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Functional Health Questionnaire

With this comprehensive evaluation of biological systems, you can gain insight into your individual biochemistry and current health status. Based on your results, we can provide personalized suggestions to optimize your health or overcome chronic disease naturally. Note: you can skip any section as you wish, but know that doing so can skew your overall results + treatment approach. Now, let's get started!
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    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 13
    Many dysfunctions in the body will resolve themselves once the upper GI is well. If you scored 10 or higher, consider naturopathic assessment + treatment to avoid complications of poor digestion, such as irritable bowel, fatigue, nutrient deficiency, obesity, food cravings, allergies, ulcerative colitis, + Crohn’s disease. Natural treatments, such as betaine HCl, Enzymes, vitamin C, fiber, + probiotics are often considered + utilized to support GI health.
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  • 14
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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    The liver has over 500 known functions. It's involved with digestion, the endocrine system, controlling blood sugar, + protein + fat metabolism. The liver also produces a substance called bile that is stored in the gallbladder, which is essential for proper fat emulsification + is also a major route of elimination for the body. When your score is 12 or higher, this signifies distress in the liver +/or gallbladder possibly caused by detoxification problems that can significantly affect liver function, biliary insufficiency, biliary stasis, a low fat diet, or eating hydrogenated oil. Nutrients to support phase II liver detoxification, cleansing herbs, antioxidants like glutathione + vitamin C are often used to restore function here.
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  • 16
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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    The small intestine is the site for further digestion, absorption + assimilation of the majority of nutrients. It is split up into 3 distinct areas: the Duodenum, Jejunum, + Ileum. About 90% of all absorption takes place in the small intestines. However, success in the small intestine is dependent on the health of the stomach, gallbladder, + pancreas. Dysfunction in any one of these systems will lead to the production of metabolic toxins. The bacterial flora in the small intestine feasts on maldigested nutrients + produce metabolic toxins that cause damage to the lining of the small intestine leading to problems such as leaky gut syndrome + malabsorption. If you scored 8 or higher, this signifies distress in the small intestine. This may be caused by dysbiosis, bowel toxemia, malabsorption, leaky gut syndrome, or allergies. Immune support, GI support, herbs, + amino acids like glutamine are often implemented to restore small intestine function.
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  • 18
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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    The large intestine is the area in the GI where water is reabsorbed back into the body + creates feces with inorganic salts, sloughed off cells, + bacteria. Successful bowel movements are dependent on optimal function in the rest of the digestive tract. If you scored 10 or higher, then there is a need for further assessment + treatment to reduce distress in the large intestine. This may be caused by a sluggish colon, a fast bowel transit time, dysbiosis, bowel toxemia, or a yeast overgrowth in the colon. Enzymes, vitamin C, taurine, larch arabinogalactins are often used to naturally restore health in the large intestine + optimize elimination.
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  • 20
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 21
    If you scored 13 or higher, then there is a need for further assessment + treatment of the systems that help regulate the mineral balance in your body. Mineral imbalance may be caused by an inability to absorb minerals from the diet, essential fatty acid insufficiency, adrenal hormone imbalance, systemic pH issues, vitamin D insufficiency, + general hormone imbalance. Treatment considerations may include mineral replacement, digestive enzymes, + mixed fatty acids.
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  • 22
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 23
    If you scored 5 or higher, then there is a need for further assessment and treatment to help regulate essential fatty acids usage in your body. This may be caused by eating hydrogenated oil, gallbladder insufficiency, a low fat diet, + a diet low in essential fatty acids. Further assessment + treatment may include checking your pH level, muscle or blood testing, essential fatty acid replacement + nutrients like vitamin C, taurine, + phospathidyl choline.
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  • 24
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 25
    If you scored 7 or higher, then there is a need for further assessment and treatment to help regulate your blood sugar levels. Dysregulation may be caused by eating refined sugars or hydrogenated oil, adrenal insufficiency, obesity, + lack of exercise. Nutritional advice, adaptogenic herbs, hormone replacement, antioxidants, + cholesterol support can all help to restore blood sugar balance, reverse Type II diabetes, insulin resistance, + reduce severity of Type I diabetes effects.
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  • 26
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 27
    According to nutrition experts, the average Western diet contains too many refined carbohydrates, not enough essential fatty acids, + too little fiber. The combination of low fiber and highly refined carbohydrates + fat contributes to an increased risk of heart disease, cancer, + diabetes. Even conventional medical authorities believe that the average Western diet is not ideal since it is linked to poor health. Based on your score, dietary changes, blood or urine tests, B12 or nutrient shots, IV therapy, + supplements may be warranted.
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  • 28
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 29
    If you scored below 13, continue doing what you're doing to keep a healthy handle on the stressors in your life. If you scored 13 or higher, this signifies distress in the systems that help regulate the adrenals response to stress. This may be caused by eating refined carbohydrates + sugar, high levels of stress, over exercise, lack of sleep, pain, inflammation, worry, anxiety, etc. Physical examination, saliva, blood, or urine testing, as well as hormone replacement, adaptogenic herbs, + specific nutrients may be warranted to support a healthy stress response.
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  • 30
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 31
    The pituitary gland resides in the brain + is a master hormone regulator under the control of the hypothalamus gland. The biofeedback system between these two glands ensures a healthy level of circulating hormone. A score of 5 or higher signifies often complex glandular dysfunction + hormone dysregulation. Consideration of pituitary or hypothalamic tissue replacement or blood sugar imbalance may be considered when treatment of adrenal, thyroid, or sex hormone dysfunction is unsuccessful.
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  • 32
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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    If you scored 8 or higher, thyroid assessment + treatment should be considered. Common factors of dysfunction include stress, adrenal insufficiency, liver dysfunction, kidney insufficiency, a low calorie diet, iodine + selenium deficiency. Appropriate testing of thyroid hormones like FT4, FT3, + thyroid antibodies, Optimal hormone level assessment, hormone replacement, + targeted nutrition may be warranted.
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  • 34
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 35
    If you scored 6 or higher, this signifies distress in the systems that help regulate the male hormonal system possibly due to an enlarged prostate, zinc deficiency, andropause, + impotence. Physical examination, PSA, creatinine, PAP, zinc levels, + nutritional support of prostate health like saw palmetto, pumpkin seed oil or deer antler velvet may be warranted.
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  • 36
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 37
    If you scored 10 or higher, this signifies female hormone distress possibly due to poor dietary habits, gallbladder insufficiency, a low fat diet, + essential fatty acid deficiency. Physical assessment, cycle mapping, FSH, LH blood tests, saliva or urine hormonal tests, BHRT, black currant seed oil, ovary tissue, + targeted nutrition may be warranted.
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  • 38
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 39
    Cardiovascular disease is one of the major killers in western society. It's important to determine whether cardiovascular dysfunction is due to an actual heart problem or other conditions that put significant stress on the heart. If you scored a 5 or higher, this signifies distress in the cardiovascular system possibly due to poor dietary habits, IBS, EFA deficiency, high homocysteine, kidney + biliary insufficiency, etc. Physical assessment, specialized functional testing, medication management, CoQ10, B vitamins, Hawthorne berry, + referral to a Cardiologist may be warranted.
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  • 40
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 41
    The majority of the questions in this section are concerned with kidney disease or infection. If you scored 4 or higher, this signifies a need for further assessment + treatment of the kidneys. Physical examination, Urinalysis + blood test, kidney supportive herbs, dietary changes, adequate hydration, P5P, vitamin A, bioflavonoids, + referral to a Nephrologist for imaging may be warranted.
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  • 42
    Read the following questions and choose the number that applies: KEY: 0 =No, symptom does not occur (leave blank) 1=Minor or mild symptom, rarely occurs (monthly) 2=Moderate symptom, occurs occasionally (weekly) 3=Severe symptom, occurs frequently (daily)
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  • 43
    We live in a toxic world, which constantly challenges the immune system. With a score of 5 or higher, this signifies stress on the immune system possibly increased by poor dietary habits, symbiosis, bowel toxemia, + overall toxicity in the body. Physical examination, nutrient, allergen, specialized tests, calcium d-glucarate, thymus tissue replacement, colloidal silver, ozone therapy, + high dose vitamin C may be necessary to strengthen your immune response.
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    You've reached the end of the Dr. Varela's functional health assessment! We hope you found it educational + insightful. If you'd like to discuss your results + discover how we may help you improve your results, please schedule a consultation with us! BOOK HERE

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