The Truth About the Blue Zones

The so-called Blue Zones are regions where there’s a high proportion of very old people, nonagenarians and centenarians.  Is that really the truth about the Blue Zones?

The number of Blue Zones depends on whom you ask, but on the “official” site, there are five:

  • Barbagia region of Sardinia
  • Ikaria, Greece
  • Nicoya Peninsula, Costa Rica
  • Seventh Day Adventists – Highest concentration is around Loma Linda, California.
  • Okinawa, Japan

Do Blue Zones even exist?

That’s a strange question to ask, one might think, but given past hype about allegedly long-lived people that turned out not to be true, it might pay to be skeptical.

How much do the Blue Zones have in common with gerrymandering or redistricting? In the United States, a ruling political party often redraws congressional and other districts to make them full of people who will elect that political party. It’s easy to do, just by drawing lines on a map. Have researchers drawn lines on a map that includes high numbers of centenarians and then dubbed them Blue Zones?

I have no evidence that they did that, but it reminds me of how numerous, above-average cases of leukemia or other cancers have been found in certain locations, only to find out later they were statistical flukes.

A problem, as I see it, in this research, is that people tend to see what they want to see.

Why are some groups included and not others?

Take the Adventists of Loma Linda, California; male Adventists live about 7 years longer than other white Californians, and this is ascribed to their lifestyle. The Adventist church recommends being vegetarian, although not all Adventists follow that stricture.

But Mormons in California and Utah appear to have about the same increase in life expectancy as the Adventists, and they are not vegetarians. So why aren’t Mormons on the Blue Zone list? Is it because of an agenda? Not sure what that might be, since Adventists are looked at as almost equally “weird”  — not by me, just saying that’s the perception.

Maybe there are other places in the world where people live a lot longer, but because they don’t fit an agenda, they’re not included. I’m not accusing anyone of cooking the books, just noting that biases are everywhere, and our own biases are the hardest to see.

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The above chart shows differences in life expectancy in the U.S. by religion. (Source.) Why not Jews in the Blue Zones? I’ll speculate that it’s because Jews have no special health practices (that I’m aware of), but live longer because of intelligence, education, and income. You can’t really point out a long-lived group and say “be like them” if being like them is impossible.

The Blue Zones are not in Western Europe

The Blue Zones all lie outside Western Europe, and except for the Adventists, none of the people inhabiting them are Western European. To a great extent, the factor that unites all of these groups is either being less touched by modernity, or actively rejecting it.

Western Europe is characterized by the nuclear family, which consists of parents and children to the exclusion of other relations. Outside Western Europe, households are more likely to include grandparents, aunts, uncles, cousins, etc., or in any case they all live quite near each other.

Observers have noted that social cohesion is a common factor in the Blue Zones. Even among the Adventists, who are mainly of European origin, their minority religious status ensures that they stick together. Church attendance is also associated with longer life.

How would social cohesion make people live longer? Probably by giving older people a sense of purpose and belonging, leading them to actively participate in family and society.

The average American over the age of 65 watches television more than 7 hours a day. What would that do to their sense of belonging and purpose, much less the amount they spend in physical activity? Television viewing time independently raises the risk of death; each 1 hour of viewing associates with an additional 4% risk of death. Whether that’s due to lack of physical activity, decreased social cohesion, genetic confounds, or demoralization from crap TV shows, can’t be determined. But it seems doubtful that people in the Blue Zones are watching TV that much.

Food and the Blue Zones

What you eat is undoubtedly important for health, but whether it’s important enough to get a larger fraction of people to live to very old ages is another matter. Most non-scientific commentary on the Blue Zones emphasizes that they eat a lot less meat than others.

The Okinawan diet has been perhaps the most studied. Okinawans in 1949, representing the cohort that was long-lived, ate a high-carbohydrate diet, low in fat and protein, and low calorie too. Okinawans ate about 15% fewer calories than in mainland Japan. Of interest, most of their diet consisted of sweet potatoes, and they only ate half as much rice as in Japan. They ate about 1% of calories as fish, and < 1% as meat, compared to 4% and < 1% respectively for mainland Japan.

So what’s the magic ingredient for Okinawan longevity?

They ate the same amount of meat as in Japan, although quite a bit less fish. Hard to see how meat could be a factor.

They ate a lot less rice, a food with a high glycemic index.  Nearly 70% of their calories came from sweet potatoes, compared to 3% for mainland Japan. The sweet potatoes look like this:

Image result for okinawan sweet potato

Looks very high in beneficial polyphenols.

In animals, calorie restriction is the most robust lifespan-extension intervention. And the Okinawans ate a lot less.

Here’s how the Okinawan diet has been characterized:

  • Relatively high consumption of unrefined, low GI carbohydrates: principally vegetables, legumes, and fruits. 
  • Moderate fish and marine food consumption. 
  • Lower intake of meat with emphasis on lean meats. 
  • Liberal use of medicinal plants, herbs, spices or oils. 
  • Regular tea consumption and moderate alcohol consumption.

The secret to Okinawan longevity could be

  • less food overall
  • less fish
  • less rice
  • more sweet potatoes
  • hormetic phytochemicals
  • something else or a combination of the above.

I can state for a fact that Okinawans in 1949 watched zero television.

Many but not all of the Adventists are vegetarians, and the residents of other Blue Zones appear to eat less meat than others.

Iron

Metals in plasma of nonagenarians and centenarians living in a key area of longevity. This study shows that in one of the Blue Zones, in Sardinia, nonagenarians and centenarians had much lower levels of iron than middle-aged controls — almost 40% less. The important health risk factor of iron may be a key point in longevity in the Blue Zones.

No one discusses this. Few people know it. See my book, Dumping Iron.

Adding longevity factors

An article about the Adventists in JAMA Internal Medicine, Ten Years of Life: Is It a Matter of Choice?, says that the average Adventist man lives 7.3 years longer than other men in California. The article looks at the risk factors to see what are the most important driving the difference. See chart below.

 

Expected ages at death (95% confidence intervals) in men with jointly high- or low-risk values for the risk factor in a particular column and those to its left (other variables at medium-risk values). BMI indicates body mass index.

 

Smoking and body weight are by far the most important risk factors, and curiously, the next most important is eating nuts. That’s followed by exercise, with vegetarian status being the least important.

Risk factors for Okinawans could be similar when compared to mainland Japan. Okinawans probably smoked a lot less, since they were poor, and they probably weighed less, since they ate less. They may have been more physically active, since many of them were farmers or fishermen.

Conclusion: How to Live Long, and the Truth About the Blue Zones

The factors that make for a long life in the Blue Zone people could be one or a combination of

  • less smoking
  • lower body weight
  • less food
  • lower body iron stores
  • less meat eaten
  • less refined carbohydrates eaten
  • more plant foods eaten
  • higher social cohesion
  • religious attendance
  • importance of family
  • greater physical activity
  • less modern life (TV, cars, alienation)

My money would be on the first four: smoking, body weight, food, and iron.

Although the Okinawans eat substantially less food than in Japan, the other Blue Zones may not be similar.

In Nicoya, Costa Rica, men at age 60 have a life expectancy of 24 more years, reportedly the highest in the world currently. Male Nicoyans apparently have the same rate of cancer as other Costa Ricans; their mortality advantage is due to less heart disease. If that statistic is true for those in other Blue Zones, then that helps us zero in on the important factors. Of course, cancer and heart disease have lots of overlapping causes.

I’m skeptical that eating less meat has much if anything to do with it, although lower iron levels may point to it as a factor.

The truth about the Blue Zones, as I see it, is that there’s a lot more here than meets the eye.

Living a long time requires a confluence of factors coming together.

Even though I see certain risk factors as more important, I don’t dismiss any of them. For example, it seems clear to me that being well-integrated with your own family as you get older is very important for health, and so is being well-integrated with society and with a church.

PS: See my books for more on how to live a long time.

PPS: You can support this site by purchasing through my Supplements Buying Guide for Men.

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21 comments
Drifter says January 1, 2017

Nice post. A few comments:
– Okinawans eat a lot of pig ears which are high in glycine
– Data based on conditions in 1949 in Okinawa would have been influenced by the starvation conditions that existed there during WWII when quality protein was essentially unavailable. Yes, people seemed to live a long time but it would be hard to call them healthy at that time. Paul Jaminet’s writing on this topic is worth reading for those with an interest, and the non-wartime diet there is basically a balanced whole-foods diet.
– When I briefly visited Okinawa, the first thing our guide mentioned was that the traditionally living people who are the people referred to in Blue Zone studies have very low stress levels, so that is likely a factor
– The older traditionally living people there are basically healthy old people, not people who have maintained much of their youthful ability. Most people reading this blog (certainly me) will want to maintain a much higher level of youthful vigor when we get to their age which will likely mean more protein, more food in general, and various other things.
– They never take their sets to failure.(Just kidding. I didn’t ask about this, but I suspect it’s true.)
– Lack of nighttime artificial light and good sleep likely has a lot to do with it.

Reply
    P. D. Mangan says January 1, 2017

    Thanks, Drifter. I agree about wanting good function when old. I saw a documentary on Okinawans, one of the featured people was a 90-year-old fisherman; it showed him jumping from his boat into the water to place and repair his nets, amazing really. Re stress, seems to me that WW2, which these people lived through, would have been pretty stressful.

    Reply
Drifter says January 1, 2017

Actually the more I think about it, I think the better question is, given all the things the Blue Zone people are clearly doing right, why don’t they live much longer and why don’t they retain much more youthful vigor? In other words, what do most of us reading this blog need to do to beyond doing the things you’ve listed in this post to retain our youthful abilities (or exceed them) and slow the aging process, likely at the genetic level? I don’t know but weightlifting at a sustainable intensity level, stretching, sprinting, intermittent fasting and competing against young people in non-collision sports like basketball seem like good candidates while we wait for some more radical genetic interventions.

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    P. D. Mangan says January 1, 2017

    Yes. Those long-lived people did so by coincidence, one might say. If someone were dead set on it, he could do better.

    Reply
George Henderson says January 1, 2017

One of the things Seventh Day Adventists are not supposed to eat is sugar. The Vegan SDA are the group that adheres most to all the rules, including the sugar one.
Okinawa had huge demographic shifts in WW2, young men overseas in the army, many dying, the rest finding their way home in dribs and drabs. 1949 would not be a great year to start a reliable survey.
See the note at the foot of this page; Okinawa is main Ryukyu population, 15,000 survivors were returned, but how many were dead or in USSR captivity for longer?
http://www.combinedfleet.com/Minoo_t.htm

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    P. D. Mangan says January 2, 2017

    In Taubes’ new book, he mentions the famous finding of young American men killed in the Korean War, in whom autopsies revealed arterial fatty streaks in men as young as 18. Korean men had no such streaks. The blame was always put on fat consumption, but Taubes points out that Americans ate tons of sugar, Koreans none. Anyway, I should have discussed sugar more in my post; however, Okinawa, for example, gets compared to mainland Japan, and I imagine the Japanese didn’t eat a lot of sugar either. Also, I suspect that there must be at least a little sugar consumption in Ikaria, Sardinia, and Nicoya.

    Reply
Heisenberg says January 1, 2017

Low saturated fat and low iron absorption are the common denominators.

Without going vegetarian, it can mean switching meat for fish can be the easiest change to do in your diet

Ask yourself how many times a week you eat meat and how many times a week you eat fish.

Aim for fish everyday and meat twice a week (the average american is eating the opposite proportion)

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    George Henderson says January 1, 2017

    Low saturated fat may not always apply to Sardinia:

    The consumption per capita of some high-energy foods
    was still lower than in the other Italian regions. In particular, the
    overall intake of meat was only 77% of the Italian average,
    although in the LBZ [longevity blue zone] the figures were much higher owing to the
    consumption of sheep and goat meat not registered in official
    statistics. The same could be said about milk and its derivatives, as
    Tivaroni in 1921 estimated a 79% higher dairy intake in Sardinia as
    a whole compared with the Italian mainland.[1]

    However, this was SFA from whole foods, with none from shortenings or oils.
    Mechanistically, any harm from SFAs can only come from C:16 and C:18 when they are combined with refined carbohydrate in sufficient quantities to cause a rise in these serum SFAs,[2, 3] producing insulin resistance, or a rise in the small,dense fraction of LDL.
    These diets were very low in high-GI carbs or sugar, so this interaction was unlikely to have much effect.

    [1] Pes GM, Tolu F, Dore MP, Sechi GP, Errigo A, Canelada A, M Poulain M. Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors. European Journal of Clinical Nutrition (2015) 69, 411–418; doi:10.1038/ejcn.2014.230; published online 5 November 2014

    [2] Volk BM, Kunces LJ, Freidenreich DJ, et al. Effects of Step-Wise Increases in Dietary Carbohydrate on Circulating Saturated Fatty Acids and Palmitoleic Acid in Adults with Metabolic Syndrome. PLoS ONE. 2014;9(11):e113605. doi:10.1371/journal.pone.0113605.

    [3] Lossow WJ, Chaikoff IL. Carbohydrate sparing of fatty acid oxidation. I. The relation of fatty acid chain length to the degree of sparing. II. The mechanism by which carbohydrate spares the oxidation of palmitic acid. Arch Biochem Biophys. 1955; 57(1):23-40.

    Reply
Someone says January 1, 2017

https://en.wikipedia.org/wiki/Nicoya

Wiki claims the water in the Nicoya area of Costa Rica is both high in calcium (hard) and magnesium. Magnesium is very important in many ways, starting with cardiac issues. It would be interesting to test water elsewhere.

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garymar61 says January 1, 2017

These days, when you go to an Okinawan restaurant, you can order “tako raisu”. Now “tako” means “octopus” in Japanese, “raisu” is just “rice”, so you think you’re getting some kind of octopus on a bed of rice dish. Healthy seafood!

Nope, tako here is actually Mexican tacos. All the contents of a tacos, hamburger, cheese, lettuce, tomato, just dumped on a bed of rice. Not the tortilla shell, though. Okinawa was returned to Japanese jurisdiction until 1971.

I just looked up the latest longevity rates for each Japanese prefecture. Okinawa is still #1 for women, but only #25 (out of 47) for men.

Reply
The Truth About the Blue Zones says January 1, 2017

[…] post The Truth About the Blue Zones appeared first on Rogue Health and […]

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JW says January 2, 2017

My main concern is bone and join pain in older age as I see increasing levels of this in people over 60 – arthritis, hip replacements, pain killers. Why so many are getting hip replacements at younger ages – ie was it leftover from the 70’s/80’s running/aerobic days? What can we do to avoid?

Reply
    P. D. Mangan says January 3, 2017

    Running isn’t kind on joints. The big factor in knee replacements is obesity. So, avoid both of those. Weightlifting, if done right, doesn’t stress the joints in the same way, since movements are done along natural lines, the way the body was designed to move. Arthritis, whether rheumatoid or osteo-, seems highly connected to inflammation, and thus to diet and exercise.

    Reply
      JW says January 5, 2017

      It’s all rather bleak, I was reading an interview with Michael Fossel and I gathered he didn’t seem to think there was much we could do as an individual to protect telomeres apart from telomere therapy. He starts a trial in a year’s time where he believes he will find a cure for Alzheimers within 2 years.

      Reply
bigmyc says January 5, 2017

As far as the church thing goes, if that’s your bag then good for you. The very idea of church is about community and clearly, this would mesh with the importance of stable family relations. I suppose that what I’m saying is that being a part of any greater social outfit is going to be beneficial to health in the longer term and church participation is but one of the many varieties of that.

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Joshua says January 6, 2017

I note that in that study about plasma metals in Sardinia, not only iron, but also selenium was inversely associated with longevity. Selenium? What gives? I was under the impression this was a health-promoting seafood nutrient that most of us could use more of. Not so, then?

Fodder for more research/blog posts, maybe?

Reply
    George Henderson says January 6, 2017

    One possible explanation is that selenium in water associates with other heavy metals, especially as a product of industrial pollution.
    In this hepatocellular cancer study from Taiwan there were diminishing returns for the upper quintile of Se, and I suspect this is due to pollutant exposure in this group.
    https://www.ncbi.nlm.nih.gov/pubmed/10453813

    Reply
      P. D. Mangan says January 6, 2017

      Thanks George – and Joshua. I was a bit puzzled myself about the selenium; what you say makes sense.

      Reply
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