Blue zones: what they can teach us about aging well?

Dr Anna Spellman, Epidemiologist

Into the Blue Zones: Dr Anna Spellman unlocks the secrets of longevity from those communities that live longest.

Blue Zones are areas of the world where people are reported to live longest, and more often than not reach the ripe of age of 100 years of age.

Initial interest in these centarians was prompted by scientists from Sardinia who noticed that some villages in the island’s interior had a lot of very old men and women. They used a blue marker to outline spots on the map where the long-lived clustered – hence the term ‘Blue Zones’. The idea was taken up by the US National Institute on Aging and National Geographic, who dispatched an investigator, Dan Buettner, to report on Blue Zones around the world.

Okinawa in Japan (‘the land of immortals’); Ikaria in Greece (‘the island where people forgot to die’), Nicoya in Costa Rica, California’s 7Th Day Adventists (a religious community with a simple lifestyle and a ‘Biblical diet’ of seeds and grains), and an area in rural Sardinia were designated Blue Zones.


Something old

Buettner’s travels led to best-selling books, a website, and inspired projects claiming to increase longevity by several years.

But these people don’t just live a long time – they are relatively healthy to the end. Along with low middle-aged mortality and high life expectancy, people from Blue Zones retain high levels of physical and mental health, and experience active, disability-free living into advanced old age.

And it doesn’t seem to matter which blue zone were talking about because, in spite of geographical and cultural diversity, similarities were found across them all, including:

  • A simple plant-based diet
  • Moderation in eating and drinking
  • Good sleep habits
  • Exercise integrated into daily activities
  • A collectivist rather than individualist attitude to life
  • Strong social and family networks
  • Living with a sense of purpose
  • De-stressing with hobbies or social activites.


Something borrowed

So, apart from moving to rural Sardinia or Costa Rica to achieve a ripe and sprightly old age, what can we adapt from the Blue Zones to our current modern lifestyles?

A list of Blue Zone healthy-living habits (the ‘Power 9’) recommends:

  1. Regular movement as part of daily life: There’s no need to wear yourself out at the gym; simply walking to the shops or pottering in the garden is sufficient.
  2. Eat vegetables: Although not strictly vegetarian or vegan, the Blue Zone diet is plant-based. Beans and other legumes (such as chickpeas and tofu) are staples. Meat is eaten, but irregularly, or at festivals. Fermented foods in various forms (such as yoghurt) feature in the diet, as do dairy products, like goat’s cheese.
  3. Moderate drinking: But 7Th Day Adventists are generally abstainers.
  4. 80% rule and portion control: Small meals and eating most early in the day is advised, as is stopping when 80% full (‘Hara hachi bu’ in Japanese). Excess is discouraged as wasteful.
  5. Have a sense of purpose: Making plans, keeping busy, hobbies and community investment enhance health and well-being.
  6. Loved ones first: Prioritise family or significant others.
  7. Belong: Social engagement is key. Okinawans create ‘moai’ (social circles you commit to from youth to old age) which provide support, friendship, entertainment, and a means to de-stress.
  8. Right tribe’: Structure an environment made up of people, things and activities that make a healthy lifestyle the obvious choice.


Something new?

Blue Zone guidance can come across as a form of rebranded ‘old news’; its main strength comes from filling in the detail about healthy diet and lifestyle through the study of diversely located long-lived. Happily the emphasis is on what to do, rather than what not to do. Some fun stuff has been added: moderate drinking and ‘sex twice a week after age 50’ are promoted as reducing mortality (might be a bit tricky for our remotely situated centenarians?), as are regular naps.

Before striding down the street shrieking ‘I’m Staying Aliii-ve!’, a word of caution on the pitfalls of interpreting longevity research.

Verification: Studies in the 1970s on clusters of long-lived in Ecuador were undermined by revelations of age exaggeration and misreporting, exposing to scepticism similar recent claims: not so much a case of ‘the island where people forgot to die’ but ‘the island where people forgot their age’.  Early research in Okinawa drew on interviews and relatives’ reports rather than on recorded sources.

The role of genes: Blue Zones are isolated; in Sardinia, gene profiling has revealed genetic divergence from the surrounding population. The prospect of the existence of ‘longevity genes’ has aroused intense interest, and controversy has arisen about the sale of Blue Zone samples to a private company, and associated ethical and consent concerns.

The role of migration and measuring longevity differences: Calculating proportions of centenarians out of the local population in places where young people migrate and the elderly stay put can result in overestimation. To get around this problem, current studies compare areas and calculate proportions of very elderly only for the population over 60, but because centenarians are rare and villages small, it can be difficult to amass numbers required for statistical testing.

Self-selection into environments and lifestyles: A form of the ‘chicken or egg’ problem: people may self-select into particular environments and lifestyles based on their physical and mental health. Those staying to grow old in an isolated Blue Zone may have been robust to begin with, and it is this underlying in-built toughness which determined their eventual long lives. Early in the 1900s when the Sardinian centenarians were young, far from the rural idyll observed by National Geographic, the Blue Zones were described as grindingly poor, where people by necessity lived hard lives and walked vast distances. This leads to the next point.

Early or current lifestyle?: Rather than the current lifestyle observed in Blue Zones, it may have been the early lifestyle of centenarians which is crucial for longevity, and it is really this that we need to describe and copy.


‘No country for old men’

The jury is out on the merits of the Blue Zone approach to longevity, but while there are, no doubt  many facets we can learn from, perhaps the question we should be asking ourselves is what old age could look like.

A 2014 Age UK survey reported that one million over 65s hadn’t spoken to anyone in the past month, and 2 in 5 described the TV or pets as their main companions.  Contrast this with accounts of Blue Zone communities that honour the aged, and where centenarians have ‘a steady stream of visitors’ dropping by for advice. A fresh approach to environment and lifestyle design promoting quality of life as we age is much needed.