Sugar Consumption Questionnaire

The first step in determining whether sugar and blood sugar levels are involved in your anxiety
is identifying whether you are consuming too much sugar or are addicted to sugar.
This questionnaire will help you figure that out.

Check off any items that apply to you. For items that mention "any other sweetener," this
includes brown sugar, honey, maple syrup, date sugar, artificial sweeteners, xylitol, stevia,
fructose, agave nectar, and so on.

Date Group Member

Do you add sugar or any other sweetener to foods or beverages?

Yes No

Do you eat processed foods, candy, cookies, or cake containing sugar

or any other sweetener?
Yes No

Do you drink regular sodas, diet sodas, diet drinks, sports drinks, or fruit juices?
Yes No

Do you enjoy something sweet after a meal or have a sweet tooth?

Yes No

Do you replace sugar with equal amounts of supposedly healthier sweeteners,

such as honey, maple syrup, or agave nectar?
Yes No

Do you use xylitol, stevia, or artificial sweeteners (sucralose, aspartame, and so on)?
Yes No

Do you eat large quantities of fruit (ten or more servings a day)?

Yes No

Do you snack on dried fruit as a treat?

Yes No