A disproportionately high number of Cilento's residents are over 100 years old and in remarkably good health. Photo / Dario Bronniman, Unsplash
Cilento, south of Naples, is known for its national park, its sparkling coastline – and its disproportionately high number of centenarians.
On the west coast of Italy, just south of Naples, is the region of Cilento. It’s known for its sprawling national park which overlooks the crystal clear Mediterranean Sea, yet its most impressive feature is its residents. A disproportionately high number of them – roughly 300, in fact – are over 100 years old, and in remarkable health, free of heart problems and mental ailments.
Professor Salvatore Di Somma, founder of Great Health Science, which runs research programmes investigating healthy ageing, has studied Cilento’s residents for the past decade, alongside a team of scientists from Italy and the United States. He first visited the region in the late 1970s and, as a young doctor, was immediately enamoured with it. “I was surprised to see people over the age of 90 still very healthy, with no cardiovascular disease, very active in mind, not even wearing glasses, and with well-functioning health systems,” he says.
The researchers, collaborating under the CIAO (Cilento Initiative on Ageing Outcomes) study, believe Cilento should be designated an official “Blue Zone”.
“It’s a special place where people enjoy long and healthy lives with habits similar to residents in official Blue Zones, like Sardinia and Greece,” says Di Somma. “There is a lot we can learn from them.”
After 10 years of research, he believes the team has only begun to uncover Cilento’s secrets to robust ageing. But if we’re not living in a beautiful Italian village by the sea, here’s what else we can do.
For Nicolina – a 101-year-old resident who lives in the mountainous village of Eremiti – her homemade olive oil is medicine. If she has a cold, her family physician will put a drop of it up her nose, and if she’s constipated, she’ll drink a spoonful of the golden liquid. It’s a staple of the Mediterranean diet, and packed with antioxidants which are good for the gut and heart. In fact, Cilento is considered the birthplace of the Mediterranean diet – it’s where Ancel Keys, the American physiologist, first discovered it in the 1950s, and made the link between certain dietary patterns and reduced cardiovascular risk.
In 2022, Harvard researchers found that eating more than half a tablespoon of olive oil each day – especially in place of butter, margarine or mayonnaise – may boost longevity. They speculated this is due to olive oil’s anti-inflammatory and antioxidant properties, which aid cardiovascular health and may reduce inflammation in the body.
Di Somma and his team compared the health of middle-aged residents in Cilento to their counterparts in Malmo, Sweden. “In north Europe they have totally different food habits and lifestyles. They use a lot of meat, and they use butter rather than olive oil,” he explains. In the study, they compared the lifestyle, dietary habits, and prevalence of cardiovascular disease and neurodegenerative biomarkers.
Perhaps unsurprisingly, they discovered the residents in Malmo had a higher chance of cardiovascular disease and cancer, as well as higher LDL (“bad”) cholesterol levels. The Mediterranean diet played a role in the better health of Cilento’s residents, the researchers concluded, although they believed further protective factors were also at play.
Carnivores, look away now. The residents of Cilento eat a very different diet to the average Westerner, explains Dr David Brenner, the president and chief executive of Sanford Burnham Prebys, a research unit working on the CIAO Study. Beef is rare – in fact, they don’t eat much meat at all.
Their diet centres around fruit, vegetables, nuts, legumes, and wholegrain breads and cereals. They flavour their meals with rosemary – healthy fats are key – and their preferred animal proteins are fish and seafood, particularly anchovies.
Whilst we know red meat is a great source of protein and iron, it has also been linked to increased cancer risk. In 2019, Oxford University found that eating it just once a day could increase bowel cancer risk by a fifth. Meanwhile, although anchovies are more of an acquired taste, research consistently shows that they’re good for the heart due to their omega-3 fatty acid content.
As Nicolina proves, many of the elderly residents in Cilento are mentally sharp. She perfectly remembers many of her friends who sadly died years ago, and enjoys baking fresh cookies for her regular visitors. Meanwhile a fellow resident, 98-year-old Ida, who lives in the village of Gioi, makes her own fresh pasta and loves to sing.
In fact, in 2020 the team studied the loneliness and wisdom of middle-aged and elderly people in Cilento compared with adults in San Diego, using two scientific scales. The UCLA Loneliness Scale uses a four-point rating mechanism to assess how often a person feels disconnected from others, whilst the San Diego Wisdom Scale measures seven traits including emotional regulation, spirituality, and acceptance of different viewpoints.
“We found they [Cilento residents] are in a very healthy cognitive state and this was linked to a very high level of wisdom,” Di Somma explains. He believes this is partly due to their strongly held and practised Christian beliefs. “They have no Alzheimer’s and very low levels of depression because they live by the day and have a close relationship with religion, which gives them purpose.”
By investing time in their favoured hobbies and interests, they are likely to be happier, more satisfied and mentally active, according to a 2023 study by UCL, which are all important factors in maintaining a healthy brain.
In Cilento, there are no retirement homes. “Everyone lives at home and the older people will see their children, grandchildren, and great-grandchildren every day,” Brenner says. Their houses have been in their families for over 400 years and there’s a “sense of worth, community and interaction”, he explains.
Nicolina lives alone but her son comes to visit her each night and she’s continually visited by friends and neighbours. Her son and grandchildren will always offer to help her, but she’s fiercely independent and consistently refuses. When asked if she ever feels alone, she answers “no” without hesitation.
The researchers believe this sense of community, independence and intergenerational communication helps to keep the residents younger, sharper and happier. It marks a stark contrast to the UK, whose care home population is nearly half a million, with many elderly people battling multiple or complex needs.
The land in Cilento is enviably rich and fertile, whilst the villages are hilly, which means many residents simply spend their days gardening and incline walking. Exercise is, therefore, an integral and natural part of their lives.
“They produce a lot of their own vegetables, which means they learn to garden from a young age and keep doing it as they get older. It’s part of their tradition,” Brenner explains.
The benefits of a daily walk are well established, with one 2023 study in GeroScience highlighting its profound impact on cardiovascular health and a reduced risk of hypertension. Meanwhile, 2024 research outlines the benefits of gardening, including improved physical health and related behavioural practices like eating more fruits and vegetables.
The residents in Cilento have little need for cars, phones or fancy clothes. “They live without much in the way of money but have a high-quality life because many of their things are very inexpensive or inherited,” Brenner says. Nicolina is incredibly content spending her afternoons listening to Radio Maria, a Catholic broadcaster, and making food for her many visitors.
Brenner says the residents exhibit a good amount of grit, balanced alongside a mindset of “overcoming adversities with a positive attitude”. They don’t have much and they’re happier for it.
Additionally, in a 2022 study which analysed Cilento’s population against key longevity factors, the researchers found that “those who lived [there] adopted specific lifestyles, such as hard work, love of the land, family, and religion, which allowed them to maintain mental well-being and made them particularly resilient and optimistic”.
These daily habits and routines are, of course, only half the picture when it comes to the remarkable health and longevity of Cilento’s residents. The researchers are also examining their stem cells, brains, and metabolites through advanced testing run by Professor Catriona Jamieson’s team at the Sanford Stem Cell Institute.
They hope to discover some of the key biological markers of extreme longevity to aid the development of medical strategies for the treatment of age-related conditions.
However, what we can learn from Cilento’s residents is that surrounding yourself with friends and family, learning to be content with what you have, and opting for a regular splash of olive oil may be the key to living happier, healthier and for longer.