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Diet

 How Healthy Is Your Diet?

Circle your answers after careful thought, then add up your points (numbers in parentheses).

 

  1. How many fruits do you normally eat each day (1/2 cup fresh or dried fruit, 1 medium piece, 1 cup unsweetened juice)?
    1. 0 (-2)
    2. 1 (0)
    3. 2 to 3 (+2)
    4. 4 or more (+3) (score) _____

 

  1. How many vegetable servings do you normally eat each day (1 cup leafy greens, 1/2 cup any other veggie, raw or cooked)?
  1. 0 (-4)
  2. 1 (0)
  3. 2 (+1)
  4. 3 (+2)
  5. 4 or more (+3) (score) _____

 

  1. How many different varieties of vegetables do you eat in a normal month?
  1. 2 or less (-4)
  2. 3 to 4 (0)
  3. 5 to 6 (+1)
  4. 7 to 8 (+3)
  5. 9 or more (+4) (score) _____

 

  1. How many times do you eat dried beans or peas (legumes, lentils, chickpeas, kidney beans, green peas, etc.) in a normal week?
  1. 0 (-2)
  2. 1 to 2 (0)
  3. 3 to 4 (+1)
  4. 5 to 6 (+2)
  5. 7 or more (+3) (score) _____

 

  1. How many times do you eat red meat in a normal week?
  1. 6 or more (-4)
  2. 4 to 5 (-3)
  3. 1 to 3 (-1)
  4. Less than once a week (+2)
  5. 0 (+3) (score) _____

 

  1. How many times do you eat in a fast food restaurant in a normal week?
  1. 6 or more (-5)
  2. 4 to 5 (-4)
  3. 1 to 3 (-3)
  4. Less than once a week (-2)
  5. 0 (0) (score) _____

 

  1. In a typical day, what do you drink most often?
  1. Soda (regular or diet) (-4)
  2. Caffeinated coffee or tea (-1)
  3. Decaffeinated coffee or tea (0)
  4. Milk or fruit juice (0)
  5. Herbal tea or water (+3) (score) _____

 

  1. How many 12 oz. cans of soda do you drink in a normal day?
  1. 6 or more (-5)
  2. 4 to 5 (-4)
  3. 2 to 3 (-3)
  4. 1 (-2)
  5. Less than 1 (-1)
  6. 0 (0) (score) _____

 

  1. How often do you eat fish in a typical week?
  1. Never (-2)
  2. Once (+1)
  3. Twice (+2)
  4. 3 to 5 times (+3) (score) _____

 

  1. In a typical week, how often do you eat whole grains (100% whole grain bread, whole oats, brown rice, quinoa, whole rye crackers)?
  1. Never (-3)
  2. 1 to 2 times a week (-1)
  3. 3 to 4 times a week (0)
  4. 5 to 6 times a week (+1)
  5. 1 or more times a day (+3) (score) _____

 

  1. How often do you eat sweets such as cookies, cakes, or ice cream?
  1. 1 or more times a day (-3)
  2. Every other day (-2)
  3. Twice a week (-1)
  4. Once a week (0)
  5. 2 to 3 times a month (+1)
  6. Rarely (+3) (score) _____

 

 

Your Total Score __________________

 

Scoring: 22–28 – Great eating habits

17–21 – Pretty good eating habits

10–16 – Needs some improvement

9 or less – Needs much improvement; try to change one habit at a time

 



Diet, Nutrition, and Lifestyle Journal – 1 Day

Patient Name_______________________________________________________________ Date___________________ Food Plan Type: _____________________________________________________________________________________

Day 1

Day Event

Food & Drink Intake (include type, amount, brand)

Macronutrients (PFC) and Phytonutrients

Rising Time

   

Breakfast

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL o W/T/BR

Mid-AM Snack

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL ☐ W/T/BR

Lunch

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL o W/T/BR

Mid-PM Snack

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL o W/T/BR

Dinner

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL o W/T/BR

PM Snack

Time

 

_________________ P _________________ F ________________ C ☐ R ☐ O ☐ Y ☐ G ☐ B/P/BL o W/T/BR

Bed Time

   

P : Proteins; F : Fats; C : Carbohydrates; R : Red; O : Orange; Y : Yellow; G : Green; B/P/BL : Blue/Purple/Black; W/T/BR : White/Tan/Brown

Sleep & Relaxation

Exercise & Movement

Stress

Relationships

Sleep

Quantity: ______ (hours) Quality:
☐ Poor ☐ Fair ☐ Good

Relaxation

☐ Yes ☐ No Type/Amount:

Type, Duration, & Intensity o Aerobic ☐

☐ Strength: ☐ Flexibility:

Stress Reduction Practices:

Stressors:

Supporting:

Non-supporting:

Mental

Emotional

Spiritual

     


Hidden Foods

Hidden Food Sources of 5 Common Allergens

The following list will help you identify hidden sources of re fi ned simple sugars, egg, dairy, soy, and wheat that may be added to many common foods. Always read labels carefully and don’t hesitate to make inquiries of the food manufacturer if you have any doubts as to a food’s contents.

SUGAR

Baby Foods Biscuits, Breads Cakes
Candies
Cereals
Chocolate
Cocoa Drinks Cookies
Crackers
Creamed Foods Custards, Puddings Doughnuts Frostings

Hard Candies
Ice Cream, Sherbets Lunch Meats Marshmallows Macaroons Mayonnaise Meringues Pancakes,Wa ffl es Processed Foods Salad Dressings Sauces
Soft Drinks
Soups
Yogurt

EGG

Bavarian Cream Breads
Breaded Foods Cakes

Egg Noodles Flour Mixes French Toast Fritters
Frostings
Frying Batters Glazed Roll Hamburger Mix Hollandaise Sauce Ice Cream Macaroons Marshmallows Mayonnaise

Meat Loaf Meringues Pancakes,Wa ffl es Puddings

Salad Dressings Sauces Sausages Sherbets Sou ffl és

MILK

Au Gratin Foods Bavarian Cream Breads, Biscuits Butter, Hard Sauces Buttermilk, Cream Cakes, Cookies Candies

Crackers
Cheeses, Sour Cream Chocolate
Doughnuts
Chowders
Cocoa Drinks Creamed Foods Custard, Pudding Flour Mixes
Gravies
Meat Loaf
Hot Dogs
Ice Cream, Sherbet Mashed Potatoes Omelets, Sou ffl és Ovaltine, Malted Milk Pancakes,Wa ffl es Salad Dressing Scalloped Dishes Soups (creamed) Whey
Yogurt

SOYBEANS

Baby Foods Breads, Biscuits Butter Substitute Cakes
Crackers
Cereal
Crisco Spray Candies
Ice Cream Infant Formulas Lecithin
Lunch Meats Margarine
Milk Substitutes Oil
Oriental Sauces Pastries
Prepared Meats Salad Dressings Soups
Soy Flour
Soy Noodles Soy Sauce Tamari
Tempeh Tempura
Tofu
Tuna

WHEAT (Gluten) Beer, Alcohol

Biscuits, Rolls

Breads:

Wheat, Rye, Oat, Spelt, Pumpernickel

Breaded Fish Breaded Meats Bouillon Cubes Cakes, Mu ffi ns Candy, Chocolates Cereals

Crackers

Cocoa Drinks

Cookies, Pretzels

Cooked Meat Dishes

Corn Bread, Mu ffi ns

Crackers

Doughnuts, Popovers

Dumplings

Flour:

White,Wheat

Gravies
Matzos
Packaged Mixes Pancakes,Wa ffl es Pasta, Noodles
Pie Crust
Postum, Ovaltine Sou ffl és
Soy Sauce
Tamari
Wheat Germ, Bran



Cross Reactions Between Food and Environmental Allergens

Having seasonal allergies may increase a person’s likelihood of having certain food allergies and vice versa. There is also some evidence that the level of reaction to food allergies will be higher in people that are also sensitive to particular environmental allergens. The following table shows potential cross-reactions that should be taken into account when evaluating a person with allergies.

ENVIRONMENTAL ALLERGEN

FOODS

Fruits

Vegetables

Spices

Others

Mugwort

(Artemisia vulgaris)

Apple Nectarine Cherry Pear Peach Plum/prune Apricot Quince

Kiwi

Celery Carrot Potato

Anise Mustard Basil Oregano Caraway Paprika Coriander Parsley Dill Pepper Fennel Tarragon Marjoram Thyme

Hazelnuts Almonds Walnuts

Tree pollen

(Esp. birch and alder) 50% of people with tree pollen allergy have cross- reactivity with some fruits and vegetables

Apple Pear Cherry Plum
Fig Peach
Kiwi Prune Lychee Persimmon Nectarine Strawberry

Beans
Carrot
Celery
Green Pepper Potato Tomato Parsnip

Peas

Anise Marjoram Basil Oregano Dill Parsley Caraway Paprika Chicory Pepper Coriander Tarragon Cumin Thyme Fennel

Hazelnuts Almonds Walnuts

Ragweed

(Ambrosia artemisiifolia)

Melon* Watermelon Cantaloupe Honeydew Banana

Zucchini Cucumber

 

Sunflower seeds

Latex

Over 50% of people with latex allergy react to fruit; >35% of these reactions are anaphylactic

Banana Avocado Kiwi Papaya Apricot Apple Melons*

Celery Potato Tomato Carrot

 

Chestnut

*90% of people with melon allergy have another fruit allergy.

References

  1. GrierT.Latex cross-reactive foods fact sheet.American LatexAllergyAssociation.http://latexallergyresources.org/latex-cross-reactive-foods-fact-sheet
  2. Pauli G, Metz-Favre C.“[Cross reactions between pollens and vegetable food allergens]. Rev Malad Respir.April 2013; 30(4): 328–37. doi:10.1016/j.rmr.2012.10.633.
  3. Vieths S, Scheurer S, Ballmer-Weber B. Current understanding of cross-reactivity of food allergens and pollen. Ann New York Acad Sci. May 2002; 964: 47–68.
  4. Egger M,Mutschlechner S,Wopfner N,et al.Pollen-food syndromes associated with weed pollinosis:an update from the molecular point of view.Allergy.April 2006;61(4):461–76. doi:10.1111/j.1398-9995.2006.00994.x.
  5. Sano A,Yagami A, Inaba Y, et al. Sensitization pro fi les of a case of pollen-food allergy syndrome. Allerg Intl. 2011; 60(1): 97–101. doi:10.2332/allergolint.10-CR-0235.
  6. Pollert SM,Warniment C,MoriT.Latex allergy.Am Fam Phys.2009;80(12):1413-1418.
  7. Blanco C,CarrilloT,Castillo R,et al.Latex allergy:clinical features and cross-reactivity to fruit.AnnAllergy.1994;73:309-14.
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