Biological Age Evaluation


 Your Biological Age reflects your internal health as well as the lifestyle choices you’ve made that have affected your health today. The difference between your Biological Age and your chronological age can be used as a guide in making new lifestyle choices to regain andmaintain optimal health and well-being.

 

 

Persian Version

 

There are 26 questions in this survey.

Section A: Chronological Age

1.    What is your current age (in years)?

SECTION B: Dietary Choices

2.    How frequently do you consume grilled, fried or barbecued foods?
Often
Once a day
A few times/week
Once/week
Almost Never
3.    How often do you eat cold-pressed nutritional oils (not heated or fried)? (Example: cold-pressed flax seed oil)
Never
Once a Week
Once a Day
2+ Times a Day
 4.     How many servings of fruits and vegetables do you eat?
Almost Never
A Few times/week
Once/Day
3/day
5+/day
5.    How often do you eat whole grains and/or fibre? (eg. brown/wild rice, whole wheat)
Almost Never
Once / week
A Few Times/Week
Often
6.    How many glasses of water do you drink per day? (this does not include coffee, alcohol, soft drinks, soda, fruit juice, black tea)
Almost Never
Once / Day
4 per Day
8 per Day
10+ per Day
7.    Do you consume sugar, white flour, soft drinks, soda, or any other processed foods? (Example: fast food, canned food, TV dinners. foods with preservatives)
3+ times/day
Once / Day
A Few Times/week
Almost Never
8.    How many alcoholic drinks do you consumer per week?
12+/Week
8 per Week
4 per Week
2 per Week
Almost Never
9.     How often do you add salt to your food?
All Food
Daily
Few Times/Week
Once /Month
Almost Never

SECTION C: Dietary Supplementation

10.    Do you take a multi-vitamin?
Almost Never
Once A Week
A Few Times/Week
Daily
11.    Do you take an Anti-Oxidant? (Example: Selenium, Grape Seed Extract)
Almost Never
Once A Week
A Few Times/Week
Daily

Section D: Daily Activities

12.     Do you exercise? (should be 30 minutes or more continuously with no stops)
Almost Never
Once/Week
3 Times/Week
5+ Times/Week
13.    When exercising, does your session exceed 2 hours? (If you don’t exercise, put ‘0…zero’ as your answer)
Most Times
50% of The Time
Almost Never
14.    Do you sleep soundly and well? And awake feeling rested?
Almost Never
Sometimes
Usually
Always
15.    How frequent are your normal bowel movements?
Once A Week
Every 4 Days
Every 2 Days
Daily
2+ Times/Day

Section E: Medical History

16.     Family Medical History: How many of the following health conditions     exist in your family? Cancer, Diabetes, Depression,  Heart Disease, Obesity,  Liver Disease, High Cholesterol, High Blood Pressure.
2 or more
One
None

17.    Do you suffer, or have you suffered previously, from the following     conditions?

Cancer, Diabetes, Depression,  Heart Disease, Obesity,  Liver Disease, High Cholesterol, High Blood Pressure.

2 or More
One
None

18.    How often do you suffer from the following conditions?
Headache, Fever, Colds or Flu, Rashes, Swelling, Fever, Sore Throat, Muscle Aches (not exercise-induced)

Once A Day
Once A Week
Once A Month
Almost Never
19.    Have you ever been exposed to toxic substances or to heavy metals? Examples are, if you have been in these professions: Hair Dressing, Mechanics,  Beauty, Dentistry, Oncology
Daily
Weekly
Monthly
Almost Never

20.    Have you ever had exposure to heavy metals ~ via dental work and/or dental fillings?
Examples are mercury fillings, silver fillings and any other metal fillings.

3+ Fillings
2 Fillings
1 Filling
Never

Section F: Stress

21.    How many full meals do you eat a day?
(A snack is not considered a full meal.)

Never
4+ A Day
3 Per Day
2 Per Day
1 Per Day

22.    How often are you in front of electronic equipment (at home or at work)? Examples are computers, live cameras, television and electrical wires.

8+ Hours/Day
6+ Hours/Day
A Few Hours/Day
Almost Never

23.    How often are you exposed to cigarette smoke, direct or second-hand?

All Day
A Few Times/Day
A Few Times/Week
Almost Never

24.     Do you use, or have you used in the past, recreational or street drugs?

2+ Times/Day
Once/Day
Once/Week
Once/Month
Never

25.    Do you drive in heavy traffic?

For A Living
Daily 3+ Hours
Daily 1 to 2 Hours
Almost Never

26.    Do you experience stress at home and/or at work?

Very High
High
Moderate
Slight
Almost None