you answer ‘yes’ to any of the following, score one or two points depending on the specific question (some symptoms are more relevant to food intolerances, so they score 2 points), as shown below.
SECTION ONE – DIGESTIVE SYMPTOMS
Do you suffer on a regular basis (i.e. more than 3 times a week) from any of the following?
abdominal bloating/distension (2)
abdominal cramps (2)
abdominal or stomach pain (2)
burping after eating certain foods
catarrh (mucus) (2)
difficulty gaining weight
difficulty losing weight
enuresis (bed-wetting) (2)
excess wind (flatulence)
gallbladder problems (difficulty digesting fats)
Gastro-oesophageal Reflux Disease (GORD) (2)
glue ear (otitis media) (2)
gritty feeling in the eyes (2)
haemorrhoids (piles) (2)
indigestion (recurring) (2)
inexplicable weight gain or weight loss
irregular bowel motions (e.g. constipation or diarrhoea) (2)
Irritable Bowel Syndrome (IBS) (2)
itchy bottom
itchy, red ears (2)
metallic taste in the mouth (2)
mouth ulcers (2)
nausea
persistent need to clear your throat/sore throat (2)
post-nasal drip (2)
rhinitis (runny nose) (2)
sinusitis (2)
sneezing – frequent (2)
water retention (oedema)
(20 x 2 = 40)
(9 x 1 = 9)
Sub-total/maximum = /49
SECTION TWO – MENTAL, EMOTIONAL AND NERVOUS SYSTEM SYMPTOMS
addictions
aggressive outbursts
anxiety
Attention Deficit Disorder/ADHD (2)
behavioural problems (2)
blankness or momentary difficulty finding the right word(s) (2)
blurred vision (2)
brain fog (2)
changes in handwriting (2)
clumsiness (2)
confusion
constant hunger (2)
dark circles under your eyes (2)
depression
dilated blood vessels in your cheeks and nose (2)
dizziness
dyslexia (2)
fidgeting
foggy head (2)
food cravings (2)
headaches
hyperactivity (especially in children) (2)
inability to think clearly (2)
insomnia
irritability
lack of motivation/get up and go
migraines (2)
mood swings
palpitations
panic attacks
phobias
poor concentration
racing pulse
restless legs syndrome
slurred speech
spaciness (2)
tenseness
tinnitus (ringing in the ears) (2)
uncharacteristic inability to make decisions
(18 x 2 = 36)
(21 x 1 = 21)
Sub-total/maximum = /57
SECTION THREE – OVERT PHYSICAL SIGNS AND SYMPTOMS
abnormal physical weakness or tiredness
aching muscles and joints for no good reason (2)
arthritis
asthma
chronic infections
eczema
fibromyalgia (diagnosed by a physical therapist or doctor) (2)
hives (urticaria) (2)
itching (2)
painful joints in which the pain moves from one joint to another (2)
painful joints not associated with excessive use (2)
psoriasis (2)
rheumatoid arthritis
rough, dry skin
