Leaky Gut Assessment By Dr. Laara Van Bryce | July 26, 2018 Click Next to begin. Intestinal Permeability or Leaky Gut is real and defined as a condition where the lining of the small intestine becomes damaged, causing undigested food particles, toxic wastes and bacteria to "leak" through the intestines and flood the bloodstream setting off a cascade of protective immune responses. One reason why leaky gut has been hard to identify is that its bodily impact is not limited to the gastrointestinal tract – it impacts the brain, thyroid, immune system, skin, and joints and varies based on a person’s genetic and epigenetic expressions. This Assessment presents questions that your healthcare practitioner can use to determine if further testing for leaky gut is warranted. Assessment brought to you by Dr. Jack Tips (Ph.D., C.C.N.). Frequent constipation?YesNo Frequent diarrhea?YesNoMedically diagnosed with: IBS, GERD, Crohn’s, Diverticulitis, Ulcerative Colitis? YesNoOften find blood in stool?YesNoAbdominal pain after eating?YesNoFood Sensitivities?YesNoBelching, frequent?YesNoBloating after eating, drinking (more than once a week)?YesNoFood allergies, several?YesNoFood intoleranceYesNoGas, frequent, foul?YesNoHeartburn?YesNoChronic Fatigue?YesNoEnergy drops after eating?YesNoOften feel stressed?YesNoAnxiety, feel anxious?YesNoDepression?YesNoForgetfulness?YesNoDifficulty focusing thoughts?YesNoAcne?YesNoDry patches not responsive to topical moisturizersYesNoEczemaYesNoHivesYesNoItchy skin, without eruptionsYesNoRosaceaYesNoFemale: PMSYesNoMale: Enlargement of breast tissue?YesNoFemale & Male: Cherry Angiomas (little red dots in the skin)YesNoAny Autoimmune Issue (Arthritis, Asthma Celiac, Diabetes I, Hashimotos, Lupus, Multiple Sclerosis, Myasthenia Gravis, etc.? YesNo Antibiotic, used in past 10 years?YesNoRx NSAID, in the past 5 years?YesNoAspirin, in the past 4 years?YesNoIbuprofen, in the past 4 years?YesNoTylenol, in the past 4 years?YesNoAlcohol—consume 4+ beverages/week?YesNoLess than 6-hrs, sleep/night?YesNoHigh starch/sugar/sweets dietYesNoCrave sweets YesNoEat Fast Foods, 2 or more times/week?YesNoUse processed, packaged foods 2 or more times/week?YesNoConsume GMO foods (corn, soy, canola oil, Hawaiian (rainbow) papayas, potatoes, Arctic apples yellow crookneck ‘summer’ squash, zucchini, sugar beets, alfalfa)?YesNoConsume sodas and/or sugar-free sodas? YesNoConsume sugar-free foods (AspartameTM)?YesNoExercise less than 4 times a week?YesNoAllergies: Environment Allergies, Animals, Perfumes aggravates, Pollens, Dust?YesNoBad Breath even after brushingYesNoJoint/Muscle Pain after eating certain foods, e.g. nightshades (tomatoes, potatoes, peppers eggplant, gogi berries,)?YesNoFrequent post-nasal drainageYesNoFrequent sinus infectionsYesNoOngoing nasal congestionYesNoOptional comment box. Disclaimer: This personal assessment is not diagnostic of any health condition. It is designed to help licensed health practitioners organize varied body occurrences that, when viewed as an organized whole, may lead to a common factor. First name Last name Email Time is Up!
