DiabetesHigh Blood PressureHigh CholesterolRenal DiseaseHeart DiseaseCancerOsteoporosisArthritisIron Deficiency AnemiaVitamin / Mineral DeficiencyIrritable Bowel SyndromeAcid-RefluxGoutChronic DehydrationImpaired ThyroidOther
1 month1-3 months3-6 months6-12 months12+ months
YesNo
NeverMonthlyWeeklyDailyEvery Meal
KitchenDining RoomOfficeLiving/Family RoomBedroomOutside
KitchenTVComputerPhoneListen to musicTalk with person you're eating withNo distractions...I just eat in silence
0-1010-2020-3030+
0-12-45-77+
Day ofDay PriorFew Days PriorWeek Prior
NoneMorningMid-DayAfternoonEvening
AlwaysOftenSometimesNever
BakedBroiledGrilledFriedOther
None1-44-88-1212+
12345
Never1-23-45-6Daily
Fact OR Fiction Guide.
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