Bioselftest_Holly

Metabolic & Body Chemistry Profiling and Rebalancing Assessment

* Indicates required field

Name *

First

Last

Date of Birth *

Blood Type (if known) *

On a scale of 1 - 10 how do you rate your health and vitality right now? (1 being flat on your back, 10 being walking on air). *

Email *

Weight (Kgs) *

Time Testing Carried out *

Are you on any medications? If so, please note here ... *

Pre-existing conditions

Please list any pre-existing health conditions, health concerns, symptoms or any other relevant information that might be of help with this assessment *

Self-Testing Introduction

Congratulations, you have taken the first step towards truly understanding you biological individuality and precisely what you need to do in order to bring your body back into homeostasis and full health.

You're about to learn how to run some very simple physiological tests on your body. The information gained from these tests will help me assess your Metabolic Health and identify any imbalances that will need to be corrected in order for you to move forward with your health. Once you have carried out your self-testing part of this assessment, please enter your results into the relevant "Your Results" box (don't do this until you have done all your numbers because you may lose entered data if you move to another web-page or shut down the computer). There are number of further questions to answer once you have completed these physiological tests. Some of these questions are repeated in different sections - please answer all of them. Please click the "SUBMIT" button at the bottom of the form once all questions have been answered. Your answers to these self-tests and questionnaire will be assessed as soon as possible after I have received this completed form. As soon as I receive your blood sample back I will then contact you in order to organise consultation to talk you through your results and customised protocol.

Equipment Needed

Glucometer (or use at chemist)
Blood Pressure Monitor (or use at chemist)
Stopwatch
pH Testing Strips

TESTS

Fasting Blood Glucose Test

NOTE: Please convert to mg/dl as per chart below if you are measuring in mmol/l
Wash your hands prior to testing so residue from lotions, etc. don’t affect the test results. Insert a new lancet into the lancing device (Never re-use lancets), prick your finger and allow the blood to make a small bubble. (You can squeeze your finger if needed.) Depending on your glucometer, either drip the blood on top of the test strip or place the test strip up against the drop of blood and it will sip the blood up into the strip like a straw. To get your fasting glucose, test before breakfast and before you drink anything other than water or before you brush your teeth (if possible). When you want to check your fasting glucose, it's best to leave the glucometer out where you will see it first thing in the morning so you won't forget.

Your Result

Blood Glucose Reading mg/dl *

Hours since last meal? *

Blood Pressure Test (resting & resting to standing)

NOTE: Ideally take this test at least 2 hours away from eating a meal.

To test your resting blood pressure, lie down, relax for a few minutes and test on your left arm according to the directions for your blood pressure cuff.

To test your standing blood pressure, lie down, push the button to start the inflation, wait approx 4 seconds and then stand up and hold your arm still (by your side) as not to disturb the machine from taking its reading. Wait approximately 5 seconds before taking the reading.

Your Results

Resting

Resting Systolic *

Resting Pulse *

Resting Diastolic *

Standing

Standing Systolic *

Standing Pulse *

Standing Diastolic *

Breath Hold Time Test

Sit comfortably. Take 3 full, deep breaths in and out. On the 4th inhale, start your stopwatch or timer at the end of the inhale and hold your breath as long as you can. Don’t pass out or anything or make this like it's a contest you have to win. But do hold your breath as long as you comfortably can. It's best not to look at the stop watch while you're holding your breath. If you do, you may be inclined to turn it into a competition and hold your breath longer than you normally would.

Your Results

Breath Hold (seconds) *

Breath Rate

This is hard to test on yourself when you’re conscious of what you’re doing because you might adjust your breathing. If you can, get someone else to test this for you so you can let your mind wonder to other things and just breathe normally - it will probably be a more accurate reading. Lie down and relax. Try to think of other things so that you breath normally. Start your timer and count the number of times you inhale for 60 seconds.

Note: If someone else is doing this reading for you it might be a good idea to place something light coloured on your tummy so that the other person can clearly see each breath.

Your Results

Breath Rate (60 seconds) *

Saliva & Urine pHs

The first morning urine test, while being a valid test, takes greater discretion to sort out the results because you are unloading the previous days "metabolic debt", or those acids you accumulated through the previous day. By testing your urine and saliva pH either just before lunch or just before dinner, ideally it will have been at least 2 hours since you have eaten any food. This will be an easier test to discern what the numbers are showing.

Urine: Simply hold the test strip in your urine stream for a second and read against the colour chart. If the chart goes from 6 to 6.5 and it’s somewhere in between, make a guess and say 6.3 or wherever you think it lands.

Saliva: Try not to drink or have anything in your mouth for 20 minutes before testing, and wait at least 2 hours after eating. Just bring up a little saliva between your lips and run the test strip through the saliva. Read against the chart right away. With urine, it is not as important to read against the chart right away. But with saliva, the Co2 in your saliva will outgas and that reading will often rise the longer you wait to read it.

Note: Do both these pH tests at the same time.

Your Results

Saliva pH *

Urine pH *

Spit Test

Before going to bed, place a clear glass full of water on your bathroom counter or wherever you go first thing in the morning when you wake up. This will help remind you to do this test when you see the glass so you don’t brush your teeth first. Make sure the glass is see-through so you can see what’s going on inside. Immediately upon waking, swallow the saliva in your mouth and bring up some new saliva. Let it drop gently into the glass on top of the water. Now watch what happens. You’re looking to see if the saliva floats on top of the water or if it starts to string down into the water. Watch for 30 seconds or so to determine this.

Your Results

Spit Test *

Dermographic Line

To perform this test, run the non-ink side of a pen across the inside of your arm and then wait 20-30 seconds to see if your skin turns red, white, or the mark just disappears. If the mark disappears, you would be considered balanced in this test.

This is an autonomic nervous system indicator. Typically if a person's vascular system is constricted, the dermographic line stays with a white centre and can indicate the individual is leaning too far on the sympathetic side. If the dermographic line stays red, that can indicate a person is leaning toward the parasympathetic side.

Your Results

Dermographic Line *

Gag Reflex

Gag reflex is another indicator of the autonomic nervous system. High gag reflex is indicating that a person is leaning toward the parasympathetic side. The lack of a gag reflex indicates a leaning toward the sympathetic side. No test is required here. Simply ask yourself, if I'm brushing my teeth and the toothbrush goes a little too far back, do I have a tendency to gag?

Your Results

Gag Reflex *

Pupil Size

Pupil size is another indicator of the autonomic nervous system. Small pupils indicate parasympathetic; large pupils indicate sympathetic. Looking at the coloured area of your eye, if your pupils cover less than 25% of that space, they can be considered small. If your pupils cover more than 50% of the coloured area, they can be considered large. If your pupils take up between 25% - 50% of the coloured space, this can be considered normal.

Select one of the 9 pupil sizes below and record results.

Your Results

Pupil Size *

Questionnaire

Do you suffer from vertigo (a specific kind of dizziness - a sense that you, or your environment, is moving or spinning, even though there is no movement)? *

Do you suffer from depression? *

Do you suffer from general fatigue? *

Do you suffer from insomnia? *

Do you have cravings? *

Do you suffer cramps? *

Do you suffer hypertension? *

Do you have poor circulation? *

Do you suffer cardiovascular disease? *

Do you normally have a high body temperature? *

Do you have polyuria (excessive or abnormally large production or passage of urine)? *

Do you find it hard to wake up in the morning? *

Do you suffer from anxiety? *

Do you normally have a low body temperature? *

Do you have olyguria (low output of urine)? *

Do you often have soft / loose stools? *

Do wake up in the morning easily? *

Are you slow to heal? *

Do you get migraines? *

Do you suffer from muscle loss? *

Do you suffer from weight issues? *

Do you get irritable when hungry? *

Do you have type II diabetes? *

Are your hands normally warm and dry? *

Are your fingers warmer than your triceps? *

Do you suffer from asthma? *

Do you suffer from allergies (not food)? *

Are your hands normally cold? *

Are your fingers colder than your triceps? *

Is your mouth normally dry? *

Do you suffer from food allergies? *

Do you suffer from shortness of breath? *

Do you suffer from chronic fatigue? *

Do you suffer from sleep apnea? *

Do you normally suffer from Osteoarthritis? *

Do you normally suffer from Rheumatoid Arthritis? *

Do you frequently pass gas after meals? *

Do you suffer from reflux or heartburn? *

Do you often burp after meals or feel bloated? (Even just small burps.)? *

Does your meal ever feel like it's sitting in your stomach like a rock for too long? *

Do you crave sweet or salty foods? *

Do some foods make you nauseous? *

Is your stool sometimes lighter than the colour of corrugated cardboard? *

Do you have regular (daily) bowel movements? *

How many bowel movements do you have on a typical day? *

Do you ever experience heartburn or acid reflux? *

Have you recently taken any antacids or acid reflux medications? *

Are you frequently constipated? *

Do you frequently experience diarrhoea? *

Do you have a stomach ulcer? *

Have you had your gallbladder removed? *

Do you ever see undigested food in your stool? *

Do you seem to gain weight no matter what you eat? *

Do cravings frequently derail your weight loss attempts? *

Conductivity Readings

NOTE: This test is only for those of you that have access to a conductivity meter (not essential). Ideally these readings are taken later in the day/early evening.

Add some urine to a clear plastic cup, hold the cup up to the light and gauge how much debris is floating around in the urine (small bits/particles):

If you can see clearly through the cup with only a few bits or particles floating around, select LOW.
If you can see clearly through the cup but notice a higher level of bits or particles floating around in the sample, select MEDIUM.
If you cannot see clearly through the cup and notice large amounts of particles floating in the sample, select HIGH.

Urine mS *

Saliva mS *

Urine Debris

NOTE: Please carry out this test towards the end of the day at least an hour away from drinking anything.

Add some urine to a clear plastic cup, hold the cup up to the light and gauge how much debris is floating around in the urine (small bits/particles):

If you can see clearly through the cup with only a few bits or particles floating around, select LOW.
If you can see clearly through the cup but notice a higher level of bits or particles floating around in the sample, select MEDIUM.
If you cannot see clearly through the cup and notice large amounts of particles floating in the sample, select HIGH.

Level of debris in Urine *

Approximately how many litres of water do you drink per day (not including coffee / tea / soft drinks etc? *

Do you drink coffee regularly? *

Do you drink alcohol on a regular basis? *

Do you smoke tobacco? *

How much salt do you normally add to your food or water each day? *

What type of salt do you normally use (normal table salt / Celtic sea salt / Himalayan pink salt etc.) *

Do you take recreational drugs? *

Do you normally drink water / alcohol / other drinks with your meals? *

What is normally your first drink of the day? *

Do you normally drink your first drink of the day before you eat any food? *

Please list any other drinks you would normally drink each day *

How many hours of sleep on average do you get each night? *

How often do you exercise? *

What type of exercise do you do? *

Please list any supplements you are taking and why you are taking them. *

Do you normally eat breakfast? *

Please list foods you would normally eat for breakfast? *

Do you normally eat lunch? *

Please list foods you would normally eat for lunch *

Do you normally eat tea / evening dinner? *

Please list foods you would normally eat for tea / evening dinner? *

Do you normally eat supper? *

Please list foods you would normally eat for supper *

On a scale of between 1 an 10 (1 being very poor and 10 being excellent), how would you rate your current emotional wellbeing? *

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