Ask the Doctors: The basics are more important than biomarkers as you age

Q: What does the term "biological age" refer to? How do you go about figuring out what your biological age is? I will turn 80 at the end of the year, am physically active and I eat a vegetarian diet. Is there anything else I should be doing to get "younger"?

A: When you say you will be turning 80 later this year, you are referring to your chronological age. That's a straightforward measure of how many years someone has been alive.

Biological age, by contrast, is a concept that looks at a diverse range of physiological factors to determine someone's potential life span and the likelihood of their developing an age-related illness. Based on these findings, someone may turn out to be older or younger than their chronological age says they are.

There is no universal formula for determining biological age. However, a core group of metrics are typically used. These begin with someone's health history, their family medical history and any existing diseases or conditions. Lifestyle also plays an important role. This includes exercise, mental health, sleep habits, smoking and drinking, muscle mass, grip strength, balance, endurance, social networks and the individual's physical environment.

Also taken into consideration are metabolic health, certain blood test results and specific aspects of cardiac function. These include resting heart rate and how quickly the heart recovers from exertion.

Biological age is also measured at a cellular level. One factor is something known as DNA methylation. This is a biological process in which certain structural changes take place in someone's DNA. These changes affect gene expression and have been shown to have an adverse impact on aging. Also important are telomeres, which are structures found at the ends of chromosomes. Shortened telomeres are associated with older age.

The concept of biological age is certainly intriguing. Surging interest has led to the marketing of at-home tests that, based on test results from blood or urine samples or a cheek swab, claim to reveal someone's biological age. Theoretically, you take a test, make lifestyle changes guided by the results, then retest to see if they helped. The catch is that no one knows if the tests are sensitive enough to be effective monitors.

There's also the fact that, depending on what's going on at the cellular level, different parts of the body are likely aging at different rates. Your cartilage may be "older" than your heart, which may be aging faster than your brain. Outside of the rigors of anti-aging research, biological age is more of a novelty than a useful metric.

Rather than focusing on the biomarkers linked to aging, it's more beneficial to look at the big picture. That brings us back to the basics that studies continue to show are important to good health and longevity - namely, a healthful diet, regular exercise, managing stress, preventive health care, getting adequate and good-quality sleep, and robust social engagement. The good news is that, from the description of your own habits, it sounds as though you're already hitting those goals.

Q: I'm a 69-year-old African American male with high blood pressure. I get conflicting advice from my primary care doctors, and my BP readings are never taken under the same conditions. I'm confused and losing confidence in my medical network. Can I see a specialist for hypertension?

A: As doctors, and also as patients, we feel your plight. Blood pressure, or BP, is an important metric in maintaining good health and well-being. Yet, accurate readings often pose a challenge. A primary reason for this is that blood pressure fluctuates, not only throughout the course of the day, but also from moment to moment.

The factors that can influence someone's blood pressure readings include general physical health, the medications or supplements they are taking, caffeine and alcohol usage, hydration, sleep, exercise, family history, their emotional state and even what they had for breakfast that morning.

Check someone's blood pressure 10 times over the course of the day, and you will receive 10 surprisingly varied measurements.

Adding to the difficulty is that blood pressure readings performed in a medical office can run artificially high. It's common enough that there's even a name for it: "white coat hypertension." For this reason, in our own practices, we worry less about the numbers arrived at in the office and focus more on readings taken when someone is at home. We advise patients to check BP in the morning, while they are feeling calm and rested. These readings are usually an accurate representation of resting BP.

In the trials used to arrive at blood pressure guidelines, participants are asked to sit quietly for a set period of time prior to BP readings being taken. The effects of blood pressure medications, which are typically dosed daily, last for 24 hours. The timing of these meds should not significantly affect BP readings. The goal, according to the current guidelines, is 130/80 for everyone.

Ambulatory blood pressure monitoring, which involves wearing a device that takes dozens of readings throughout a 24-hour period, is possible. However, we don't use this approach in our own practices. We find a week's worth of readings, taken first thing in the morning, will provide an accurate and instructive average.

When we see a significant difference between morning readings and those taken later in the day, when the stressors of daily life have kicked in, that introduces questions about the tone of the nervous system.

With our patients, we will open a discussion about approaches to "training" the nervous system to become less volatile. This can include deep breathing, meditation or mindfulness exercises, or practices such as yoga and tai chi. Walking, weightlifting and simply being in nature have proven to be helpful in managing blood pressure.

As to your question about working with a specialist, it is certainly an option. When blood pressure is difficult to control, a cardiologist can be helpful. Kidney problems can also contribute to hypertension. For that reason, your primary care doctor may request certain tests to see if a kidney specialist, known as a nephrologist, would be a good choice.

Q: A co-worker is doing something called a parasite cleanse. She says if you have symptoms like gas, muscle aches, insomnia and feel hungry all the time, it means you have parasites. How would you get parasites, and how would you know? Does a cleanse really help?

A: As with many odd and sometimes dubious health trends, you need look no further than social media for the popularity of the so-called "parasite cleanse" that your co-worker is following.

While the specifics of these cleanses can vary depending on the source, they typically focus on a cocktail of supplements that are supposed to clear the infection. To better understand the issue, we should begin by talking about parasites.

A parasite is an organism that lives on or within the blood, tissues or intestines of a host. It gets its food from the host, often at the expense of the host's health and well-being. External parasites - such as ticks, lice or mites - are known as ectoparasites.

In this case, though, we are talking about human intestinal parasites. These are divided into two categories: protozoa and helminths. Protozoa are one-celled organisms that are able to multiply within the host. Helminths are multi-celled organisms that fall into three main groups: tapeworms, roundworms and thorny-headed worms. While adult helminths do not proliferate in the intestines, they can produce eggs that are excreted in the host's feces.

The most common method of transmission of intestinal parasites is eating or drinking something that has been contaminated with feces from an infected individual. Helminth infections can also be acquired from soil in which infected feces is present. Helminth eggs can attach to produce and can be ingested in contaminated water.

During a certain part of their life cycle, hookworms can actively penetrate skin. Contact with contaminated soil can result in infection. Living in a subtropical or tropical region, living with poor sanitation systems, having poor personal hygiene and lacking access to clean water increases the risk of acquiring a parasitic infection.

Symptoms of parasite infection can include abdominal pain, bloating, gas, diarrhea, anal itching, unexplained weight loss and exhaustion. However, these are common to a number of other conditions.

Just because someone experiences these symptoms does not automatically mean they have a parasitic infection. To determine that, and to learn the source of a potential infection, you need a medical diagnosis. This begins with a review of symptoms, information about recent travel and details about possible dietary exposure, such as eating uncooked meat or fish, or drinking so-called raw water, which has not been filtered or treated.

If parasites are suspected, laboratory tests to analyze stool or blood will be used. When parasites are found, drug therapies specific to the infection are prescribed.

There is evidence that some of the ingredients commonly used in a parasite cleanse, such as wormwood, can be helpful. However, when symptoms and risk factors indicate a parasitic infection, a medical diagnosis, along with targeted treatment, are the best way forward. A parasitic infection can cause considerable harm and needs to receive proper treatment.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.