___Inability of Eyes to Adjust to Darkness___Cracks & Sores in the Corners of the Mouth

Metabolic Assessment Inventory

Instructions:Indicate with an X which circumstances apply to you now and indicate with a P symptoms or signs you have had in the past.

___Inability of eyes to adjust to darkness___Cracks & sores in the corners of the mouth

___See poorly in dim light___Red, sore tongue

___Eyes have lost luster: vision impaired: eyes dry & inflamed___Tongue is shiny

___Skin is rough, scaly & dry, especially elbows, knees, buttocks ___Feeling of grit or sand in eyelids

___Unable to distinguish yellow and blue___Burning or itching of the eyes

___Eyelids “glue” together, especially in the morning___Eyes sensitive to light

___Loss of sense of smell___See many blood vessels in whites of eyes

___Loss of appetite or desire to eat___Frequent sores on lips

___Skin blemishes, including “liver spots” and skin rashes___Female: itching of the vaginal area

___Repeated or frequent infections of bladder or urinary tract___Male: itching of the scrotum

___Dryness of scalp (flakiness or dandruff)___Swelling or feeling of swelling of tongue

___Dryness of the nose and throat___Muscle cramps in lower legs and feet

___Brittle nails (fingers and toes)___Scaling around nose, mouth, forehead & ears

___Ridges in nails (fingers and toes)___”Whiteheads” especially on bridge of nose and under

___Frequent spells of fatigue eyelids

___Frequent spells of diarrhea___Spells of dizziness

___Loss of hearing___Oily skin and/or oily hair

___Known gall stones___Excessive watering of eyes

___Known kidney stones___Have or had cataracts

___Recurrent styes in eyes___Lack of stamina and vigor

___Frequently work in brightly lit area, especially fluorescent___Unexplained weight loss

Lighting_____TotalVitamin B2 (riboflavin) 5

___Frequently work in dimly lit areas

___Female: have you had a spontaneous abortion___Ringing sounds in ears

___Known ulcers (stomach, duodenal, colon)___Sore lips mouth and tongue

___Frequent allergies (any kind)___Loss of hair (thinning)

___Frequent canker sores___Numbness & cramps in arms and/or legs

___Subject to constant stress___Muscular weakness

_____TotalVitamin A (7)___Often nauseous or dizzy

___Nervousness, irritability, depression

___Twitching of eye muscles___Often confused

___Swelling around eyes (puffiness)___Painful joints of fingers and hands

___Frequent blood-shot eyes___Swelling of hands, feet, ankles

___Fatigue easily or abnormally tired___Increase in urination

___Loss of appetite or desire to eat___Known low blood sugar (hypoglycemia)

___Easily upset and irritable___Convulsions (black-out spells)

___Loss of strength in the lower arms & legs___Fainting spells

___Hurt all over but can’t pinpoint area___Use oral contraceptives (present or past)

___Tenderness of calf muscles___Skin condition known as eczema

___Confusion and forgetfulness___Require frequent dental visits for tooth decay

___Gastric distress (abdominal pains, indigestion)___Have or had kidney stones

___Constipation___Known to have a high cholesterol

___Diastolic blood pressure over 90 (bottom number)___Skin condition known as juvenile acne

___Irregularities of the heart beat___Frequent attacks of diarrhea

___Told you have enlarged heart___Urine sometimes has greenish tint

___Delayed or slow reflexes___Burning sensations in feet

___Prickling sensation in lower extremities_____TotalVitamin B6(pyridoxine)5

_____TotalVitamin B1 (thiamine)4

___Known to be anemic or have had pernicious anemia___Muscular weakness

___Soreness or weakness in arms and legs___Generally fatigued

___Arm and shoulder pain___Loss of appetite or desire for food

___Shooting pains in any part of the body___Frequent indigestion and/or diarrhea

___Loss of appetite or desire to eat___Red skin across the nose & under eyes

___Sore tongue___Bad breath
___General muscular weakness ___Frequent canker sores

___Inability to concentrate___Can’t get to sleep or stay asleep

___Painful facial muscles___Hands and/or feet hot

___Hot and cold sensation___Irritable, easily upset

___Feel you have lost your incentive in life___Hands and/or feet hot

___Difficulty in walking (stumbling, shuffling)___Recurring headaches

___Stammering occasionally___Subject to constant stress, strain, tension

___Jerking sensation of limbs___Deeply-depressed feeling

_____TotalB12 (Cobalmin) 3___Loss of memory

___Dry, scaly skin patches where exposed to ___Tongue often sore sunlight

___Frequent skin inflammations___Burning sensation of the tongue

___Suffer from insomnia___Tongue is dark red and mouth is sore

___Have poor appetite___Chronic skin inflammation

___Frequently nauseated___Have desire for alcohol

_____TotalBiotin (1)_____TotalB3 (niacin) (5)

___Have eczema___Have had sulfa therapy

___Diagnosed as having arteriosclerosis___Extreme fatigue

___Told you have high blood pressure___Known to be anemic

___Have a problem losing weight___Irritable

___Diagnosed as having myasthenia gravis___Depressed

_____TotalCholine (1)___Nervous

___Headaches

___Muscle pains___Constipation

___Poor appetite___Early graying of hair

___Dry and/or peeling skin_____TotalPABA

___Lack of energy

___Sleeplessness___Subject to constant stress pressure, tension

___Redness or inflammation of skin___Chronic headache

___Mental depression___Physically feel weak

___Have heavily used sulfa drugs or antibiotics___Abnormally tired

___Bloatedness___Frequent colds or upper respiratory infections

___Flatulence___Suddenly feel dizzy

___Loss of desire for meat___Physically and/or mentally overworked

___Hungry at start of meal, but can eat very little___Feel lightheaded when getting up or standing up

___Known to have blood in urine___Loss of feeling in hands and feet

___Overweight___Suffer from allergies

_____TotalLipotrophic Factors (3)___Frequent gastric distress

___Have periods of deep depression

___Early graying of hair___Abdominal cramps and pains

___Inflammation of the tongue___Chronic constipation

___Changes in bowel movements (alternating loose and hard stools)___Known to have low blood sugar (hypoglycemia)

___Easily fatigued___Diagnosed as arthritic

___Chronically fatigued___Attacks of vomiting

___Shortness of breath_____TotalB5 (4)

___History of cleft palate

___Spells of dizziness

___Had diagnosis of macrocytic anemia

___Use of oral contraceptives

___Grayish-brown pigmentation of the skin especially the face

_____TotalFolic Acid (1)

___Known to have anemia___Known intestinal malabsorption problems

___Bleeding or inflamed gums___Known colitis (colon irritation or inflammation)

___Easy-bruising___Cuts bleed a long time

___Small red or pink spots just under skin___Have used antibiotic treatment (frequently/large doses)

___Susceptible to infections, including colds___Known gall bladder problems or disease

___Shortness of breath_____TotalVitamin K (1)

___Swollen or painful joints

___Frequent nosebleeds___numbness and or tingling in arms & legs

___Smoke (cigar, cigarettes, and pipe)___Frequent muscle cramps

___Ruptured blood vessel in either eye___Vague pains in joints

___Have “fleeting joint pain”___Heart palpitations

___Known metal poisoning ___Slow pulse rate

___History of severe burns (including sunburns)___Can’t get to sleep or stay asleep

_____Total Vitamin C (3)___Female: menstrual cramps

___Trembling fingers

___Unusual heart beat (varies fast to slow)___Dull backache

___Poor bone development___Frequent tooth decay

___Muscular numbness, tingling or spasms_____TotalCalcium (2)

___Had rickets (bow legs, knock-knees, and bone enlargement)

___Tissues are flabby___Told you have high cholesterol

___Dull pains in lower back and thigh___Told you have diabetes

___Have you had an abnormal number of cavities___Have alcohol intolerance

___Deep pains in lower back and thighs_____TotalChromium (1)

___Had a diagnosis of osteomalacia (softening of the bones)

___Vague aches and pains___Have weak hair and nails

___Had a diagnosis of arthritis___Have fungus infections of nails

___Feeling of soreness of tenderness in ribs or breast bone___Eyes sensitive to light

___Stomach or gastric ulcers_____TotalCopper (1)

_____Total Vitamin D (5)

___Have now or had “disc” problems___Told you are anemic

___Changes in heart rate (fast to slow)___Fingernails pale in colour

___Known heart weakness or problems___Dizzy spells

___Female: one or more miscarriages___Tire easily or chronic fatigue

___Use mineral oil for laxative purposes___Difficult breathing

___Have seen “fat” in your stool or stool floats___ Shortness of breath

___Known gall bladder trouble___Cry easily without reason

___Known colon trouble (colitis)___Poor appetite

___Impaired circulation (cold spots or patchy skin)___Finger nails appear flat & brittle

___Male: known sterility or loss of sex drive___Pain in the heels

___Female: menstrual discomfort of heat flashes___Pain in the fingertips

___Varicose veins___Rapid heart fire

___Chest pain in left arm___Shoulder joints are painful

___History of blood clot___Sleepy in daytime, sleepless at night

___History of phlebitis (inflamed veins)___Sensation of spots before eyes

_____Total Vitamin E (3)___Constipation

_____TotalIron (4)

___Brittle or lusterless hair

___Finger or toenails: break, peel, crack, brittle

___Have allergies (any type)

___Underweight and cannot gain

___Have skin disorders

___Frequent attacks of diarrhea

___Dandruff

___Known to have kidney trouble

_____TotalEFA’s (2)

___Feeling of apprehension___Have dry tongue and shrunken, loose skin (dehydration)

___Easily irritable___Feel exhausted all the time

___Teeth sensitive___Prefer vegetable and starches to protein

___Twitching muscles___Prefer winter to summer

___Loose teeth___Prefer Mountains to seaside

___Tremors of the hands___Skin of face is more white than red

___Irregular pulse or heart beat___Body disorders are usually on the left side

___Constantly cold_____TotalSodium (2)

___Muscular weakness

___Frequent muscle cramps___Wounds heal slowly

___Have convulsions or seizures___Loss of sense of smell

___Easily confused___Loss of sense of taste

___Dimmed vision___Diagnosed as diabetic

___Feeling disoriented___Feel more tired than usual

___Feel depressed frequently___Have acne

_____TotalMagnesium (3)___Male: have diagnosed prostatitis

_____TotalZinc (2)

___Poor muscle co-ordination

___Prone to athletic injuries___Feeling of coldness even in warm weather

___As a child, had partial paralysis of unknown cause___Known low blood pressure

___As a child, had poor and/or failing eyesight___Tendency to gain weight

___As a child, had poor and/or failing hearing___Dull pain under the shoulder blades

___Diagnosed as having myasthenia gravis___Sluggish metabolism

___Diagnosed as diabetic___Dry hair

___Have diagnosed allergies___Brittle nails

___Attacks of dizziness___Eyes sensitive to bright light

___Have bone deformities___Have recurrent styes

___Noises in the ears___Diagnosed as having high cholesterol

_____TotalManganese (3)___Decreased sexual interest

___Dull headaches

___Have pyorrhea (gum disease)___Swelling of the eyes, hand & feet

___Often feel both physically and mentally fatigued___Known goiter

___Often feel as if your breathing is irregular___Alternating fast and slow pulse

_____TotalPhosphorus (1)_____TotalIodine (3)

___Swelling of ankles and hands___Have indigestion

___Occasional rapid heart beat for no reason___Have excessive belching & intestinal gas

___Feel as if muscles are “too weak”___Suffer in hot weather

___Have irregular heart beat___You over breathe (hyperventilate)

___Told you have diabetic tendency___Nervous without obvious cause

___Prefer meat to vegetables & starches___Have diabetes or tendency

___Prefer seaside to mountains___Currently on a low sodium diet

___Prefer summer to winter_____TotalChloride (2)

___Skin of face is more red than white

___Body disorders are usually on right side

_____TotalPotassium (2)

___Been diagnosed as having cancer

___Have a family history of cancer

___Have or children have birth defects

_____TotalSelenium (2)

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