Sleep Habits
The green part of the questionnaire has a twofold effect. The first effect is to awaken the patient to daily activities and to notice them while writing them down and secondly for you to see how conscious they really are.
Many times a client tells you how good their diet is while on closer look you see that this statement can only be made from a very uneducated standpoint.
Vital body gives life to a person and should therefore be seen as an important part that gives you insights into the energy a person has to change those things that are required to heal.
When do you go to sleep?
A patient should go to bed no later than 10pm to ensure they receive enough phase 3-4 REM sleep (regeneration).
When do you wake up?
A person should wake after about 8 hours of sleep (age dependent). They should try to wake as close to sunrise as possible because sunlight disturbs production of the sleep hormone melatonin.
How many hours of sleep do you feel like you need a night?
This gives an indication to what a patient is used to. Not everyone requires exactly eight hours and individuality must be accounted for. If a person feels like they could sleep forever and not wake refreshed then this can also be a sign of hypothyroidism/adrenal fatigue or other hormonal dis-regulation.
How long does it take you to fall asleep?
It should take a person 15-20 minutes for their brain to unwind and their body to relax. If the patient falls asleep quicker then he/she is too exhausted (cause may be any number of factors). If the patient struggles to fall asleep then hormonal balance (thyroid, adrenal, serotonin/melatonin, GABA) and stress should be addressed.
Do you wake during the night?
Waking during the night disrupts the balance of REM cycles, which can cause exhaustion and impaired regeneration.
How often?
This is an indication of the severity of the situation. Waking once a night to go to the toilet is not considered harmful to health.
Was there a reason you woke up (baby, bathroom, other noise disturbances)?
This is just a simple question that allows a practitioner to see if the reason for sleep disturbances is something they can incorporate in treatment or is something that cannot be changed, e.g. baby requiring breastfeeding.
Do you have trouble falling back asleep?
This question is important to see if the time awake disturbs their sleep to the extent that they are unable to fall back asleep. Pre-diabetics suffer from this due to hormone disruption, people under sever stress, even nutritional deficiencies can result in difficulty falling back asleep. Sleep hygiene practices such as avoiding bright light (especially blue light as it disturbs melatonin production the most) during their time awake can dramatically change their sleeping patterns and allow them to fall directly back to sleep.
When you wake up in the morning, do you feel refreshed?
This relates back to the earlier question about how much sleep they feel like they need. Hypothyroidism is a distinct possibility as well as adrenal fatigue or chronic fatigue. Quality of sleep must also be examined; lights, EMF disturbances, geopathic stress, quality of mattress, sleep apnea, etc.
After waking, how long does it take you to get hungry?
If it takes a long time to get hungry after waking this is a clear sign of cortisol deficiency. The cortisol pathway needs to be examined and possibly nutritionally supported. Other factors such as depression and eating disorders can play a role in this factor too.
How are your energy levels during the day?
In relation to sleep this gives an indication if the patient is having adequate REM cycles. It also indicates to a multitude of other disorders, however, it is important to eliminate causes and disturbed sleep or lack of sleep is a simple cause for low energy that practitioners often overlook due to its simplicity.
Rate them out of 1-10 (1 being really tired and 10 being full of energy).
This is simply a scaling question for the one above and clarifies how the patient feels. It can also be charted easily as treatment progresses with the patient.
Is there a better or worse time during the day?
This is important to eliminate cortisol insufficiency. A distinctive drop in cortisol during the early afternoon (2-3pm) is a clear sign of cortisol dis-regulation and can be a precursor to chronic fatigue.
Do you have any naps during the day?
This leads on from the previous question and can show the severity of cortisol insufficiency. Naps during the afternoon can also be related to intolerances to foods consumed and adrenal exhaustion.
Exercise Habits
How many times a week do you exercise?
Gives an indication of fitness.
What kind of exercise do you perform?
Important to examine due to detrimental effects certain exercise forms can have on specific conditions.
How do you feel after exercise?
Exercise should be invigorating. If a patient feels extremely; tired, sluggish, exhausted or has severe muscle soreness then he/she may be suffering from adrenal fatigue, blood glucose regulation issues or is performing too much exercise (intensity or duration).
Where do you exercise?
Although gym work is beneficial, especially for weight bearing exercises (bone strengthening), it has been proven in several studies that sunlight, fresh air and green trees create endorphins in the body that are extremely healing. Therefore to compliment gym work out sessions, time outdoors cannot be ignored.
Do you get cramps or sore muscles after exercise?
Important to identify due to the link with magnesium deficiency and dehydration.
Drinking Habits
How many litres of ‘water’ do you drink a day?
An adult requires around two litres of water per day (size/age/activity dependent) to maintain electrolyte, blood pressure and toxin excretion balanced.
How many litres of liquid, other than water, do you drink a day?
Depending on what makes up the other liquids, this may be a key intervention to regulate sugar intake and reduce acidity. Numerous studies have shown that the consumption of soft drinks lowers the bone mineral density and is linked with an increased risk of osteoporosis and bone fractures.
Do you drink coffee, and if so, how many cups and when?
Caffeine is associated with a long list of side effects including addiction and numerous medical conditions. Not only is coffee acidifying but is normally consumed with sugar, which increases the acidifying effect. The amount of stimulation through caffeine also relates back to adrenal fatigue, hypothyroidism, insomnia and anxiety. The time of day coffee is consumed plays an important role as it can be used to combat cortisol deficiencies, which show around 2-3pm.
Do you drink alcohol, and if so, how often per week/month (whatever is applicable)?
Alcohol is well known for its dangers; liver necrosis, cancer and diabetes, just to name a few. Therefore, the consumption must be closely monitored and completely eliminated in cancer patients.
When you do drink alcohol, how much do you consume?
This gives an indication if the patient drinks a glass of wine with dinner or gets drunk on the weekends. Both have their own respected issues and must therefore be addressed accordingly.
How many soft drinks do you consume per week?
Soft drinks, as mentioned above, is linked with lowered bone mineral density and is linked with an increased risk of osteoporosis and bone fractures. The disturbance of calcium metabolism, absorption and deposition has far reaching effects beside bone mineral density and needs to be addressed if damaged, or the consumption of soft drinks needs to be reduced (stopped if possible).
Do you drink fruit juice, and if so, how much?
Many people believe fruit juice is a healthy alternative to drinking soft drinks, coffee and alcohol. Recent studies have shown that the damaging affect of high fructose fruit juices has detrimental effects on the body that are similar to alcohol. They increase the growth rate of cancer, acidify and raise inflammation in the body. It is directly linked with diabetes and liver necrosis.
Do you consume liquid with your meals?
Consumption of liquids with meals decreases the potential for HCL to break down proteins and fats in the stomach. The reduction of acidity actually results in an inverse acidifying of the small intestine and leads to poor digestion and has been linked to increased food intolerances.
Do you get thirsty?
Diabetes is associated with never ending thirst and is important to identify in the treatment of a chronic disease patient.
Toxic Habits
Do you have any hobbies or a job which exposes or has exposed you to chemicals and pesticides? Jobs like that would be in a lab, farming, home garden, carpentry, painting, hairdressing, florist, dentistry.
Constant exposure to chemicals such as paints, pesticides, herbicides, petrol, clues, formaldehyde, mercury...increases the risk of chronic diseases. Client with a high history of exposure need to be tested and adequately detoxed.
Have you been a frequent flyer?
Frequent flyer are exposed to high radiation. Airline pilots and cabin crew have an increased risk for certain cancers.
Have you had many X-rays, CT scans?
Studies have associated x-ray exposure with thyroid, breast, and lung cancer and leukemia.
Do you live in a house, flat or other accommodation that was built before 1970?
Before 1970, paints containing high levels of lead were used in many houses. Also a highly-effective and inexpensive fire-retardant material and thermal and acoustic insulator, asbestos was used extensively in home construction from the early 1940s through the 1970s. However, prolonged exposure to asbestos fibers can lead to lung disease and eventually to lung cancer.
Do you live or have lived in a building with mold or persistent unrepaired water leaks?
Mold is one of the many biotoxins found in water-damaged buildings, and the illness caused by exposure to these toxins is highly complex. People who had mold exposure are very often highly sensitive to detox protocols.
Also someone living in a building with mold either needs to move or seek professional help to eliminate the mold problem.
Is your furniture made out of particle board?
Cheap particle board furniture can out gas formaldehyde, which is a highly toxic gas. Formaldehyde is listed as a human carcinogen and can cause cancer of the throat, nose, and blood.
Do you dry clean your clothes?
Dry cleaners routinely use the toxic solvent perchloroethylene (PERC). PERC exposure can lead to headaches, nausea, dizziness and memory problems.
Do you have an older sofa or mattress made out of polyurethane foam?
A chemical called polybrominated diphenyl ethers, or PBDEs, was used as a flame retardant in foam materials. The chemical was showing up in people’s bodies, and research suggested that it disrupted hormone signaling and children’s developing brains and nervous systems. While most PBDEs are no longer used in couches, other potentially problematic chemicals are substituted.
Do you use fragrances?
Artificial fragrances are a cocktail of chemicals which are absorbed through lungs and skin.
Do you use conventional care products and cosmetics?
Care products and cosmetics contain several toxins which are absorbed directly by the skin.
Do you drink water from plastic bottles?
Plastic bottles contain BPA and Phthalates, which are both endocrine disruptors. Health effects related to these toxins are hormone depended cancers, obesity, miscarriage, hyperactivity, diabetes, altered immune system....
Have you eaten much fish before or since you've been ill, especially tuna, swordfish, shark or other large fish near the top of the food chain?
Fish at the end of the food chain are highly contaminated with mercury and other heavy metals. Ingesting these fishes for a long time can lead to mercury toxicity.
Dietary Habits
Please fill out the diet diary below. It is designed as an insight into your ‘average’ daily diet. Please describe your diet as honestly and extensively as possible. For example, vegetables, what kind of vegetables? How are they prepared? How big is the serving?)
The diet dairy can give a quick understanding of a patient’s belief of healthy food. It is important to note that unless the patient is extremely honest he/she is most likely to bend the truth regarding this diary. However, it is still a key component and is used fundamentally when designing a new diet for the patient. When assessing this diary it can be useful to do so in an interactive manner with the patient to summaries and question the specifics written down.
Please describe your diet as accurately as possible:
Breakfast
Morning tea
Lunch
Afternoon tea
Dinner
Supper
Are you responsible for your own food choices/preparation?
This question is extremely relevant to most men, children, teenagers, students, certain occupations, sickly and elderly. If a patient is not responsible for the food preparation then the application of any dietary changes must be discussed and addressed with the person responsible. Although it may seem obvious, this is often the reason why dietary interventions do not work as communication between patient and carer is not adequate or possible.
Do you have an aversion to any foods?
An aversion to a food can be more complex than a simple taste bud aversion. It is often associated with a psychological connection to that food. These psychological blockages may affect the nutritional status of a patient or it may be the only indicator to finding a deeply hidden trauma or psychological scar. Some people who are sensitive to their body’s reactions may also have aversions to foods that they have intolerances to. Along with functional IgG, IgA and IgE, asking this can be used to avoid foods that cause inflammation in the body.
Do you crave salty foods?
Craving salty foods can indicate a number of things, however, the most notable are: dehydration (may be linked with kidney disease or diarrhetic drug misuse), nutritional deficiency (electrolyte insufficiency due to dietary or supplemental imbalances), adrenal insufficiency (decreased cortisol hormone production, which affects the entire system and is characterised by salty and sweet cravings).
Do you crave sweet foods?
Sugar, which is a key component of energy production, also has numerous detrimental effects on our health. Fructose is metabolised by the same chemical pathway as alcohol. The toxic byproducts this creates is a serious issue in today’s society due to the over-consumption of sugar (especially fructose). Sugar cravings can be the first sign of insulin resistance and dis-regulation of blood sugar balance. Sugar addictions are also becoming more common and are a side effect of low serotonin and dopamine neurotransmitter levels (feel good neurotransmitters). However, on a more simplistic level, this question allows a practitioner to see how compliant a patient may be to a less sweet diet. If sugar cravings are present it is important to investigate which sweet foods satisfy this craving as they may require further investigation. For example, specific chocolate cravings may indicate; magnesium, chromium, B vitamins and essential fatty acid insufficiency.
Do you have problems with digesting fat?
Issues digesting fats may present with symptoms such as: Nausea, steatorrhea, bloating, stomach pain/cramps, heart burn and other IBS symptoms. The primary reasons that may lead to these symptoms are: a high fat diet, chronic pancreatitis, gallstones, gastroporesis, elevated estrogen hormone and congested liver. Although all of the above can be a cause for fat intolerances, the most common are related to the liver (especially impaired phase 2 detoxification). Further functional testing may be required to distinguish the cause of fat intolerances. However, due to the important role the liver plays in toxin clearance, this is an important factor to address.
How do you mostly feel after you have been eaten, tired or energised?
The energy and feeling a patient gets after a meal can be the single most important factor when deciding what foods will benefit a patient’s health. Therefore, it is important to examine if the patient’s current diet is working for them. Impaired digestion (low HCL, bowel mucosa inflammation/perforation, diabetes, intolerances, allergies, diverticulitis, etc.) can also affect the energy a person receives from food.
How is your appetite throughout the day?
This question can be an indicator of many things. Decreased appetite may be an indicator of: bacterial and viral infections, psychological (anorexia, grieving, anxiety, stress, boredom), chronic liver or kidney disease, hepatitis, HIV, dementia, hyperthyroidism, Cancer (stomach, ovaries, pancreas), medication (antibiotics, codeine, morphine, chemotherapy drugs), etc.
Increased appetite may be an indicator of: anxiety, drugs (corticosteroids, antidepressants), bulimia, diabetes mellitus, Graves disease, hyperthyroidism, hypoglycemia, premenstrual syndrome, increased exercise, celiacs (other absorption disorders), dehydration, starvation, etc.
Do you follow any special diet, and if so, why?
Spiritual and psychological bonds to diets or certain foods must be known and taken into consideration when addressing dietary changes.
If you are a vegan/vegetarian, are you prepared to eat meat or fish if advised to?
This question is related to the previous question and must be asked to see if the patient is flexible to changes. Further investigation into the patient’s compliance with animal product based supplements is necessary especially if the patient is not open to changing some of their dietary habits.
Do you eat snacks or sweets not covered in your diet diary?
These foods are often linked with emotional or stressful situations and asking additional questions regarding these consumed foods is necessary to find underlying psychological connections and possible ramifications these foods are having on the patient’s health (especially relevant if the patient is in an advanced disease state).
Do you eat out, and if so, what do you normally eat?
Similar to the question above, it links the foods that may not be included in the diet diary into their diet. It also lets you, the practitioner, examine the effects some foods (MSG food enhancer, saturated trans fats) have on the body and may help find the cause for certain symptoms.
Do you think you go wrong with your diet?
Focused on the patient’s psychological relationship to food, this question allows a practitioner to examine how willing the patient is to change and how aware he/she is of their food choices.
How many times a week do you consume fish, and if so, what kind?
Mercury levels are on the rise around the globe and consumption of fish is one of the primary sources of exposure for humans. However, the consumption of fish for their omega-3 fatty acids is extremely beneficial to health. The cost to gain ratio of this food must be examined and fish that are lower in mercury are preferred. Tuna, shark and other large fish are large red flags containing high amounts of mercury and other heavy metals, even the WHO advises against the consumption of tuna during pregnancy.
Do you consume meat, and if so, how many times a week and what kind?
Meat contains many of the essential nutrients required for health that are scarce or impossible to find in vegetarian sources. Although meat contains these extremely beneficial nutrients, it is also associated with many health concerns. Some of these concerns are related to an overconsumption, which may lead to increased acidity in the body. However, the largest causes for concern are related to the farming, processing and cooking methods of the meat.