Food, Drink, Activity, and Symptom Log
Use this log to record your eating habits, other health behaviors, and how you feel. Jot down everything you eat and drink for a week or two. Include weekdays and days on the weekend. This log has space for two days. Use more pages as needed. Include the amount or size of the food or drink (one large apple, 1 cup of lettuce, 8 ozs. of coffee). Be specific. For example, does your drink contain caffeine? What’s in your salad or casserole? Do you see any unhealthy habits that you would like to change? Do you see any connections between how you feel and your habits? Use this information as you set health goals.
| Date: ______________________ |
Date: _______________________ |
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Record food and amount |
Record food and amount |
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Breakfast |
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Morning Snacks |
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Lunch |
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Afternoon Snacks |
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Dinner |
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Evening Snacks |
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Record other things that were happening on these days |
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Hours I slept |
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Ways I relaxed |
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How active I was |
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How stressed I felt |
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How I felt physically and emotionally |
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For you to consider:
- Was it difficult to keep this log? What could you do to help yourself with this task?
- Did you see any unhealthy habits that you would like to change?
- Do you see any connections between how you feel and what you are eating and drinking? Any connections between how you feel and the other health habits you recorded? Any connections between what you are eating and drinking and your other health habits?
- What is the first food and drink goal you will work on?
- Do you have any questions for members of your health care team? Do you want guidance from them in helping you set a goal for yourself?
The information in this handout is general. Please work with your health care team to use the information in the best way possible to promote your health and happiness.
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ORGANIZATION |
TITLE |
DESCRIPTION |
|---|---|---|
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Osher Center for Integrative Health |
A variety of Integrative Whole Health handouts |
What we know about integrative health care has come to us thanks to the efforts, experiences, and collective wisdom of people from many cultures and backgrounds. We wish to acknowledge all the healers, researchers, patients, and peoples who have informed the content of this tool.
Author(s)
This handout was adapted for the Osher Center for Integrative Health at the University of Wisconsin-Madison from the original written by Charlene Luchterhand, MSSW.
Originally Created: November 2016, Updated: May 2022