Total Toxin Load Questionnaire

Part 1 - Occurring Symptoms

Point Count for Symptoms  

Never have the symptom 0

Rarely and/or very mild 1

Sometimes and/or effect is mild 2

Fairly often and/or effect is moderate 3

Very often and/or effect is severe 4

 

General/Metabolic

Feel the cold

Compulsive eating/drinking alcohol

Water retention

Fatigue/sluggishness

Significant weight gain

Cellulite

Significant weight loss

Burning sensation in limbs/hands/feet

Sensitive to strong odours/exhaust/perfumes etc.

Rapid heart beat

Subtotal

 

Skin

Increased sweating

Skin rashes

Brown spots on hands and face

Boils

Skin tags (small hanging warts)

Hives, rashes, dry skin

Acne

Psoriasis

Eczema

Fever blisters

Warts

Hair loss (Non-hereditary) /Alopecia

Subtotal

Digestive System   

Loose stools

Heartburn

Constipation

Bloating

Abdominal pain

Intolerance to certain foods

Nausea or vomiting

Subtotal

 

Joints and Muscles

Muscle aches

 Aching joints

Tendinitis (sore tendons)

Fibromyalgia (painful muscles)

Gout (high acidity)

Arthritis

Tremors in muscles/hands/wrist

Stiffness/limited movement

Subtotal

 

Mind/Emotions

Irritability

Nervousness

Mood swings

Frequent crying

Anger or impatient behaviour (eg. road rage)

Stressed

Anxiety

Confusion

Depression

Panic attacks

Suicidal thoughts

Subtotal

 

 

Eyes/Ears/Nose/Throat

Eyes watery/itchy/red/swollen

Floaters in vision field (dark spots)

Bags or dark circles under eyes

Blurred vision

Mouth ulcers

Frequent colds or flu

Sinusitis/sneezing episodes

Hoarseness in throat

Swollen or discoloured lips/tongue/gums/mouth

Sore throats

Hay fever

Ear infections

Bronchitis

Loss of smell

Cough

Subtotal

 

Cognitive Score

Hyperactivity

Stammering/speech problems

Difficulty in concentration

Difficulty in making decisions

Headache

Poor memory

Poor coordination

Compulsive behaviour

Sleep disturbance

Memory loss

Dizziness/faintness

Tingling/burning/electric sensation in head/body

Subtotal

 

Liver/Kidney

Fatigue/malaise

Dark coloured urine (not from B vitamins)

Bad breath / coated tongue

Nausea (not pregnant)

Yellow tinge to skin and eyes/jaundice

Increase in urination frequency and amount

Needing to get up in the night to pass urine

Urinary tract infections/cystitis

Poor appetite in the morning

Kidney stones

Blood in the urine or stool

Have a strong reaction to caffeine

Subtotal

 

Part 1

TOTAL SCORE

 

 

Part 2 - Enviromental Exposures

Environmental Influences 2A -‐ Do you/have you…  Score 

Own a new car (within 12 months) 3

Recent painting (home painting/artistic) 2

Use dry‐cleaned clothes/linen 2

Noticed changes in health since moving home 5

Use industrial chemicals/metal de‐greasers 5

Regularly swim in chlorinated pools/spa ( > 3 times p/w) 5

Live in an old home (built prior to 1970) 5

Moved into a new home/new office building (within 1 year) 5

Live on/near a non‐organic farm (within 100 meters) 5

Use mobile phone/ computer / screens daily 5

Have new carpets/lounge suite/drapes 5

Been in contact with glues/resins/epoxy (within last month) 1

Smoke cigarettes or other smoking 10

Pesticides/weed killers are used on your property 10

Work in an industry known to have toxic environment 10

Use fumigants/insect repellants 2  

Have fluorescent/energy saving lights 5

Use moth balls 2

Use air fresheners 1

Use non‐natural commercial household cleaners 3

Own known fumigated furniture (in past 2 yrs) 5

Live near a golf course (within 100 metres) 5

Live near an industrial area (within 100 metres) 5

Live near a landfill (within 100 metres) 5

Live near power lines (within 100 metres) 5

Sleep near active electrical items or power points 2

Have wifi in your home on 24 hours daily 10

Been exposed to known radiation 10

Use mildew cleaners/rug/carpet cleaners/spot stain removers 2

Live in a damp home 5

Have poor ventilation at home or work 1

Have an open fire place 1

Have gas heating or cooking 1

Live near or on a busy road 5

Is your home chemically termite treated 2

Have a known existing chemical/heavy metal exposure 10

Subtotal Environmental Influences (2A)

 

Environmental Influences 2B -‐ Do you/have you… Score 

Eat non-organic rice regularly ( > 3 times p/w) 2

Eat non-organic chicken regularly ( > 3 times p/w) 2

Drink coffee each day 2

Consume gluten containing grains ( > 3 times p/w) 5

Consume berries/grapes/stone‐fruit/apples ( > 3 times p/w) 2

Eat smoked/cured meats regularly ( > 3 times p/w) 3

Use plastics in your kitchen/home 10

Eat tuna, swordfish, shark, orange roughy (> 3 times p/w) 10

Cook with aluminum pots and pans 5

Consume rice milk/ soy milk regularly ( > 3 times p/w) 2

Consume cow’s milk or dairy products ( > 3 times p/w) 2

Drink alcohol (more than 7 glasses p/w) 5

Regularly eat canned food ( > 3 times p/w) 5

Regularly touch/handle newsprint/magazines 1

Use commercial sunscreen regularly ( > 3 times p/w) 2

Use toothpaste with flouride 2

Sleep with an electric blanket on 1

Use a microwave daily 2

Drink soft drinks such as cola or diet sodas ( > 3 times p/w) 5

Eat processed foods regularly ( > 3 times p/w) 5

Use Teflon cooking pans 5

Use commercial fabric softener / spray starch 2

Drink tap water 10

Use hair spray 1

Have mercury fillings 10

Have had mercury filling removed in last 10 years 5

Use recreational drugs (once per month or more) 10

Wear commercial make‐up/body moisturizer most days 5

Dye your hair (non‐henna) 2

Use deodorant containing aluminium 5

Take any medication with suspected toxicity (ask your practitioner) 5

Use medication for reflux/heart burn ( > 3 times p/w) 5

Use painkillers/steroid/NSAID medication ( > 3 times p/w) 5

Use medications for nerve pain/muscle relaxants (> 3 times p/w) 5

Regularly use antihistamines or anticholinergic medications 5

Take mood altering medication (antidepressants / antipsychotics 5

Subtotal Environmental Influences (2B)

 

Part 2

TOTAL SCORE:

 

Part 1 + 2

TOTAL SCORE:

 

Interpreting Results for Total Toxin Load Score

Total Toxin Load Score <80 - Relatively low Total Toxin Load. Probably no action required.

Total Toxin Load Score 81-150 - Suggestive of mild to moderate toxin load. Regular detoxification may be beneficial.

Total Toxin Load Score 151-250 - Suggestive of moderate to severe toxin load. Detoxification and possible further testing is recommended.

Total Toxin Load Score > 250 - Suggestive of severe toxin load. Immediate detoxification and further testing is recommended.

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