Dr. Padda once ran a heat experiment on himself in a sauna. He drew his own blood, wore a heart monitor and pushed his heart into an irregular rhythm called bigeminy. A cold plunge brought it back. He will tell you that was not his smartest afternoon. It did teach him the rule he now applies to every patient who crosses the river: read the body’s chemistry before you change it, not after.

Which blood test will show inflammation?

Two tests do most of the work. The hs-CRP test, short for high-sensitivity C-reactive protein, measures a protein the liver makes when inflammation is running. ESR, the sed rate, measures how fast red blood cells settle in a tube. Both are on the guideline’s list of optional tests.

Both share one limit. They say inflammation is present. They do not say where it is or why it started. A high hs-CRP in someone with back pain could come from the back, the gums, the liver or the fat around the organs.

In chronic pain, the why is usually metabolic. Dr. Padda’s position is that roughly 93% of chronic pain involves metabolic dysfunction. Two engines feed that fire. High insulin keeps tissue in storage mode instead of repair mode. Fat packed around the organs sends out inflammatory signals day and night. Then life adds fuel. Rotating shifts at the refinery or the mill wreck sleep. Dinner comes from a gas station. A long commute leaves no time to cook. The inflammation test sees the smoke. The metabolic tests find the fuel.

What blood tests should I get before starting a low-carb diet?

The guideline sets a baseline before anyone cuts carbs. Your doctor records your weight, height, waist size and blood pressure. Then come three blood tests and one urine test:

• A comprehensive metabolic panel. It checks blood sugar, liver, kidneys and body salts.
• A lipid panel. Total cholesterol, LDL, HDL and triglycerides.
• Hemoglobin A1C. Your average blood sugar over about three months.
• A urine albumin-to-creatinine ratio. This one is for people with diabetes, to check the kidneys.

The guideline then lists optional tests, chosen by need. They include fasting insulin or HOMA-IR, thyroid tests, vitamin D, hs-CRP, ESR, uric acid, B12 and C-peptide. It also lists an advanced NMR lipid panel with ApoB and Lp(a), a DXA body-fat scan and a coronary calcium score.

Know what kind of document this is. The guideline is expert agreement, not a clinical trial. A panel voted in rounds; 26 people answered the final round, and all 18 statements cleared a 70% bar. The authors say they did not formally grade the evidence. Dr. Padda holds the society’s Metabolic Health Practitioner credential. He did not write or vote on this guideline.

Which tests find insulin resistance before A1C does?

Dr. Padda orders a wider panel, and he reads it in order. Each marker moves at a different stage of the damage.

• LP-IR. A score from the advanced lipid test. He treats it as the early marker of insulin resistance, the one that climbs before A1C does.
• Fasting insulin. He reads it on its own, not only inside HOMA-IR. In our clinic, a fasting insulin above 10 µIU/mL is high risk.
• GGT. A liver enzyme that warns of fatty liver early. His risk cutoff is above 20 U/L, well under where most lab reports raise a flag.
• Oxidized LDL and the omega-6 to omega-3 ratio. Read together, they show how much processed food and seed oil the diet carries.
• Omega-3 index. The share of omega-3 fat in your red blood cells. His target is above 8%.
• hs-CRP. The general fire alarm, read next to everything above.
• Vitamin D. Measured as 25-hydroxyvitamin D.
• B12, with MMA or holotranscobalamin. A plain B12 level can look normal while the body runs short.
• Homocysteine. A check on whether your B vitamins are doing their job.

The guideline names fasting insulin, hs-CRP, vitamin D, B12 and the NMR lipid panel. LP-IR, GGT, oxidized LDL, homocysteine and the omega markers are Dr. Padda’s additions. He adds them because they move first. By the time A1C rises, the damage has had years to work. For the steroid side of this story, read why a pain clinic checks your blood sugar.

Who should not start a low-carb diet alone?

Most people can start with a doctor watching. Some need a written plan first. The guideline names these groups:

• Kidney disease. Protein is held near 0.8 grams per kilogram of body weight a day. That is lower than the usual low-carb goal.
• Gout. Ketones and uric acid leave through the same exit, so uric acid can rise during the switch. A flare is more likely early. The rise settles over 2 to 8 weeks, and a doctor may use preventive medicine such as colchicine.
• Gallbladder disease. A slower start, especially after the gallbladder has been removed.
• Pregnancy and breastfeeding. No planned ketosis. Carbs stay above 50 grams a day from starchy vegetables or fruit, and ketones are checked.
• Other conditions. Pancreatitis, heart rhythm problems, heart failure, eating disorders, Addison’s disease, or a long list of medicines all call for a specialist’s eye.

Medicines are the other half. If you take insulin, a sulfonylurea, an SGLT2 inhibitor or blood-pressure pills, your doctor changes those doses, not you. Some need to come down on day one. The guideline also says joint pain and migraine may ease as metabolic health improves. That means the medicines for those deserve a second look, too.

This is one reason sodium belongs in your baseline labs. The guideline lists NSAIDs, opioid pain medicines and several antidepressants among the drugs that can make low sodium worse once carbs come down. Sodium is already part of the comprehensive metabolic panel the guideline lists as a baseline test, so the number is there before day one.

Is inflammation in a blood test serious?

It is a signal, not a verdict. One high reading can follow a cold, a bad night or a hard week. A reading that stays high, next to a high fasting insulin and a high GGT, is a pattern. Patterns are what we treat.

The useful move is to test before you change anything, and again after. Then you know what the change did. Without a first number, the second number means very little.

Bring your numbers across the river

If you live in the Metro East, bring the last year of lab results from your Illinois doctor. We read what is already drawn and add only what is missing. You leave with a plan built on your own numbers, not a diet sheet. Our page on metabolic health and pain explains why the terrain matters as much as the MRI.

Reading the chemistry first protects three things. It protects the tissue you are trying to heal. It protects you from a medicine dose that no longer fits your body. And it turns “eat better” into numbers you can watch move.

Frequently asked questions

Do I need to fast for these blood tests?

Sometimes. The guideline lists a fasting lipid panel. It says the metabolic panel does not need fasting if an A1C is drawn with it. Fasting insulin is, as the name says, a fasting test. Ask which tests are on your order before you eat breakfast.

Will a low-carb diet raise my cholesterol?

LDL may rise for a while during weight loss, and it often returns to where it started, according to the guideline. HDL tends to rise and triglycerides tend to fall. The authors say some uncertainty remains until outcome studies are done. That is one more reason to draw a lipid panel before you start.