Questionnaire

Part 1. Predisposing factors

1. I went through long periods of stress that took a toll on my

well-being.

1. I had one or more major stressful events that affected my well-being.
2. I brought myself to exhaustion.
3. I neglected rest and daily recovery for long periods of time.
4. I have had widespread, severe or recurring respiratory infections.
5. I have taken long-term or intensive steroid therapy (corticosteroids).
6. I tend to gain weight, especially in the abdomen (lifebuoy).
7. I have a history of alcoholism and/or drug abuse.
8. I am very sensitive (emotionally and physically).
9. I have insulin resistance or diabetes (type II).
10. I have PTSD.
11. I suffer from anorexia.
12. I have one or more chronic diseases or illnesses

Part 2. Key signs and symptoms

1. My ability to cope with stress or pressure has decreased.
2. I am less productive at work.
3. It seems that my cognitive abilities have declined. I can’t think as clearly as before.
4. My thinking gets confused when I’m in a hurry or I’m under pressure.
5. I try to avoid emotional situations.
6. Under pressure, I usually get very nervous and can get punched to shiver.
7. When I’m stressed, I get nervous and upset stomach.
8. I have many unexplained fears/anxiety.
9. My sex drive is noticeably less than it used to be.
10. I get dizzy when I get up quickly from a sitting or lying position.
11. I’m getting grey hair.
12. I am chronically tired; fatigue, which usually does not go away after sleep.
13. I don’t feel well most of the time.
14. I notice that my ankles are swollen – swelling increases in the evening.
15. I usually need to lie down or rest after my psychological or

emotional stress.

1. Sometimes my muscles seem weaker than they should be.
2. Tremor or restless leg syndrome appeared.
3. I have an allergy or increased frequency/severity allergic reactions.
4. When I scratch my skin, a white line remains for a minute or more.
5. Small irregular shapes appeared on the forehead, face, neck and shoulders dark brown spots (pigmentation).
6. 34. Sometimes I feel weak both mentally and physically.
7. I have unexplained and frequent headaches.
8. I often feel cold (chilly).
9. I have a reduced cold tolerance.
10. I have low blood pressure.
11. I often feel hungry, confused, trembling, or paralysed by stress.
12. I lost weight for no reason, I feel very tired and lethargic.
13. I feel a sense of hopelessness and despair.
14. My tolerance has decreased. People annoy me more.
15. Lymph nodes in my neck often swell (I have swollen glands in my neck).
16. I have occasional nausea and vomiting for no apparent reason.

Part 3. Energy sources

1. Often I have to force myself to do something. Everything seems heavy/dull/boring.
2. I get tired easily.
3. It’s hard for me to get up in the morning.
4. I suddenly run out of energy.
5. I usually feel much better by noon
6. I often have low energy between 3:00 pm and 5:00 pm.
7. If I don’t eat regularly, I have little energy, I become cranky, or my mind is clouded.
8. I usually feel better after 6 pm.
9. I feel tired all day, but I can’t fall asleep on time.
10. I like to sleep late in the morning
11. My best, most refreshing sleep is usually around 7:00-9:00 in the morning.
12. I often work best late at night (early in the morning).
13. 57. If I stay up until 11:00 pm, I get a second boost of energy around 23:00, often lasting until 2:00.

Part 4. Diseases

1. 58. I may have a persistent runny nose or cough.
2. I have frequent recurring bronchitis, pneumonia, or other respiratory infections (more than 2 times a year).
3. I suffer from asthma, colds and other

respiratory diseases two  or more times a year.

1. I often get rashes, dermatitis, or other skin problems.
2. I have rheumatoid arthritis.
3. Allergy to one or more components appeared or increased.
4. I am highly sensitive to household and other chemicals,
5. I have chronic fatigue syndrome.
6. I have pain in my upper back and lower back for no apparent reason.
7. I have pain in the side muscles of my neck.
8. I have insomnia or sleep problems.
9. I have fibromyalgia.
10. I suffer from asthma.

Part 4. Nutrition

1. In the morning I need coffee or another stimulant.
2. I often want to eat fatty foods and feel better after eating them .
3. I often eat fatty, salty, fried foods, and after eating them, I

become more comfortable.

1. 74. I often use stimulants (caffeine) and fast carbohydrates.
2. I often crave salt and/or high salt foods. I love

salty food.

1. I feel worse if I eat foods high in potassium (eg bananas, figs, raw potatoes), especially if I eat them in the morning.
2. I really like foods with a high

protein content (meat, cheeses).

1. I crave sweet foods (pies, cakes, pastries, doughnuts, dried fruits,

sweets or desserts).

1. I feel bad if I skip meals.

Part 5. Lifestyle

1. I have constant stress in life or at work.
2. I have an eating disorder (compulsive overeating).
3. My relationships at work and/or at home do not satisfy me.
4. I don’t exercise regularly.
5. I eat a lot of fruit.
6. There are not enough pleasant events in my life.
7. I have little control over how I spend my time.
8. I limit my salt intake.
9. I have infections or abscesses in my gums and/or teeth.
10. I don’t eat regularly.

Part 6. Feeling better

90 I feel better almost immediately after resolving a stressful situation.

91 Regular meals reduce the severity of my symptoms.

92 I often feel better after

meetings with friends

93 I often feel better when I lie down.

If you answered yes to more than 20 questions, then you most likely have Adrenal Fatigue Syndrome. If you answered yes to less than 10 questions, then most likely your stage is 1-2, and you can recover fairly quickly.

The sum of points is used to determine the severity of the syndrome: the more points, the more severe the stage. If you score over 45, you should see a functional doctor or naturopath.

Anything in the 45-point zone can be considered stages 2, 3, 4