Lessons From the Blue Zones: There is No Silver Bullet (or Magic Pill) for a Long, Healthy Life

Abstract

This LM2024 Keynote Address outlines the Blue Zones story, beginning with the methodology that led Dan Buettner to identify the original blue zones, five regions in the world with disproportionately high concentrations of centenarians, low rates of middle-age mortality, and seniors living in good health. We glimpse the lifestyle of these long-lived people by journeying briefly to Sardinia, Italy; Okinawa, Japan; the Seventh Day Adventist community in Loma Linda, California, USA; Nicoya, Costa Rica; and Ikaria, Greece. Rigorous research, interviews and fieldwork in these communities have yielded surprising insights about the environmental and lifestyle factors that produce the world’s longest-lived people. The Power 9, a summation of these factors, suggests an approach to longevity that runs counter to the prevailing American focus on diet, supplements and exercise. In contrast to an intentional pursuit of health, the insights drawn from the world’s blue zones demonstrate that longevity ensues from the right environment, an ecosystem of factors that make the healthy choices both easy and unconscious.

“The definition of purpose in all blue zones always has an altruistic component to it.”

How the Blue Zones Research Started

This research began 25 years ago, following the Danish twin study, which established that approximately 20% of longevity is dictated by our genes. ¹ In order to find what the other 80% is, instead of looking for answers in petri dishes or test tubes or genetic codes, I went out with a team of experts to find places around the world that are demographically confirmed, geographically defined areas, where people are measurably living the longest. I received a grant from the National Institutes on Aging and an assignment from National Geographic, and the reason underlying the assignment and the grant was that I was approaching the problem in a new way.

Prior to our work on longevity, age exaggeration, inaccuracy, and record keeping fraud had been widely reported. In fact, in 1973 National Geographic had published an article proclaiming the Hudson Valley, Vilcabamba and the Caucasus as longevity hot spots, ² but these were later debunked.

Using Demographic Methods for Identifying Centenarian Hot Spots

At the time, new expertise from the field of demography was actually confirming ages, so I partnered with four of the best demographers in the world (S. Jay Olshansky, Gianni Pes, Luis Rosero-Bixby, and Michel Poulain), who developed systems to not only identify areas where people are living the longest, but also to confirm their ages, and then to rank them internationally. This is a giant job: it involves finding places with a high concentration of centenarians, who are not necessarily living today, but who have lived over the past 150 years.

If researchers go to a place where there is a high concentration of centenarians and count them, there is selection bias. In the farm towns in the prairies of Minnesota, for example, there are a lot of centenarians. The reason is because the young people have moved to Minneapolis, resulting in an artificially high concentration of the oldest old and, therefore, a high concentration of centenarians. Or in a place like Naples, where rich people have moved for retirement, it is easy to find a lot of centenarians.

What you want to find are clusters where centenarians have lived. This involves first parsing through years and years of census data, to establish a report of very high life expectancy. It is actually low rates of middle-aged mortality that we are looking for; a high concentration of centenarians over time; lots of siblings over 90. Once we found them, I received National Geographic grants. We then went to each of these hot spots, these potential blue zone areas, and spent weeks in the municipal archives, the public registries, looking at birth certificates.

To research age correctly, we start with a cohort of birth: for example, people who were born between 1904 and 1924. Those people are between 100 and 120 today. Every year, all the births are recorded in an annual birth book. There is a birth listed at the top of the page; then the next entry is the infant who was born, perhaps, the next day; and the entry under that is the infant who was born the following day. The births are recorded sequentially: it is impossible to add a birth that did not happen 100 to 120 years ago. In another column, the person’s death is also recorded, with a stamp. To make sure that the deaths are accurate, we went to the city hall and checked the death certificates for any centenarian in the birth records. Often, it was necessary to go to churches to look at baptismal records, or to go to cemeteries to check the dates. For the people still surviving, that is easy: for those who were born over 100 years ago according to birth records, we went to their house to talk to them. Thus, using the birth book, it is possible to count all the people born over 100 years ago, either living or dead.

Searching for the Common Denominators of Longevity

This took years, since it takes about a year per expedition, and this is where I spent most of my time. It takes about a year per expedition, but it yields research that is published in respectable academic journals. Before we set off to understand why these people are living such a long time, we made sure there was one or more peer reviewed articles about each of these places, published by career demographers in academic journals.^3-6 Then we had found a population where there was a high concentration of people who have lived over 100 for a long time. They have achieved the outcomes we want; they show the capacity of the human body; and they likely have not reached it because they have superior genes alone (remember the Danish twin studies). It’s because they’re eluding the diseases that foreshorten their lives: they’re not getting Type II diabetes or cardiovascular disease, or 30 or 40% of the types of cancers that kill us, or even dementia. These are the outcomes that we all want.

Once we establish this, then I put together another team of advisors ¹ who could help me find the correlations or the common denominators in each of these blue zones. Again, this is another big job: it involves doing a thorough literature review and interviewing all the experts in the field; I interviewed 105 experts. And then over the past 20 years (and I was just in Sardinia about three weeks ago) I’ve interviewed over 400 centenarians. I use a questionnaire devised by the National Institutes on Aging.

What I’m looking for is what these centenarians have done most of their lives. It doesn’t matter what they’re doing today. I want to know what they were doing as little kids, in middle age, and when they were recently retired. Then remarkable themes begin emerging, some common denominators: no matter where you go in the world and see long-lived people, you see the same things happening over and over again. We found nine of these common denominators. In order to explain them, I will first take you to each of the blue zones to get a feeling for what it’s like to live there.

A Journey through Each of the Blue Zones

The First Blue Zones Region: Sardinia, Italy

We found the first blue zones region, about 200 miles off the coast of Italy, in Sardinia (not the entire island, just a cluster of five villages of about 80 000 people that live in the Ogliastra region, a very remote region up in the highlands). ³ This place is remarkable because it has the highest concentration of male centenarians (we have records going back to 1850)—the highest in the world, about 14 times higher than the United States.

These men have about 10 extra years of life expectancy at age 60. That is an enormous value proposition, those 10 extra years. These are years where people are not only making it to 100, they’re doing so with vigor and vitality: riding their bike at 102, cutting wood at 106, and beating a guy 65 years younger in arm wrestling. (By the way, I would never recommend a tumbler of red wine for breakfast, but if you make it to 106, you can have whatever you want for breakfast.) Gianni Pes and I did the surveys. We interviewed over 300 centenarians in Sardinia, and started looking for the biggest predictors.

In reverse order, the three biggest predictors of making it to 100 in Sardinia were:

Number three, the steepness of the village—not the altitude. Everybody thinks they live in the mountains, so they live a long time. No, altitude has nothing to do with longevity; it’s steepness. And most of you can figure out why. Because every time you go to the market or every time you go over to a friend’s house, you’re walking practically vertically.

The second biggest predictor: how many daughters you had. Guys with the best chance of reaching age 100 had five or more daughters. Now, we do not know if that is because daughters take better care of their aging fathers than sons do, or if it is because if you can survive five adolescent girls, then making it to a hundred is no problem. Either way, daughters are good for us, as far as I am concerned—I have one.

The biggest predictor was actually profession. The farmers in Sardinia were not living any longer than their Italian counterparts; it was specifically the shepherds. So my photographer and I embedded with these shepherds to see what their life was like. We expected them to be extremely hard working, but they woke up when the sun was warm. They had a leisurely breakfast, had a little time with their animals, and then they walked maybe 2 or 3 miles in the morning with their sheep, pasturing their animals. They would stop for lunch. They would take a nap, then a couple more hours with their animals, and by five o’clock they’re back in the village having a glass of wine with their buddies.

Once or twice a year, the Sardinian shepherds had to do something called transhumance: they have exhausted the capacity of the pastures near their village, so they take their sheep up to 100 miles to other pastures where their sheep can eat. This involves a journey of a month or two. When they are on the road (and they have been doing this for centuries) there is no McDonald’s along the way, or 7-11. They had to bring their food with them. And they developed a type of whole grain flatbread, an unleavened bread, that would make the journey. It is packed really thinly, and they call it Carti di Musica. They have their own sheep, so they make fresh sheep’s milk cheese called Pecorino, which is very high in Omega-3 fatty acids, grass fed.

And they brought wine as well: their wine is made from a type of Grenache grape, Cannonau. This wine had a reputation for having the highest levels of polyphenols in the world, and these people drink a little bit every day; they do not slam it down. With friends and meals, it is definitely a cornerstone of this particular longevity diet.

When they are back home, they are eating a variant of the Mediterranean diet. The Mediterranean diet changes depending on location in the Mediterranean, for example, North Africa or Greece. But here, it is very high in fava beans, and a lot of pasta and bread. Until about 1965, almost 60% of their dietary intake came from bread, all kinds of breads. Yes, carbs: the longest-living men in the world were eating a lot of it. Their diet changed over time, and now it’s now much worse, but it was mostly a plant-based, vegetable-heavy, whole grain-heavy diet.

These Sardinians did eat meat. Traditionally speaking, they ate meat about five times per month, usually celebratory food after church on Sunday, a birthday, a wedding, and so forth. Never beef: there was no beef up in that blue zone, maybe a little bit of chicken, but it is usually pork, because the family had a pig and treated the pig nicely for a couple years, and then there was a festival, and the pig was the center of it.

This is a different culture than the rest of Sardinia. It is actually a Bronze Age culture, and we know from looking at mitochondrial DNA that these people originated in what is today the Basque country. They made their way through southern France, down through Corsica to Sardinia, and were pushed into the highlands by the Phoenicians and the Romans. They have stayed up there since about the time of Christ, and they incubated their own lifestyle, different from the rest of Sardinia.

It is a matriarchal community. The women are at the head of the table, and they are taking care of the kids, and they are up on the roof, fixing the roof and taking care of finances. And they are in charge of defense. They are the ones that wield the rifles and the arms. To survive, they had to develop a fanatical zeal for the family. You would never put your aging parent in a retirement home in the highlands of Sardinia.

Instead, older people are seen as treasures: they are honored. The older you are, the more revered you are. You live there with the rest of the family, but not as recipients of care. We worry a lot about that in America, with our social security system. No, they are seen for what they are, the repository of wisdom. The men tend to have the agricultural wisdom; they have the wine-making wisdom, know where to pasture animals, and so forth. Meanwhile, the women possess the culinary tradition that goes back about 500 years. The way they eat has evolved very slowly, mostly for taste; the ingredients have stayed the same, but the taste has gotten better over time.

For me, the single most telling culinary story is this. There is a place called Seulo, and every Friday afternoon, from about noon to 4 pm, all the ladies of the village come together in this one little stone house. They bake bread, and they build a fire, and they knead the bread. I don’t know if any of you have ever kneaded bread for an hour, but it is like a workout. They have “Popeye arms” by the end of it; and they also complain about their man and get rid of stress. But the grandmas bring the starter dough, and that starter dough possesses a type of bacteria called Lactobacillus, and they mix it with regular wheat (their wheat is probably better than ours) and let it rise, it metabolizes out almost all the gluten. It has about 2% of the gluten in a typical loaf of bread. In studies, it has been shown that when you eat this sourdough bread, it lowers the glycemic load of the entire meal by 25%.^7,8 Eating this same bread at every meal, for decades or half a century, starts to add up. Grandmas are the ones that possess this wisdom. Grandmas bring it to bear, bring their wisdom and their bacteria, every Friday afternoon.

Indeed, this is something called the “grandmother effect”: in cultures around the world that keep grandparents nearby, ideally in the home, the children in those families have lower rates of disease and lower rates of mortality.^9,10 This is a beautiful virtuous circle: older people are told, directly and indirectly, that they matter, and they stay engaged in their brains and their bodies, and they live longer, and the children have lower rates of mortality. This creates a virtuous circle, producing a manifestly longer lived society.

Women Centenarians in Okinawa, Japan

On the other side of the planet, a thousand miles south of Tokyo, is the archipelago of Okinawa. This used to be called the Ryukyu Kingdom, and it was later taken over by Japan in 1879. Okinawa is very different than the rest of Japan; here is a culture that produces the longest-lived women in the history of the world, and still does to this day (but barely). Among a cohort of women 60 or over, you have about 25 times more female centenarians than you would have in a similar population in the United States. And once again, they’re not only living a long time, they are doing so with vitality.

A few interesting features of the Okinawans: until 1972, two-thirds of their caloric intake came from one food—not rice, not fish—but purple sweet potatoes. Why? Because typhoons whipped through Okinawa almost every year and blew away the terrestrial plants. What was left underground was shelf-stable and delicious, and it turns out that purple sweet potato is almost a perfect food. It has about 150% of the same antioxidant found in blueberries, folic acid, complex carbohydrates, and even protein. And this was the cornerstone of the diet. They knew how to make it taste delicious with different recipes, such as cooking it with beautiful garlic greens.

The Okinawans also eat about eight times more tofu than we do. They did eat a little pork, but usually at Lunar New Year, a birthday or a big festival. Beginning about 2005, the diet began to unravel in Okinawa, largely because of the American military base and the force of fast food restaurants that popped up around them. Today, the Okinawans are the least healthy population in Japan, with the highest rates of obesity. Nevertheless, when I was doing the story in 2005, they were producing the world’s longest-lived people.

We believe we found the set of factors that accompany that extraordinary longevity: it is not only the food, but how they connect. And I’m sure you all know this statistic, but if you report loneliness in America, that reduces life expectancy by about 8 years. It is as bad as a smoking habit; and we live in a culture where there is no guarantee we’re going to have people around us who care about us.

In Okinawa, around 5 years of age, traditionally parents would cluster a child with four or five other 5-year olds. There is a ceremony, and the children are expected to travel through life together. And if things go well (a good crop, someone gets a raise), they are expected to share it with this cluster of friends, called a moai. And if things go sour (a parent dies, a child gets sick, a divorce), they have this social safety net, not only for loaning some money when needed, but also to support them spiritually or psychologically in times of hardship.

For example, I met five ladies who had belonged to the same moai for 97 years. Their average age is 102. They still get together every night, they gossip, they drink sake, they argue about who was liked best back in 1941—but they still look after each other. They do not need an employer or some government program or long-term care insurance. If one of them does not show up, the other four are putting their kimono on and shuffling across the village to help out. We can see why this is a powerful longevity strategy.

Interestingly, Okinawa does not even have a word for “retirement.” Have you ever thought about the word “retirement”? It is that artificial punctuation at the end of your productive life, and the beginning of your life of repose. And there is a very dangerous mortality spike that year: about 11 000 more people die the year they retire, than normally should. And it might be because they lost their social network. It might be because they lost their sense of meaning. It might be because they are less active. It might be because they have a troublesome spouse at home. But nevertheless, retirement might not be such a great idea in many respects.

In Okinawa, instead of the word “retirement,” they have the word ikigai. Roughly translated, it means “the reason for which I wake up in the morning.” This was a question in our questionnaire, and not once did anybody fail to answer that question. They knew off the top of their head why they wake up in the morning. If you ask five of your friends what their life purpose is, they may not be able to give you a very good answer. But here it is very clear. For this 102-year old karate master, it was passing down a martial art that originated in Okinawa. For this 97-year-old fisherman, he does not do it professionally any more, but what gets him out of bed in the morning, out of the easy chair, is spear fishing. He puts on his rubber suit and his bamboo goggles and goes out and spears fish in the morning, but it gives him that excuse to go see his kids and his grandkids, and his neighbors who might need a little extra food, and it keeps him socially engaged. That was his ikigai. For Kamada-san, a 103-year old spiritual leader of her village, her job was the spiritual health of the community. Her ikigai was her great-great-great granddaughter. These two females are separated in age by one hundred one and a half years, and when I asked her what it felt like to have a descendant more than a century younger, she said “it feels like leaping into heaven.”

It also turns out that likable people are more likely to get better health care, more attention from their nurses, better care from the nurses, and more time with their doctors (according to one study from Japan, ¹¹ for example). And of the 400 centenarians I interviewed, I can only remember about five who were grumpy. The rest were interested, interesting, generous, and just loving—something we have largely overlooked.

An American Blue Zones Region: Loma Linda, California

I work for National Geographic, and the legendary expeditions editor Peter Miller said to me, “You know, Dan, you really need to find America’s blue zones region.” As I alluded to earlier, I spent a long time in the prairies of Minnesota, where we do have high concentrations of centenarians, but that was a dry well. I dug a lot of dry wells on this project at first, but I eventually got a tip from the National Institutes of Health. Eighty miles west of Los Angeles, down the San Bernardino Freeway, six lanes of traffic, smog overhead, take the Loma Linda exit, and the first thing you see in America’s blue zones region is a Del Taco and a Weiner Hut.

Loma Linda has the highest concentration of Seventh-day Adventists. Adventists distinguish themselves from other Christians: number one, they evangelize with health. They run some of the biggest hospitals in America. They also celebrate their Sabbath, not on Sunday, but on the seventh day—on Saturday. For a long time, they have asserted they are the healthiest Americans, ever since Ellen White started the religion in the 19th century.

The National Institutes of Health funded a study called the Adventist Health Study, which is gold standard epidemiology; it followed the health of Americans for 30 years.^12,13 Life expectancy for Americans right now is just under 80 (it’s getting a little better after COVID-19). But for adherent Adventist women, their life expectancy is about 9 years longer. And for the men, it’s even more dramatic: Adventist men live 11 years longer. ¹⁴

Think about this: this is not Okinawa, or a Mediterranean island, in the hills of Sardinia—this is next to the Wiener Hut in America. If we look at Adventist congregations, is it their genes? No, the Adventists are mostly of European extraction, but also include African Americans and Asian Americans and Latinos. It is a melting pot. So what is going on here?

We embedded in the community, took six trips there, spent a long time talking to the very good experts at Loma Linda University, and talked to Gary Fraser from the Adventist Health Study. A few things emerged.

First of all, Adventists take their Sabbath very seriously, which is more powerful than we think. The Orthodox and Hasidic Jews have this in their culture as well. From sunset on Friday until sunset on Saturday, no matter how busy they are, no matter what work is telling them to do, no matter where the kids need to be driven, no matter what the social schedule is dictating, they stop everything. For 24 hours, they take a “sanctuary in time,” as they call it. Friday night is spent with their family, without TV. Saturday morning is spent with their congregations; they tend to have long services. On Saturday afternoon, they rejuvenate their social circles with potluck lunches. Hardwired right into their religion, right after lunch on Saturday afternoon, is a nature walk. It is not something they do during the “wellness month” at work—this is every Saturday for years or decades.

They take their diet directly from the Bible. If you open up to Genesis, chapter 1 verse 29, God lays out the diet for the Garden of Eden: “every tree that bears fruit” (for Adventists, tomatoes and oranges and lemons and avocados); “every plant that bears seed” (grains, legumes, nuts and beans). Then one chapter later, God talks about green plants, but pork ribs are not in there anywhere. The Adventists believe that is what the Bible says, so let us do that. Most Adventists have plant-based diets.

I took some time to cook with a 95-year old pilot named Dorothy. We spent a whole afternoon together. To be from National Geographic, you want to know the science, and we report it as rigorously as everybody else, but you also want to live it a little bit. You want to be able to bring it to life through characters and through photography. So I cooked with Dorothy for an afternoon, and the moment it all came to light for me—like a diamond bullet in the forehead—was when she opened the refrigerator. This is what the refrigerator of a healthy 95-year old looks like: there is no bacon in there, there are no hot pockets, there are no fruity drinks, there are no pudding cups. It is all whole food, plant-based; it is food your grandparents would recognize.

This is a culture that has produced Ellsworth Wareham, a 98-year old multi-millionaire. Yet when a contractor wanted $6000 to build a privacy fence, he said, “For that kind of money, I’ll do it myself.” And for the next three days, as my photographer followed him around in the blistering heat, as he shoveled cement and hauled timbers, he was impressed. On the fourth day, Ellsworth Wareham ends up in the operating room; but it is not Ellsworth Wareham getting open heart surgery. Ellsworth Wareham is doing the open heart surgery, which he continued to do until age 100. He was a vegan as well.

Ed Rollings, a 106-year old cowboy, started his day with a swim, and on the weekends, he put on his boards and thew up rooster tails, waterskiing. This is where you want to be at 106. And then my favorite, Marge Jetton, 105 years old. She woke up every morning at 6 am, read her Bible for a half hour, and she was very prescriptive about her breakfast. She had the same breakfast every morning: slow cooked steel-cut oatmeal with walnuts and dates, topped with soy milk, and followed by what she called a prune juice shooter. Marge would go on to pump iron, ride her bicycle, and then get in her 1994 Cadillac and barrel down the San Bernardino freeway, where she volunteered for seven different organizations, including the Loma Linda Senior Center, where she helped out the old folks. That is where you want to be at 100.

Costa Rica: Local Health Teams

I first wrote up this story for National Geographic—and I had always wanted to write for them. I never made any money; I never made more than $40,000 till I was 40. But then I wrote this article and it was one of the most successful in their history. I got a big book contract, wrote a New York Times bestseller, and all of a sudden I had money. And like a good explorer, I blew the money, mostly doing more explorations.

I hired the demographers (Luis Rosaro-Bixby from Ann Arbor University, who is Costa Rican, and Michel Poulain from Belgium), and we went out looking for more blue zones regions. We got a signal from the Bill and Melinda Gates Foundation about a place in Central America that had the highest concentration of siblings still surviving over 90. We got another National Geographic grant. We spent the better part of two weeks in Costa Rica, and we found a population with the lowest rate of middle age mortality in the world. In other words, these people have about a two and a half-fold better chance of reaching a healthy age 95. ⁵

It is a really remarkable population. Part of it is because of what they eat. 70% of their caloric intake until about the year 2000 came from the three foods that compose, I argue, the greatest diet the human species has ever invented: (1) corn, which is ground into beautiful whole grain tortillas, (2) squash and (3) beans. You bring those three foods together and they are called the “Three Sisters,” invented in Mesoamerica about 7000 years ago. They grow perfectly sustainably, and together they’re full of micronutrients, especially niacin and complex carbohydrates, and they have all the amino acids necessary for human sustenance. You do not need to eat dead animals. These three foods together give you all the protein you need, and this is mostly what the traditional Costa Ricans were eating.

When we go into cities with Blue Zones Projects, I hear all the time, “get fresh vegetables into the inner city.” Fresh vegetables are not shelf-stable, they are expensive, and many people do not know how to make them delicious. But if you give people beans and rice, or beans and corn tortilla, they know exactly what to do, and they know how to make them taste delicious. They are affordable, shelf-stable, and they solve about 96% of the nutritional needs of most people. But for some reason we overlook them.

The other reason for longevity in Costa Rica is—and I hope you pay attention a little bit, because I think it is vastly overlooked in the four and a half trillion dollar health care spending the United States does—every man, woman and child in Costa Rica has access to what is called a “basic health team” (El equipo básico de atención integral en salud or EBAIS). Five people are on every basic health team: a doctor, a nurse practitioner, a record keeper, and two mobile health ambassadors. In every small city there is a health post, puesto de salud, and over the course of the year, a health ambassador goes to every single house and knocks on the door. They have your health records; they sit down with you; they talk to you. Lonely people who do not get much interaction get at least one quality interaction a year. They screen you for depression, check your blood pressure, screen you for Type II diabetes, check your medicines, go out in the back and look for standing water where mosquitoes that carry infectious disease often breed. And then they go into your refrigerator and look for signs of chronic disease.

But the point here is: they catch a disease before it is a six-figure problem in the emergency room. They will catch it years ahead of time. They are investing in catching diseases before they happen, not trying to mop up the mess like we in the United States are largely doing. Interestingly, this is producing not only the lowest rate of middle-age mortality, but they spend 1/15 the amount we do on health care. The myth that you have to be rich, or have to spend trillions more to fix the problem—it is just plain wrong. In fact, the healthiest people, the ones with the longest life expectancy (and Stanford followed me, by the way, and took telomere lengths)—the ones with the longest telomere length were the poorest people. The poorest people were eating mostly plant-based, and they were living with their children.

A Lifetime of Beans and Herbs: Ikaria, Greece

Finally, we found the last blue zones region off the coast of Turkey on the island of Ikaria. This is another extraordinary place with 8000 people, a largely overlooked island. It had no natural ports, so it was not too involved in the evolution of Western civilization. They were largely left alone to produce a place that has about half the rate of cardiovascular mortality, living 8 years longer than Americans. ⁶ And most interestingly, almost no dementia. In America if a person is over 85 years old, they have a much higher chance of dementia. We found every single person on the island over 65 and found only three very light cases of dementia, and no full-blown Alzheimer’s. If you want to look for the secret to preventing Alzheimer’s, I would say Ikaria is a good place to look.

What are these people doing? They have the purest form of the Mediterranean diet in the world (there are assessment scores for how closely a diet follows the Mediterranean diet^15,16). The Mediterranean diet here has a lot of beans—black eyed peas, lentils, garbanzo beans—vastly over-weighted in beans. As for greens, they eat the type we would remove from our backyards: dandelions, and the tops of fennel, and so forth—they take these and gather them up. They are free, and they bake them in beautiful pies, and make salads out of them, and sauté them with olive oil and lemon and some herbs. We sent many of these herbs—the endemic oregano, the rosemary, the sage and the catnip—to University of Athens, and these herbs have powerful antioxidants. They are anti-inflammatory, and they are also mild diuretics, so they are lowering people’s blood pressure slightly.

But the remarkable thing is not so much that these herbs have this quality. The big finding was that people in Ikaria have consumed them every single day of their lives. They could not afford coffee. If they want a warm beverage to wake up in the morning, they start with the oregano. If they want a mellowing beverage at the end of the night to sleep, they drink the sage. They go in their backyard, they grab the herbs, they infuse it in hot water, and they have their tea. But they are doing this every day for a lifetime: that is where it makes a difference.

I often tell the story of Stamatis Moraitis. He moved to America when he was 21 to get a job as a painter. He made some money right away, married a Greek American, and bought a Chevrolet. But at age 66 he found himself short of breath and went to three doctors, all of whom told him: you have terminal lung cancer, get your affairs in order. He decided that instead of getting buried in Detroit, “I’m going to move back to Ikaria and get buried with my ancestors, overlooking the Aegean Sea. The funeral would be a lot cheaper and I would have money left over for my wife.” So he and his wife move in with his parents, who are perfectly fine at 85, and he goes there to die. But he starts drinking these teas, drinking the wine, connects with his friends, reconnects with his religion, and eats the Ikarian diet. Six months come and go, and he’s feeling pretty good. He goes out in his backyard and he plants a vineyard, and he thinks to himself, “Well, I’m not going to be around to enjoy this these grapes, but my wife will pick these grapes, and then when my wife picks these grapes, she’ll think of me, and she’ll remember me.”

When I met Stamatis Moraitis 38 years later, he was still picking those grapes, and making 200 liters of wine a year, all of which he drank. And when I asked him about his secret to longevity, he just shrugged: “I don’t know. I guess I just forgot to die.” He then articulated the true reason (and this is where I get to the main point—this is a different way of thinking about health). When I asked him what his secret was, he could not really answer. Indeed, in all the blue zones, nobody really knows why they are living a long time. One thing I know for sure is that none of them at age 50 said, “Darn it. I’m going to get on that longevity diet.” None of them joined CrossFit or ran triathlons or got on the internet and ordered superfoods, or ran down to Costa Rica for stem cells, or started Rapamycin or Metformin. None of them tried to live longer.

THE POWER 9: Secrets to Living Life Longer, Better

The epiphany for me is that these people are not pursuing health. That is what we do in the United States: we pursue health. We find the right program, we try to get enough resources, and then we muster the discipline and we go at it, and we hope we have the presence of mind. But it is not working.

In the blue zones, they do not pursue longevity. It ensues. It is a byproduct of the right environment, the right ecosystem. This brings me to the Power 9, the common denominators for longevity that we found across the blue zones.

Move Naturally

No matter where we found long-lived people, they are moving naturally every day. Every time they go to work, a friend’s house, when they are out to eat, it occasions a walk. They have gardens. Their houses are not full of mechanical conveniences.

Downshift

In the blue zones, people worry about the same things that we worry about, but they have sacred rituals to unwind the stress of the human condition: ancestor veneration, church, taking a nap.

Purpose

They have vocabulary for purpose. We know that people who can articulate their sense of purpose live about 8 years longer than people who do not.

Moderate Wine

They drink a little bit. And I am very well aware of the epidemiology that is saying no amount of alcohol is safe. But if you look at the dietary surveys in the blue zones regions, in almost all of them, they are drinking wine, and they have for almost all of history. By the way, most of that epidemiology research is done with alcohol (that includes liquor, Harvey wall bangers, Cosmos and martinis etc.), whereas we are talking about homegrown, organic wine.

Plant Slant

More important is what they eat. If you want to know what a centenarian ate to live to be 100, you have to know what she ate her entire life. We found 155 dietary surveys done over the past 80 years in all five blue zones (and Harvard’s Walter Willett helped me do the meta-analysis), and this took me 8 years to do, but it was worth it, because we started to see clearly. This chart (Figure 1) shows what the longest-lived people have eaten, most of their life.

Figure 1.

The centenarian diet in the blue zones.

They eat a 90%-100% whole food, plant-based diet. It’s very high in carbohydrates, but remember, both lentil beans and jelly beans are carbohydrates. We are talking about the lentil bean type. Whole grains, greens and garden vegetables, tubers, nuts and beans are the cornerstone of every longevity diet in the world. I can tell you this beyond a shadow of a doubt. If you are eating a cup of beans a day, it is probably adding about four years to your life expectancy, over eating protein from less healthy sources.

In the blue zones, they do eat meat, but 5 times a month on the average. In America, we eat over 200 pounds of meat per person, per year. I can tell you, that is not good for your health. In the blue zones regions, they enjoy about 20 pounds of it; it’s a celebratory food. They also eat a lot less fish than you might think (less than 3 times per week). There is no cow’s dairy in the traditional blue zones diets. They have a little pecorino cheese or a little bit of goat cheese, which is very flavorful, but not the large amounts of mozzarella that we pour on our pizzas.

And when it comes to what they drink: six glasses of water, teas of every kind, both herbal and caffeinated, coffee and a little bit of wine, usually with friends and with the meal.

80% Rule for Moderate Eating

They are not focused on what nutrients to add to their diet, but they have strategies to engineer out the extra calories. (Much of the world’s population will die of over-nutrition, not under-nutrition.) The longest-lived people eat breakfast like a king; lunch, like a prince; dinner, like a pauper. All their calories are eaten in an eight-hour window. They sit down and eat with their family; they are not snacking all day long.

Loved Ones First

Then the foundation on which all of this rests, is how people connect. This is not discussed much, because nobody can make any money off of this. This is probably 50% of the longevity formula: they invest in their families. They keep their aging parents nearby. They invest in their spouse, they stay committed to their partner, and they invest in their kids.

Belong

They belong to a faith-based community and show up. We know that people who go to church live 4 to 14 years longer than people who do not. We do not exactly know why; it is just an epidemiological artifact.

Right Tribe

And they pay attention to who they let in the room. We now know that if your three best friends are obese and unhealthy, there is a much better chance that you’ll be overweight yourself. So people in the blue zones tend to surround themselves with people who support the right behaviors.

I know a lot of you think this is common sense, but it is nowhere near common sense! Maybe 2% of Americans live like this, and we certainly do not pay for this approach to health in America.

The Sisyphean Loop of Pursuing Health

Of our $4.3 trillion health care expenditure every year, we spend about 3%–4% on prevention. Most of that prevention is spent on diets ($60.9 B), supplements ($28.1 B) and exercise. And I am not necessarily badmouthing those, but we spend a lot of money on them; it is a little bit like Sisyphus.

But these do not last long. Look at the best diets ¹⁷ : if 100 people start a diet today, 10% might be lost after 3 months, and 90% after 7 months. Almost all of them will not continue after 2 years. If a financial planner showed us this return curve, they would be fired. But every year, 80 million people think, “I’m going to get on a diet and lose weight.” Or they join a gym, and that does not work out so well either. Or “I’m going to get that new gadget, I’m going to get the Oura ring or the pedometer or the Fitbit,” but none of them have been shown to work. ¹⁸ Or “I’m going get that anti-aging supplement, that Metformin or Rapamycin.” Yet there has been no pill, supplement, hormone, or any intervention that has been shown to reverse, stop, or even slow aging in humans. And there is a lot of risk that we often ignore in the pursuit of the silver bullet. But even if one of these did work, Americans probably would not take it long enough to make a difference. ¹⁹

So if that does not work, what does?

There is a very clear message from the blue zones, and I do not know why we are not paying more attention to it. Here we have five disparate cultures that are manifestly living many years longer than Americans do, with a fraction of the rate of chronic disease. And by the way, the journey is enjoyable. They grow their own food. They live close to nature. They walk. They wave to their neighbors. They eat dinner with their family. They have a spiritual life. It is joyous. They are in the top quintile of the happiest places in the world. And they offer us some very clear lessons that I think you and your patients will benefit from. But it requires thinking differently.

We saw that in the blue zones regions they are eating a mostly plant-based diet, but how do we get Americans to do that? Over 70% of the food in grocery stores has added sugar or is ultra-processed. ²⁰ We go out to dinner 110 times per year, on average. Every time we go out, we consume about 300 more calories than we would if we just stayed at home, ²¹ and those calories tend to be high in sodium and high in sugar. So what is the answer?

Takeaways from the Blue Zones

• ➢ Plant slant

Look to your grandma: cook at home. We need to give people some skills; they need a good plant-based cookbook (I wrote one myself called The Blue Zones Kitchen). Cook with your family, and cook enough of the recipes to gain the skills, but cook until you taste enough recipes and there are a half dozen that you love. Then my job is over; people will do it.

• ➢ Move naturally

I am not a big fan of exercise, and I argue it has been an unmitigated public health failure. It is like Sisyphus: we keep trying it, but it is not working. America continues to get heavier and heavier. What are people in the blue zones region doing that we can take away? First of all, most of their physical activity is walking. If we can take a sedentary patient and get them walking 20 minutes a day, it can add 3 years to their life expectancy. ²² There is no pill that can do that. Walk to your friend’s house, walk to the cafeteria, set up “nudges” in your house so you are moving more, maybe getting rid of the mechanical conveniences. My approach: I do something every day that is fun. Some days I feel like swimming. Some days I feel like yoga. Some days I ride my bike, but I never force myself to do it.

• ➢ Purpose

Know your sense of purpose. People rolled their eyes when I wrote a book in 2005 and talked about purpose, but we now know it works. (But what does it mean? Do I get really good at knitting, or build model airplanes?) Take the time to know what you like to do, what you are good at, what your passions are, what your values are, and find an outlet. The definition of purpose in all blue zones always has an altruistic component to it. You are good at something to better your community or better your family.

• ➢ Right tribe

Who are you surrounding yourself with? I am a big fan of curating a circle of friends around me. I would not necessarily tell you to dump your old unhealthy friends, but I will tell you that the best strategy for getting healthy this January 1st is going to your contacts, and proactively bringing a few people closer to you. The type of people you want to look for are the people whose idea of recreation is walking or gardening or biking or pickleball; friends who care about you on a bad day. It is not a bad idea to have a vegan or vegetarian in your intermediate social circle, because they are going to show you where and how to add delicious, healthy, plant-based food to your diet. If you make friends with me, I will come over to your house, but you have to cook me plant-based meals.

• ➢ Right community

And finally, this is the biggest thing, the thing we have completely missed: our community, our environment. We know beyond a shadow of a doubt that the cities with the highest life expectancy in America also have the lowest BMI. Why? Because they have better gym memberships, because they have better individual responsibility, or because they are better Americans? No. Look at Kentucky, for example: the life expectancy in parts of Kentucky is 22 years lower than Boulder, Colorado. Why? Because in Boulder, Colorado, the streets are walkable. The policies favor the cyclist and the pedestrian, over the motorist. Their food policies favor healthy food, over junk food and junk food marketing. There are no junk food billboards; only so many junk food restaurants are allowed. They favor the non-smoker over the smoker.

In 2009 I manufactured a Blue Zones Community in Albert Lea, Minnesota. We brought health care costs down by about 40%, and life expectancy went up. ²³ I do not own Blue Zones, LLC anymore, but my good buddy and co-founder of Blue Zones Project, Ben Leedle (the CEO of Blue Zones), has taken this model of improving cities to over 70 cities, and measurably lowered BMI, smoking, and other health risk factors in these cities. ²⁴ Fort Worth reported a quarter of a billion dollars of health care cost savings every year. Longevity lessons from places like Sardinia are put to work in cities all over America.

The secret to longevity is not in any one factor. Marketers will take one factor and tell you it is a silver bullet—but there is no silver bullet.

It is the interconnected, mutually supporting factors that keep people doing the right things and avoiding the wrong things for long enough so they do not develop a chronic disease. This means shifting our focus from the folly of thinking we are going to convince 330 million people to eat the right way and to move the right way—to instead, shaping their environment so that the healthy choice is the easy choice.

That is the big idea: looking at the environments we live in, and setting up nudges and defaults so people’s unconscious decisions are better.

Remember Stamatis Moraitis, who forgot to die in Ikaria? I called him a few years ago. I was interviewing him for the New York Times. He let me go on about 30 minutes, but then said, “Hurry this up. I got friends coming over for happy hour.” I said, “All right, one last question, did you ever figure out how you beat lung cancer? Almost nobody beats lung cancer.” He said, “Yeah, yeah. I thought about that a lot. In fact, about 15 years ago, I went back to the States to get some tests.” I said, “What did you find out?” He said, “Nothing. I got back to the United States and all my doctors were dead.”

ORCID iD

Dan Buettner https://orcid.org/0009-0009-4978-3249