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Triage Ultimate Guide to Eating Out
At Triage, our goal is to empower our clients to make informed decisions about their health, so that they can enjoy life to the fullest while also achieving their health, body composition and performance goals. In this guide, we'll give you the best choices to make when it comes to eating out in a variety of restaurants, as well as eating at delis and drinking alcohol. By the end, you'll know which choices to make to match your health and fitness goals, not only around managing calories, but also around eating higher protein and getting better quality food, even
when you're eating out (or in, in the case of takeaways!).
Blood Tests 101 Part 2: Lipids & Hormones
As noted in Part 1, testing your blood can be an informative way to learn about what's going on
inside your body. This can help with diagnostics, but it can also provide insight into the way in which your lifestyle is impacting your health. In this article, I am going to share with you some of the basics of blood lipids & sex hormones, with a focus on those blood tests you are likely to see when your doctor takes your bloods.
Lipidology - Cholesterol Tests
In the realm of preventive medicine, blood lipids are a core part of cardiovascular health. There are layers of depth in blood lipid panels, but most doctors test for a few basics before going deeper. Those core components on most blood lipid panels include LDL-Cholesterol, HDL-Cholesterol, Total Cholesterol, and
Triglycerides. Low-Density Lipoprotein Cholesterol (LDL-C)
LDL-C is often referred to as "bad cholesterol". This is a bit misleading, as there is no "good" or "bad" cholesterol; all cholesterol is the same. Rather, what this
reflects is the lipoproteins carrying that cholesterol. LDL-C is a reflection of the amount of cholesterol on low density lipoproteins, and it is these lipoproteins (among others) that can cause plaque development in the arteries (atherosclerosis). These LDLs are tagged with an apolipoprotein called Apolipoprotein B (ApoB), and measurement of ApoB is sometimes done as part of more advanced testing, as it is more informative.
Elevated LDL-C levels are associated with an increased risk of atherosclerosis and coronary artery disease, particularly when LDL-C is elevated long term (e.g. from young adulthood). Optimal levels for LDL-C really depend on the context, as lower seems to be better in most cases, but low targets are of most importance for those with the most risk factors, or alternatively a history of cardiovascular disease. Values between
2.6-3.3 mmol/L or 100-129 mg/dL are considered near-optimal or "good" for most people, while those above 3.3 mmol/L or 130 mg/dL may require lifestyle modifications or pharmacological intervention. Research on LDL-C seems to consistently demonstrate that lower values for longer periods of time are most cardioprotective, which is why we often recommend testing your
blood lipids when you are young, rather than waiting until plaque has already developed. High-Density Lipoprotein Cholesterol (HDL-C)
HDL-C, or "good cholesterol", is again referred to as such not because the cholesterol is
different, but rather that the lipoproteins themselves are. Higher levels of HDL-C are generally associated with a lower risk of cardiovascular disease. However, this is likely reflective of generally good metabolic health, functioning as a "systems biomarker", rather than something that would directly reduce risk if elevated (e.g. by medication).
There also
remain some unknowns or areas of development regarding HDL, as these particles can vary in their function and subtype, but this is beyond the scope here. For now, note that higher levels of HDL-C are generally a good thing. Triglycerides
Elevated triglyceride levels are often seen in individuals with obesity, insulin resistance, and metabolic syndrome, and can contribute to heart disease. It's important to note that triglycerides are elevated in the post-feeding state, and therefore fasting blood tests are essential to get an accurate assessment.
It's also important to consider
the lipid profile as a whole, rather than isolated values. For example, the most harmful lipid profile is that of atherogenic dyslipidaemia, characterised by: High LDL-C, High Triglycerides, and Low HDL-C. This is typically seen in the context of insulin resistance, obesity, and diabetes, and a component of the metabolic syndrome. Conversely, Low LDL-C, Low Triglycerides, and High HDL-C is the 'optimal' lipid profile that a healthy person should be looking for to minimise heart disease risk long
term. Case Example: 25-year-old male presents with concern about his heart disease risk, as his father has had two heart attacks before the age of 60. His blood tests show normal Triglycerides & HDL-C, but an LDL-C of 5.4 mmol/L or 210 mg/dL. This level of LDL-C is likely
reflective of Familial Hypercholesterolaemia, which is a common genetic cause (with mixed genetic contributors) of atherosclerosis, secondary to elevated LDL-C. For a young man like this with a positive family history, early intervention with medication (e.g. statins) would likely be required, as lifestyle change is unlikely to be sufficient.
Hormones - Sex Hormone Testing
One of the key differences between men and women is that hormones, specifically the sex hormones. Like blood lipids, there are advanced testing parameters that could be detailed here, but remain beyond the scope of this article. For now, I will touch on the basics of male & female sex hormone testing, including the
results you are likely to see in conventional medical tests.
Testosterone (Men and Women) Men: Testosterone is the primary male sex
hormone, responsible for the development of male reproductive tissues, along with other male traits such as muscularity, hair growth, and even psychological traits. Normal testosterone levels in men typically range from 10 to 35 nmol/L or 300 to 1,000 ng/dL. Levels below or above this range may indicate conditions such as hypogonadism or androgen excess, respectively. It's very common for men to worry about testosterone levels, and we often see people attribute all kinds of symptoms or problems to 'low testosterone'. Even if you are in the low end of the normal range, it's unlikely that you will actually suffer any significant side effects or training maladaptation, as we don't see much variation in outcomes within that normal range. For those who do have low testosterone with symptoms (e.g. low energy, libido, etc.), testosterone-replacement therapy (TRT) is an option, but proper clinical evaluation is important here to rule out underlying causes of low testosterone. It's becoming more and more common for guys to jump on TRT prematurely, so this point needs to be emphasised.
Women: While present in
smaller amounts in women, testosterone plays a crucial role in maintaining libido, bone density, and muscle mass. Interestingly, women still have far more testosterone than estrogen, which is a useful trivia question to know the answer to. Ask your friends at your next dinner party, and most will assume that testosterone is far less abundant (don't blame me when people call you a nerd for raising the topic of hormones at the dinner table!).
Normal testosterone levels in women range from 0.5 nmol/L to 2.5 nmol/L or 15 to 70 ng/dL. Elevated levels may be associated with conditions like polycystic ovary syndrome (PCOS), and low levels can also be a problem in some women, particularly post-menopause. Interestingly, men that
identify as women and wish to compete in women's sports have to engage in testosterone suppression therapy, and the current IOC regulations allow athletes to compete if testosterone levels have been lowered to <10 nmol/L for 12 months. However, as you can see, 10nmol/L remains 4-20x that of women's testosterone levels, which remains a source of controversy.
Estradiol (Estrogen) (Women)
Women: Estradiol is the primary type of estrogen in women, crucial for the regulation of the menstrual cycle,
bone health, and reproductive function. Normal estradiol levels vary throughout the menstrual cycle, and thus interpretation of estradiol levels should consider the point in a woman's cycle, contraceptive use, and any pre-existing pathologies impacting the menstrual cycle. Abnormal levels may indicate conditions such as ovarian dysfunction or menopause, and
frequently in the fitness industry, undereating and overexercising. We have encountered many cases over the years of women experiencing amenorrhoea (lack of period/menses) who were not particularly concerned as they weren't trying to conceive. Unfortunately, this demonstrates that many young women are unaware of the health benefits of estrogen (and thus a normal cycle), as one could still be losing bone mass during this time.
Progesterone (Women)
Women: Progesterone is essential for the regulation of the menstrual cycle and maintenance of pregnancy, and thus the
normal range can vary widely depending on the context. Elevated levels are observed during pregnancy, ovarian cysts, and more, while low levels can indicate issues with ovulation, other hormonal issues such as hypothyroidism, hypothalamic amenorrhoea, and more. As with estrogen, progesterone levels will be stable, without demonstrating the menstrual variation, in a woman on the combined oral contraceptive pill.
Prolactin (Men and Women)
Prolactin is primarily known for its role in lactation, hence the name, but it also influences reproductive function. Elevated prolactin levels can cause
menstrual irregularities in women and erectile dysfunction and reduced libido in men. When prolactin is elevated, this is often a cause for concern, as a common cause is pituitary disease (e.g. tumour), which may require surgical treatment.
There are many other things one could know about sex hormone testing, but these are some of the basics. The interested reader should move on to understand Sex Hormone Binding Globulin (SHBG), Free Testosterone, Adrenal Function, Luteinising Hormone (LH) & Follicle-Stimulating Hormone (FSH). For now, if you have any
further questions about these topics, or if you'd like more content on this, respond to this email and let me know.
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