. The mechanisms include increased triglyceride exchange into HDL particles (making them unstable and rapidly cleared) and chronic low-grade inflammation. Low HDL in obesity is a strong independent predictor of cardiovascular disease risk.

LDL Cholesterol: In obesity, LDL cholesterol levels may not be dramatically elevated in absolute concentration, but LDL particle size is often smaller and denser, which makes them more likely to penetrate arterial walls and contribute to plaque formation. This qualitative change increases cardiovascular risk even when LDL numbers appear “normal.”

Total Cholesterol: Total cholesterol in obesity varies—some individuals have high values, but many have normal totals despite a high-risk lipid pattern. This is why total cholesterol alone is an unreliable predictor of risk in obesity.

Predictive Strength: Obesity, especially when measured as waist circumference or waist-to-hip ratio, is predictive of these lipid abnormalities even more strongly than body mass index (BMI) alone. The link is so robust that lipid screening is a standard component of evaluating patients with obesity. The presence of dyslipidemia in obese individuals often predicts concurrent metabolic syndrome, insulin resistance, and increased long-term cardiovascular risk.