VITAMIN-MINERAL APPRAISAL
Please circle N for any symptom you are currently experiencing and circle P for any
symptom you have experienced in the past.
Vitamin A
N P
Eyes do not adjust to darkness
N P
See poorly in dim light
N P
Eyes are dry and inflamed
N P
Skin is rough, scaly, dry (esp. elbows, knees, buttocks)
N P
Unable to distinguish between yellow and blue
N P
Eyelids ‘glue’ together, esp. in morning
N P
Loss of sense of smell
N P
Loss of appetite
N P
Skin blemishes and discoloration
N P
Frequent infections of bladder/urinary tract
N P
Dry scalp (flakiness)
N P
Dry nose and throat
N P
Brittle nails
N P
Frequent diarrhea
N P
Loss of hearing
N P
Gallstones
N P
Recurrent styes in eyes
N P
Spontaneous abortion
N P
Ulcers (gastric, duodenal, colon)
N P
Frequent Allergies
N P
Frequent canker sores
N P
Subject to constant tension, stress, strain
Total
Vitamin B1
N
N
P
P
Twitching of eye muscles
Puffiness around eyes
N
N
N
N
N
N
N
N
N
N
N
P
P
P
P
P
P
P
P
P
P
P
Frequent blood shot eyes
Fatigue easily, abnormally tired
Loss of appetite
Easily upset or irritable
Loss of strength in lower arms/legs
Hurt all over, can’t pinpoint area
Tenderness in calf muscles
Confusion and forgetfulness
Gastric distress (indigestion)
Constipation
Diastolic blood pressure over 90 (Bottom number)
N
N
N
N
Total
P
P
P
P
Irregular heart beat
Enlarged Heart
Delayed/slowed reflexes
Prickling sensation in lower extremities
Vitamin B2
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
Cracks in the corner of the mouth
Red sore tongue
Shiny tongue
Feeling of sand in eyes
Eyes tire easily
Burning or itching of the eyes
Eyes are sensitive to light
Blood shot eyes
Frequent sores on lips
Vaginal itching
Scrotal itching
Swelling of tongue
Muscles cramps in lower legs and feet
‘Whiteheads’, especially on bridge of nose and under eyelids
Dizzy spells
Oily skin or hair
Excessive watering of the eyes
Have or had cataracts
Lack of stamina or vigor
Unexplained weight loss
Grayish brown pigmentation of the skin, especially face
Vitamin B3
Muscular Weakness
General fatigue
Loss of appetite
Frequent indigestion
Red skin around nose and eyes
Bad breath
Frequent canker sores
Can’t fall asleep
Hands and/or feet go numb
Irritable, easily upset
Hands and/or feet feel hot
Recurring headaches
Subject to constant stress, strain, tension
Depression
Loss of memory
Dry, scaly patches where skin is exposed to sunlight
N P
N P
N P
N P
Total
Burning tongue
Tongue is dark and mouth sore
Chronic skin inflammation (eczema, psoriasis)
Desire alcohol
Paba
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
N
N
N
N
N
N
N
N
N
P
P
P
P
P
P
P
P
P
Have had sulfa therapy
Extremely fatigued
Anemia
Irritability
Depression
Nervousness
Headaches
Constipation
Early graying of hair
Vitamin B5
Subject to constant stress and tension
Chronic headache
Physically feel weak
Abnormally tired
Frequent cold and upper respiratory infections
Sudden dizziness
Physically/mentally overworked
Feel lightheaded when standing up
Loss of feelings in hands and feet
Allergies
Frequent gastric distress (indigestion)
Experience periods of deep depression
Abdominal cramps and pains
Chronic constipation
Low blood sugar (hypoglycemia)
Arthritis
Have attacks of vomiting
Vitamin C
Anemia
Bleeding or inflamed gums
Easily bruise
Small red or pink spots under the skin
Susceptible to infections, including colds
Shortness of breath
Swollen or painful joints
Frequent nosebleeds
Smoking (cigarettes, cigar, pipe)
N P
N P
N P
N P
Total
Ruptured blood vessels in the eye
Have fleeting joint pain
Known metal poisoning
Hisotry of sever burns (including sunburns)
Vitamin D
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
Irregular heart beat
Poor bone development
Muscular numbness, tingling or spasms
Had rickets (bow legs, knock-knees, bone enlargement)
Tissues are flabby
Dull pains in low back and thighs
A lot of cavities
Deep pains in the leg (bone pain)
Diagnosed with osteomalacia (softening of the bones)
Magnesium
Poor muscle coordination
Prone to athletic injuries (strained knees)
As a child had partial paralysis for unknown reasons
As a child had failing eyesight
As a child had failing hearing
Myasthenia Gravis or Multiple Sclerosis
Diabetes
Allergies
Dizzy Spells
Bone deformities
Ringing in ears
Menstrual cramps
Crave chocolate before period
Muscle spasms
Manganese
N P
N P
N P
Total
N P
N P
N P
N P
N P
N P
Total
Gum disease
Physically and mentally fatigued
Breathing feels irregular
Phosphorus
Swelling in ankles and hands
Occasional rapid heart beat for no reason
Muscles feel weak
Diabetic tendency
Prefer meat to vegetables and starch
Skin of face is more red than white
Potassium
N P
N P
N P
Total
Cancer
Family history of cancer
Birth defects
Sodium
N P
N P
N P
N P
Total
Loose skin
Exhausted all of the time
Prefer vegetables and starches to meat
Skin of face is more white than red
N P
N P
N P
N P
N P
N P
N P
Total
Wounds heal slowly
Loss of sense of smell
Loss of sense of taste
Diabetes
Feel more tired than usual
Acne
Prostate problems
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
N P
Total
Feel cold even in warm weather
Low blood pressure
Gain weight easily
Dull pain under shoulder blades
Sluggish metabolism
Dry hair
Brittle nails
Eyes sensitive to bright light
Recurrent styes
High cholesterol
Decreased sexual interest
Dull headaches
Swelling of the eyes, hands and feet
Goiter
Alternating fast and slow pulse
N
N
N
N
N
N
N
Indigestion
Excessive belching or gas
Can’t tolerate hot weather
Hyperventilate easily
Nervous without obvious cause
Diabetes
Eat a low salt diet
Zinc
Iodine
Chloride
P
P
P
P
P
P
P