The communities where people live longest – so-called ‘Blue Zones’ – share behaviours available to us all, says the researcher who first identified them and he shares a surprising finding about what those people are eating.
In February, Dan Buettner stood before a US Senate special committee on ageing and delivered a message he remains passionate about communicating. He told them the healthiest groups of older people on the planet haven’t got that way thanks to any special diet plans or exercise regimes. They don’t need to count steps or calories. Neither are they running off to Latin America for expensive stem cell treatments; in fact, longevity bio-hacks play no role at all. These populations are healthier purely because it is the easy thing to be.
US senators tend to listen to what Buettner says, as does the wider world, because the journalist, author and explorer founded the concept of Blue Zones. Collaborating with experts including demographers and scientists, he identified the regions in the world where people live especially long and healthy lives – the Blue Zones – and investigated why. (The origin of the name is prosaic: during their research, Buettner and his colleagues literally drew blue circles around the places they identified on a world map.)
The name is now a trademarked, multimillion-dollar global brand. There are books, a Netflix documentary series (Live To 100 – Secrets of The Blue Zones), meal products (heirloom rice bowl, anyone?) and the Blue Zones Project helps entire US towns to adopt the habits credited with being the reason people in the Blue Zones avoid or delay the diseases that shorten our lives: type 2 diabetes, cardiovascular disease, cancer, dementia.
Buettner sold the Blue Zones company in 2020 for US$78 million to Adventist Health, a US West Coast healthcare provider owned by the Seventh-day Adventist church (whose followers have a strong presence in the Loma Linda, California, Blue Zone) but he remains committed to the concept. He believes the environments we live in and the communities that surround us are the real key to longevity and good health, and that a focus on individual responsibility isn’t getting us anywhere.
“If you try to change people’s behaviour, you’ll fail with almost all the people, almost all the time,” Buettner tells the Listener via Zoom from his Miami Beach home. “All you have to do is look at the literature on diet and exercise programmes. They’re Sisyphean endeavours that people can focus on for a few months or maybe a year, but then they run out of discipline or intention or presence of mind, and they fail.
“The reason people live longer in the Blue Zones is not because of willpower. It’s because they live in places where it’s easier to walk than take the car. Plant-based foods are cheapest and most accessible. They live in extended families and next to neighbours, so social interaction isn’t something they need to do mindfully.”
Buettner and his team of researchers discovered residents in Blue Zones share nine specific lifestyle habits that are associated with longevity:
■ They move naturally – walking, gardening, doing chores.
■ They have a sense of purpose, which is worth an extra seven years of increased life expectancy.
■ They have routines and rituals to refresh themselves and manage stress – Ikarians, in the Greek islands, take a nap, Adventists pray.
■ They don’t over-eat and tend to have their smallest meal in the late afternoon or evening.
■ Meals are mostly plant-based. Meat is consumed relatively rarely.
■ They have a sense of belonging, which may stem from being part of a faith-based community.
■ They keep family around them.
■ Their community of friends and family shares similar healthy behaviours.
■ And (except the Adventists) they drink a couple of glasses of wine a day.
Walking the talk
Buettner is a charismatic 64-year-old who walks the Blue Zone talk. He lives in a neighbourhood where it is easy to go strolling and swimming, has lots of friends, is a self-described bicycle fanatic and shows me the contents of his freezer, which is big on three-bean minestrone and wholegrain sourdough bread. “I’m probably in better shape than anyone else my age that I know,” he says.
But he never set out to be a longevity expert. “I don’t want to be a guru. What I am is a researcher. I’m very good at translating enormous amounts of data. I mean, these are very simple, elegant insights. If you want to help people live longer, change your environment, not your population.”
The zones are not without controversy. One of the original founders, demographer Michel Poulain, has broken away from the collaboration and curated his own list of locations and slightly different lifestyle habits. Poulain includes the French island of Martinique but omits Loma Linda, on the outskirts of San Bernadino, and Buettner’s latest addition, Singapore. (The other original Blue Zones identified by Buettner and his research team were Ikaria, Sardinia, Nicoya, in Costa Rica, and Okinawa, Japan.)
Lost records & pension fraud
There has also been a move to discredit the Blue Zones philosophy and the original research that informed it by Saul Newman, of University College London. He claims those regions that are home to the longest-lived people also tend to be places with poor record-keeping – such as lost birth certificates for claimed centenarians – and high levels of pension fraud. Although Newman’s work has drawn plenty of attention, and won an Ig Nobel Prize (awarded for unusual or amusing advancements in science) last September, it has yet to be peer reviewed, and Buettner vigorously rebuts it.
“He’s … hungry for attention and has found an easy way to do it,” he says. “The fact is, we spent three years, and two National Geographic grants, verifying ages, and our work is not hearsay or subjective. It’s a straightforward compiling of data: birth records, baptismal records, death records; there’s no ambiguity.
“I can tell you beyond a shadow of doubt that people in Blue Zones live significantly longer. While I don’t appreciate going to a party and hearing people say, ‘Oh yeah, I heard Blue Zones is all fake,’ I put my head on the pillow at night and know my colleagues and I did our homework.”
But even in the zones, things are changing, and life expectancies with them. Buettner believes that within a generation or two, they may be gone.
“I’ve been going to Okinawa for 25 years and it’s a mess now. I’ve seen it deteriorate into a forest of junk food restaurants, concrete highways and snarled traffic. They follow the American way and their health goes into the shitter.”
The way Buettner sees it, we need policy change and leadership to re-engineer our environments and make healthy behaviours easier for all of us.
He singles out Singapore as succeeding in reverse-engineering the urban environment to make being healthy the easiest option for its citizens. Outdoor fitness areas are found throughout the city, high taxes mean owning a car is expensive, so most people walk and use public transport, the sugar content in fizzy drinks has been capped, tobacco is heavily taxed, healthier ingredients have been subsidised.
Since phasing-in such policies in recent decades, Singapore has seen a significant rise in life expectancy. “Currently, they have one of the world’s highest healthy life expectancies, according to the Global Burden of Disease Project,” says Buettner. “This isn’t Dan Buettner with a backpack on looking at village births and deaths records; this is a confederation of thousands of scientists.”
Cities redesigned
In the US, there are ongoing projects to redesign cities using Blue Zone wisdom. In 2009, Buettner started working on the first pilot project with a small Minnesota city, Albert Lea (population: 18,000), making it a more walkable environment with more pavements and a pathway around the lake. The positive results promoted other US cities to get in on the action.
“I’ve personally worked on 20 cities,” says Buettner. “We hired a third party, Gallup, to measure BMI [body mass index] at the population level, physical activity, vege-table consumption, life satisfaction. They measure it when we come in, at year two and year five. Our interventions involve working with city councils to adopt policies that favour healthy food over junk food, active living streets, policies that favour the non-smoker over the smoker.
“Then we have another team that administers Blue Zone certification for restaurants, grocery stores, workplaces, schools and faith-based organisations that agree to optimise their designs to favour more movement and better eating. And we get a critical mass of ambassadors who agree to reshape their immediate surroundings and social networks and get out and volunteer.
“This approach has been very effective at comprehensively setting up enough nudges at the population level that we can see improvements in just a few years. And when you think about it, this is exactly what people in Blue Zones have done. They live their lives in environments where they’re set up for success.”
Not all aboard
Blue Zones Project cities have seen drops in the number of overweight adults, lower smoking rates, increased activity, healthier eating habits and lower healthcare costs. But it requires some effort, says Buettner.
“We’ve had probably 1000 places say they want to be Blue Zone cities now. We have what we call a readiness assessment. So, we talk to the mayor, the chamber of commerce, the police chief, the superintendent of schools, the CEOs, etc, and we explain that what works is changing their policies and changing their environment and that it requires them to think differently and use their political equity, so are they signed up for that?
“We have to jump over two hurdles. The first is that a lot of people in America are very freedom-focused and are afraid this is a nanny state intervention. In which case, we say, ‘Goodbye, keep doing what you’re doing, we can’t help you if you’re not going to be open-minded to this’.
“The other issue is that we can only be successful if we have a full-time staff for five years and that money has got to come from somewhere. So, the only way it can successfully happen is if they can go out and find funding.”
They follow the American way and their health goes into the shitter.
Cities don’t need to become official Blue Zone Projects to make effective change, he says. All the information is out there, so they can mimic the approach if they want to. Having sold the company to Adventist Health and completed his five years as a consultant, Buettner now has no official involvement with the organisation.
“I might get back involved if I can figure out a way to be really influential in the work and not have it consume my life,” he says. “What I like doing best is coming up with a new idea and seeing it birth into a reality. I’m good at tracking down original sources of information and synthesising them into stories that drive home the point. But ask me to sit through a board meeting and you’ll be disappointed.
“The Blue Zones company now has 185 employees and you start having to spend more time with lawyers and board meetings and recalcitrant mayors. I like to write. I enjoyed doing the Netflix series and hope to do another one. Plus, I like to enjoy my life rather than working all the time.”
He has been working, of course. He spends some of his time speaking around the world to audiences that include medical conferences and political leaders. His last cookbook, The Blue Zones American Kitchen, was a New York Times bestseller and another one is coming. This time, it’s on one-pot meals based on Blue Zone eating patterns and AI-derived data on the flavours that people find most delicious – one is curry. He’s also researching a book investigating areas in the world with the highest health-adjusted life expectancy (the average number of years a person can expect to live in full health). “I’m finding common denominators and it’s extraordinary in that you get a very clear signal of what’s driving health. It’s sort of the next generation of longevity.”
High-tech options
Much of the science focused on extending life span and delaying disease has been looking at advancements such as stem-cell therapies, growth-hormone injections and infusions of youthful blood. Some experts are developing anti-ageing supplements, others seek to repurpose existing drugs, such as the immunosuppressant rapamy-cin, which is believed to protect ageing muscles and has been shown to extend the lifespan of mice.
Buettner is dismissive of these attempts to slow the biological clock. “All these longevity hacks that everyone’s on fire about, even if they do work – for which there’s no evidence – I don’t know of anything to suggest that people will do it for long enough to make a difference.”
To his way of thinking, the Blue Zones approach has more evidence to back it and has already been proven to be achievable.
“You want a shiny longevity hack from Dan Buettner?” he asks. “Take a hundred of these a day: black beans. Research suggests it will be worth about four extra years of life expectancy. It’ll be great for your microbiome. They’re full of protein, which we’re obsessed with right now. And everyone can afford them. It doesn’t have to be black beans; it can be any kind you like.
“Is it sexy? No. Is the big bean industry paying me off? No. But I can point to five populations in the world that are manifestly living longer and eat a cup of beans a day. They’re not suffering the diseases that are bankrupting our economies.”
The late epidemiologist Geoffrey Rose influenced Buettner’s thinking. Rose’s theorem, also known as the prevention paradox, is that preventing disease in the entire population rather than focusing on high-risk people is more effective in reducing overall disease burden.
“But change takes time,” Buettner says. “Most big new changes take decades. It’s been 15 years since I started this intervention and it’s catching on now. I think there will continue to be pockets of enlightenment. People are driven by comfort and their appetites, and business is driven by pandering to them.
“What I do, it’s not a quick fix, it’s hard work even though ultimately it brings more joy to life. So, I would say in pockets we’ll see it but not systematically, at least not for a while.”
