Gut focused survey

1.

Please note that The Cure Parkinson's Trust and Parkinson's Movement will not share your personal information with any third party, however anonymised results may be published in a written report. By completing the survey you are agreeing to Parkinson's Movement's terms and conditions and data and privacy policy.

With many thanks
The Cure Parkinson's Trust Team

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* 1. Are you Male or Female?

Male

Female

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* 2. How old are you?

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* 3. How long have you had Parkinson's?

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* 4. How tall are you and what is your weight?

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* 5. Over the past 10 years, would you say you drink

a lot of tea and or coffee

moderate amounts of tea and or coffee

not much at all tea and or coffee

Other (please specify)

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* 6. Over the past 10 years would you say you have been a

heavy smoker

moderate smoker

smoked very little

never smoked

Other (please specify)

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* 7. Have you ever been told by your doctor that you have any of the following?

	Yes	No
Diabetes?	Diabetes? Yes	Diabetes? No
Insulin dependent diabetes?	Insulin dependent diabetes? Yes	Insulin dependent diabetes? No
Asthma?	Asthma? Yes	Asthma? No
Irritable Bowel Syndrome?	Irritable Bowel Syndrome? Yes	Irritable Bowel Syndrome? No
Coeliac disease?	Coeliac disease? Yes	Coeliac disease? No
Rheumatoid Arthritis?	Rheumatoid Arthritis? Yes	Rheumatoid Arthritis? No
Food allergy?	Food allergy? Yes	Food allergy? No
Food intolerance?	Food intolerance? Yes	Food intolerance? No
Hayfever or dust allergy?	Hayfever or dust allergy? Yes	Hayfever or dust allergy? No

Other (please specify)

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* 8. Do you regularly take anti-inflammatory medicines, if so which?

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* 9. If yes, do you feel it has an affect on your Parkinson's and if so what?

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* 10. Which, if any, of the following do you have?

daytime sleepiness

problems going to sleep

problems with your sense of smell

anxiety

depression

variable mood

excessive saliva

bile after eating

difficulty with swallowing

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* 11. Do you use laxatives?

Yes

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* 12. If yes, how often do you take laxatives?

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* 13. On average, how often do you have a bowel movement?

Less than once a day

once a day

once to twice a day

More than twice per day

Other (please specify)

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* 14. My appetite is

very poor

poor

average

good

very good

Other (please specify)

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* 15. When I eat

I feel full after eating only a few mouthfuls

I feel full after eating about a third of a meal

I feel full after eating over half a meal

I feel full after eating most of the meal

I hardly ever feel full

Other (please specify)

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* 16. I feel hungry

Rarely

Occassionally

Some of the time

Most of the time

All of the time

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* 17. When do you feel hungry?

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* 18. Do you feel hungry when

you smell food cooking

you see food cooking

after exercise

only in the morning

only in the evening

Other (please specify)

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* 19. Compared to when I was younger, my sense of taste is

much worse

worse

just as good

better

much better

Other (please specify)

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* 20. Normally I eat

less than one meal a day

one meal a day

two meals a day

three meals a day

more than three meals a day

Other (please specify)

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* 21. I feel sick or nauseated when I eat

most of the time

often

sometimes

rarely

never

Other (please specify)

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* 22. Would you say your diet has an emphasis towards carbohydrates or fatty/oily foods e.g Salmon, Tuna?

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* 23. Do you take any vitamins or health food supplements regularly such as amino acids, multivitamins, co enzyme Q10, fish oils, if so which and how?

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* 24. Do you eat a lot of chocolate?

Yes

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* 25. Do certain foods impact on your Parkinson's symptoms, if so which and how?

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* 26. Do certain foods effect the efficacy of your Parkinson's medication, if so which and how?

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* 27. Have you noticed any patterns or correlation between the state of your Parkinson's and what you eat?

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* 28. Have you noticed any patterns or correlation between the state of your Parkinson's and your overall gut function?

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* 29. We think people with Parkinson's may have significant insight into cause(s)/progress of their condition. Do you feel that your Parkinson's might be related to a gut issue?

Definitely

Very likely

Perhaps

Unlikely

Don't know

Other (please specify)

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* 1. Are you Male or Female?

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* 2. How old are you?

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* 3. How long have you had Parkinson's?

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* 4. How tall are you and what is your weight?

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* 5. Over the past 10 years, would you say you drink

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* 6. Over the past 10 years would you say you have been a

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* 7. Have you ever been told by your doctor that you have any of the following?

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* 8. Do you regularly take anti-inflammatory medicines, if so which?

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* 9. If yes, do you feel it has an affect on your Parkinson's and if so what?

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* 10. Which, if any, of the following do you have?

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* 11. Do you use laxatives?

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* 12. If yes, how often do you take laxatives?

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* 13. On average, how often do you have a bowel movement?

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* 14. My appetite is

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* 15. When I eat

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* 16. I feel hungry

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* 17. When do you feel hungry?

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* 18. Do you feel hungry when

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* 19. Compared to when I was younger, my sense of taste is

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* 20. Normally I eat

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* 21. I feel sick or nauseated when I eat

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* 22. Would you say your diet has an emphasis towards carbohydrates or fatty/oily foods e.g Salmon, Tuna?

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* 23. Do you take any vitamins or health food supplements regularly such as amino acids, multivitamins, co enzyme Q10, fish oils, if so which and how?

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* 24. Do you eat a lot of chocolate?

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* 25. Do certain foods impact on your Parkinson's symptoms, if so which and how?

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* 26. Do certain foods effect the efficacy of your Parkinson's medication, if so which and how?

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* 27. Have you noticed any patterns or correlation between the state of your Parkinson's and what you eat?

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* 28. Have you noticed any patterns or correlation between the state of your Parkinson's and your overall gut function?

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* 29. We think people with Parkinson's may have significant insight into cause(s)/progress of their condition. Do you feel that your Parkinson's might be related to a gut issue?

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* 30. Do you have any other comments in relation to Parkinson's and the gut?