Nutritional Deficiency Lactic Acidosis Quiz

Part 1: Body, Muscles, Arms, Legs

1. Bouts of body fatigue and/or weakness - Can be extreme like Chronic Fatigue Syndrome*

Yes
No

2. Muscles ache or sore too easily - Can be extreme like Fibromyalgia*

Yes
No

3. Nerve tingling in arms or face*

Yes
No

4. Ankle swelling*

Yes
No

5. Deep ache in the calves*

Yes
No

6. Muscle cramping*

Yes
No

7. Digestive symptoms like nausea, loss of appetite, or acid reflux*

Yes
No

8. Underactive thyroid*

Yes
No

9. Core body temperature cold*

Yes
No

10. Poor circulation to hands and feet*

Yes
No

Part 2: Chest, Lungs, Heart:

11. Any kind of asthma*

Yes
No

12. Narrowing or tightening feeling in the chest of chest pain*

Yes
No

13. Choking sensation, throat fullness, esophageal spasm*

Yes
No

14. Heart pounding or palpitations*

Yes
No

15) Difficulty breathing or shortness of breath*

Yes
No

Part 3: Brain:

16. Anxiety*

Yes
No

17. Bad thoughts like fear, grief, depression*

Yes
No

18. Wanting to leave*

Yes
No

19. Obsessive-compulsive*

Yes
No

20. Dizzy*

Yes
No

21. Violent thoughts*

Yes
No

22. Fear of impending doom*

Yes
No

23. Intrusive thoughts especially "I can't..." or questioning your life decisions*

Yes
No

24. Avoiding the friction of social contact*

Yes
No

25. You've medicated this pain through drugs, alcohol, or medications which make it better temporarily but in the long run make it worse and may have caused addiction*

Yes
No

26. Have you been super stressed out over one or more life events that you never recovered from?*

Yes
No

27. Have you been eating or grow up on bread, pasta, sugar, or rice?*

Yes
No

Name*

First Last

Phone*

Email*

How do you wish to be contacted with the results?*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list the top five main concerns for your health.

Is there anything else you would care to say or ask?

Phone

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