Photo: Mark Epstein/Centre for Ageing Better

What are the secrets of a long and healthy life?
Jeane Calment, who died at the age of 122 years and 164 days, was the oldest person ever to have lived. She attributed her longevity to an occasional glass of Port and a diet rich in olive oil.  Scientists have speculated whether her great age was due to her genes, her diet or her social life. Sceptics have suggested that it may have been a mother-daughter fraud.

Discussions like this abound in the online world. But the current focus of the science of healthy ageing is not so much about lengthening our lifespans but compressing the number of unhealthy years we may have towards the end.

The Blue Zones project, which began over 20 ago, was one of the first holistic investigations and has influenced longevity research ever since. Scientists teamed up with National Geographic magazine and the US National Institute on Ageing to discover which areas, globally, had the highest percentage of healthy centenarians. Five geographically and culturally diverse areas were identified: Nicoya in Costa Rica; Sardinia, Italy; Ikaria, Greece; Okinawa, Japan; and a community of Seventh Day Adventists, Loma Linda, in the USA.

The original blue zones

Nicoya: This 80-mile peninsula is home to a close-knit community that values their elders, facilitating a strong sense of purpose and engagement among successful centenarians.

Ikaria: This tiny rocky island has an isolated culture, rich in tradition. Dementia and chronic diseases are uncommon and one in three Ikarians live into their 90s. They enjoy red wine, late night socialising and a relaxed, stress-free lifestyle.

Sardinia: Home to the largest community of the world’s longest-living men, people in this isolated community carry a rare gene that is linked to exceptional longevity. They also adhere to a traditional lifestyle that involves hunting, fishing and harvesting the food they eat.

Okinawa: Okinawans have less cancer, heart disease and dementia than the global average and women are the longest-lived in the world. Older people tend gardens, and their diets are rich in soy.

Loma Linda: People in this religious community in California live a decade longer than the average American. They view health as central to their faith and are vegetarians who do not smoke or drink alcohol.

The investigators dubbed these areas The Blue Zones and sent teams of anthropologists, demographers, epidemiologists and other researchers to discover what, if anything, they may have in common. They came up with nine rules for healthy living:

1. Move naturally: These communities are physically active as part of their work and daily lives. The majority live simply, without appliances, and eschew a formal exercise routine. For example, the Ikarians exercise naturally by just gardening or walking the hilly terrain to visit friends.
2. Purpose (or why I wake up in the morning): A sense of purpose, goals and meaning in life—any kind—was estimated to add up to seven years to life expectancy. In Nicoya this is called ‘plan de vida’ or reason to live and facilitates a positive outlook that keeps elders active.
3. Downshifting: All communities in the Blue Zones have natural inbuilt strategies for relieving stress. This includes prayer, napping, socialising and happy hours.
4. The 80% rule: Eating patterns are important. In the Blue Zones it is usual to eat until you are only 80% full, and to eat the smallest meal in the evening and fast until breakfast.
5. Plant slant: Plant based meals dominate the diet in all the Blue Zones. The focus is on beans, pulses and vegetables. Animal products, including dairy, are eaten occasionally and in small quantities. Processed and junk foods are seldom consumed. This has been described as the Mediterranean diet and is widely recommended by nutritionists today.
6. Wine @5: Most Blue Zoners drink alcohol regularly, but in small quantities. Preferably wine, and with a meal.
7. Belong: The majority of centenarians belong to a faith-based community—the denomination was not important. The Seventh Day Adventists in Loma Londa regard the Sabbath as a time to focus on family, God, camaraderie, and nature, and claim this relieves their stress and strengthens social networks,
8. Loved ones first: Study participants were engaged with family and community and had strong social networks. Okinawans maintain a powerful social network and have a lifelong circle of friends that supports people well into old age.
9. The right tribe: These communities share a culture that supports healthy behaviours. Blue zone authors quote scientific studies that suggest that smoking, obesity, happiness, and even loneliness are “contagious”.

These factors provided a basis for subsequent research, and there is a prolific sub-agenda for each of these categories. Not all researchers subscribe to the original Blue Zones study, but its general conclusions of have not been disputed. Ongoing research has also identified numerous additional factors for healthy ageing, including not smoking, clean air, good sleep and sexual intimacy. New Blue Zones, for example Singapore, have also been identified.

 The Blue Zones concept also has its critics, many of whom have remarked that the most important common factor is that the communities are isolated; and with the exception of Loma Linda, are islands. Others have cast doubts on the reliability of birth records, and other aspects of the study. Of more concern is recent research that shows that longevity in these areas may now be declining as younger generations adopt different diets and lifestyles.

References:

• The Blue Zones website: https://www.bluezones.com/
• Deiana L, et al. The Sardinia Study of Extreme Longevity. 1999 Jun;11(3):142-9. PMID: 10476308.
• Blue Zones: Lessons from the world’s longest lived. Dan Buettner and Sam Skemp. American Journal of Lifestyle Medicine, 2016.
• Gavrilova NS,et al. Okinawa diet and longevity. Gerontology. 2012;58(3):221-3; discussion 224-6. doi: 10.1159/000329894.