Reassessment

You have completed all 4 experiments, sugar, fitness and strength, sleep and food and now it is time to repeat your assessment and see if you have achieved the goals that you set out when you started the lifestyle experiment. Now we can step back and look at the entire picture again to determine whether or not those goals have been met or whether further intervention is needed. Here is a guide to some of the top goals that you should be striving for with each successive trip through the lifestyle experiment cycle.

1. Reduction in Body Fat and in particular Visceral Fat: Many of our patients are trying to eliminate visceral fat all together. This goal is ambitious but not impossible to achieve especially if you really emphasize the sugar experiment and the fitness part of the fitness and strength experiment. If you can't achieve that, then try for a body fat percentage less than 20% for men and 30% in women. That is a great place to start.
   

2. Improvements in Muscle Mass: Particularly if you are older than 65 and have started to see a decline in your muscle mass, you will want to emphasize this goal. To focus on this goal you should emphasize the strength part of the fitness and strength experiment and you will want to focus on protein intake as part of the food experiment.
   

3. Improvements in Fat Metabolism: All 4 experiments have an impact on insulin resistance and therefore fat metabolism. It should be a major part of your entire experiment. Consider the following goals in order of importance:
   

   1. Triglycerides: You should try and lower your fasting triglyceride level by as much 20-50% depending on where you started out. Absolute values less than 100 are another target. The sugar experiment is the best way to quickly lower triglyceride followed by the fitness experiment and then the food experiment.
      

   2. Total Cholesterol and LDL: We have seen many patients lower their total cholesterol to less than 200 and their LDL to less than 130 using the lifestyle experiment. Depending on your risk factors for heart disease, you may already have been given these targets by your physician, so this one is a good one to discuss with your doctor before you set specific goals.
      

   3. HDL: The most effective way to raise your HDL is through cardiovascular exercise and loss of body fat. It is surprisingly, not affected as much by the food experiment as you would think. Reducing concentrated carbohydrate as we do in the sugar experiment is helpful too. Men should try and get their HDL above 45 and women should try and get it above 55 using the lifestyle experiment. In some cases you won't be able to to achieve this due to genetics in and in others it will be quite easy.
      

4. Eliminate all evidence of inflammation: We can not underemphasize the importance of this goal. Too often what we see in our program is people who lower their cholesterol with medicines as a way to avoid heart disease. While this can be an important thing to do, and we do support the use of cholesterol lowering medicines, it is insufficient for cardiovascular prevention. Elimination of body fat and improvements in insulin sensitivity both have a profound effect on inflammation. As long as you don't have another reason for inflammation, such as asthma, severe allergies, autoimmune disease etc. you can target getting your hsCRP below 1.0 by using the lifestyle experiment.
   

5. Improve measures of glucose control: Sustained improvements in glucose control are a primary goal of the lifestyle experiment. It seems intuitive that the Sugar Experiment should be the emphasis for this goal but all 4 experiments can have profound effects on glucose control including the Sleep Experiment. Consider the following targets for your lifestyle experiment:
   

   1. HbA1c: The classic goal for blood glucose control is HbA1c. Your goal for this metric depends on where you started out. If you started out above 7, you are probably already working with your doctor on diabetes medicines. If you are not, now is a good time to do that. If you started at less than 7, then you should target getting your HbA1c below 6 using the lifestyle experiment. If you started at a value between 5.6 and 6 (mild "prediabetes) then you should target normalizing your HbA1c to 5.6 or less.
      

   2. Fasting Insulin: Use this metric if you have prediabetes or increased visceral fat. In fact, it may be the most important metric in the entire program in those cases. If you have elevated fasting insulin level, it will be very difficult to lose weight and body fat until you get it down. You should target getting your fasting insulin to less than 10.
      

   3. Fasting Glucose: This is one of the major goals in the sugar experiment and you should retest it now during the reassessment. Your goal is a fasting glucose less than 100.