The “blue zones” and countries where the longest living people are from
One of the keys to understanding how we can live longer healthier lives is by studying healthy populations of the oldest people living around the world.
The most popular study of these populations is the blue zone research made famous by Dan Buettner’s book Blue Zones and by research from Michel Poulain, Gianni Pes and Anne Herm. According to Blue Zones, the longest living people are from:
- Sardinia, Italy
- Okinawa, Japan
- Nicoya, Costa Rica
- Loma Linda, USA
- Ikaria, Greece
These locations are called blue zones because when Michel Poulain first found populations of exceptionally healthy older individuals in Sardinia, he marked the zones on a map with blue ink.
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Table of contents: Where are the longest living people from?
- Sardinia, Italy
- Okinawa, Japan
- Nicoya, Costa Rica
- Loma Linda, USA
- Ikaria, Greece
- What do these long living people have in common?
- How do we know this data is actually correct given how old the records are?
- Other places around the world with high life expectancy
- What do the longest living people and cultures eat?
- Do blue zones drink coffee or tea?
Interesting features and findings: Genetically isolated, rocky and hilly area, they drink red wine from cannonau grapes.
Sardinia is a small island off the west coast of Italy. It’s home to towns like Barbagia which have a high number of centenarians, a disproportionate number of which are males. Sardinians from these blue zones came from a historically isolated genetic group. This means some of their genes are positively amplified such as longevity among males and resistance to malaria.
According to research on Danish twins, genes only contribute to 25% of how long you’ll live with the other 75% being a result of your lifestyle, including food and physical activity. Sardinians living in blue zones like Fonni, Gavoi, Villagrande Strisaili and Arzana have a number of food and lifestyle habits that supposedly contributes to their longevity, including:
- Eating a mostly vegetarian diet. Sardinians eat a diet full of whole-grain breads, fava beans, garden vegetables, fruits, mastic oil, pecorino cheese and occasional meat on the weekend.
- They put family first. Families prefer to personally take care of their elderly relatives rather than leaving them in an aged-care facility. Research shows that living with your family in old age has numerous health benefits.
- They celebrate their elders. Elders are respected in Sardinian culture and provide numerous benefits to the younger generations including financial aid, motivation and encouraging them to continue traditions.
- They walk a lot. All of the centenarians Beuttner interviewed were hard-working farmers or shepherds who were very active each day. Buettner recommends walking 5 miles (8 km) or more each day to get the cardiovascular benefits without the joint damage or running.
- Drinking a glass or two of red wine each day. Sardinians regularly drink homemade wine. This is made from cannonau grapes, which are very dark and have 2 – 3 times the amount of flavonoids in it than other wines. Flavonoids may help protect against free radicals and may even help with lowering blood pressure.
- They laugh with friends. Sardinians are regularly reducing stress by hanging out with friends and laughing.
Interesting features and findings: Close-knit social groups, they eat high amounts of soy, they have a clear life purpose
Okinawa is a Japanese island between mainland Japan and Taiwan. At the time Buettner wrote Blue Zones, Okinawan women had the highest life expectancy in the world.
Buettner wrote about the many things he noticed Okinawans did (listed below) but two that really stuck out to me is that these Okinawans ate a diet that was calorically light but nutritionally dense, and they only ate until 80% full.
Unfortunately while there’s a higher percentage of centenarians (people over 100) and supercentenarians (people over 110) in Okinawa, recent changes to diet and lifestyle (Okinawans import 5 million pounds of Spam each year and are Japan’s biggest hamburger eaters) mean that it now has Japan’s highest levels of obesity.
The centenarians interviewed for Blue Zones had a number of healthy habits:
- They live purpose-filled lives. The elderly Okinawans interviewed in the book had a clear reason for waking up, called an ‘ikigai’.
- They eat mostly plant based. Okinawans traditionally eat lots of sweet potato, tofu and vegetables, with pork eaten at special occasions.
- They stay active and eat well by gardening. Gardening means Okinawans keep active, have a steady supply of vegetables to eat and helps to reduce stress. It also means they grow lots of medicinal plants like turmeric and mugwort.
- They eat lots of soy. Okinawans regularly eat tofu and miso soup, which contains soy. Soy contains flavonoids which may have a range of health benefits.
- They are socially active in their close-knit friend circles, called a ‘moai’. Okinawans regularly meet with their close social circles, which can have financial, emotional and stress reducing benefits.
- They get adequate vitamin D through sun exposure. Okinawans are often outside and absorb vitamin D, which may help reduce bone fractures in the elderly.
- They regularly walk and stay active. Okinawans sit on the floor get up and down regularly each day. This may help them maintain their lower body strength and their balance.
- They have a good attitude. Being likeable when you’re older may actually help you live longer by giving you a wider support network.
Loma Linda, California, USA
Interesting features and findings: They follow religious health guidelines including a forced-rest day (the Sabbath), they eat a light dinner
Loma Linda is a blue zone in California. According to Buettner, part of the reason for the higher number of centenarians here is because it contains a large population of Seventh-Day Adventists.
The Seventh-day Adventist Church is a denomination of Christianity that follows healthy guidelines discouraging smoking, drinking and eating large amounts of meat. At the time of writing Blue Zones, Loma Linda had the highest life expectancy in the USA.
The Adventist Health Study 1 (AHS-1) which began in the late 70s, showed that 30 year old vegetarian Seventh-Day Adventist men live 9.5 years longer than the average white 30 year old Californian man. Vegetarian Seventh-Day Adventist women live 6.1 years longer than the average 30 year old white Californian woman. The newer AHS-2 began in 2002 and is currently still underway but is showing some early findings.
There are a number of food and lifestyle choices the Loma Linda Seventh-Day Adventists follow including:
- They observe the sabbath. Seventh-Day Adventists have a 24-hour Sabbath period each week where they rest and cease regular work activities to be with family and friends. This helps them to reduce stress and build up their social networks.
- They have healthy BMIs. The Adventists Buettner studied had healthy BMIs, and when combined with a low meat diet, showed less cardiovascular disease and lower blood pressure and blood cholesterol than Americans with a higher BMI.
- They get regular, moderate exercise. Like other blue zone residents, the AHS-1 study found that regular low-intensity exercise including walking reduced the chance of some cancers and heart disease.
- They spend time with like-minded people. Adventists tend to spend time with other Adventists, reinforcing their healthy habits.
- They eat lots of nuts. Adventists who ate nuts at least five times per week reduced their risk of heart disease by 50% and lived 2 years longer than those who didn’t.
- They volunteer and give back regularly. This may help reduce depression and contribute to a sense of purpose.
- They eat meat in moderation and eat lots of plants. This is a common thread in Blue Zones, and has a number of claimed health benefits including protection from a number of cancers.
- They eat a light, early dinner. This means they’re not taking in a large number of calories during the most inactive period of the day.
- They drink plenty of water. According to the AHS-1 study, men who drank 5 – 6 glasses of water each day had a 60 – 70% lower risk of heart attack.
Nicoya, Costa Rica
Interesting features and findings: Their water has high calcium content, they tend to live with their families, they have common Chorotega Indian heritage
The Nicoya Peninsula in the west of Costa Rica is home to just under 50,000 people, with a higher percentage than normal who are centenarians.
Nicoyans also eat lots of corn and use lime to help prepare the corn kernels for cooking. This may infuse the corn with calcium which protects against heart disease and also strengthens bones (hip fractures are a leading cause of death for the elderly).
Most of the high functioning 90+ year olds in Nicoya have a strong sense of purpose and service to their families, and interestingly, the majority of the men interviewed in Blue Zones had extra lovers in addition to their spouses.
According to Blue Zones, the longevity lessons from Nicoya include:
- Having a strong sense of purpose. The centenarians from Nicoya felt needed, like many of the blue zoners in this list.
- Drinking “hard” water. The water they drink has very high calcium content which may explain their stronger bones and lower heart disease rates.
- They tend to live with their family. Those who live with their family in old age can have less accidents and and eat healthier than those who don’t.
- They only eat a light dinner. Nicoya centenarians eat a small dinner similar to the Okinawans and Adventists in other blue zones.
- They maintain social networks. The elderly in Nicoya are socially active and regularly visit and receive visitors. This may help to reduce their stress.
- They work hard physically. Like the others on this list, the centenarians in Nicoya have worked physically hard their whole lives.
- They regularly get sunshine. The centenarians in Nicoya receive sensible amounts of sunshine, which helps their bodies to produce vitamin D. This can help avoid bone fractures and osteoporosis.
- They have a common heritage. Many of the centenarians in Nicoya have a common Chorotega Indian heritage which has a traditional corn and bean diet and is low in stress.
Interesting features and findings: They drink goat’s milk, they nap regularly, they occasionally fast for religious reasons
Ikaria is a rocky Greek island near the west coast of Turkey. It has 3x the number of healthy people over 90 compared to the rest of Greece, with equal numbers of healthy males and females (usually women outnumber men 4:1 in developing countries at these ages).
Ikarians basically eat a Mediterranean diet with lots of vegetables, greens, olive oil, beans, fruit, low amounts of meat and diary and a moderate amount of alcohol. They also drink herbal teas including rosemary and oregano.
Like many of the blue zones, Ikaria has a strong sense of community, and the residents here exercise by walking and gardening.
The longevity lessons from Ikaria include:
- Drink goat’s milk. Those in the Ikaria blue zone drink plenty of goat’s milk, which has calcium, potassium and tryptophan, a stress-reducing hormone.
- They exercised effortlessly. Ikaria is a mountainous area, so the residents of its blue zone get a good workout just gardening or walking to a friend’s house.
- Eat a mediterranean-style diet. Mediterranean diets include lots of olive oil, fruits and vegetables.
- Drink herbal tea. Ikarians drink rosemary, oregano and sage teas which act as diuretics and can help to regulate blood pressure.
- They nap regularly. According to Blue Zones, those who nap regularly have a 35% lower chance of dying from heart disease.
- Infrequent fasting. Ikarians regularly cut calories for religious reasons, which may have a number of health benefits.
- Make family and friends a priority. Ikarians regularly visit friends and family and have strong networks, which can benefit longevity and health.
What do these long living people have in common?
Buettner and the researchers studying blue zones boiled down the lessons from each culture into 9 common habits:
- Move naturally. The centenarians studied in Blue Zones got their daily physical exercise needs met through their jobs, gardening or walking. Buettner recommends low intensity, regular physical activity, for 30 – 60 minutes per day.
- Eat until you’re only 80% full. A common theme from Blue Zones is that the overall calories eaten by the residents there was low e.g 1,900 calories per day for Okinawans and 2,000 calories for Sardinians. Eating until you’re only 80% full effectively means you’re cutting calories by 20%, and calorie restriction is one of the ways animal life has been prolonged in lab tests. Buettner gives suggestions such as eating from a smaller plate or buying smaller packages of food.
- Avoid meat and processed foods. None of the blue zone residents were expressly vegetarian or vegan apart from some of the Seventh-Day Adventists in Loma Linda. But even if the other blue zone residents weren’t calling themselves vegetarians, they didn’t have regular access to meat. The benefits of a diet lower in meat is something that’s also explored in Dr Valter Longo’s book The Longevity Diet. None of the blue zone residents ate diets regularly featuring processed foods like soft drinks. On the other hand, most blue zone centenarians ate beans, whole grains and garden vegetables. Buettner also suggests nuts are a vital part of a longevity diet.
- Drink red wine in moderation. Buettner suggests many of the centenarians from the blue zones he studied drank wine (or sake in Okinawa), but implores readers to drink in moderation. As he explains, alcohol has been associated with lower rates of heart disease, and red wine in particular has polyphenols which can help protect against arteriosclerosis (thickening and hardening of blood vessels).
- Find your purpose. Many of the blue zone centenarians woke up with a clear sense of purpose. Buettner points to research by Dr Robert Butler showing that those aged between 65 – 92 who had a clear goal in life lived longer. You might see your purpose as being present for your grandchildren, to get better at a hobby or you may still have a job. In the Blue Zones book, Nicoyan centenarian Don Faustino travelled to the markets every Sunday to do his grocery shopping so that he could cook a soup for his family after church.
- Take time to relieve stress. Another commonality between long-living blue zoners is that they reduce stress by slowing life down. The Seventh-Day Adventists of Loma Linda have the Sabbath where they don’t work or do organised sports, but instead relax and spend time together. Buettner suggests stress reduction techniques like meditating, leaving for events early so you can take your time getting there and reducing time spent with the internet, TV and radio.
- Participate in a spiritual community. Most of those studied in the blue zones research project had religious faith. Buettner lists research from 2004 by Marc A. Musick and others showing that those who participate regularly in religious activities once per month have a 30 – 35% reduced risk of death in the 7.5 year follow-up period. Religious activities can encourage people to follow healthy habits, self-reflect and meditate. Buettner suggests ethical societies for non-religious readers, and there are groups like Oasis in some parts of the USA which are non-faith communities.
- Make family a priority. Blue zone research suggests those who invest more in their families live longer. This is because those that invest in their families have their families to help them as they grow older. Research shows that those who live with their families have less accidents, eat healthier and are less stressed.
- Be surrounded by those with blue zone values. Regularly interacting and spending time with those who also have beneficial attitudes to longevity can reinforce these attitudes in yourself. Buettner suggests that you carefully think about your inner circle and spend more time with those who have good blue zone habits.
How do we know this data is actually correct given how old the records are?
A recent pre-printed research paper suggested that the blue zones tend to be in places where birth records are notoriously unreliable or fraudulent. Fraud may be used by the relatives of the elderly in order to receive pensions, and error may be present because of calamitous world events such as the end of World War 2 in Japan.
There’s also well known cases of supercentenarians like the record-breaking Jeanne Calment which some researchers argue may also be fraudulent.
Buettner has responded to these claims on his friend Garth Davis M.D’s website.
Other places around the world with high life expectancy
There’s not a whole lot of information about where other blue zones might exist. While Blue Zones only contained 5 locations, demographer Michel Poulain, the original pioneer of the blue zone research hinted that Crete and Majorca were potential candidates, but “Not so special as Sardinia”.
If we look more broadly, according to the World Health Organisation’s 2016 data, the 10 countries with the highest average life expectancy at birth for both sexes are:
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For males, the top 10 countries for life expectancy from birth are:
For females, the top 10 countries for life expectancy from birth are:
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What are the diets of the longest living cultures?
According to blue zone research, the longest living people regularly eat:
- Whole grains
- Garden vegetables
Additionally, Blue Zones specifically mentions a number of foods eaten by the blue zone residents:
- Corn (Nicoya, Costa Rica)
- Nuts (Loma Linda, California)
- Olive oil (Ikaria)
- Goat’s milk (Ikaria and Sardinia)
- Herbal teas (rosemary, sage and oregano in Ikaria and bitter melon, jasmine and green in Okinawa)
- Tofu (okinawa)
- Mastic oil (Sardinia)
- Pecorino cheese (Sardinia)
- Sweet potato (Okinawa)
- Red wine (Sardinia and Ikaria)
The Longevity Diet by Dr Valter Longo outlines a similar diet to that in Blue Zones for longevity, with the key points being:
- Eat two meals per day plus a snack (this depends on your body weight and muscle mass however)
- Eat mostly vegan with fish low in mercury (this can include shrimp, molluscs, anchovies and sardines)
- Limit protein to 0.31 – 0.36 grams per pound of bodyweight per day
- Eat good nuts and oils e.g salmon, almonds and walnuts
- Eat complex carbohydrates e.g whole bread and vegetables
- Condense eating to a 11 – 12 hour window
- Eat a diet low in sugar and bad fats e.g limit pasta, rice, white bread and fruit juices
- Do a fast mimicking diet 1 – 6 times per year depending on your goals
- Choose a diet similar to what your ancestors would have eaten within the above parameters
Do blue zones drink coffee or tea?
Buettner specifically mentions that Nicoyans and Ikarians regularly drank coffee.
Ikarians and Okinawans also regularly drink tea. Ikarians drink herbal teas made from rosemary, mint, dandelion, sage and wild oregano and regularly rotate them. Okinawans drink bitter melon, jasmine, fennel and green teas.
Conversely, some Seventh-Day Adventists do not drink coffee or other drinks containing caffeine.