Chronic diseases are becoming increasingly prevalent in old age. While genetics play a role in determining lifespan and susceptibility to these diseases, lifestyle factors likely have a more significant impact. In certain areas around the world, termed "Blue Zones," people exhibit remarkably low rates of chronic disease and exceptional longevity. These "Blue Zones" are geographic areas with lower rates of chronic diseases and longer life expectancy. The term "Blue Zone" is a nonscientific term given to geographic regions that are home to some of the world’s oldest people. It was first used by the author Dan Buettner, who was studying areas of the world in which people live exceptionally long lives. They are called Blue Zones because when Buettner and his colleagues were searching for these areas, they drew blue circles around them on a map. Diet, fasting, and exercise are factors associated with Blue Zones. Italy, Greece, Japan, Costa Rica, and the United States have Blue Zones. This article explores the common lifestyle features of people in Blue Zones, focusing on the dietary habits that contribute to their extended lifespans.
Identifying the Blue Zones
In his book called “The Blue Zones,” Buettner described five known Blue Zones:
- Icaria (Greece): This Greek island boasts a population that adheres to a Mediterranean diet rich in olive oil, red wine, and homegrown vegetables. In Ikaria more than 75 varieties of edible greens grow like weeds; many contain ten times the polyphenols found in red wine.
- Ogliastra, Sardinia (Italy): The mountainous region of Ogliastra in Sardinia is inhabited by some of the world's oldest men, who typically work on farms and consume copious amounts of red wine. Sardinians drink wine moderately. Cannonau wine has 2 or 3 times the level of artery-scrubbing flavonoids as other wines.
- Okinawa (Japan): Okinawa is home to the world’s oldest women, who eat a lot of soy-based foods and practice tai chi, a meditative form of exercise.
- Nicoya Peninsula (Costa Rica): The Nicoyan diet is based around beans and corn tortillas. The people of this area regularly perform physical jobs into old age and have a sense of life purpose known as “plan de vida.” Nicoyans spend just 15% of what America does on health care and are more than twice as likely than Americans to reach a healthy age of 90 years.
- The Seventh-day Adventists in Loma Linda, California (USA): This religious group follows a strict vegetarian diet and lives in tight-knit communities. This Adventist community in California outlives the average American by a decade. Taking their diet directly from the Bible they consume a vegan diet of leafy greens, nuts, and legumes.
While Buettner's research primarily focuses on these five areas, it is plausible that other unidentified regions around the globe may also qualify as Blue Zones.
The Power 9
What began as a National Geographic expedition, lead by Dan Buettner, to uncover the secrets of longevity, evolved into the discovery of the 5 places around the world where people consistently live over 100 years old, dubbed the Blue Zones. Dan and his team of demographers, scientist and anthropologists were able to distill the evidence-based common denominators of these Blue Zones into 9 commonalities that they call the Power 9.
- Move naturally. The world’s longest-lived people do not pump iron, run marathons, or join gyms. Instead, they live in environments that constantly nudge them into moving without thinking about it.
- Purpose.
- Downshift. Even people in the Blue Zones experience stress. Stress leads to chronic inflammation, associated with every major age-related disease. What the world’s longest-lived people have that others do not are routines to shed that stress.
- Hara hachi bu-the Okinawan 2500-year old Confucian mantra said before meals reminds them to stop eating when their stomachs are 80% full. The 20% gap between not being hungry and feeling full could be the difference between losing weight or gaining it.
- Plant slant. Beans, including fava, black, soy, and lentils, are the cornerstone of most centenarian diets. Meat-mostly pork-is eaten on average only 5 times per month.
- Wine at 5. People in all Blue Zones (except Adventists) drink alcohol moderately and regularly. Moderate drinkers outlive nondrinkers. The trick is to drink 1 to 2 glasses per day (preferably Sardinian Cannonau wine), with friends and/or with food.
- Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter.
- Loved ones first. Successful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love.
- Right tribe. The world’s longest lived people chose-or were born into-social circles that supported healthy behaviors, Okinawans created moais-groups of 5 friends that committed to each other for life. Research from the Framingham Studies2 shows that smoking, obesity, happiness, and even loneliness are contagious.
The Predominantly Plant-Based Diet
A common dietary characteristic shared across Blue Zones is a diet that consists of approximately 95% plant-based foods. Although most individuals in these regions are not strict vegetarians, they tend to consume meat sparingly, about five times per month. A number of studies, including one in over half a million people, have shown that avoiding red meat and processed meat can significantly reduce the risk of death from heart disease, cancer, and a number of other different causes. Instead, diets in the Blue Zones are typically rich in the following:
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- Vegetables: They’re a great source of fiber and many different vitamins and minerals. Eating more than five servings of fruits and vegetables a day can significantly reduce your risk of heart disease, cancer, and death. The best of the best longevity foods in the Blue Zones diet are leafy greens such as spinach, kale, beet and turnip tops, chard, and collards.
- Legumes: Legumes include beans, peas, lentils, and chickpeas, and they’re all rich in fiber and protein. A number of studies have shown that eating legumes is associated with lower mortality. Beans are the cornerstone of every Blue Zones diet in the world: black beans in Nicoya; lentils, garbanzo, and white beans in the Mediterranean; and soybeans in Okinawa. The long-lived populations in these blue zones eat at least four times as many beans as we do, on average.
- Whole grains: Whole grains are also rich in fiber. A high intake of whole grains can reduce blood pressure and is associated with reduced colorectal cancer and death from heart disease. We found that oats, barley, brown rice, and ground corn figured into Blue Zones diets around the world.
- Nuts: Nuts are great sources of fiber, protein, and polyunsaturated and monounsaturated fats. Combined with a healthy diet, they’re associated with reduced mortality and may even help reverse metabolic syndrome. A handful of nuts equals about two ounces, which appears to be the average amount that blue zones centenarians are eating.
Other Dietary Factors
Beyond the predominantly plant-based nature of their diets, other dietary factors distinguish the Blue Zones.
- Fish Consumption: Fish is often eaten in Icaria and Sardinia. It’s a good source of omega-3 fats, which are important for heart and brain health. Eating fish is associated with slower brain decline in old age and reduced heart disease. Select fish that are common and abundant, not threatened by overfishing. Favor mid-chain fish like trout, snapper, grouper, sardines, and anchovies. To replicate a Blue Zones diet, avoid predator fish like swordfish, shark, or tuna.
- Calorie Restriction and Mindful Eating: A number of studies have also shown that eating slowly can reduce hunger and increase feelings of fullness, compared to eating rapidly. This may be because the hormones that make you feel full only reach their maximum blood levels 20 minutes after you eat. Therefore, by eating slowly and only until you feel 80% full, you may eat fewer calories and feel full longer.
- Moderate Alcohol Consumption: Consuming one to two glasses of red wine per day is particularly common in the Icarian and Sardinian Blue Zones. Sardinian Cannonau wine, which is made from Grenache grapes, has been shown to have extremely high levels of antioxidants, compared to other wines. Antioxidants help prevent damage to DNA that can contribute to aging. Therefore, antioxidants may be important for longevity.
The Role of Physical Activity
Aside from diet, exercise is another extremely important factor in aging. In the Blue Zones, people don’t exercise purposefully by going to the gym. Instead, it’s built into their daily lives through gardening, walking, cooking, and other daily chores. A study of men in the Sardinian Blue Zone found that their longer lives were associated with raising farm animals, living on steeper slopes in the mountains, and walking longer distances to work. A study of more than 13,000 men showed that these habitual activities benefit them. The amount of distance they walked or stories of stairs they climbed each day predicted how long they would live.
Social and Lifestyle Factors
Aside from diet, exercise, and rest, a number of other social and lifestyle factors are common to the Blue Zones and they may contribute to the longevity of the people living there.
- Being Religious or Spiritual: Blue Zones are typically religious communities. A number of studies have shown that being religious is associated with a lower rate of death. This may be due to social support and reduced rates of depression.
- Having a Life Purpose: People in Blue Zones tend to have a life purpose, known as “ikigai” in Okinawa or “plan de vida” in Nicoya. This is associated with a reduced risk of death, possibly through psychological well-being.
- Older and Younger People Living Together: In many Blue Zones, grandparents often live with their families. Studies have shown that grandparents who look after their grandchildren have a higher chance of living longer.
- A Healthy Social Network: Your social network, called “moai” in Okinawa, can affect your health. Okinawans also attribute their longevity to the old Confucian mantra said before meals Hara Hachi Bu, which reminds them to stop eating when 80% full, so they do not overeat.
Blue Zones Project
Blue Zones started as a way of discovering the healthiest lifestyles that lead to vitality and longevity. Now, 12 years after the start of this massive project, Blue Zones is a way to design the healthiest lifestyles possible for individuals and for entire communities.
To engineer an environment where longevity ensues, Blue Zones worked with researchers to create a blue print to optimize the Life Radius. The team started by analyzing what individuals can do for themselves. Individuals can engineer their kitchen, so they eat about 100 fewer calories and engineer their home, so they burn a couple of hundred extra calories through physical activity.
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Then, the researchers looked at places within the life radius. There are 115 evidence-based design tweaks and policies that can be put in place, so that when people show up to school, work, church, stores, and restaurants they are mindlessly nudged to eat less and move more.
Practical Tips for Emulating Blue Zone Diets
- Prioritize Plant-Based Foods: Make fruits, vegetables, legumes, and whole grains the foundation of your diet.
- Limit Meat Consumption: Reduce your intake of meat, especially red and processed meats, to a few times per month. Favor true free-range chicken and family-farmed pork or lamb instead of meats raised industrially.
- Incorporate Fish: Consume small portions of fish a few times per week, opting for sustainable choices like sardines, anchovies, and cod.
- Choose Healthy Fats: Use olive oil liberally in cooking and incorporate nuts and seeds into your daily meals.
- Reduce Sugar Intake: Limit your consumption of added sugars and sweets, reserving them for special occasions.
- Embrace Mindful Eating: Practice eating slowly and stopping when you feel 80% full.
- Stay Active: Incorporate physical activity into your daily routine through walking, gardening, and other active pursuits.
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