Meal pattern. Does patient consume this food weekly or daily?
Wheat products (pasta, noodles, bread etc?)
Frequent eating of sweets/sugar, snacks, candies etc?
Fast food, chips, cookies, candy, etc.
Dairy products (milk, ice cream, cheese, yoghurt, etc.)
Soy products (tofu, tempeh, soy sauce, soy flour, etc.)
Prepackaged processed meats (canned meat in any form, meat mixes, bacon, lunch meat, sausages, etc.)
Consuming boxed, canned, bagged and ready-to-eat foods from supermarkets (cereals, frozen meals, etc.)
Low-quality fats, (soybean, canola, corn, highly processed oils, hydrolyzed butter, etc.)
Juices, cold-pressed juices, smoothies, shakes, etc.
Powdered foods (spirulina, chlorella, whey, athletic mixes, etc.)
Soups, stews, etc.
Coffee, tea, ginseng, chocolate (foods or drinks containing caffeine)
Alcohol, beer, wine, mixed drinks. How often, and what type
Clean fresh water. I drink how much each day
“White food” (white rice, white noodles, white bread, white sugar, white milk, white salt, etc.)
Raw foods (salads, nuts, sushi, etc.)
Seed oils such as cottonseed, soybean, canola, corn, palm oil, etc.
Pure extra virgin coconut oil (EVCO) or extra virgin olive oil
Wild or semi-wild foods, such as avocado, mango, coconut, fresh sea fish, berries, etc.
Others not listed above. Please describe.
