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Anecdotal Research Initiative TNF – Data Collection

Anecdotal Research Initiative TNF - Data Collection
This form collects people's stories and experiences of living a "Low Carbohydrate High Fat (LCHF)" lifestyle.

The aim is to extract as much measurable data as possible for anecdotal data analysis. Your help will further LCHF research.

Don't be deterred by all the questions on the form. Answer those that you can, leave the others blank!

Thank you so much for your help with furthering LCHF nutritional research. If you have any questions, please send an email to jana@thenoakesfoundation.org.

* Required
About you
Name *
Please add your name. Note: We will never make your name public.
Your answer
Surname *
Please add your surname. Note: We will never make your surname public.
Your answer
Email address *
Please add your email address. Note: We will never make your email public.
Your answer
Country
Where do you live?
What city or town do you live in?
Your answer
Participant focus
Why did you first go on a LCHF food plan?
Age
Please select your.
Choose
Under 18
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Gender
LCHF or Banting Lifestyle
Do you follow a LCHF food plan (including Banting, ketogenic, Atkins, Dunkan, etc)?
Time on a LCHF Lifestyle (months)
Please select the number of months you have been on a LCHF (or other low carbohydrate choice such as Atkins, Dukan etc.)
Choose
Not on LCHF
0-1
1-3
5-6
6-12
12-18
18-24
24-36
36-48
48-60
60+
Measurements
How tall are you in centimetres (cms)?
If you do not know centimetres, please select 'unknown' and fill in the next question.
Choose
Unknown
140
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Or: How tall are you? (for example, in ft and inches)
Only answer if you did not answer the previous question. If you do not know, please leave blank.
Your answer
Please enter your pre-LCHF weight in kilograms.
If you do not know, select unknown. If you know your weight in another unit, please go to the next question.
Choose
43
44
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Or: Please enter your start weight (for example, in pounds or stones).
Only answer if you did not answer the previous question. If you do not know, please leave blank.
Your answer
Please enter your current weight in kilograms.
If you do not know, select unknown. If you know your weight in another unit, please go to the next question.
Choose
Unknown
40
41
42
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44
45
46
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>221
Or: Please enter your current weight (for example, in pounds or stones).
Only answer if you did not answer the previous question. If you do not know, please leave blank.
Your answer
Weight lost (kilograms)
Please enter the amount of weight you have lost in kilograms. If you do not know, please leave blank. If you know in another unit, please go to the next question.
Choose
0
1
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100
101+
Or: Weight lost (stones, pounds, etc)
Only answer if you did not answer the previous question. If you do not know, please leave blank.
Your answer
Start waistline measurement (cm)
Please select your start waistline measurement to the nearest centimetre. If you know in another unit, please go to the next question.
Choose
Unknown
45
46
47
48
49
50
51
52
53
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Or: Start waistline measurement (inches etc)
Only answer if you did not answer the previous question. If you do not know, please leave blank.
Your answer
Current waistline measurement (cm)
Please enter your final waistline measurement to the nearest centimeter. If you know in another unit, please go to the next question.
Choose
Unknown
50
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54
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58
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60
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Or: Current waistline measurement (inches etc)
Only answer if you did not answer the previous question. If you do now know, please leave blank.
Your answer
Blood work - glucose, insulin & HbA1c
Are you diabetic?
Choose
Type I Diabetes
Type II Daibetes
Diabetic (type unknown)
Pre-diabetic
Insulin resistant
No (Not diabetic)
I don't know
Pre-LCHF average blood glucose (mmol/L)
Please select the range which best describes your average glucose readings pre-LCHF, in mmol/L. If you do not know in mmol/L, please go to the next question.
Choose
4-6
4-8
6-10
6-12
8-12
8-14
10-14
10-16
12-18
14-20
16-20
18-22
22+
Unknown
Or: Pre-LCHF average blood glucose (preferred unit)
Please enter your glucose readings in your preferred unit (eg. mg/dL), pre-LCHF. Only answer if you did not answer the previous question.
Your answer
Current Glucose (mmol/L)
Please select the range which best describes your average glucose readings currently, in mmol/L. If you do not know in mmol/L, please go to the next question. If unknown, leave blank.
Choose
4-6
4-8
6-10
6-12
8-12
8-14
10-14
10-16
12-18
14-20
16-20
18-22
22+
Unknown
Or: Current Glucose (preferred unit)
Please enter the range which best describes your average glucose readings currently, in your preferred unit (eg. mg/dL). If unknown, leave blank.
Your answer
Pre-LCHF Glucose - fasting (mmol/L)
Please select the range which best describes your average fasting glucose readings pre-LCHF.
Choose
4-6
4-8
6-10
6-12
8-12
8-14
10-14
10-16
12-18
14-20
16-20
18-22
22+
Unknown
Pre-LCHF Glucose - fasting (preferred unit)
Please enter the range which best describes your average fasting glucose readings currently, in your preferred unit (eg. mg/dL). Only answer if you did not answer the previous question. If unknown, leave blank.
Your answer
Current Glucose - fasting (mmol/L)
Please select the range which best describes your average fasting glucose readings currently, in mmol/L. If you do not know in mmol/L, please go to the next question.
Choose
4-6
4-10
6-10
6-12
8-12
8-14
10-14
10-16
12-16
12-18
14-18
14-20
16-22
18-22
22+
Unknown
Or: Current Glucose - fasting (preferred unit)
Please enter the range which best describes your average fasting glucose readings currently, in your preferred unit (eg. mg/dL). Only answer if you did not answer the previous question. If unknown, leave blank.
Your answer
Pre-LCHF - HbA1c
Please enter your HbA1c reading pre-LCHF. If this is not relevant/unknown, please leave blank.
Your answer
Current HbA1c
Please enter your HbA1c reading whilst on a LCHF food plan. If this is not relevant/unknown, please leave blank.
Your answer
Pre- LCHF - Fasting Insulin
Please enter your fasting insulin reading pre LCHF. If this is not relevant/unknown, please leave blank
Your answer
Current - Fasting Insulin
Please enter your current fasting insulin reading whilst on a LCHF food plan. If this is not relevant/unknown, please leave blank.
Your answer
Pre-LCHF - 2 hour Glucose Reading after Glucose Tolerance Test
Please enter your first 2 hour Glucose Reading result after the Glucose Tolerance Test . If this is not relevant/unknown, please leave blank.
Your answer
Current - 2 hour Glucose Test after Glucose Tolerance Test
Please enter your current 2 hour Glucose Test results after the Glucose Tolerance Test on a LCHF lifestyle. If this is not relevant/unknown, please leave blank.
Your answer
Pre-LCHF - 2 hour Insulin Level after Glucose Tolerance Test
Please enter your first 2 hour Insulin Test results after the Glucose Tolerance Test pre-LCHF. If this is not relevant/unknown, please leave blank.
Your answer
Current - 2 hour Insulin Test after Glucose Tolerance Test
Please enter your current 2 hour Insulin Test results after the Glucose Tolerance Test on a LCHF lifestyle. If this is not relevant/unknown, please leave blank.
Your answer
Cholesterol
Pre LCHF - Cholesterol (total)
Please enter your first cholesterol reading before starting a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Current - Cholesterol (total)
Please enter your current cholesterol reading on a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Pre LCHF - LDL cholesterol
Please enter your LDL readings before starting a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Current - LDL cholesterol
Please enter your current LDL readings on a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Pre LCHF - HDL cholesterol
Please enter your HDL cholesterol readings before starting a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Current - HDL cholesterol
Please enter your current HDL readings on a LCHF food plan. If this is not given enter 0.
Your answer
Pre LCHF - Triglycerides
Please enter your Triglycerides (Trig) readings before starting a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Current - Triglycerides
Please enter your Triglycerides (Trig) readings on a LCHF food plan. If this is not relevant/unknown, please enter 0.
Your answer
Medication
Before being on a LCHF food plan, did you take any medication?
Choose
Yes
No
Unsure
Currently, do you take any medication?
Choose
Yes
No
Unsure
Start Medication (pre LCHF)
Were you on any medication before starting a LCHF food plan? Select all that apply. If not applicable, leave blank.
Current Medication
What medication are you taking currently, compared to before your LCHF lifestyle? If not applicable, leave blank.
Increased dose
Same dose
Decreased dose
Stopped medication
Diabetes - tablets
Diabetes - insulin
Cholesterol or statins
Depression
High blood pressure
Heartburn/reflux
Arthritis (osteoarthritis or rheumatoid arthritis)
Gout
Iriitable bowel syndrome or other digestion medication
Thyroid
Asthma or respiratory related
Allergies (eg/ antihistamines)
Increased dose
Same dose
Decreased dose
Stopped medication
Diabetes - tablets
Diabetes - insulin
Cholesterol or statins
Depression
High blood pressure
Heartburn/reflux
Arthritis (osteoarthritis or rheumatoid arthritis)
Gout
Iriitable bowel syndrome or other digestion medication
Thyroid
Asthma or respiratory related
Allergies (eg/ antihistamines)
Medication Notes
Do you have any medication information or stories you would like to share? If this is not relevant, please leave blank.
Your answer
Sports and activity
How active are you?
Choose
Sedentary
Lightly Active
Moderately Active
Very Active
Extremely Active
What sports do you do?
Pick all that apply.
What is the other sports or sporting events you takes part in?
If this is not applicable, please leave blank.
Your answer
Best sporting achievements pre-LCHF
Before going on a LCHF food plan, what wasvyour best/furthest sporting distance covered? (e.g. 30 minute walk daily, 89 kms for the Comrades marathon, number of kilograms lifted, personal best for running). If not relevant please leave blank.
Your answer
Best sporting achievements currently
Whilst on LCHF, what is your best/furthest sporting achivement? (eg. 30 minute walk daily, 89 kms for the Comrades marathon, number of kilograms lifted, personal best for running). If not relevant please leave blank.
Your answer
Training and recovery on your LCHF food plan
Select all that apply.
Improved
Unchanged
Reduced or gotten worse
Sports performance
Sports recovery
Sports training
Sports results (in general)
'Race day' performance
Improved
Unchanged
Reduced or gotten worse
Sports performance
Sports recovery
Sports training
Sports results (in general)
'Race day' performance
Training and recovery on your LCHF food plan
What success or difficulties have you had training and with post race recovery on a LCHF plan?
Your answer
LCHF lifestyle
What is your overall experience on LCHF?
Choose
Positive
Positive - with some questions
Neutral
Negative
LCHF Lifestyle Results - general
Please select all that apply.
Improved
Unchanged
Worsened
Weight management
Diabetes
Sports results (in general)
Cholesterol
Use of medication
Well-being
Sleep
Energy
Health issues (in general)
Improved
Unchanged
Worsened
Weight management
Diabetes
Sports results (in general)
Cholesterol
Use of medication
Well-being
Sleep
Energy
Health issues (in general)
Further comments or results
What are some of your other results? Do you have any stories to share with us?
Your answer
Use of information
Do you give permission to use your story? *
Required
Do you have a website/blog/Facebook page etc. that can be referred to?
Your answer
Do you allow The Noakes Foundation to use your data for research purposes? Is this information accurate to the best of your knowledge? *
Required
Can we contact you, should we have some questions? *
Required
Can we send you information on LCHF living? *
Required
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