Doctor called - my cholesterol's a bit high. Lay off the pizza, go for a jog, nothing to worry about. Standard advice, standard panel. Except it's never that simple. Lipid panels are a tool of the 70's meant to measure how much free floating fat is in our blood. What these panels don't tell us is particle count, size, and how many of these are actively embedding themselves, hardening our arterial walls. Well that's the answer I really need, so that's the test I got. And it paints a very different picture.

I decided to get a very comprehensive lipid panel with the goal of understanding what my cardiovascular risk looks like and what it takes to fix it. For this test, I decided to use Function Health. Function Health runs a far more comprehensive panel than you'll get from a standard annual physical, including the advanced lipid markers covered in this post. I use them as my primary testing platform. If you want to run the same panel, you can use my referral link to save $25.

See The Numbers to get a snapshot of where these panels test at for baseline and future checkpoints. A note - I'm no physician or researcher. Everything here reflects my own results and research. I discuss it all with my doctor and you should too.

Lipid Panel

Top line cholesterol came in at 214. Not a great result, but not terrible. Under 200 is a minimum requirement, but in reality I'd like to see that total far under. But if we dive deeper, the picture goes from "a bit above normal" to much more concerning. HDL, what we often call "healthy cholesterol" is low, just barely into normal at 45. The great bulk of my cholesterol is LDL, what doctors often call "bad cholesterol". Over time, what we've learned is blanketing all LDL as bad is misguided. Larger LDL particles, in reasonable numbers, can have a protective effect - whereas smaller, dense particles more readily penetrate arterial walls, aggressively building up plaque. These are the ones we want to avoid, and these are the ones I have the most of. My LDL total is at 145. As a top line, this raises concern, but doesn't provide the full picture. ApoB is a protein; one molecule sits on the surface of every atherogenic particle, LDL or otherwise. ApoB count is therefore a direct count of all dangerous particles in your blood, making it a more precise risk marker than LDL concentration alone. My ApoB at 125 is above normal and concerning. Reinforcing this is my Pattern B LDL classification, meaning my LDL particles are small and dense, not the large buoyant ones I'd prefer. Too many particles of the wrong kind.

So, all added up we see HDL's low, LDL's high, and indications that these are made up of many small, dense, and harmful particles. These numbers are my number one most concerning result, and need the most aggressive intervention. Luckily, the remedy is directly aligned with the program.

Liver

ALT came in elevated at 70 and AST normal at 35. The ALT elevation is the one worth paying attention to as it's the liver-specific marker. When ALT is high and AST is normal, the liver is under stress but not in crisis. For me in particular, I've seen a pattern of elevated ALT in the past - never in dangerous ranges, but something I'm acutely aware of. The most likely explanations are visceral fat around the liver, the fact that I developed cold symptoms hours after this test, and GLP-1 medication, which is a known cause of transient ALT elevation particularly early in treatment. None fully explains it away, but nothing is overly concerning here. I'm watching this closely, limiting alcohol throughout this program, and expecting to see improved numbers in November at the retest.

Inflammation and Stress

Inflammation and stress are two markers with significant effect on our cardiovascular system and general health. hs-CRP is a highly sensitive protein that acts as an inflammation marker. It's often used to predict risk for cardiovascular disease and a host of other inflammatory diseases. At <0.2, I'm in a genuinely good range and show no signs of systemic inflammation despite the other negative cardio markers. Homocysteine at 10.5 sits at the upper edge of acceptable. Not flagged, but worth watching as chronically elevated levels are associated with cardiovascular and cognitive risk over time. Last, cortisol is your primary stress hormone, and it regulates energy mobilization, immune response, and inflammation. In a healthy pattern, it peaks shortly after waking up and gradually drops through the day. Chronically elevated cortisol is associated with muscle loss, fat storage (particularly visceral), and poor immune function. At 8.6 mine is normal, which matters given the training load I'm building toward. It's a marker I'll continue watching as volume increases.

Testosterone

Total testosterone is essentially a measurement that tells us whether or not we produce testosterone. For me, I'm squarely in the healthy range. The more pertinent number is free testosterone — what's unbound to SHBG or albumin and actively available to the body. This is what drives muscle protein synthesis, energy, and mood. At 67.2 pg/mL, I'm in the low-normal range for a 32 year old. Excess adipose tissue converts testosterone to estrogen via aromatase, reducing what's available as free T — so body fat is likely a contributing factor here. Throughout the program, weight loss and increased muscle volume should improve this number, even if modestly.

Biological Age

Function Health's biological age testing uses epigenetic methylation patterns, essentially reading how your cells are aging at a molecular level, independent of how many years you've been alive. Mine came back at 21.4, against a chronological age of 32, so about 11 years in the right direction. I'll take it, but I won't lean on it. Epigenetic testing methodology is still maturing, and a single snapshot has limited predictive power. What's more interesting is the conflict in these results. My cells are apparently aging well, while my cardiovascular markers are telling a different story. That's exactly why you don't optimize for one metric. The bio age is a bright spot. The lipid panel is where the work is.

Interventions

From these numbers, the lipid panel is where most of the work needs to be done. My body fat and visceral fat are likely major drivers of the negative lipid panel results. They're also likely contributing to the suboptimal ALT and free testosterone. My interventions will directly target:

   1. Reduce overall body fat, bringing down visceral fat with it
    2. Optimize diet to increase HDL, reduce LDL, and shift particle composition away from small dense Pattern B toward larger buoyant particles
    3. Train in Zone 2, which is associated with improved lipid profiles and better insulin sensitivity

In following articles you'll see the science behind how these interventions and more help achieve this. Subscribe and follow along!

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