Blood panel
Enter Roadmap blood markers from your lab report. Choose the unit printed on the report. Targets convert with the unit.
Temperature and pulse come first. Use Tracking. For drug, vitamin, and mineral unit math, use Lab units. Educational only. Not medical advice.
See also Blood Tests, Thyroid, and Roadmap step 2.
Prolactin
Target: Male 4-7 ng/mL, female 1-12 ng/mL.
Roadmap. Lower is better. Rises with TSH. mIU/L uses WHO ~21.2 (assay-dependent).
I think the prolactin should be around 9 to 12. Prolactin and TSH tend to increase together.
The "normal range" for prolactin has been expanded upward. The lower range was better for judging health.
Prolactin and TSH tend to increase together. Optimally, the TSH should be very low, but the thyroid gland should keep functioning without needing much stimulation.
Total cholesterol
Target: 160-200 mg/dL.
Roadmap. SI: mmol/L × 38.67 ≈ mg/dL.
If your cholesterol is above 200, and the thyroid supplements didn't warm you up, it's possible that something is interfering with your steroid synthesis.
If low cholesterol is combined with slightly low thyroid, the protective steroids aren't produced in normal amounts, and inflammatory processes develop.
Keeping the cholesterol in the range of 160 to 220 helps with stress, too.
Reverse T3
Target: No fixed target.
No fixed Roadmap number. Stress and cortisol drive inactive rT3.
Yes, it's probably induced by stress, with cortisol inducing the type of deiodinase that makes the inactive rT3. A low sugar diet can cause chronically high cortisol.
Stress hormones are responsible for raising reverse T3, and just supplementing T3 is seldom enough to normalize the stress hormones.
TSH
Target: Below 1 mIU/L, ideally near 0.4 mIU/L.
Roadmap: below 1, near 0.4. mIU/L = µIU/mL.
I think it's best to keep the TSH around 0.4. I think it's good to have TSH below 0.4.
Usually free T3 and TSH are the most important ones. Judging by symptoms, temperature, and pulse rate is really the basic thing.
I think it's best to keep the TSH around 0.4.
PTH
Target: Near 15 pg/mL (±5).
Roadmap ~15 pg/mL. Intact PTH: pmol/L × 9.43 ≈ pg/mL.
High parathyroid hormone will increase calcium and lower phosphate. Both vitamin D and calcium in the diet tend to lower parathyroid hormone.
I think 50 ng/ml is a good goal. The point at which it lowers parathyroid hormone would be the right amount.
Both vitamin D and calcium in the diet tend to lower parathyroid hormone, and the serum calcium level.
CO2 / bicarbonate
Target: Near 30 mmol/L (±3).
Panel total CO2 / HCO3. mmol/L = mEq/L. Not blood-gas mmHg.
Did they mention the CO2 or bicarbonate? That's usually low with hypothyroidism, and CO2 is what regulates calcium.
Did they mention the CO2 or bicarbonate? That's usually low with hypothyroidism, and CO2 is what regulates calcium.
Did they mention the CO2 or bicarbonate? That's usually low with hypothyroidism, and CO2 is what regulates calcium.
Serum calcium
Target: Near 9 mg/dL (±0.5).
Roadmap ~9 mg/dL. SI: mmol/L × 4.008 ≈ mg/dL.
Keeping the phosphate in the diet low relative to calcium might help, also vitamin D.
High parathyroid hormone will increase calcium and lower phosphate.
Milk and cheese are the best foods for getting enough calcium.
Serum phosphate
Target: Near 3 mg/dL (±0.5).
As elemental phosphorus. SI: mmol/L × 3.097 ≈ mg/dL.
Keeping the phosphate in the diet low relative to calcium might help, also vitamin D.
High parathyroid hormone will increase calcium and lower phosphate.
Keeping the phosphate in the diet low relative to calcium might help, also vitamin D.
Ferritin
Target: No fixed target.
Peat distrusted ferritin alone (Tier 4): it rises with inflammation, not just iron stores. Watch hemoglobin/transferrin saturation too.
High ferritin doesn't directly imply high iron stores, it has a defensive effect, and can be increased by inflammation. TSH promotes inflammation.
I don't think ferritin is meaningful enough to worry about. Watching your hemoglobin level at the low end of the normal range is the safest place to be.
Ferritin should basically be an intracellular storage form that's invisible to anything in the blood. But as you start getting stressed and overloaded, it starts leaking out of the cells.
Cortisol
Target: No fixed target.
No fixed Roadmap number. Peat judged it against protective steroids (pregnenolone, progesterone, DHEA, testosterone), not the number alone.
With age, if you're producing less of the protective steroids, a given amount of cortisol might not look extremely high in relation to the standards. But if your pregnenolone, progesterone, DHEA, and testosterone are lower than average, even a moderate amount of cortisol begins eating up your muscles and skin.
It's popular to talk about "weak adrenals," but the adrenal cortex regenerates very well.
Thyroid is needed for the adrenals to function well, and adequate cholesterol, as raw material. So I think the "low adrenal" people are simply low thyroid, or deficient in cholesterol or nutrients.
Free T3
Target: No fixed target.
Peat considered the dialysis 'free' hormone method itself misleading; temperature and pulse read T3 status better than this number.
Ask them what they mean by free, exactly. The idea of a free hormone is very vague and contradictory. The way they measure it, I think currently they're still using a dialysis method that what passes through a dialysis membrane is called free. But in the blood, hormones actually travel with proteins and fats and in and on the blood cells.
The blood isn't such a great test for thyroid anyway because if you have more estrogen, more cortisol, more free fatty acids, different amounts of protein, a given amount of T3 or T4 in your blood isn't going to have the same effect on the cells.
The thyroid hormones can bind to albumin, for example. Albumin has free access in and out of cells, even into the nucleus. So anything bound to the albumin is going in and out of cells.
Vitamin D (25-OH)
Target: Near 50 ng/mL (±10).
One of the few blood tests Peat specifically recommended. Target ~50 ng/mL, the level that suppresses PTH. SI: nmol/L × 0.4 ≈ ng/mL.
During the winter for a couple of months 10,000 units of D should be safe, but it's better to increase calcium and vitamin K, keeping the vitamin D a little lower unless you have the blood level checked occasionally.
Usually 2000 i.u. during the winter will make up for no sunlight. Some people need 5000 iu according to their blood tests, to keep it in the middle of the range.
I think 50 ng/ml is a good goal. The point at which it lowers parathyroid hormone would be the right amount.
Fasting glucose
Target: Near 90 mg/dL (±10).
Peat considered low blood sugar more dangerous than mildly high. ~90 mg/dL alongside stable BP and an 80-85 pulse marks good metabolic function.
To a great extent, the rising blood sugar shouldn't be fought in itself, the cause that interferes with the use of glucose should be concentrated on.
Blood sugar normally falls during the hours of darkness. This is compensated by a rise in free fatty acids in the bloodstream. That is the same pattern that happens when you are under stress.
That tends to go with a stable blood sugar usually around 90 and a stable blood pressure usually roughly in the range of 120 over 80.
Testosterone
Target: No fixed target.
No fixed Roadmap number. Peat judged it against cortisol and estrogen: testosterone above mid-range, cortisol and estrogen below.
It's best to have cortisol no higher than the middle of the range, estrogen below the middle, testosterone above the middle.
4 milligrams of testosterone and 15 mg of DHEA is a normal daily production for young men, and half of that amount is effective for middle aged men, unless the problem is something else.
Too much thyroid can create stress and waste testosterone. Not enough thyroid will cause testosterone to be converted into estrogen.
Progesterone
Target: No fixed target.
Serum underrepresents brain levels (~10x higher). No fixed Roadmap number; read against estrogen (E2:P4 ratio matters more than either alone).
Progesterone won't turn into estrogen, but along with thyroid and aspirin it will tend to reduce the amount of estrogen in the body.
Since progesterone helps the thyroid to secrete, and helps the liver to regulate glucose and convert T4 to T3, women who are low in progesterone usually have hypothyroid symptoms.
When progesterone is available and fills that protein receptor, it destroys the estrogen receptor, so progesterone is an anti-estrogen in a very absolute sense.
Estradiol
Target: No fixed target.
Peat distrusted serum estrogen (Tier 4): tissue estrogen rises with age while serum falls. Read against progesterone, not alone.
Estrogen increases the formation of serotonin, and both of these substances increase the formation of prolactin, and activate the renin-angiotensin system, and increase secretion of the antidiuretic hormone vasopressin, all of which synergize with estrogen in promoting water retention.
It's best to have cortisol no higher than the middle of the range, estrogen below the middle, testosterone above the middle.
When progesterone is available and fills that protein receptor, it destroys the estrogen receptor, so progesterone is an anti-estrogen in a very absolute sense.
DHEA-S
Target: No fixed target.
No fixed Roadmap number. Peat's supplement hierarchy: pregnenolone first, DHEA second, testosterone only if needed.
Its production decreases fairly steadily with age, from a daily maximum of 12 to 15 mg in the teens, to nearly zero at 90, so supplements of 5 to 10 milligrams are usually safe for middle aged people.
If your thyroid is very low, you should be cautious with the DHEA, because stress hormones can cause it to turn to estrogen.
Thyroid and other antiinflammatory things (even aspirin) help to prevent conversion to estrogen.
Serum magnesium
Target: No fixed target.
Peat considered serum magnesium unreliable (Tier 3): only ~1% of body magnesium circulates. Thyroid status governs cellular retention more than intake.
Getting enough sodium in the diet helps to retain magnesium, but both of them are lost easily when thyroid function is low; when the thyroid status is good, the requirement for magnesium is easily met by ordinary foods.
The things I most often recommend for magnesium are the water from boiling greens such as beet, chard, turnip and kale, and coffee. Magnesium carbonate is a very good supplement, except that it can cause intestinal irritation.
Cooked green leaves, or the water they were boiled in, is a very good source of magnesium, with other minerals in safe ratio. Coffee is another good magnesium source.
Pregnenolone
Target: No fixed target.
Rarely on routine panels. Brain levels run ~10x blood levels, so serum underrepresents neurological status. Deficiency common by the forties.
You can't push upstream in the adrenals. The more pregnenolone or progesterone you take, the more normal you become. It is the endpoint hormones, like aldosterone, estrogen, and cortisol, that are produced normally only in extreme situations.
Lipschutz called pregnenolone and progesterone the anti-fibromatogenic steroids, they start out inhibiting fibrous overproduction and end up protecting against tumors.
It turns into either progesterone or DHEA, according to need.
Free T4
Target: No fixed target.
T4 is a precursor Peat considered nearly meaningless alone. What matters is the T4:T3 conversion ratio (healthy ~3:1-4:1) and functional signs.
Pigs' and cows' thyroids are very similar to people's, with a ratio usually between 3:1 and 4:1. The blood serum of hypothyroid people can have a ratio of 50:1 or 100:1, when the liver is failing to convert thyroxin.
In diabetes, when cells aren't getting enough glucose, T4 can't be converted to the active T3, and so it can build up in the body to levels that interfere with metabolism, but the advantage of a combination is that T4 inhibits TSH.
It probably leads to more reverse T3 production. Sometimes a vitamin D deficiency interferes with how your body is handling the thyroid.
Fasting insulin
Target: No fixed target.
Peat treated 'insulin resistance' as a protective adaptation to PUFA-blocked glucose oxidation, not pure pathology. No fixed Roadmap number.
Several years ago, medical people started talking about the harmful effects of insulin, such as stimulating fat production, so 'insulin resistance' which keeps a high level of insulin from producing obesity would seem to be a good thing, but the medical obesity culture really isn't thinking very straight.
One factor in the 'insulin resistance' created by PUFA involves estrogen, chronic accumulation of PUFA in the tissues increases the production of estrogen, and the polyunsaturated free fatty acids intensify the actions of estrogen, which acts in several ways to interfere with glucose oxidation.
Any polyunsaturated fats out of storage are very toxic to the insulin-producing cells in the pancreas. Normally they're constantly turning over; in a diabetic they're being renewed faster than normal.
Vitamin B12
Target: No fixed target.
Peat considered serum B12 unreliable without functional markers (MCV, homocysteine, symptoms); blood level doesn't always track functional status.
I don't think the real causes of a B12 deficiency are known. A generous dietary source of both A and B12 is desirable, but usually not essential.
Without adequate B12, red blood cell precursors cannot divide normally, producing large, immature cells (megaloblasts) instead of normal red blood cells.
Carotene can be converted to vitamin A when B12 is available.
SHBG
Target: No fixed target.
Context marker, not a target by itself: read alongside testosterone, estrogen, and cortisol. High SHBG is protective against estrogen but can limit free testosterone.
I think that is the body's defense against estrogen. When it's high, a woman has a lower risk of breast cancer because it keeps the estrogen out of cells. It actually tends to pull estrogen out of cells protectively.
They've attached the hormone covalently to albumin so that it can't possibly get loose. So it's absolutely a protein-bound hormone, and they find that it works. It goes right into the cell.
It's best to have cortisol no higher than the middle of the range, estrogen below the middle, testosterone above the middle.
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Notes
[edit]- Markers: prolactin, total cholesterol, reverse T3, CRP, TSH, PTH, CO2, serum calcium, serum phosphate.
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