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Questionnaire

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There are many different factors which may contribute towards Magnesium deficiency. 

Research suggests we are not getting enough Magnesium in our diet to meet our body´s needs this might be due to an increase demand for
magnesium times of physical or emotional stress, because of acute or chronic illness, or due to our diet, lifestyle and medications, or our life stage
such as ageing, pregnancy and lactation.

Magnesium is an important mineral required for the healthy functioning of our nervous system, our heart and bones, our metabolism and for healthy daily energy levels.

Magnesium Status Questionnaire is designed to give information's about your body's Magnesium levels and determine if Magnesium supplement may be beneficial for you.

If any of the following statements apply to you, tick the corresponding box.
After completing the questionnaire, add the subtotals scored in each section to provide your Total Magnesium Status Score.

Section A - Diet/Lifestyle:

Drink alcohol everyday or more than 7 alcoholic drinks per week 5
Strenuous exercise or training more than 3 times per week (running, sports, gym etc.)5
More than 3 coffees daily 4
High sugar containing foods daily 2
Eat processed food or junk food daily1
Consume a diet high in fatty food daily
(fried foods, butter, hamburgers, bacon, ice-cream, cheese) 4
A diet low in green leafy vegetables, seeds and nuts (less than one serve every day)5
Consume soft drinks/fuzzy drinks daily4
Frequently have undigested food or fat in your stools (more than 3 times per week)1
 

Section B - Health Conditions:

Chronic headaches or migraines15
Asthma5
Diabetes10
Glaucoma4
Osteoporosis5
Chronic kidney disease5
High blood pressure 5
An overactive thyroid, or underactive thyroid2
An endocrine condition such as Hyperaldosteronism or Hyperparathyroidism5
Very fast heart beats, irregular heartbeats, or arrhythmia
(or have experienced these symptoms in the last 12 month)10
Chronic intestinal disease, Ulcerative colitis, Crohn's disease or Irritable bowel syndrome5
Frequent diarrhea or constipation4
PMS or menstrual cramps5
Frequent lethargy or fatigue3
Known parasites (e.g. Pinworm)2
Currently Pregnant5
Recently pregnant (in the last 12 month)1
Breastfeeding or recently breastfed for longer than 12 month3
Have diagnosed Hemochromatosis (Iron overload)5
In a previous pregnancy had high blood pressure or pre-eclampsia5
Recent traumatic stress, physical or emotional (in the last 12 month)5

Section C - Medications/Supplements:

   
Taking Digitalis (Digoxin)3
Taking any kind of diuretic medication10
Known to have low blood Potassium2
Known to have Vitamin D deficiency2
Taking Calcium supplements regularly without Magnesium5
Medically diagnosed malnutrition5
Taking Iron or Zinc supplements regularly without Magnesium2
Told by your practitioner you have an acid/alkali imbalance4
Told or know you have had exposure to heavy metals
such as Mercury, Cadmium, Aluminum or Lead2
Frequently use antibiotics (more than 3 courses in the last 6 month)3
Currently on steroid medication (e.g. Prednisolone, Sybacort, Cortisone)1
Taking oral contraceptives4
Had recent radiation therapy or exposure (in the last 12 month)5

Section D - Nervous System:

1= Almost never, 2= Sometimes, 3= Fairly often, 4= Very often
Easily startled by sounds or people1     2     3     4
Muscle spasms in hands or feed1     2     3     4
Difficulty sleeping1     2     3     4
Irritability, or being easily provoked1     2     3     4
Feeling restless, or agitated1     2     3     4
Small muscle twitching around your eyes, facial muscles1     2     3     4
Small muscle twitching anywhere else in your body1     2     3     4
Convulsions1     2     3     4
Experience long or intense periods of stress1     2     3     4
Shakiness or tremor in your hands1     2     3     4
Muscle cramps1     2     3     4
Chronic lack of interest, indifference, or apathy1     2     3     4
Poor memory1     2     3     4
Experience physical or mental fatigue1     2     3     4
Loss of concentration1     2     3     4
Anxiety1     2     3     4
Mood swings 1     2     3     4
Depression for no apparent reason1     2     3     4
Feelings of disorientation as to time or place1     2     3     4
Experience emotional stress1     2     3     4
Feelings that people are against you1     2     3     4
Cold hands or feet1     2     3     4
Numbness in face, hands, or feet1     2     3     4
Experience tingling or "pins and needles" anywhere in your body1     2     3     4
Loss of libido1     2     3     4


Total Magnesium Status Score:  Section A + B + C + D =                                       __________

Interpretive Guide to your Total Magnesium Status Score:

Score: 0 - 25
Suggests it is unlikely there is a Magnesium deficiency; however it is important to maintain a healthy diet rich in Magnesium by consuming nutritious whole foods including nuts and seeds whole grains and green leafy vegetables. During times of physical or emotional stress, you might want to take bioavailable Magnesium.

Score: 26 - 50
Suggests it is likely your Magnesium Levels are low. You are better of taking Magnesium regular to improve intracellular Magnesium Levels quickly. It is also important to consume Magnesium rich foods such as nuts and seeds, whole grains and green leafy vegetables.

Score: over 50
Suggests it is highly likely you are suffering from low Magnesium levels and may be experiencing Magnesium deficiency Symptoms.
It is advisable that you take bioavailable Magnesium, proven to improve Magnesium status quickly. It is also important to consume
Magnesium rich foods such as nuts and seeds, whole grains and green leafy vegetables.