Ixcela Detailed Gut Health Assessment

 Ixcela Detailed Gut Health AssessmentFrom the list below what are you hoping to improve from the Ixcela test results?Alleviate GI distress or discomfortFeel less bloatedHave regular digestionReduce the number of times I get sickSleep better Weight Loss Improve my emotional well beingHave more energyFeel better mentallyPerform better athletically Relieve GI distress during exercise or competitionImprove overall health Take my health to the next levelUnderstand my gut health Have you taken antibiotics in the last year? YES / NOAre you currently taking a probiotic? YES / NODo you suffer from chronic GI distress (bloating, diarrhea, constipation, IBS/IBD, colitis, etc)? YES / NOIf so, explain: _________________________________________________________________Have you ever had candida, SIBO, yeast overgrowth or fungal overgrowth? YES / NOIf so, explain: _________________________________________________________________On a scale of 1 to 10 how has your GI distress affected your daily life over the last 6 months?12345678910Over the last 4 weeks, how often do you experience gastrointestinal distress or discomfort?AlwaysFrequentlySometimesRarelyNeverOther: _______How many bowel movements do you have on a daily basis? _______Do you experience bloating or gas after meals on a regular basis?YES / NOIf so, explain: _________________________________________________________________Do you experience indigestion, or acid reflux, more than once a week? YES / NOIf so, explain: _________________________________________________________________On a daily basis, about how many servings of non-starchy vegetables (leafy greens, carrots, broccoli, cabbage, peppers, etc.) do you consume? (1 cup raw or ? cup cooked vegetables = 1 serving)7 or more 5 - 6 servings of vegetables3 - 4 servings of vegetables1 -2 servings of vegetables1 or fewer servings of vegetablesI rarely eat vegetablesOn a weekly basis, about how many fermented foods (yogurt, kimchi, sauerkraut, kombucha, etc.) do you consume?At least 1 per day4 - 5 per week 2 - 3 per week 1 per week Occasionally, but not weeklyNeverDo you think you have slow metabolism and can’t seem to lose weight? YES / NOIf so, explain: _________________________________________________________________Do you tend to devour or eat your food quickly? YES / NOIf so, explain: _________________________________________________________________How many servings of processed foods do you typically consume on a daily basis? (crackers, bread, chips, candy, pastries, sweets, nutrition bars, supplements, sugary beverages (diet and full calorie), frozen meals, fast food, etc.)0-12-3 4-56-77 or morePlease list the foods you typically include: ____________________________________________Would you consider yourself someone who has a sweet tooth? YES / NOIf so, explain: _________________________________________________________________What time do you start eating and drinking everyday? ___________ What time do you stop eating and drinking everyday? ___________How many cups (8 ounces) of caffeinated beverages do you consume daily?0-12-3 4-5More than 5 cups dailyApproximately how much water in ounces do you typically drink on a daily basis? (Note: a standard plastic water bottle is 16 ounces)Less than 30 ounces30-50 ounces60-70 ounces80-100 ounces100 ounces or moreOver the last 6 months, how would you rate your sleep quality?Very goodFairly goodFairly badVery badOther: _______How often do you take supplements or medication to support your ability to fall asleep?AlwaysFrequentlySometimesRarelyNeverOther: _______Do you feel tired or exhausted even when you get enough sleep? YES / NOIf so, explain: _________________________________________________________________From the list below, which mindfulness activities do you participate in weekly? slow stretching/yoga - breathing techniques - meditation - self-reflection - positive self-talk - mindfulnessOther mindfulness activities you practice weekly: ____________________________________________Does work dominate your life, leaving little time to relax? YES / NOIf so, explain: _________________________________________________________________How many times over the past year did you experience cold or flu-like symptoms?Often (more than 4 times per year)Occasionally (once or twice a year)Yearly (once a year) Never (can’t remember the last time I got sick)Not sure.Do your symptoms last longer than a week? YES / NO / UNSUREDo you have skin issues like dry skin, ance or redness? YES / NOIf so, explain: _________________________________________________________________How confident are you in your nutrition habits?Very confident in my nutrition habitsSomewhat confident in my nutrition habitsI have some knowledge, but think I need to learn more.Still learning, but I have a long way to go. I am not confident in my nutrition habits or my knowledge about nutrition. How confident are you in your exercise habits?Very confident in my exercise habitsSomewhat confident in my exercise habitsI exercise sometimes, but think I need more guidance.Still learning, but I have a long way to go. I am not confident in my exercise habits and knowledge about exercise. How confident are you in your mindfulness habits?Very confident in my mindfulness practicesSomewhat confident in my mindfulness practicesI practice mindfulness sometimes, but would like to learn more.I haven’t practiced mindfulness, but I am interested in learning more about mindfulnessI am not sure what mindfulness is.I am not sure mindfulness is right for me. How confident are you in your ability to manage stress and navigate stressful situations?Very confident in my ability to manage stress.I am confident with my ability to manage stress.Somewhat confident in my ability to manage stress.I am not confident in my ability to manage stress.I need to work on my ability to manage stress. What are your short term goals? (Hoping to achieve in the next 2-3 weeks)What are your long term goals? (hoping to achieve in the next 2-3 months) ................
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