part0017

Write down everything you eat and drink for three days, including all snacks, beverages, and water. Please include approximate amounts. Describe energy, mood or digestive responses associated with a meal/snack, and record it in the right-hand column. Use an up arrow (↑) for an increase in energy/mood, down arrow (↓) for a decrease in energy/mood, and an equal sign (=) if energy/mood is unchanged.

Time of waking: ________________________a.m. / p.m.

1. How much time passed between when the client awakens and when they eat breakfast? Is the client eating breakfast?

One should always eat breakfast, containing at least 3–4 ounces of protein within 30 minutes of waking for proper energy and blood sugar balancing.

2. How much water/broth is the client drinking throughout the day?

Water intake should be about 50 percent of body weight every day in ounces (example: if a person weighs 160 lb, they should be drinking 80 ounces of water daily).

3. How often is the client eating? How many hours between each meal or snack?

Food should be eaten every 3–4 hours to prevent mood swings, and the client should have at least 3 meals/day and 2 snacks.

4. How many servings of vegetables is the client eating per day?

At least 3 servings of vegetables should be eaten every day. A serving equals from ½ to 1 cup.

5. Is the client eating raw vegetables and fruits?

At least 1–3 servings of raw fruit or vegetables should be eaten every day.

6. Is the client eating enough protein? Note if lack of protein corresponds to drops in mood.

Proteins help to stabilize energy and balance mood and should be emphasized during the daytime hours.

7. Is the client eating enough fats? Note if lack of fats corresponds to mood shifts.

Fats help to stabilize energy and balance mood and should be emphasized during the daytime hours.

8. How many servings of starchy carbohydrates is the client eating and at what times of day?

During the day carbohydrates are best when combined with protein, and carbohydrates should be emphasized in the evening for relaxation.

9. What is the quality of the food the client is eating (freshly prepared vs. canned or prepackaged foods)?

Recommend whole, fresh, organic foods over packaged and canned foods.

10. Is the client eating enough soluble fiber?

Soluble fiber is found in foods like oat bran, nuts, beans, lentils, psyllium husk, peas, chia seeds, barley, and some fruits and vegetables. Men should be eating about 38 grams/day, and women 25 grams/day.

11. Is the client eating enough insoluble fiber?

Insoluble fiber is found in wheat bran, corn, whole grains, oat bran, seeds and nuts, brown rice, flaxseed, and the skins of many fruits and vegetables.

Food/Mood Diary Name: _____________________ Date: (dd/mm/yy) _______________________
Write down everything you eat and drink for three days, including all snacks, beverages, and water. Please include approximate amounts. Describe energy, mood or digestive responses associated with a meal/snack, and record it in the right-hand column. Use an up arrow (↑) for an increase in energy/mood, down arrow (↓) for a decrease in energy/mood, and an equal sign (=) if energy/mood is unchanged.
Time of waking: ________________________a.m. / p.m.
Meal	Beverages	Energy Level (↑, ↓ or =)	Mood (↑, ↓ or =)	Digestive Response (gas, bloating, gurgling, elimination, etc.)
Breakfast (Time:______)
Snacks (Time:______)
Lunch (Time:______)
Snacks (Time:______)
Dinner (Time:______)
Snacks (Time:______)

Clinician Checklist for the Food-Mood Diary
Question	Answer	Goals and Recommendations
1. How much time passed between when the client awakens and when they eat breakfast? Is the client eating breakfast?		One should always eat breakfast, containing at least 3–4 ounces of protein within 30 minutes of waking for proper energy and blood sugar balancing.
2. How much water/broth is the client drinking throughout the day?		Water intake should be about 50 percent of body weight every day in ounces (example: if a person weighs 160 lb, they should be drinking 80 ounces of water daily).
3. How often is the client eating? How many hours between each meal or snack?		Food should be eaten every 3–4 hours to prevent mood swings, and the client should have at least 3 meals/day and 2 snacks.
4. How many servings of vegetables is the client eating per day?		At least 3 servings of vegetables should be eaten every day. A serving equals from ½ to 1 cup.
5. Is the client eating raw vegetables and fruits?		At least 1–3 servings of raw fruit or vegetables should be eaten every day.
6. Is the client eating enough protein? Note if lack of protein corresponds to drops in mood.		Proteins help to stabilize energy and balance mood and should be emphasized during the daytime hours.
7. Is the client eating enough fats? Note if lack of fats corresponds to mood shifts.		Fats help to stabilize energy and balance mood and should be emphasized during the daytime hours.
8. How many servings of starchy carbohydrates is the client eating and at what times of day?		During the day carbohydrates are best when combined with protein, and carbohydrates should be emphasized in the evening for relaxation.
9. What is the quality of the food the client is eating (freshly prepared vs. canned or prepackaged foods)?		Recommend whole, fresh, organic foods over packaged and canned foods.
10. Is the client eating enough soluble fiber?		Soluble fiber is found in foods like oat bran, nuts, beans, lentils, psyllium husk, peas, chia seeds, barley, and some fruits and vegetables. Men should be eating about 38 grams/day, and women 25 grams/day.
11. Is the client eating enough insoluble fiber?		Insoluble fiber is found in wheat bran, corn, whole grains, oat bran, seeds and nuts, brown rice, flaxseed, and the skins of many fruits and vegetables.