Email Address: Digestive Sensitivities 1. After eating a meal, I often feel bloated and gassy. 1 2 3 4 2. I am constipated or have diarrhea more often than not. 1 2 3 4 3. I have foul-smelling gas and/or stools. 1 2 3 4 4. I often feel foggy and lethargic and lack focus after I eat. 1 2 3 4 5. I crave certain foods and beverages and/or often eat the same things. 1 2 3 4 6. I often feel nauseous after eating or after taking a supplement. 1 2 3 4 7. I use over-the-counter pain relievers regularly. 1 2 3 4 8. I tend to crave alcohol, sugar, bread, and other “yeasty” foods. 1 2 3 4 9. I often (two to three times a week) have headaches, intestinal pain, and/or joint pain. 1 2 3 4 10. I feel ill when it is muggy or damp or in specific environments (e.g., my office, my basement). 1 2 3 4 11. I regularly (two to three times a week) eat out at restaurants or get takeout. 1 2 3 4 12. I am prone to flushing, pimples, and/or acne breakouts. 1 2 3 4 Digestive Sensitivities SCORE Hormonal Imbalance 1. Lately, my periods are more irregular and can be very heavy. 1 2 3 4 2. I am having trouble falling asleep and/or staying asleep at night. 1 2 3 4 3. I have intense mood swings and cravings before I get my period. 1 2 3 4 4. Lately I cry at everything, even cheesy TV commercials. 1 2 3 4 5. My hair and skin feel dry and coarse. 1 2 3 4 6. I am experiencing heart palpitations, hot flashes, and/or night sweats. 1 2 3 4 7. I feel much calmer after my period starts. 1 2 3 4 8. I have little interest in sex, and even when I do have interest, my vagina stays dry. 1 2 3 4 9. I’ve lost a lot of muscle recently or I can’t make muscle, no matter how much I exercise. 1 2 3 4 10. I tend to store my extra weight around my hips and thighs. 1 2 3 4 11. Lately, my breasts are more tender and/or painful. 1 2 3 4 12. I have a history of PMS, postpartum depression, and/or abnormal periods or irregular bleeding. 1 2 3 4 Hormonal Imbalance SCORE Adrenal Imbalance 1. I feel as if I am always on the go and am known for getting things done. 1 2 3 4 2. I am exhausted and irritable a lot of the time—I have a short fuse. 1 2 3 4 3. When I’m not exhausted, I feel restless and agitated. I can’t relax. 1 2 3 4 4. Usually, I crash in the afternoon, only to get a second wind in the evening. 1 2 3 4 5. I often crave salty foods, or I crave sugar and can’t stop eating it. 1 2 3 4 6. I am light-headed and queasy in the mornings, or when I get up too fast. 1 2 3 4 7. I find it difficult to wake up and/or get out of bed—I can’t live without coffee! 1 2 3 4 8. I often feel anxious and have no idea why. 1 2 3 4 9. Sex is about the last thing on my mind these days. 1 2 3 4 10. When I want something done right, I have to do it myself. 1 2 3 4 11. If I sit or lie down for a minute in a warm spot, I tend to fall asleep. 1 2 3 4 12. I usually need a sugar or caffeine jolt in the afternoon. 1 2 3 4 Adrenal Imbalance SCORE Neurotransmitter Imbalance 1. I binge-eat regularly, especially on carbohydrates. 1 2 3 4 2. I don’t get much pleasure out of most of my activities. 1 2 3 4 3. I’m drinking more alcohol than I used to. 1 2 3 4 4. I crave comfort food. 1 2 3 4 5. I feel tense, guilty, and anxious much of the time. 1 2 3 4 6. I feel flat, unfocused, and empty much of the time. 1 2 3 4 7. Lately I’ve been sleeping a lot more/less than usual. 1 2 3 4 8. I’ve been told that I’m moody. 1 2 3 4 9. Sometimes, I just want to scream at everybody. 1 2 3 4 10. Eating makes me feel better. 1 2 3 4 11. I worry a lot. 1 2 3 4 12. I feel stuck and my self-esteem is pretty low. 1 2 3 4 Neurotransmitter Imbalance SCORE Inflammatory Issues 1. Most of my weight gain is around my belly. 1 2 3 4 2. I have a BMI over 28 and/or I am more than 30 pounds overweight. 1 2 3 4 3. I’m prone to acne and skin rashes like eczema and psoriasis. 1 2 3 4 4. I have high blood pressure and/or high cholesterol. 1 2 3 4 5. I’ve been diagnosed with irritable bowel syndrome, or I often have diarrhea and/or intestinal pain. 1 2 3 4 6. I suffer from chronic pain, multiple joint/arthritic pain, and/or chronic headaches and migraine. 1 2 3 4 7. I’m under so much stress! 1 2 3 4 8. I smoke. 1 2 3 4 9. When I get injured, it takes a long time to heal. 1 2 3 4 10. I catch every bug that goes around, without fail. 1 2 3 4 11. Since taking certain medications or a combination of medications, I’ve gained more weight. 1 2 3 4 12. I’ve been diagnosed with asthma, chronic allergies, Type II diabetes, fibromyalgia, heart disease, hypertension, or metabolic syndrome. 1 2 3 4 Inflammatory Issues SCORE Detoxification Issues 1. I’m very sensitive to medications; I usually only take a half dose. 1 2 3 4 2. I have a stuffy nose/congestion, and/or postnasal drip often. 1 2 3 4 3. I consume caffeine and/or alcohol on a daily basis. 1 2 3 4 4. I use recreational drugs on a regular basis, including nicotine and/or marijuana. 1 2 3 4 5. I’m often constipated (two to three times a week). 1 2 3 4 6. I think I eat too much junk food and candy. 1 2 3 4 7. I am gaining weight, even though I’m not overeating. 1 2 3 4 8. I have problem skin and/or rosacea. 1 2 3 4 9. I have five or more metal alloy fillings. 1 2 3 4 10. I used to tolerate caffeine and alcohol much better than I do now. 1 2 3 4 11. I’m very sensitive to chemical/environmental odors and perfumes; I get headaches when I go into certain stores or offices. 1 2 3 4 12. I was once exposed to a high level of toxic chemicals, or I’ve been exposed to small amounts of toxic substances and/or heavy metals over an extended period of time. 1 2 3 4 Detoxification Issues SCORE Summary Digestive Sensitivities SCORE Hormonal Imbalance SCORE Adrenal Imbalance SCORE Neurotransmitter Imbalance SCORE Inflammatory Issues SCORE Detoxification Issues SCORE