This is not medical advice. This information is for education and entertainment purposes. Seek Professional Guidance and support with any lifestyle and nutritional change.
Working out your needs
In this incredible age of information, we’re empowered like never before to take charge of our health, but navigating the flood of wellness trends can be overwhelming. Instead of chasing the latest fad, true vitality lies in addressing your unique health needs through bio-individuality—understanding that your body’s response to toxins, like heavy metals, is distinct.
By focusing on your specific exposure risks, revealed through this symptom questionnaire, you can take targeted action to restore balance and thrive.
This questionnaire helps identify symptoms that may be related to heavy metal exposure. Answer based on your experiences over the past 6 months. Share results with a healthcare professional to discuss if a heavy metal detox or testing is needed.
IMPORTANT: Detox protocols may affect medications, so professional guidance is critical. The options with medications and also amalgam fillings will be detailed in the information in this program.
Instructions
- For symptoms (Questions 1–13), select how often you experience each:
- Never (0)
- Rarely (1)
- Sometimes (2)
- Often (3)
- Always (4)
- For exposure history (Questions 14–21), select Yes/No and note details if you are making notes for your Health Practitioner.
General Symptoms
- Unexplained fatigue or low energy
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Difficulty concentrating or “brain fog”
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Irritability, anxiety, or depression without clear cause
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Frequent headaches or migraines
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
Neurological Symptoms
- Tremors, shakiness, or muscle twitching
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Numbness, tingling, or burning in hands or feet, mouth
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Memory problems or difficulty recalling information
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
Digestive and Metabolic Symptoms
- Nausea, bloating, or abdominal pain
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Changes in appetite or unexplained weight loss/gain
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Metallic taste in mouth or bad breath, burning mouth, dry mouth
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
Immune and Skin Symptoms
- Frequent infections or weakened immune system
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Skin rashes, itching, or unusual sensitivity
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
- Joint pain or muscle aches
- Never [ ]
- Rarely [ ]
- Sometimes [ ]
- Often [ ]
- Always [ ]
Exposure History
Environmental and Occupational Exposure
- Exposure to potential heavy metal sources (e.g., contaminated water, occupational exposure, dental amalgams, fish consumption)?
- No [ ]
- Yes [ ]
- If Yes, describe: frequent fish consumption, worked in industrial setting
- Lived in or visited areas with known environmental pollution?
- No [ ]
- Yes [ ]
- If Yes, describe: near industrial site, old housing with lead pipes
Water Consumption
- Regularly drink tap water without a filtration system?
- No [ ]
- Yes [ ]
- If Yes, describe frequency and source; e.g., city or tank water daily, city tap water
- Frequently boil tap water for drinking or cooking (which may concentrate heavy metals)?
- No [ ]
- Yes [ ]
- If Yes, describe frequency: boil water daily for tea
Beauty, Hair, and Cleaning Products
- Use beauty or hair products (e.g., lipsticks, eyeliners, hair dyes, shampoos) that may contain heavy metals like lead, mercury, or aluminum?
- No [ ]
- Yes [ ]
- If Yes, describe products and frequency: daily use of hair dye, weekly use of lipstick
- Use household cleaning products (e.g., sprays, detergents, polishes) that may contain heavy metals or related chemicals?
- No [ ]
- Yes [ ]
- If Yes, describe products and frequency: weekly use of bleach-based cleaner
Medication Use
- Taking medications or supplements that may contain heavy metals as inactive ingredients or contaminants (e.g., antacids, pharmaceuticals, supplements)?
- No [ ]
- Yes [ ]
- If Yes, describe medications/supplements: daily antacid, herbal supplement
- If considering a heavy metal detox, have you discussed with a healthcare provider how it might affect medication efficacy or dosage?
- No [ ] Yes [ ]
- Not applicable (I am not taking medications)
Blood Donation and Menstrual History
- If female, do you still have a regular menstrual cycle?
- No [ ] Yes [ ]
- Not applicable (I am not female)
- If No, describe (e.g., menopause, medical reason): post-menopause, hysterectomy
- Do you regularly donate blood?
- No [ ]
- Yes [ ]
- If Yes, describe frequency (e.g., how often in the past year): donated blood 3 times in the past year
Results and Next Steps
Scoring
- Add up your scores from Questions 1–13 (0–4 per question).
- 0–15: Low likelihood of heavy metal toxicity symptoms.
- 16–30: Moderate symptoms; consider consulting a healthcare provider.
- 31–52: High symptom burden; consult a healthcare professional for evaluation and testing.
Important
- This is not a diagnostic tool. This is to provide structure in an area of interest that may need some grounding of information. Symptoms may have other causes.
- Some medications/supplements may contain trace heavy metals, and detox protocols could affect their absorption, efficacy, or dosage.
- Always consult a healthcare provider before starting a detox or changing medications.
Maree Frawley 