* 1. Please rank each statement with its importance to you.

  All the time Sometimes Not applicable Not sure
I feel bloated, have stomach cramps, or diarrhea after I eat.
Sometimes I would rather not eat anything because I don’t know what foods are safe for me to eat.
I frequently have abdominal pain, diarrhea, constipation, pain during bowel movements, weight loss or gain, weakness or fatigue, or loss of appetite.
I think I might have food allergies but I don’t know where to start.
I feel like my stomach doesn’t empty for hours after I eat.
I have acid reflux or Barrett’s Esophagitis.
I have had a history of frequent use of antibiotics, steroids or NSAIDS.
I have been diagnosed with an auto-immune disease.
I have been diagnosed with an intestinal infection or stomach ulcer.
I eat a high fiber diet and I am still constipated.
I occasionally see food particles in my stools or see an “oily film” in the stools.
I frequently have odorous flatulence (farting).

* 2. If you marked any of these questions, a session with our certified nutrition educator is a great place to start. If you would like to send Cece Davis Gifford, RD, CSSD, LD an email she can contact you for further questions or to set up an appointment at Cece@nutritiontulsa.com. We think nutrition education would benefit you.

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