EVERYDAY EPIGENETICS
EVALUATOR FOR ADULTS—E3A
Copyright © 2015 by Martha Herbert, MD, and Patricia Lemer, MEd
DIET (25)
1. ____Don’t eat breakfast (2)
2. ____Eat canned food >3x/week (3)
3. ____Eat/drink dairy products daily (2)
4. ____Buy nonorganic vegetables (2)
5. ____Eat <5 servings fruit and vegetables/day (3)
6. ____Drink soda (1)
7. ____Drink diet soda (2)
8. ____Eat out >3x/week (2)
9. ____Eat at fast food restaurants >2x/week (2)
10. ____Eat >15 grams sugar/day (3)
11. ____Eat sushi and/or tuna fish (1)
12. ____Microwave food (2)
EMFs (7)
13. ____Known cell phone tower within 1 mile of home (1)
14. ____TV and/or computer in bedroom (1)
15. ____Talk on cell phone >1 hour/day (2)
16. ____Use home alarm system (2)
17. ____Wi-Fi on at night (1)
SLEEP (9)
18. ____Get fewer than 8 hours’ sleep >3 nights/week (3)
19. ____Use nonorganic mattress (2)
20. ____Get <30 minutes of exercise per day (2)
21. ____Use sleep number bed (2)
SOCIAL-EMOTIONAL (6)
22. ____Estrangements in family (2)
23. ____Stress in marriage (2)
24. ____Financial worries (2)
MEDICAL/DENTAL (31)
25. ____Have “seasonal” allergies (2)
26. ____Carry an EpiPen (3)
27. ____Poop <1x/day (2)
28. ____Get flu shot (2)
29. ____Antibiotics in past 5 years (2)
30. ____Take Tylenol (2)
31. ____Low thyroid (3)
32. ____Known low vitamin D level (3)
33. ____Mercury amalgams (4)
Copyright © 2015 by Martha Herbert, MD, and Patricia Lemer, MEd Page 1/4
34. ____Root canal(s) or dental implants (2)
35. ____Wear glasses with progressive lenses or monovision contacts (2)
36. ____Take >2 prescription meds (2)
37. ____Major surgeries to remove organs (2)
TOXINS (18)
38. ____Work exposure to toxins (2)
39. ____Play or live near a golf course (1)
40. ____Use a lawn service (1)
41. ____Fluoride in toothpaste (1)
42. ____Use dryer sheets (1)
43. ____Use perfume, lipstick, dye hair (1)
44. ____Use antibacterial soap and/or hand sanitizer (1)
45. ____Spray for bugs regularly (1)
46. ____Have been exposed to mold (2)
47. ____Smoke now or in the past (2)
48. ____Use deodorant containing aluminum (1)
49. ____Renovated/painted home (1)
50. ____Live near freeway (1)
51. ____Use plug-in air fresheners (1)
52. ____Work or live in space without windows that open (1)
HYDRATION (4)
53. ____Drink <32 ounces of H2O/day (2)
54. ____Drink tap water (2)
PRENATAL (13)
1. ____Conceived with fertility assistance (2)
2. ____Birth mother with >5 amalgams (2)
3. ____Mother with chronic fatigue, low thyroid, or fibromyalgia (3)
4. ____>3 sonograms during pregnancy (1)
5. ____Mother vaccinated pregnant (2)
6. ____Mother used drugs, smoked, or drank alcohol (2)
7. ____Born by C-section (1)
DIET AND HYDRATION (24)
8. ____Formula fed as infant (1)
9. ____Picky eater (3)
10. ____Eats bread or crackers daily (2)
11. ____Eats/drinks dairy products daily (2)
12. ____Eats <3 servings fruit and vegetables/day (3)
13. ____Drinks soda or diet soda (2)
14. ____Eats at fast food restaurants >2x/week (2)
15. ____Eats >15 grams sugar/day (3)
16. ____Eats microwaved food (1)
17. ____Eats foods with artificial ingredients (1)
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18. ____Drinks <32 ounces of H2O/day (2)
19. ____Drinks tap water (2)
MEDICAL/DENTAL (26)
20. ____History of ear infections (1)
21. ____Hep B shot at birth (2)
22. ____One or more vaccine reactions (2)
23. ____Has “seasonal” allergies (2)
24. ____Carries an EpiPen (2)
25. ____Poops <1x/day (1)
26. ____Gets flu shot (1)
27. ____Took antibiotics in past year (1)
28. ____Takes Tylenol (2)
29. ____Known low vitamin D level (3)
30. ____Mercury amalgams (3)
31. ____Root canal(s) (1)
32. ____Wears glasses (1)
33. ____Has orthodontics (1)
34. ____Walked early; didn’t crawl (2)
35. ____Shallow or mouth breathing (1)
TOXINS (8)
36. ____Fluoride treatments or toothpaste (1)
37. ____Swims in chlorinated pool (1)
38. ____Dryer sheets used in laundry (1)
39. ____Uses nonorganic lotions and shampoo (1)
40. ____Uses antibacterial soap and/or hand sanitizer (1)
41. ____Home sprayed for termites (2)
42. ____Uses bug spray and/or sunscreen (1)
SLEEP (8)
43. ____Sleeps fewer than 10 hours >3 nights per week (3)
44. ____Uses flame-retardant mattress (2)
45. ____Gets <30 minutes of exercise per day (2)
46. ____Attends school or lives in space without windows that open (1)
EMFs (5)
47. ____Known cell phone tower within one mile of home (1)
48. ____TV and/or computer in bedroom (1)
49. ____Uses tablet/computer >1 hour/day (1)
50. ____House has alarm system (2)
SOCIAL-EMOTIONAL (11)
51. ____Stressful/abusive family situation (2)
52. ____Major sudden loss or trauma (2)
53. ____Adopted or in foster care (2)
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54. ____Sees one parent infrequently (1)
55. ____Bullied at school (1)
56. ____Has >3 siblings (1)
57. ____Has <3 friends (2)
ACADEMIC (5)
58. ____In lower grade than age (2)
59. ____Has IEP or 504 accommodations (2)
60. ____Receives tutoring (1)
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