Blue Zones

Abstract

‘However, many individuals have the capacity to make it well into the early 90s and largely without chronic disease.’

The Danish Twin Study1 established that only about 20% of how long the average person lives is dictated by our genes, whereas the other 80% is dictated by our lifestyle. In 2004, Dan Buettner, CEO of Blue Zones LLC, was determined to uncover the specific aspects of lifestyle and environment that led to longevity. By teaming up with National Geographic and the National Institute on Aging, Dan and his team, found the 5 demographically confirmed, geographically defined areas with the highest percentage of centenarians (Loma Linda, CA, USA; Nicoya, Costa Rica; Sardinia, Italy; Ikaria, Greece; Okinawa, Japan; seen in Figure 1). These 5 areas were located using epidemiological data, statistics, birth certificates, and other research. These areas were dubbed Blue Zones, where people reach age 100 at 10 times greater rates than in the United States. Once these areas were established, they sent in a team of anthropologists, demographers, epidemiologists, and researchers to identify the lifestyle characteristics that might explain longevity. They found that the lifestyles of all Blue Zones residents shared 9 specific characteristics. These are called the Power 9.

Figure 1.

Blue Zones (reprinted with permission from Dan Buettner).

Power 9

To make it to age 100, it seems that a person must have to win the genetic lottery. However, many individuals have the capacity to make it well into the early 90s and largely without chronic disease. Blue Zones uncovered 9 evidence-based common denominators among the world’s centenarians that are believed to slow this aging process.

1. 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. They grow gardens and do not have mechanical conveniences for house and yard work.
2. Purpose. The Okinawans call it Ikigai and the Nicoyans call it plan de vida; for both, it translates to “why I wake up in the morning.” Knowing your sense of purpose is worth up to 7 years of extra life expectancy.
3. 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. Okinawans take a few moments each day to remember their ancestors; Adventists pray; Ikarians take a nap; and Sardinians do happy hour.
4. 80% Rule. 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. People in the Blue Zones eat their smallest meal in the late afternoon or early evening, and then, they do not eat any more the rest of the day.
5. 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. Serving sizes are 3 to 4 oz, about the size of a deck of cards.
6. Wine @ 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. And no, you cannot save up all week and have 14 drinks on Saturday.
7. Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy.
8. 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. (They’ll be more likely to care for aging parents when the time comes.)
9. 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. So the social networks of long-lived people have favorably shaped their health behaviors.

Blue Zones

Medical

Obesity and diabetes are running rampant in the United States. Currently, the culture is focused on adhering to different diets and exercise programs. It has been found that these are not sustainable changes. Within the first 7 months of a diet, more than 90% of individuals will have given up. There is a similar decline when it comes to adherence to gym memberships; after just 2 years, the number of attendees will have dropped by 70%. It is clear that there is no quick fix, but there must be small changes to the environment to see long-lasting health changes.

Life Radius

Research shows that individuals spend about 90% of their lives within 5 miles of their home, known as the Life Radius, seen here in Figure 2. 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. This is done through small changes such as putting a bowl of fruit on the counter, serving food at the stove and not on the table, using hand tools for yard work, and many more. In every community, 80% of people want to change their health habits. By creating social networks of these health conscious people, it encourages healthy living and gives people a sense of purpose.

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. These tweaks include things such as standing desks at work, removal of vending machines in schools, no breadbaskets at restaurants, safe walking paths, and encouraging moais.

According to the Centers for Disease Control and Prevention, the best investment on health is through policy. By creating environments where fruits and vegetables are most accessible over fast food, a dramatic decrease in obesity is seen. If there are 6 or more fast food restaurants within half a mile of an individual’s home, they are 40% more likely to be obese than if there are less than 3. By putting policies in place to limit the number of fast food restaurants and putting regulations on smoking, policy makers can see a drastic increase in health. If streets are walkable and bikeable, parks are cleaned up, and the active option is the easy option, physical activity of the entire population can rise by 30%.

Albert Lea

In 2008, Dan and the Blue Zones team finalized the blue print for Life Radius. They had to make sure that it could be applied to an American city. Buettner and his team interviewed 5 cities to be the pilot project, and they picked Albert Lea, MN, a town of 9000 people. The team first went in and listened to the organizations to find what they needed. They brought in Dan Burden who works with communities across the country to create more walkable environments. Albert Lea wanted to widen Main Street and up the speed limit. Blue Zones convinced them to build a walking path around their lake instead. The path is now packed 11 months out of the year with individuals walking. The sidewalks throughout the community were connected, so people could walk from their homes to downtown without having to walk through fields or busy intersections.

Grocery store and restaurant pledges were created to help individuals change the way they eat. Restaurants were required to offer 3 plant-based entrées. When a sandwich was ordered, the customers automatically got fruit instead of fries. By using different adjectives rather than the “healthy choice,” individuals were more likely to choose the best option. Grocery stores created healthy checkout isles, so that instead of candy bars and soda greeting people in the checkout, they saw fruit, water, and healthy snacks.

Schools signed Blue Zones pledges. They do not sell candy for fundraisers, and there was no candy for good grades. Based on a University of Minnesota study calculation that prohibiting eating in hallways and classrooms would occasion a 11% per year drop in student body mass index (BMI), the project convinced schools to adopt the policy. Then, 25% of the community signed a personal pledge that they would take steps toward a healthy lifestyle.

After about a year and a half, there was a 3.2-year bump in life expectancy; the community lost a combined weight of 7280 pounds; and health care costs dropped by 40%.

Blue Zones Expansion

After seeing the results in Albert Lea, Blue Zones began interviewing larger cities to take on. The beach cities of Los Angeles were chosen.3 Blue Zones worked with city planners to make the streets built for humans instead of cars. The rate of smoking went down by 30%; BMI went down by 14%; and people reported healthy behaviors.

From there, Blue Zones moved into Iowa with the same strategy; 10 cities were chosen.4 Smoking went down by 8.8%, and healthy eating went up by 10.5%. Then, Blue Zones started working in Fort Worth, TX, and Kauai, HI, and are now in 27 cities across the United States.

Vitality Compass

In association with the University of Minnesota Public Health Department, Dan and his team created the Vitality Compass, named the Best Online Tool for Retirement and Longevity by the Wall Street Journal. This tool has users answer lifestyle and background questions based on the Power 9 teachings of Right Outlook, Move Naturally, Eat Wisely, and Belong; it then calculates their biological age, overall life expectancy, healthy life expectancy, and the years they are gaining/losing because of their habits. It then gives the users 12 customized recommendations to help them live longer and better. This is a useful tool to take initially as a baseline test, then try out some of the specific lifestyle recommendations, and 3 to 6 months later, take the quiz again. Recommendations include reducing salt intake, joining a faith-based community, quitting smoking, improving attitude, and many more.

Summary

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. The goal for Blue Zones is to not only make the healthy choice the easy choice, but also the unavoidable choice.

Footnotes

References