THE BLUE ZONES
Where There is Great Longevity and Health*
A Danish population-based twin study on general health in the elderly showed that only about 25 percent of how long we live is determined or dictated by genes. The other 75 percent is determined by our lifestyles and the everyday choices that we make. It follows that if we optimise our lifestyles, we can maximise our life expectancies within our biological limits.
If you live to be a 100 years old, what sort of a 100-year-old are you going to be? Are you going to bed ridden and unable to take care of yourself? Or are you going to be reasonably independent and alert.
The Blue Zones
What is the meaning of the term ‘Blue Zone’? Dr Michael Poulain, researching longevity in Sardinia, established the Extreme Longevity Index. This index considered all the centenarians born in Sardinia between 1880 and 1900 [his studies were carried out in 2000]. He recognised that the mountainous region, Barbagia, in the district of Ogliastra in Italy, had some of the longest-lived people in Sardinia. He circled the area on a map with blue ink - giving rise to the term ‘Blue Zone’.
The Blue Zone phenomenon primarily affected men. These men appeared to retain their vigour and vitality longer than men almost anywhere else. In most developed parts of the world, women centenarians outnumbered men four to one. In Barbagia, the ratio was one to one.
Later, the term ‘Blue Zone’ was adopted by demographers to include longevity pockets around the world.
The following are notes extracted from the book The Blue Zones. 9 Lessons for Living Longer by Dan Buettner, and include his conclusions and recommendations based on extended visits to each of the Blue Zones and research carried out by him and his colleagues.
Each of the Blue Zones revealed its own recipe for longevity. But many of the fundamental ingredients were the same. These common ingredients form his "Nine Lessons of Living Longer".
The five ‘Blue Zones’ analysed in Dan Buettner’s book are:
· The Barbagia region of Sardinia, Italy
Sardinia is the 2nd largest island in the Mediterranean Sea and is an autonomous region of Italy. It is located 120 miles (192 Km) west of mainland Italy. The population is 1.6 million.
· Okinawa in Japan
The Okinawa prefecture is the southernmost prefecture of Japan. It comprises hundreds of the Ryukyu Islands in a chain over 1000Km long. The Ryukyus extend southwest from Kyushu to Taiwan. The population is 1.3 million.
· The Seventh-Day Adventist community of Loma Linda in California
Loma Linda is a city in San Bernardino County, California, United Sates. The population in 2010 was 22,216. The city has a total area of 7.5 square miles (19 square km). Loma Linda is the centre of activity for the Seventh-day Adventist (SDA) church and is home to the Loma Linda University, an SDA Christian health sciences Institution of higher learning, with a world renowned Medical Centre.
· The Nicoya Peninsula in Costa Rica
The Nicoya Peninsula is on the Pacific side of Costa Rica.
· The Greek island of Ikaria
Ikaria (Icaria) is a Greek island in the Aegean Sea, 10 nautical miles (19km) southwest of Samos. The island is 98 square miles (255 sq. km) with a population of 8,312. The island is mostly mountainous.
The Sardinian Blue Zone
"Where women are strong, family comes first, and health springs from the rugged hills."
The things Sardinian men have in common are strong will, high self esteem, and great stubbornness.
Arzanol is a potent mPGES-1 inhibitor: an anti-inflammatory agent. It is isolated from the Sardinian dwarf curry plant found on the slopes of the Gennargentu Mountains of Sardinia and around the village of Arzana. It has anti-inflammatory, anti-HIV, and antioxidant properties. It may be useful in the treatment of diseases involving inflammatory mediators such as autoimmune diseases and cancer. It is said to be one of the most powerful anti-inflammatory drugs ever found. Sheep do not eat this plant, while goats do. This may be one of the clues as to the longevity of Sardinians, as goat milk is routinely consumed.
The Sardinian men walk great distances, with mountain climbing being routine. Walking five miles (8km) a day or more provides the type of low-density exercise that yields all the cardiovascular benefits necessary for health, and also has a positive effect on muscles and bones - without the joint-pounding damage caused by running marathons and triathlons. Sardinian male centenarians seem to avoid bone loss and fractures. One Italian study has shown that Sardinian centenarians reported less than half as many fractures as the average Italian centenarian.
The Sardinian diet was lean and largely plant-based with an emphasis on beans, whole wheat, and garden vegetables, often washed down with flavonoid-rich wine. Also, the diet included goat milk and mastic oil. [Pistaria lentisxus is a deciduous evergreen shrub or small tree from which mastic is harvested: originally a liquid, it dries to a brittle, translucent resin.]
Sardinia's Blue Zone Lessons
· Eat a lean, plant-based diet accented with meat.
The classic Sardinian diet consists of whole-grain bread, beans, garden vegetables, fruits, and in some parts of the island, mastic oil. Pecorino cheese, made from grass-fed sheep, is high in omega-3 fatty acids and is traditionally eaten. Meat is largely reserved for Sundays and special occasions.
· Put family first.
Sardinia's strong family values help assure that every member of the family is cared for. People who live in strong, healthy families suffer lower rates of depression, suicide, and stress.
· Drink goat milk.
A glass of goat milk contains compounds that might help protect against inflammatory diseases of ageing such as heart disease and Alzheimer's disease.
· Celebrate elders.
Grandparents can provide love, childcare, financial help, wisdom, and expectations/motivations to perpetuate traditions and push children to succeed in their lives. This may all add up to healthier, better adjusted, and longer-lived children.
· Take a walk.
Walking five miles a day or more as Sardinian shepherds do provides all the cardiovascular benefits you might expect, and also has a positive effect on muscle and bone metabolism.
· Drink a glass or two of red wine daily.
· Laugh with friends.
Men in this Blue Zone of Sardinia are famous for their sardonic sense of humour. Laughter reduces stress, which can lower one's risk of cardiovascular disease.
The Blue Zone in Okinawa
"Sunshine, Spirituality, and Sweet Potatoes"
In Okinawa, people enjoy what may be the highest life expectancy, and one of the highest centenarian concentration ratios (5 per 10,000). They suffer from diseases that kill Americans [and Australians], but at much lower rates: a fifth the rate of cardiovascular disease, a fourth the rate of breast and prostate cancer, and a third the rate of dementia.
The idea of retirement never occurred to the Okinawan peasant. To this day, there is not a word for it in their language.
"Hara hachi bu". This is a Confucian-inspired adage, meaning "Eat until you are 80 percent full". All the older Okinawans say it before they eat. It keeps them from eating too much. Another Japanese proverb is "Eight parts of a full stomach sustain the man; the other two sustain the doctor."
The blood of both male and female centenarians has higher levels of sex hormones. Soy products that contain phytoestrogens are better than hormone supplements. Okinawans eat an average of three ounces of soy products per day. Tofu is their main source of soy. [Tofu is non-fermented soy, as is soy milk. Fermented soy is better and includes miso, soy sauce, tempeh and natto.]
Roles are very important in Okinawa. It is called ikigai -- the reason for waking up in the morning.
"Okinawans see vegetables. I see powerful anti-inflammatory, anti-viral, anti-cancer drugs." (Dr Greg Plotnikoff.)
"It is not only what Okinawans eat, but how much. Their food has a very low calorie density, yet it is very nutritious. Compare a typical Okinawan meal - a tofu stir-fry, some miso soup, and some greens to an American hamburger. The Okinawan meal has three or four times as much volume and more nutrients but only about half the calories of a burger. So you're feeling fuller but getting leaner and living longer." (Dr Greg Plotnikoff)
Dr Nobuyoshi Hirose discovered that the daily intake of protein, fat, carbohydrate, and total calories was lowest among centenarians (mostly because of their lower body weight).
Okinawans enjoy sunlight exposure, with resultant vitamin D production. Vitamin D is an important ingredient in the longevity recipe. Without vitamin D, we increase our risk for nearly all age-related diseases including many types of cancer, high blood pressure, diabetes and autoimmune diseases like multiple sclerosis.
Owkinawans also have an extra vitamin, Vitamin S!. “You Smile in the morning and it fortifies you all day long”.
Dr Hirose found that Japan has seven super-centenarians per million people, referring to those over age 110. In Okinawa, the rate is 35 super-centenarians per million.
Okinawa's Longevity Lessons
- Embrace an ikigai (a role).
- Rely on a plant based diet.
- Eat more soy.
- Enjoy the sunshine for optimal vitamin D.
- Stay active.
- Maintain an active garden, including medicinal plants such as ginger and turmeric.
- Have a secure social network.
Loma Linda - An American Blue Zone
"The Longevity Oasis in Southern California"
The Seventh Day Adventist church is a fundamentalist Bible based Christian church. Worldwide there are more than 70,000 churches with a baptised membership of some 18.2 million, and 175 hospitals. Loma Linda has the largest SDA church with some 7,000 members.
Their (recommended) diet is lacto-ovo-vegetarian which allows milk and eggs but not animal flesh. Smoking is not allowed, and they abstain from alcohol, tea, coffee and all caffeine-containing beverages and foods. They take their diet directly from the Bible, Genesis 1:29: "And God said: ' Behold, I have given you every herb yielding seed .... and every tree, in which is the fruit of a tree yielding seed; to you it shall be for food'".
In 1973, the 100,000 members of the Seventh-day Adventist church in California were asked to participate in the "Adventist Health Study" (AHS), a planned 15-year study conducted by the Loma Linda University. Only about 50% adhered to the SDA recommended diet and abstinences (alcohol etc). The following are some of the results:
- Those who ate higher quantities of red meat, fatty foods, eggs and coffee could be compared to those who emphasise fruits and vegetables or those who had a relatively small intake of most foods, thus consuming relatively few calories. The high fat/meat group had a risk of dying almost four times greater than either of the other two dietary patterns in the younger age group (30-50 years), with this advantage remaining discernible and sustained into the 80's.
- Consuming a variety of fruits and vegetables decreases the risk of cancer of the pancreas, colon, lung, and perhaps kidney and stomach.
- Meat eating appears to increase the risk of bladder and maybe even of colon cancer. Eating flesh foods more than once a week was related to doubling the risk of bladder cancer.
- Statistics demonstrate a clear relationship between the consumption of nuts at least five times a week and an almost 50% reduction in the risk of coronary heart disease compared to Adventists who ate nuts only once a week, even when adjusted for intake of meat, other dietary habits, past smoking, diabetes, hypertension, exercise, and obesity.
- A relationship of almost the same significance as nuts was shown between eating whole wheat and reduced heart disease. Those who ate whole wheat bread, as opposed to white bread, had a 40% decrease in the risk of a heart attack.
- Eating fruit three or more times a week reduced the risk of lung cancer by two-thirds compared to rarely eaten fruits (independent of smoking or not smoking).
- Eating beans, peas, lentils, raisins, dates, or dried fruits at least three times a week markedly reduced the risk of pancreatic cancer, an uncommon but usually fatal disease.
- Men who ate dried fruits three or more times a week decreased their risk of prostate cancer by 40%.
Except for the causes of death strongly related to alcohol or tobacco, Seventh-day Adventists die from basically the same diseases as the general population. However their age-adjusted mortality rates are low because they tend to die much later in comparison to the general population. Apparently, the Seventh-day Adventists have less exposure to causative factors, more exposure to protective factors, and so are more resistant to disease.
Loma Linda's Blue Zone Secrets
The above study, conducted by the University of Loma Linda, surveyed the Seventh-day Adventists in California. The following conclusions, and recommendations, are based on the study of the lifestyles of centenarians of Loma Linda.
· Find a sanctuary in time.
Take a weekly break from the rights of daily life. For the SDA, this is the weekly 24-hour Sabbath, which they celebrate on Saturday. Adventists claim that this relieves their stress, and strengthens social networks.
· Maintain a healthy Body Mass Index (BMI).
Adventists with their healthy BMIs [20-25] who keep active, and eat meat sparingly, if at all, have lower blood pressure, lower blood cholesterol, and less cardiovascular disease than heavier Americans with higher BMIs. [26-30 is overweight, 30+ is obesity]
· Get regular, moderate exercise.
The Adventist Health Survey shows that you don't have to be a marathoner to maximise your life expectancy. Getting regular, low-intensity exercise (daily walks) appears to help reduce your chance of having heart disease and certain cancers.
· Spend time with like-minded friends.
· Snack on nuts.
Adventists that consume nuts at least five times a week have about half the risk of heart disease and live about 2 years longer than those who don't.
· Give something back.
The SDA Church encourages and provides opportunities for its members to volunteer.
· Eat meat in moderation.
Many Adventists (~50%) follow a vegetarian diet. The AHS shows that consuming fruit and vegetables and whole grains seem to be protective against a wide variety of cancers.
· Eat an early, light dinner.
"Eat breakfast like a king, lunch like a prince and dinner like a pauper", as recommended by Adele Davis (an American nutritionist), is an attitude also reflected in Adventist practices.
· Drink plenty of water.
The AHS suggests that men who drank 5 to 6 daily glasses of water had a substantial reduction in the risk of a fatal heart attack - 50-70% - compared to those who drank considerably less.
Costa Rica's Blue Zone
"Tortillas and Beans, Hard Work, and Something in the Water"
The Nicoya Peninsula is in the northwest of Costa Rica. Until recently, this was one of the most isolated regions of Costa Rica.
As in all Blue Zones, the ages of the centenarians were carefully checked. Different methods were used in the different zones.
Like other people in the Blue Zones, the Nicoyans ate a low calorie, low-fat, plant-based diet, rich in legumes. Unlike other Blue Zones, the Nicoyan diet featured portions of corn tortillas at almost every meal and huge quantities of tropical fruit.
The corn (maize) is dried, then soaked and cooked in an alkaline solution, usually lime water, to loosen the tough outer skin. It is then ground, made into dough, and patted into tortillas. It is believed that corn is the most significant component of the Nicoyans’ diet. The lime (calcium hydroxide) that is used in the cooking of the kernels makes all the difference. It infuses the grain with a high concentration of calcium and unlocks certain amino acids. The Nicoyans call the resulting maize dough maiz nixquezado. The process is called nixtamalization.
Nicoyans’ (of Costa Rica) Longevity Secrets
From the research done looking at all aspects of their lives, not just the diet, the secrets of the longevity of the Nicoyans of Costa Rica include the following:
· Have a purpose ... a Plan de Vida.
Successful centenarians have a strong sense of purpose. They feel needed and want to contribute to a greater good.
· Drink hard water.
Nicoyan water has the country's highest calcium content, perhaps explaining the lower rates of heart disease, as well as stronger bones and fewer hip fractures.
· Keep a focus on family.
Nicoyan centenarians tend to live with their families, and children or grandchildren provide support and a sense of purpose and belonging.
· Eat a light dinner.
Eating fewer calories appears to be one of the surest ways to add years to your life. Nicoyans eat a light dinner early in the evening.
· Maintain social networks.
Nicoyan centenarians get frequent visits from neighbours. They know how to listen, laugh, and appreciate what they have.
· Keep hard at work.
Centenarians seem to have enjoyed physical work all their lives. They find joy in everyday physical chores.
· Get some sensible sun.
Nicoyans regularly take in sunshine, which helps their bodies produce vitamin D, for stronger bones and healthy body function.
· Eat a healthy diet.
Their healthy diet is plant-based (low in calories and low in fat) including their traditional diet of fortified maize (corn) and the tortillas made from it, and beans. Very little meat (mainly pork) is consumed, and only on special occasions.
The Island of Ikaria - The Greek Blue Zone
"Where People Forget to Die"
Ikaria's longevity recipe is woven into their lifestyle.
"Just 15 kilometres over there you have the island of Samos. It's a completely different world. There they are much more developed. There are high-rises and resorts and homes worth millions of euros. In Samos, they care about money. Here (Ikaria) we don't. For the many religious and cultural holidays, people pool their money and buy food and wine. If there is money left over, they give it to the poor. It's not a ‘me’ place. It's an ‘us’ place."
Ikarians eat a version of the Mediterranean diet, a menu rich in olive oil and vegetables, low in dairy and meat, with some alcohol daily. There is an abundance of potatoes, goat milk, beans, and some fruit. Seasonally, more than 150 varieties of greens that grow wild are gathered for salads.
The panacea in Ikaria is honey. They use it for everything from treating wounds to curing hangovers, or for treating influenza. Old people start their day with a spoonful of honey. They take it like medicine.
Typical diet: breakfast of goat milk, condensed wine, sage tea or coffee, and honey and bread. Lunch was always beans (lentils, garbanzos), potatoes, greens, and whatever seasonal vegetables their garden produced. Dinner was bread and goat milk. Meat was reserved for festivals and holidays, when they would slaughter the family pig.
The team investigating the longevity of the Ikarians was 15 scientists and producers.
Studies of Ikaria's longevity showed that the island had three times as many healthy people over age 90 as the rest of Greece (relative to population), equal numbers for male and female. (In most developed countries, women over 90 outnumber males over 90 by four to one).
It is relevant to pay attention to how they prepare their food, not just what they eat.
A preliminary study suggested that about 80% of Ikarian males between the ages of 65 and 100 were still having sex, over a quarter of those doing so regularly with "good duration" and "achievement".
The Ikarians have regular naps. A recent study by the University of Athens Medical School on 23,000 Greek adults, who were followed for an average of 6 years, measured their diet, physical activity, and how much they napped. They found that occasional napping decreased a person's risk for coronary heart disease by 12%, but that regular napping decreased their risk by 37%.
Not only were the people of Ikaria reaching 90 at extraordinary rates, they were also living about five to ten years longer before succumbing to common diseases such as cancer. In addition, among Greeks under 80, Ikarians suffered half the rate of cardiovascular disease, a third of the rate of depression and exceedingly low rates of dementia.
Teas were made from different herbs. Tea drinking was routine for the Ikarians. The five most commonly consumed teas were analysed by the University of Athens. All of the herbal teas showed strong antioxidant properties and were rich sources of polyphenols. They also had mild diuretic properties (diuretics lower and control blood pressure).
The island of Ikaria is for the most part mountainous. Walking up and down the steep slopes is the standard exercise. They don't go to gyms or engage in vigorous exercises. Exercise was part of every day living.
In the longevity of the Ikarians and well as the other Blue Zones there is NO single silver bullet. The power lies in the mutually reinforcing relationship between lots of little bullets - silver buckshot.
Ikaria's Blue Zone secrets:
· Goat milk provides a great source of calcium, potassium, and the stress-relieving hormone tryptophan. Goat milk is very similar to human milk and provides oligosaccharides, which promote healthy intestinal flora.
· The longest living Ikarians tended to be poor people living in the island's highlands. Exercise is part of the daily routine.
· Ikarians eat a variation of the Mediterranean diet, with lots of fruits and vegetables, whole grains, beans, potatoes, and olive oil.
· People in Ikaria enjoy drinking herbal teas, which have a significant antioxidant content.
· Take a cue from the Ikarians and take a mid-afternoon nap. People who nap regularly have up to 35% lower chance of dying from heart disease.
· Fasting or caloric restriction is part of their religious beliefs. The Ikarians have traditionally been fierce Greek Orthodox Christians. Caloric restriction is the only proven way to slow the ageing process in mammals.
· Ikarians foster social connections, which have been shown to benefit overall health and longevity.
Putting the Blue Zone Lessons to Work in Your Life
The above are some of the highlights from the work of Dan Buettner and colleagues. For more details, as well as interviews with many centenarians in the five Blue Zones, his book The Blue Zones is a "must read". A summary of the findings from the five Blue Zones are set out in the book as "9 Lessons for Living Longer". The following is an abridged version of these 9 lessons.
1) Move Naturally
"Be active without having to think about it"
Longevity all-stars don't run marathons or compete in triathlons; they don't transform themselves into weekend warriors on Saturday mornings. Instead, they engage in regular low-intensity physical activity, often as part of a daily work routine. The data suggests that a moderate level of exercise that is sustained is beneficial. An ideal routine would include a combination of aerobic, balancing, and muscle-strengthening activities. In all longevity cultures, regular, low-intensity activities are routine.
2) Hara Hachi Bu
"Painlessly cut calories by 20 percent”
The Okinawan elders intone this Confucian-inspired adage before eating: hara hachi bu - a reminder to stop eating when their stomachs are 80% full. Stop eating as soon as you no longer feel hungry .... not when "I'm full". This becomes a way of life. It is not a diet. It is a way of eating.
3) Eat a Plant-Based Diet
"Avoid meat and processed foods"
Most centenarians in Nicoya, Sardinia, and Okinawa never had the chance to develop the habit of eating processed foods, soda pop, or salty snacks. For much of their lives, they ate small portions of unprocessed foods. They avoided meat - or more accurately, didn't have access to it - except on rare occasions. They ate what they produced in their gardens, supplemented by staples: durum wheat (Sardinia), sweet potato (Okinawa), and maize (Nicoya). Strict Seventh-day Adventists avoid meat completely. A plant based diet provides adequate protein. Beans, whole grains, and garden vegetables are the cornerstones of all these longevity diets. Tofu (soy-bean curd) is a daily feature of the Okinawan diet. Nuts should be an important constituent of the diet.
4) Grapes of Life
"Drink red wine (in moderation)"
Epidemiological studies seem to show that people who have a daily drink of beer, wine, or spirits may accrue some health benefits. The Secrets of the Blue Zone suggest that consistency and moderation are key. Red wine offers an extra bonus because of the polyphenols. Caution: there are toxic effects of alcohol on the liver and brain. Moderation, a glass of alcohol with a meal, is the ideal.
5) Purpose Now
"Take time to see the big picture".
Okinawans call it ikigai, and the Nicoyans call it plan de vida, but in both cultures the phrase essentially translates to "why I wake up in the morning". They have a strong sense of purpose. Studies have shown that, when people had a clear goal in life - something to get up in the morning, something that made a difference - they lived longer and were sharper than those who did not. A new activity can give you a purpose. Exercising the brain is important.
"Take time to relieve the stress"
People who have made it to 100 seem to exude a sense of sublime serenity. Take time to smell the flowers along the way. Take a day of rest each week, as the Seventh-day Adventists do. Take time to meditate. "Life is short. Don't run so fast you miss it".
"Participate in a spiritual community".
Healthy centenarians everywhere have faith. The Sardinians and Nicoyans are mostly Catholic. Okinawans have a blended religion that stresses ancestor worship. Loma Linda centenarians are Seventh-day Adventists. Ikarians have traditionally been Greek Orthodox. All belong to religious communities. The simple act of worship .... in whatever way …… is one of those subtly powerful habits that seem to improve your chances of having more good years. It doesn't matter if you are Muslim, Christian, Jewish, Buddhist, or Hindu. Generally, the faithful are healthier and happier. Belonging to a religious community can foster larger and denser social networks.
8) Loved Ones First
"Make family a priority".
The most successful centenarians in the Blue Zones put their family first. Families represent the highest degree of social network. All generations of a family should make a point of spending time together. "Successful families make a point of eating at least one meal a day together, taking annual vacations together etc."
9) Right Tribe
"Be surrounded by those who share Blue Zone values".
This is perhaps the most powerful thing you can do to change your lifestyle for the better. Social connectedness is ingrained into the world's Blue Zones. Studies (independent of the Blue Zones) have shown that those with the most social connectedness lived longer. Higher social connectedness led to greater longevity. One study, over a nine-year period, showed that those with least social connectedness were between two and three time more likely to die than those with the most social connectedness. The type of social connectedness was not important in relation to longevity - as long as there was connection.
Don Buettner ends his book:
"As my centenarian friends showed me, the choice is largely up to us."
*Copyright 2015: The Huntly Centre.
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