Domain 1 of 7

Domain 1: Insulin & Blood Sugar Dysregulation

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Energy crashes 1–2 hours after eating

2. Strong carbohydrate or sweet cravings, especially in the afternoon

3. Difficulty losing weight despite caloric restriction

4. Abdominal or belly fat th3. Difficulty losing weight despite caloric restrictionat is disproportionate to overall body weight

5. Brain fog, poor memory, or difficulty concentrating

Domain 2 of 7

Domain 2: Thyroid Function

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Unexplained fatigue despite adequate sleep

2. Weight gain despite controlled diet and exercise

3. Cold hands and feet, or feeling cold when others are comfortable

4. Thinning hair or hair loss, especially the outer third of the eyebrow

5. Brain fog, poor memory, or difficulty concentrating (copy)

Domain 3 of 7

Domain 3: Sex Hormone Balance

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Low libido, reduced motivation, or loss of competitive drive

2. Unexplained anxiety, depression, or persistent irritability

3. Poor sleep and quality or frequent nighttime waking

4. Weight accumulation in hips, thighs, or abdomen despite minimal food intake

5. Fatigue that is not resolved by rest or additional sleep

Domain 4 of 7

Domain 4: Cortisol & Stress Axis

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Difficulty falling asleep due to a racing or active mind

2. Belly fat that accumulates regardless of exercise or dietary changes

3. Feeling wired but tired — exhausted but unable to relax

4. Energy crash in the late afternoon, typically between 3 and 5pm

5. Reliance on 2 or more cups of caffeine daily just to function normally

Domain 5 of 7

Domain 5: Gut Health & Inflammation

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Bloating after meals, especially after carbohydrates or fiber

2. Multiple food sensitivities or intolerances beyond obvious triggers

3. Joint pain or widespread body aches without a clear cause

4. Skin conditions such as eczema, psoriasis, rosacea, or acne

5. Brain fog that noticeably correlates with eating certain foods

Domain 6 of 7

Domain 6: Sleep & Energy Production

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Less than 7 hours of sleep per night on average

2. Difficulty entering or maintaining deep, restorative sleep

3. Waking unrefreshed regardless of how many hours you slept

4. Fatigue that is not resolved by rest or sleep

5. Daytime sleepiness that meaningfully impairs your ability to function

Domain 7 of 7

Domain 7: Toxic Load & Environmental Exposures

Rate each symptom based on your experience over the past 4 weeks. Maximum score: 15 points.

1. Regular use of plastic food containers, water bottles, or microwave plastic

2. Daily use of non-stick cookware such as Teflon or similar coatings

3. Regular exposure to synthetic fragrances — candles, air fresheners, or dryer sheets

4. Non-organic produce consumed 5 or more times per week 0 Never 1 Occasionally

5. History of unexplained neurological symptoms such as tremor, memory issues, or poor balance