252x Filetype PDF File size 1.10 MB Source: www.worldgastroenterology.org
Digestive Health Food Diary Use this diary to record what you eat & drink every day for 14 consecutive days Supported by www.loveyourtummy.org Your 2-week food diary Name Date To Food diary instructions: 1. List everything you eat and drink at each meal for every day 2. In the side section, tick all the relevant boxes 3. Take your completed diary with you when you visit your doctor or nurse to discuss if changes can be made to your diet and lifestyle that may help improve your digestive health www.loveyourtummy.org Week 1 Food eaten Symptoms Severity Day 1 Bloating Diarrhoea None Flatulence/wind Constipation Mild Breakfast Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Lunch Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Dinner Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia To Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Snacks Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Day 2 Food eaten Symptoms Severity Bloating Diarrhoea None Flatulence/wind Constipation Mild Breakfast Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Lunch Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Dinner Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Snacks Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Food eaten Symptoms Severity Day 3 Bloating Diarrhoea None Flatulence/wind Constipation Mild Breakfast Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Lunch Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Dinner Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Snacks Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Day 4 Food eaten Symptoms Severity Bloating Diarrhoea None Flatulence/wind Constipation Mild Breakfast Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Lunch Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Dinner Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong Bloating Diarrhoea None Flatulence/wind Constipation Mild Snacks Abdominal ache/pain Heartburn Medium Indigestion/dyspepsia Strong
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