8 Weeks: Chapter 2

8 Weeks: Chapter 2

Week 2: Self Evaluation

Now it’s time to start your detective work by filling out the general health questionnaire. It’s similar to the one I use in my office for my own patients. It not only gives me insight into what may be going on with them but also allows them to become familiar with my approach.

These are somewhat different from the usual physician questions because they focus on conditions that are bodywide and are not restricted to the individual systems (e.g., cardiovascular or respiratory). You’ll be the only one who will read your answers, and, in order to get to the root of your health problems, it’s essential for you to be completely honest. You should copy these pages and put them in your journal.

Fill out the entire questionnaire. It’s important to do all the sections, even if you think they don’t apply to you. You’ll notice that some symptoms are involved in several imbalances.

In each of the following sections, put a checkmark next to the symptoms that apply to you:

General Health Questionnaire

List your major symptoms:









Section 1: Lifestyle and Stress

Difficulty relaxing



Tension headaches


Sense of isolation from others

Taking on too much responsibility

Difficulty delegating

Recent major life change (marriage, divorce, birth of child,
death of close relative, purchase of home, new job, loss of job, etc.)

Section 2: Brain Chemistry


Excessive fatigue

Low energy

Weight gain/difficulty losing weight

Memory loss/difficulty concentrating

Sustained high stress level



Crying easily and often

Anxiety, irritability

Section 3: Sex Hormones

Note all of the symptoms that apply to you within two weeks before your period:
Weight gain

Depression, anxiety, irritability

Sore or swollen breasts

Abdominal bloating or swelling

Lower backache

Craving for sweets


Vaginal itching

Recurrent vaginal discharge

Irregular periods

Breast lumps (fibrocystic breasts)

Intensification of other premenstrual syndrome (PMS) symptoms
Note all of the symptoms that apply to you during your period:

Bad cramps

Heavy bleeding
Note all of the symptoms that apply to you if you are experiencing menopause or perimenopause:

Hot flashes, night sweats

Mood swings, irritability


Erratic or missed periods

Dry skin, hair, vagina

Painful intercourse

Known or suspected osteoporosis

Joint pain



Loss of interest in sex

Section 4: Thyroid and Adrenals


Excessive fatigue, especially first thing in the morning

Weight gain/difficulty losing weight

Dry skin

Dry, brittle hair


Easily chilled; cold and/or numb hands, feet


Low sex drive


Outer third of eyebrow missing or thinning

Low Adrenal Function

Excessive fatigue

Inhalant allergies such as dust, mold, asthma, hay fever

Sensitivity to smog, fumes, and smoke

Trouble falling asleep and, even more, staying asleep

Low blood pressure

Craving for salty foods

Sensitivity to weather changes

Dizziness when standing up suddenly

Dark blue or black circles under eyes

Susceptibility to colds or infections

Puffy and swollen body (water retention)

Section 5: Blood Sugar

Note all of the symptoms from the list that apply to you:


Excessive fatigue

Dizziness when standing up quickly

Irritability, shakiness, or headache with missed meal, relieved by food

Craving for sweets

Heart palpitations when you eat something sweet

Fatigue one to three hours after eating, especially carbs/sweets

Use of caffeine to get energy

Mood swings

Poor concentration

Wakefulness during the night with restlessness and worry


Extreme thirst

Frequent urination

Extreme fatigue

Night sweats


Frequent infections including yeast infections

Family history of diabetes

Slow wound healing

Numbness or tingling in hands and/or feet

Section 6: Digestive Imbalance Including Dysbiosis, Yeast (Candida), and Food Sensitivities

Use of antibiotics for more than one month at any time in your life

Recent use of broad-spectrum antibiotics

Digestive problems including bloating and gas

Cravings for sweets, alcohol, bread, pasta

Recurring vaginitis

Cystitis, interstitial cystitis, or recurring bladder infections

General feeling of being tired all over

Poor concentration and memory; feeling spacey at times

Sensitivity to perfumes, strong smells, tobacco smoke


Muscle aches

Pain or swelling in joints

Endometriosis or infertility

Section 7: Toxin Overload

Susceptibility to infections



Frequent irritability and anger

Memory loss, which may be intermittent

Irregular heartbeat



Tinnitus (ringing in the ears)

Numerous food allergies and/or sensitivities

Unexplained fatigue

Section 8: Headaches, Arthritis, and Osteoporosis

Generalized aches or stiffness

Stiff, painful, or swollen joints

Easy fracture; i.e., brittle bones

Muscle spasms or cramps

Leg cramps at night

Back pain

Bursitis or tendinitis

Neck and shoulder pain


Extreme fatigue

Manually add up the number of checks in each category.

If you’ve noted three or more symptoms in a category, you can go to the appropriate chapter for more information. It will give you some more clues about the direction you’ll need to take to regain your health. Then you will create your action plan based on what you’ve discovered. This will include food, supplements, activities, and further investigation, including lab tests.

In the entries for Week 2 in your Wellness Journal, make a note of the imbalances you are further investigating. Here are topics to address:

1. Category or categories in which I checked three items or more on the questionnaire: _______________________________

2. After reading the relevant chapters, these are my insights and thoughts: ___________________________________

3. Based on my newfound information and my intuition, my major imbalance is: _____________________

4. The reasons I think this are: ____________________________

For a sample journal to track your food and supplements, click here.

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