A variety of events can trigger symptoms, including diet, emotions, physical activity, temperature, and inhaled substances. A Symptom and Trigger Journal can help you understand more about your personal triggers.
Here’s an example and tips on how to complete a journal.
Record Your Journal
- Symptoms: 1) Identify your most important symptoms and give each symptom a letter. Record the letter in the “Symptom” column with severity….. 0 (absent); 1 (minimal); 2 (significant); 3 (debilitating). In the example above, A-1 at 9 AM, means minimal heartburn.
- As needed meds: Medication you take to control your symptoms (i.e. not your routine medications).
- Food and Drink: Record what you eat and drink; be as detailed as possible. Include the amount (you can estimate, rather than measure). Food sensitivity symptoms usually increase with larger quantities, so it is helpful to record this information.
- How You Eat: How you eat may be more important than what you eat, including the temperature of food, eating too quickly, the volume of food/drink, etc. There isn’t room to record everything, so only record deviations from normal.
- Other Events: Record changes in other potential triggers, such as heat, emotions, physical activity, alcohol, medication, inhaled substances, etc. If another event is an important trigger, make a separate column to record more details. For example, if physical activity is a trigger, record details about the type, duration, and intensity.
- Recording a journal can be tedious. If you have daily symptoms, complete the journal for about two weeks. If your symptoms are occasional, capture at least four episodes. If you record the journal for too long (e.g. several weeks), it may become a burden and reduce your quality of life.
- Record the information for the specified period without judging or analyzing. Constant analysis is exhausting and is rarely helpful.
Review Your Journal
- When you finish recording your journal (e.g. two weeks), look for patterns between potential triggers and symptoms. In other words, identify events that increase or decrease symptoms.
- Rather than reviewing the entire journal at once, review it several times, looking at different aspects each time, such as a specific food.
- Look for patterns, rather than absolutes. If your symptoms increase most of the time after eating carrots (but not every single time), that is still a pattern.
- In addition to looking for triggers, you can also review your journal to see if anything makes your symptoms better. Clients often report improved symptoms on days when they engage in relaxing activities.
- Decreased “as needed medication” indicates improvement, even if your symptoms have not changed.
- Review your journal when you are relaxed and rested. Try gently breathing or another focusing activity. It is easier to see patterns when you are relaxed.
- Consider asking a friend or family member to review your journal. However, it is a time consuming and challenging task, so accept when people decline.
- Symptom and trigger journals as described above are a lot of work.
- An alternative is to record your symptoms (three at most) with one or two events at the end of each day (rather than all day long).
- For example, if you want to know if stress affects your headaches, create a journal with these two variables. In the example below, you would record your headache severity in the second column….. 0 (absent); 1 (minimal); 2 (significant); 3 (debilitating) and stress in the fourth column (create your own scoring system for this).
- Score each variable at the end of the day- independently, trying not to let one influence how you rate the other. It can be tricky if both symptoms are subjective.
- Decide how long to record your journal. As discussed above, don’t review it until you are finished recording.
- If you like graphs, a line graph would quickly show patterns between the variables you are recording.
Working with the patterns you identify
- A pattern does not mean cause and effect; it is just information. For example, if you record increased symptoms during your morning coffee, coffee may be a symptom trigger, or you may be more likely to notice symptoms when you were relaxed.
- If you have identified food as a potential trigger, the next step is to learn more about it. The most common tools are 1) elimination diet and food challenge: eliminate potential trigger(s) and then reintroduce them 2) rotation diet: For example, with a four-day rotation diet, you would eat a particular food, once in four days. If a specific food is troublesome, a symptom pattern should emerge. If your symptoms are inconsistent, despite a consistent intake, food is probably not a trigger.
What if you don’t pinpoint patterns?
- If you can’t pinpoint specific patterns between external events (e.g. food, etc.) and your symptoms, internal triggers (changes inside your body) may be more important. It is difficult to monitor or control internal changes. However, accepting this lack of control can help prevent a futile search for external triggers, which may improve your quality of life.
- Sometimes food sensitivities do not have obvious patterns. See Inconsistent Food Sensitivity - Why is This Happening?
- If a Symptom and Trigger Journal has not helped, but you still feel that specific foods may be a trigger - consider an elimination or rotation diet as described above.