Feel free to mark more than one answer if necessary. If none of the choices apply and “none of the above” is not an option then do not mark anything.

    1. I mostly crave A) sugar in the form of sweets, fizzy drinks and general junk food and/or carbs, such as pasta and bread.B) chocolate.C) fatty foods, (especially fried), and stodgy carbs such as chips, crisps and potatoes.D) salty foods.E) meat.F) nothing at all.

    2. I am quickest to gain weight

    A) around the chest/breast area and/or on the back of the arms ("bingo wings")B) over my abdominals.C) around my hips, bottom or thighs.D) in the knee and calf area.E) just below my armpits - above the rib cage.F) on the waist ("love handles") and/or the upper backG) evenly across my whole physique.

    3. I frequently feel

    A) unexplainable thirst.B) hunger even after just eating.C) strange tingling sensations in my hands and/or feet.D) a weakness, or pain in my muscles and/or jointsE) an unusual sensitivity to cold.F) an unusual sensitivity to heatG) itchiness.H) bloated.

    4. The following best describes my energy levels:

    A) Feeling the need to nap in the middle of the day even after a full night’s sleep.B) Tired all of the time.C) Hyper-excitability - I find it hard to chill out and do nothing.D) Often lethargic.E) severe fatigueF) none of the above

    5. Mentally, I find myself:

    A) feeling anxious and worried.B) feeling slightly depressed and/or experiencing a lack of motivation.C) confused, or finding it hard to concentrate when trying to retain information.D) experiencing memory loss.E) going through mood swings and/or feeling irritable at times.

    6. My appearance is affected by:

    A) dark patches around the chest and/or neck area.B) a pale complexion.C) thinning hairD) a puffy face.F) spoon shaped nails.G) easy bruising.

    7. Using the toilet usually involves:

    A) frequent urination.B) frequent bowel movement.C) uncomfortable, runny bowel movement.D) constipation.E) Diarrhoea.

    8. I have often experienced:

    A) nausea and/or vomiting.B) spasm and/or cramps in the muscles.C) acne, eczema and/or or loss of hair.D) frequent illness, infections, or a sore tongue.E) headaches, or migraines.F) hoarseness, or a raspy voice.

    9. I have noticed myself having:

    A) a shortness of breath.B) heart palpitations.C) a loss of taste.D) altered tasted.E) seizures.F) low libido.

    10. Sleeping involves

    A) insomnia.B) struggling to get out of bed once I wake up.C) waking up several times throughout the night.D) the constant need to sleep throughout the day.E) None of the above.

    11. I have been diagnosed with:

    A) high blood pressure.B) an eating disorder.C) a mental disorder, ADD, or ADHD.D) impaired immune system function.E) psoriasis.F) tinnitusG) Celiac, or Crohn’s diseaseH) Arthiritis

    If you are female, do you experience painful or uncomfortable menstrual cycles?


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