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Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

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Page 1: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

www.kalenaspire.com Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Bloat Journal

Page 2: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com

The KalenaSpire digestive formula is simple but powerful:

IDENTIFY causes.

COMMIT to changes.

EXPERIENCE the freedom of pure wellness.

Bloat Journal

Christine E. CherpakIntegrative Nutrition Health Coach (INHC)

Certified International Health Coach (CIHC)

Functional Nutrition & Wellness Expert

Yoga Instructor

Kalena Spire, Inc.

Bye Bye BellyBloat Journal

Page 3: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com

Copyright © 2015 by Christine E. Cherpak

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher or author, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission request, E-mail the author at [email protected] or write in your request to Kalena Spire, Inc., PO Box 28, Kings Park, NY 11754.

Published by Kalena Spire, Inc.

Printed in the United States of America

Kalena Spire, Inc.PO Box 28Kings Park, NY 11754

To contact the publisher, visitwww.kalenaspire.com

To contact the author, visitwww.kalenaspire.com

CAUTIONARY DISCLAIMER:

The content of this publication is for general instruction and educational purposes only. Each person’s physical, emotional, and spiritual condition is unique. The instruction in this book is not intended to replace or interrupt the reader’s relationship with a physician or other professional, nor is it intended to treat or diagnose any health condition. Please consult your doctor for matters pertaining to your specific health and diet.

The publisher, author, and distributor are not responsible for any adverse effects or consequences resulting from the use of any information or procedures described in this book.

Bye Bye BellyBloat Journal

Page 4: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page

Introduction

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Journaling is an invaluable tool for identifying digestive disturbances that contribute to belly bloat. It assists you with making connections among food and lifestyle factors so that you can pinpoint causes of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable you to track your progress so that you can create an individualized plan for long-term success. Embrace daily and weekly journaling as an unexpected way to get more out of life as you monitor and learn from your journey towards optimal wellness.

Journaling need not be time consuming or overwhelming. I’ve carefully constructed a critical roadmap for you based on years of research and experience. The strategic journal questions and prompts are easily laid out for you to minimize your time and maximize your results. With pen or pencil in hand, all you need are a few moments to be present with yourself as you develop your relationship with your body. Let your body’s feedback answer the questions.

To begin using the Bye Bye Belly Bloat Journal, complete the Wheel of Digestive Balance (see next page for instructions). This is your baseline. Each day, fill in the daily Bye Bye Belly Bloat Journal page and take a few moments at the end of each day to synthesize the information that your body has offered you. After you’ve succeeded through one week of using the Bye Bye Belly Bloat Journal, complete the Weekly Check-In and the Wheel of Digestive Balance. Spend a few moments comparing your daily journal entries to your Weekly Check-In. Do you notice any patterns? Do you need to tweak your daily food intake or lifestyle factors? Maybe you need to eat smaller meals, or perhaps you need to take a few breaks throughout the day to breathe deeply. You may have even noticed that your belly bloat occurs if you eat two different foods together, but you don’t experience symptoms if you consume those two foods separately. Whatever it is, become a detective in your healing journey and don’t overlook seemingly small associations. You are a scientist and your body is your laboratory.

Once you’ve completed four weeks of the Bye Bye Belly Bloat Journal, repeat the above evaluative process to notice how your belly bloat has improved. Utilize the information your body taught you to refine your customized Bye Bye Belly Bloat plan for food choices and lifestyle factors. As you learn which foods and supplements work best for you, add them to the My Belly Supporting Foods List at the end of the journal.

Your relationship with your body is dynamic and will change at different points in your life. The Bye Bye Belly Bloat Journal will assist you with making the adjustments requested by your body well after four weeks. You may find that you want to continue using the Bye Bye Belly Bloat Journal on a daily basis. Or, you may find that you revisit it every few months. Discover what supports your individual needs. When you learn to tune in to your body, you will say Bye Bye Belly Bloat and move into a state of optimal wellness!

www.kalenaspire.com • Page 1

Bye Bye BellyBloat Journal

Page 5: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Pagewww.kalenaspire.com • Page 2

Energy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

This exercise will help you discover physical and lifestyle factors affecting your digestion. Each of the ten sections has a scale 1-5, where 1 indicates optimal well-being and 5 corresponds to dissatisfaction. For each section, place a dot on the number that reflects how satisfied you are with that area of your health. A dot placed at the center of the circle conveys imbalance, while a dot placed on the periphery exhibits optimized wellness. Then, connect the dots to visually assess your Wheel of Digestive Balance. This will highlight areas of digestive imbalance, allowing you to determine where you may want to focus your attention to optimize digestion. I suggest you perform this assessment when you first start using the Bye Bye Belly Bloat Journal, at the end of each week for four weeks, and periodically after completing the Bye Bye Belly Bloat Journal. Make sure you date each Wheel of Digestive Balance to monitor your progress. The more digestive balance you achieve, the closer to the periphery your circle will lay, and the more circular and brighter your Wheel of Digestive Balance will be. Like the colors of the spectrum, the Wheel of Digestive Balance points to the pure light of digestive wellness when the components are maximized by synchronicity.

I’ve included a completed Wheel of Digestive Balance as a sample for you. Use it as a springboard for your own journaling experience in your pursuit of optimal wellness. This is a rare special occasion, presenting you with the opportunity to master digestive wellness and get more out of life. IDENTIFY causes. COMMIT to changes. EXPERIENCE the freedom of pure wellness.

Instructions for Use

Wheel ofDigestive Balance

Page 6: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Wheel Of

Digestive BalanceEnergy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 3

Date:

Page 7: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Bristol Stool Chart

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 4

By Cabot Health, Bristol Stool Chart (http://cdn.intechopen.com/pdfs-wm/46082.pdf) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Page 8: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 5

Page 9: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 6

Page 10: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 7

Page 11: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 8

Page 12: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 9

Page 13: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 10

Page 14: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Date:_______Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

www.kalenaspire.com • Page 11

Page 15: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page

Overall Digestion: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bloating: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Gas: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bowel Movements: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Energy and Vitality: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Mood: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Stress: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Foods that supported digestion: ____________________________________________________

_______________________________________________________________________________

Potential food reactions (were symptoms dependent on serving size, interactions with other

foods, and/or preparation methods?) ____________________________________________________

______________________________________________________________________________________

Biggest challenge: _______________________________________________________________________

______________________________________________________________________________________

Greatest accomplishment: ________________________________________________________________

______________________________________________________________________________________

Three inspirational words to strengthen your commitment to the Bye Bye Belly Bloat Journal:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Week 1:Weekly Check-In

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 12

Bye Bye BellyBloat Journal

Page 16: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Energy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 13

Date:

Wheel Of

Digestive Balance

Page 17: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 14

Page 18: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 15

Page 19: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 16

Page 20: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 17

Page 21: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 18

Page 22: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 19

Page 23: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 20

Page 24: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page

Overall Digestion: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bloating: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Gas: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bowel Movements: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Energy and Vitality: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Mood: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Stress: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Foods that supported digestion: ____________________________________________________

_______________________________________________________________________________

Potential food reactions (were symptoms dependent on serving size, interactions with other

foods, and/or preparation methods?) ____________________________________________________

______________________________________________________________________________________

Biggest challenge: _______________________________________________________________________

______________________________________________________________________________________

Greatest accomplishment: ________________________________________________________________

______________________________________________________________________________________

Three inspirational words to strengthen your commitment to the Bye Bye Belly Bloat Journal:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Week 2:Weekly Check-In

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 21

Bye Bye BellyBloat Journal

Page 25: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Energy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 22

Date:

Wheel Of

Digestive Balance

Page 26: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 23

Page 27: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 24

Page 28: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 25

Page 29: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 26

Page 30: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 27

Page 31: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 28

Page 32: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Date:_______

www.kalenaspire.com • Page 29

Page 33: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page

Overall Digestion: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bloating: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Gas: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bowel Movements: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Energy and Vitality: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Mood: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Stress: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Foods that supported digestion: ____________________________________________________

_______________________________________________________________________________

Potential food reactions (were symptoms dependent on serving size, interactions with other

foods, and/or preparation methods?) ____________________________________________________

______________________________________________________________________________________

Biggest challenge: _______________________________________________________________________

______________________________________________________________________________________

Greatest accomplishment: ________________________________________________________________

______________________________________________________________________________________

Three inspirational words to strengthen your commitment to the Bye Bye Belly Bloat Journal:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Week 3:Weekly Check-In

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 30

Bye Bye BellyBloat Journal

Page 34: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Energy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 31

Date:

Wheel Of

Digestive Balance

Page 35: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 32

Page 36: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 33

Page 37: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 34

Page 38: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 35

Page 39: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 36

Page 40: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 37

Page 41: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Time settled to sleep last night: _______________________________________________________

Time arose in the morning: ___________________________________________________________

Quality of sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Number times woken up at night: _____________________________________________________

Amount of body movement: _________ min. Type of body movement: _______________________

Water/hydrating liquids (oz): Morning: ________ Mid-Day: _________ Evening: ________

Caffeine Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Alcohol Intake (oz): Morning: ________ Mid-Day: _________ Evening: ________

Energy (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Mood (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Bloating (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Gas (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Digestion (Excellent/Good/Fair/Poor): Morning: ________ Mid-Day: _________ Evening: ________

Meal Food/LiquidInclude quantity

SymptomsInclude times. Include

severity (mild/moderate/severe). Include any

symptoms, not just digestive (i.e. eczema, joint pain,

headache, mood, brain fog)

SupplementsNote if taken before/after symptoms & if helpful

Did You Have a Bowel Movement?

Include Bristol type (see Bristol Stool Chart on page 4)

Breakfast Time: _________

YES / NO Time: ________________Bristol Type: ___________

Mid-Morning Time: _________

YES / NO Time: ________________Bristol Type: ___________

Lunch Time: _________

YES / NO Time: ________________Bristol Type: ___________

Afternoon Time: _________

YES / NO Time: ________________Bristol Type: ___________

Dinner Time: _________

YES / NO Time: ________________Bristol Type: ___________

Evening Time: _________

YES / NO Time: ________________Bristol Type: ___________

Bye Bye BellyBloat Journal

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

Date:_______

www.kalenaspire.com • Page 38

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Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page

Overall Digestion: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bloating: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Gas: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Bowel Movements: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Energy and Vitality: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Mood: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Sleep: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Stress: ¨ Excellent ¨ Good ¨ Fair ¨ Poor

Foods that supported digestion: ____________________________________________________

_______________________________________________________________________________

Potential food reactions (were symptoms dependent on serving size, interactions with other

foods, and/or preparation methods?) ____________________________________________________

______________________________________________________________________________________

Biggest challenge: _______________________________________________________________________

______________________________________________________________________________________

Greatest accomplishment: ________________________________________________________________

______________________________________________________________________________________

Three inspirational words to strengthen your commitment to the Bye Bye Belly Bloat Journal:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Week 4:Weekly Check-In

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 39

Bye Bye BellyBloat Journal

Page 43: Bloat Journal - KalenaSpire · 2016-03-11 · of belly bloat and use that information to implement positive changes in your daily routine. The Bye Bye Belly Bloat Journal will enable

Energy Bloating

Gas

Bo

wel

Movem

ent

Dig

estio

n

StressSleep

Dee

pB

reat

hing

Moo

d

1

2

3

4

5

1

2

3

4

5

12

34

5

15 4 3 25

4 3

2

1

5

4

3

2

1

543

2

1

54321

54

32

1

5

4

32

1

Body

Movem

ent

Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 40

Date:

Wheel Of

Digestive Balance

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Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 41

My Belly Supporting Foods List

Protein:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Vegetables:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Fruits:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Fats:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Dairy/Non-Dairy Substitutes:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Grocery:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Beverages:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Spices/Herbs:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Grains (If not Paleo/Grain-Free)

• ____________________

• ____________________

• ____________________

Sweeteners:

• ____________________

• ____________________

Condiments:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Favorite Go-To Meals:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Supplements:

• ____________________

• ____________________

• ____________________

• ____________________

• ____________________

Notes: _______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Bye Bye BellyBloat Journal

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Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.www.kalenaspire.com • Page 42

Notes: _________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Bye Bye BellyBloat Journal My Discoveries

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Copyright © 2015 Kalena Spire, Inc. All Rights Reserved.

About The Author:Christine Cherpak is a Functional Nutrition & Wellness Expert, and the founder of KalenaSpire, a holistic health coaching and private yoga practice that specializes in freeing people from chronic digestive discomfort. Christine supports her clients in understanding the root cause of their digestive discomfort, creates a custom plan to put them on the road to healing, and shows them how to make sustainable lifestyle changes so they can finally enjoy and elevate their lives.

Learn more at www.kalenaspire.com