On average, how often do you use a cell phone? This is only when the phone is actually held up to your ear, not when using an ear bud or using 'hands-free', such as in a car.
Don't know
Never/Rarely
Less than 30 minutes a day
30 to 60 minutes a day
Over an hour each day
860.
Do you exercise aerobically for a minimum of 20 minutes or more?
Don't know
No / rarely
1-2 times per week
3-4 times per week
At least 5 times per week
861.
Aside from specific exercise sessions, for approximately how many hours each week are you strenuously active? This includes activities / jobs that involve lifting/carrying heavy objects, digging, running, etc..
Don't know
None
1 to 5
6 to 10
More than 10
862.
If you are not getting as much exercise as you should (at least three 20-minute sessions of aerobic exercise per week), what is the reason for this? Work-related activity involving raised heart rate and sweating qualifies as exercise.
Not applicable (I do exercise enough) / don't know
I just don't feel like it
I don't have the time
Physical problems prevent me
Disease / illness prevents me
863.
When you exercise (run, walk fast, cycle, etc.), do you easily get a 'stitch' in your side?
Don't know
No, never
Rarely
Regularly, but under half the time
Most of the time
864.
Excessive exercise. Is it likely that others might think that you exercise compulsively?
Don't know
No, definitely not
Possibly (?)
Yes, definitely
865.
Do you practice Yoga?
Never / don't know
Once per month or less
Once per week or less
A few times per week
At least daily
866.
Have juice or water fasts helped you? Please only count those that have been 5 days or longer.
I have never tried one / don't know
No, there has been no noticable benefit
They may help a little
They sometimes help significantly
They always help significantly
867.
When was the last water or juice fast you experienced? This would be any water fast of longer than 5 days or a juice fast of longer than approximately 10 days.
Not applicable / don't know
Over a year ago
Within the last year
Within the last 3 months
Within the last month
868.
Do you use chewing tobacco?
No / don't know
Minor use in the past only
Major use in the past only
Minor current use / occasionally
Major current use / frequently
869.
Second-hand smoke. Within the last eight years, roughly how much time have you spent in smoked-filled environments? Heavy exposure is defined as being in a room with visible smoke/haze for more than 4 hours per day.
Don't know
None / minimal
1-4 years of light exposure
5-8 years of light exposure or 1-4 years heavy
5-8 years of heavy exposure
870.
Have you smoked tobacco within the last 8 years?
Don't know
No
Yes, I have smoked More questions later...
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SUPPLEMENT, MEDICATION AND DRUG USE
871.
Multiple vitamin supplement. Only include broad-spectrum preparations, not individual nutrients or specialty combinations such as B-vitamins. "One-a-Day" types are usually of low potency; high potency products involve taking several tablets per day.
Whether you use aspirin or not, is it an effective pain reliever for you?
Don't know
No
Somewhat
Definitely
875.
Have you taken other dietary or nutritional supplements within the past year? These include vitamins, minerals, nutraceuticals and others (except hormones) generally found in a health food store, not a pharmacy.
No / don't know
Yes More questions later...
876.
Have you used herbs, algae products or botanical extracts within the last year?
Don't know
No
Yes More questions later...
877.
Have you used antacids or drugs to prevent acid reflux during the past 2 years?
Don't know
No
Yes, but is no longer used More questions later...
Yes, currently using More questions later...
878.
Have you used prescription antibiotics within the past 5 years? This includes antiviral, antifungal and antiparasitic medications.
Don't know
No
Yes More questions later...
879.
Have you used tranquilizers, sedatives or psychotropic (perception, emotion or behavior-altering) prescription drugs within the past 2 years for conditions such as anxiety, depression, mania, OCD?
Have you used any hormones or prescription hormone-altering / like drugs? Examples include estrogens, testosterone, birth control pills, OTC progesterone, Thyroid, DHEA, and melatonin for example.
Have you ever used recreational ("illegal") drugs? Include those that were used for medicinal purposes.
I would prefer not to say / don't know
No
Yes More questions later...
893.
Have you taken other prescription or over-the-counter medications that have not been covered so far? Examples include stimulants, blood thinners, decongestants, anti-nausea drugs…
Don't know
No
Yes More questions later...
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
PAST MEDICAL PROCEDURES This section deals with invasive, manipulative or reparative physical procedures that have been carried out on your body. You may note any others below.
894.
Have you received any blood transfusions?
No / don't know
Yes, one
Yes, several
895.
Have you had any form of transplant surgery?
No / don't know
Yes, 3 or more years ago
Yes, less than 3 years ago
896.
Are you going to be having surgery in the near future?
Don't know
No
Only a very minor surgery
Possibly
Probably
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LABORATORY VALUES - COMMONLY KNOWN These values - if known - will help to confirm or rule out certain conditions. Skip questions you are uncertain of and older tests that are no longer valid. At the end you may provide further information.
897.
Blood Type. Only answer if you are certain what it is.
Don't know
Type O
Type A
Type B
Type AB
898.
Pulse rate - What is your resting pulse rate?
Don't know
Less than 60
60 to 70
71 to 80
Over 80
899.
Is your blood pressure outside of the normal range, either low or high? This is your blood pressure without medication use.
Don't know More questions later...
No
Minor issue in the past, but not now
Yes More questions later...
900.
Have you had any diagnostic/lab tests performed within the past year? These include analyses such as blood, urine, stool, hair, saliva, X-rays, scans, biopsies, etc.
Don't know
No
Yes More questions later...
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GLOSSARY
Aerobic: Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
Antacid: Neutralizes acid in the stomach, esophagus, or first part of the duodenum.
Anti-inflammatory: Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Antiviral: Any of a number of herbs, drugs or agents capable of destroying viruses or inhibiting their growth or multiplication until the body is capable of destroying the virus itself. Most antiviral agents are members of the antimetabolite family.
Anxiety: Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Asthma: A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.
Ayurvedic: Type of alternative medicine in which diet and therapies, such as herbal inhalation and massage, are dictated by individual's body type; 4,000 year-old traditional Indian system believed to be helpful to those suffering insomnia, hypertension and digestive problems.
Bulk Laxative: These products increase fecal (bowel content) volume in order to stimulate its movement. Bulk-forming laxatives provide the closest approximation to the natural process of increasing fecal volume, and are normally the first line recommendation for functional constipation. They contain natural or semi-synthetic polysaccharides or cellulose derivatives that pass through the gastrointestinal tract undigested. Examples include wheat bran, psyllium, flax, methylcellulose, ispaghula husk, and Sterculia urens.
Chelation: Chelation therapy uses EDTA or other supplements that carry heavy metals such as lead, cadmium and arsenic, as well as other foreign substances, from the body. In the process of chelation, a larger protein molecule surrounds or encloses a mineral atom. The purpose of chelation is to increase the flow of blood to the vital organs and tissues of the body by reducing calcium deposits in the arteries and blood vessels.
DHEA: Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diuretic: An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
EDTA: (Ethylene Diamine Tetraacetic Acid): An organic molecule used in chelation therapy.
Fecal Lubricant: An example of such a laxative is liquid paraffin, which is indigestible and absorbed only to a small extent. It penetrates and softens the feces, and coats the surface with an oil film, which facilitates its passage through the intestine. It is considered to have a usefulness as an occasional laxative in situations where straining at the stool must be avoided, but it has several drawbacks which make it unsuitable for regular use.
Fecal Softener: These act by lowering the surface tension of the intestinal contents, allowing fluid and fat to penetrate, emulsify and soften fecal material for easier elimination. The feces are kept soft, and evacuation is achieved without straining. An example is docusate sodium, an anionic surfactant that also exerts a stimulant laxative effect similar to that of the anthraquinones.
Herbs: Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hormones: Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Intravenous Infusion: (IV): A small needle placed in the vein to assist in fluid replacement or the giving of medication.
Laxative: A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.
Melatonin: The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Mineral: Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Osmotic Laxative: Osmotic laxatives exert a laxative effect by drawing water into the colon and retaining fluid in the bowel or by changing the pattern of water distribution in the feces. Unlike stimulant laxatives, they are safer and non-habit-forming. The most commonly used osmotic laxatives include magnesium hydroxide ("Milk of Magnesia"), magnesium citrate, magnesium sulfate (Epsom salts), sodium potassium tartrate, lactulose, glycerol and polyethylene glycol. Some are administered orally and others by enema.
Over-The-Counter: A drug or medication that can legally be bought without a doctor's prescription being required.
Stimulant Laxative: Stimulant laxatives are believed to stimulate nerve endings in the nerve plexuses of the bowel wall, increasing the movement of its content via several mechanisms. The most common active ingredients include the Anthraquinones (Senna, Aloin, Frangula, Cascara and Powdered rhubarb) and the Diphenylmethane derivatives (Bisacodyl, Sodium picosulfate, Phenolphthalein). Traditionally-used castor oil has fallen into disuse because of its 'drastic' action and unpleasant taste.
Testosterone: The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
Thyroid: Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
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