Synergise Symptoms and nutritional deficits Questionnaire.

Please check through the lists of symptoms marking those you have suffered from either with a B. for before, P. for the present or F. for frequently.

Candida Albicans

1. Have you had persistent or recurrent cystitis, vaginitus, prostatis, urethritus?
2. Have you had recurrent thrush [oral or vaginal]
3. Have you had a history of pelvic inflammatory disease or endometriosis?
4. Have you had athlete's foot or other fungal infections on the hands nails etc?
5. Are you severely affected by exposure to fumes, pollutants, perfumes etc.?
6. Do you have a variety of allergies?
7. Do you suffer from abdominal bloating, distension and diarrhea or constipation?
8. Do you suffer from premenstrual syndrome?
9. Are you lethargic depressed, unnaturally fatigued?
10. Do you suffer from poor memory, or feelings of unreality?
11. Do you crave sweet foods, bread or alcohol?
12. Do you have unaccounted for aches and pains?
13. Do you have vaginal discharge and or menstrual cramps?
14. Do you suffer from lack of sexual desire?
15. Do you frequently have spots before your eyes?
16. Do you have excessive oral mucous?

Vitamin A

1. Mouth Ulcers
2. Poor Night vision
3. Acne
4. Frequent colds or infections
5. Dry flaky skin
6. Dandruff
7. Thrush or cystitis
8. Diahrroea

Vitamin B1

1. Tender muscles
2. Eye pains
3. Irritability
4. Poor concentration
5. Prickly legs
6. Poor memory
7. Stomach pains
8. Constipation
9. Tingling hands
10. Rapid heart beat

Vitamin B2

1. Cracked lips
2. Burning or gritty eyes
3. Sensitivity to bright lights
4. Sore tongue
5. Dull or oily hair
6. Exzema or dermatitis
7. Split nails

Vitamin B3

1. Lack of energy
2. Diarrhoea
3. Insomnia
4. Headaches or migraine
5. Poor memory
6. Anxiety or tension
7. Depression
8. Irritability
9. Bleeding or tender gums
10. Acne

Vitamin B5

1. Muscle cramps or tremors
2. Apathy
3. Poor concentration
4. Burning feet or tender heels
5. Nausea or vomiting
6. Lack of energy
7. Exhaustion after light exercise
8. Anxiety or tension
9. Teeth grinding

Vitamin B6

1. Infrequent dream recall
2. Water retention
3. Tingling hands
4. Depression or nervousness
5. Irritability
6. Muscle tremors or cramps
7. Lack of energy
8. Flaky skin

Vitamin B12

1. Poor hair condition
2. Eczema or dermatitis
3. Mouth over sensitive to hot or cold
4. Irritability
5. Anxiety or tension
6. Lack of energy
7. Constipation
8. Tender or sore muscles
9. Pale skin

Folic Acid

1. Eczema
2. Cracked lips
3. Anxiety or tension
4. Poor memory
5. Lack of energy
6. Depression
7. Poor appetite
8. Stomach pains

Biotin

1. Dry skin
2. Poor hair condition
3. Prematurely greying hair
4. Tender or sore muscles.
5. Poor appetite or nausea.
6. Eczema or dermatitis.

Vitamin C

1. Frequent
2. colds
3. Lack of energy
4. Frequent infection
5. Bleeding or tender gums
6. Easy bruising
7. Nosebleeds
8. Slow wound healing
9. Red pimples on skin

Vitamin D

1. Rheumatism or arthritis
2. Backache
3. Toothache
4. Hair loss
5. Excessive sweating
6. Muscle cramps or spasms
7. Joint pain or stiffness
8. Lack of energy

Vitamin E

1. Lack of sex drive
2. Exhaustion after light exercise
3. Easy bruising
4. Slow wound healing
5. Varicouse veins
6. Loss of muscle tone
7. Infertility

Linoleic and GLA

1. Dry rough skin
2. Dry eyes
3. Frequent infections
4. Poor memory
5. Loss of hair or dandruff
6. Excessive thirst
7. Poor wound healing
8. P.M.S. or breast pain
9. Infertility

Mineral Profile

Calcium

1. Muscle cramps
2. Insomnia or nervousness
3. Joint pain or arthritis
4. Tooth decay
5. High blood pressure

Magnesium

1. Muscle tremors or spasms
2. Muscle weakness
3. Insomnia or nervousness
4. High Blood Pressure
5. Irregular heart beat
6. Constipation
7. Fits or convulsions
8. Hyperactivity
9. Depression

Iron

1. Pale skin.
2. Sore tongue
3. Fatigue or listlessness
4. Loss of appetite or nausea
5. Heavy periods or blood loss

Zinc

1. Poor sense of taste or smell
2. White spots on nails
3. Frequent infections
4. Stretch marks
5. Acne or greasy skin
6. Low fertility
7. Pale skin
8. Tendency to depression
9. Poor appetite

Manganese

1. Muscle twitches
2. Childhood growing pains
3. Dizziness or poor sense of balance
4. Fits or convulsions
5. Sore knees

Selenium

1. Family history of cancer
2. Signs of premature aging
3. Cataracts
4. High blood pressure
5. Frequent infections

Chromium

1. Excessive or cold sweating
2. Dizziness or irritability after six hours without food
3. Need for frequent meals
4. Cold hands
5. Need for excessive sleep
6. Drowsiness during the day
7. Excessive thirst
8. Addicted to sweet foods

Symptoms of low blood sugar:

1. Accidents.
2. Aging
3. Alcoholism
4. Balance lacking
5. Belligerence
6. Blackouts
7. Collapse
8. Poor concentration
9. Craving for sweets
10. Craziness
11. Crying
12. Do not understand what they have done wrong
13. Dropping out
14. Fatigue
15. Flatulence
16. Frigidity
17. Germ caused diseases
18. Headaches
19. Impotence
20. Indecision
21. Irritability
22. Lack of sex drive
23. Loss of consciousness
24. Poor memory
25. Muddling
26. Post puerperal problems
27. Procrastination.
28. Quick temper
29. Rebelliouseness
30. Generally run down state
31. Tiredness
32. Vertigo
33. Excessive worrying

Aspartame

Do you drink diet sodas or use artificial sweeteners in tea and coffee?

A.

Please list all your major illnesses

B.

List major family illnesses

Please do the Broda Barnes temperature test: To do this you must take your temperature every morning for a week, before getting out of bed or eating or drinking and after shaking the thermometer right down as low as you can get it. Then write the exact temperature down.

Return your completed questionnaire to:

OR: rosamund.parker@googlemail.com

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