Low Energy Symptom Survey

Page 1 of 5

Mark all the symptoms you have that are related to a Dopamine deficiency:

Mind symptoms: (low dopamine)

have no mental energy;

frequently dont feel alert or focused;

trouble concentrating, or have attention problems;

Page 2 of 5

Mark all the symptoms you have that are related to a Serotonin deficiency:

Emotion symptoms: (low serotonin)

you tend to be negative, depressed or pessimistic;

your head is full of ANTs (automatic negative thoughts);

frequently feel worried, anxious, joyless;

frequent feelings of low self-esteem, guilt, or shame;

a perfectionist or a neat freak;

obsessed with certain thoughts or behaviors (e.g., your body, your weight, biting your nails);

tend to be controlling with others;

subject to irritability or anger;

have anxiety attacks or panic attacks;

have phobias: fear of heights, small spaces, crowds, snakes, etc;

Page 3 of 5

Mark all the symptoms you have that are related to a GABA deficiency:

Mind symptoms: (low GABA)

mind feels cluttered and its hard to focus, restless;

hard to turn your mind off when you want to relax;

Page 4 of 5

Mark all the symptoms you have that are related to a Acetylcholine deficiency:

Mind symptoms: (low acetylcholine)

find yourself writing things down so you wont forget them;

find it hard to do math in your head;

problems with directions or getting orientated;

misplace your keys, wallet, or glasses frequently;

have trouble focusing during long conversations or meetings;

get nervous or anxious when you have to learn something new;

when reading a book or watching a movie, you find it harder to follow the plot than it used to be;

have a hard time finding words or remembering what you were saying if interrupted;

feel like your brain is just not functioning at its peak, you have memory loss;

find your mental responsiveness is slow;

Page 5 of 5

Mark all the symptoms you have that are related to a Endorphin deficiency:

Mind symptoms: (low Endorphins)

often feel sad, lonely or hurt;

you tear up or cry easily (even at TV commercials);

you adore animals and need their loving company;

tend to avoid dealing with painful issues;

find it hard to get over losses or get through grieving;

you consider yourself (or others consider you) to be very sensitive;

Emotion symptoms: (low dopamine)

low energy, sleepy, lethargic, or fatigued;

often feel depressed, flat, bored, apathetic, worthless or hopeless;

low motivation, enthusiasm or drive to accomplish anything;

easily bored and feel the need for some excitement;

lose your temper for minor reasons, feel anger or aggression under stress;

you frequently desire to isolate yourself from others;

you have unexplained lack of concern for family or friends;

Body symptoms: (low dopamine)

feel tired a lot, have to push yourself to exercise or do anything physical;

don’t have a lot of stamina, you run out of energy quickly;

seem to need a lot of sleep and are slow to wake up in the morning;

are easily chilled or frequently have cold hands or feet;

have a low libido (low desire for sex)

you don't feel like you have energy for sex

you feel most people are more active than you are

if you had more energy you would do more things in life

you drink coffee or caffeine and feel run down afterwards

Craving symptoms: (low dopamine)

crave caffeine, coffees, sodas, iced teas, energy drinks, or chocolate;

you desire coffee or caffeine multiple times per day

crave sweets. they give you a “pick-me-up”;  

you like drugs that stimulate you and make you more alert, like: ritalin, adderall, caffeine, nicotine, diet pills, methamphetamine, cocaine, etc.;

Body Symptoms: (low Serotonin)

tend to be hyperactive;

often have a nervous stomach (knots, butterflies) or digestive issues;

you’re a night owl or have middle of the night insomnia;

commonly unable to fall into deep restful sleep;

have benefitted from SSRI antidepressant drugs (like Zoloft, Lexapro, or Prozac);

have depression when it’s cloudy or when there is lack of sunlight;

you’re not enjoying friendships, relationships, hobbies or your favorite foods;

a low desire for sexual connection/intimacy or have no joy in sex;

have strong PMS/Menopausal moodiness

you have: Fibromyalgia (unexplained muscle pain), TMJ pain/tension/jaw grinding, migraine headaches, irritable bowel syndrome, asthma or obesity

Craving Symptoms: (low Serotonin)

your cravings are strongest in the afternoon or evening;

you crave sweet or starchy foods;

you crave alcohol, stimulants, caffeine, nicotine, chocolate, sugar, aspartame, or marijuana;

you eat to get to sleep or to get back to sleep (if wake up in the night-head for the fridge.)

you crave more (and perhaps gain more) in fall and winter. Your mood is worse in winter, too;

Emotion Symptoms: (low GABA)

often feel overworked, pressured, dead-lined, overstressed or burnt out;

find yourself worrying about petty things;

unable to relax and loosen up easily;

find it hard to be still, meditate, pray, be mindful or at peace;

easily upset, frustrated, angry or snappy under stress;

easily stressed out or overwhelmed, you just can’t get it all done;

have feelings of anxiousness or panic for no reason;

tend to be shy, unsure and like to play it safe;

Body Symptoms: (low GABA)

often feel stiff, tense, or have painful muscles;

sensitive to pain;

feel weak or shaky at times;

don’t get away on regular vacations to relax, rest, and regenerate;

it’s hard to get to sleep (or stay asleep) at times because of the above symptoms;

bothered by bright lights, loud noises, too much activity or chemical fumes

have difficulty having an orgasm or getting into sex;

feel anxious or stressed if you skip meals or go too long without eating;

can eat way too much, way too fast. Like to eat when emotional - like to be full;

Cravings Symptoms: (low GABA)

reach for snack food to counteract stress;

drawn to alcohol or marijuana on a regular basis;

use alcohol, tobacco, food, marijuana or drugs to relax and calm down;

Emotion Symptoms: (low Acetylcholine)

don’t feel creative anymore;

feel unusually introverted and want to be alone;

feel anxiety, agitation, depression, despair, bipolar;

your emotional state feels unpredictable, chaotic;

Body Symptoms: (low Acetylcholine)

physical activity leads to exhaustion;

your emotions are unstable or unpredictable and hard to cope with;

difficulty sleeping or staying asleep;

have slow digestion, constipation or poor digestion;

get dizzy and feel weak when standing sometimes;

feel flush (redness) in the face or neck at times;

frequently have abnormal sweating;

mouth or eyes are often dry;

difficulty with sexual arousal (unable to focus on it);

occasionally have a racing heart for no reason;

have symptoms of: Hyper/Hypo-thyroidism, high blood pressure/high cholesterol/ADHD/diabetes/heart disease/fatty liver

Cravings Symptoms: (low Acetylcholine)

find yourself craving fried foods, fatty foods;

find yourself craving creamy deserts (cheesecake, ice cream);

Body Symptoms: (low Endorphins)

very sensitive to emotional or physical pain;

you’ve been through a great deal of physical or emotional pain;

get a “high” from bulimic bingeing or purging or from restricting calories;

Cravings Symptoms: (low endorphins)

crave treats that give you feelings of pleasure, enjoyment, or reward and taste “sooo goood”;

crave pleasure, comfort, reward, enjoyment, or numbing from treats like: chocolate, bread, wine, romance novels, marijuana, tobacco, or lattes;

you get extra pleasure if you read, watch TV, or play a game while you eat;

bread, cookies, pasta, pizza are at the top of your list of foods you love;

find cheese, ice cream, frozen yogurt, butter, and even milk are irresistible;

crave things like: painkillers, marijuana or alcohol; serious aerobic exercise, porn, or self-harm;

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