Food and Symptom Diary
Date issued: September 2022
Review date: September 2024
Ref: C-127 v8
PDF: Food and Symptom Diary final September 2022 v8.pdf [pdf] 220KB
To help us to assess your diet and symptoms, it is important that we have an accurate record of what you usually eat and drink, and the symptoms you are experiencing.
Please use this diary to record everything that you eat and drink and your symptoms for 3 to 5 days, including at least one weekend day. If you run out of space, please continue to record on separate sheets of paper.
Your diary needs to include:
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Exactly what you eat and when
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Any symptoms that you experience, such as lip/mouth tingling or swelling, rashes, nausea, cramping pains, loose stools, constipation, and/or bloating
Tips:
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Try to write down foods and drinks consumed as soon as possible after eating/drinking, whilst the information is still fresh in your mind.
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Please do not change what you usually eat. The information in your food diary is confidential and the content will not be judged. An accurate food diary will help us to make links between dietary intake and symptoms, allowing us to tailor a dietary plan that meets your individual needs.
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Don’t forget snacks, sweets and drinks, including alcohol.
Describing foods and measuring portion sizes
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Try to give an accurate description, e.g., a sandwich is 3 foods (bread, filling and butter or spread).
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Spoons - indicate teaspoon, dessertspoon, or tablespoon, and whether they are level or heaped.
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Bread - what type of bread and how thick were the slices?
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Butter or margarine - was it spread thickly or thinly?
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Describe meat, fish, and cheese portions e.g.
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2 large thin slices ham
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2 small lamb chops (no fat eaten)
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small fillet of cod grilled with 1 teaspoon spread
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Small matchbox sized portion of Cheddar cheese
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Vegetables, cereals, puddings etc. can be measured in tablespoons.
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For dishes prepared at home, please give a recipe and state the proportion eaten e.g., half a portion.
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How was the food prepared?
e.g. fried (with fat or oil), boiled, casseroled, roasted, or grilled.
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Remember to look at labels and wrappers. Write down the brand name, weights and proportions eaten, e.g., ½ a 450g tin Del Monte® pears in syrup.
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State whether drinks are in glasses, mugs or cups and measure the volume e.g., 240ml mug of tea with semi-skimmed milk (no sugar).
Describing symptoms
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Try to give an accurate description.
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Write down all of your symptoms and score them depending on how severe they are. Use the symptom scores given below.
Symptom Score
1 = Mild
Occasional or mild symptoms, but you can continue with normal activities.
2 = Moderate
Frequent symptoms that sometimes interfere with normal activities.
3 = Severe
Frequent symptoms that often interfere with normal activities.
4 = Very Severe
Continuous symptoms that mean you are unable to perform normal activities
