AJLXXX10.1177/1559827616637066American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine research-article6370662016

American Journal of Lifestyle Medicine Sep • Oct 2016

Dan Buettner, BA, and Sam Skemp, BA Blue Zones: Lessons From the World’s Longest Lived

Abstract: What began as a National lives is dictated by our genes, whereas might explain . They found Geographic expedition, lead by Dan the other 80% is dictated by our that the lifestyles of all Blue Zones Buettner, to uncover the secrets of lifestyle. In 2004, Dan Buettner, residents shared 9 specific longevity, evolved into the discovery of CEO of Blue Zones LLC, was characteristics. These are called the the 5 places around the world where determined to uncover the specific Power 9. people consistently live over 100 years old, dubbed the Blue Zones. Dan and his team of demographers, scientist However, many individuals have and anthropologists were able to distill the evidence-based common the capacity to make it well into denominators of these Blue Zones into 9 commonalities that they call the the early 90s and largely without Power 9. They have since taken these principles into communities across chronic disease. the working with policy makers, local businesses, schools and individuals to shape the environments aspects of lifestyle and environment Power 9 of the Blue Zones Project Communities. that led to longevity. By teaming up What has been found is that putting with and the To make it to age 100, it seems that a the responsibility of curating a healthy National Institute on Aging, Dan and person must have to win the genetic environment on an individual does his team, found the 5 demographically lottery. However, many individuals have not work, but through policy and confirmed, geographically defined the capacity to make it well into the environmental changes the Blue Zones areas with the highest percentage of early 90s and largely without chronic Project Communities have been able to centenarians (Loma Linda, CA, USA; disease. Blue Zones uncovered 9 increase life expectancy, reduce obesity Nicoya, Costa Rica; , ; evidence-based common denominators and make the healthy choice the easy Ikaria, Greece; Okinawa, ; seen in among the world’s centenarians that are choice for millions of Americans. Figure 1). These 5 areas were located believed to slow this aging process. using epidemiological data, statistics, Keywords: Blue Zones; Power 9; Life birth certificates, and other research. 1. Move naturally. The world’s longest- Radius; Vitality Compass; Longevity; These areas were dubbed Blue Zones, lived people do not pump iron, run Health; Dan Buettner where people reach age 100 at 10 marathons, or join gyms. Instead, they times greater rates than in the United live in environments that constantly States. Once these areas were nudge them into moving without established, they sent in a team of thinking about it. They grow gardens he Danish Twin Study1 anthropologists, demographers, and do not have mechanical established that only about 20% epidemiologists, and researchers to conveniences for house and yard Tof how long the average person identify the lifestyle characteristics that work.

DOI: 10.1177/1559827616637066. From Blue Zones, LLC, Minneapolis, . Address correspondence to: Dan Buettner, BA, Blue Zones, LLC, 80 South 8th Street, STE 1400, Minneapolis, MN 55402; e-mail:[email protected]. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2016 The Author(s) These articles are based on The Annual Conference of the American College of Lifestyle Medicine (ACLM) held November 1-4, 2015, in Nashville, Tennessee—Lifestyle Medicine 2015: Integrating Evidence into Practice. 318 vol. 10 • no. 5 American Journal of Lifestyle Medicine

Research from the Framingham Figure 1. Studies2 shows that smoking, obesity, Blue Zones (reprinted with permission from Dan Buettner). happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.

Blue Zones Sardinia Located off the coast of Italy, Sardinia is home to the world’s longest-lived men. This community of shepherds walk 5 mountainous miles a day or more. This natural movement provides all the positive cardiovascular benefits you might expect and also has a positive effect on muscle and bone metabolism without the point pounding of running marathons. The classic Sardinian diet is plant based, consisting of whole-grain 2. Purpose. The Okinawans call it Ikigai 6. Wine @ 5. People in all Blue Zones bread, beans, garden vegetables, and and the Nicoyans call it plan de vida; (except Adventists) drink alcohol fruits. Meat is largely reserved for for both, it translates to “why I wake moderately and regularly. Moderate Sundays and special occasions. up in the morning.” Knowing your drinkers outlive nondrinkers. The Sardinians drink wine moderately. sense of purpose is worth up to 7 trick is to drink 1 to 2 glasses per day Cannonau wine has 2 or 3 times the years of extra life expectancy. (preferably Sardinian Cannonau level of artery-scrubbing flavonoids as 3. Downshift. Even people in the Blue wine), with friends and/or with food. other wines. Moderate wine consumption Zones experience stress. Stress leads to And no, you cannot save up all week may help explain the lower levels of chronic inflammation, associated with and have 14 drinks on Saturday. stress among men. every major age-related disease. What 7. Belong. All but 5 of the 263 the world’s longest-lived people have centenarians interviewed belonged to Okinawa that others do not are routines to shed some faith-based community. Home to the world’s longest-lived that stress. Okinawans take a few Denomination does not seem to women, these South Pacific islands offer moments each day to remember their matter. Research shows that attending many secrets to longevity. The Okinawa ancestors; Adventists pray; Ikarians take faith-based services 4 times per tradition of forming a moai provides secure a nap; and Sardinians do happy hour. month will add 4 to 14 years of life social networks. These safety nets lend 4. 80% Rule. Hara hachi bu—the expectancy. financial and emotional support in times of Okinawan 2500-year old Confucian 8. Loved ones first. Successful need and give their members the stress- mantra said before meals reminds centenarians in the Blue Zones put shedding security of knowing there is them to stop eating when their their families first. This means keeping always someone there for them. In stomachs are 80% full. The 20% gap aging parents and grandparents Okinawa, at age 5, children are put into between not being hungry and nearby or in the home (it lowers these committed social networks. One feeling full could be the difference disease and mortality rates of children specific moai that Dan discovered had between losing weight or gaining it. in the home too.). They commit to a been together for 97 years; the average age People in the Blue Zones eat their life partner (which can add up to 3 of the group is 102. They meet every day to smallest meal in the late afternoon or years of life expectancy) and invest in drink sake and gossip. If one of them does early evening, and then, they do not their children with time and love. not show up, the other 4 put on their eat any more the rest of the day. (They’ll be more likely to care for kimonos to walk across the village to check 5. Plant slant. Beans, including fava, aging parents when the time comes.) on their friend. Okinawans also attribute black, soy, and lentils, are the 9. Right tribe. The world’s longest lived their longevity to the old Confucian mantra cornerstone of most centenarian diets. people chose—or were born said before meals Hara Hachi Bu, which Meat—mostly pork—is eaten on into—social circles that supported reminds them to stop eating when 80% full, average only 5 times per month. healthy behaviors, Okinawans created so they do not overeat. They also hold a Serving sizes are 3 to 4 oz, about the moais—groups of 5 friends that strong sense of purpose in their family. size of a deck of cards. committed to each other for life. One centenarian described the feeling of

319 American Journal of Lifestyle Medicine Sep • Oct 2016

holding her great great great grandchild as “Jumping into heaven.” Figure 2.

Loma Linda Life radius (reprinted with permission from Dan Buettner). This Adventist community in California outlives the average American by a decade. Taking their diet directly from the Bible they consume a vegan diet of leafy greens, nuts, and legumes. They recognize the Sabbath and downshift for 24 hours every week. Many of the Adventists are still very active into their late 90s; Dr Ellsworth Wareham, who is 95 years old, was told that a contractor wanted $6000 to build a privacy fence in his yard. Instead of paying the contractor he decided to do it himself. After 3 days of work he ended up in the hospital, but Ellsworth was not on the table, he was the surgeon performing the open-heart surgery, one of 20 surgeries performed that month. Similarly, Marge Jetton age 105 woke up People who nap regularly have up to have dropped by 70%. It is clear that every morning at 5:30 am read her Bible, 35% lower chances of dying from heart there is no quick fix, but there must be had a breakfast of slow cook oatmeal, disease. It may be because napping small changes to the environment to see nuts, and dates with soymilk and a prune lowers stress hormones or rests the heart. long-lasting health changes. juice shooter. She would then ride her One Ikarian in particular, Stamatis stationary bike for 30 minutes and get in Moraitis, moved to America when he was Life Radius her Cadillac and drive to her volunteer 22 years old to pursue the American jobs for 7 different organizations. dream. He was a painter, and Research shows that individuals spend immediately started having success, about 90% of their lives within 5 miles of Nicoya bought a house, married, and had 3 kids. their home, known as the Life Radius, Nicoyans spend just 15% of what At the age of 66 years, he developed seen here in Figure 2. To engineer an America does on health care and are terminal lung cancer. Instead of dying in environment where longevity ensues, more than twice as likely than Americans America, he decided to move back to Blue Zones worked with researchers to to reach a healthy age of 90 years. Faith Ikaria and moved in with his parents. He create a blue print to optimize the Life and family play a strong role in Nicoyan started breathing the air, drinking the Radius. The team started by analyzing culture. So does plan de vida, or reason wine, and eating a Mediterranean diet. what individuals can do for themselves. to live, which helps Nicoyan elders After a few months, he planted a garden Individuals can engineer their kitchen, so maintain a positive outlook and active not planning on ever getting to harvest they eat about 100 fewer calories and lifestyle. Nicoyans eat little to no the vegetables; 37 years later he has a engineer their home, so they burn a processed foods but plenty of vineyard producing 200 L of wine a year. couple of hundred extra calories through antioxidant-rich tropical fruit. But they His secret he says? “I just forgot to die.” physical activity. This is done through also have 1 unique secret: calcium- and small changes such as putting a bowl of magnesium-rich water, which wards off fruit on the counter, serving food at the Medical heart disease and promotes strong bones. stove and not on the table, using hand Obesity and diabetes are running tools for yard work, and many more. In Ikaria rampant in the United States. Currently, every community, 80% of people want to People on this tiny Aegean island live 8 the culture is focused on adhering to change their health habits. By creating years longer than Americans do. They different diets and exercise programs. It social networks of these health conscious experience 20% less cancer, half the rate has been found that these are not people, it encourages healthy living and of heart disease, and almost no sustainable changes. Within the first 7 gives people a sense of purpose. dementia. Ikarians eat a variation of the months of a diet, more than 90% of Then, the researchers looked at places Mediterranean diet, with lots of fruits and individuals will have given up. There is a within the life radius. There are 115 vegetables, whole grains, beans, similar decline when it comes to evidence-based design tweaks and potatoes, and olive oil. Ikarians also adherence to gym memberships; after policies that can be put in place, so that downshift with a midafternoon break. just 2 years, the number of attendees will when people show up to school, work,

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church, stores, and restaurants they are When a sandwich was ordered, the on the Power 9 teachings of Right mindlessly nudged to eat less and move customers automatically got fruit instead Outlook, Move Naturally, Eat Wisely, and more. These tweaks include things such of fries. By using different adjectives Belong; it then calculates their biological as standing desks at work, removal of rather than the “healthy choice,” age, overall life expectancy, healthy life vending machines in schools, no individuals were more likely to choose expectancy, and the years they are breadbaskets at restaurants, safe walking the best option. Grocery stores created gaining/losing because of their habits. It paths, and encouraging moais. healthy checkout isles, so that instead of then gives the users 12 customized According to the Centers for Disease candy bars and soda greeting people in recommendations to help them live Control and Prevention, the best the checkout, they saw fruit, water, and longer and better. This is a useful tool to investment on health is through policy. healthy snacks. take initially as a baseline test, then try By creating environments where fruits Schools signed Blue Zones pledges. out some of the specific lifestyle and vegetables are most accessible over They do not sell candy for fundraisers, recommendations, and 3 to 6 months fast food, a dramatic decrease in obesity and there was no candy for good grades. later, take the quiz again. is seen. If there are 6 or more fast food Based on a University of Minnesota study Recommendations include reducing salt restaurants within half a mile of an calculation that prohibiting eating in intake, joining a faith-based community, individual’s home, they are 40% more hallways and classrooms would occasion quitting smoking, improving attitude, and likely to be obese than if there are less a 11% per year drop in student body many more. than 3. By putting policies in place to mass index (BMI), the project convinced limit the number of fast food restaurants schools to adopt the policy. Then, 25% of Summary and putting regulations on smoking, the community signed a personal pledge policy makers can see a drastic increase that they would take steps toward a Blue Zones started as a way of in health. If streets are walkable and healthy lifestyle. discovering the healthiest lifestyles that bikeable, parks are cleaned up, and the After about a year and a half, there was lead to vitality and longevity. Now, 12 active option is the easy option, physical a 3.2-year bump in life expectancy; the years after the start of this massive activity of the entire population can rise community lost a combined weight of project, Blue Zones is a way to design by 30%. 7280 pounds; and health care costs the healthiest lifestyles possible for dropped by 40%. individuals and for entire communities. The goal for Blue Zones is to not only Albert Lea make the healthy choice the easy choice, Blue Zones Expansion In 2008, Dan and the Blue Zones team but also the unavoidable choice. finalized the blue print for Life Radius. After seeing the results in Albert Lea, They had to make sure that it could be Blue Zones began interviewing larger Authors’ Note applied to an American city. Buettner cities to take on. The beach cities of Los and his team interviewed 5 cities to be Angeles were chosen.3 Blue Zones To join the Blue Zones mission, contact [email protected]. the pilot project, and they picked Albert worked with city planners to make the More information about the project can be obtained at https:// communities.bluezonesproject.com/. The authors disclose the Lea, MN, a town of 9000 people. The streets built for humans instead of cars. following conflicts of interest: Dan Buettner is the CEO of Blue team first went in and listened to the The rate of smoking went down by 30%; Zones and Sam Skemp works at Blue Zones as Program organizations to find what they needed. BMI went down by 14%; and people Manager. AJLM They brought in Dan Burden who works reported healthy behaviors. with communities across the country to From there, Blue Zones moved into References create more walkable environments. Iowa with the same strategy; 10 cities Albert Lea wanted to widen Main Street were chosen.4 Smoking went down by 1. Herskind AM, McGue M, Holm NV, and up the speed limit. Blue Zones 8.8%, and healthy eating went up by Sorensen TIA, Harvlad B, Vaupel JW. The heritability of human longevity: a convinced them to build a walking path 10.5%. Then, Blue Zones started working population-based study of 2,872 Danish around their lake instead. The path is in Fort Worth, TX, and Kauai, HI, and are twin pairs born 1870-1900. Hum Genet. now packed 11 months out of the year now in 27 cities across the United States. 1996;96:319-323. with individuals walking. The sidewalks 2. Christakis NA, Fowler JH. The spread of throughout the community were obesity in a large social network over 32 Vitality Compass connected, so people could walk from years. N Engl J Med. 2007;357:370-379. their homes to downtown without In association with the University of 3. Buettner D. The Blue Zones: 9 Lessons for having to walk through fields or busy Minnesota Public Health Department, Living Longer From the People Who’ve Lived intersections. Dan and his team created the Vitality the Longest. Washington, DC: National Geographic Society; 2008. Grocery store and restaurant pledges Compass, named the Best Online Tool 4. Buettner D. The Blue Zones Solution: were created to help individuals change for Retirement and Longevity by the Wall Eating and Living Like the World’s the way they eat. Restaurants were Street Journal. This tool has users answer Healthiest People. Washington, DC: required to offer 3 plant-based entrées. lifestyle and background questions based National Geographic Society; 2015.

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