What’s Your Longevity Potential?

Family History

Score

Any grandparent lived to be 85 or over

+2

All four grandparents lived to be 80

+4

Either parent died of a stroke or heart attack before 50

-4

Any parent, brother or sister have cancer

-3

Any parent, grandparent, brother, sister, aunt, or uncle have any of the following:

Stroke

-2

Diabetes

-2

High Cholesterol

-1

High blood Pressure requiring treatment

-2

Total_____

Medical Conditions

Have you been diagnosed with any of the following:

High Blood Pressure

-1

Congestive Heart Disease

-2

TIAs (Transient Ischemic Attacks)

-1

Angina/Stroke

-1

Depression

-1

(moderate to severe for 12 months or longer)

Diabetes

-2

Cancer

-3

Colitis

-1

High Cholesterol

-1

Annual Medical / Laboratory Exam

+1

Total_____

Lifestyle

Married and living in a long term positive relationship

+4

Married and living in a long term negative relationship

-4

Divorced

-2

If divorced, subtract 1 for every 10 years you have

-1

been living alone since age 25

Do you feel:

Angry/resentful much of the time

-2

Intense, aggressive, and irritable much of the time

-2

Loved

+1

You give love

+1

Easy going and calm most of the time

+1

No time for relaxation/contemplation

-1

Happy most of the time

+1

Sad most of the time

-1

Achieving goals & expectations

+1

Not achieving goals & expectations

-1

Unhappy, dissatisfied, or depressed

-3

Rushed, hurried, or pressured most days

-3

Unhurried most days

+1

Have had a speeding ticket or accident in the last year

-4

Other traffic violations

-1

Wear seatbelts more than 90% of the time as driver and passenger

+1

Have a pet

+1

Actively involved in a spiritual/religious practice

+2

Have positive friendships outside of marriage

+2

Take at least one vacation a year

+2

Total_____

Diet

Eat 1-2 fruits daily

+1

Eat 3-5 servings of vegetables per day

+2

Avoid saturated fats and cholesterol

+2

Eat 6-11 servings of whole grains/day

+2

Limit Protein intake to less than 4 oz meat per day

+1

Eat meat 2-3 times per day (more than 4 oz per day)

-1

Avoid dairy products (ie. Milk, butter, etc.)

+1

Caloric intake of 2000-2500 per day (U.S. average 3500)

+1

Eat poultry and fish as primary protein source

+2

Vegetarian

+2

Eat breakfast

+1

Total_____

Smoking

Never smoked

+3

Smoke more than one half to one pack per day

-3

Live or work with someone who smokes heavily

-3

Smoke one or two packs per day

-6

More than two packs per day

-8

Total_____

Alcohol

NOTE: 2oz. of 80 proof whiskey=20 oz. Beer (4.5% Alcohol) =

¼ bottle of wine. All contain 20-24ml of alcohol (not equal volume)

Never consume alcohol

+1

2 oz. or less Alcohol per day

-1

For each additional 2 oz. per day

-1

Total_____

Sex

Male

-2

Female

+3

Regular, fulfilling sexual relations

+2

Lack of sex drive or interest (libido)

-2

Sexual activity with multiple partners

-1

Total_____

Education

Finished college

+1

Earned a graduate or professional degree

+2

Total_____

For Women Only

Used birth control pills for 7 or more years

-3

Smoke and use birth control pills

-2

Began regular sexual activity before 18

-1

Used synthetic hormone for 7 or more years

-3

Have used natural Estriol (E3) hormone for 5 or more years

+2

Jewish heritage

-1

Mother or sister had or has breast cancer

-4

Over age 30 and do not have an annual gyn exam

-2

Annual Mammogram after age 40

-2

Annual Mammogram after age 50

-1

Total_____

For Men Only

Have taken steroids for body building

-3

BPH (Benign Prostate Hyperplasia)

-2

Erectile Dysfunction

-1

Male over 40 and do not have annual prostate exam

-2

Total_____

Work and Environment

Enjoy occupation / job

+1

Detest occupation / job

-1

Work with supportive / caring staff

+1

Work with negative or competitive staff

-1

Have 3 or more project deadlines per month

-1

Frequent financial stress or worries

-2

Minimal financial stress or concerns

+1

Earn over $50,000 dollars annually

+2

Worked with asbestos for 1 or more years

-8

Use cell phone daily

-1

Work regularly with vinyl chloride

-4

Work in ongoing contact with toxic agents or radiation

-3

Over 65 and still working

+3

Over 65 and self-employed

+1

Live in an urban area with a population over 2 million

-2

Live in a town under 10,000 or on a farm

+2

Total_____

Physical Fitness

Resting Pulse (Heart Rate) between 54 and 68

+2

Resting Pulse (Heart Rate) greater than 80

-2

Get regular physical exercise at work

+2

Exercise at a “moderate” aerobic level (i.e. jogging,

Swimming, bicycling, walking, etc., at least 30 min/day, 4 times/week

+2

Do stretching exercises at least 3 times per week

+1

Have limber and pain free spine, joints and muscles

+2

No regular aerobic exercise

-5

Total_____

Weight

5-20 pounds over ideal weight

-2

20-30 pounds over ideal weight

-3

30-40 pounds over ideal weight

-4

40-50 pounds over ideal weight

-6

Over 60 pounds over ideal weight

-8

Waist to hip ratio:

Women more than 0.8 inches

-3

Less than 0.7 inches

+3

Men more than 0.9 inches

-3

Less than 0.85 inches

+3

Total_____

Sleep

Fall asleep watching television

-2

Get 5 or 6 sleep cycles per night (1 Sleep Cycle = 1 ½ hrs)

i.e. sleep 7 ½ or 9 hours per night)

+3

Sleep less than 6 hours per night

-3

Awaken to alarm clock

-1

Awaken more than once per night

-2

Fatigued or tired most days

-2

Total_____

Nutritional Supplements

Vitamin C (400 mg or more per day)

+1 per decade use

Vitamin E (400 mg per day)

+1 per decade use

Proanthocyanidin Flavonoids (200 mg per day)

+1 per decade use

Folic Acid (800 mcg per day for at least 15 years)

+1

Selenium (200 mcg per day for at least 5 years)

+1

Chromium (200 mcg per day for at least 15 years)

+2

Total_____