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Biological Age Questionnaire
Biological age is the measure of your inner health, which is influenced by your genetics and your lifestyle choices.
Biological age is an effective indicator of your true age because it measures how well you are taking care of your body.
This questionnaire is divided into different sections, please answer all questions and add the scores:
Dietary Choices
How frequently do you eat fried, grilled or barbequed foods?
Often
|
4 |
Once a
day
|
3 |
Few times a week
|
2 |
Once a
week
|
1 |
Almost
never
|
-2 |
How often do you consume nutritional oils (not fried or heated)?
(eg: organic flaxseed oil or omega 3 fish oils)
| Never
|
2 |
Once a week
|
1 |
Once a day
|
0 |
| 2+ per day
|
-1 |
How many serving of fruits and vegetables do you consume?
| Almost Never
|
3 |
Few Times a week
|
2 |
1 Per Day
|
1 |
3 Per Day
|
-1 |
| 5+ Per Day |
-2 |
How often do you consume whole grains?
(eg: whole wheat, psyllium, brown or wild rice)
Almost never
|
3 |
Once a week
|
2 |
Few times a week
|
1 |
Often
|
-2 |
How many glasses of water do you consume daily?
(water does not include tea, coffee, soft drinks, alcohol)
Almost Never
|
3 |
One a
day
|
2 |
4 a day
|
1 |
8 a day
|
0 |
| 10+ a day |
-2 |
Do you consume sugar, soft drinks, white flower, or other processed foods?
(eg: canned foods, fast foods, foods with preservatives added)
| 3+ times per day
|
3 |
One a
day
|
2 |
Few times
|
1 |
Almost
never
|
-1 |
How many alcoholic drinks do you consume per week?
12+ per week
|
3 |
6-8 per week
|
2 |
2-4 per week
|
1 |
Almost
never
|
-1 |
How often do you add salt to your food?
All food
Daily
|
2 |
Few times a week
|
1 |
Almost
never
|
-1 |
Score ---------------
Dietary Supplementation
Do you take a multivitamin?
Almost Never
|
2
|
Once a
week
|
1 |
Daily
|
-1
|
Do you take antioxidants?
| Almost never
|
3 |
Once a
week
|
2 |
Daily
|
-2 |
l Score --------------
Daily Activities
Do you exercise (30 or more minutes of continuous activity)?
Almost never
|
3 |
| Once a week
|
2 |
3+ per week
week
|
-2 |
| 5+ per week
week
|
-3 |
When you exercise, do you do so for more than 2 hours?
Most times
|
4
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50% of the time
|
2
|
| Almost never
|
0
|
Do you sleep well and awake rested?
Almost never
|
3 |
| Sometimes |
2 |
Usually
|
0
|
| Always
|
-1
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How often do you have normal bowel movement?
Once a week
|
4
|
| Every 2-4 days
|
3 |
Daily
|
1
|
| 2+ times per day
|
-2 |
l Score ---------------
Medical History
Is there a history of the following conditions in your family?
Cancer, diabetes, heart disease, obesity, depression, liver disease, high cholesterol, high blood pressure.
2 or more
|
1
|
One
|
0 |
| None |
-1 |
Have you ever had any of the above conditions?
| 2 or more
|
3 |
One
|
2 |
None
|
-2 |
How frequently do you experience the following conditions?
Headache, fever, sore throat, muscle aches, colds or flu, rash, swelling
| Once a Day
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3 |
| Once a week
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2 |
Once a month
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0
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| Almost never
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-1
|
Have you ever been exposed to heavy metals or toxic substances?
(eg: mechanics, hair dressers, beautician, etc.)
| Daily
|
4 |
| Weekly
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3 |
| Monthly
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2 |
| Almost Never
|
0 |
Have you been exposed to heavy metals via dental works or fillings?
| 3+ Fillings
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4 |
| 2+ Fillings
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3 |
1 Filling
|
2 |
Never
|
0 |
Score --------------
Stress
How many full meals do you eat per day?
| Never
|
3 |
| 4+ per day
|
3 |
3 per day
|
0
|
2 per day
|
1 |
| One per day
|
2 |
At work or at home, how often are you in front of electronic equipment?
(eg: computers, television, live cameras, electrical wires, mobiles)
| 8+ hours per day
|
3 |
| 6+ hours per day
|
2 |
Few hours per day
|
1 |
| Almost never
|
0 |
How often are you exposed to cigarette smoke (direct or second hand)?
All day
|
4 |
| Few times a day
|
3 |
| Few times a week
|
1 |
| Almost never |
-1
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Do you use recreational or street drugs?
| 2+ per day
|
4 |
Once a day
|
3 |
Once a week
|
2 |
Once a month
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1 |
Never
|
0
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Do you drive in heavy traffic?
| For a living
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3 |
| Daily 3+ hours
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2 |
Daily 1-2 hours
|
1 |
| Almost never |
-1 |
At work and or at home , do you experience stress
| Very High |
4 |
| High |
3
|
Moderate
|
2 |
Slight
|
1 |
Almost None
|
-2 |
Score -------------
Add all your score and put the total amount here:
TOTAL SCORE---------------
+ or -
Chronological age----------------
=
Biological age-----------
Depending on your score, add or subtract the total amount from your chronological age (your current age in years)
Example: if you chronological age is 45 and your total score was -6, your biological age would therefore be 45-6= 39
Equally if your total score was +6 your biological age would be 45+6= 51
Results
If your biological age is minus 11 years or more than your chronological age your health picture is excellent.
If your biological age is minus 1-10 years your health picture is good and you should continue with your healthy lifestyle choices, diet, exercise and stress management.
If your biological age is the same as your chronological age certain changes are required to achieve optimal health. The supplements we have recommended will help you achieve this.
If your biological age is more than your chronological age, following the same lifestyle will cause a further rise to your biological age and heighten the risk of serious health problems. The supplements we have recommended should certainly help, alternatively for our members we offer a free consultation with one of our practitioners who will tailor make a programme special to your needs.
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