Silent Inflammation Questionnaire
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SILENT INFLAMMATION QUESTIONNAIRE The following questionnaire is not meant to be a diagnostic tool. It s designed to help you do two things: 1. self-assess how your current lifestyle habits may be contributing to inflammation in your body and 2. read some of the signs (or body signals ) of silent inflammation. By taking inventory of your current lifestyle habits and paying attention to your body signals, you create more self-awareness about your susceptibility to chronic inflammation, which is the first step in your healing journey. After you answer each question and total your scores, you can use this feedback to help you decide if you would benefit from starting an antiinflammatory diet and lifestyle program.
Part 1: Lifestyle Habits Directions: Read each statement below and rate yourself using the point scale. Write the point value next to each statement and total your scores at the end. If you score higher than 20, it would probably be very beneficial to start an anti-inflammatory diet and lifestyle program. Point Scale: 0=Never or rarely (a few times a year) 1=Seldom (a few times a month) 2=Often (several times a week) 3=Daily Mental/Emotional 1. I worry or feel stressed out. 2. I dwell on the past, replaying events over in my head. 3. I get upset easily when things go wrong and/or I lash out/take my anger out on others. 4. I feel anxious, irritable, moody, or aggressive, and unable to relax. 5. I hopeless and/or unhappy with my life right now. Diet 6. I eat grains (whole or processed grain products). 7. I sugary/refined carbs. (i.e. cookies, pastries, crackers, cereals, granola, chocolate, soda, fruit juices, wine etc.) 8. I eat corn oil, safflower oil, sunflower oil, cottonseed oil, soybean oil and/or foods made with these oils such as mayonnaise, condiments, margarine and nearly all salad dressings. 9. I eat soy (or soy products), corn, peanuts (or peanut products) and/or pasteurized, homogenized dairy products. 10. I eat meat and eggs from grain fed animals (regular supermarket brands). 11. I eat more non-organic produce than organic produce. 12. I skip breakfast and/or go more than four hours between eating meals.
Sleep 13. I got to sleep after 10pm. 14. I watch TV or do activities on an ipad/computer within an hour of going to bed. 15. I eat sugars/refined carbs (i.e. cookies, pastries, crackers, cereals, granola, chips, chocolate, soda, fruit juices, wine etc.) within two hours of going to bed. 16. I have a hard time falling asleep and/or staying asleep at night. 17. I wake up feeling groggy/unrested. Movement 18. I use rigorous exercise (i.e. running, kickboxing, dance classes, weights etc.) to relieve stress. 19. I don t feel well (i.e. tired, achy, stiff, nauseous etc.) during or after I exercise. 20. It takes me a long time to recover after exercise. NOTE: If you don't exercise at all, leave questions 18-20 blank and add 6 points to your total score. Total Score:
Part 2: Body Signals Directions: Read each statement below and rate yourself using the point scale. Write the point value next to each statement and total your scores at the end. If you score 5 or higher, it would probably be very beneficial to start an anti-inflammatory diet and lifestyle program. Point Scale: 0=No 1=Yes 1. I have chronic aches and pains, such as back pain, neck pain, headaches, or general muscle and/or joint soreness. 2. I have low bone density or I ve been diagnosed with osteopenia or osteoporosis. 3. I have elevated cholesterol. 4. I have signs of a hormonal imbalance like hot flashes, vaginal dryness, night sweats and/or low sex drive. 5. I am currently overweight and/or it is hard for me to lose weight/fat. 6. I currently have excess belly fat. 7. I frequently feel physically tired and have low stamina. (More than a couple of times per month.) 8. I frequently feel mentally lethargic I have difficulty concentrating and remembering things. (More than a couple of times per month.) 9. I look old and/or feel old for my age. 10. My skin looks crepey and saggy. 11. I have red, dry, itchy or burning skin. 12. I am prone to colds, allergies and flu symptoms. 13. I have food sensitivities or allergies.
14. I m frequently constipated. (More than a couple of times per month.) 15. I have frequent diarrhea/loose stools. (More than a couple of times per month.) 16. I have frequent gas, bloating and/or abdominal pain/cramps. (More than a couple of times per month.) 17. I have frequent indigestion, heartburn or an upset stomach. (More than a couple of times per month.) 18. I have an autoimmune disease (i.e. fibromyalgia, arthritis, osteoporosis, cancer, psoriasis, eczema, Hashimoto s thyroiditis, rheumatoid arthritis, lupus, multiple sclerosis etc.) Total Score: