Medical Questionnaire – Genetic screening questionnaire

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This questionnaire allows us to determine which of your 7 main genes regulating the key activities of your body may have a disrupted function.
Firstly, step 1 of the questionnaire is necessary to roughly assess the function of your genes.
Secondly, once your professionals have proposed a specific management plan based on your results, which you have adopted for a minimum of 2 weeks, you can complete step 2 of the questionnaire to determine which genes remain problematic and require further attention to improve their function.
Step 1
MTHFR (out of a total of 17)
- I have headaches.
- I sweat easily and profusely when I exercise.
- I take supplements with folic acid or consume foods enriched with folic acid (flours).
- I have depression issues.
- I have cold hands and feet.
- My white blood cell count has always been at the lower limit of normal.
- I have hypothyroidism.
- I experience many side effects of “nitric oxide” gas.
- I have undergone InVitro fertilization or significant fertility intervention to become pregnant or sustain a full-term pregnancy.
- One or more of my children is on the autism spectrum.
- One or more of my children have Down syndrome.
- My doctors tell me that I do not tolerate medications such as Methotrexate, 5-fluorouracil, or Phenytoin as well as other patients.
- I have menstrual cramps and clots in my menstruation.
- My homocysteine levels are consistently high (>12um/L).
- My levels of folic acid and/or B12 are high.
- I do not eat green vegetables every day.
- I feel significantly better when I eat green vegetables.
DAO (out of a total of 30)
- I tend to experience the following symptoms after eating leftovers, lemon, or fish: irritability, sweating, nosebleeds, runny nose, headaches.
- I am sensitive to red wine and alcohol.
- I am sensitive to several foods or suffer from food intolerances.
- I generally feel better 2-3 hours after a meal compared to 20 minutes after eating.
- I felt better during pregnancy and could eat a greater variety of foods.
- Je suis souvent irritable, j’ai chaud ou ma peau démange après avoir mangé
- I am often irritable, feel hot, or have itchy skin after eating.
- I cannot tolerate yogurt, sauerkraut, or kefir.
- I cannot tolerate seafood.
- I cannot tolerate chocolate.
- My feet sweat a lot.
- I often have stomachaches and need antacids.
- My eyes often itch.
- I have skin problems like eczema or hives.
- I often have nosebleeds.
- I have asthma or often have difficulty breathing.
- I have migraines and/or frequent headaches.
- I have motion sickness and/or often feel/dizzy easily.
- I have ringing in my ears, especially after eating.
- I have been told that I suffer from leaky gut syndrome.
- I occasionally have diarrhea for no reason I can identify.
- I have been diagnosed with ulcerative colitis.
- I often take antihistamines.
- I often have a runny nose or am congested.
- I have difficulty falling and staying asleep.
- My blood pressure is often <100/60mmHg.
- I have exercise-induced asthma.
- I often have joint pain.
- I have arrhythmias.
- I have side effects from Morphine, Metformin, NSAIDs (ASA or ibuprofen), antacids, clonidine, Isoniazid, Pentamidine, and/or Amiloride.
COMT (Slow) (out of a total of 21)
- I have headaches.
- I find falling asleep at night challenging.
- I easily feel anxious or irritable.
- I suffer from premenstrual syndrome.
- I am sensitive to pain.
- I have always been able to focus and study for long hours.
- I love to travel and explore.
- I tend to be a workaholic.
- When stressed, it takes me a very long time to relax.
- I tend to work hard for several weeks, then collapse and need a long break to recharge.
- I am easily panicked.
- Caffeine increases my stress.
- I am easily irritated, often wake up on the wrong side of the bed.
- I have strong bones.
- My skin glows, and people compliment me on it.
- I had menstruation very early in my life.
- I have heavy menstrual periods (menorrhagia).
- I have had or still have uterine fibroids.
- Eating a high-protein diet makes me even more irritable.
- I poorly tolerate medications like Ritalin, Adderall, Vyvanse, Concerta.
- I tolerate calming medications like Intuniv better.
COMT (Fast) (out of a total of 19)
- I have difficulty with attention and focus on a task (I have thought of having ADHD).
- I easily get addicted to substances or activities (shopping, compulsive gambling, tobacco, alcohol, drugs, social media…).
- I am prone to feelings of depression.
- I often lack motivation.
- I tend to go with the flow without taking initiative.
- I am not a workaholic.
- When stressed, I recover easily and quickly and move on.
- I fall asleep quickly.
- I NEED coffee in the morning.
- Eating a protein-rich diet makes me feel very good.
- I feel significant relief after eating a lot of carbohydrates/starches, but the feeling of depression returns quickly after.
- I am not very excited about things.
- I started menstruating late.
- I do not experience premenstrual syndrome.
- I typically have very light menstruations.
- I have weak bones.
- I am very tolerant to pain compared to others.
- I feel much better with stimulating medications like Ritalin, Vyvanse, Adderall, or Concerta.
- I feel less well with calming medications like Intuniv.
MAOA (slow) (out of a total of 16)
- I tend to be rather aggressive.
- It takes me some time to slow down.
- I can focus on the same task for a very long time.
- When I drink alcohol, I become angry/impulsive.
- I am not attracted to carbohydrates/starches; I feel less irritable when I eat fewer of these substances.
- I am more irritable and angry when I eat chocolate, cheese, and/or drink wine.
- It takes me some time before I manage to fall asleep.
- When I fall asleep, I tend to sleep throughout the night.
- My doctor has prescribed an SSRI for depression, and I became even more irritable.
- Melatonin does not work well for me. It makes me feel even more irritable and awake.
- Caffeine tends to make me feel irritable.
- Inositol makes me feel overstimulated.
- Lithium helps regulate my mood.
- 5-HTP makes me anxious and irritable.
- I am confident.
- I am a man.
MAOA (fast) (out of a total of 18)
- Since I was a child, I have had a lot of difficulty focusing and paying attention to things.
- I have a strong desire to eat cheese, drink wine, and eat chocolate, and consuming these substances makes me feel better.
- I have a strong desire to eat carbohydrates/starches, and they make me feel less depressed.
- I fall asleep quite easily but tend not to sleep through the night. I often need a snack to go back to sleep.
- I have an autoimmune disease such as Graves’ disease, Hashimoto’s thyroiditis, multiple sclerosis, celiac disease.
- I feel chronic inflammation.
- Winter and prolonged periods of darkness affect my mood. I have been told that I have seasonal affective disorder.
- I love to exercise; it helps my mood.
- I am a woman.
- I am a fighter in life.
- I tend to be depressed and anxious.
- I am somewhat obsessive about things.
- I have irritable bowel syndrome, fibromyalgia, constipation, or the syndrome.
- Melatonin works well to help me sleep.
- Inositol helps my mood.
- 5-HTP helps my mood.
- Lithium makes me more depressed.
- My doctor has prescribed an SSRI, and it has helped my mood.
GST/GPX (out of a total of 10)
- I am sensitive to chemicals.
- I drink tap water and/or live in the city/suburbs.
- I developed gray/white hair early.
- I have a chronic condition such as asthma, inflammatory bowel disease, autoimmune disease, type 1 diabetes, eczema, psoriasis.
- I have neurological problems resulting in tics, tremors, seizures, or problems with balance and gait.
- I am or have been infertile.
- I am sensitive to odors.
- I feel better after a sauna or intense exercise.
- It’s easy for me to gain weight, even if I watch what I eat.
- There are cases of cancer in my family.
NOS3 (out of a total of 11)
- I have abnormal blood pressure (>120/80mmHg).
- My hands and feet are cold.
- I tend to heal slowly after surgery or injury.
- I have type 2 diabetes.
- I am postmenopausal.
- Several people in my family have hypertension.
- Heart attacks are frequent in my family.
- I have had a heart attack.
- I have circulation problems related to my diabetes.
- There are cases of strokes in my family.
- I tend to breathe through my mouth.
PEMT (out of a total of 17)
- I have generalized muscle pain.
- I have been diagnosed with fatty liver (fatty liver).
- I am vegetarian and do not eat much beef, animal organs, caviar, or eggs.
- I have liver stones or have had my gallbladder removed.
- I rarely eat green vegetables.
- I have been diagnosed with small intestinal bacterial overgrowth (SIBO).
- During my pregnancy, my gallbladder caused me problems.
- I have had a genetic test, and I know I have an MTHFR C677T genetic polymorphism.
- I am deficient in vitamin B12.
- I have an intolerance to fatty foods.
- My estrogen levels are low.
- I take antacids.
- I have pain or discomfort in the upper right quadrant of my abdomen.
- My right shoulder is stiff because of my shoulder blade.
- I tend to be constipated.
- I tend to have itching.
- I am a postmenopausal woman.

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This questionnaire allows us to determine which of your 7 main genes regulating the key activities of your body may have a disrupted function.
Firstly, step 1 of the questionnaire is necessary to roughly assess the function of your genes.
Secondly, once your professionals have proposed a specific management plan based on your results, which you have adopted for a minimum of 2 weeks, you can complete step 2 of the questionnaire to determine which genes remain problematic and require further attention to improve their function.
Step 2
MTHFR (out of a total of 11)
- I feel out of breath and red in the face after exercising.
- Sometimes I experience exercise-induced asthma.
- My moods often fluctuate between irritability and depression.
- I cannot tolerate alcohol of any type.
- I generally feel tired and “toxic.”
- I do not eat green vegetables every day.
- I feel capable of focusing and concentrating quite well when I am not angry or sad.
- I have difficulty falling asleep at certain times.
- I have been exposed to “nitric oxide” gas at the dentist or doctor in the past and felt very unwell afterward.
- When I feel irritated, it takes me some time to calm down.
- There are certain days when I push boundaries and take risks, but it’s usually not my style.
DAO (out of a total of 14)
- I generally feel hot or itchy after eating.
- I may have random joint pains that move from one joint to another and come or go.
- I cannot tolerate yogurt, kefir, chocolate, alcohol, lemon, fish, wine (especially red), or cheese.
- I have skin problems like eczema, hives, or psoriasis.
- If I scratch my skin, I cause red marks.
- I cannot tolerate most probiotics.
- I have been diagnosed with SIBO (Small Intestinal Bacterial Overgrowth).
- I have many allergies or digestive intolerances.
- I have ringing in my ears, especially after eating.
- I have a diagnosis of “leaky gut” or “leaky gut syndrome,” Crohn’s disease, or ulcerative colitis.
- I have migraines or headaches quite frequently.
- My nose runs, and I have nosebleeds quite frequently.
- I cannot fall asleep for several hours after eating or drinking.
- I have asthma or exercise-induced asthma.
COMT (slow) (out of a total of 11)
- I feel more irritable after eating a protein-rich diet.
- I am easily irritated, and it takes me some time to calm down.
- I frequently (or used to) have premenstrual syndrome.
- I am a happy, cheerful person, but it is easy to irritate me.
- I am not very patient.
- I have always been able to study and focus on a task for long hours.
- I have always had difficulty falling asleep since I was a child.
- My doctor has prescribed the contraceptive pill to control acne or heavy periods.
- I have (or have had) uterine fibroids.
- Caffeine wakes me up, but I have to be careful not to drink too much, or I become irritable.
- I don’t like taking risks; I am rather cautious.
COMT (fast) (out of a total of 14)
- I have difficulty concentrating on something.
- I often feel depressed.
- When I feel stressed, I can calm down quite easily.
- I am calm most of the time, but I don’t always like to be.
- I take risks easily. I love pushing boundaries because I feel proud and well afterward.
- I am (or was) the class/workplace clown. I love making people laugh.
- I am often moving or feel restless.
- I sometimes pinch myself so hard that it hurts.
- In the morning, I have difficulty starting my days and getting active.
- I find it easy to become dependent on certain activities (video games, social media, tobacco, alcohol, drugs, compulsive shopping).
- I don’t have a great interest in sex.
- When it’s bedtime, my head hits the pillow, and I fall asleep within seconds.
- Caffeine helps me focus and pay attention to things.
- I often crave foods high in fat and sugar. They make me feel better, but only for a while.
MAOA (slow) (out of a total of 5)
- I am easily stressed, panicked, or anxious.
- I find it difficult to calm down after being stressed or irritated.
- I love cheese, wine, and/or chocolate, but I tend to become irritable or less joyful after consuming them.
- I suffer from headaches or migraines.
- I have difficulty falling asleep, but once I do, I easily stay asleep.
MAOA (fast) (out of a total of 5)
- I fall asleep quite quickly but wake up earlier than I would like.
- I am prone to depression and lack of motivation.
- I find that chocolate improves my mood.
- I tend to smoke or develop alcohol dependence.
- I feel better when I have eaten carbohydrates/starches, but this mood improvement does not help my focus or attention.
GST/GPX (out of a total of 13)
- I am sensitive to chemicals and odors.
- I feel much better after taking a sauna or sweating profusely.
- It is easy for me to gain weight, even if I eat well.
- Cancers are common in my family.
- I have noticed gray/white hair, especially in stressful times.
- I have prematurely settled gray hair.
- I have high blood pressure.
- I have just gotten rid of an infection.
- I tend to be very stressed all the time.
- I have an autoimmune disease.
- I have chronic inflammation.
- I have asthma or difficulty breathing. I often feel like I don’t have enough air.
- I often feel tired and “toxic.”
NOS3 (out of a total of 14)
- I have high blood pressure.
- I have had a heart attack/coronary bypass.
- I have type 1 or type 2 diabetes.
- My feet and hands are cold.
- I have asthma.
- I snore, breathe through my mouth, or have sleep apnea.
- I notice that my memory is getting worse.
- I had pre-eclampsia during my pregnancy.
- I have atherosclerosis.
- I am postmenopausal.
- My moods are fluctuating and very disorganized.
- I don’t exercise much and/or I don’t move much.
- I have an autoimmune disease.
- I have chronic inflammation.
PEMT (out of a total of 14)
- I am postmenopausal.
- My estrogen levels are low.
- I have or have had liver stones.
- I don’t eat green vegetables very often.
- I don’t eat eggs or meat very often.
- I have been told I have fatty liver disease.
- I have SIBO (Small Intestinal Bacterial Overgrowth).
- I am vegetarian or vegan.
- I have had my gallbladder removed.
- I have had widespread pain (internally and externally) for years.
- I do not tolerate fatty foods well.
- My symptoms started halfway through pregnancy and have gotten worse since.
- My child has had a congenital defect since birth.
- Breastfeeding drained me physically and mentally.
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