Name *

First Name

Last Name

Inflammation

If you have answered yes to 5-8 of these, it's likely you have severe inflammation

I have pain in my body, such as neck pain, back pain, knee pain, or headaches

I have skin rashes, such as eczema, psoriasis, rosacea, or allergic dermatitis

I have chronic digestive problems, such as bloating, diarrhea, ulcers, reflux, or indigestion

I have asthma or allergies

I'm constantly tired or lethargic

I eat a diet that is not based on Whole Foods and contains many processed foods and sugars

I have a family member with an autoimmune disease

I have been formally diagnosed with PCOS

Insulin Resistance Quiz

If you have answered yes to 7-11 of these it's likely you have severe insulin resistance. If you have answered yes to 3-6, it's likely you have moderate insulin resistance. If you've answered yes to 0-2 of these, you may of mild or undetectable insulin resistance.

My waist is 35 inches or more.

I gain weight predominantly around my abdomen.

I crave sugar.

I have struggled with weight loss.

I crave carbohydrates, such as rice, bread, and potatoes.

I don't feel full easily and eat too much at one sitting, or I binge at times.

There are people in my immediate family who have diabetes.

I am sensitive to not eating for periods of time and experience symptoms of hypoglycemia, such as shakiness, irritability, or dizziness.

I have dark, velvety patches in the folds of my skin behind my neck, at the crease of my thighs, or under my arms. (acanthuses nigricans)

I have skin tags.

I have a fatty liver.

Adrenals and Stress Quiz

If you have answered yes to 14-21 of these, it's likely you have a severe adrenal/stress factor. If you have answered yes to 5-13 of these, it's likely you have a moderate adrenal/stress factor. If you've answered yes to 1-4 of these, it's likely you have a mild adrenal/stress factor.

I have a lot of stress in my life.

I have experience extreme stress in the past 5-8 years.

I do not get enough sleep.

I have anxiety.

I have depression.

I consume too much sugar.

I have heart palpitations.

I drink a lot of coffee to get through the day.

I get irritated easily.

I have serious mood symptoms when I have PMS.

I have low blood pressure.

I have dizziness when I stand up too quickly.

I overwork and do not take time to relax.

I have taken steroids for medical reasons.

I gain weight around my abdominal area.

I have an eating disorder now or have had one in the past (binge eating, anorexia, bulimia, or orthorexia.)

I have a low libido.

My muscles feel weak.

I feel very tired between 3:00 and 5:00 PM.

I feel best in the evening.

I have had high DHEA-S readings on bloodwork.

Androgen Excess Quiz

If you have answered yes to any of these, you have the androgen excess factor to a significant degree.

I have hirsutism: the growth of excess or coarse hairs on my chin, face, upper lip, chest, or abdomen.

I have significant acne that is present after the age of 20. The acne is concentrated around the jawline, back, or chin or has recurred after intensive treatment, such as isotretinoin or birth control pills.

I have hair loss that is either diffuse or is concentrated behind the hairline

I have a deep voice.

I have high DHEA-S, testosterone, androstenedione, or DHT levels on blood testing.

Hormone Balance Quiz

If you have answered yes to any of these, you have the hormonal imbalance factor to a significant degree.

My cycles are or have been 35 days or longer for significant periods of time in my life.

I've had polycystic ovaries on ultrasounds.

I ovulate late in my cycle - around day 18 or later.

I've needed to take medications to help me ovulate.

The medications intended to help me ovulate didn't help on at least one occasion.

I've had high anti-Mullerian hormone (AMH) reading on a blood test.

I've had a high luteinizing hormone (LH) to follicle-stimulation hormone (FSH) ratio on a day-three blood test.

I have had low progesterone readings on bloodwork.

Thyroid Quiz

If you've answered yes to either #15 alone, or to 10-15 of these, you have a significant thyroid factor.

I feel cold compared to others around me.

I feel tired a lot or exhausted without reason.

I do not lose weight easily, despite dieting and exercising.

I am constipated.

I have dry, flaky skin.

I'm losing hair: It is brittle, coarse, and dry. Or I am losing outer eyebrow hair.

My nails are brittle.

I'm depressed or anxious.

I have chronic muscle and joint pains.

I feel pressure or swelling in my neck, have difficulty swallowing, and my voice has become hoarse.

I have a family member with thyroid disease or an autoimmune disease.

I have high cholesterol that does not respond to diet changes or medication.

I have unexplained changes in my weight, unrelated to my lifestyle.

I have changes in my memory and concentration.

I have had abnormal thyroid testing results (including autoimmune thyroid antibody testing) or am taking thyroid medication already.

Diet and Nutrition Quiz

If you have answered yes to 1-4 of these, you have a moderately high need for nutritional support and would benefit from making dietary changes.

When I have made changes in my diet in the past, I've seen significant improvements in my PCOS symptoms.

There are areas of my diet that I feel I could use some improvement.

I consume fast food or sweets at least twice per week.

I have intense cravings for sugar or carbohydrates.

I find it difficult to stop eating, or I binge at times.

I don't get enough vegetables in my diet.

I'm not really sure what I should be eating.

I know what to do with my diet, but I find it hard to actually make good decisions when the time comes to eat.

I tend to eat the same foods all of the time.

I go through periods of eating well, followed by periods of eating poorly.

I scored moderate to high on the insulin resistance quiz. (3-10 yes responses.)