Roadmap/02 - Self diagnosis & markers

Diagnosing symptoms

Symptoms, temperature and pulse, appetite, regularity of bowel movements and urination, and the appearance of the tongue are generally the most useful health metrics on their own, enough to indicate what's going on and what to try next. Getting more data is good, but a lack of data is not a reason to delay change and progress.

Thyroid - Temperature and heart rate

Oral or armpit temperature in the morning, before getting out of bed, should be around 98° F [36.6º C], and it should rise to 98.6° F [37.1º C] by mid-morning. […] Healthy populations have an average resting pulse rate of about 85 per minute.

— Ray Peat

Markers of health	Ideal	Waking	After breakfast	Afternoon
Temperature	98.6 - 99F 37.0° - 37.2°C	~97.8°F	~98.6°F	Holding steady, no drop
Heart rate	85 - 90 BPM	75 - 90 bpm	75 - 90 bpm	75 - 90 bpm, staying steady rather than spiking

Before diving into diet and supplements, establish a baseline using the table above. Track daily averages and aim for steady rises, not single readings; post-meal temperature should rise if metabolism is healthy (fuel burning), and drops if stress hormones dominate instead.

Temperature

• Waking temperature: Take immediately upon waking, before getting up
• After-breakfast temperature: Take 1 hour after breakfast
• Afternoon temperature: Take again later in the day to catch stress-driven drops that a single midday reading can miss
• Goal: Waking ~97.8°F, rising to ~98.6°F by midday, holding steady into the afternoon

At low temperature, nearly every metabolic process slows together: detoxification, enzyme activity and ATP production, cognition, immune function, and androgen production all decline as temperature drops.

Checking your temperature when you wake up, then about an hour after breakfast, can give you an idea of your thyroid status. It should get up to about 98.5 by mid-morning.

— Ray Peat

Pulse

• Resting pulse: Sit quietly for 5 minutes, then measure, at waking, after breakfast, and again in the afternoon
• Goal: 75-90 bpm at rest
• Important: Pulse driven by metabolism stays steady all day. Pulse driven by adrenaline spikes and crashes.

"If it's from your basic metabolism, it will stay close to that all day while sitting."

— Ray Peat

Warning signs of adrenaline-driven pulse

A high pulse with cold hands, anxiety, or inability to sit still often indicates adrenaline compensation for low thyroid, not true high metabolism. See also Body markers → Extremities below, cold hands and feet are the same adrenaline signal viewed as a body marker.

List of blood tests

Marek online blood test

Idealabs steroid analysis

Marker	Male	Female
Prolactin	in men 4-7 ng/ml (85–150 mU/L)	female 1-12 ng/ml
Total Cholesterol	160 - 200 mg/dl
RT3	No fixed target; stress-induced cortisol raises the deiodinase that produces inactive RT3, worsened by low-sugar diets
CRP	No fixed target; elevated CRP tracks with low FT4, low cholesterol, and low vitamin D/K status
TSH	Below 1, as close to 0 as possible
PTH	15 pg/ml
CO2	30 mmol/l
Serum calcium	9 mg/dl
Serum phosphate	3 mg/dl

Also worth including: estrogen, vitamin D, a liver panel, and an iron panel. A GI-map stool test can directly identify gut pathogens, dysbiosis, and digestive function markers.

Blood panel tool (beta)

Compare a few lab numbers to educational targets used on this site. Take results from the widget with a grain of salt, it's approximate and unfinished, the goal is to point you to primary sources with quotes that pop up below based on your results. Prefer temperature and pulse first (Tracking). See your results plotted on the Pathway map. Full page: Blood panel.

Buteyko CP and sleep quality

Buteyko control pause (breath-hold time after a normal exhale) and sleep quality are also useful day-to-day metrics, alongside temperature, pulse, and the markers above.

Self tracking

Record waking and after-breakfast temperature and pulse, appetite, and energy in the quick form; sleep, food, and supplements are under "More fields." Entries save to your private log (permanent account required).

Manual sheet

Prefer a spreadsheet, or on a shared device? Use the "Download blank CSV template" button below the charts to get an empty copy of this table's columns as a CSV file, ready to open in Excel, Google Sheets, or Numbers. It's offered as a download rather than shown inline here since the full table is too wide for the page to display cleanly.

Digestion

Bristol stool chart

Type 1		Separate hard lumps, like nuts (hard to pass)
Type 2		Sausage-shaped but lumpy
Type 3		Like a sausage but with cracks on its surface
Type 4		Like a sausage or snake, smooth and soft
Type 5		Soft blobs with clear-cut edges (passed easily)
Type 6		Fluffy pieces with ragged edges, a mushy stool
Type 7		Watery, no solid pieces - entirely liquid

Quick bowel movements two to four times a day is generally what is good to aim for. See also Body markers → Bowel movements below.

Transit-time check

Eat a portion of visibly identifiable food, whole corn kernels or grated carrot work well, and time how long it takes to appear in the stool. This gives a rough estimate of gut transit time.

Urine quality chart

Number	Color	Status	What it means	Action
1		Hydrated	Pale, odourless and plentiful urine usually means that you are well hydrated.	Keep drinking at the same rate.
2
3		Mildly dehydrated	Slightly darker yellow urine usually means that you need to drink more water.	Drink a glass of water now.
4
5		Dehydrated	Medium-dark yellow urine usually means that you are dehydrated.	Drink 2-3 glasses of water now.
6
7		Very dehydrated	Darker, strong-smelling urine in small amounts can be a sign of dehydration.	Drink a large bottle of water immediately.
8
9		Hospital	Blood	Call 9/11 now

Foamy urine is a sign of increased circulation of fatty acids, which is most common after stress. In rare cases, foamy urine may be a sign of kidney issues. See also Body markers → Urination below.

What to drink

Ray Peat's own rule of thumb is simple:

In general, it's best to drink water only when you're thirsty.

— Ray Peat

Not all fluids hydrate equally. A controlled trial measured how much of a 1 L drink stayed in the body 2 hours later versus being urinated out, as a "beverage hydration index" relative to plain water (=1.0). Whole and skim milk, and an oral rehydration solution, retained fluid best (index around 1.5), likely because the protein, fat, and electrolytes slow gastric emptying and reduce urine output; orange juice also did significantly better than water (around 1.4). Cola, tea, coffee, beer, sports drinks, and sparkling water were all statistically indistinguishable from plain water in the same trial, despite the popular claim that they hydrate better.

* = significantly higher than water (p<0.05), ** = p<0.01. ORS = oral rehydration solution. Exact BHI values are only published in the paper's text for still water, orange juice (1.40), full-fat milk (1.50), ORS (1.54), and skimmed milk (1.58); the rest (sparkling water, cola, diet cola, sports drink, lager, coffee, tea, cold tea) are read off Figure 2's bar chart, since no results table lists them numerically. Lager sits below water (alcohol's diuretic effect offsets its energy density, per the paper's discussion), not tied with it. Chart data from Maughan et al. 2016. Water quality matters more than the distilled-vs-mineral question people often worry about; good mineral content mostly reflects sunlight and soil conditions, not something to fear from soft or distilled water. Municipal tap water's fluoridation and chlorination are the more relevant quality concerns, see Fluoride.

Urine RMR test

For every 1000kcal burned, a liter of water is used. If you discard the morning urine, and collect the urine for the rest of the day while measuring your water intake, you can calculate your resting metabolic rate.

(water intake - urine volume) * 1000 = RMR

Body markers

If your hands are warm and you feel kind and energetic, you’re doing it right. If you’re cold and cranky, something is wrong

Tongue

Ideal

• Should be pink, smooth

Symptoms

• White coating, especially on the back/middle of the tongue = bacterial overgrowth, SIBO or Candida
• Cracks = likely a nutrient deficiency

Nails and Fingers

Ideal

• Fast-growing
• Nailbeds should be pink
  • means tissue is retaining CO2

Symptoms

• White horizontal lines = zinc deficiency
• Clubbed fingers = heart disease
• Brittle nails = lack of gelatin, vitamin D and calcium in the diet
• White moons at the bottom = probably low thyroid

Toenails are a more reliable sample than hair for assessing mineral status. Hair quickly absorbs minerals like copper and calcium from water/plumbing during washing, skewing results, while toenails better represent actual body composition.

Eyebrows

Ideal

• Full

Symptoms

• Queen Anne's sign = Thinning or loss of the outer third of the eyebrows is one of the physical manifestations of hypothyroidism

Eyes

Ideal

• Focused, calm and alert

Symptoms

• Eye bags = Low thyroid, gut irritation, tired
• Bulging = Grave's disease, (easily misdiagnosed as hyperthyroidism)
• Enlarged eye vessels, esp. yellow around = vitamin B deficiency, mainly B2; eating liver once a week can help
• Dark circles under the eyes = vitamin C status + impaired collagen production, oxidative stress
• Dry = Hashimotos

Hair

Ideal

• Full head of hair

Symptoms

• Thinning/norwood = high prolactin and everything
• Premature graying = often reported alongside other low-thyroid signs

Earlobe

Ideal

• Smooth

Symptoms

• Crease = heart disease or circulatory disorder

Face skin

Ideal

• Baby

Symptoms

• General puffiness around the face (edema) = high estrogen
• Crow's feet = impaired collagen / elastin production of the skin
  • Oxidative stress
  • Low vitamin C status
  • Poor collagen intake
  • Low glycine intake

Lips

Ideal

• Kissable

Symptoms

• Chapped lips = dehydration caused by lack of sealing
  • Chronic inflammation, especially from the gut
  • Hypothyroidism
  • Poor saliva production (low cholinergic / parasympathetic tone)
  • Nutrient deficiencies

Teeth

Ideal

• Solid, opaque edges

Symptoms

• Decay, or edges becoming transparent = often reported alongside other low-metabolism signs

Body skin

Ideal

• Smooth, elastic, without spots

Symptoms

• Cellulite = high estrogen, high PUFA
• Thinning skin (ungrabable) = low thyroid
• Lipufuscin spots (liver spots) = high PUFA, high iron
• Yellow skin = liver problems, high keratine,
• Cracks, ashy knees & elbows = low vitamin A
• Hives, itchiness = high histamine
• Melasma = excess estrogen upregulating melanin
• Stretch marks = low copper, zinc, and selenium, high cortisol breaks down collagen and elastin,

Veins

Ideal

• Smooth, elastic, without spots

Symptoms

• Bulging veins = high estrogen, especially on the back of the hand

Women's breasts

Ideal

• Firm, perky

Symptoms

• Tender = high estrogen
• Sagging = low connective-tissue tone from a metabolic energy problem, typically accumulated PUFA

Men's chest

Ideal

• Developed like a man's

Symptoms

• Gynecomastia = high estrogen and prolactin

Extremities

Ideal

• Warm, circulated

Symptoms

• Cold feet, hands, nose = high adrenaline, see also Diagnosing symptoms → Warning signs of adrenaline-driven pulse above
• Slow capillary refill (skin stays pale for more than 2 seconds after a gentle squeeze before pinking back up) indicates poor peripheral circulation, often from low thyroid/high adrenaline

Sweat glands

Ideal

• Moderate amount, non-stinky

Symptoms

• Inability to sweat = low thyroid

Nose

Ideal

• Reasonably dry

Symptoms

• Runny = high histamine

Posture

Ideal

• Straight, non tense

Symptoms

• Postural issues = Low androgen (DHT)

Tummy

Ideal

• Flat(ish)

Symptoms

• Bulging gut = high HGH, general SIBO
  • Could also be visceral fat accumulation or weak abdomenal muscles/PSOAs

Movement

Ideal

• Normal, balanced, free-flowing

Symptoms

• Movement disorders, twitches = high serotonin

Energy levels

Ideal

• Warm, calm, sociable, libido, good sleep, no brain fog

Symptoms

• Fatigue = low T3

Bowel movements

Ideal

• 2-4 times a day, see also Diagnosing symptoms → Bristol stool chart above

Symptoms

• Constipation or too runny

Urination

Ideal

• sparse, only during waking, clear color

Symptoms

• Foamy, frequent, or dark urine, see Diagnosing symptoms → Urine quality chart above

Appetite

Ideal

• Healthy

Symptoms

• Low appetite
• Overeating/stress eating

Voice

Ideal

• Clear, steady, no hoarseness

Symptoms

• Hoarse = mucopolysaccharides swelling the vocal cords from hypothyroidism

Cravings

Acidic/sour

• your body needs more sodium
• Aldosterone imbalance
  • When sodium drops, your adrenals compensate by releasing aldosterone to retain sodium - but this comes with costs like magnesium loss and inflammation. Simply eating more salt can turn off this stress response.
• Premenstrual shift
  • Commonly trigger pickle cravings in women. Hypothyroid women especially suffer from both sugar and salt cravings premenstrually.
• Thyroid function
  • Aging lowers your thyroid function, and your thyroid deficiency causes you to lose sodium. So the craving in most people is a very biological thing. But you could correct it by correcting your thyroid function, which makes you retain salt efficiently so you don't need to eat so much
• The manganese connection
  • Blood test of pregnant women with pickle cravings showed manganese deficiency.

Sweet

Sugar craving is usually a sign of a genuine need for sugar, commonly from hypothyroidism rather than an "addiction" in the moralistic sense.

Salty

Salt restriction itself raises adrenaline and disrupts sleep. Salting food normalizes adrenaline and improves sleep, on top of the sodium-loss mechanisms above.

Sparkling water/soda

Carbonated water raises body CO2, improving oxygen delivery to tissue via the Bohr effect and promoting vasodilation.

Achilles reflex speed

Ideal

• Fast relaxation phase (film yourself dropping foot)

Symptoms

• Slow/hanging reflex

Broda Barnes chart of common hypothyroidism symptoms

Broda Barnes chart

Symptom	% prevalence in hypothyroidism
Weakness	98.5
Sensation of cold	92
Dry skin	88
Lethargy	88
Edema of eyelids	88
Edema of face	87
Coarse skin	83.5
Cold skin	81.5
Decreased sweating	78.5
Coarseness of hair	75.5
Slow speech	73.5
Slow movements	73
Thick tongue	71
Heart enlargement	68
Gain in weight	67.5
Impaired memory	65.5
Labored or difficult breathing	63.5
Hoarseness	63
Muscle weakness	61
Depression	60
Pallor of skin	58.5
Constipation	57.5
Swelling of feet	56
Burning or tingling sensations	56
Pallor of lips	53.5
Loss of hair	49
Slowing of mental activity	49
Nervousness	43
Loss of appetite	42.5
Brittle nails	41
Muscle pain	36
Deafness	35
Excessive menstruation	32.5
Poor heart sounds	30
Joint pain	29
Palpitations	27
Poor vision	24
Pain over the heart	20.5
Changes in back of eye	20
Painful menstruation	18
Loss of weight	11
Emotional instability	11
Choking sensation	9
Fineness of hair	9
Cyanosis (bluish skin)	9
Difficulty in swallowing	3
Heat intolerance	2

Iodine deficiency

"The skin test of iodine deficiency is completely unscientific. Iodine is converted to colorless iodide by reductants, including vitamin C, glutathione, and thiosulphate... The test is completely irrational. It implies that the body should be saturated with iodine.” - Ray Peat

Excessive amounts of iodide have been linked to the development of autoimmune thyroiditis in humans and animals

Food intolerance

DIY Food Allergy Test

1. Before suspected allergenic meal, relax consciously and check resting pulse rate
2. Eat slowly, calmly
3. Wait 10 mins and check pulse again If BPM increases by
   • <10, unlikely
   • ~10-14, possibly
   • >15, likely
4. Eliminate suspected food and repeat until +ID

Why do a food allergy test?

If you have symptoms of chronic inflammation:

• Runny/stuffy nose
• Excess mucous/saliva
• Red/crusty eyes
• Itchy ears
• Brain fog/Headaches
• Myalgia/Neuralgia
• etc.

Rule out food allergies before moving onto expensive mycotoxin/heavy metal etc. testing

Testing response to specific foods and supplements

Trying specific foods or supplements one at a time and noting a positive or negative reaction can point to a specific underlying issue:

• Dairy — casein or lactose sensitivity, or Histamine intolerance
• Liver (organ meat) — reaction may reflect vitamin A, copper, or iron status
• Oysters — reaction may reflect zinc or copper status
• Eggs — reaction may reflect sulfur/methylation capacity (choline, sulfur amino acids)
• Sulfur and methylation-related nutrients (methionine, cysteine, taurine) — poor tolerance suggests impaired sulfation/methylation
• High-histamine foods (aged cheese, fermented foods, cured meats) — reaction points to Histamine intolerance, often tied to DAO capacity
• Fat — poor tolerance may reflect low bile flow or liver function
• FODMAPs — reaction may reflect SIBO or fermentation-driven gut issues
• Oxalates — reaction may reflect oxalate sensitivity tied to gut permeability or mineral status

Philosophy of testing

Testing will always be imperfect relative to overall function; the body is not a machine. Tracking data is less about hitting specific values than about creating progress in life and repeatable symptom relief.

When a measure becomes a target, it ceases to be a good measure.

— Charles Goodhart

Health is not a means to an end.

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