Bloating Assessment

What are your primary symptoms? (Select all that apply)

Bloating / Distended Stomach Excessive Gas / Flatulence Stomach Pain or Cramping Constipation (Hard, infrequent stools) Diarrhea (Loose, frequent stools) Nausea Heartburn / Acid Reflux

Describe your gas:

No specific smell "Rotten egg" (sulfur) smell Excessive but normal smell No gas issues

What does your stool look like most often? (Bristol Stool Scale)

Type 1: Separate hard lumps (severe constipation) Type 2: Lumpy and sausage-like (mild constipation) Type 3: Sausage with cracks (normal) Type 4: Smooth, soft sausage (ideal) Type 5: Soft blobs (lacking fiber) Type 6: Mushy consistency (mild diarrhea) Type 7: Liquid consistency (severe diarrhea)

Do you experience any of these NON-digestive symptoms? (Select all that apply)

Headaches or Migraines Skin Rashes or Hives Brain Fog / Poor Concentration Chronic Fatigue Joint Pain None of the above

Are you currently taking any of these medications? (Select all that apply)

For female users - Do your symptoms relate to your menstrual cycle?

Yes, bloating is worse BEFORE my period Yes, bloating is worse during perimenopause/menopause No clear pattern Not applicable (male or post-menopause with no symptoms)

Do you have any thyroid-related symptoms? (Select all that apply)

Diagnosed hypothyroidism Unexplained weight gain Chronic fatigue and cold intolerance Hair loss or thinning No thyroid issues

Which eating habits apply to you? (Select all that apply)

I eat quickly (less than 10 minutes per meal) I drink through straws regularly I chew gum frequently I eat late at night (within 2 hours of bedtime) I eat while stressed or distracted None of the above

Fruits:

Apples Pears Mangoes Cherries Watermelon Peaches Plums Dried Fruit

Vegetables:

Onions Garlic Artichoke Asparagus Cauliflower Broccoli Brussels Sprouts Mushrooms Leeks

Grains & Bread:

Wheat Bread Wheat Pasta Rye Bread Barley Couscous

Legumes:

Beans (kidney, black, pinto) Lentils Chickpeas Baked Beans

Dairy:

Milk (cow's milk) Yogurt Soft Cheese (ricotta, cottage cheese) Ice Cream

Aged & Fermented:

Aged Cheese (cheddar, parmesan, blue cheese) Sauerkraut Kimchi Kombucha Miso Cured Meats (salami, bacon, ham) Red Wine Beer

Certain Fruits & Vegetables:

Tomatoes Spinach Avocado Banana (overripe) Citrus Fruits Strawberries

Seafood:

Canned Fish (tuna, sardines) Shellfish

Other:

Chocolate Vinegar-based foods (pickles, salad dressings)

Sugar-Free Products Containing:

Sorbitol (in sugar-free gum, candy) Xylitol (in sugar-free products) Maltitol (in low-sugar chocolate, protein bars) Erythritol (in keto products)

Artificial Sweeteners:

Sucralose (Splenda) Aspartame (Equal) Saccharin (Sweet'N Low)

Other Additives:

Carrageenan (in almond milk, ice cream) Xanthan Gum (in gluten-free products, salad dressings) Guar Gum (in protein powders, dairy alternatives) Polysorbate 80 (in ice cream, processed foods)

Beverages:

Carbonated Drinks (soda, sparkling water) Beer Kombucha Energy Drinks

Fats & Preparation:

Fried Foods (french fries, fried chicken) Greasy/Fatty Foods (fast food, pizza) Spicy Foods (hot sauce, curry)

Portion Size:

I often eat large portions or until very full

The Ultimate Bloating Assessment

Part 1: Your Symptoms

Part 2: Your Medications & Supplements

Acid Blockers (Proton Pump Inhibitors - PPIs)

Pain & Anti-Inflammatory (NSAIDs)

Diabetes Medications

Cholesterol Medications (Statins)

Pain Medications (Opioids)

Antibiotics

Supplements

Part 3: Hormonal & Lifestyle Patterns

Part 4: Your Food & Drink Intake