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Gut assessment
How Healthy is YOUR Gut?
Instructions: Check the box if you experience one or more of these symptoms on a regular basis.
Gastrointestinal
Recurrent gastrointestinal infections
Chronic diarrhea
Cramps, urgency or mucus and blood in your stool at least once/week
Chronic constipation
Gas, bloating, and abdominal discomfort most days
Intolerance to carbohydrates, especially beans and fiber
Itching in the vagina, anus, or in other mucosal membranes most days
Uncomfortable fullness in stomach
Fat malabsorption
Skin/ Weight / Energy
Fatigue and/or low energy most days
Chronic bad breath
Cravings for sugar or carbohydrates
Skin issues or acne
Difficulty gaining or losing weight
Disease /Syndrome/ Medication
Chronic sinus congestion
Used antacids daily for more than 30 days in the past 2 years
Taken antibiotics more than three times in the past year
History of traveler's diarrhea or foreign travel
Food or environmental sensitivities
Diagnosed with an autoimmune disease or condition
Diagnosed with arthritis or fibromyalgia
History of food poisoning
Diagnosed with reflux, heartburn or a hiatal hernia
Systemic inflammation
Hashimotos or thyroid disease
Vitamin/Mineral Imbalance
Mood
Vitamin D deficiency
Low iron levels or anemia
Low or high Vitamin B12
Experience chronic stress
Decreased cognitive function or brain fog most days
Feel depressed or anxious most days
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