Our Cannondales came with 30-42-52 cranksets, and 11-32 cassettes. With full load this wasn't quite low enough. I first just changed the inside chainring to a 24. I thought that different chainrings would help, so i changed the cranks to a "touring" crank, with 28-38-48. I still changed the inner ring to a 22. I almost never use the granny ring, but I do find the 38 and 48 are a lot more usable than the original 42/52 rings. I almost never used the big ring(52), even when not carrying a load, and had to go to the granny ring more. Now the big ring is usable, and even on most hills you don't need the granny ring. But its there when you need it, whether its because the hills are too steep, too long, or you are too tired. And yes, it all shifts fine with STI shifters.