### TL;DR Blue Zones are areas of the World where people seem to...
There has been some controversy related to the data used to identif...
The identified Blue Zones: - Okinawa, Japan - Sardinia, Italy - ...
> They found that the lifestyles of all Blue Zones residents shared...
The aim of the Danish twin study was to explore, in a large and non...
### The Power 9 1. Move Naturally Be active and move without th...
You can learn more about Albert Lea here: [Blue Zones Project Resul...
Please add me to your mailing list. Thanks, Balu
318
Sep Oct 2016American Journal of Lifestyle Medicine
Dan Buettner, BA, and Sam Skemp, BA
Abstract: What began as a National
Geographic expedition, lead by Dan
Buettner, to uncover the secrets of
longevity, evolved into the discovery of
the 5 places around the world where
people consistently live over 100 years
old, dubbed the Blue Zones. Dan and
his team of demographers, scientist
and anthropologists were able to
distill the evidence-based common
denominators of these Blue Zones into
9 commonalities that they call the
Power 9. They have since taken these
principles into communities across
the United States working with policy
makers, local businesses, schools and
individuals to shape the environments
of the Blue Zones Project Communities.
What has been found is that putting
the responsibility of curating a healthy
environment on an individual does
not work, but through policy and
environmental changes the Blue Zones
Project Communities have been able to
increase life expectancy, reduce obesity
and make the healthy choice the easy
choice for millions of Americans.
Keywords: Blue Zones; Power 9; Life
Radius; Vitality Compass; Longevity;
Health; Dan Buettner
T
he Danish Twin Study
1
established that only about 20%
of how long the average person
lives is dictated by our genes, whereas
the other 80% is dictated by our
lifestyle. In 2004, Dan Buettner,
CEO of Blue Zones LLC, was
determined to uncover the specific
aspects of lifestyle and environment
that led to longevity. By teaming up
with National Geographic and the
National Institute on Aging, Dan and
his team, found the 5 demographically
confirmed, geographically defined
areas with the highest percentage of
centenarians (Loma Linda, CA, USA;
Nicoya, Costa Rica; Sardinia, Italy;
Ikaria, Greece; Okinawa, Japan; seen in
Figure 1). These 5 areas were located
using epidemiological data, statistics,
birth certificates, and other research.
These areas were dubbed Blue Zones,
where people reach age 100 at 10
times greater rates than in the United
States. Once these areas were
established, they sent in a team of
anthropologists, demographers,
epidemiologists, and researchers to
identify the lifestyle characteristics that
might explain longevity. They found
that the lifestyles of all Blue Zones
residents shared 9 specific
characteristics. These are called the
Power 9.
Power 9
To make it to age 100, it seems that a
person must have to win the genetic
lottery. However, many individuals have
the capacity to make it well into the
early 90s and largely without chronic
disease. Blue Zones uncovered 9
evidence-based common denominators
among the world’s centenarians that are
believed to slow this aging process.
1. Move naturally. The world’s longest-
lived people do not pump iron, run
marathons, or join gyms. Instead, they
live in environments that constantly
nudge them into moving without
thinking about it. They grow gardens
and do not have mechanical
conveniences for house and yard
work.
637066AJL
XXX10.1177/1559827616637066American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine
research-article2016
Blue Zones:
Lessons From the World’s
Longest Lived
However, many individuals have
the capacity to make it well into
the early 90s and largely without
chronic disease.
DOI: 10.1177/1559827616637066.
From Blue Zones, LLC, Minneapolis, Minnesota. Address correspondence to: Dan Buettner, BA, Blue Zones, LLC, 80 South 8th Street,
STE 1400, Minneapolis, MN 55402; e-mail:Dan@bluezones.com.
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.
319
vol. 10 no. 5 American Journal of Lifestyle Medicine
2. Purpose. The Okinawans call it Ikigai
and the Nicoyans call it plan de vida;
for both, it translates to “why I wake
up in the morning.” Knowing your
sense of purpose is worth up to 7
years of extra life expectancy.
3. Downshift. Even people in the Blue
Zones experience stress. Stress leads to
chronic inflammation, associated with
every major age-related disease. What
the world’s longest-lived people have
that others do not are routines to shed
that stress. Okinawans take a few
moments each day to remember their
ancestors; Adventists pray; Ikarians take
a nap; and Sardinians do happy hour.
4. 80% Rule. Hara hachi bu—the
Okinawan 2500-year old Confucian
mantra said before meals reminds
them to stop eating when their
stomachs are 80% full. The 20% gap
between not being hungry and
feeling full could be the difference
between losing weight or gaining it.
People in the Blue Zones eat their
smallest meal in the late afternoon or
early evening, and then, they do not
eat any more the rest of the day.
5. Plant slant. Beans, including fava,
black, soy, and lentils, are the
cornerstone of most centenarian diets.
Meat—mostly pork—is eaten on
average only 5 times per month.
Serving sizes are 3 to 4 oz, about the
size of a deck of cards.
6. Wine @ 5. People in all Blue Zones
(except Adventists) drink alcohol
moderately and regularly. Moderate
drinkers outlive nondrinkers. The
trick is to drink 1 to 2 glasses per day
(preferably Sardinian Cannonau
wine), with friends and/or with food.
And no, you cannot save up all week
and have 14 drinks on Saturday.
7. Belong. All but 5 of the 263
centenarians interviewed belonged to
some faith-based community.
Denomination does not seem to
matter. Research shows that attending
faith-based services 4 times per
month will add 4 to 14 years of life
expectancy.
8. Loved ones first. Successful
centenarians in the Blue Zones put
their families first. This means keeping
aging parents and grandparents
nearby or in the home (it lowers
disease and mortality rates of children
in the home too.). They commit to a
life partner (which can add up to 3
years of life expectancy) and invest in
their children with time and love.
(They’ll be more likely to care for
aging parents when the time comes.)
9. Right tribe. The world’s longest lived
people chose—or were born
into—social circles that supported
healthy behaviors, Okinawans created
moais—groups of 5 friends that
committed to each other for life.
Research from the Framingham
Studies
2
shows that smoking, obesity,
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
bread, beans, garden vegetables, and
fruits. Meat is largely reserved for
Sundays and special occasions.
Sardinians drink wine moderately.
Cannonau wine has 2 or 3 times the
level of artery-scrubbing flavonoids as
other wines. Moderate wine consumption
may help explain the lower levels of
stress among men.
Okinawa
Home to the world’s longest-lived
women, these South Pacific islands offer
many secrets to longevity. The Okinawa
tradition of forming a moai provides secure
social networks. These safety nets lend
financial and emotional support in times of
need and give their members the stress-
shedding security of knowing there is
always someone there for them. In
Okinawa, at age 5, children are put into
these committed social networks. One
specific moai that Dan discovered had
been together for 97 years; the average age
of the group is 102. They meet every day to
drink sake and gossip. If one of them does
not show up, the other 4 put on their
kimonos to walk across the village to check
on their friend. Okinawans also attribute
their longevity to the old Confucian mantra
said before meals Hara Hachi Bu, which
reminds them to stop eating when 80% full,
so they do not overeat. They also hold a
strong sense of purpose in their family.
One centenarian described the feeling of
Figure 1.
Blue Zones (reprinted with permission from Dan Buettner).
320
Sep Oct 2016American Journal of Lifestyle Medicine
holding her great great great grandchild as
“Jumping into heaven.
Loma Linda
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
every morning at 5:30 am read her Bible,
had a breakfast of slow cook oatmeal,
nuts, and dates with soymilk and a prune
juice shooter. She would then ride her
stationary bike for 30 minutes and get in
her Cadillac and drive to her volunteer
jobs for 7 different organizations.
Nicoya
Nicoyans spend just 15% of what
America does on health care and are
more than twice as likely than Americans
to reach a healthy age of 90 years. Faith
and family play a strong role in Nicoyan
culture. So does plan de vida, or reason
to live, which helps Nicoyan elders
maintain a positive outlook and active
lifestyle. Nicoyans eat little to no
processed foods but plenty of
antioxidant-rich tropical fruit. But they
also have 1 unique secret: calcium- and
magnesium-rich water, which wards off
heart disease and promotes strong bones.
Ikaria
People on this tiny Aegean island live 8
years longer than Americans do. They
experience 20% less cancer, half the rate
of heart disease, and almost no
dementia. Ikarians eat a variation of the
Mediterranean diet, with lots of fruits and
vegetables, whole grains, beans,
potatoes, and olive oil. Ikarians also
downshift with a midafternoon break.
People who nap regularly have up to
35% lower chances of dying from heart
disease. It may be because napping
lowers stress hormones or rests the heart.
One Ikarian in particular, Stamatis
Moraitis, moved to America when he was
22 years old to pursue the American
dream. He was a painter, and
immediately started having success,
bought a house, married, and had 3 kids.
At the age of 66 years, he developed
terminal lung cancer. Instead of dying in
America, he decided to move back to
Ikaria and moved in with his parents. He
started breathing the air, drinking the
wine, and eating a Mediterranean diet.
After a few months, he planted a garden
not planning on ever getting to harvest
the vegetables; 37 years later he has a
vineyard producing 200 L of wine a year.
His secret he says? “I just forgot to die.
Medical
Obesity and diabetes are running
rampant in the United States. Currently,
the culture is focused on adhering to
different diets and exercise programs. It
has been found that these are not
sustainable changes. Within the first 7
months of a diet, more than 90% of
individuals will have given up. There is a
similar decline when it comes to
adherence to gym memberships; after
just 2 years, the number of attendees will
have dropped by 70%. It is clear that
there is no quick fix, but there must be
small changes to the environment to see
long-lasting health changes.
Life Radius
Research shows that individuals spend
about 90% of their lives within 5 miles of
their home, known as the Life Radius,
seen here in Figure 2. To engineer an
environment where longevity ensues,
Blue Zones worked with researchers to
create a blue print to optimize the Life
Radius. The team started by analyzing
what individuals can do for themselves.
Individuals can engineer their kitchen, so
they eat about 100 fewer calories and
engineer their home, so they burn a
couple of hundred extra calories through
physical activity. This is done through
small changes such as putting a bowl of
fruit on the counter, serving food at the
stove and not on the table, using hand
tools for yard work, and many more. In
every community, 80% of people want to
change their health habits. By creating
social networks of these health conscious
people, it encourages healthy living and
gives people a sense of purpose.
Then, the researchers looked at places
within the life radius. There are 115
evidence-based design tweaks and
policies that can be put in place, so that
when people show up to school, work,
Figure 2.
Life radius (reprinted with permission from Dan Buettner).
321
vol. 10 no. 5 American Journal of Lifestyle Medicine
church, stores, and restaurants they are
mindlessly nudged to eat less and move
more. These tweaks include things such
as standing desks at work, removal of
vending machines in schools, no
breadbaskets at restaurants, safe walking
paths, and encouraging moais.
According to the Centers for Disease
Control and Prevention, the best
investment on health is through policy.
By creating environments where fruits
and vegetables are most accessible over
fast food, a dramatic decrease in obesity
is seen. If there are 6 or more fast food
restaurants within half a mile of an
individual’s home, they are 40% more
likely to be obese than if there are less
than 3. By putting policies in place to
limit the number of fast food restaurants
and putting regulations on smoking,
policy makers can see a drastic increase
in health. If streets are walkable and
bikeable, parks are cleaned up, and the
active option is the easy option, physical
activity of the entire population can rise
by 30%.
Albert Lea
In 2008, Dan and the Blue Zones team
finalized the blue print for Life Radius.
They had to make sure that it could be
applied to an American city. Buettner
and his team interviewed 5 cities to be
the pilot project, and they picked Albert
Lea, MN, a town of 9000 people. The
team first went in and listened to the
organizations to find what they needed.
They brought in Dan Burden who works
with communities across the country to
create more walkable environments.
Albert Lea wanted to widen Main Street
and up the speed limit. Blue Zones
convinced them to build a walking path
around their lake instead. The path is
now packed 11 months out of the year
with individuals walking. The sidewalks
throughout the community were
connected, so people could walk from
their homes to downtown without
having to walk through fields or busy
intersections.
Grocery store and restaurant pledges
were created to help individuals change
the way they eat. Restaurants were
required to offer 3 plant-based entrées.
When a sandwich was ordered, the
customers automatically got fruit instead
of fries. By using different adjectives
rather than the “healthy choice,
individuals were more likely to choose
the best option. Grocery stores created
healthy checkout isles, so that instead of
candy bars and soda greeting people in
the checkout, they saw fruit, water, and
healthy snacks.
Schools signed Blue Zones pledges.
They do not sell candy for fundraisers,
and there was no candy for good grades.
Based on a University of Minnesota study
calculation that prohibiting eating in
hallways and classrooms would occasion
a 11% per year drop in student body
mass index (BMI), the project convinced
schools to adopt the policy. Then, 25% of
the community signed a personal pledge
that they would take steps toward a
healthy lifestyle.
After about a year and a half, there was
a 3.2-year bump in life expectancy; the
community lost a combined weight of
7280 pounds; and health care costs
dropped by 40%.
Blue Zones Expansion
After seeing the results in Albert Lea,
Blue Zones began interviewing larger
cities to take on. The beach cities of Los
Angeles were chosen.
3
Blue Zones
worked with city planners to make the
streets built for humans instead of cars.
The rate of smoking went down by 30%;
BMI went down by 14%; and people
reported healthy behaviors.
From there, Blue Zones moved into
Iowa with the same strategy; 10 cities
were chosen.
4
Smoking went down by
8.8%, and healthy eating went up by
10.5%. Then, Blue Zones started working
in Fort Worth, TX, and Kauai, HI, and are
now in 27 cities across the United States.
Vitality Compass
In association with the University of
Minnesota Public Health Department,
Dan and his team created the Vitality
Compass, named the Best Online Tool
for Retirement and Longevity by the Wall
Street Journal. This tool has users answer
lifestyle and background questions based
on the Power 9 teachings of Right
Outlook, Move Naturally, Eat Wisely, and
Belong; it then calculates their biological
age, overall life expectancy, healthy life
expectancy, and the years they are
gaining/losing because of their habits. It
then gives the users 12 customized
recommendations to help them live
longer and better. This is a useful tool to
take initially as a baseline test, then try
out some of the specific lifestyle
recommendations, and 3 to 6 months
later, take the quiz again.
Recommendations include reducing salt
intake, joining a faith-based community,
quitting smoking, improving attitude, and
many more.
Summary
Blue Zones started as a way of
discovering the healthiest lifestyles that
lead to vitality and longevity. Now, 12
years after the start of this massive
project, Blue Zones is a way to design
the healthiest lifestyles possible for
individuals and for entire communities.
The goal for Blue Zones is to not only
make the healthy choice the easy choice,
but also the unavoidable choice.
Authors’ Note
To join the Blue Zones mission, contact Info@bluezones.com.
More information about the project can be obtained at https://
communities.bluezonesproject.com/. The authors disclose the
following conflicts of interest: Dan Buettner is the CEO of Blue
Zones and Sam Skemp works at Blue Zones as Program
Manager.
AJLM
References
1. Herskind AM, McGue M, Holm NV,
Sorensen TIA, Harvlad B, Vaupel JW.
The heritability of human longevity: a
population-based study of 2,872 Danish
twin pairs born 1870-1900. Hum Genet.
1996;96:319-323.
2. Christakis NA, Fowler JH. The spread of
obesity in a large social network over 32
years. N Engl J Med. 2007;357:370-379.
3. Buettner D. The Blue Zones: 9 Lessons for
Living Longer From the People Who’ve Lived
the Longest. Washington, DC: National
Geographic Society; 2008.
4. Buettner D. The Blue Zones Solution:
Eating and Living Like the World’s
Healthiest People. Washington, DC:
National Geographic Society; 2015.

Discussion

Please add me to your mailing list. Thanks, Balu ### TL;DR Blue Zones are areas of the World where people seem to reach age 100 at rates 10 times greater than the average of the United States. These areas have been studied looking for common factors that seem to promote longevity. While studying the Blue Zones researchers found that residents shared 9 specific characteristics. These are called the **Power 9**: - Moderate, regular physical activity - Life purpose - Stress reduction - Moderate caloric intake - Plant-based diet - Moderate alcohol intake, especially wine - Engagement in spirituality or religion - Engagement in family life - Engagement in social life Read on to learn more. The identified Blue Zones: - Okinawa, Japan - Sardinia, Italy - Nicoya, Costa Rica - Ikaria, Greece - Loma Linda, California, USA !["bluezonemap"](https://i.imgur.com/zUdwuKU.jpg) You can learn more about Albert Lea here: [Blue Zones Project Results: Albert Lea, MN](https://www.bluezones.com/blue-zones-project-results-albert-lea-mn/) ### The Power 9 1. Move Naturally Be active and move without thinking about it. 2. Purpose Have a sense of purpose, a reason to wake up in the morning 3. Down Shift Create a routine that helps you shed stress. 4. 80% Rule The 20% gap between not being hungry and feeling full - don't overeat. 5. Plant Slant Beans, including fava, black, soy and lentils, are the cornerstone of most centenarian diets. 6. Wine @ 5 Drink alcohol moderately. 7. Belong Be part of a local/spiritual community. 8. Loved Ones First Put family and loved ones first and have them close by. 9. Right Tribe Be part of social circles that support healthy behaviors. The aim of the Danish twin study was to explore, in a large and non-censored twin cohort, the nature (i.e., additive versus non-additive) and magnitude (i.e., heritability) of genetic influences on inter-individual differences in human longevity. You can find the study here: [The heritability of human longevity: A population-based study of 2872 Danish twin pairs born 1870–1900](https://link.springer.com/article/10.1007/BF02185763) > They found that the lifestyles of all Blue Zones residents shared 9 specific characteristics. These are called the Power 9. You can learn more here: [Blue Zones - Power 9](https://www.bluezones.com/2016/11/power-9/) !["power9"](https://www.bluezones.com/wp-content/uploads/2016/11/366395_LifeRadius_Power9_041119.jpg) There has been some controversy related to the data used to identify blue zones and the findings related to this study: > ***"The Blue Zone Diet assumes that common dietary factors have been identified and that following the diet will make us live longer. That appears to be a false assumption [...] The claims of longevity in those locations may be based on fraud and error. Record-keeping has been deficient in many of those areas; systematic verification of age has been practiced only recently and only in some parts of the world. People may be confused with parents and grandparents who had the same name."*** You can learn more about it here: [Blue Zones Diet: Speculation Based on Misinformation](https://sciencebasedmedicine.org/blue-zones-diet-speculation-based-on-misinformation/)