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Clinical · Bloodwork

[2026 update] Lipid changes during rapid weight loss: the expected trajectory

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f.haddadTL2 Moderator25 Dec 2024#1

Lipid changes during rapid weight loss: the expected trajectory Writing it up because I had to work it out twice and would rather nobody else did.

Asking about a population rather than about a person.

The published trials in this class mostly enrolled a fairly specific group, and the questions here frequently come from people well outside it. I would like to understand what the honest position is when someone falls outside the studied population: not "it is fine" and not "there is no data", but what the reasoning actually looks like.

54 likes 19mo
MM
maintenance_modeTL3Regular27 Dec 2024 · edited#2

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

15 likes 19mo
HB
h.brandtTL2 Moderator29 Dec 2024#3
maintenance_mode, post #2: Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone. Go to post

Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results.

2 likes in reply to #2 19mo
RV
r.venkatesanTL3Wiki editor30 Dec 2024#4

Picking up the opening post: that is the part I would want checked first.

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

0 likes 19mo
SK
s.kuuselaTL2 Moderator31 Dec 2024#5

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

0 likes 19mo
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batchlogTL3Regular2 Jan 2025#6

Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal.

21 likes 19mo
GR
g.radichTL2 Moderator3 Jan 2025#7
r.venkatesan, post #4: Picking up the opening post: that is the part I would want checked first. For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use. Go to post

I read post #5 twice before replying, because I had assumed the opposite.

Reference intervals: constructed to contain the central 95% of a reference population, which means one in twenty healthy people falls outside one by definition. Add biological variation and analytical imprecision and the base rate of a meaningless flag is substantial.

5 likes in reply to #4 19mo
TY
two_year_lineTL3Regular4 Jan 2025#8

This follows post #5 rather than contradicting it.

A single value outside interval: usually uninformative on a single draw. What makes a result interesting: a trend across multiple draws, a magnitude well beyond the interval, a pattern that coheres with other values, or symptoms that fit.

0 likes 19mo
IA
id.almeidaTL2 Moderator5 Jan 2025#9

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

0 likes 19mo
BD
baseline_driftTL2Analytical chemist6 Jan 2025#10
maintenance_mode, post #2: Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone. Go to post

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

28 likes in reply to #2 19mo
MS
m.strand_rphTL3Pharmacist7 Jan 2025#11

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

0 likes 19mo
BV
b.vanheckeTL2 Moderator8 Jan 2025#12

Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone.

3 likes 19mo
PE
ppm_errorTL3Analytical chemist9 Jan 2025#13
id.almeida, post #9: Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same. Go to post

This follows post #10 rather than contradicting it.

TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem.

16 likes in reply to #9 19mo
RP
r.petrovTL2 Moderator10 Jan 2025 · edited#14
ppm_error, post #13: This follows post #10 rather than contradicting it. TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem. Go to post

I read post #12 twice before replying, because I had assumed the opposite.

Biological variation: the person-to-person variation in a biomarker for a healthy person is larger than most people realize. Comparing your result to the reference interval is one thing; comparing your result today to your result from months ago is more sensitive to change.

32 likes in reply to #13 19mo
NH
n.haddadTL2 Moderator11 Jan 2025#15

post #14 answers the question as asked. The question underneath it is different.

Biological variation: the person-to-person variation in a biomarker for a healthy person is larger than most people realize. Comparing your result to the reference interval is one thing; comparing your result today to your result from months ago is more sensitive to change.

1 like 19mo
SC
s.coelhoTL2 Moderator12 Jan 2025#16

A single value outside interval: usually uninformative on a single draw. What makes a result interesting: a trend across multiple draws, a magnitude well beyond the interval, a pattern that coheres with other values, or symptoms that fit.

6 likes 18mo
JM
j.mwangiTL4 Moderator13 Jan 2025#17
m.strand_rph, post #11: Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post
Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results.

23 likes in reply to #11 18mo
DE
d.eriksenTL2 Moderator14 Jan 2025#18
n.haddad, post #15: post #14 answers the question as asked. The question underneath it is different. Biological variation: the person-to-person variation in a biomarker for a healthy person is larger than most people realize. Comparing your result to the reference interval is one thing; comparing your result today to your result from months ago is more… Go to post

Coming back to post #16, because the follow-up matters more than the original answer.

Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal.

0 likes in reply to #15 18mo
PN
plateau_notesTL2Regular15 Jan 2025 · edited#19

post #18 is right about the mechanism and I think understates the practical bit.

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

0 likes 18mo
CH
c.haddadTL2 Moderator16 Jan 2025#20

Worth separating two things that post #16 runs together.

HbA1c and glucose: HbA1c reflects average glucose over months; a spot glucose measurement reflects the moment. Trending glucose downward while HbA1c stays flat is a different picture than glucose going up with HbA1c.

0 likes 18mo
TH
TL4_HalvorsenTL4Leader · Journal club17 Jan 2025#21
b.vanhecke, post #12: Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone. Go to post

On post #17 — agreed on the reasoning, with one qualification.

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

0 likes in reply to #12 18mo
CC
ch.correiaTL2 Moderator17 Jan 2025#22
two_year_line, post #8: This follows post #5 rather than contradicting it. A single value outside interval: usually uninformative on a single draw. What makes a result interesting: a trend across multiple draws, a magnitude well beyond the interval, a pattern that coheres with other values, or symptoms that fit. Go to post

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

27 likes in reply to #8 18mo
FN
formulary_notesTL3Regular18 Jan 2025#23

Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone.

13 likes 18mo
CA
c.amankwahTL2 Moderator19 Jan 2025#24

TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem.

4 likes 18mo
MH
ms_hollowayTL4Mass spectrometrist20 Jan 2025#25

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

0 likes 18mo
MI
m.ibarraTL2 Moderator21 Jan 2025 · edited#26
b.vanhecke, post #12: Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone. Go to post

Reference intervals: constructed to contain the central 95% of a reference population, which means one in twenty healthy people falls outside one by definition. Add biological variation and analytical imprecision and the base rate of a meaningless flag is substantial.

0 likes in reply to #12 18mo
EF
endo_fellow_rkTL3Endocrinology fellow22 Jan 2025#27

Biological variation: the person-to-person variation in a biomarker for a healthy person is larger than most people realize. Comparing your result to the reference interval is one thing; comparing your result today to your result from months ago is more sensitive to change.

19 likes 18mo
YA
y.adebayoTL2 Moderator23 Jan 2025#28

This follows post #25 rather than contradicting it.

Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal.

8 likes 18mo
AR
a.reyesTL4 Admin23 Jan 2025#29
formulary_notes, post #23: Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone. Go to post

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

2 likes in reply to #23 18mo
JS
j.steinerTL2 Moderator24 Jan 2025#30

post #29 answers the question as asked. The question underneath it is different.

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

0 likes 18mo