Adrenal Fatigue Risk Assessment

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The Insulin Friendly Lifestyle & Rotational Fasting

Full Name *

Best Email Address: *

Phone Number *

Today's Date *

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Time

Please indicate how each of these statement are affecting your health. *

N/A

Mild = 1 point

Moderate = 2 points

Severe = 3 points

I need sunglasses when outside

I am having trouble reading for lengths of time

I have trouble seeing when I drive at night

I get winded going up stairs

I feel tired all the time

I gained weight recently

My memory is getting worse.

I can't focus; I have brain fog.

I crave sweets and carbs.

I crave salty foods.

When tired I go for sugary/fatty foods for energy.

I need coffee/tea to get me going through the day.

I can become easily irritable or angry.

I can't handle pressure like I used to.

I have acne.

My hair is thinning/falling out.

I get frequent colds and flu.

I have low libido.

My menstrual cycle is irregular.

I am intolerant to cold or temperature changes.

I don't have the same enthusiasm for life as I used to.

I get dizzy from sitting to standing.

I frequently fall asleep in the cinema/while watching TV or when reading a book.

I feel drained rather than energised after exercise.

I often need a nap to keep going through the day.

I feel like I have lost my vitality.

It takes me a long time to recover from the gym.

I feel more anxious than I used to.

I am not as productive in work as I used to be.

I feel very irritable if I go a long time without food.

I feel like I need some alcohol to unwind in the evening.

I have a sudden surge of energy in the evening.

My blood pressure is low.

I have difficulty falling asleep.

I can’t stay asleep.

I don’t wake up feeling refreshed.

I feel sleepy in the afternoon, or after lunch.

N/A

Mild = 1 point

Moderate = 2 points

Severe = 3 points

I need sunglasses when outside

I am having trouble reading for lengths of time

I have trouble seeing when I drive at night

I get winded going up stairs

I feel tired all the time

I gained weight recently

My memory is getting worse.

I can't focus; I have brain fog.

I crave sweets and carbs.

I crave salty foods.

When tired I go for sugary/fatty foods for energy.

I need coffee/tea to get me going through the day.

I can become easily irritable or angry.

I can't handle pressure like I used to.

I have acne.

My hair is thinning/falling out.

I get frequent colds and flu.

I have low libido.

My menstrual cycle is irregular.

I am intolerant to cold or temperature changes.

I don't have the same enthusiasm for life as I used to.

I get dizzy from sitting to standing.

I frequently fall asleep in the cinema/while watching TV or when reading a book.

I feel drained rather than energised after exercise.

I often need a nap to keep going through the day.

I feel like I have lost my vitality.

It takes me a long time to recover from the gym.

I feel more anxious than I used to.

I am not as productive in work as I used to be.

I feel very irritable if I go a long time without food.

I feel like I need some alcohol to unwind in the evening.

I have a sudden surge of energy in the evening.

My blood pressure is low.

I have difficulty falling asleep.

I can’t stay asleep.

I don’t wake up feeling refreshed.

I feel sleepy in the afternoon, or after lunch.

Add up all your responses to get your score using the values for each answer, then mark the appropriate result range below, and continue to the bottom to interpret the results. Scoring: Mild= (1) Moderate = (2) Severe = (3) *

27 pts. = Adrenal Fatigue/Exhaustion potential

19-26 pts. = Moderate Adrenal Fatigue

10-18 pts. = Adrenal Compromise

Option 4

You are almost done! You will find the score result interpretations below. This is a functional screening evaluation and is not a diagnosis or treatment for any medical conditions. The next question will show you how you can get more information on how the Insulin Friendly Lifestyle & Fasting Rotation can help you improve your metabolic health, along with an option to get started today. *

0-8 points: Healthy adrenals. Your score indicates that your adrenal response is strong and healthy. I know that a score like this doesn’t come as a surprise. Your adrenal or overall health regimen is paying off, congratulations! You are calm during stressful life events and situations. You wake up easily and enjoy a positive outlook and vibrant energy throughout the day. Protect what you have earned with whole food-based nutrition for “what you eat,” functional fasting for “when” you eat, regular Variable Output Exercise, maintaining habits for quality sleep, and incorporate daily stress resilience practices. And of course, I invite you to join our community at the Insulin Friendly Lifestyle & Fasting Rotation.

9-17 points: Adrenal Compromise. Your adrenals are showing signs of mild strain. Some people at this point report no significant changes in their health or quality of life even with notable strain. Many others report a drop in energy, becoming easily irritated, and get winded going up stairs. Physical stamina is decreased slightly, and you often feel “wound up” or “wired”. It’s not quite as easy to stay on task and you notice your eye are more sensitive than they used to be. This is an excellent time to address the strain on your adrenals before it progresses.

18-25 points: Moderate Adrenal Fatigue. Fatigue and what comes with it is subjective and different from person to person. You have been “running on fumes” for a while and exhaustion is apparent to you and your adrenals and it is starting to show in your life and quality of life. You know something is not “right.” Sleep has become a challenge, driving at night is difficult and causes you stress and your get up and go has gone. You have gained weight or notice your clothes feel tighter and the usual routine to drop a few pounds is not working, or even making you worse. You need to make your metabolic health a priority, do some research, and work on a plan to restore your adrenal function.

26 points or more: Adrenal fatigue/exhaustion. Your energy swings have you wired or dragging through your day. For your adrenal function to improve you will require an integrated lifestyle program that includes supplemental adrenal support, metabolic exercise, stress resilience practices, sleep improvement efforts, and a specific nutrition plan for ”what” you eat with a fasting regimen for “when” to eat. Due to your decreased adrenal function, you will need to find a health care professional with experience with these lifestyle modifications, especially fasting. Your provider must be aware of the risks and contraindications associated with adrenal fatigue. You will likely have developed insulin resistance as it almost universally accompanies adrenal fatigue and exhaustion. A good practitioner can help you see significant improvements with both adrenal fatigue and insulin resistance in one month, and you could recover completely in three to six months. There’s no more time to waste.

Adrenal Fatigue & Exhaustion robs quality of life. Adrenal issues are part of the hormonal trifecta of Insulin, Adrenals, & Thyroid, & bully other hormones contributing to: Hypothyroid, Type 2 Diabetes, Metabolic Syndrome, Pre Diabetes, Cardiovascular Disease, Obesity, Weight Loss Resistance, Adrenal Fatigue, Autoimmune Conditions, Low T & Estrogen Imbalance, stops Ketosis & Autophagy, speeds aging & 90% of cancers. Dr. Don's Insulin Friendly Lifestyle & Fasting Rotation Program stops the Trifecta, & healing starts. I'm offering a FREE 15 min call to discuss your metabolic health & how I can help, CLICK YES! Then click the calendar link to schedule! *

YES! I'm booking my FREE Meet & Greet call with Dr. Clum https://calendly.com/insulinfriendly/15min

Thank you, I will continue on my own.

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