TOBIN Domain Reference

Symptom questions (6)

• · How often are you around solvents, fumes, dusts, metals or industrial chemicals at work?
• · When exposed at work, how often is ventilation or protective equipment inadequate?
• · How often do you eat or drink from plastic containers, or heat food in plastic?
• · How often do you use fragranced personal-care or cleaning products?
• · How often are pesticides or herbicides used in your home, garden or neighborhood?
• · Has your home had water damage, dampness or visible mold?

Lab cutoffs (4)

• ALT (concern rises above 33 U/L; full at 200) — hepatic loadSource: ACG: upper limit of normal ≈ 29–33 U/L (men), 19–25 (women)
• GGT (concern rises above 50 U/L; full at 200) — hepatic and oxidative loadSource: Typical laboratory upper limit ≈ 50 U/L
• Blood lead (concern rises above 1 µg/dL; full at 10) — lead body burdenSource: CDC blood lead reference value 3.5 µg/dL (2021)
• Blood mercury (concern rises above 5 µg/L; full at 20) — mercury body burdenSource: EPA reference dose ≈ 5.8 µg/L blood equivalent

Symptom questions (4)

• · How many hours do you usually sleep?
• · How often do you feel exhausted even after rest?
• · How many days a week do you exercise?
• · Do you smoke, vape, or spend time around tobacco smoke?

Lab cutoffs (20)

• HbA1c (concern rises above 5.6 %; full at 8) — glycemic stressSource: ADA Standards of Care: 5.7–6.4% prediabetes, ≥6.5% diabetes range
• Fasting glucose (concern rises above 99 mg/dL; full at 180) — glycemic stressSource: ADA: 100–125 mg/dL impaired fasting glucose, ≥126 diabetes range
• ApoB (concern rises above 90 mg/dL; full at 160) — atherogenic lipid loadSource: ACC/AHA & ESC: ApoB ≥130 mg/dL is a risk-enhancing factor
• Triglycerides (concern rises above 149 mg/dL; full at 500) — metabolic lipid stressSource: NCEP ATP III: 150–199 borderline, 200–499 high, ≥500 very high
• HDL cholesterol (concern rises below 50 mg/dL; full at 20) — low protective lipidSource: NCEP ATP III: <40 mg/dL low (men), <50 (women)
• ALT (concern rises above 33 U/L; full at 200) — hepatic loadSource: ACG: upper limit of normal ≈ 29–33 U/L (men), 19–25 (women)
• GGT (concern rises above 50 U/L; full at 200) — hepatic and oxidative loadSource: Typical laboratory upper limit ≈ 50 U/L
• Homocysteine (concern rises above 10 µmol/L; full at 30) — methylation / B-vitamin strainSource: >15 µmol/L elevated in most laboratory references
• Reverse T3 (concern rises above 24 ng/dL; full at 40) — stress / illness pattern of T4 conversionSource: Typical reference 9–24 ng/dL; guidelines (ATA) do not recommend rT3 for routine diagnosis — grade D
• Total cholesterol (concern rises above 199 mg/dL; full at 300) — lipid loadSource: NCEP ATP III: <200 desirable, 200–239 borderline, ≥240 high
• LDL cholesterol (concern rises above 99 mg/dL; full at 190) — atherogenic cholesterolSource: ACC/AHA 2018: ≥190 mg/dL severe; 160–189 high; optimal <100
• Non-HDL cholesterol (concern rises above 129 mg/dL; full at 220) — atherogenic cholesterolSource: NLA: non-HDL <130 mg/dL desirable
• LDL particle number (LDL-P) (concern rises above 1000 nmol/L; full at 2000) — atherogenic particle burdenSource: NMR LipoProfile (Labcorp): <1000 optimal, 1300–1599 borderline-high, ≥1600 high; MESA
• Small LDL-P (concern rises above 527 nmol/L; full at 1000) — small dense LDL (insulin-resistance pattern)Source: NMR LipoProfile: ≤527 nmol/L reference
• LDL particle size (concern rises below 20.5 nm; full at 19.5) — small LDL pattern BSource: NMR: >20.5 nm pattern A, ≤20.5 pattern B
• HDL particle number (HDL-P) (concern rises below 30.5 µmol/L; full at 20) — low protective particlesSource: NMR LipoProfile: ≥30.5 µmol/L reference
• Lp(a) (concern rises above 75 nmol/L; full at 250) — inherited atherogenic particleSource: ACC/AHA & EAS 2022: ≥125 nmol/L (≥50 mg/dL) risk-enhancing; measure once in lifetime
• sdLDL-C (small dense LDL) (concern rises above 30 mg/dL; full at 60) — small dense LDLSource: Denka assay (Quest Cardio IQ, Boston Heart): <30 mg/dL optimal (lab-specific)
• Lp-PLA2 activity (concern rises above 123 nmol/min/mL; full at 225) — vascular inflammationSource: PLAC Activity test (FDA-cleared): >123 nmol/min/mL higher risk
• Oxidized LDL (concern rises above 60 U/L; full at 100) — lipid oxidationSource: Lab-specific (Cleveland HeartLab ~<60 U/L); research-grade, grade C

Symptom questions (4)

• · Do you notice hormonal symptoms such as cycle irregularity, hot flushes, low libido or breast tenderness?
• · How much has your weight changed in the past two years without an intended change?
• · How often do you have cold intolerance, hair thinning, constipation or unexplained slowing?
• · How often is your stress level high enough to affect sleep or appetite?

Lab cutoffs (14)

• HbA1c (concern rises above 5.6 %; full at 8) — glycemic stressSource: ADA Standards of Care: 5.7–6.4% prediabetes, ≥6.5% diabetes range
• Fasting insulin (concern rises above 8 µIU/mL; full at 40) — insulin signaling loadSource: Common functional reference; interpret only with a true fasting sample
• TSH (concern rises above 4.5 mIU/L; full at 20) — thyroid signaling (high)Source: ATA/Endocrine Society: 0.4–4.5 mIU/L; >10 overt range
• TSH (concern rises below 0.4 mIU/L; full at 0.01) — thyroid signaling (low)Source: ATA/Endocrine Society: 0.4–4.5 mIU/L; >10 overt range
• Free T4 (concern rises below 0.9 ng/dL; full at 0.5) — low thyroid hormoneSource: Typical reference 0.8–1.8 ng/dL (assay-specific); interpret with TSH (ATA)
• Free T4 (concern rises above 1.8 ng/dL; full at 3.5) — high thyroid hormoneSource: Typical reference 0.8–1.8 ng/dL (assay-specific); interpret with TSH (ATA)
• Free T3 (concern rises below 2.5 pg/mL; full at 1.8) — low active thyroid hormoneSource: Typical reference 2.3–4.2 pg/mL; low T3 also occurs in illness and calorie restriction
• Free T3 (concern rises above 4.4 pg/mL; full at 7) — high active thyroid hormoneSource: Typical reference 2.3–4.2 pg/mL; low T3 also occurs in illness and calorie restriction
• Reverse T3 (concern rises above 24 ng/dL; full at 40) — stress / illness pattern of T4 conversionSource: Typical reference 9–24 ng/dL; guidelines (ATA) do not recommend rT3 for routine diagnosis — grade D
• Anti-TPO antibodies (concern rises above 34 IU/mL; full at 500) — thyroid autoimmunitySource: Common cutoff >34–35 IU/mL (assay-specific); marks Hashimoto's risk (ATA)
• Thyroglobulin antibodies (concern rises above 4 IU/mL; full at 200) — thyroid autoimmunitySource: Common cutoff ≤4 IU/mL (Roche) — assay-specific; positive in ~60–80% of Hashimoto's
• Small LDL-P (concern rises above 527 nmol/L; full at 1000) — small dense LDL (insulin-resistance pattern)Source: NMR LipoProfile: ≤527 nmol/L reference
• LDL particle size (concern rises below 20.5 nm; full at 19.5) — small LDL pattern BSource: NMR: >20.5 nm pattern A, ≤20.5 pattern B
• sdLDL-C (small dense LDL) (concern rises above 30 mg/dL; full at 60) — small dense LDLSource: Denka assay (Quest Cardio IQ, Boston Heart): <30 mg/dL optimal (lab-specific)

Symptom questions (5)

• · How often do you have allergy symptoms — sneezing, itching, hives, wheeze or eczema?
• · How often do you need antihistamines, inhalers or steroids for these symptoms?
• · How often do you have bloating, pain, urgency or irregular stools?
• · How often do you get infections needing antibiotics or antivirals?
• · How often do you have joint pain, stiffness or swelling?

Lab cutoffs (8)

• hs-CRP (concern rises above 1 mg/L; full at 10) — systemic inflammationSource: AHA/CDC: <1 lower, 1–3 average, >3 higher cardiovascular-inflammatory risk; >10 suggests acute process
• Ferritin (concern rises above 300 ng/mL; full at 1000) — inflammation or iron overload (high)Source: AGA 2020: ferritin <45 ng/mL supports iron deficiency; WHO <15 depleted
• Eosinophils (absolute) (concern rises above 500 cells/µL; full at 3000) — eosinophilic / allergic activitySource: >500 cells/µL eosinophilia; ≥1500 hypereosinophilia
• Total IgE (concern rises above 100 IU/mL; full at 1000) — atopic sensitizationSource: Adult reference typically <100 IU/mL; context-dependent
• White blood cells (concern rises above 11 ×10³/µL; full at 20) — immune activationSource: Reference ≈ 4.0–11.0 ×10³/µL
• Anti-TPO antibodies (concern rises above 34 IU/mL; full at 500) — thyroid autoimmunitySource: Common cutoff >34–35 IU/mL (assay-specific); marks Hashimoto's risk (ATA)
• Thyroglobulin antibodies (concern rises above 4 IU/mL; full at 200) — thyroid autoimmunitySource: Common cutoff ≤4 IU/mL (Roche) — assay-specific; positive in ~60–80% of Hashimoto's
• Lp-PLA2 activity (concern rises above 123 nmol/min/mL; full at 225) — vascular inflammationSource: PLAC Activity test (FDA-cleared): >123 nmol/min/mL higher risk

Symptom questions (5)

• · How much of your food is packaged or ultra-processed?
• · How many servings of vegetables and fruit do you eat daily?
• · How often do your meals include a clear protein source?
• · Do you avoid whole food groups (dairy, grains, animal foods, FODMAPs) without guidance?
• · Do you take medications long term (acid blockers, metformin, diuretics, contraceptives)?

Lab cutoffs (7)

• 25-OH vitamin D (concern rises below 30 ng/mL; full at 5) — vitamin D insufficiencySource: Endocrine Society: <20 ng/mL deficient, 20–29 insufficient; IOM <12 deficient
• Ferritin (concern rises below 30 ng/mL; full at 5) — iron stores (low)Source: AGA 2020: ferritin <45 ng/mL supports iron deficiency; WHO <15 depleted
• Vitamin B12 (concern rises below 300 pg/mL; full at 100) — B12 insufficiencySource: <200 pg/mL deficient; 200–300 borderline (confirm with MMA)
• Magnesium (serum) (concern rises below 1.8 mg/dL; full at 1.2) — magnesium insufficiencySource: Serum reference ≈ 1.7–2.2 mg/dL; serum underestimates total body stores
• Omega-3 index (concern rises below 8 %; full at 3) — low essential fatty acidsSource: Harris & von Schacky: >8% desirable, <4% undesirable
• Homocysteine (concern rises above 10 µmol/L; full at 30) — methylation / B-vitamin strainSource: >15 µmol/L elevated in most laboratory references
• Free T3 (concern rises below 2.5 pg/mL; full at 1.8) — low active thyroid hormoneSource: Typical reference 2.3–4.2 pg/mL; low T3 also occurs in illness and calorie restriction