Leaky Gut Symptom & Lifestyle Tracker
“Leaky gut” is a common term used to describe increased intestinal permeability, a process in which the barrier of the small intestine may become more permeable than normal. Digestive symptoms can overlap with many different conditions, so symptoms alone cannot confirm whether increased intestinal permeability is present.
This tracker is designed to help you organize digestive symptoms, food reactions, bowel patterns, lifestyle factors, medications, stress, sleep, and other changes that may be useful to discuss with a healthcare provider or functional health practitioner.
The goal is not to diagnose the cause of your symptoms, but to help you identify patterns and prepare a clearer history before an appointment.
Symptoms to Track
Check any symptoms you have been experiencing regularly:
☐ Bloating or abdominal distention
☐ Abdominal discomfort or cramping
☐ Excessive gas
☐ Constipation
☐ Diarrhea
☐ Alternating constipation and diarrhea
☐ Reflux or indigestion
☐ Feeling unusually full after meals
☐ Food reactions or food sensitivities
☐ Unpredictable digestive symptoms
☐ Fatigue or low energy
☐ Brain fog or difficulty concentrating
☐ Changes in mood
☐ Skin changes or irritation
☐ Joint or muscle discomfort
☐ Headaches
☐ Symptoms that seem to worsen after certain foods
☐ Symptoms that seem to change during periods of stress
Digestive Patterns
Check any digestive patterns you have noticed:
☐ Symptoms tend to worsen after meals
☐ Symptoms tend to worsen after large meals
☐ Symptoms tend to worsen after high-fat meals
☐ Symptoms tend to worsen after eating processed foods
☐ Symptoms tend to worsen after eating a lot of sugar
☐ Symptoms tend to worsen after dairy
☐ Symptoms tend to worsen after wheat or gluten-containing foods
☐ Symptoms tend to worsen after onions or garlic
☐ Symptoms tend to worsen after certain fruits
☐ Symptoms tend to worsen after alcohol
☐ Symptoms tend to worsen after caffeine
☐ Symptoms tend to worsen when I eat quickly
☐ Symptoms tend to worsen when meals are very close together
☐ Symptoms improve when I eat smaller meals
☐ Symptoms improve when I leave more time between meals
☐ Symptoms seem worse during periods of stress
☐ Symptoms seem worse when I sleep poorly
☐ I cannot identify a clear pattern
When do your digestive symptoms usually feel the worst?
☐ First thing in the morning
☐ After breakfast
☐ After lunch
☐ After dinner
☐ Later in the evening
☐ Overnight
☐ During stressful periods
☐ After eating certain foods
☐ No clear pattern
Anything else you notice about when symptoms appear or what seems to trigger them:
Food Reactions and Meal Patterns
Check any food-related patterns you have noticed:
☐ I react differently to foods that I used to tolerate well
☐ I notice bloating after certain foods
☐ I notice abdominal discomfort after certain foods
☐ I notice fatigue after certain meals
☐ I notice brain fog after certain meals
☐ I notice skin changes after certain foods
☐ I notice headaches after certain foods
☐ I notice changes in bowel habits after certain foods
☐ I have removed multiple foods because I am concerned they may be triggering symptoms
☐ I feel better when I eat a simpler diet
☐ I feel worse after highly processed foods
☐ I feel worse after meals high in added sugar
☐ I feel worse after dairy
☐ I feel worse after wheat or gluten-containing foods
☐ I feel worse after alcohol
☐ I feel worse after large meals
☐ I am unsure which foods may be contributing to my symptoms
Foods I suspect may be contributing to symptoms:
Foods I seem to tolerate well:
Have your food reactions changed over time?
☐ Yes, I seem to react to more foods than I used to
☐ Yes, some foods bother me less than they used to
☐ My reactions seem inconsistent
☐ I have not noticed a major change
☐ I am not sure
Bowel Habits
Check any bowel patterns you have noticed regularly:
☐ Constipation
☐ Diarrhea
☐ Alternating constipation and diarrhea
☐ Hard, dry, or pellet-like stools
☐ Loose or watery stools
☐ Mucus in the stool
☐ Straining during bowel movements
☐ Feeling like I have not completely emptied my bowels
☐ Sudden bowel urgency
☐ Multiple bowel movements in a short period of time
☐ Going several days without a bowel movement
☐ Bowel habits that change depending on what I eat
☐ Bowel habits that change during periods of stress
☐ Bowel habits that are difficult to predict
How often do you typically have a bowel movement?
☐ More than 3 times per day
☐ 2–3 times per day
☐ About once per day
☐ Every other day
☐ Fewer than 3 times per week
☐ It varies significantly
Anything else you have noticed about your bowel habits:
Energy, Brain Fog, and Whole-Body Symptoms
Check any symptoms you have noticed along with your digestive concerns:
☐ Fatigue or low energy
☐ Feeling unusually tired after meals
☐ Brain fog or difficulty concentrating
☐ Trouble finding words or staying focused
☐ Headaches
☐ Changes in mood
☐ Feeling more irritable than usual
☐ Joint discomfort
☐ Muscle aches
☐ Skin irritation, rashes, or breakouts
☐ Changes in sleep quality
☐ Feeling generally unwell without a clear reason
☐ Symptoms that seem to flare at the same time as digestive symptoms
☐ Symptoms that seem to worsen after certain foods
☐ I am not sure whether these symptoms are connected to my digestion
Which symptoms interfere with your daily life the most?
Do these symptoms seem to change when your digestive symptoms improve or worsen?
☐ Yes, they usually get worse together
☐ Yes, they usually improve together
☐ Sometimes
☐ No clear connection
☐ I am not sure
Stress, Sleep, and Lifestyle
Check any patterns you have noticed with stress, sleep, activity, or daily routines:
☐ Digestive symptoms worsen during stressful periods
☐ Digestive symptoms worsen when I sleep poorly
☐ Digestive symptoms worsen when my sleep schedule changes
☐ Symptoms worsen when I travel
☐ Symptoms worsen when my daily routine changes
☐ Symptoms worsen when I skip meals
☐ Symptoms worsen when I eat late at night
☐ Symptoms worsen when I eat quickly
☐ Regular walking or light movement seems to help
☐ Exercise seems to improve my symptoms
☐ Exercise sometimes makes symptoms worse
☐ Digestive symptoms interfere with exercise
☐ Digestive symptoms interfere with sleep
☐ Poor sleep seems to increase fatigue or brain fog
☐ Stress seems to increase bloating, pain, or bowel changes
☐ Relaxation, breathing exercises, or time outdoors seem to help
☐ I cannot identify a clear connection between stress, sleep, and my symptoms
How would you describe your average sleep?
☐ I usually sleep well
☐ I have trouble falling asleep
☐ I wake frequently during the night
☐ I wake earlier than I want to
☐ I sleep enough hours but do not feel rested
☐ My sleep schedule changes frequently
☐ My sleep varies from night to night
Anything else you have noticed about stress, sleep, exercise, or your daily routine:
Medications, Antibiotics, and Supplements
Some medications, antibiotics, and supplements can affect digestion, bowel habits, stomach acid, or the gut microbiome. Check anything that applies to you now or recently:
☐ I have taken antibiotics within the past 3 months
☐ I have taken antibiotics within the past year
☐ I have taken multiple courses of antibiotics in the past
☐ My digestive symptoms began or worsened after antibiotics
☐ I currently use a proton pump inhibitor or other acid-reducing medication
☐ I have used acid-reducing medication long term
☐ I use laxatives or stool softeners
☐ I use anti-diarrheal medication
☐ I take fiber supplements
☐ I take probiotics
☐ I take digestive enzymes
☐ I take magnesium
☐ I take herbal supplements
☐ I take prescription medications that affect digestion
☐ I recently started or stopped a medication or supplement
☐ I have noticed digestive changes after changing medications or supplements
☐ I am unsure whether any medications or supplements are affecting my symptoms
Current medications and supplements:
Recent antibiotics, medications, or supplements that seemed to change my symptoms:
Approximate date or time period when my digestive symptoms began or noticeably changed:
Possible Triggers or Changes Before Symptoms Began
Think back to the months before your symptoms began or noticeably worsened. Check anything that may have happened around that time:
☐ I took antibiotics
☐ I had a stomach bug, food poisoning, or gastrointestinal infection
☐ I had COVID-19 or another significant illness
☐ I went through a highly stressful period
☐ My sleep became worse
☐ My diet changed significantly
☐ I began eating more processed foods or added sugar
☐ I started a restrictive diet
☐ I traveled internationally
☐ I moved into a new home or workplace
☐ I had known or suspected mold or water-damage exposure
☐ I started or stopped a medication
☐ I started or stopped a supplement
☐ I began using acid-reducing medication
☐ I had surgery or another major medical procedure
☐ I experienced a major life change
☐ My symptoms seemed to begin gradually without one obvious trigger
☐ I cannot identify anything that clearly happened before symptoms began
What was happening in your life around the time your symptoms began?
Did your symptoms begin suddenly or gradually?
☐ Suddenly
☐ Gradually over several weeks
☐ Gradually over several months
☐ Symptoms have come and gone for years
☐ I am not sure
Questions to Bring to Your Appointment
Consider writing down the questions that matter most to you before your appointment. These may include:
☐ Could something other than increased intestinal permeability be contributing to my symptoms?
☐ Are there digestive conditions that should be ruled out based on my symptoms?
☐ Could medications, antibiotics, or supplements be affecting my gut health?
☐ Are there tests that may be appropriate based on my symptoms and history?
☐ Should I track specific foods, bowel patterns, or symptoms before making dietary changes?
☐ Could stress, sleep, or lifestyle factors be contributing to my symptoms?
☐ Are there signs that my symptoms may involve motility, inflammation, infection, or another digestive issue?
☐ What should I track between appointments?
☐ What are the next steps if my symptoms do not improve?
My other questions:
When to Seek Medical Care
Digestive symptoms should not automatically be assumed to be caused by “leaky gut” or increased intestinal permeability. Speak with a medical provider if you experience symptoms such as blood in the stool, black or tarry stools, unexplained weight loss, persistent fever, severe or worsening abdominal pain, persistent vomiting, anemia, difficulty swallowing, or a major unexplained change in bowel habits.
Seek urgent medical care for severe symptoms, significant bleeding, severe dehydration, fainting, or other symptoms that feel sudden or concerning.
Work With Executive Functional Healing
If you are dealing with ongoing bloating, food reactions, bowel changes, fatigue, brain fog, or other digestive concerns and want to look more closely at the patterns that may be contributing, Executive Functional Healing works with clients nationwide through virtual consultations.
Schedule a free 15-minute discovery call to discuss what you have been experiencing and whether Executive Functional Healing may be a good fit for your next steps.