Food Groups
Diets
Please check the diets that you have tried to battle CFS
Ask about Salt in Diet
awol version
Please add anything you wish. No need to ask!
Have you been officially diagnosed with any food allergies or intolerances? Please list:
Have you tested positive for coeliac disease? ? Yes ? No
Have you been tested for food intolerences?
Which, if any of the following diets have you attempted since becoming ill?
? Atkins ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Stone Age ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Macrobiotics ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? anti-candida ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Specific Carbohydrate diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Alkaline Diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Low Oxalate Diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
Have you ever tried an elimination diet to determine food sensitivities? ? Yes ? No
Please select which non-allergy food sensitivities you have, and which symptoms they affect:
? phenols symptoms:
? oxalates symptoms:
? sulphite symptoms:
? salicylate symptoms:
? histamine symptoms:
? fructose symptoms:
? lactose symptoms:
? alcohol symptoms:
? artificial colouring symptoms:
? aspartame symptoms:
? beans symptoms:
? caffeine symptoms:
? chocolate symptoms:
? citrus fruit symptoms:
? complex carbs (starch) symptoms:
? corn symptoms:
? dairy symptoms:
The specific problem is ? casein ? lactose ? unknown
? gelatin symptoms:
? gluten symptoms:
? MSG symptoms:
? mushrooms symptoms:
? nickel symptoms:
? nightshades symptoms:
? nuts symptoms:
Please list which ones:
? soy symptoms:
? sugar symptoms:
? yeast symptoms:
- Grains - much worse / somewhat worse/ no effect / somewhat better / much better
- Dairy -
- Meats -
- Legumes -
- Vegetables -
- nightshade vegetables
- Fruits -
* dried fruits - Nuts -
- Starchy foods (potato's, sweet potatoes, cassova, etc.) -
- Sugary Foods (sweets, candy bars, etc.) -
- Caffeine -
- Salt
Diets
Please check the diets that you have tried to battle CFS
- Atkins
- Stone Age / Paleo
- Elimination
- Macrobiotics
- anti-candida
- gluten-free
- casein-free
- gluten-free & dairy-free
- low fructose
- vegetarian
- alkaline
- specific carbohydrate diet
- Blood Type Diet
- Genotype Diet
- phenol intolerance
- sulphite intolerance
- salicylate intolerance
- Histamine intolerance
- Fructose malabsorption
- Lactose intolerance
Ask about Salt in Diet
awol version
Please add anything you wish. No need to ask!
Have you been officially diagnosed with any food allergies or intolerances? Please list:
Have you tested positive for coeliac disease? ? Yes ? No
Have you been tested for food intolerences?
Which, if any of the following diets have you attempted since becoming ill?
? Atkins ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Stone Age ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Macrobiotics ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? anti-candida ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Specific Carbohydrate diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Alkaline Diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
? Low Oxalate Diet ? extremely helpful ? moderately helpful ? no effect noticed ? negative effects
Have you ever tried an elimination diet to determine food sensitivities? ? Yes ? No
Please select which non-allergy food sensitivities you have, and which symptoms they affect:
? phenols symptoms:
? oxalates symptoms:
? sulphite symptoms:
? salicylate symptoms:
? histamine symptoms:
? fructose symptoms:
? lactose symptoms:
? alcohol symptoms:
? artificial colouring symptoms:
? aspartame symptoms:
? beans symptoms:
? caffeine symptoms:
? chocolate symptoms:
? citrus fruit symptoms:
? complex carbs (starch) symptoms:
? corn symptoms:
? dairy symptoms:
The specific problem is ? casein ? lactose ? unknown
? gelatin symptoms:
? gluten symptoms:
? MSG symptoms:
? mushrooms symptoms:
? nickel symptoms:
? nightshades symptoms:
? nuts symptoms:
Please list which ones:
? soy symptoms:
? sugar symptoms:
? yeast symptoms: