ASSESSMENT: What’s Your Telomere Trajectory? Protective and Risky Factors
Next we are going to focus on the body—activity, sleep, eating. But before reading further, you are probably wondering how your telomeres are doing, and how you can find out. We pause here for a mini-assessment. We have telomeres in every cell of our body, in our different tissues, organs, and blood. They are correlated loosely—if we have short telomeres in our blood, we tend to have short telomeres in other tissues. A few commercial labs offer tests that measure the length of telomeres in your blood, but for individuals the usefulness of this is limited (see “Information about Commercial Telomere Tests” here and our website for a discussion of blood measures). It is more useful to assess the factors that are known to protect or damage telomeres and then, with the results of the assessment in mind, try to shift aspects of our daily lives so that our telomeres are more protected. That leads us to the Telomere Trajectory Assessment.
TELOMERE TRAJECTORY ASSESSMENT
You can assess the personal wellbeing and lifestyle factors that we know are related to telomere length. This assessment takes around ten minutes to complete and will help you identify the main areas you may want to improve.
When possible, we reprinted the actual scales used in the research described in this book. Research details for each scale are described after each section.
You will be asked about these areas:
Your Wellbeing
current major stressful exposures
clinical levels of emotional distress (depression or anxiety)
social support
Your Lifestyle
exercise and sleep
nutrition
chemical exposures
Do You Have Any Severe Stress Exposures?
Enter 1 next to any questions that apply to you and 0 next to any questions that don’t apply. The situations must have been ongoing for at least several months for a score of 1.
Are you experiencing severe ongoing job stress, where you feel emotionally exhausted, burned out, cynical about your work, and fatigued, even when you wake up?
Are you serving as a full-time caregiver for an ill or disabled family member and feeling overwhelmed by it?
Do you live in a dangerous neighborhood and regularly feel unsafe?
Are you experiencing severe extreme stress almost every day due to some chronic situation or a recent traumatic event?
TOTAL SCORE
Calculate your TOTAL SCORE by adding up items 1–4: _____
Circle the telomere points below that relate to your score.
Severe Stress Exposure Score: If you scored 0, you have low risk.
Telomere points (Circle): 2
Severe Stress Exposure Score: If you scored 1, you have some risk.
Telomere points (Circle): 1
Severe Stress Exposure Score: If you scored 2 or higher, you have high risk.
Telomere points (Circle): 0
Explanation: This Severe Stress Exposure Checklist is not a standardized scale. Instead, it measures whether you are experiencing an extreme situation that has been linked to shorter telomeres. For example, work-related emotional exhaustion,1 being a caregiver for a family member with dementia,2 and regularly feeling unsafe where you live3 are related to shorter telomeres in at least one study, after controlling for factors such as BMI, smoking, and age. Any severe event has the potential to contribute to telomere shortening, if it occurs over years. Exposure alone is not a determinant—your response is important, too, as we discuss in chapter 4. Last, having one situation may be manageable, but having more than one severe chronic situation is more likely to exhaust one’s coping resources. Multiple severe chronic situations are categorized here as a higher risk.
Any Mood Disorders?
Have you been currently diagnosed with depression or an anxiety disorder (such as posttraumatic stress disorder or generalized anxiety)?
Circle the telomere points below that relate to your score:
Clinical Distress Score: If you do not have a diagnosable condition, you are at low risk.
Telomere Points (Circle): 2
Clinical Distress Score: If you have been diagnosed with a severe condition, you are at high risk.
Telomere Points (Circle): 0
Explanation: From various studies, it appears the symptoms of moderate distress alone are not related to shorter telomeres, but actual diagnoses—which means symptoms that are severe enough to interfere with your daily life—are related.4
How Much Social Support Do You Have?
Answer the following questions about social support you typically receive from significant others, family, friends, and community members.
1. Is there someone available to give you good advice about a problem?
| 1 None of the time |
2 A little of the time |
3 Some of the time |
4 Most of the time |
5 All of the time |
2. Is there someone available whom you can count on to listen to you when you need to talk?
| 1 None of the time |
2 A little of the time |
3 Some of the time |
4 Most of the time |
5 All of the time |
3. Is there someone available to you who shows you love and affection?
| 1 None of the time |
2 A little of the time |
3 Some of the time |
4 Most of the time |
5 All of the time |
4. Can you count on anyone to provide you with emotional support (talking over problems or helping you make a difficult decision)?
| 1 None of the time |
2 A little of the time |
3 Some of the time |
4 Most of the time |
5 All of the time |
5. Do you have as much contact as you would like with someone you feel close to, someone in whom you can trust and confide in?
| 1 None of the time |
2 A little of the time |
3 Some of the time |
4 Most of the time |
5 All of the time |
TOTAL SCORE
Now calculate your total score by adding up the numbers you circled.
Circle the telomere points below that relate to your score.
Social Support Score: If you scored 24 or 25, you are high in social support.
Telomere Points (Circle): 2
Social Support Score: If you scored between 19 and 23, you are average in social support.
Telomere Points (Circle): 1
Social Support Score: If you scored between 5 and 18, you are low in social support.
Telomere Points (Circle): 0
Explanation: This questionnaire is the five-question version of the ENRICHD Social Support Inventory (ESSI), originally created to assess social support of post–heart attack patients and used in epidemiological studies.5 Versions of this questionnaire have been used in studies relating telomere length to social support.6
Cutoffs for the social support categories are approximations from data from a large study, and the effects in this study were found in the oldest age group only.7 The ENRICHD trial used the score of 18 as a lower cutoff point to define people who were low on social support.
How Much Physical Activity Do You Do?
During the past month, which statement best describes the kinds of physical activity you usually did?
1. I did not do much physical activity. I mostly did things like watching television, reading, playing cards, or playing computer games, and I took one or two walks.
2. Once or twice a week, I did light activities such as getting outdoors on the weekends for an easy walk or stroll.
3. About three times a week, I did moderate activities such as brisk walking, swimming, or riding a bike for about 15–20 minutes each time.
4. Almost daily (five or more times a week), I did moderate activities such as brisk walking, swimming, or riding a bike for 30 minutes or more each time.
5. About three times a week, I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time.
6. Almost daily (five or more times a week), I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time.
Circle the telomere points that relate to your score.
Exercise Score: If you chose options 4, 5, or 6, you are at low risk.
Telomere Points (Circle): 2
Exercise Score: If you chose option 3, you are at average risk.
Telomere Points (Circle): 1
Exercise Score: If you chose option 1 or 2, you are at high risk.
Telomere Points (Circle): 0
Explanation: This questionnaire is the Stanford Leisure-Time Activity Categorical Item (L-CAT) (permissions granted by Nature Publishing Group).8 The L-CAT assesses six different levels of physical activity. Scores of 4, 5, or 6 meet the CDC recommendations for aerobic activity (150 minutes of moderate exercise, like brisk walking, or 75 minutes of vigorous exercise like jogging; note the CDC also recommends muscle-strengthening activities at least two days a week). As we explain in chapter 7 (“Training Your Telomeres”), if you are fit and do regular exercise, there doesn’t appear to be an upper limit to its benefits as long as you don’t overdo it during workouts and you give yourself recovery time after big workouts. Think “regular exerciser,” not “weekend warrior.”
People who are more physically active appear to be better buffered from the telomere shortening that occurs due to extreme stress than people who are less active.9 Additionally, an intervention showed that exercising forty-five minutes three times a week led to increases in telomerase.10
What Are Your Sleep Patterns?
During the past month, how would you rate your sleep quality overall?
| 0 Very good |
1 Fairly good |
2 Fairly bad |
3 Very bad |
How many hours of sleep do you get on average each night (not including lying in bed awake)?
| 0 7 hours or more |
1 6 hours |
2 5 hours |
3 Less than 5 hours |
Circle the telomere points that relate to your score.
Sleep Score: If you scored a 0 or 1 on both questions, you’re at low risk.
Telomere Points (Circle): 2
Sleep Score: If you scored a 2 or 3 on one question, you’re at some risk.
Telomere Points (Circle): 1
Sleep Score: If you scored 2 or 3 on both questions, or you have poorly treated sleep apnea, you have high risk.
Telomere Points (Circle): 0
Explanation: The item on sleep quality is from the Pittsburgh Sleep Quality Index (PSQI), which assesses quality and disturbances of sleep.11 Several studies relating telomere length to sleep have used the PSQI to measure sleep quality.12 Duration of sleep is also important. If you report sleeping at least six hours per night and describe your sleep as good or very good, you’re at low risk. If you report either poor sleep quality or shorter sleep durations, this adds risk. And if you report both poor sleep quality and shorter sleep durations, this is categorized as high risk. Since studies have not tested for an additive effect of both short and poor sleep, we are making an assumption that having both is worse.
If you have sleep apnea and do not treat it nightly, you are also at risk.
What Are Your Nutrition Habits?
How often do you have the following? Circle 1 or 0 for each question.
1. Omega-3 supplements, seaweed, or fish that contains high omega-3 oils:
3 servings or more a week of these products?: 1
Less than 3 times a week: 0
2. Fruits and vegetables:
At least daily?: 1
Not every day: 0
3. Sugared sodas or sweetened beverages (not including when you add your own sugar to coffees or teas, which typically adds up to substantially less sugar than in commercially sweetened drinks):
At least one 12-ounce drink on most days: 0
Not regularly: 1
4. Processed meat (sausage, lunch meats, hot dogs, ham, bacon, organ meats):
Once a week or more: 0
Less than once a week: 1
5. How much of your diet is whole foods (whole grains, vegetables, eggs, unprocessed meats) versus processed food (packaged or processed with salts and preservatives)?
Mostly eat whole foods: 1
Mostly eat processed foods: 0
Add your total points from all five nutrition questions, creating a score between 0 and 5.
TOTAL SCORE (sum of items 1–5): _____
Circle the telomere points that relate to your score.
Telomere Nutrition Score: If you scored a 4 or 5, you have excellent protection from diet.
Telomere Points (Circle): 2
Telomere Nutrition Score: If you scored a 2 or 3, you have average risk from diet.
Telomere Points (Circle): 1
Telomere Nutrition Score: If you scored 0 or 1, you have high risk from diet.
Telomere Points (Circle): 0
Explanation: The frequencies were extrapolated from telomere studies.
For omega-3s, food sources are best. If you rely on supplements, try algae-based products instead of fish for sustainability reasons. People with higher blood levels of omega-3 fatty acids (DHA, or docosahexaenoic acid, and EPA, or eicosapentaenoic acid) have slower attrition over time.13 Those who ate a half serving of seaweed each day had longer telomeres later in life.14 An omega-3 supplement study found that dose didn’t matter as much as what’s absorbed in your blood: Taking either a 1.25 gram or 2.5 gram omega-3 supplement decreased the ratio of omega-6s to omega-3s in the blood at least to some extent for most people, which in turn was associated with an increase in telomere length.15 It’s hard to know how much your body will absorb, but it should be sufficient to have fish several times a week, or take a gram of omega-3 oils a day.
While supplements are also associated with longer telomere length, real foods with antioxidants and vitamins are superior if available (i.e., lots of vegetables and some fruit).
Sugar carbonated beverages are linked to shorter telomeres in three studies,16 and it is prudent to assume that daily consumption would be a sufficient dose to have an effect, as suggested in one of these studies. Most sweetened beverages have over 10 grams of sugar, typically 20 to 40 grams.
For processed meat, one study showed that those in the highest quartile of the sample—those who ate processed meats once a week (or a tiny portion each day)—had shorter telomeres.17
How Much Are You Exposed to Chemicals?
Circle either Yes or No for the following questions.
Do you regularly smoke cigarettes or cigars?
Yes
No
Do you do regular agricultural work with pesticides or herbicides?
Yes
No
Do you live in a city with very heavy traffic-related pollution?
Yes
No
Do you work in a job with heavy exposure to chemicals listed on the Telomere Toxins table (see here), such as hair dyes, household cleaners, lead or other heavy metal exposure (for example, in a car mechanic’s shop)?
Yes
No
Telomere Chemical Exposure Score: If you answered all nos, you have low risk from chemical exposures.
Telomere Points (Circle): 2
Telomere Chemical Exposure Score: If you answered yes to one or more, you have high risk.
Telomere Points (Circle): 0
Explanation: Here we listed exposures that have been linked to telomere shortness in at least one study. The exposures include smoking,18 pesticide exposure,19 chemical exposures in dyes and cleaners,20 pollution,21 lead exposure,22 and exposures in a car mechanic shop.23
How Did You Score Overall?
Area
WELLBEING: Stress exposures
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
WELLBEING: Clinical emotional distress
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
WELLBEING: Social support
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
LIFESTYLE:: Exercise
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
LIFESTYLE: Sleep
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
LIFESTYLE: Nutrition
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Area
LIFESTYLE: Chemical exposures
Telomere Points (Circle)
high risk: 0
average: 1
low risk: 2
Total Score (range 0 to 14)____
How to Understand Your Total Telomere Trajectory
The summary score is a way to show overall risk and protection of your telomere rate of decline. If you have a high score, you likely have great telomere maintenance. Keep up the good work! The most useful way to use this assessment is to focus on individual areas rather than your total score. If you scored a 2 on any area in the summary grid, you are doing a great job at telomere protection. You are doing more than simply dodging risk. Typically, this score means you are performing protective behaviors every day, engaging in the daily work creating the foundation of a good healthspan.
If you scored a 0 (high-risk category), you are likely to experience the typical age-related telomere decline, made worse by risk factors, but ones that you hopefully can gain more control over.
Choose an Area to Work On
The best way to use this chart is to notice the areas in which you scored 0, and then decide which will be the easiest for you to change. If you don’t have any 0s, choose a category in which you scored a 1. Wherever you begin, we suggest you choose only one area to work on at a time. Make a commitment to improve one small thing in this area. Put a reminder of the change you’re trying to make on your bedside table, or set a reminder alarm on your phone to go off at a helpful time of day. At the end of Part Three, you will see some tips to get you started on your new goal.