Chronic Disease Risk Profile
...For heart disease, diabetes, obesity, hormone disruption and other conditions of blood sugar imbalance.
Email address *
I engage in binge or uncontrolled eating. *
Almost never
Daily
I crave coffee or sugar in the afternoon. *
No
Always
I get shaky if I go too long without eating. *
Longer than 8 hours
withing 3-4 hours
I feel sleepy in the afternoon. *
Rarely
Daily
If I skip a meal, what is the likelihood that I will have a headache? *
Not likely
Almost certainly
I feel fatique that is relieved by eating. *
Rarely
Frequently
I get irritable before meals. *
Not at all
Very much
I awaken from sleep after a few hours and find it difficult to return to sleep. *
Never
Daily
I crave sweets. *
Not at all
Severely
I eat candy, desserts, or refined sugar. *
Less than once a month
More than once a day
I eat refined flour or baked goods. *
Less than once a month
More than once a day
I have been diagnosed with hypoglycemia, insulin resistance, gestational diabetes, pre-diabetes, or diabetes. *
No
Yes
Number of family members with diabetes *
None
3 or more
Age Range *
Required
Gender *
Required
What do you think your level of risk is for heart disease, diabetes, obesity, or hormone disruption?
No risk
High risk
Submit
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