Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#42 Let's Live to be 100. Do the Blue Zones guide the way?
In this episode, I explore whether the famed Blue Zones offer genuine insights for longevity or if they’re more marketing myth than science, while highlighting what the evidence truly shows about living to 100.
We begin by considering how many people actually reach 100. Currently, just 0.03% of Americans are centenarians, though this is expected to quadruple by 2054, with women comprising about 78% of that group (Pew Research). Globally, regions like Hong Kong show higher longevity, where 12.8% of females and 4.4% of males are projected to reach 100 (Nature). This brings us to the question: what might we learn from regions like the Blue Zones?
I break down how the Blue Zones concept originated, starting with Sardinia where researchers Pes and Poulain mapped centenarians with blue dots, hence the term Blue Zones. Their 2004 study highlighted clusters of longevity (ScienceDirect). Dan Buettner later popularized these findings through his National Geographic article (Blue Zones PDF) and subsequent books, documentaries, and programs. The Blue Zones promote nine lifestyle habits: daily activity, minimal meat and processed foods, moderate red wine intake, calorie reduction, life purpose, stress reduction, spiritual community involvement, prioritizing friendships, and surrounding oneself with like-minded people.
While these recommendations align in part with my six pillars of health—exercise, nutrition, mind-body harmony, sleep, exposure to heat/cold, and social relationships—the Blue Zones overlook critical factors like sleep and heat/cold exposure. Their encouragement of moderate alcohol use also contrasts with emerging evidence on alcohol’s risks.
I examine critiques of Blue Zone science, including flawed birth records that may inflate longevity claims, as seen historically in the U.S. and Greece (bioRxiv, UCL). Some regions, like Okinawa and Sardinia, no longer display exceptional longevity, possibly due to regression to the mean or changes in lifestyle (PubMed).
I also share a rigorous epidemiologic study tracking 80-year-olds to 100, identifying key predictors like non-smoking, low alcohol use, regular exercise, healthy BMI, and dietary diversity (fruits, vegetables, fish, beans, tea). Those with high lifestyle scores had a 60% greater chance of reaching 100 (JAMA).
Ultimately, while Blue Zones have helped popularize valuable lifestyle habits, the science behind their claims is mixed. My six pillars remain grounded in evidence that applies to real-world aging.
Takeaways: Focus on proven factors—exercise, balanced nutrition, sleep, mind-body practices, social connections, and thoughtful heat/cold exposure—to enhance both lifespan and healthspan. Be cautious about adopting longevity claims without strong evidence. Remember, while genetics play a larger role at extreme ages, your daily choices still profoundly influence your journey toward living long and well.
I'd like to live to be 100. Wouldn't you? Now, how might we do that? Do the learnings from the blue zones guide us in the right direction? Or is it all unscientific marketing hype? As always, let's see where the evidence takes us. Let's see where the evidence takes us. Hi, I'm Dr Bobby Du Bois and welcome. To Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide.
Speaker 1:Welcome my listeners to episode 42. Let's live to be a hundred. Do the blue zones guide our way? Do the blue zones guide our way? Well, a few episodes back, number 39, we explored the question together of how many years do we have left and how many of those will be good years. Now it seems logical to ask can we increase that number? So, if actuarial tables or predictive equations say likely you'll live to be 82, can we increase that to 85, to 90, and perhaps live to be 100?. What might allow us to achieve that? Well, one approach no surprise to you, my listeners are the six pillars that I talk about Exercise, sleep, nutrition, mind-body harmony, exposure to heat and cold, and social relationships, as we've talked about in each of the first seven episodes. Each of those elements has a compelling set of evidence that it makes a difference. It helps us to live long and well, and the information, the evidence that I shared with you during those episodes two through seven or eight was looking at one of those pillars at a time. But maybe if we combined all of the pillars or multiple aspects of what we do or don't do now, we might get to a different place and learn whether we could live to be 100.
Speaker 1:You might have heard about the blue zones. There was a lot of buzz about it. A couple years back there was a documentary on Netflix and it focused on regions of the world where a lot of people, relatively speaking, a lot of people, live to be 100. Now the question is do the blue zones and what they learn from them in admittedly not a scientific way, but are the learnings good guidance or is it really just unscientific marketing hype. That's the question for today. Well, one action item before we dive in please tell your friends about this podcast. There have been a bunch of new followers and I thank you for recommending people, and I've been really excited that when people decide to follow me, they also appear to be starting at episode one and working their way through all 40 some odd of them now. So thank you very much, okay.
Speaker 1:Well, if we're going to think about living to 100, how many folks actually make it there? Well, today in the United States, there's about 100,000 people who are 100 or above. Now, that sounds like a pretty good number, but if you look as a percentage of the population, it's only 0.03%. So tiny percent. But this number is projected to quadruple by 2054. Also turns out that the vast majority of the folks who live to be 100, 78 percent or so in the US are women. Well, if we turn this around and ask the question now you're a newborn baby, what's the probability you'll live to be 100? Well, it's about 5% in females, but less than 2% in males. So women are more likely to live that long, to live that long. But here's a teaser of a data point. In Hong Kong, almost 13% of the females and over 4% of the men are projected to live to be 100, based on 2019 life tables. So is there something from Hong Kong or other places in the world where people tend to live longer? And that brings us to the story of the Blue Zones. Now, these are places where more people than you might anticipate live to be 100. And so the obvious question is why are there factors inherent in those environments lifestyle issues, maybe genetic issues that cause there to be more folks that live that long, cause there to be more folks that live that long?
Speaker 1:Well, it turns out that the findings of the blue zones are qualitative, they're subjective, they're not statistical. There's no randomized control trials, there's not even a formal observational study where you follow people over time, look at the factors that predict who's going to live a long time or not. Now where they focus in the world. Now, that is quantitative. Yes, they did demographic analysis and says, oh, there's a lot of old people that live to be 100 here versus there. But that's the where. The where has some science and quantitative elements to it and some of it's been published. But the all-important why? Why do those regions have more older folks? That's all subjective and ultimately it's just interesting theories, but maybe some of those interesting theories are similar to the pillars that I talk about. Let's see.
Speaker 1:Well, this all began at a conference in 1999, where two academic researchers, pes and Poulin, visited Sardinia and presented what they found at this conference in 1999. And presented what they found at this conference in 1999., and it turned out they found a lot of people above the age of 100. Now, how did these get to be called the Blue Zones? Well, apparently this is what happened. They went to certain regions in Sardinia and every time they verified that a person actually was 100, they looked at birth records or whatever they looked at, they put a dot and in fact it was a blue dot. And so ultimately they had a map with a bunch of blue dots and in some areas, geographically, those dots clustered and those got to be called blue zones. Clustered and those got to be called blue zones. And in those blue zones, many people or at least more than average in terms of what happens elsewhere live to be 100. And in many of those places, some of them were men.
Speaker 1:The first academic paper built around this came out in 2004. Now, in the beginning there was no real explanation. They thought well, perhaps it's genetics, because some places in the world, like the Amish, do seem to live long and they seem to have a certain genetic component that corresponds perhaps to that. Maybe it was because they lived in mountainous locales, so in the beginning they didn't really know. Well, around the same time, there was work happening in Okinawa In 2005,.
Speaker 1:An author, an explorer, by the name of Dan Buechner, did a National Geographic story the Secrets of Long Life a National Geographic story, the Secrets of Long Life and so he found many people who lived to be 100 in Okinawa, later looked at Sardinia, looked at Loma Linda in California, and in all of these regions there were a fair number of people who lived to be 100. And so he did interviews. Now, this is non-scientific, non-statistical, but he talked to a bunch of people and he grouped the ideas. Again, not epidemiologic research, but this is what's done. It's often done in a documentary style and that's what they did. Well, buechner created a list of nine recommendations that were either evident in those communities or kind of logical extensions from them. These are the nine recommendations for living a long life In these communities.
Speaker 1:People were active, they walked a lot, they tended not to eat a lot of meat or processed meats. They drank red wine in moderation, of course. They tended to reduce calories. They tended to eat less than we would in a typical American city. They had a life purpose. They tried to reduce stress. They had a spiritual community that they were a part of. They made friends a priority and they surrounded themselves by folks who did the same.
Speaker 1:On the surface, this looks really good. Many of these are similar to the six pillars, but before we jump right in and say let's live the Blue Zone life, we should at least be aware of some of the concerns Now, as I mentioned, many of the factors like being active and having connection to other people, your diet those were common factors to my six pillars. But, as you'll notice, one of my key pillars and it's felt now to be so important is sleep. Nowhere in the real discussions of the blue zones in the original findings was sleep a focus. I also have shown data evidence that's quite compelling about saunas and cold plunges. Yeah, you don't see that in the cold in the blue zone work and they support drinking alcohol and, as I've talked about, alcohol can be problematic and there's a push to do plant-oriented diets where, frankly, the data are fine if you want a plant-oriented diet, but not necessarily going to make you live to be 100.
Speaker 1:The second area of concern financial motives. There's a real business element to the Blue Zone work and in fact the original three people who came together Pest, poulan and Buechner have separated into separate kind of areas of focus because perhaps it was related to the business side of things. Yeah, there's a Netflix documentary. Buechner's written seven books. He runs diet and cooking classes. He does consulting on doing a blue zone in your community. So you have to always wonder, especially if there isn't strict, rigorous science behind the factors they identify. Is there a financial motive that's pushing certain things?
Speaker 1:Third, and this is where it gets really important, there are concerns that the blue zones which are built around how long people live are built around birth data, and some of that birth data may be flawed. So when people say they're 100, maybe they're not. So I'm going to give you some examples that have been written about. Now it's not specifically about Sardinia or Okinawa, but these concepts may also apply and people have raised this.
Speaker 1:In the US, birth certificates were not something that was done, but around 1900, the US government started to issue birth certificates. Soon after that, when you look back, there were far fewer people living to be 100, the theory being people had misrecorded age. And when you look at birth records, what you found was an awful lot of those folks were born on the first of the month. So statistically, you wouldn't expect people to be all born on the first of the month. So statistically you wouldn't expect people to be all born on the first of the month, but there's a large number that were. Again, it suggests that birth records, certainly in the old days, were not rigorous and necessarily something we can kind of say are absolutely true. Well, moving away from the US, in Greece at some point they decided to look at people who were receiving pensions, because they didn't want to be paying out pensions if people were, frankly, no longer alive. What they found was 70% of the people receiving pensions who were in their least, 100 were actually dead. So a second example of where the data on which you determine how old people are may not be accurate.
Speaker 1:Okay, that was the third area of concern. The fourth is many of the regions which are held up as look at what these people are doing in this part of the world. Many of those regions no longer qualify as blue zones. Well, let's start with an example Okinawa. There are 47 regions in Japan and Okinawa was the one that was highlighted as a blue zone. But now they are the highest of all, 47 on BMI. They're number two on beer consumption. They're number four at suicide above the age of 65. They also have found that people who were born after World War II versus before, their longevity appears to be less so. More recent time frames suggest that the lifespans in Okinawa are perhaps less than the rest of Japan. Sardinia no longer shows exceptional longevity, and that was one of the blue zones.
Speaker 1:So what's going on here? Is it a simple statistical finding of regression to the mean? Anytime you find something that looks like an outlier, oh, this class of students are so tall. This other group have very, very high average IQs. What tends to happen is over time those findings go away. Everybody else gets taller, so the classroom isn't quite so tall and maybe, as they get older, other factors fold in and maybe the IQ testing scores aren't so high. This is called regression to the mean. You have a horrible back pain or headache and eventually it goes away. But if we talk to you at that point when you had the pain, the pain would be very high. So it's possible this was a statistical artifact that the blue zones weren't absolutely rigorous, and true, but now they're regressing to the mean. Or it's possible that at the time, people were doing these good behaviors and since then, frankly, it hasn't been that long. Maybe they've dropped some of those behaviors and since then, frankly, it hasn't been that long. Maybe they've dropped some of those behaviors.
Speaker 1:So many reasons to be interested in the blue zones, but also some reasons to question the data. Well, one more approach I want to share with you. The six pillars are one way to think about living long and well. The blue zones are another way of thinking about how to live to be 100. There's a more classic epidemiologic approach, and this is a study that was published not long ago. The researchers started with about 5,000 people, and many of these were old. Many of these were about 80. And so they asked a really interesting question what factors in these 80-year-olds predicted whether they would live to be 100? So this was a more rigorous epidemiologic approach and they focused on lifestyle so similar to the six pillars, similar to the blue zones and they came up with a score, a healthy lifestyle score. So what they found was were you a smoker? Did you drink a lot of alcohol? Did you have a high BMI suggestive of obesity? Did you exercise and did you have something called dietary diversity? And food diversity was based upon how often you have fruits in your diet, vegetables, fish, beans and tea. What did they find? They found that people who did well on this score had a 60% increased likelihood of living to be 100. So the factors at 80 that characterize somebody's life. If they were that they exercised, if it were that they had this dietary diversity and they didn't smoke, they were more likely to live to be 100. And this was sort of classic epidemiology.
Speaker 1:Well, it's time to wrap up. I am comfortable that the six pillars that I share with you. There is evidence to support each one of them. There's evidence that comes from people, not just test tubes or mice. The blue zones they do identify lifestyle factors that some of them are similar to the six pillars. Some of them are similar to the six pillars but, as I mentioned, there are key distinctions. The blue zones drink some alcohol in moderation. They don't appear to have a particular focus on sleep or saunas and cold plunges. Do the blue zones get influenced by financial reasons. Perhaps Are there academic concerns about the blue zones. Yes, on the positive side, many of the factors are ones that we know work, and if the blue zones have popularized some of them, that's wonderful. I'm happy about that.
Speaker 1:So are we all going to live to be 100?
Speaker 1:Well, if you look at people who live to be 70, it's been estimated that 20% of that likelihood is related to genetics, and perhaps 80% is environment or other things. But it's also felt that to live to be 100, maybe it's 70% is genetically driven. Again, we don't have rigorous evidence on this, but to live to be quite, quite old may have a large genetic component. Now, whether you're convinced by my six pillars, whether you're convinced by the blue zones, by my six pillars, whether you're convinced by the blue zones or the work I just talked about about the 80-year-old living to be 100, there are some common themes. My six pillars are exercise, nutrition, mind-body harmony, social relationships, sleep and exposure to saunas and cold plunge. I hope that all of you can live to be 100 or beyond, and perhaps we'll all continue talking to each other through this podcast for many decades to come.
Speaker 1:Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's Dr, as in D-R Bobby. Live long and wellcom.