In Nutritional Therapy, we give clients a BIG questionnaire with 321 questions to rank 0 to 3 on frequency.

The Nutritional Assessment Questionnaire sections include:

  1. Upper GI
  2. Liver and Gallbladder
  3. Small Intestine
  4. Large Intestine
  5. Mineral Needs
  6. Essential Fatty Acids
  7. Sugar Handling
  8. Vitamin Need
  9. Adrenal (HPA Axis)
  10. Pituitary
  11. Thyroid
  12. Men Only
  13. Women Only
  14. Cardiovascular
  15. Kidney and Bladder
  16. Immune System

After my clients complete the nutritional assessment questoinniare (or N.A.Q.), I take note of each symptom in all of the categories that were marked a “2” or a “3” on frequency or severity. THEN I look up each symptom that is a concern in my “Guide to the NAQ” manual.

This is a long process and perhaps old school assessment of their results, but I love diving into each symptom and correlating it to the clients history, complaints, concerns, our FDN Metabolic Scorecard, their food log with symptoms tracked for at least three days and then their selected functional lab tests suggested in our FDN practitioner program.

For example -a symptom of “stomach upset by taking vitamins”

  • Belching or gas one hour after a meal
  • heartburn or acid reflux
  • bloating shortly after eating (1 hour)
  • are you vegan? (high intake of carbs linked to low HCL)
  • feel like skipping breakfast
  • fingernails chip, peel or break easily
  • stomach cramps or pains
  • chronic diarrhea
  • loss of taste for meat
  • sense of fullness after meals
  • feel better if you don’t eat
  • sleepy after meals

…could be a related to poor digestion habits, lack of HCL acid and digestive enzymes.

UPPER GI SYSTEM: hypochlorhydria …low stomach acid is a common problem for many reasons. Adequate stomach acid (pH 1.5-3) is required for proper absorption of vitamin B12.

We need to have proper digestion systems for adequate B12 digestion and absorption as well as Zinc and other minerals. Often we are deficient in HCL and digestive enzymes- as well as minerals (zinc!) and need to supplement appropriately to support our digestive processes.

Another tip – anemia issues and unresponsiveness to iron may be due to nutritional deficiency as B12 and folate. Vitamin B12 needs sufficient stomach acid (HCL) for it to be absorbed. Zinc deficiency has been associated with low HLC acid and should be assessed.

Example if you have “Stomach upset with vitamins”

  • Sign of hypochloridria and need to HCL supplemental
  • Low stomach acid can cause discomfort when taking supplement vitamins

Low HCL is a common problem and leads to a number of digestion complaints as Pylori, bowel toxemia, dysbiosis, pancreatic insufficiency and leaky gut

Hypochloridria has a number of etiologies including:  which can lead to irritation of the gut wall lining- mucosa- causing a decreased output of acid from the parietal cells

  • Sympathetic dominance
  • Antacid drug use
  • Excess sugar and refined foods
  • Constant snacking between meals
  • Excess carbohydrate and alcohol consumption
  • Nutrient deficiencies as zinc and thiamin
  • H.Pylori infection
  • Feel like skipping breakfast” is a sign of ….
    • Sign of HCL or need for pancreatic enzymes
    • Pattern in clients who eat a large dinner very fast without chewing food properly
    • Causes food to stay in digestive system longer period of time – morning still digesting food and not hungry
    • Break the habit by eating smaller breakfast, regular meal and early smaller dinner
    • Zinc deficiency associated with hypochloridria
  • Fingernails that peal or chip”…
    • Protein and mineral deficiency secondary to maldigestion
    • Sign of low HCL
    • Nutritional deficiencies as protein, trace minerals, essential fatty acids
    • Protein and trace mineral deficiencies are caused by low stomach acid and pancreatic insufficiencies
    • HCL -number of etiologies including:
      • Sympathetic dominance
      • Antacid drug use
      • Excess sugar and refined foods
      • Constant snacking between meals
      • Excess carbohydrate and alcohol consumption
      • Nutrient deficiencies as zinc and thiamin
      • H.Pylori infection
    • It is essential to have enough stomach acid to adequately digest and break down our foods
    • Protein and trace minerals especially depend on this process to make the nutrients available for absorption and assimilation into the blood stream
    • Without optimal digestion, we are not able to absorb the structural protein molecules as for fingernails- leading them to be weak and brittle. 
    • Assess digestion function and ensure good quality of nutrients

Dark circle under eyes -another major symptom and sign of dysfunction but what does it mean?

  • Classic sign of food allergies
  • Allergies are over reactions of the immune system
  • GI disturbance tends to build up over the many years
  • Dysbiosis = disturbance to the intestinal environment
  • Abnormal intestinal flora
  • Abnormally permeable intestinal mucous membrane
  • When the intestinal flora is not intact- the absorptive ability of the intestinal mucous membranes become impaired
  • Low HCL and pancreatic enzymes contribute to maldigestion of foods
  • Undigested left large macromolecules form the substrate for dysbiosis formation
  • Over time the villi -large absorptive surface of the intestines- become irritated and inflamed – causing less density
  • The large incompletely digested macromolecules (proteins) start to be able to penetrate the intestinal mucous membrane
  • The destruction of the villi reduces the GALT and sIgA (first line of defense against foreign invaders
  • Once in the blood stream -the body’s immune system recognizes the small protein or part of a protein as a foreigner and produces antibodies against it
  • Reaction is created – antibody/antigen complex- produces classic allergy symptoms

MINERAL NEEDS: Calf, foot or toe cramps at rest

Indication of calcium, magnesium or potassium deficiency

Minerals are needed as effective co-factor as supplemental to HCL and essential fatty acids with will increase their digestion and or absorption

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