Signs, Symptoms and Nutritional

Deficiency Questionnaire.
Use this questionnaire to help improve your nutritional intake through better diet
choices and supplementation. Check through the lists of symptoms marking those
you suffer from either with a circle or a yes answer.

Candida Albicans (Yeast Infection) Signs and Symptoms

1. Have you had persistent or recurrent cystitis, vaginitus, prostatis, urethritus?
2. Have you had recurrent thrush (oral or vaginal)? Whiteness on tongue?
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 and or chronically fatigued?
10. Do you suffer from poor memory, lack of concentration or feelings of
unreality?
11. Do you crave sweet foods, bread or alcohol?
12. Do you have chronic 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 mucous excretions (nose, eyes, vaginal, bowel)?
17. Do you have reoccurring sinus infections?
18. Do you experience kidney and or bladder infections?
19. Do you have diabetes or hypoglycemia?
20. Do you have arthritis?
21. Do you presently or have you in the past had cancer?
22. Are you severely affected by another serious disorder or illness?
23. Do you experience itching of the eyes, nose, ears and rectum?
24. Do you experience mood swings?

Candidiasis, also more commonly known as a yeast infection, is a chronic issue for a
vast majority of people because of unhealthy modern diets and exposure to a vast
array of environmental pollutants. Candidiasis goes grossly undiagnosed. If you have
a few of these symptoms or a vast majority of them, your chances of having an
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overgrowth of candida albicans are a real possibility. Learn more about candidiasis
by going to this page http://www.natural-health-girl.com/candida-yeast-infection-
symptoms.html.

Vitamin A Deficiency Signs

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. Diarrhea
9. Dry hair
10. Weight loss
11. Cancer
12. High cholesterol
13. Heart disease and stroke

Vitamin B1 Deficiency Signs

1. Muscle atrophy
2. Eye pains
3. Irritability
4. Poor concentration
5. Prickly legs
6. Poor memory
7. Stomach pains
8. Constipation
9. Tingling hands and or feet
10. Rapid heart beat
11. Poor circulation
12. Enlarged liver
13. Edema
14. Heart problems
15. Labored breathing
16. Loss of appetite 2
17. Nervousness
18. General weakness

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Vitamin B2 Deficiency Signs

1. Cracked lips and mouth sores
2. Inflammation of the mouth and tongue
3. Burning or gritty eyes
4. Sensitivity to bright lights
5. Dull or oily hair
6. Eczema or dermatitis
7. Split nails
8. Insomnia
9. Poor digestion
10. Slowed growth
11. Dizziness
12. Hair loss

Vitamin B3 Deficiency Signs

1. Lack of energy
2. Diarrhea
3. Insomnia
4. Headaches or migraines
5. Poor memory
6. Anxiety or tension
7. Depression
8. Irritability
9. Bleeding or tender gums
10. Canker sores
11. Indigestion
12. Bad breath
13. Limb pain
14. Low blood sugar
15. Muscle weakness
16. Acne
17. Loss of appetite
18. Schizophrenia or other mental illness
19. Lack of circulation
20. High cholesterol
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Vitamin B5 Deficiency Signs

1. Muscle cramps or tremors
2. Apathy
3. Poor concentration
4. Burning feet or tender heels
5. Nausea or vomiting
6. Lack of energy, fatigue
7. Exhaustion after light exercise
8. Anxiety or tension
9. Teeth grinding
10. Anemia
11. Digestion problems
12. Headache
13. Tingling in hands and or feet
14. Adrenal fatigue

Vitamin B6 Deficiency Signs

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, fatigue
8. Flaky skin
9. Premenstrual syndrome
10. Cancer
11. High cholesterol
12. Kidney stones
13. Allergies
14. Arthritis
15. Asthma
16. Mental health issues
17. Headaches 4
18. Nausea and or vomiting
19. Sore tongue
20. Learning disabilities
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21. Hair loss

22. Stunted growth
23. Carpal tunnel syndrome
24. Anorexia
25. Impaired wound healing
26. Dizziness
27. Hearing problems
28. Numbness
29. Memory loss

Vitamin B12 Deficiency Signs

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, fatigue
7. Constipation
8. Tender or sore muscles
9. Pale skin
10. Digestion disorders
11. Infertility
12. Dizziness
13. Bone loss
14. Depression
15. Eye disorders
16. Hallucinations
17. Enlarged liver
18. Headaches
19. Inflamed tongue
20. Labored breathing
21. Memory loss
22. Moodiness
23. Anemia
24. Ringing in the ears 5
25. Spinal cord degeneration
26. Abnormal gait
27. Nerve damage

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Folic Acid Deficiency Signs

1. Eczema
2. Cracked lips
3. Anxiety or tension
4. Poor memory
5. Lack of energy, fatigue
6. Depression
7. Poor appetite
8. Stomach pains
9. Hardening of the arteries
10. Sore tongue
11. Anemia
12. Apathy
13. Paranoia
14. General weakness
15. Labored breathing
16. Birth defects
17. Graying hair
18. Digestion disorders
19. Insomnia
20. Stunted growth

Biotin Deficiency Signs

1. Dry skin
2. Dull hair condition
3. Prematurely graying hair
4. Tender or sore muscles
5. Poor appetite or nausea
6. Eczema or dermatitis (cradle cap)
7. Anemia
8. Depression
9. High blood sugar
10. Hair loss
11. Insomnia 6
12. Muscle pain

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7 Signs, Symptoms and Nutritional Deficiency Questionnaire

Vitamin C Deficiency Signs

1. Frequent colds
2. Lack of energy, fatigue
3. Frequent infections
4. Bleeding or tender gums
5. Easy bruising
6. Nosebleeds
7. Slow wound healing
8. Red pimples on skin
9. Cancer
10. Scurvy
11. Edema
12. Joint pain
13. Poor digestion
14. Tooth loss
15. Extreme weakness

Vitamin D Deficiency Signs

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, fatigue
9. Bone loss
10. Tooth loss
11. Weak heart
12. Cancer
13. Thyroid disorders
14. Loss of appetite
15. Diarrhea
16. Insomnia 7
17. Visual problems
18. Depression
19. Burning sensation in throat or mouth
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Vitamin E Deficiency Signs

1. Lack of sex drive
2. Exhaustion after light exercise
3. Easy bruising
4. Slow wound healing
5. Varicose veins
6. Loss of muscle tone
7. Infertility
8. Cancer
9. Heart disease
10. Nerve disorders
11. Menstrual problems
12. Miscarriage
13. Neuromuscular impairment
14. Age spots
15. Dull hair
16. Poor skin condition
17. Eye problems
18. Fibrocystic disease
19. High blood pressure
20. Premature infants

Vitamin K Deficiency Symptoms

1. Cancer
2. Osteoporosis
3. Liver disorders
4. Internal bleeding

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Linoleic and Gamma-linolenic Acid Deficiency Signs

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

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Mineral Profile
Calcium Deficiency Signs
1. Muscle cramps
2. Insomnia or nervousness
3. Joint pain or arthritis
4. Tooth decay
5. High blood pressure
6. Bone loss
7. Brittle nails
8. Heart palpitations
9. High blood pressure
10. Eczema
11. Numbness
12. Pasty complexion
13. Rickets
14. Depression
15. Delusions
16. Hyperactivity
17. Convulsions
18. Cognitive impairment
19. Preeclampsia during pregnancy
20. Heart disease

Chromium Deficiency Signs

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
9. Imbalanced blood sugar, diabetes, hypoglycemia
10. Anxiety 10
11. Arteriosclerosis
12. Osteoporosis
13. High cholesterol

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Iron Deficiency Signs

1. Pale skin
2. Sore tongue
3. Fatigue or listlessness
4. Loss of appetite or nausea
5. Heavy periods or blood loss
6. Brittle hair and or hair loss
7. Spoon shaped nails or nails with ridges
8. Dizziness
9. Digestive disturbances
10. Fragile bones
11. Nervousness
12. Obesity
13. Slowed mental reactions
14. Difficulty swallowing

Magnesium Deficiency Signs

1. Muscle tremors or spasms
2. Muscle weakness
3. Insomnia or nervousness
4. High blood pressure
5. Constipation
6. Fits or convulsions
7. Hyperactivity
8. Depression
9. Birth defects
10. Confusion
11. Poor digestion
12. Seizures
13. Tantrums
14. Rapid heartbeat
15. Diabetes
16. Cardiovascular problems
17. Chronic pain syndromes 11
18. Irritable bowel syndrome
19. Kidney stones
20. Osteoporosis
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21. Cataracts
22. Moodiness
23. Birth defects
24. Cancer
25. High cholesterol
26. Premenstrual syndrome
27. Premature labor
28. Irregular body temperature
29. Stress

Manganese Deficiency Signs

1. Muscle twitches, contractions, tremors
2. Childhood growing pains
3. Dizziness or poor sense of balance
4. Fits or convulsions
5. Sore knees
6. Anemia
7. Confusion
8. Pancreatic problems
9. Profuse perspiration
10. Memory loss
11. Irritability
12. Hypertension
13. High cholesterol
14. Hearing problems
15. Heart disorders
16. Rapid pulse
17. Tooth-grinding
18. Breast ailments

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Potassium Deficiency Signs

1. Dry skin
2. Acne
3. Chills
4. Cognitive impairment
5. Constipation
6. Depression
7. Diarrhea
8. Diminished reflexes
9. Edema
10. Nervousness
11. Excessive thirst
12. High cholesterol
13. Glucose intolerance
14. Growth impairment
15. Low blood pressure
16. Muscle weakness
17. Headaches
18. Nausea and vomiting
19. Insomnia
20. Heartbeat fluctuations
21. Respiratory distress

Selenium Deficiency Signs

1. Family history of cancer
2. Signs of premature aging
3. Cataracts
4. High blood pressure
5. Frequent infections
6. Cancer
7. Heart disease
8. Exhaustion
9. Arthritis
10. Male infertility
11. AIDS
12. Growth impairment 13
13. Pancreatic insufficiency
14. Liver disorders
15. Sterility

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14 Signs, Symptoms and Nutritional Deficiency Questionnaire

Zinc Deficiency Signs

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
10. Delayed sexual maturation
11. Fatigue
12. Growth impairment
13. Hair loss
14. High cholesterol
15. Impaired vision
16. Impotence
17. Memory impairment
18. Diabetes
19. Prostate problems
20. Slow wound healing

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Symptoms of Low Blood Sugar

1. Accidents
2. Premature aging
3. Alcoholism
4. Lacking physical balance
5. Belligerence
6. Blackouts
7. Collapse
8. Poor concentration
9. Craving for sweets
10. Craziness
11. Crying
12. Feelings of “What have I done wrong?”
13. Inability to carry through on tasks
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. Post puerperal problems/infection of the female reproductive organs/fever
26. Procrastination
27. Quick temper
28. Rebelliousness
29. Generally run down state
30. Vertigo (dizziness)
31. Excessive worrying

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Aspartame Toxicity
Do you drink diet sodas or eat or drink other foods with artificial sweeteners?

Large numbers of people have reported severe health problems from ingesting
aspartame. Reported reactions include: headaches, mood swings, vision problems,
nausea and diarrhea, sleep disorders, memory loss and confusion, convulsions and
muscle pain just to name a few. Children should not be fed aspartame, because of
these dangerous side effects.

Other artificial sweeteners are best avoided as well. If the label says sugar free, read
the label. Chances are that the ingredients include an artificial sweetener.

There are numerous sweetener substitutes to white sugar that are healthier options,
some of which include: sucanat, muscavodo sugar, stevia, xylitol, raw honey and raw
agave nectar. These natural sweeteners are high in nutrients, unlike their refined,
white counterparts.

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Disclaimer

This information is not intended as a substitute for consulting with a

competent health care professional.

Information and statements regarding dietary supplements have not been

evaluated by the Food and Drug Administration and are not intended to
diagnose, treat, cure or prevent any disease.

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