The Paleo Solution Part 11

Misconception 2: One will experience some kind of deficiency without grains, legumes, and dairy in the diet.

Misconception 3: The only place to get dietary fiber is grains and legumes.

And this last point is not so much a misconception as a serious lack of understanding on the part of dieticians: One should eat a low-calorie diet. Now, I'm not arguing about the calorie content per se, but rather how they tackle it, as you will see.

Let's look at the following tables and do a little thinking. Table 1 comes from: Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.

In the far left-hand column we have a list of vitamins and minerals. The other columns you will find various food categories and how those foods rank for specific nutrients (this is comparing equal, 100-calorie portions). The ranking system is on a scale from 1 to 7, with 1 being lowest and 7 being highest. What we observe is that whole grains and milk are not particularly nutritious on a calorie-per-calorie basis as compared to meats, sea foods, veggies, and fruits. This one chart handily addresses misconception 1 (grains and dairy are nutritious) and it implies that if we are considering nutrition on a calorie-by-calorie basis, grains and dairy are not the winners. What if we look at this data represented as a modern interpretation of a Paleo diet? Luckily, Prof. Cordain has both asked and answered this question (see: L Cordain. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Nutraceut a.s.soc 2002;5:15-24).

TABLE 1.

TABLE 2.

Sample 1-day menu for a modern diet based upon Paleolithic food groups for females (25 yrs, 2200 kcal daily energy intake).

Let's next consider table 2, which lays out a sample 2,200-calorie meal plan composed of lean meats, seafood, fruits, veggies, nuts, and seeds. If you notice, there are no processed foods in this plan-but is it nutritious? Will you keel over and die from a plan like this? Is your doctor's or dietician's fear accurate that you will develop horrific deficiencies on this plan? Will your b.u.m forget how to p.o.o.p without "whole grains" providing fiber?

What we notice in table 3 is pretty interesting: 42 grams of fiber from these wacky things called "fruits and vegetables." Also interesting is the fact that our essential fatty acid ratio (n-3:n-6) is 1:1.5. In other words, "perfect."

TABLE 3.

Macronutrient and other dietary characteristics in contemporary diet based on Paleolithic food groups for females (25 yrs, 2200 kcal daily energy intake).

The really interesting information is in table 4. If you notice we not only meet the recommended daily allowance (RDA) of all the vitamins and minerals (with the exception of calcium, which I'll discuss in a moment), but we have anywhere from several hundred to a thousand times the RDA. It is well understood that the RDA is a minimum and likely does not reflect an optimum nutrient level for performance, health, and longevity. Interestingly, however, we do not see significant health improvements from nutritional supplements (more on this in the supplement chapter). Epidemiology consistently shows consumption of nutrient-dense foods to be beneficial, not vitamin pills.

Now, as to the calcium issue, this is simple chemistry. Look at how much magnesium we obtain on this plan. Calcium and magnesium work synergistically in the body, and if our magnesium intake is high, our calcium needs dramatically decrease (see supplement chapter for further details).

TABLE 4.

Trace nutrients in a modern diet based on Paleolithic food groups for females (25 yrs, 2200 kcal daily energy intake).

ELEVEN.

Tracking Your Progress There are two possible outcomes: if the result confirms the hypothesis, then you've made a measurement. If the result is contrary to the hypothesis, then you've made a discovery.

-Enrico Fermi Blood is not thicker than money.

-Groucho Marx We have come a long way together, but we are not finished yet. And not to be mean, but this is your fault. How so? Here is what I've observed working with people: They will give the Paleo Solution a shot, look, feel, and perform better than they have in years, and then talk to a know-it-all friend, family member, or doctor and get scared that a lack of grain will somehow kill them. So, we need to take some measurements and offer up proof, whether it is to pacify your curiosity or quiet your physician who has yet to connect the dots between evolution, biology, and medicine.

So, what types of things might we measure and why? Well, we will start with simple measurements like photos and a few dimensions that we can take with a standard measuring tape. As they say, photos do not lie, and the information we gain from a simple waist/hip measurement can tell us more than thousands of dollars of diagnostic blood work. Speaking of blood work, we will look at key markers of health and disease and educate you on how to ask for tests your doctor may not know about. I'll help you interpret these tests, as well as tell you what to do if your numbers are not looking so great.

Keep in mind that any nutrition and lifestyle approach that is worth doing should not have "side effects." If what we are doing is sound, we should look, feel, and perform better. We should be able to track biomarkers of health and disease (blood work), and we should see this go in a favorable direction. Easy enough, right? Well, let's look at the easy stuff, then move to the blood work and biomarkers.

Photos This process is so simple it hardly seems worth mentioning, but a remarkable number of folks who begin an exercise or nutritional program fail to adequately doc.u.ment or quantify progress. Photos should be taken in the same clothing. Ideally, clothes that are formfitting, light in color, and show some skin! This outfit does not need to be something that you feel comfortable sharing on Facebook-it's something you will use to evaluate your progress. Take the photos from the same position and make sure you doc.u.ment a front, side, and back photo. A close-up of your face in profile and straight on is also helpful, as we tend to lose fat from our face and neck first.

You can update these photos weekly, and then make them into a slide show to really get a sense of your progress. Remember! Consistency is critical for the photos to really help you judge progress. Changing your placement, clothing, or lighting will alter your perception of the change. If you are too embarra.s.sed to get help with the photos, use a mirror to take them-just keep the camera out of the way! Remember, this process is for you! You can share the photos if you want, or hide them in your secret place. That's up to you. Just to recap: 1. Take photos in the same clothing. Make the clothing formfitting where appropriate. Nonexistent clothing is even better.

2. Get front, side, and back photos.

3. Get a close-up of your face, both frontal and profile.

4. Update photos weekly and make sure to label them with the date if your camera does not automatically do this.

5. Stand in the same place when taking the photos.

Tape It It may be surprising, but a simple measuring tape may offer more insight into your metabolic health than an extensive battery of blood work. The waist-to-hip ratio (WHR) is the measure of the narrowest portion of the waist (typically at or slightly above the belly b.u.t.ton) divided by the widest portion of the hips. In general, the hips of both men and women will be greater in diameter than their waist. As you might have guessed, there are ancestral norms here that we can use to give us some guidance. Measurements of .9 for men and .7 of women seem to correlate well with health and wellness, to say nothing of attractiveness. So, what happens to our numbers if the waist gets larger and what might cause that?

Well, if the waist gets larger, it makes that number approach 1 (or even more than 1 in certain situations), and insulin resistance is what causes this increase. It should not come as a surprise that a waist-to-hip ratio that is too large is a.s.sociated with everything from periodontal disease to cancer and heart attack. It is a simple, visible measure of insulin-resistant fat. So here are the steps to figuring out your own waist to hip ratio: 1. Measure your waist at the narrowest point. Use your belly b.u.t.ton as a reference point and thread the tape around you, meeting again at the front. You might find it easiest to use centimeters. I'm still embarra.s.sed that the United States is using inches, but it will not matter so long as you are consistent with either inches or centimeters. Now, repeat that measurement three times. Each measurement should be pretty darn close, but we will use a little statistics to keep us honest. After you have your three measurements, add them together and divide by three. This will minimize any errors you have in your measurements and it will earn you a "Jr. Scientist First-Cla.s.s Award." This is your waist measurement.

2. Measure your hips at the widest part. Repeat the measurements three times, add the measurements together, divide by three. Just like for your waist. This is your hip measurement.

3. There is a rule in publis.h.i.+ng that you will cut your readers.h.i.+p by 50 percent for every equation you have in a book. Well, here goes: Take your waist measurement and divide it by your hip measurement.

4. High-five your bad self. You have now calculated your waistto-hip ratio.

5. Track this number every two weeks. Try to take the measurements at the same time of day to minimize variables such as fluid retention. Women may see some variability in WHR due to changes in their menstrual cycle, but this variability will decrease with dietary and lifestyle compliance, as excessive water retention will cease to be a problem when ancestral norms in insulin levels are maintained.

What Does It All Mean?

A WHR of .8 and above for women and .95 and above for men would indicate an increased risk of diseases related to insulin resistance. Cancer, diabetes, heart attack-remember the insulin chapter? In my opinion, perhaps the most important measurement you can take is simply your waist circ.u.mference. Decreased waist circ.u.mference? Good. Increased? Bad. Pretty d.a.m.n easy, and this works not just for dietary compliance, but any type of insulin resistance, whether caused by poor food choices or elevated cortisol due to excessive exercise or inadequate sleep.

Blood Work I see this section being relevant for several types of people or situations: 1. It provides guidelines for those of you who are geeked-out on your health. You want to do everything "right," and this will provide the tight guidelines you desire.

2. To help bring your doctor on board. I beat up on doctors a fair amount in this book, but the reality is most doctors legitimately, sincerely want to see their patients get healthier. But they also get their primary education after medical school from drug companies. Doctors are not used to patients who take an active role in their health, so when you suggest an "unproven" dietary and lifestyle approach, they get nervous. The blood work should help because we can predict what should happen when you change your nutrition and lifestyle and then confirm these changes via time-tested lab values.

3. This section is also good for those of you who still think meat and fat will kill you. Many of you are coming from a vegetarian camp. All I suggest is you follow the recommendations in this book for a month, and compare your blood work before and after doing this. Easy enough, right?

Most of the blood work we need comes with a standard blood test. There are a few add-ons I will suggest to help paint as accurate a picture of your metabolic health as we can. One could easily spend thousands of dollars on diagnostic blood work, but to what end? If you look, feel, and perform better; if we bring a few of your biomarkers into ancestral norms; if we can show a marked decrease in your systemic inflammation by adopting a few simple nutrition and lifestyle changes, then why complicate things? It's your money, so spend it how you want to, but I'd rather see a vacation than blood work. I'm just silly that way.

Order Up!

You will need to work with your doctor to get this blood work ordered. You need to make absolutely sure that your blood work is performed in a fasted state. All doctors should know this, all testing labs should know this, but I cannot tell you how many people have spent money on blood work that was useless as the samples were taken in a nonfasted state. Shoot for at least a nine- to twelve-hour fast. Let's look at what to order and what those tests mean.

The Basics: This stuff comes with most blood work.

Total cholesterol HDL.

LDL.

Triglycerides Glucose Add-ons: LDL particle size Glycated hemoglobin (Hba1c or just A1C) C-reactive protein Total Cholesterol What Is That?

This is a measure of several blood lipid fractions that are in part proteins used to shuttle fats and cholesterol around the body. For simplicity, they are lumped under the general term "cholesterol." This includes VLDLs (very low-density lipoproteins), LDLs (low-density lipoproteins), and HDLs (high-density lipoproteins). As we will see, each of these categories of lipoproteins has specific physiological roles, as well as their own subcategories.

How Much?

We are looking for numbers between 120140mg/dl on cholesterol. This reflects our ancestral norms, the range we see in all primates, and, interestingly, all newborn babies. Although there is some controversy here (some examples of various populations having relatively high cholesterol levels but low CVD levels), this is a safe range to shoot for. But as you will see, things are not as simple as one total number.

HDL Cholesterol What Is That?

HDL is a form of lipoprotein that actually helps to move fats from the peripheral body back to the liver. In digestive physiology, the liver is literally the center of the universe. Food that is absorbed from the intestines is sent to the liver for processing, distributed throughout the body, and then brought back to the liver for reprocessing. This last part of the distribution process involves carrier molecules like HDL. HDLs are generally considered "good" cholesterol, as they appear to act as scrubbers in our arteries and veins, bringing fats back to the liver for processing. This notion is not entirely correct, but it's correct enough for our purposes.

How Much?

We are actually concerned with too little HDL cholesterol. Modern, sedentary populations show levels that are low due to consumption of trans fats and inadequate exercise. I'd like to see yours above 50 mg/dl.

LDL Cholesterol What Is It?

LDL plays opposite HDL in the process of distributing lipid (fat) substances throughout the body. The energy we need to run our muscles, the raw material for our cell membranes, the omega-3 fats that make up our brain, are all shuttled around with the help of LDL (and chylomicrons for you geeks). LDL is generally considered the "bad" flavor of cholesterol, but as we will see, this is due to a myopic view of blood lipids in general and cholesterol in particular.

How Much?

Ancestral levels of LDL cholesterol appear to run in the range of 4070mg/dl, but this is not the only consideration with LDL. We also have an issue of LDL particle size. Our LDL particles can come in a range of sizes from small and dense (called a "type B" profile) to large and puffy (called a "type A" profile)-and just so all the LDL particles feel good about themselves, the particles between small and large are considered "intermediate." Lipid scientists are nothing if they are not crafty with their names!

What does all this mean? It appears the type of LDL particle is of significantly greater importance than the amount. The type B profile, for example, appears to be particularly bad as the small, dense LDL particles get trapped in the nooks and crannies of the blood vessels. Our immune system is not used to seeing things get stuck in the gaps between cells in our blood vessels. Our immune system mistakes the small/dense LDL particles for a foreign invader and attacks them. This is the beginning of an atherosclerotic plaque, which can narrow key arteries such as the carotid artery. As you know, the carotid artery serves a fairly important organ-the brain. The coronary arteries that keep your ticker-ticking are also susceptible to blockage from atherosclerotic plaques. As the arteries narrow, your heart begins working less and less efficiently. This can progress until you have a really bad day: a small chunk of circulating schmootz plugs a narrowed artery in your heart or brain: heart attack or stroke.

Is this situation "luck-o-the-draw" with regard to what type of LDLs we have? Our medical establishment would have you believe it's only vaguely under dietary control. All the commercials about cholesterol-lowering drugs have an obligatory comment about "If diet and exercise does not change your condition, you might consider this drug." Cardiovascular disease can be easily controlled with diet and lifestyle changes-they just need to be the right changes!

Check This Out: Type B LDLs are certainly atherogenic. Type A LDLs appear to be nonatherogenic. Type B (small, dense LDLs) are caused by high insulin levels. Our diet of choice (according to the American Heart a.s.sociation) is a high-carb, low-fat diet. Hmmm. So, if you want to turn your LDL particles into nasty, highly reactive type Bs, you just need to eat a high-carb, grain-based diet! Now, what about the number of LDLs? How does diet affect that? Well, interestingly, high insulin levels increase total cholesterol production by up-regulating a key cholesterol synthesis enzyme called HMG-Co-a-Reductase. High insulin means not only small, dense cholesterol particles, but lots of them! Interestingly, glucagon reduces the activity of HMG-Co-A-Reductase. Do you see how all this stuff fits together?

So, when I put out that recommendation of 4070 mg/dl of LDL cholesterol, we need to temper that with an awareness that LDL count is not nearly as compelling as the types of LDLs we have. Our medical establishment is still hyperfocused on the amount of cholesterol we have, yet people with low-medium cholesterol levels have heart attacks every day. If it was simply a numbers game, this should not happen. The folks who have low numbers and CVD, tend to have dense, reactive particles and some other markers of systemic inflammation we will look at in a moment. When accurately a.s.sessing our cardiovascular risk factors, the bottom line with LDL cholesterol is we need to consider quality first (large or small particles) and quant.i.ty second.

Triglycerides What Is It?

When we talk about dietary fats, we are actually talking about triglycerides. This is a molecule with three fatty acids (tri-) attached to a glycerol backbone. Triglycerides are a measure of circulating blood fats, so you would think a "high-fat diet" would mean high triglycerides, right? Interestingly, this is not the case. Triglycerides are in fact an indicator of dietary carbohydrate and insulin sensitivity. High carbs and poor insulin sensitivity = high triglycerides. Don't forget, excess dietary carbohydrate is converted to palmitic acid in the liver! Counterintuitively, excessive carbohydrate intake forms the backbone not only for most triglycerides but also small, dense, reactive LDL particles.

How Much?

Ancestral levels of triglycerides appear to be in the 5080 mg/dl range. Triglycerides are, however, more the "canary in the coal-mine" than a direct cause of problems. If we have low triglycerides, we can be pretty sure we are not taking in too many dietary carbohydrates and our lifestyle issues are in order such that we are insulin sensitive. Conversely, if our triglycerides are above 100, we are likely to develop problems with inflammation and a s.h.i.+ft toward the atherogenic blood profile predominated by small, dense LDL particles. Our clients routinely have triglycerides in the range of 3040 mg with their other blood lipids following in lockstep. Oh, yeah-booze can create havoc with your triglycerides. If you are not particularly insulin sensitive, you need to go easy on the booze. Robb's Rule for Boozing: Drink enough to optimize your s.e.x life, not so much that it impacts your blood lipids.

Hb1Ac (also goes by the alias "A1c") The A1c has been one of my favorite lab values for years. It is a measure of how much sugar is sticking to your red blood cells. Since your red blood cells replace themselves every 120 days, this gives you a measure of your blood glucose levels over time. Folks with blood glucose management problems are encouraged to monitor blood glucose levels. This is helpful, but it provides a narrow slice of information. Blood glucose levels can be misleading in that they may be abnormally high or low at a given point due to stress, exercise, or other factors. The A1c is inexpensive, accurate, and tells us a ton of information. If your A1c level is above 5, you have big problems brewing. Your likelihood of CVD, cancer, and all the problems a.s.sociated with elevated insulin levels is greatly elevated. I'd like to see your A1c level in the 4s. Keep in mind, if sugar is sticking to your red blood cells, it is also sticking to all the vital proteins in your body. This process, advanced glycation end products, appears to be the mechanism behind much of what we a.s.sume to be "normal" aging. Stiffness, loss of vision, and decreased kidney and brain function share AGEs as a causative mechanism. The A1c can tell us much about your nutrition, as well as your lifestyle. Inadequate sleep or other stressors that impair insulin sensitivity will manifest in elevated A1c, even if your nutrition is solid. I have recommended this biomarker in situations as different as cortisol management to gestational diabetes because of the amount of information obtained from this one measure.

C-Reactive Protein What Is It?

C-reactive protein (CRP) is a marker of systemic inflammation. It is a by-product of immune cell activity and is not a problem itself, but rather an indicator of overall inflammation. If you have an infection, CRP will be elevated (hopefully), as you have immune cells battling the infection. This battle between your immune system and the infectious agent, be it viral, bacterial, fungal, or parasitic, causes an increase in CRP. What if you have elevated CRP but do not appear to have an infection? This may be an indicator of hidden inflammation in wacky places like the intestines or your gums. It is well understood that brus.h.i.+ng and flossing is strongly correlated with decreased incidence of cardiovascular events. Why? Because dealing with gingivitis decreases systemic inflammation, which can increase one's likelihood of developing atherosclerotic lesions. Now consider that you have significantly more surface area in your intestines. What if they are inflamed from Neolithic foods, stress, and inadequate sleep? You can bet your CRP is elevated due to elevated immune activity and systemic inflammation.

How Much?

Healthy levels of CRP are below 1.0 mg/l. If you start with high numbers, altering your food and lifestyle should bring this number down.

Hypothetical Blood Work Now that we have what to look for with regard to blood work, let's look at a hypothetical scenario so these numbers have some context. I will also look at the factors that are causing these numbers and how we might expect them to change with some smart nutrition and lifestyle changes.

Donny "DOA" Donnatelli Donny is a forty-five-year-old business owner in Las Vegas. He travels frequently, as he must oversee the growth of his IT company. Donny rarely sleeps more than five hours per night, and he is driven and stressed. He is married, has three kids. He has not exercised in years, and his nutrition is rough by anyone's standards: Breakfast: Venti Caramel Macchiato with extra whip-cream, scone.

Snack: Donny makes frequent rounds at the office, as there are numerous trays of cookies and pastries littered about.

Lunch: Sandwich, soda, bag of chips, large cookie.

Dinner: While his wife makes his favorite meal, spaghetti and meatb.a.l.l.s, Donny "unwinds" with a martini or three. With his main course, he eats toasted French bread with olive oil and consumes three gla.s.ses of wine. Tiramisu for dessert.

Donny has gained quite a bit of weight the past few years, but he is a big guy and has adjusted his wardrobe "up" when he needs new clothes. One day while trying to make a connection in the worst airport in the world, Phoenix Sky Harbor, Donny feels light headed and has some tightness in his chest. When he gets home, his wife guilts him into going to the doctor. His family doctor runs some standard blood work and refers him for a cardiac stress test. The cardiac stress test shows impaired heart function. Donny's blood work comes back the following: Total cholesterol: 275 HDL 38.

LDL 145.

LDL particle size (predominantly type B, small, dense particles) Triglycerides 300 A1c 5.8 Blood glucose 102 C-reactive protein 4.2 mg/l Donny is lucky in that his doctor is a member of the Physician Network for Paleolithic Nutrition. His doc knows there is much more to the story than HDL/LDL. At Donny's follow-up, his doctor points out that in addition to Donny's poor performance on the cardiac stress test, he also has sleep apnea, serious acid reflux, and what might be gall-stones.

Donny's doctor lays it out: Donny will be lucky to see the age of fifty. He has a better chance to win the lottery than see age sixty. Without a serious overhaul, Donny's wife will be collecting his life insurance and retiring to Florida with Raul the pool boy. Donny likes the idea of that happening even less than dying, so he takes his doctors advice 100 percent-a grain-free, dairy-free, Paleo diet. He cuts back his travel schedule and starts delegating more tasks. He begins lifting weights a few days a week and walks on the other days. He guts the house and has nothing that is not fish, fowl, meat, fruit, veggies, or nuts in the pantry. The kids have a meltdown for a few days, then decide apples, oranges, almonds, and jerky are pretty d.a.m.n tasty, especially when compared to starvation.

Six weeks later, Donny goes in for a checkup. He is down almost twenty-eight pounds and has removed four inches off his waist. His acid reflux and sleep apnea are "gone." His blood work has changed "a little": Total cholesterol: 177 HDL 58.

LDL 102.

LDL particle size (mainly type A, large, nonreactive) Triglycerides 84 A1c 5.1 Blood glucose 85 C-reactive protein 2.5 mg/l This is very typical for a four- to eight-week change. Insulin levels plummeted due to a change in eating and lifestyle. Total cholesterol, triglycerides, and A1c dropped due to a decrease in dietary carbohydrates. HDL went up due to exercise and fish oil. Blood glucose is lower due to better overall diet, lower stress, and better insulin sensitivity. LDL particles have s.h.i.+fted to the large, puffy type A profile. With continued adherence to this program, these numbers would likely settle out in this neighborhood: Total cholesterol: 153 HDL 58.

LDL 78.

LDL particle size (type A, large, nonreactive) Triglycerides 45 A1c 4.6 Blood glucose 72 C-reactive protein 0.7 mg/dl Is Donny's example extreme? Unfortunately, his previous lifestyle is all too common and is closer to the norm than not. Fortunately, however, his change is quite typical of someone who gives the program a legitimate shot. I have worked with dozens, if not hundreds, of "Donnys," and if they actually commit to the program, none find the sacrifice to be greater than the benefits: improved health and longer life.

How Often Should I Track Blood Work?

If you are sick and just beginning a program of nutrition and lifestyle changes, you should get a baseline before making any changes, run with things for a month, then retest. If you are sick or significantly overweight, I'd track blood work monthly for three to six months. This will give you a window into your change, and it offers nice support and motivation for your efforts. Once you reach a stable maintenance level, rechecking blood values once per year is fine, so long as your compliance is solid.

What If Things Are Not Working?

Are things going in the right direction? They should be, and if they are not, let's make the first point of evaluation one of honest self-reflection: Are you really doing the program 100 percent. Sleep, food, exercise? The folks we see who have "problems" in their blood work happen to be the same people who have "compliance issues." This stuff works, but only if you do it.

I've worked with enough people now to understand the trends clearly. Do some people tolerate more carbohydrate than others? Yes, so if we do not see triglycerides fall or LDL particle sizes change, and you are still eating a bunch of carbs, even if it's from "Paleo carbs" like fruit, we have an obvious place to look for a fix. Although we will look at different levels of compliance, if you have blood work that is in the danger zones, and you want that to change, do a grain-free, dairy-free Paleo diet, no exceptions. Sleep. Exercise. If you are not doing the program but hoping to garner the results, this is simply not realistic. Give the program a shot, get healthy, then decide if health and long life are actually worth the "sacrifices."

What about Statins?

Whenever blood work is discussed, statins are not far behind. The drugs were developed when we first thought cholesterol was the cause of CVD. They are designed to lower cholesterol with the idea being lower cholesterol = decreased CVD. Well, statins do lower cholesterol, and they also lower CVD risks for some people, but it has little to do with the cholesterol-lowering effects. When you dig a little deeper into the pharmacology of statins, you find they are anti-inflammatories. Unfortunately, however, statins also have some nasty side effects. If you have high cholesterol, your doctor will want to put you on statins. Your doctor is likely to think all this Paleo talk is unscientific prattle, so here is a deal you might try to broker with your doc: Let you try this madness for thirty to sixty days. Track the above recommended blood work. Take some fish oil and a few other supplements we will look at later. If everything goes the direction it "should"-i.e., your systemic inflammation goes down, your LDL particles s.h.i.+ft to the type A profile, your triglycerides plummet, your HDL goes up-maybe, just maybe, you do not need statins. That is ultimately up to you and your doctor to hash out, but if the main pharmacological action of statins is anti-inflammatory (it is), why is an anti-inflammatory lifestyle change not as good?

What If Things Are a Bit Different?

Occasionally, we have a client whose metabolism is just a bit different and the total cholesterol does not come down as much as they and their doctors might want. Is it time to panic or go wild with statins? I don't think so! Here's what I'd look at: CRP-If C-reactive protein is low, your systemic inflammation is likely low.

LDL particle size should be large and puffy. If this is the case, things are looking good.

A1c should be less than 5. If so, back away from the statins.

Triglycerides are less than 50 mg. If your other biomarkers are in line, it's virtually a given this will be in line as well. If it's not, then it means we have some excess carbohydrate, stress, or a combination of the two.

What if all these biomarkers are just, well, close to being good? Well, how much do you enjoy living? If the biomarkers do not fall into place, you might have some genetic variability that makes your numbers a bit odd, and that may or may not mean a d.a.m.n thing for your CVD risks. But this is rare. More often, these borderline numbers are proof you are a Cheater Mccheaterkins. Lack of compliance means lack of results, so be honest with yourself in this regard. It's just your life.

Here is all of the above information in one location. It includes the biomarker and recommended amounts or ranges, but remember, many of these items have a complex story a.s.sociated with them.

Cholesterol total: 120140 mg/dl HDL cholesterol >50 mg/dl LDL cholesterol 4070 mg/dl Triglycerides 5080 mg/dl C-reactive protein <1.0 mg/dl="" hb1ac=""><5>

Thirty-Day Meal Plan I'm pretty handy in the kitchen, but I wanted to bring in a different voice for the thirty-day meal plan. The first person I thought of was my good friend, strength coach and "underground" chef, Scott Hagnas. Scotty is not only one of the most knowledgeable coaches I know, he is also amazingly talented in the kitchen. Scotty has written a monthly Paleo Recipe column for the Performance Menu online journal for four years, and he has two amazing Paleo recipe books (Cooking for Performance and Health vols. 1 and 2, available at www.performancemenu.com).