Male Quick Symptom Questionnaire

1.Is depleted brain chemistry the problem?

4 Sensitivity to emotional (or physical) pain; cry easily

4 Eat as a reward of for pleasure, comfort, or numbness

4 Worry, anxiety, phobia, or panic

4 Difficulty getting to sleep or staying asleep

3 Difficulty with focus, attention deficits

2 Low energy, drive, and arousal

4 Obsessive thinking or behavior

2 Inability to relax after tension, stress

3 Depression, negativity

4 Low self-esteem, lack of confidence

4 More mood and eating problems in winter or at the end of the day

3 Irritability, anger

4 Use alcohol or drugs to improve mood

2. Are you suffering because of low-calorie dieting?

4 Increased cravings for and focus on food; overeating

4 Regain weight after dieting, more than was lost

3 Increased moodiness, irritability, anxiety, or depression

3 Less energy and endurance

3 Usually eat less than 2,100 calories a day

3 Skip meals, especially breakfast

3 Eat mostly low-fat carbohydrates (bagels, pasta, frozen yogurt, and others)

2 Constantly think about weight

2 Use aspartame (Nutrasweet) daily

2 Take Prozac of similar serotonin-boosting drugs

2 Have become vegetarian

3 Have decreased self-esteem

4 Have become bulimic or anorectic

3. Are you struggling with blood sugar instability and stress?

4 Crave a lift from sweets or alcohol, but later experience a drop in energy and mood after ingesting them

3 Dizzy, weak, or headachy, especially if meals are delayed

4 Family history of diabetes, hypoglycemia, or alcoholism

3 Nervous, jittery, irritable on and off throughout the day; calmer after meals

3 Crying spells

3 Mental confusion, decreased memory

3 Hear palpitations, rapid pulse

4 Frequent thirst

3 Night sweats (not menopausal)

5 Sores on legs that take a long time to heal

4 Crave salty foods

4 Often feel stresses, overwhelmed

4 Dark circles under eyes

4 More awake at night

4. Do you have unrecognized low thyroid function?

4 Low energy

4 Easily chilled (especially hands and feet)

4 Other family members have thyroid problems

4 Can gain weight without overeating; hard to lose excess weight

3 Have to force yourself to do even moderate exercise

4 Find it hard to get going in the morning

3 High cholesterol

3 Low blood pressure

4 Weight gain began near the start of menses, a pregnancy, or menopause

3 Chronic headaches

3 Use food, caffeine, tobacco, and/or other stimulants to get going

5. Are you addicted to foods you are actually allergic to?

3 Crave milk, ice cream, yogurt, cheese, or doughy foods (pasta, bread, cookies, among others) and eat them frequently

3 Experience bloating after meals

4 Gas, frequent belching

3 Digestive discomfort of any kind

3 Chronic constipation and/or diarrhea

4 Respiratory problems, such as asthma, postnasal drip, congestion

3 Low energy or drowsiness, especially after meals

4 Allergic to milk products or other common foods

3 Under eat or often prefer beverages to solid food

3 Avoid food or throw up food because bloating after eating meals makes you feel fat or tired

4 Can’t gain weight

3 Hyperactivity or manic-depression

3 Sever headaches, migraines

4 Food allergies in family

7. Do you have yeast overgrowth triggered by anti-biotics, cortisone, or birth control pills?

4 Often bloated, abdominal distension

3 Foggy-headed

2 Depressed

4 Yeast infections

4 Used antibiotics extensively (at any time in life)

4 Used cortisone or birth control pills for more than one year

4 Have chronic fungus on nails or skin or athlete’s foot

3 Recurring sinus or ear infections as an adult or child

3 Achy muscles and joints

3 Chronically fatigued

4 Rashes

3 Stool unusual in color, shape, or consistency