Leaky Gut Syndrome Questionaire


Welcome to your Leaky Gut Syndrome Questionnaire

This questionnaire has been reprinted from Dr. Elizabeth's Lipski's book, Leaky Gut Syndrome.

Circle the number that mostly fits.
1 = Symptom is not present or rarely present
2 = Mild/sometimes
3 = Moderate/often
4 = Severe/almost always

Constipation and/or diarrhea
Abdominal pain or bloating
Joint pain, swelling, arthritis
Chronic or frequent fatigue or tiredness
Food allergies, sensitivities or intolerance
Sinus or nasal congestion
Chronic or frequent inflamations
Eczema, skin rashes or hives, asthma, hay fever, or air borne allergies
Confusion, poor memory or mood swings
Use of NSAIDS (Aspirin, Tylenol, Motrin)
Alcohol consumption makes you feel sick
Ulcerative colitis, Crohn's or Celiac disease

WHY IS IT IMPORTANT TO KNOW IF YOU HAVE A LEAKY GUT?

Symptoms of leaky gut are related to local inflammation of the intestines and include abdominal pain, bloating, excess gas, increased food sensitivies and chronic diarrhia or constipation. More widespread effects might include general aches and pains.

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