Book Review: The Blue Zones
Here’s my review of The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest, a 2008 book by Dan Buettner. I give the book four stars on Amazon.com’s five-star system (”I like it”).
The publisher donated three copies of The Blue Zones as give-aways which I will mail to the first three readers who request one, as long as the shipping address is in the U.S. Win a book by emailing me at steveparkermdATgmailDOTcom. Expect three weeks for delivery. (Update Dec. 31, 2009: Sorry - no free books left.)
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The lifestyle principles advocated in The Blue Zones would indeed help the average person in the developed world live a longer and healthier life. The book is a much-needed antidote to rampant longevity quackery. Dan Buettner’s idea behind the book was “discovering the world’s best practices in health and longevity and putting them to work in our lives.” He succeeds.
Mr. Buettner assembled a multidisciplinary team of advisors and researchers to help him with a very difficult subject. Do people living to 100, scattered over several continents, share any characteristics? Do those commonalities lead to health and longevity?
They studied four longevity hot spots (Blue Zones):
- Okinawa islands (Japan)
- Barbagia region of Sardinia (an island off the Italian mainland)
- Loma Linda, California (a large cluster of Seventh Day Adventists)
- the Nicoya Peninsula (Costa Rica).
Research focused on people who lived to be 100.
Until recently, two of the Blue Zones—the Nicoyan Peninsula and Sardinia—were quite isolated, with relatively little influence from the outside world.
Mr. Buettner et al identify nine key traits that are associated with longevity and health in these cultures. Of course, association is not causation, which Mr. Buettner readily admits. He draws more conclusions from the data than would many (most?) longevity scientists. Scientists can wait for more data, but the rest of us have to decide and act based on what we know today. Here are the “Power Nine”:
- regular low-intensity physical activity
- hari hachi bu (eat until only 80% full—from Okinawa)
- eat more plants and less meat than typical Western cultures
- judicious alcohol, favoring dark red wine
- have a clear purpose for being alive (a reason to get up in the morning, that makes a difference)
- keep stress under control
- participate in a spiritual community
- make family a priority
- be part of a tribe (social support system) that “shares Blue Zone values”
Of these, I would say the available research best supports numbers 1, 4, 7, 8, and the social support system.
I doubt that hari hachi bu (eat until you’re only 80% full) will work for us in the U.S. It’s never been tested rigorously. The idea is to avoid obesity.
The author believes that average lifespan could be increased by a decade via compliance with the Power Nine. And these would be good, relatively healthy years. Not an extra 10 years living in a nursing home.
Appropriately and early on, Mr. Buettner addresses the issue of genetics by mentioning a single study of Danish twins that convinces him longevity is only 25% deterimined by genetic heritage. Environment and lifestyle choices determine the other 75%. I believe he underestimates the effect of genetics.
Over half the population of the Nicoya Peninsula Blue Zone are of Chorotega Indian descent, not from Spanish Conquistadores. Would a Danish twin study have much to say about Chorotega Indians’ longevity? We don’t know, but I’m skeptical. Also, the Sardinians and Okinawans would seem to have centuries of a degree of inbreeding, too, according to Buettner’s own documentation.
Do the Adventists tend to marry and breed with each other (like Mormons), thereby concentrating longevity genes? You won’t find the question addressed in the book.
Because I think genetics plays a larger role in longevity than 25%, I’d estimate that the healthy lifestyle choices in this book might prolong life by six or seven years instead of 10. But I’m splitting hairs. I don’t have any better evidence than Mr. Buettner, just a hunch plus years of experience treating diseased and dying patients.
These four Blue Zones do share a mostly plant-based diet of natural foods with minimal processing. Two of the populations—the Okinawans and Costa Ricans—didn’t seem to have any choice. Heavy meat consumption just wasn’t an option available to them. Rather than promoting a low-meat plant-based diet, it might be more accurate to conclude that “you don’t have to eat a lot of meat, chicken, or fish to live a long healthy life.”
In other words, it may not matter how much meat you eat as long as you eat the healthy optimal level of fruits, vegetables, and whole grains. It’s a critical difference not addressed in this book except among the Adventists.
Even if you could live an extra two years as a vegan, I’m sure many people would choose to eat meat anyway. By the way, this book conflates vegan, lacto-vegetarian, lacto-ovo vegetarian, near-vegetarian, and vegetarian into one: vegetarian. They are not necessarily the same. It’s a common problem when considering the health aspects of vegetarianism.
By the same token, plenty of my patients have told me they don’t like any kind of exercise and they won’t do it, even if it would give them an extra two years of life. What many don’t realize is that from a functional standpoint, regular exercise makes their bodies perform as if they were ten years younger. There’s a huge difference between the ages of 80 and 70 in terms of functional abilities.
Why read the book now that you have the Power Nine? To convince you to change your unhealthy ways, and indispensible instruction on how to do so.
Disclosure: The publisher’s representative did not pay me for this review, nor ask for a favorable review. They offered me a review copy and three give-aways, and I accepted. I figure the cost of the books to the publisher was $16 USD total.
December 19th, 2009 at 6:25 pm
From data in lower animals, I’d agree that longevity is more than 25% genetic. I have to profess ignorance at twin studies. I’m a bit surprised that it’d be as low as 25%, though.
I think that #5 has probably been understudied and understated in western science, hence the data is somewhat lacking. I seem to recall some small but interesting studies looking at patients post MI and correlating survival with the intent of social contact, ie those who had regular social events be it a bridge club, weekly lunch with friends, etc. It seemed to suggest those that had something and someone to look forward to, did better over time. I can’t recall the source right now, though.
December 19th, 2009 at 8:46 pm
Your comment reminds me that when one partner in an older couple dies, the other is often not far behind. Or does it only seem that way? I’m sure that’s been studied.
December 20th, 2009 at 8:59 am
It’s an interesting concept (the elderly couples who seem to pass within months of each other).
I’m no medical professional, but from the reading I’ve done on the subject over the past year or so, a plant-based diet with low levels of meat intake and plenty of raw foods almost always seems to contribute to a longer life span and lower levels of obesity + lower levels of disease compared to Western, developed countries where the diets are high in processed foods and large quantities of meat.
Interestingly enough, the results almost always seem to favor diets like the Mediterranean Diet and places like Norway and Japan, where their diets are high in vegetables and raw foods, and their main meat intake is from fish.
I know myself personally…I have almost cut red meat completely out of my diet. Being a born-and-raised redneck who grew up on a dairy farm in the Midwest, I never thought I’d see the day, but these days the only meat I consume is either fish or chicken. I might eat pork once every 3-4 months, and the same with red meat. I can’t speak for anything other than the “how” I feel, because I feel a lot “lighter” than I used to. I am far more “regular” than I ever used to be, I have higher levels of energy, and I find my concentration and sex drive through the roof. How much of that is contributed to regular exercise and healthy living I have no idea, but I very much believe in positive thinking combined with healthy living. Stress just has so many downsides…what’s the point?
Another great read
Thanks!
December 21st, 2009 at 8:29 am
I’ve not studied the health effects of raw foods, specifically. They are a hot trend in the U.S. for the last several years.
In all the survey-based observational studies trying to associate health outcomes with diet, I bet they didn’t ask whether vegetables and fruits were cooked or not. Just “how many servings of vegetables do you eat in a typical week?”
December 26th, 2009 at 4:32 pm
to cook or not to cook? AFAIK, when you cook you destroy some of the more fragile healthful molecules. But if you don’t cook, then you don’t absorb nearly as much of the other nutrition. After all, we can’t break down the cellulose cell-wall that seals off the healthful contents.
So you have to chew and chew like a cow, or maybe use some electric powered device to try and burst open every plant cell.
Another thing I wonder: have we become too big (height-wise especially) to exist on the same type of diet that our ancestors did for millions of years at much smaller body size?
April 6th, 2010 at 7:49 pm
I loved The Blue Zones by Dan Buettner. You can also watch the Blue Zone special on Ikaria with Anderson Cooper via the internet.
One thing I find interesting is that many in the Mediterranean consume milk, yogurt and cheese made from goat and sheep. We can assume that most of these dairy products are not homogenzied nor pastuerized. Of course they aren’t laden with antibiotics, estrogen or growth hormones either. Naturally, these animals graze on grass and wild greens.
Heart disease is lower in the Mediterranean countries, yet most all consume some type of dairy. One could say, “they consume in moderation.” What is moderation? Three times a day? Once a day? If saturated dairy fat is the king of evil, why do these people not have plaqued arteries? Is it because their dairy is not pastuerized? Is it the Omega-3’s in the product? Is it the chemical composition of goat and sheep milk versus cow’s milk?
I know it’s popular to recommend low-fat or nonfat dairy on Mediterranean diets, but people on those countries do not consume low-fat or nonfat dairy. The often make their own yogurt, yogurt cheese and drink raw milk. In some of countries (Lebanon and Greece), they use butter made from cow’s milk as well. Though it’s common to “finish” dishes with a pour of olive oil, butter is used in many dishes as well.
To me, it’s very perplexing.
April 7th, 2010 at 10:03 pm
LynnP-
It seems to me that saturated fats and total fat intake have been unfairly demonized. I researched this issue over 80 hours last year and summarized my findings at the NutritionData Heart Health Blog:
http://blog/nutritiondata.com/heart_health_blog/2009/07/saturated-fats-and-cardiovascular-health.html
The first inkling that the traditional Mediterranean diet was healthy came from data based on the eating of those in the region in the 1950s and 1960s. They were not eating the reduced-fat versions of food so common today (common in the U.S., anyway).
-Steve
April 8th, 2010 at 9:40 am
Hi Dr. Steve -
I just changed my own diet to a low-carb sort of Mediterranean diet. I’m using plain Fage yogurt (the 2% as I haven’t found full-fat yet) and 4% cottage cheese as my main proteins (I really don’t care for meat, poultry and fish that much), along with lots of salads dressed with lemon juice and olive oil, nuts, seeds, and some low-glycemic fruits.
Type II Diabetes and heart disease are both prevelant in my family. I believe that removing the “omentum” fat that I have and continuing to exercise is about the best I can do for myself. I thought about the McDougall or Esselstyn plan but I’m not sure about the no added fat idea. It seems to work for some people but I’d worry about triglycerides rising…though I suppose blood lipids improve with weight loss on any diet.
I just wonder if the best diet/lifestyle is one that is low enough in calories to maintain a lower bodyfat (no omentum fat to speak of), plenty of moderate exercise, lots of activity and a positive attitude.
April 13th, 2010 at 3:38 am
LynneP, thanks for pointing out the bad link above. I can’t get it to work. Here’s the same information:
http://advancemediterraneandiet.com/blog/2009/07/06/are-saturated-fats-really-all-that-bad/
-Steve