Paleo 101 Part 2: Top 3 Roadblocks When Going Paleo
By Dr. Justin Marchegiani
Welcome to Part 2 of our Paleo Diet series, where we are looking at lab markers to help you transition successfully to a healthy diet and the roadblocks that can get in your way. In part 1 of our Paleo Diet series. We discussed inflammation, blood sugar, and lipid lab markers and what to look for on these tests as you begin a Paleo diet, or template. Briefly, we want to see your lipids improve, whether it’s triglyceride to HDL ratio of cholesterol to HDL ratio, and we want to see improvement in inflammation and blood sugar. These would be the nice benefits of an anti-inflammatory, nutrient-dense, low-toxin eating plan.
So let’s say you’re one to two months in, and you’re seeing some improvement. It’s going well, and you’re on the right track; but now, you’re hitting some roadblocks. Maybe you’re fatigued or have energy issues, your fingernail quality doesn’t look good, you still have some digestive issues (bloating, gas, constipation, or diarrhea). And maybe they have gotten even worse since you you’ve increased your protein content.
Anti-inflammatory, nutrient‑dense, low-toxin food should not make you feel worse unless your digestive system is impaired in some way or another. So now, it’s time to dig in a bit deeper and get those roadblocks out of the way.
What Are the Paleo Roadblocks?
The three main roadblocks we’re going to address are anemia, infections, and thyroid issues. We’ll also cover the lab markers we would look at when considering each.
In people whose hydrochloric acid (HCl, stomach acid) levels are low, anemia can be an issue. Interestingly, this happens in people who eat a lot of easy-to-digest food. Because of anemia, their stomach acid and their digestive secretions weaken because they aren’t staying tuned up with the proper proteins.
This is seen in people who have a strictly vegetarian or vegan diet. There may even be some gastrointestinal inflammation preventing us from binding minerals. And the low HCL may be preventing us from ionizing so the minerals, such as iron, calcium, selenium and magnesium can get into our bloodstream.
Lab Tests for Anemia
When we see anemia issues, the first pattern we’ll look for is a decrease in red blood cells, hematocrit, and hemoglobin. It may not necessarily be low, but it may just be in that bottom 20% of the range. This will tell us if there’s a broad-spectrum anemia.
The next anemia pattern we’ll look for is through the iron panel. TIBC and UIBC are different iron-binding proteins, and they actually tend to go high when iron is low. So the more binding proteins we have, the more iron our body needs. We will also typically see iron saturation and ferritin levels drop. If we see these markers in our anemia patterns, then we know we probably have an iron-based anemia.
We’ll also look for anemia patterns through B vitamin markers. We’ll look at MCHC, MCV, and MCH. These markers just tell us how big the red blood cells/hemoglobin are. The bigger our red blood cells are, the more immature they are. Red blood cells get smaller as they mature. So this will be an indicator of two kinds of anemia—B vitamin and iron.
Click here for professional advice from a functional medicine doctor regarding how to get started one a Paleo template.
A chronic infection, such as a parasite infection, bacterial infection, viral infection, or even a fungal infection, may be present. These infections will affect our immune system. About 70–80% of our immune system lives in the gastric associated lymphoid tissue (GALT) of our stomach and in the mucosal associated lymphoid tissue (MALT) of our intestinal tract. So with so much of our immune system living in our stomach and intestinal tract, it’s clear to see why an infection could be affecting our ability to properly absorb nutrients.
When we have digestive immune stress, it fires the sympathetic nervous system (i.e., our fight-or-flight system). We have two branches to our nervous system. Our sympathetic nervous system is our flight-or-flight nervous system, and our parasympathetic nervous system is our rest-and-digest system.
When our sympathetic nervous system is fired up, it’s going to drive more of our fight-or-flight response. It will decrease hydrochloric acid and enzymes, and it will increase blood flow to the extremities—arms, hands, and feet—to allow us to fight and flee. This is one of the major issues when we’re under chronic stress, and those stressors could come from infections.
Lab Tests for Infections
One lab test we would look at for infections would be a stool panel, and not just the conventional hospital or Lab Corps tests—I run many of those and they sometimes miss the infection. We would run a specialty test, especially the DNA, PCR-based testing. We have a higher level of sensitivity and specificity on them. Also, we can draw conclusions from a CBC with differential panel. This looks at our white blood cells—our neutrophils, lymphocytes, monocytes, eosinophils, and basophils (an easy way to remember these: Never Let Monkeys Eat Bananas). We might consider the following based on an increase in these cells:
- Neutrophils—If we see neutrophils high, we’ll consider a bacterial infection. Particularly high neutrophils, above 60, and we’re automatically going to gravitate toward pylori issues.
- Lymphocytes—If we see lymphocytes low, we automatically think a chronic viral issue; if we see them high, we think acute viral issue. When we see lymphocytes low, however, along with neutrophils high, this is a common pattern for an pylori bacterial infection.
- Monocytes—If we see monocytes high, it typically means our immune system is fighting an infection.
- Eosinophils—If we see eosinophils above three, we almost always think parasites. At this point, we would run those specialty stool tests because they will help us determine exactly what type of infection we are dealing with.
- Basophils—If we see basophils go out of range, typically above one or two, we start to think tissue inflammation and potential allergies.
Next we have thyroid issues. Cold hands, cold feet, constipation, mood issues, and energy issues are all signs the thyroid is not functioning appropriately. So we’ll want to run a complete thyroid panel.
Lab Tests for the Thyroid
We typically run our TSH, which is a brain hormone. This gives us a peek inside the window to what’s happening with our brain and how it’s communicating with our thyroid. We’ll also look at thyroid hormones: free T4 and T3, total T4 and T3. T4 tells us what is coming out of the thyroid tissue, and T3 gets converted by the liver and intestines, by healthy stress levels, and at the thyroid (about 20% gets converted at the thyroid).
We’ll also run our antibodies, too, which are basically looking at our immune system. Our immune system could actually be attacking our thyroid gland and making various antibodies called TPO, TB antibodies, thyro-binding globulin antibodies, and even TSH receptor site antibodies. This would tell us if we are dealing with an autoimmune thyroid condition, such as Hashimoto’s thyroiditis.
It takes time when transitioning to an anti-inflammatory, nutrient-dense, low-toxin diet. The Paleo template will get you on the right road, but you will likely encounter a few roadblocks along the way. Don’t let them dissuade you—address them one by one, and before you know it, those roadblocks will be far behind you.
To schedule a consult with a functional medicine doctor to help with lab markers as you prepare to begin Paleo template, click here.
Paleo Part 101: Top 3 Lab Markers for Going Paleo
By Dr. Justin Marchegiani
There are major lab tests you need to do if you’re starting with a poor diet and transitioning to a Paleo diet. In part 1 of this two-part series, I’m going to discuss the lab tests you need to be checking and the results you need to be aiming for in order to be successful with your Paleo diet. Part 2 of the series will cover roadblocks to your success and what those underlying barriers might be that are preventing you from getting to the next level. First, I’m going to discuss the Paleo diet, or as I like to call it—the Paleo template.
The Paleo Template
I don’t like the word diet, so while that may be the more common word, I like to use the word template instead. A template is less constricting and provides more flexibility. It also gives us the ability to adjust our macronutrients, which are proteins, fats, and carbs (PFC). So then we can adjust our template according to our energy levels and our metabolic needs.
Some patients are insulin-resistant and have blood sugar issues. They may really do well on a ketogenic style of Paleo template. Some are CrossFit types and may already be pretty healthy, meaning their body is able to process and handle blood sugar and insulin normally. So they could possibly handle a little more carbs. Their Paleo template can adjust to this.
When we talk about a Paleo template (or diet), really what we’re talking about is anti-inflammatory, nutrient-dense, low-toxin foods. Foods that we’ve had enough time to evolutionarily adapt to. However, our standard American diet today consists of grains and a lot of refined sugar (non-Paleo foods). So our goal is to go from pre-Paleo to post-Paleo. This is where we’re really one or two months in to our Paleo template and we’re seeing significant benefits, whether its energy, less inflammation, relief with joint pain, less brain fog, and so on.
We only started to consume grains about ten thousand years ago. So if you look at the start of the Paleo era, about 2 million years ago, we’ve been consuming grains for a very small percentage of that time. We’ve evolved away from hunter-gatherer societies, which consumed lots of meat and bone marrow, starchy tubers, and fruit and vegetable carbohydrates (not grain-based). But the evolution to grain-based diets has been at a rapid pace, which is highly problematic because our bodies haven’t had enough time to adapt to those things. Some people can handle it better than others, but in my opinion, for people who are sick or inflamed, grains are going to be their dietary kryptonite. A Paleo template will bring your body back in-line with its evolutionary expectations.
Click here for professional advice from a functional medicine doctor regarding how to get started one a Paleo template.
The Top 3 Lab Markers for Going Paleo
As my patients prepare for or begin a Paleo template, I will run lab tests to check for 3 key markers: inflammation, blood sugar, and lipids.
1. Inflammation Markers
Inflammation is just a sign that your body is breaking down faster than it’s building up because of some type of physical, chemical, or emotional stressor. These can include the following:
- Gluten in the diet
- Sleep deprivation
- Excessive exercise
- Toxin exposure (pesticides, herbicides, rodenticides, fungicides)
- Hidden infections
- Consuming high-glycemic index foods (lots of sugar and grain carbs)
When we cut these things out, we go Paleo and we put an emphasis on food quality. The toxins mentioned above have only been around for 40 to 80 years. Grains have been around for 10,000 years, and flour only for 200 years. People think organic food is a fad thing, but if you look at beyond 50 or 60 years ago, everything was organic. We didn’t douse our foods in pesticides. There was no GMO. So cutting out toxic foods will significantly help improve inflammatory markers.
When looking for inflammation markers through lab testing, I like to see:
- C-reactive protein (CRP): below 1
- Homocysteine: Agood sign of vascular integrity and vascular inflammation is below 7.5–8.
- B vitamins: Folate, B12, B6—can have a big effect on homocysteine. Inability to methylate, which is important for detoxification and brain health, and gut absorption issues can also impact homocysteine levels.
- Fibrinogen: It is a measure of our clotting factor, and elevations of it can make our cells “sticky” and cause occlusions and blockages. So the healthier and less inflamed we are, the smoother our blood flows. Also, the less chance of blockages and heart attacks, one of the great benefits of going Paleo.
2. Blood Sugar Markers
A lab test I like to look at for blood sugar markers are:
- A1C: A 90-day window of how our blood sugar fluctuates. When we are on the Paleo template, our blood cells get healthier because they’re exposed to fewer toxins. So we may see slightly high A1Cs, 5.6–5.7, though we may still be eating healthy. Maybe with a little bit of low-sugar fruit, so A1C isn’t the be all or end all, but keep an eye on it.
- Fasting insulin: It should be below 5. Insulin basically opens the door for blood sugar to come into the cell. And the more we spit out sugar, the more we spit out insulin and the more numb to insulin we get. This is called insulin resistance. There’s a strong relationship between high levels of insulin and tumors and cancer. We also see it in a lot of hormonal disorders like elevations in testosterone and androgens for women.When fasting insulin is below 5, it means our body is very sensitive to sugar. Then it’s more likely to take that sugar into the muscle and be able to burn it instead of storing it in fat. So when we are more sensitive to insulin, we make less fat and we burn our sugar for fuel.
- Fasting glucose: Below 100 is ideal, and some even say below 95 or even 90. This really depends on our stress levels and cortisol levels—glucose can go higher because cortisol can increase glucose. It may not necessarily be a bad thing if you have a healthy stress response in the morning, but we can even do what’s called a functional glucose tolerance. We would measure one to three hours after our regular meal and see how we do in those various intervals; ideally below 140 within an hour, 120 within two, and back below 100 within three hours is a pretty good measurement.
3. Lipid Markers
- Triglyceride-to-HDL: This is a really good marker of insulin resistance. Basically our triglycerides go high when we consume too much carbohydrate. Our HDLs go up when we’re consuming healthy quality fats, like fish oils, and good clean saturated fats, like coconut oil and butter. So as HDLs go up and triglycerides come down because we’re not consuming excess sugar, that’s a really good ratio. Ideally we like a 1:1 or so, but I’ll settle for a 2:1 ratio. This would be, for example, triglycerides at 100 and HDL at 50.
- Total cholesterol-to-HDL ratio: It should be around 4:1. So if your HDL is at 60, your total cholesterol should be under 240. Total cholesterol by itself is not that important when we look at inflammation markers like CRP and homocysteine and fibrinogen. If inflammation levels are low, but cholesterol’s on the higher side, 250–260, it may not necessarily be a bad thing, especially if we see something called LDL particle size.
- Particle size A (large) is good, and particle size B (small) is bad: The larger and fluffier and more buoyant our particle size is, the less likely it’s going to stick into the endothelial fissures and create various blockages and occlusions. We get more large particles with the healthy fats and by restricting a lot of the refined sugars and carbohydrates and grains and inflammatory foods.
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To be successful on the Paleo template, it’s important to avoid the foods that humans have had less time to adapt to and eat the foods that we’ve had more time to adapt to, are going to be low in toxicity, drive less inflammation, and essentially have higher levels of nutrient density. Anything you can get in vegetables and meat and low sugar berries and starchy tubers, you’re going to be able to get every single nutrient in those food items that you would in grains and other refined products.
People may say, “You can’t cut out a food group,” but don’t look at your food as a category; look at it by the nutrients it contains. Ask yourself, “Can I get that from something else?” And if you can get that nutrient from another food without taking on the inflammatory compounds, like those you get with the gluten for example, then that’s a win-win in my book.
Natural solutions to optimize the brain, thyroid and adrenal connection
By Dr. Justin Marchegiani
Today’s talk will address how important nutrients and nutrition are for healthy thyroid, adrenal and brain function. I’ll do a brief overview of how the thyroid works just so you’ll have some foundational information. And then I’ll cover what you need or what you may be missing that’s preventing your thyroid from functioning optimally on the nutritional side. So let’s dig in.
Overview of Thyroid Hormone Production
Let’s outline how the thyroid hormonal cascade or domino rally works. The first step we have is really the brain signalling down to the thyroid. This pathway is known as our thyroid stimulating hormone (TSH). Our TSH is coming from the brain, particularly the pituitary, and it’s telling the thyroid to make thyroid hormone.
From there, our thyroid spits out some T4, and about 20% of that T4 actually gets converted to T3 at the thyroid, and we’ll review some of the nutrients that we need to help that conversion. So 20% actually happens in the thyroid gland. The other 80% actually happens peripherally, and 60% of that 80% actually happens in the liver.
Factors to consider in thyroid hormone production
A healthy liver function is very important. If we’re getting toxins, chemicals, and various plastics in our food, then we’re not getting enough sulfur-based amino acids or antioxidants in our diet to run those pathways. Our liver may be burdened and that may affect our body’s ability to convert and activate thyroid hormone.
One of the enzymes that’s responsible for thyroid conversion, the 5-deiodinase enzyme—you break it down 5-deiodinase. De-i is taking an iodine off. So the T and the number 4 stands for how many Iodines there are. The 4 stands for the number of iodines. So de-iodinate means pulling an Iodine off, and that’s why it goes from T4 to T3, because we’re pulling 1 iodine molecule off it, and we’re doing it with that liver-based enzyme known as the 5-deiodinase enzyme, which is selenium-based.
So things like egg yolk, seafood, nuts, seeds—things like that are going to be very rich in Selenium, which we’re going to need for that liver enzyme to work. Selenium is also a strong precursor to glutathione. So selenium also helps with our detoxification, also supports the liver. Liver is very important for thyroid hormone conversion.
Next we see gut bacteria. We need good, healthy gut bacteria because about 20% of conversion happens in and around the gut with acetic acid or the various sulfatase enzymes, and these enzymes are important at taking inactivated T3 and activating it. So if you have dysbiosis or imbalances in gut bacteria from various infections, pathogens, or even small intestinal bacterial overgrowth (SIBO), that can throw off the balance of your gut bacteria, and that can decrease your gut’s ability to activate thyroid hormone.
The adrenals are profound and very important for activation of thyroid hormone, mainly because of the fact that if we’re under adrenal stress, that can increase our reverse-T3 levels. I count the adrenals as being a 20% contributor of activating thyroid hormone. They do it a couple of ways. If the body’s under too much stress, cortisol is too high. If we have high cortisol, we’ll have more reverse T3s. And reverse T3 is inactive T3.
How this happens is that the reverse T3 molecule gets in the receptor site in the cell. It doesn’t have the same metabolic effect of the T3. The T3 can’t make its way into the receptor site because the receptor site is blocked. So that’s kind of how reverse T3 works. It’s like taking a gun and putting blanks in the magazine. When you fire that gun, the effect that you’re looking for is for that bullet to come out, but all you hear is the noise. And you don’t get the actual end result, same thing. Metabolically, we see a hormone in that receptor site, but it’s a hormone that doesn’t have the same type of stimulation that thyroid hormone does at the nuclear-receptor-site level.
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So on that note, we need healthy levels of cortisol for thyroid conversion to happen. So the adrenals are also affected because high levels of cortisol, stress, etc.—these can actually affect TSH. TSH levels can go off with an extreme amount of stress via cortisol, and if we’re depleted, if our adrenals are so dysfunctional that our cortisol levels are now low like at a stage-3 adrenal fatigue level (cortisol levels <23), then we’re not going to have enough cortisol to make that conversion happen. We need cortisol to really activate that thyroid hormone.
When we do thyroid temperature testing, we’ll see chronically low temperatures with low thyroid function. When we see adrenal stress, we’ll see aberrations in temperature greater than 0.3 degrees Fahrenheit. So what we’ll see when we have adrenal and thyroid issues is if this is the threshold we want to be at temperature-wise, we’ll have a low temperature but we’ll have aberrations in that low temperature. If it’s just a straight low temperature, that’s a thyroid dysfunction. If it’s low and aberrant, that’s thyroid and adrenals. And if it’s normal and aberrant, that’s just adrenal function. So that’s a great way that you can use temperature to assess whether you have a thyroid issue, adrenal issue, or both.
Nutrients and Thyroid Hormone Activation
Now that you have a good background of how the thyroid gland converts a lot of the T4 and T3 into active hormones, let’s talk about some of the nutrients that are involved for activating thyroid hormone.
Our TSH is the signaler. So TSH is an inverse hormone. It goes high when thyroid hormone is low, and it goes low when thyroid hormone is high essentially. So if I’m yelling at someone and I’m not getting their attention, I’ll have to raise my voice louder until I get that person’s attention. Think of that as what TSH is doing: the brain is yelling down to the thyroid to make hormone, and if it’s not high enough, it will increase the amount of TSH. TSH is a very bad indicator to use for thyroid dysfunction because it’s so late-stage. It comes on so late in the game, 5 to 10 years down the road.
We really need to be looking at the actual active hormone downstream, the T3. This is much more important and much more indicative of an early-stage thyroid issue. A lot of times people may have healthy levels of TSH because T4 feeds back into the brain better than T3. We could have normal levels of T4 but have low levels of T3, and it may not even be reflected in the TSH. I see that all the time in my patients. That’s why we have to be very careful. We actually have to look at TSH, T4 free and total, T3 free and total, and maybe even look at reverse T3 and the thyroid antibodies.
We talked about the nutrition—vitamin A, zinc, various B vitamins, and protein—for healthy thyroid-hormone function knocking that first domino over, which is TSH. And, again, if we have a gut issue, you can see that nutrition isn’t just a given. If we take in nutrient-rich foods, but we have a gut issue, malabsorption, low stomach acid, dysbiosis, and infection, you can see how that may impede the absorption of these nutrients, thus causing deficiency even though we have a really good diet. So keep that in mind: we always need to look deeper at the gut, deeper at the liver, and deeper at the adrenals. We can’t ignore these three body systems.
Iodine is an important nutrient for thyroid-hormone creation. The process known as iodination involves iodine and tyrosine being cleaved together. The T in T4 and T3 stands for tyrosine (an amino acid), and the 4 and the 3 stand for the number of iodines. We don’t need too much iodine to have this healthy conversion and activation.
There’s a lot of debate out there that we need more iodine, into the high milligram range. Some say we only need the recommended daily allowance (RDA), 250 or so micrograms, to make our thyroid hormone. We have to be careful because iodine can be a strong stimulator of autoimmunity, and there’s a great deal of research showing that excess iodine can actually stimulate Hashimoto’s. It activates TPO or thyroglobulin antibody that can increase thyroid destruction.
Iodine and Autoimmune Conditions
A lot of people say that the reason iodine’s a contributing issue with autoimmune conditions is because people also are very low in selenium, and when iodine is being fused to thyroid hormone via this process known as iodination, a result is that hydrogen peroxide gets kicked out. This hydrogen peroxide can be very inflammatory and can cause our B cells to come up and infiltrate. It also starts attacking the thyroid tissue. That’s why if you’re getting any amount of iodine, you want make sure there are adequate levels of selenium. This is because selenium actually neutralizes the hydrogen peroxide. It pulls an oxygen off it and makes it H20, which is water, which is very benign.
Getting iodine and not having selenium there by its side can definitely be a recipe for destruction. So with iodine, be very careful. Make sure you’re working with a functional medicine doctor. Make sure you’re not autoimmune or have any autoimmune symptoms before you give iodine at higher levels. About 200 micrograms will probably be okay, but double-check with your functional medicine doctor.
This is really important. If you have a microcytic, hypochromic anemia, that’s going to be a major issue. Low iron—we need iron to make thyroid hormone. But we also need iron to help carry oxygen throughout our body.
B6 is super important because B6 helps with dopamine activation, and if we look at the hypothalamus, which is the top part of the brain, we actually need dopamine from the hypodopamine production to actually stimulate the hypothalamus to make thyrotropin-releasing hormone (TRH). TRH is important at stimulating TSH. So dopamine is essential, and a lot of people may have neurotransmitter issues that need to be fretted out doing an in-depth organic acid test.
So Iodine, Tyrosine, Iron, and your B vitamins are really important for energy, for making the Krebs cycle go around. Vitamin C is a really important antioxidant and helps the adrenals as well. Vitamin D is really important for immune function. A lot of people with Hashimoto’s and hypothyroid autoimmune issues tend to have a vitamin D polymorphism at the receptor site of the vitamin D receptor. And they need higher levels of vitamin D, 70 to 100. So be very mindful if you have an autoimmune thyroid. Make sure your vitamin D levels are up at 70 to 100, just to make sure you have that therapeutic immune balancing effect.
We already talked about the nutrients needed for our T4 to T3 and that Selenium is essential also for the autoimmune effects of helping to neutralize the hydrogen peroxide into water.
Zinc is also very important for thyroid conversion. Zinc is also essential for sex hormone production, making testosterone essentially, and then also it’s an important building block for making Hydrochloric acid. If our Hydrochloric acid levels aren’t adequate enough, we won’t keep a nice, low pH in the stomach. If we don’t have that nice, low pH, we won’t be able to break down protein and fat adequately and we’ll have a harder time ionizing minerals. We need to ionize minerals and hit them with Hydrochloric acid, so we can then take them into our blood so they’re not like rocks floating in our bloodstream. We actually need to ionize them so they’re absorbable. If we have issues with these nutrients, we may see other problems in the thyroid hormone chain that could be happening as well.
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Thyroid autoimmunity is a big issue—40% of people that test for thyroid autoimmunity actually are a false negative. This means they come back negative, but they may still have a positive thyroid autoimmune condition. So make sure you get your thyroid looked at either by palpation and/or by ultrasound. Just to make sure there are no nodules or inflammation in the thyroid that could be caused by Hashimoto’s.
So outside of that, if you have a thyroid issue, nutritional issue or neurotransmitter issue that could be affecting your thyroid, and you’re not quite sure of the next step to take, click here to schedule a consult with me to dig deeper or get my Thyroid Hormone Balancing Series for more information on how you can get your thyroid back into balance.