#42 Let's Live to be 100. Do the Blue Zones guide the way?

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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.

Episode Transcript

Speaker 1 (00:01):
I'd like to live to be 100.
Wouldn't you?
Now, how might we do that?
Do the learnings from the bluezones guide us in the right
direction?
Or is it all unscientificmarketing hype?
As always, let's see where theevidence takes us.

(00:22):
Let's see where the evidencetakes us.
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, apodcast where we will talk about
what you can do to live as longas possible and with as much

(00:43):
energy and figure that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published

(01:05):
several hundred scientificstudies.
I'm honored to be your guide.
Welcome my listeners to episode42.
Let's live to be a hundred.
Do the blue zones guide our way?
Do the blue zones guide our way?

(01:29):
Well, a few episodes back,number 39, we explored the
question together of how manyyears do we have left and how
many of those will be good years.
Now it seems logical to ask canwe increase that number?
So, if actuarial tables orpredictive equations say likely
you'll live to be 82, can weincrease that to 85, to 90, and

(01:54):
perhaps live to be 100?
.
What might allow us to achievethat?
Well, one approach no surpriseto you, my listeners are the six
pillars that I talk aboutExercise, sleep, nutrition,
mind-body harmony, exposure toheat and cold, and social

(02:19):
relationships, as we've talkedabout in each of the first seven
episodes.
Each of those elements has acompelling set of evidence that
it makes a difference.
It helps us to live long andwell, and the information, the
evidence that I shared with youduring those episodes two

(02:42):
through seven or eight waslooking at one of those pillars
at a time.
But maybe if we combined all ofthe pillars or multiple aspects
of what we do or don't do now,we might get to a different
place and learn whether we couldlive to be 100.

(03:03):
You might have heard about theblue zones.
There was a lot of buzz aboutit.
A couple years back there was adocumentary on Netflix and it
focused on regions of the worldwhere a lot of people,
relatively speaking, a lot ofpeople, live to be 100.

(03:24):
Now the question is do the bluezones and what they learn from
them in admittedly not ascientific way, but are the
learnings good guidance or is itreally just unscientific
marketing hype.
That's the question for today.

(03:51):
Well, one action item before wedive in please tell your
friends about this podcast.
There have been a bunch of newfollowers and I thank you for
recommending people, and I'vebeen really excited that when
people decide to follow me, theyalso appear to be starting at
episode one and working theirway through all 40 some odd of

(04:14):
them now.
So thank you very much, okay.
Well, if we're going to thinkabout living to 100, how many
folks actually make it there?
Well, today in the UnitedStates, there's about 100,000
people who are 100 or above.
Now, that sounds like a prettygood number, but if you look as

(04:35):
a percentage of the population,it's only 0.03%.
So tiny percent.
But this number is projected toquadruple by 2054.
Also turns out that the vastmajority of the folks who live

(04:56):
to be 100, 78 percent or so inthe US are women.
Well, if we turn this aroundand ask the question now you're
a newborn baby, what's theprobability you'll live to be
100?
Well, it's about 5% in females,but less than 2% in males.

(05:16):
So women are more likely tolive that long, to live that
long.
But here's a teaser of a datapoint.
In Hong Kong, almost 13% of thefemales and over 4% of the men
are projected to live to be 100,based on 2019 life tables.

(05:41):
So is there something from HongKong or other places in the
world where people tend to livelonger?
And that brings us to the storyof the Blue Zones.
Now, these are places wheremore people than you might

(06:01):
anticipate live to be 100.
And so the obvious question iswhy are there factors inherent
in those environments lifestyleissues, maybe genetic issues
that cause there to be morefolks that live that long, cause

(06:25):
there to be more folks thatlive that long?
Well, it turns out that thefindings of the blue zones are
qualitative, they're subjective,they're not statistical.
There's no randomized controltrials, there's not even a
formal observational study whereyou follow people over time,
look at the factors that predictwho's going to live a long time
or not.
Now where they focus in theworld.

(06:46):
Now, that is quantitative.
Yes, they did demographicanalysis and says, oh, there's a
lot of old people that live tobe 100 here versus there.
But that's the where.
The where has some science andquantitative elements to it and
some of it's been published.
But the all-important why?
Why do those regions have moreolder folks?

(07:09):
That's all subjective andultimately it's just interesting
theories, but maybe some ofthose interesting theories are
similar to the pillars that Italk about.
Let's see.
Well, this all began at aconference in 1999, where two

(07:31):
academic researchers, pes andPoulin, visited Sardinia and
presented what they found atthis conference in 1999.
And presented what they foundat this conference in 1999.
, and it turned out they found alot of people above the age of
100.
Now, how did these get to becalled the Blue Zones?
Well, apparently this is whathappened.

(07:52):
They went to certain regions inSardinia and every time they
verified that a person actuallywas 100, they looked at birth
records or whatever they lookedat, they put a dot and in fact
it was a blue dot.
And so ultimately they had amap with a bunch of blue dots

(08:13):
and in some areas,geographically, those dots
clustered and those got to becalled blue zones.
Clustered and those got to becalled blue zones.
And in those blue zones, manypeople or at least more than
average in terms of what happenselsewhere live to be 100.

(08:33):
And in many of those places,some of them were men.
The first academic paper builtaround this came out in 2004.
Now, in the beginning there wasno real explanation.
They thought well, perhaps it'sgenetics, because some places
in the world, like the Amish, doseem to live long and they seem
to have a certain geneticcomponent that corresponds

(08:56):
perhaps to that.
Maybe it was because they livedin mountainous locales, so in
the beginning they didn't reallyknow.
Well, around the same time,there was work happening in
Okinawa In 2005,.
An author, an explorer, by thename of Dan Buechner, did a

(09:17):
National Geographic story theSecrets of Long Life a National
Geographic story, the Secrets ofLong Life and so he found many
people who lived to be 100 inOkinawa, later looked at
Sardinia, looked at Loma Lindain California, and in all of
these regions there were a fairnumber of people who lived to be

(09:38):
100.
And so he did interviews.
Now, this is non-scientific,non-statistical, but he talked
to a bunch of people and hegrouped the ideas.
Again, not epidemiologicresearch, but this is what's
done.
It's often done in adocumentary style and that's

(10:00):
what they did.
Well, buechner created a listof nine recommendations that
were either evident in thosecommunities or kind of logical
extensions from them.
These are the ninerecommendations for living a
long life In these communities.
People were active, they walkeda lot, they tended not to eat a

(10:23):
lot of meat or processed meats.
They drank red wine inmoderation, of course.
They tended to reduce calories.
They tended to eat less than wewould in a typical American
city.
They had a life purpose.
They tried to reduce stress.
They had a spiritual communitythat they were a part of.

(10:47):
They made friends a priorityand they surrounded themselves
by folks who did the same.
On the surface, this looksreally good.
Many of these are similar tothe six pillars, but before we
jump right in and say let's livethe Blue Zone life, we should
at least be aware of some of theconcerns Now, as I mentioned,

(11:10):
many of the factors like beingactive and having connection to
other people, your diet thosewere common factors to my six
pillars.
But, as you'll notice, one ofmy key pillars and it's felt now
to be so important is sleep.
Nowhere in the real discussionsof the blue zones in the

(11:35):
original findings was sleep afocus.
I also have shown data evidencethat's quite compelling about
saunas and cold plunges.
Yeah, you don't see that in thecold in the blue zone work and
they support drinking alcoholand, as I've talked about,
alcohol can be problematic andthere's a push to do

(12:00):
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.
The second area of concernfinancial motives.

(12:21):
There's a real business elementto the Blue Zone work and in
fact the original three peoplewho came together Pest, poulan
and Buechner have separated intoseparate kind of areas of focus
because perhaps it was relatedto the business side of things.
Yeah, there's a Netflixdocumentary.
Buechner's written seven books.
He runs diet and cookingclasses.

(12:44):
He does consulting on doing ablue zone in your community.
So you have to always wonder,especially if there isn't strict
, rigorous science behind thefactors they identify.
Is there a financial motivethat's pushing certain things?
Third, and this is where it getsreally important, there are

(13:06):
concerns that the blue zoneswhich are built around how long
people live are built aroundbirth 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 someexamples that have been written
about.
Now it's not specifically aboutSardinia or Okinawa, but these

(13:30):
concepts may also apply andpeople have raised this.
In the US, birth certificateswere not something that was done
, but around 1900, the USgovernment started to issue
birth certificates.
Soon after that, when you lookback, there were far fewer
people living to be 100, thetheory being people had

(13:54):
misrecorded age.
And when you look at birthrecords, what you found was an
awful lot of those folks wereborn on the first of the month.
So statistically, you wouldn'texpect people to be all born on
the first of the month.
So statistically you wouldn'texpect people to be all born on
the first of the month, butthere's a large number that were
.
Again, it suggests that birthrecords, certainly in the old

(14:16):
days, were not rigorous andnecessarily 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 whowere receiving pensions, because
they didn't want to be payingout pensions if people were,

(14:39):
frankly, no longer alive.
What they found was 70% of thepeople receiving pensions who
were in their least, 100 wereactually dead.
So a second example of wherethe data on which you determine
how old people are may not beaccurate.

(15:00):
Okay, that was the third area ofconcern.
The fourth is many of theregions which are held up as
look at what these people aredoing in this part of the world.
Many of those regions no longerqualify as blue zones.
Well, let's start with anexample Okinawa.

(15:20):
There are 47 regions in Japanand Okinawa was the one that was
highlighted as a blue zone.
But now they are the highest ofall, 47 on BMI.
They're number two on beerconsumption.
They're number four at suicideabove the age of 65.

(15:44):
They also have found thatpeople who were born after World
War II versus before, theirlongevity appears to be less so.
More recent time frames suggestthat the lifespans in Okinawa

(16:05):
are perhaps less than the restof Japan.
Sardinia no longer showsexceptional longevity, and that
was one of the blue zones.
So what's going on here?
Is it a simple statisticalfinding of regression to the
mean?
Anytime you find something thatlooks like an outlier, oh, this

(16:27):
class of students are so tall.
This other group have very,very high average IQs.
What tends to happen is overtime those findings go away.
Everybody else gets taller, sothe classroom isn't quite so
tall and maybe, as they getolder, other factors fold in and

(16:49):
maybe the IQ testing scoresaren't so high.
This is called regression tothe mean.
You have a horrible back painor headache and eventually it
goes away.
But if we talk to you at thatpoint when you had the pain, the
pain would be very high.
So it's possible this was astatistical artifact that the

(17:10):
blue zones weren't absolutelyrigorous, and true, but now
they're regressing to the mean.
Or it's possible that at thetime, people were doing these
good behaviors and since then,frankly, it hasn't been that
long.
Maybe they've dropped some ofthose behaviors and since then,
frankly, it hasn't been thatlong.
Maybe they've dropped some ofthose behaviors.

(17:31):
So many reasons to be interestedin the blue zones, but also
some reasons to question thedata.
Well, one more approach I wantto share with you.
The six pillars are one way tothink about living long and well
.
The blue zones are another wayof thinking about how to live to
be 100.

(17:51):
There's a more classicepidemiologic approach, and this
is a study that was publishednot long ago.
The researchers started withabout 5,000 people, and many of
these were old.
Many of these were about 80.
And so they asked a reallyinteresting question what
factors in these 80-year-oldspredicted whether they would

(18:16):
live to be 100?
So this was a more rigorousepidemiologic approach and they
focused on lifestyle so similarto the six pillars, similar to
the blue zones and they came upwith a score, a healthy
lifestyle score.

(18:36):
So what they found was were youa smoker?
Did you drink a lot of alcohol?
Did you have a high BMIsuggestive of obesity?
Did you exercise and did youhave something called dietary
diversity?
And food diversity was basedupon how often you have fruits

(19:02):
in your diet, vegetables, fish,beans and tea.
What did they find?
They found that people who didwell on this score had a 60%
increased likelihood of livingto be 100.
So the factors at 80 thatcharacterize somebody's life.

(19:26):
If they were that theyexercised, if it were that they
had this dietary diversity andthey didn't smoke, they were
more likely to live to be 100.
And this was sort of classicepidemiology.
Well, it's time to wrap up.
I am comfortable that the sixpillars that I share with you.

(19:48):
There is evidence to supporteach one of them.
There's evidence that comesfrom people, not just test tubes
or mice.
The blue zones they do identifylifestyle factors that some of
them are similar to the sixpillars.
Some of them are similar to thesix pillars but, as I mentioned

(20:09):
, there are key distinctions.
The blue zones drink somealcohol in moderation.
They don't appear to have aparticular focus on sleep or
saunas and cold plunges.
Do the blue zones getinfluenced by financial reasons.
Perhaps Are there academicconcerns about the blue zones.

(20:34):
Yes, on the positive side, manyof the factors are ones that we
know work, and if the bluezones have popularized some of
them, that's wonderful.
I'm happy about that.
So are we all going to live tobe 100?
Well, if you look at people wholive to be 70, it's been
estimated that 20% of thatlikelihood is related to

(20:58):
genetics, and perhaps 80% isenvironment or other things.
But it's also felt that to liveto be 100, maybe it's 70% is
genetically driven.
Again, we don't have rigorousevidence on this, but to live to
be quite, quite old may have alarge genetic component.

(21:21):
Now, whether you're convincedby my six pillars, whether
you're convinced by the bluezones, by my six pillars,
whether you're convinced by theblue zones or the work I just
talked about about the80-year-old living to be 100,
there are some common themes.
My six pillars are exercise,nutrition, mind-body harmony,

(21:53):
social relationships, sleep andexposure to saunas and cold
plunge.
I hope that all of you can liveto be 100 or beyond, and
perhaps we'll all continuetalking to each other through
this podcast for many decades tocome.
Thanks so much for listening toLive Long and Well with Dr Bobby
.
If you liked this episode,please provide a review on Apple

(22:13):
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobblivelongandwellcom.
That's Dr, as in D-R Bobby.

(22:36):
Live long and wellcom.