It started with a mystery: Why do residents of Okinawa, Japan, live longer—and with better health—than people anywhere else on earth?
Dan Buettner, an explorer, author, and National Geographic Fellow, was intrigued by data from the World Health Organization showing that Okinawans live into their eighties, nineties, and even 100s—with little disability or dementia. At that time (the early 2000s), Buettner was leading scientific expeditions focused on solving mysteries, so he pitched the “mystery of longevity” to National Geographic and got the green light. He subsequently embarked on wide-ranging research, whose latest iterations include the Netflix series Live to 100: Secrets of the Blue Zones and the book The Blue Zones Secrets for Living Longer.
Buettner and a team of researchers from the University of Minnesota and the National Institute on Aging identified five places around the globe—the Okinawa archipelago; Sardinia, Italy; the Nicoya peninsula in Costa Rica; Ikaria, Greece; and Loma Linda, CA—where people enjoy extraordinary longevity and high quality of life. “We were looking for the correlations among these five regions, which we called blue zones because we circled them on a map in blue ink. We hypothesized that there were commonalities in their lifestyles that led to longevity,” Buettner explains.
After collecting data on diet, exercise, social interactions, and other factors, he and his team discovered patterns: The people in these areas mostly eat a whole-food, plant-based diet; they have strong social connections; and they participate in regular physical activity. “People engage in natural movements like walking, gardening, and manual labor,” Buettner says.
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Dr. Daniel Correa speaks with author and explorer Dan Buettner on the Brain & Life Podcast. Dan shares his knowledge of longevity from traveling the world and meeting people who live in communities that have high populations of people who live past 100 years old.
That's not so for most Americans, says Janet L. Jankowiak, MD, a retired geriatric and behavioral neurologist in Boston who has interviewed elite female athletes in their seventies, eighties, and nineties for an upcoming book on resilience. “Americans tend to be sedentary, with spurts of exercise at the gym,” she says. “People in blue zones are active throughout the day, with most still working into their nineties. Gardening is a part of life, as is raising animals. And walking and biking are major means of transportation.” The benefits of even light exercise were demonstrated in a 2022 review of seven studies in Sports Medicine, which reported that just a few minutes of walking after a meal significantly lowers blood sugar levels.
Blue Zones and Stress
In blue zones, strong social networks and community bonds also have proved vital for people's mental and emotional well-being, says Buettner. “In Okinawa, older women rely on moais—close-knit groups of about 20 older friends who look out for one another,” says Dr. Jankowiak. “They gather almost daily and play games. And they make a monthly contribution to a communal fund that each can access should the need arise.”
That sense of community yields other benefits as well, Buettner notes. “Having a clear sense of purpose in life gives people a reason to get up in the morning and motivates them to participate in meaningful activities.”
Blue zone residents also protect their mental health. “They engage in daily rituals to help them unwind,” says Buettner, “such as prayer, ancestor veneration, and happy hour—yes, in most of the blue zones they drink alcohol in moderation.”
Food is another key component of healthy living in blue zones, says Buettner. People there tend to consume unprocessed foods, beans, legumes, fruits, and vegetables—often following traditional recipes that have been passed down through generations. That style of eating is good for heart and cognitive health, says Linda Hershey, MD, PhD, FAAN, professor of neurology at the University of Oklahoma Health Sciences Center in Oklahoma City. “Numerous high-quality studies support the benefits of the MIND, DASH, and Mediterranean diets, which emphasize green leafy vegetables, fruits, beans, nuts, fish, poultry, oil, and whole grains, and discourage fried food, processed meat, snack foods, and sweets,” Dr. Hershey says.
“In Okinawa, people stop eating when they are 80 percent full,” says Dr. Jankowiak. “In several of the blue zones, the largest meal is consumed in the morning, with meals for lunch and dinner progressively smaller.” These habits also may be a factor in the low rates of obesity in the blue zones, Dr. Jankowiak adds.
Discoveries about blue zone habits align with other research on older adults, says Claudia Kawas, MD, professor of neurology and of neurobiology and behavior at the University of California, Irvine, who has supervised the 90+ Study, which spans two decades and assesses factors contributing to longevity. “Essential elements are regular physical activity, social engagement, and cognitive and socially stimulating activities like attending church and visiting museums,” says Dr. Kawas, who notes that her study found that taking supplements didn't significantly affect longevity.
Blue Zones and Brain Health
Buettner and his researchers have observed a much lower incidence of dementia and depression among older people in blue zones compared with the worldwide population. To some extent, that could be because of a low-stress lifestyle. “Anxiety has serious negative health consequences, in part because it interferes with sleep,” says Dr. Jankowiak. “The slower pace in these communities allows people to be more in sync with their normal circadian rhythms.”
Some blue zones, such as Sardinia, have traditions that involve sensory experiences, like wine making or crafting. These activities may stimulate the brain and help maintain cognitive vitality, says Buettner.
In addition, Dr. Jankowiak says, “many of these communities have strong family ties and intergenerational interactions. Older adults benefit significantly from teaching younger generations and require a lot of flexibility to respond to the inquisitiveness of young children.” Dr. Hershey agrees that strong community ties can boost brain health. “Loneliness and social isolation are risk factors for dementia. We need contact with others to keep our minds sharp. And physical activity is important for reducing the risk of vascular dementia and Alzheimer's disease.”
Residents of the blue zone in the United States—a community of Seventh-Day Adventists in Loma Linda, CA—follow a plant-based diet, get regular physical activity, and connect through faith. “They also strictly observe a day of Sabbath, which has restorative benefits,” says Dr. Jankowiak.
“People in blue zones aren't consciously trying to live a long time; instead, their longevity is a product of their environment,” says Buettner, who collaborates with governments, community organizations, and citizens in areas across the U.S. (more than 75 to date) to change public policies related to housing, zoning, and the environment. This effort to replicate characteristics of blue zones aims to make healthy choices more accessible to everyone—which is particularly crucial considering the higher rates of diabetes, obesity, and dementia among Black and Hispanic populations.
Creating a Blue Zone
In 2019, a study published in the International Journal of Environmental Research and Public Health appraised a Blue Zone initiative in Albert Lea, MN, which was supported by the AARP and the University of Minnesota School of Public Health. Among the accomplishments were the creation of walking groups (similar to Okinawa's moai concept) to promote physical activity and community interaction; introducing “Blue Zones” labels on healthier products in grocery stores; and replacing unhealthy snacks in schools with nutritious alternatives.
The initiative wasn't entirely successful, says Cathy Malakowsky, director of community engagement and enrichment for the city of Albert Lea. Everyone was excited initially, she says, but dietary problems remain. “It was fun to see the community come together to form walking groups, coordinate healthy potluck dinners, and remove TVs from their bedrooms to encourage more movement,” Malakowsky says. More than 10 years on, though, “many people in our community still eat too much processed food that is high in sodium and saturated fat,” she says. “That's why we work with restaurants to highlight the healthy choices.”
Under the Blue Zones program, restaurants, schools, and churches can earn certification for their efforts to nudge people into blue zone–like habits. “The certification is handled locally,” says Malakowsy. “In our case, the Chamber of Commerce oversees it, starting with an assessment of the organization's goals: Do you want to reduce tobacco use? Add a workout room? Add a healthy snack bar? Create a walking path on your grounds?”
Other places in the country have aimed to improve quality of life with a blue zone approach. A proposed affordable housing development funded by New York State in East New York, Brooklyn, for example, would include walking paths, recreation areas, facilities that foster community, and even a farm for growing fresh vegetables.
A neurologist in private practice in Houston has created her own blue zone environment. “I grew up in India eating fresh, mostly plant-based foods, with all the generations engaging in moderate physical activities. I believe people can bring blue zones to wherever they are by putting these healthy practices in place,” says Madhureeta Achari, MD, FAAN. “My office is in a little house in an old neighborhood. I have a garden and a walking trail near the office, and our staff enjoys communal meals with no shop talk.”
Buettner hopes his Netflix show conveys the pleasure of healthy living. “I wanted the series to offer more than just longevity hacks. People crave answers beyond technology, beyond genetic intervention. I wanted longevity to look beautiful, to be aspirational.” Indeed, the series is exquisitely shot, as much a travelogue as a documentary. “I wanted to pair longevity with deliciousness and gorgeousness. I think this series demonstrates that there's a joyousness to blue zones.”
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