Nutrient Assessment Chart
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1 INSTRUCTIONS: 1. PLACE A CHECK MARK NEXT TO ALL THAT APPLY 2. SCHEDULE YOUR GET YOUR HEALTH IN BALANCE! FREE 20 MINUTE CONSULTATION 3. UPON RECEIPT OF ACCEPTANCE OF APPOINTMENT, SUBMIT YOUR ASSESSMENT RESULTS: balance@trueselftotalhealth.com, SUBJ: Your Life In Balance Event Gift Vitamin A Assessment Chart! Chicken skin on backs of arms! Chronic acne! Dry eyes! Food allergies! Poor night vision! Recurrent infections and colds! Reduced hair growth in children! Ulcers B Vitamins! Afternoon slump! Cold hands and feet! Chronic fatigue! Focus issues! Moodiness! Poor digestion! Splitting nails! Vertical ridges on nails! Flaky cuticles! Splitting skin in corners of mouth! Thin hair! Tongue and mouth pain! Cracks in corner of mouth Vitamin B1! Hysteria ; in extreme cases beriberi (mostly in alcoholics).! Muscle cramps Vitamin B2! Cracks and sores around the mouth and nose! Visual problems.! Low energy! Eyes sensitive to light and tire easily! Sore lips! Sensitive tongue! Trembling! Itching of skin around eyes, ears, mount, scrotum, forehead and scalp Vitamin B3 - Niacin! Bad breath! Dermatitis! Emotional instability! Memory impairment! Skin eruptions and inflammation
2 Assessment Chart Vitamin B5 - Pantothenic Acid! Abdominal pains! Burning feet! Chronic gas or constipation! Eczema! Immune impairment! Low blood pressure! Muscle spasms! Poor coordination! Seasonal allergies! Beefy tongue Vitamin B6! Carpal tunnel! Convulsions! Patches of itchy, scaling skin! PMS! Poor dream recall! Stiff fingers in AM! Water retention in AM! Scalloped tongue! Tooth decay! Essential Fatty Acid deficiency that doesn t respond to taking fats! Magnesium deficiency that doesn t respond to magnesium Biotin (Vitamin B7)! Dermatitis! Eye inflammation! Loss of muscle control! Dry lips Folic Acid (Vitamin B9)! Apathy! Gastrointestinal upsets Headaches! Impaired cell division! Neural tube defects in fetus! Paranoia! Shortness of breath! Tender tongue
3 Assessment Chart Vitamin B12! Tender tongue! Pale skin! Shortness of breath! Headache! Cold hands and feet! Heart palpitations! Chest pain! Vomiting! Heartburn! Abdominal gas! Weight loss without trying! Numbness and tingling in the hands and feet! Unsteadiness! Difficulty walking! Hallucinations! Memory loss! Vertical ridges on nails! Bloating Vitamin C! Bruise easily! Hemorrhoids! Joint injuries! Puffy, bleeding, red gums! Varicose veins! Weakened immune system! Mucus membranes raw and bleeding! Spongy and bleeding gums are spongy Calcium! Brittle nails! Cramps! Delusions! Nervousness! Osteoporosis! Palpitations! Periodontal disease! Rickets! Tendency towards headaches! Tooth decay! Twitches! LAB: Serum Calcium
4 Assessment Chart Chromium! Adult-onset diabetes! Glucose intolerance Copper! Arterial damage! Fragile bones! Hyperthyroidism Iodine Iron! Cretinism! Hypothyroidism! Weight gain! Brittle nails! Headaches! Inflamed tongue! Mouth lesions! Spooning nails! Pale blue nails Magnesium! Chronic stress! Cramps! Heart attack! Hyperactivity! Irregular heartbeats! Irritable Bowel Syndrome! Nervousness! Noise sensitivity! PMS! Restlessness! Spasms! Twitching! Sores around mouth Manganese! Atherosclerosis! Elevated cholesterol! Glucose intolerance! Hearing loss! Loss of muscle control! Ringing in ears
5 Assessment Chart Phosphorus Potassium! Anorexia! Bone pain! Anorexia! Muscle cramps Zinc! Acne! Decreased sense of taste! Form scars easily! History of Crohn s disease! Overconsumption of sweets! Poor perception of sweet! Rashes! Retarded growth and delayed sexual development in children! Slow wound healing! Smelly feet! Tendency towards infections! White spots on fingernails! Cracked finger tips Amino Acids! ADHD! Difficulty building muscle mass! Inability to concentrate! Lack of motivation! Learning disabilities! Mood swings Essential Fatty Acids! Acne! Dry skin and hair! Eczema! Gall stones! Immune impairment! Infertility! Liver degeneration! Poor wound healing! Premenstrual syndrome! Sores around mouth! Dry lips! Split cuticles! Splitting nails
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