Section A
Night Blindness
Weight Loss, Indigestion, Episodes of Diarrhea (all present)
Dry Eyes
Premature Gray Hair
Sleep Disturbances with Bone Pain
Mild Jaundice
Frequent Fractures
History of Cleft Deformities
History of Cystic Fibrosis
Birth Defects
Chronic Pancreatitis
Feeling Fatigued from Stress
History of Obstructive Liver Disease
Burning Feet Syndrome
Excessive Thirst
Faint Feeling upon Standing up Quickly
Anxiety
Chronic Colds or Being Sickly
Trouble Getting Deep Breath
Slow Wound Healing
Painful Fissures in Center of Mouth
Leg Cramps
Painful Tongue
Frequent Urination
Scaling of Skin
Taking Diuretics
Swollen, Bright Red Tongue
Excessive Sweating Due to Occupation or Other
Depression With Insomnia
Muscle Spasms or Fasciculation's
Wrist Pain Worse at Night (or carpal tunnel)
Tremor
Numbness in Extremities
Taking High Amounts of Calcium
Irritable and Depressed (both)
Rough Dry Skin
Skin on Face is Dry, Shining, Scaling
Swollen Prostate (slowed urine flow)
Inside of Mouth and Tongue sore
Lack of Taste (cannot taste food well)
Prolonged Use of Egg White Protein Supplement
Symptoms of Unexplained Chest Pain
Hair Loss
White Finger Nail Beds
Outside of Nostrils, External Ear or Eyelids
Chronic Muscle Pain and Tenderness
Become Reddened, Scaly, Greasy, Painful
Blood Sugar Imbalance
Lack of Endurance
Eat Mostly Carbohydrates
Section B1
Heavy Alcohol Use
Depression
Sensitive to Chemical Smells (perfume, new car,pet, etc.)
Headaches
Sick Headaches
Mental Confusion
Steroid use (anabolic, estrogens, contraceptives)
Parasites (numbness and tingling)
Unexplained Heart symptoms (arythmia, heart pounding)
Respiratory Tract Allergies
High exposure to certain chemicals (cleaning solvents,
pesticides, antibiotics,diuretics, thyroid medicine, nsaids i.e. Tylenol,
Ibuprofen)
Section B2
Fatigue (unusual)
Weakness in Arms or Legs
Muscle Pains (fairly constant)
Anemic
Symptoms worse after Dental work
Dizziness
Tremors
Poor Coordination
Section B3
Migraine Headaches
Sinus Congestion
Eczema
Indigestion
Arthritis
Intestinal Gas
Inflamed Bowel
Diarrhea/Constipation
Asthma Symptoms
General Fatigue
Irritable Bowel
Feeling Worse After Eating
Rash or Hives
Section C4
Feel "Spacey"
Chronic Infection of Skin and Nails
Feel "Drained"
Have Taken Antibiotics Within the Last Year
Spots in Front of Eyes
Severely Crave Sugar, Feel Worse After Eating It
Itching
Chronic Yeast Infection
Symptoms Worse on Damp, Muggy Days
Section C5
Abdominal Cramps
Chronic Low Back Pain
Rectal Itching
Symptoms Worse Around Full Moon
Flatulence and Abdominal Bloating
Eaten Food Out of the USA Within the Last Year
Foul Smelling Stools
Eat Raw Oysters or Raw Seafood
Abdominal Distention
Heartburn, Nausea, and Vomiting (all three)
Section C6
Night Sweats
Loss of Appetite
Sore Throat
History of Mononucleosis
Swollen Lymph Glands
History of Oral Herpes, Genital Herpes or Shingles
Stomach Ache
History of Epstein Barr Virus (chronic fatigue syndrome)
Cough
History of Viral Hepatitis
Odd Skin Sensations
Section D7
Eat mostly carbohydrate foods (rice, potatoes, pasta, bread,
sweets, etc.)
Drink sweetened beverages (sodas,sweet tea, Gatorade, juice, lemonade)
Eat or crave sweets (deserts, candy, etc)
Feel like you have to have something sweet with meal
Get shaky (or weak) when hungry
Eat fast food more than five times per week
Have lost weight using protein diets
Eat junk food more than five times per week
Avoid eating meat
Are hypoglycemic or diabetic
Have high cholesterol
Presence of gallstones
More than 20 pounds overweight
Section D8
Exhaustion
Emotional, Easily Upset (cry for no reason)
Low Blood Pressure
Slow Wound Healing
Dry Skin and Hair
Panic Attacks
Inappropriate Weight Gain
Cold Hands or Feet
Constipation
Light Headed Or Ringing In Ears
High Cholesterol
Depression
Insomnia
Have Goiter
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