activity, blue zones, california, centenarians, costa rica, diet, exercise, family, greece, health, ikaria, italy, japan, lifestyle, loma linda, longevity, nicoya, okinawa, protein, religion, sardinia
The Effect of Diet and Lifestyle on Longevity
The benefits of diet and exercise to health and longevity are well understood in modern Western culture. In studying various clusters of populations around the world, it has been found that certain demographic and geographical regions around the globe seem to provide a setting for healthy living and producing relatively high rates of centenarians. These geographical clusters have been defined as ‘Blue Zones’. National Geographic fellow Dan Buettner identifies five ‘Blue Zones’ in Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Ikaria (Greece), and Loma Linda (California). It is evident that these populations live robust and healthy lives. In contrast, modern society is used to seeing diet fads in the media, being told what is healthy and what is not. In reality, there is no one diet that all should follow. One’s dietary palate should be shaped by what is made available by the natural landscape. In this paper, I will examine these five geographical regions, describe the characteristics of the foods eaten by each population and explain how lifestyle and diet affect longevity. Identifying lifestyle patterns and commonalities amongst these communities may help us to understand how changes in lifestyle can impact our health profiles and longevity.
The Nuoro province, a central-eastern mountain region of Sardinia, is home to one of the largest concentrations of centenarians in the world. A combination of modifiable — lifestyle and nutritional — factors influences especially male age rates. However, the exact secret behind this phenomenon has not been fully established. Many believe that there is something in the air that puts the men and women in such a jovial state. The Sardinians of Nuoro live in very close proximity to the land, an intimate relationship that has been fostered for several centuries. The land’s character is rugged, protected throughout history from invaders and with little immigration of outsiders. Thus, many of the admired genetic traits are preserved. In particular, there is a gene in the Y chromosome that greatly reduces the risk of heart attack or stroke in men. Alfonso Melis, a sibling in a family recognized by the Guinness World Records commented on the secret to longevity: “We eat genuine food, meaning lots of minestrone and little red meat and we are always working.” Breakfast for the typical family consists of a fried egg, sourdough bread, goat’s milk and coffee. Lunch is oriented around a bowl of a heartfelt minestrone with lard and a piece of bread, accompanied by a glass of red wine. Dinner reintroduces some soup, moving into vegetables, bread, pecorino cheese, and wine.
The majority of the diet comes from locally grown vegetables, olive oil, lemon, garlic and spices. Dairy reflects the topography of the land and its animals, comprising a rich part of the Sardinian diet. The abundance of sheep and goats in the region shaped the palate, making milks and cheeses widely consumed. Both are nutritionally higher than cow’s milk, and are digested easier. Both sheep’s and goat’s milk reduce bad cholesterol, have anti-inflammatory properties, and fight against cardiovascular disease. Bone density in Sardinia is strong due to the high level of calcium and phosphorus in the goat’s milk. Pecorino is eaten frequently, and contains high levels of omega-3 fatty acids. The widely consumed carta di musica and carasù flatbreads are made from high-protein, low-gluten durum wheat, designed to be portable and easily accessible with high nutritional content for shepherds who pasture their sheep for long durations of time, away from home (Buettner, 59). The bread’s glycemic score is very low, thus it does not induce a spike in blood sugar. Furthermore, barley is considered a large contributor to the Sardinian (and centenarian) diet. Barley is ground into flour and made into bread, or added to soups. With a low glycemic index, barley is high in protein, magnesium, and fiber. Similarly, sourdough bread is made from whole wheat flour and instead of using yeast, it adopts live bacteria that help to raise the dough (Buettner, 60). Flatbreads and sourdoughs are accompaniments to every meal.
Fennel is used widely and is high in fiber as well as vitamins A, B and C. The chickpeas and fava beans of Sardinia are added to stews and provide fiber and protein. Tomatoes are also widely grown and deliver vitamin C and potassium. The cooking of tomatoes into sauce unlocks many antioxidants, and combined with olive oil, assists the body in nutrient absorption (Buettner, 60). Almonds provide a high-density lipoprotein cholesterol, meanwhile reducing blood pressure. Milk thistle is also popularly consumed on the island, and is made into a tea that contains silymarin, an antioxidant with many anti-inflammatory benefits that also cleanses the liver. Lastly, red wine (Cannonau wine) is produced from the Grenache grape, and is consumed with each meal of the day. The drink is very high in antioxidants, and helps to reduce heart attacks. (Buettner, 61). Wine is an ordinary component of Sardinian culture (Tsai, 2012). Sugar is naturally avoided and meat (eaten only one to two times per week) consumption is minimal, usually served as a condiment with vegetables being the primary dish. The Sardinian diet is high in antioxidants, vitamins, fiber and protein, providing inhabitants of the Nuoro province with a wholesome diet complemented by an active and low-stress lifestyle.
Ikaria, an island located about 30 miles off the western coast of Turkey, like Sardinia, is jagged and mountainous. The 99 square mile island has a rich history in providing healthy air and water to many centenarians. Because of the lack of natural harbors on the island, Ikaria has developed to become self-sufficient. This has allowed the island to hone and evolve its gastronomic culture and lifestyle without the dominating influence of modernization. All of the vegetables are homegrown or locally produced. This diet is paired with a lifestyle similar to that observed in the Nuoro province of Sardinia. The clock loses its significance, naps are frequent, and life is about enjoyment of the natural beauty in the company of old friends and close family.
The food and drink of Ikaria act doubly as nourishment and medicine. Breakfast consists of goat’s milk, wine, sage tea, coffee, honey and bread. Lunch typically consists of lentils, garbanzo beans, potatoes, fennel, dandelion and horta (green vegetables). Every meal is determined by what the earth provides and what is available in each family’s garden. Dinner consists of simple bread and goat’s milk. During special occasions, a family may slaughter a pig and distribute and savor portions of pork for months to come (Buettner, 2005). A “mountain tea” — composed of marjoram, sage, mint, rosemary, dandelion, lemon — steeped with ingredients native to the island, is served at the end of each day and provides nourishment to the people. The tea serves as an “island ritual” (Buettner, 42).
Dr. Ioanna Chinou comments on the bioactive properties of herbs and other natural products found on the island. The teas consumed date back to traditional remedies used for centuries. The inhabitants of Ikaria have passed down from generation to generation crucial information to stimulate and promote health. They understand that the diet they follow, rich in polyphenols and antioxidant properties, works for them and is tailored to their environment. Wild mint helps combat against gingivitis as well as gastrointestinal disease. Rosemary remedies gout and artemisia promotes blood circulation. It is likely that the tea, which contains mild diuretics, has slowly been reducing blood pressure. The famous Ikaria Study surveyed 1,420 Ikarians and tested 673 individuals over the age of 65. The study highlights the magnified version of the Mediterranean diet by which the Ikarians live, favoring vegetables, fruits, fish, whole grains, olive oil, goat’s cheese and milk, and red wine (Buettner, 38). The low consumption of saturated fats (found in meat) — limited to once or twice a week — is correlated with lower risk of heart disease. Olive oil, extracted cleanly and without any intervening treatment, promotes good cholesterol and reduces bad cholesterol, protecting consumers from heart disease. Daily consumption of olive oil is about four tablespoons. The goat’s milk, made into feta cheese through the process of fermentation of the milk with rennin (found in goats’ stomachs), produces a high-protein probiotic food that has anti-inflammatory properties. The vegetables produced on the island contain a tremendous amount of minerals (calcium, iron, magnesium, potassium) and antioxidants, also associated with red wine, containing flavonoids (Buettner, 40-42). Ikarian diet consists of the land’s offerings, and unlocks the power that nature provides to stimulate good health.
The women of Okinawa are recorded to live very long, with healthy, local food and a purposeful lifestyle. They live surrounded during their lifetimes by a social ring of several friends, their moai. The average life expectancy for men is 80, while for women this number jumps to 88. With some of the highest centenarian ratios, roughly 6.5 in 10,000 people in Okinawa live to age 100. Disease rates are a fraction of those recorded to cause death in Americans. They show a fifth the rate of breast and prostate cancers, a fifth the rate of cardiovascular disease and less than half the rate of dementia. All of this neatly boils down to lifestyle and diet. However, during World War Two the United States established a military base in the heart of Okinawa. As a result, Western culture and an economic drive seeped into Okinawan tradition. Disease rates nearly doubled, dairy consumption rose, and eggs, meats and poultry became a regular part of the diet. Daily caloric intake from 1949 to 1972 increased by 400 calories (Buettner, 49-50).
There is still a population, however, of those over a certain age who retain all aspects of tradition and are oblivious to the looming fast food culture outside their villages. It is interesting to note that carbohydrates make up about 80 percent of the traditional Okinawan diet. The sweet potato — an Okinawan staple — is considerably high in flavonoids, fiber, carotenoids, vitamin C and antioxidants (sporamin). This irony alone is significant because the diet culture in America aims to reduce carbohydrate intake. In addition, fish is eaten several times per week, served with vegetables and grains. Tofu (soy) is widely consumed, and is high in flavonoids. Dairy and meat constitutes a meager 3 percent of the daily caloric intake. Similar to the older generations on Sardinia, the Okinawans butcher the family pig and feast on special occasions. It is widely believed that pork contrasts with the vegan diet associated with robust health and high life expectancy. Yet, the Okinawans prepare the pork such that it endures a stewing process that lasts days, resultantly skimming out the fat. Dietician Kazuhilo Taira commented that human blood vessels often develop small tears, and this pork protein serves as a coating sealant that reduces consequential rates of stroke.
At the start of each meal, members of the table say in unison, “Hara hachi bu,” which is a Confucian adage that reminds everyone to stop eating when they feel 80 percent full (Buettner, 45). Dominated by vegetable and traditional dishes, a typical meal begins with miso soup (with seaweed, tofu, sweet potato and leafy greens). The main dish is a stir-fry of vegetables with the bounty of the nearby garden. Commonly-consumed vegetables include goya (bitter melon), okra, pumpkin, burdock root, green papaya, as well as small portions of meat or fish, and noodles cooked with herbs and spices. Like the Ikarian “mountain tea,” the Okinawans enjoy jasmine tea, as well as millet brandy. Green tea is widely consumed, with added jasmine flowers and turmeric, and may contribute to the low rates of heart disease and cancers, as well as the absence of diabetes and mental deterioration. Goya has proved to be anti-diabetic, reducing blood sugar levels, as well as high in antioxidants that fight the production of free radicals. Tofu is made from curdled soy milk and pressed into a block, with tremendous support of heart health by lowering cholesterol and triglycerides. Seaweeds are consumed widely and provide carotenoids, folate, iron, calcium, magnesium and iodine, as well as antioxidants. Lastly, brown rice is eaten every day in Okinawa and before cooking, the seeds having nearly having germinated, are soaked in water, releasing many enzymes that break down sugar and protein (Buettner, 41-52).
Okinawans have an intimate relation with and knowledge of the food they eat and are aware of their uses and effects on the body. The belief that food is medicine is embedded in Okinawan philosophy (Sho, 2001). With this, traditional Okinawan lifestyle includes regular physical activity, constant and reinforced social support, as well as a rich diet that has evolved with the land and its people.
Nicoya Peninsula, Costa Rica
The Nicoyan region of Costa Rica, located in the northeast of the Republic and bordering the Pacific Ocean, is considered another zone of longevity. Considering the high life expectancy of elder Costa Ricans in a general sense, inhabitants (particularly men) of the Nicoya Peninsula particularly stand out, with a death rate of 0.71 compared to the rest of the country (Rosero-Bixby et al., 2013). The probability for a 60 year old Nicoyan male to become a centenarian is seven times that of a Japanese male, with a life expectancy 2.2 years greater. Studies show that telomere lengths are a significant marker for the longevity of the Nicoyans (Rosero-Bixby et al., 2013). Additionally, Nicoyan diet is rich in traditional foods with historical roots such as beans, rice and animal proteins, all of which have a relatively low glycemic index and high fiber content.
The diet of a typical country day in the life of an average mid-aged Nicoyan includes waking up early (before sunrise), joining family for some black coffee and a tortilla. After chores, a complete, hearty breakfast is served and consists of fried eggs, rice and beans. After work, in the early afternoon, the workers return to their homes to a midday meal of soup (containing meat, plantains, taro, yuca, greens) along with beans, rice, eggs, and vegetables (squash, cabbage or wild products available to them). Meat appears often, interestingly in contrast with the other ‘Blue Zone’ diets. The typical tortillas accompany every meal. The meal concludes with coffee and fruit. Finally, dinner is a much simpler and less hearty meal of beans, rice and eggs. One interesting characteristic of the Nicoyan diet is the minimized consumption of cow’s milk, considered by many scientists a method to avoid autoimmute-response diseases such as diabetes. Most Nicoyans tend to their family gardens that contain a great diversity of edible plant species. They also forage forest fruits that are high in antioxidants. It is evident that the Nicoyan diet is high in carbohydrates, similar to the Okinawan diet, being roughly 68 percent. Fat composes about 20 percent of the diet, and protein is approximated at 10 percent. The Nicoyans are well aware of the Mesoamerican agricultural rite of the “three sisters” that includes beans, corn and squash. The combination of the three in a meal provides complex carbohydrates, calcium, niacin and protein.
Many staples of Nicoya are considered longevity-promoting foods. Maize, in the form of tortillas, is consumed daily. Nicoyans prepare the tortillas in such a way that increases the body’s absorption of essential minerals, calcium and iron. They first soak the corn in lime and water then grind it into flour, meanwhile unlocking the corn’s niacin. Squash delivers high levels of carotenoids. Likewise, papayas are considerably high in vitamins A, C and E, as well as papain (an enzyme known to reduce inflammation). Black beans, widely consumed and considered a staple in the Nicoya Peninsula, are packed with longevity promoting components and contain more antioxidants than any other bean. Bananas and plantains are high in carbohydrates, fiber and potassium. This rich menu of healthy foods, combined with the emphasis on local production, family contact and an active lifestyle puts the inhabitants of the Nicoya Peninsula at a particular advantage.
Loma Linda, California
The case of Loma Linda, California is an interesting one because it combines elements of the other ‘Blue Zones’ — all of which have retained traditional and decades-old practices and values — with contemporary American culture, food routes and lifestyle. Fueled by strong religious virtues, the Seventh-day Adventists (a group of conservative Protestants who prioritize good health and celebrate the Sabbath on Saturday) avoid technology and modern distractions. They frequently socialize with one another, spend extensive amounts of time outdoors and shun alcohol, smoking and dancing.
Regarding diet, the Seventh-day Adventists of Loma Linda pursue a primarily “biblical” (Barclay, 2015), well-balanced diet of fruits, grains, nuts and vegetables, low in salt, sugar and refined foods. Moreover, adhering to other religious dietary restrictions (Kosher and Halal), the Adventists shun the consumption of pork and shellfish. The promoted beverage for everyone is water. The Adventists consume many foods that are available to any American who can afford them. First, nuts are preventative of high cholesterol, blood pressure, inflammation, diabetes and cardiovascular-related disease. A fair portion of nuts is consumed at least five times per week. Beans and other legumes compose a large percentage of the daily protein intake. Salmon promotes heart health, rich in omega-3 fatty acids, thus minimizing risk of heart attack. Oatmeal, another staple, offers a well-proportioned mixture of carbohydrates, fats and protein, as well as vitamin B and iron. It is high in fiber, and makes the consumer feel full after a small portion, reducing total intake. Whole wheat bread, rather than processed white bread, is popularly consumed. Adventists also drink soy milk, low in fat and high in protein, and are protective against some cancers. Water is heavily endorsed, with the notion that it flushes out toxins and ameliorates blood flow (Buettner, 65-70).
This plant-based diet is one of the healthiest recorded in America, promoting whole grains, nuts, beans, soy, and is low in salt, sugar and refined grains. Animal products are consumed at a minimal amount. They do not smoke and they make it a priority to engage in regular physical activity. As a result, rates of heart disease and diabetes are considered the nation’s lowest. Considering that the Adventists are essentially everyday Americans — living amidst people who consume regular amounts of fast-food and engage in activities that those of Loma Linda would shun — it is possible for the rest of the American population to modify their lifestyles and diets for the better.
Common Themes Between Blue Zones
The inhabitants of the explored ‘Blue Zones’ share certain characteristics related to lifestyle and diet that shed light on their remarkable longevity. First, each population puts great emphasis on family and social circles, using social interaction to complement and enhance the pleasures of life. Each individual is integrated well with his or her community. Similarly, many people are engaged in spiritual or religious groups, emphasizing the importance of social support to the well-being of an individual and the community. Second, all diets observed in these regions practice a form of semi-vegetarianism, with minimal meat consumed. The majority of the daily protein intake comes from plants and plant-based foods. Third, regular physical activity is built into the fabric of the daily routine, and is enjoyed thoroughly and spiritually. Stress is reduced to a minimum, with mechanisms to deal with when confronted. On a similar note, smoking is greatly avoided, if not entirely nonexistent. The road to improving individual longevity (regardless of the region) is to understand the agricultural topography of the area, adopt any number of these commonalities and implement them constantly such that they become a standard part of an individual’s routine.
Diet and lifestyle have direct impacts on longevity, as it is established that genetics contribute to 20 percent of one’s determined lifespan. For an extended period of time, scientists have examined the effects of individual foods on overall health, rather than general dietary patterns, customs and lifestyle (Appel, 2008). Studies and anthropological observations conclude that specific components of the lifestyle and diet present in these ‘Blue Zones’ reduce rates of disease and increase lifespan. The key to living healthier and more robust lives lies not in the constant search for the new fad diet, but rather adopting the culinary fabric of a region and living locally, understanding how environmental factors play such an pronounced role in longevity.
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