Gut Assessment GUT ASSESSMENT FOR LOW STOMACH ACID, PANCREAS FUNCTION, BILE ACID, DYSBIOSIS, LEAKY GUT AND OTHER GUT RELEATED ISSUESPlease enable JavaScript in your browser to complete this form.Give yourself one point for each question you answer with a yes.Do you get nausea, vomiting, fever, stomach/intestinal cramps a lot?yesNoDo you have chronic diarrhea?yesNoDo you have cramps, urgency, or mucus and blood in your stool at least once a week?yesNoDo you have chronic constipation?yesNoDo you notice that you have decreased thinking/mental function or brain fog most days?yesNoDo you have gas, bloating and abdominal discomfort most days?yesNoDo you notice that you have intolerance to carbohydrates, especially beans and fiber?yesNoDo you have fatigue and/or low energy most days?yesNoDo you feel depressed or anxious most days?yesNoDo you have chronic sinus congestion?yesNo Do you have itching in the vagina, anus, or other mucosal membranes most days?yesNoDo you have chronic bad breath?yesNoHave you used antacids daily for more than thirty days in the past two years?yesNoHave you taken antibiotics more than three times in the past years?yesNoDo you have a history of traveler’s diarrhea during foreign travel?yesNoHave you been diagnosed with a vitamin D deficiency?yesNoDo you have any food sensitivities?yesNoHave you been diagnosed with an autoimmune disease or conditions?yesNoHave you been diagnosed with arthritis or fibromyalgia?yesNoDo you experience severe chronic stress?yesNo Have you been diagnosed with reflux, heartburn or a hiatal hernia?yesNoWhat Is The Total Point Scored?Next SectionDo you have indigestion/fullness two to four hours after a meal?yesNoDo you have stomach distension, bloating or flatulence two to four hours after a meal?yesNoDo you have undigested food in your stool?yesNoDo you have chronic constipation?yesNoWere you ever told you have a B12 deficiency (often discovered as a cause of anemia)?yesNoDo you have swelling in the ankles?yesNoDo you bruise easily? (This can be a sign of a vitamin K deficiency)?yesNoHave you been diagnosed with glucose intolerance?yesNoDo you have pale, foul-smelling or bulky stool?yesNoWhat Is The Total Point Scored?Next SectionHave you had your gallbladder removed?yesNoHas blood work ever revealed that you were low in vitamin A, E or K?yesNoDo you have chronic diarrhea?yesNoWhat Is The Total Point Scored?Next SectionDo you experience bloating or belching immediately following most meals?yesNoDo you have a sense of fullness or nausea after eating?yesNoDo you often have itching around your rectum?yesNoAre your fingernails weak, peeling, and/or cracked?yesNoDo you have undigested food in your stool?yesNoDo you have dilated capillaries on your face?yesNoDo you have an iron deficiency?yesNoDo you have chronic intestinal infections such as candida and parasites?yesNoDo you have a history of multiple food allergies?yesNoDo you have flatulence with your bloating?yesNoHave you been diagnosed with reflux or gastroesophageal reflux diseases (GERD)?yesNoDo you have a history of taking proton pump inhibitors, acid blockers, or antacids?yesNoWhat Is The Total Point Scored?Next SectionDid you uncover more than one food sensitivity from the elimination diet in?(If you have tried any)yesNoDid you score over a 10 on the stress scale?yesNoGut microbiome imbalance (For doctor only to fill)Have you been diagnosed with an autoimmune diseases?yesNoWhat Is The Total Point Scored?Proceed To Bristol Chart