When learning about the Blue Zones (key locations around the world that appear to have high levels of centenarians), sooner or later one comes across alternate views and those who want to debunk the very idea of them. Typically the key areas of contention are related to diet and population age data.
Are the Blue Zones all hokum and marketing? Certainly as the term - and the brand - of Blue Zones has become increasingly commercial we should be cautious of any statements or claims being made. In this article we dig deeper, reviewing what are the building blocks of the Blue Zones and Blue Zone healthy living, where and how they are criticised and by whom.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to supporting studies, news reports and resources are found at the bottom of page.
What does Blues Zones messaging say, their so-called common findings from Blue Zones around the world and guidance for healthy living. These are categorised as the 'Power 9':
Move Naturally, movement (rather than exercise) is incorporated into daily living.
Purpose, have a sense of purpose.
Down Shift, reduce stress to reduce chronic inflammation.
80% Rule, do not overeat.
Plant Slant, have a plant-based diet, meat is usually enjoyed about 5 times per month.
Wine at 5. Moderate alcohol consumption (usually a dark rich red wine) in a convivial social setting can extend life.
Belong. Being a member of a faith-based community can provide purpose and social health.
Loved Ones First. Families that support each other live longer and healthier. No social isolation.
Right Tribe. Being with people who live healthily, leads to everyone living healthier lives.
There doesn’t appear to be anything inherently wrong with any of these statements, essentially: daily exercise (or movement), a plant forward diet, good social health and so forth. But for a vocal minority this is a source of debate:
Are the Blues Zones team mistaken or deliberately lying to the public, is the evidence wrong?
Is this message not in keeping with the totality of evidence for healthy living?
Are these tenets of longevity out of alignment with the pillars of health (a set of lifestyle practices for physical, mental and social health) as promoted by doctors and health coaches in the lifestyle medicine community?
Debunking the Blue Zones
So what are the common arguments that ‘Debunk the Blue Zones'? Scanning through YouTube (yes, a great source for everything!), common arguments to debunk the Blue Zones are made as follows and mainly have a focus on diet.
“It is not a scientific study. It is a narrative.” This is true, the original Blue Zones work was a research project, postulated by Blue Zone’s protagonist Dan Buettner, published in National Geographic. And he has done well from it. The Blues Zones do, however, now tie into a mountain of research from across the world, either focused on lifestyle in the Blues Zones or other traditionally based cultures that appear to agree with its healthspan promoting principles.
“The longest life expectancy country in the world is meat eating Hong Kong, it’s not a Blue Zone.” Blue Zones are not countries, they are regions within countries. Unlike Hong Kong, that eats more than its share of meat, Blue Zone populations do not have the benefit of easy access to first class hospitals or convalescent care. According to the Hong Kong's own Department of Health "Over 70% of elders suffer from one or more chronic illness(es)" . The aged in Blue Zones are healthy due to their lifestyle practices and environment, chronic illness is rare.
“Age data and records of the so-called centenarians are made up or corrupted.” Some records from 100 years ago (1920s, 1930s) might sketchy but the Blue Zones team are aware of the problem and try to verify the data, say, from church and other records. Usually these are accurate. Certainly, some old data may be incorrect. Are the team lying? Hard to say. Is there any proof? No.
It is worthwhile to see what the definition of a Blue Zone is, from the Blue Zones website: “the highest healthy life expectancy, where people reach their 90s with low rates of chronic disease, and where there is a high probability to reach 100.” The website also goes on to explain how data is verified or double checked.
Since June 2024 media reports have shared a new study, still in pre-print and not peer reviewed. According to the preprint, clerical errors, pension fraud and a lack of birth certificates explain Blue Zones and their above-average numbers of centenarians: "Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors and pension fraud" Saul Justin Newman. Watch this space.
“Meat is everywhere in the Blue Zones, restaurant menus are meat heavy.” Restaurant menus are hardly representative of the meals eaten at home by relatively impoverished populations. Nor are the standard diets enjoyed by younger families, say the children of Blue Zone centenarians. When Blue Zones living refers to 'plant based' it does not mean 100% plant based or vegan. Meat, eggs, fish and dairy are enjoyed, in limited amounts, alongside large amount of legumes and vegetables.
“Spam is Okinawa’s favourite dish” As a legacy from post World War 2 US occupation, Spam is very popular in Okinawa but not for everyone. Many younger people in (modern) Okinawa also enjoy MacDonald’s but they are not the one’s being studied, those increasingly rare few that have made it to a healthy 90 years old or more.
“We have a study showing that countries with higher meat consumption have longer lifespans.” These exist but there are not many. There are also many studies showing that populations that eat fewer animal products are healthier and live longer too. When it comes to studies, less developed nations that eat more animal products can be shown to have better health outcomes and, with the nutrition transition, developed nations with more animal products have worse health outcomes. This can be further complicated by a transition from whole foods to processed and ultra processed foods. Nutrition science and epidemiology can be complicated and confusing.
“Blue Zone farmers all have animals and they grill animals on spits on the weekends”, “Blue Zones are a myth because people don’t eat like that anymore”. If you've made it to 95 or 105, you have grandkids and a plot in the countryside, you may well eat a goat on a family weekend. On a daily basis, if you are more economically secure in the 2020s compared to the 1960s, with an extended family to support you, likely you will eat more meat.
The super aged in the Blue Zones are not static, frozen in time. Buettner clearly states that times, diets, lifestyle are changing… for the worse. The healthy super aged are a dying breed, along with the simple, agrarian lifestyles that they lived.
“It’s not the diet, it’s the exercise” Exercise, or rather physical activity, is important. Blue Zone living has a mix of different healthy habits that contribute to the healthspan of Blue Zone inhabitants, thus the Power 9.
"Some of centenarians drink alcohol, recently proven to be harmful to health at any level." On a mechanistic level this is 100% true but as with any population study outcomes may differ from the lab. Yes alcohol has been shown to be harmful to the body, but in this situation is the negative compensated by the social benefits entailed with the enjoyment of (limited amounts of) alcohol? In the case of wine consumption in Sardinia, the Blues Zone report that the wine is unusually polyphenol rich.
Who is Debating the Data?
It makes sense to ask who is making the arguments. Regarding the age data, we have previously touched on this.
As far as I can tell from viewing other 'debunks' these primarily come from people who espouse the carnivore diet or those that confuse plant based eating (predominantly plants but not to the exclusion of meat or fish) with a diet that completely excludes meat. Their language is generally in tones of ridicule and contempt rather than presenting data.
There seems to be little if any criticism of the Blue Zone's other tenets of healthy living. Some argue that, walking - not diet - is the key to longevity. Likely the Blue Zones team would agree that walking is indeed a vital part of the overall longevity health mix.
An Alternate Definition of the Blue Zones
For an alternate insider view on the Blue Zones, it is worth visiting the website and reading the research from Buettner's (less well known) ex research partner Michel Poulain. Interestingly they only agree on 4 locations being Blue Zones: Ikaria, Nicoya, Okinawa and Sardinia.
Final Thoughts
While it is easy to fall in love with a romanticised idea of Blue Zone living, the reality is that the healthy Blue Zone living consists of generally poor communities living a lifestyle that is dying out. Lifestyles that are rapidly being surpassed by modern living and unhealthier lifesyle dominated by processed foods, little physical activity and more stress.
The only Blue Zones that exist as modern, thriving populations are relatively wealthy cultures: the well studied Seventh Day Adventists in Loma Linda, California and, a new addition with a new definition, Singapore, an 'engineered Blue Zone version 2'.
And what if some of the 'healthy aged' are not 105 but actually 100? Not 95 but actually 85. Enjoying life and physical independence, rather than dead or bedridden in a hospice? Compared to much of the rest of the world in their final decade, I’ll take the evidence offered by the Blue Zones team as proof that Blue Zones exist. I think the real question to ask is...
Are the tenets of Blue Zone healthy living, the Power 9, inherently flawed or do they promote health and longevity?
What do you think?
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Related Resources and Studies
Articles and Other
Article on Blue Zones history and relationship between Buettner and Poulain: Science, "Blue zones, supposed havens of longevity, have become a global brand. But skeptics think they rest on shaky science", 21 November 2024, Ignacio Amigo
UCL new report, 13 September 2024, UCL demographer’s work debunking ‘Blue Zone’ regions of exceptional lifespans wins Ig Nobel prize
Elderly Health Service, Department of Health, Hong Kong "Coping with Chronic Illness"
Studies
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Ghosh TS, Rampelli S, Jeffery IB, Santoro A, Neto M, Capri M, Giampieri E, Jennings A, Candela M, Turroni S, Zoetendal EG, Hermes GDA, Elodie C, Meunier N, Brugere CM, Pujos-Guillot E, Berendsen AM, De Groot LCPGM, Feskins EJM, Kaluza J, Pietruszka B, Bielak MJ, Comte B, Maijo-Ferre M, Nicoletti C, De Vos WM, Fairweather-Tait S, Cassidy A, Brigidi P, Franceschi C, O'Toole PW. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut. 2020 Jul;69(7):1218-1228. doi: 10.1136/gutjnl-2019-319654. Epub 2020 Feb 17. PMID: 32066625; PMCID: PMC7306987.
Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, Pietruszka B, Meunier N, Caumon E, Malpuech-Brugère C, Santoro A, Ostan R, Franceschi C, Gillings R, O' Neill CM, Fairweather-Tait SJ, Minihane AM, Cassidy A. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Stiffness in Older Adults. Hypertension. 2019 Mar;73(3):578-586. doi: 10.1161/HYPERTENSIONAHA.118.12259. PMID: 30636547; PMCID: PMC6380440.
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