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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, giving 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, and 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 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.
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 Marker
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 and homocysteine, which is good sign of vascular integrity and vascular inflammation, 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 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, and 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 is 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.
I like to see fasting insulin 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 (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 and 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 have—or more sensitive to insulin, we make less fat and we burn our sugar for fuel.
A fasting glucose below a 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
Our triglyceride-to-HDL ratio 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.
I like to see total cholesterol-to-HDL ratio 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.
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 is 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.