Blue Zones: a guide to longevity or a health myth?

In 2004, National Geographic journalist Dan Buettner teamed up with Italian physician Gianni Pes and Belgian demographer Michel Poulain, who wanted to map where the largest concentrations of people living past 100 in good health were found and to understand the secrets of longevity in those places. Together, the three created the concept of Blue Zones, places where people not only lived a long time but aged without chronic diseases. 

The two scientists had already carried out an investigation in Sardinia, Italy, but they joined forces with the American network to travel to places such as Okinawa (Japan) and Loma Linda (California), pursuing their research and documenting it for a general audience. The journey was documented and shared across National Geographic’s channels and media, generating great public interest.

Over time, the concept became popular among both the general public and scientists. But it was followed by some weak criticism, pointing to “overblown marketing” and the oversimplification of existing habits. However, demographer Saul Justin Newman (a researcher at University College London and the Australian National University) began bringing stronger counterarguments into the debate.

In 2024, Newman published a data analysis paper (preprint) showing that the overwhelming majority of people recorded as being over 110 years old (supercentenarians) worldwide did not have a formal birth certificate. 

The researcher revealed that peaks of extreme longevity coincided perfectly with places that historically had poorer public record-keeping and a high incidence of pension fraud (situations in which an elderly person died but the family did not notify the government so they could keep collecting the pension).

The paper was awarded the Ig Nobel Prize in Demography, which is given to serious scientific studies that “first make people laugh, and then make them think.” 

Which leads us to ask: how much can we trust the concept of Blue Zones? To find out, Prime Health Report spoke with two experts to better understand whether or not the concept can be trusted.

First: what does the Blue Zones concept say?

Buettner and Pes’s Blue Zones are places around the world where people not only lived a long time but aged without chronic diseases. Originally, they mapped five locations:

• Sardinia (Italy): Where it all began, famous for its high rate of centenarian men who worked as shepherds;

• Okinawa (Japan): Known for the longest-lived women in the world and a strong sense of community (Moai);

• Loma Linda (California, USA): A community of Seventh-day Adventists who live about 10 years longer than the average American thanks to strong spirituality and a vegetarian diet;

• Ikaria (Greece): An isolated island in the Aegean Sea with extremely low rates of dementia and heart disease;

• Nicoya (Costa Rica): A peninsula where older adults maintain an active routine based on traditional foods (such as corn, beans and squash).

By analyzing these five locations, the researchers isolated nine habits that seemed to help with longevity, the Power 9:

1. Move Naturally: The world’s longest-lived people don’t go to gyms or run marathons. Instead, they live in environments that constantly nudge them to move without thinking. They tend gardens, walk to work, clean the house by hand and use simple mechanical tools.

2. Purpose (Ikigai or Plan de Vida): Knowing why you wake up every morning. Having a clear purpose in life may be worth up to seven extra years of life expectancy.

3. Downshift: Even centenarians experience stress, but they have daily routines to shed it. Adventists pray, Okinawans remember their ancestors, Sardinians have a happy hour and Ikarians take a nap.

4. 80% Rule (Hara Hachi Bu): This is the Okinawan mantra that reminds people to stop eating when their stomachs are 80% full. That 20% difference may be the key to losing or gaining weight. In addition, people in the Blue Zones eat their smallest meal in the late afternoon or early evening and don’t eat anything else for the rest of the day.

5. Plant Slant: The cornerstone of most centenarian diets is beans (including fava beans, lentils and soy). Meat is eaten on average only five times a month, in small portions (about the size of a deck of cards).

6. Wine: With the exception of the Adventists (who abstain from alcohol), people in the Blue Zones drink alcohol moderately and regularly (1 to 2 glasses a day, usually Cannonau red wine in Sardinia), always with friends and/or with food.

7. Belong: Of the 268 centenarians interviewed in the original studies, almost all belonged to some faith-based community. Research shows that attending religious services four times a month may add 4 to 14 years of life expectancy.

8. Loved Ones First: Centenarians keep aging parents and grandparents nearby or in the home, commit to a life partner (which can add up to 3 years of life expectancy) and invest time and love in their children.

9. Right Tribe: The longest-lived people choose — or were born into — social circles that support healthy behaviors. Okinawans form moais, groups of five friends who commit to supporting one another for life. Because health behaviors (such as obesity and smoking) are “contagious,” having friends with healthy habits shapes your own longevity.

Should we trust the Blue Zones concept?

For geriatrician Leonardo Oliva, president of the Sociedade Brasileira de Geriatria e Gerontologia (SBGG), it’s important to understand that a single methodological challenge does not invalidate an entire body of population observation. “It’s natural for there to be some methodological questions, especially when we’re looking at centenarians. However, even if extreme cases may be overestimated, those regions do in fact have unusual concentrations of long-lived people,” he notes.

General practitioner and geriatrician Paulo Camiz, a member of the medical staff at Hospital Sírio Libanês, believes the criticism is always relevant, since a change of a single year can affect the number of centenarians in a given place. “We can understand good things that happened there. It’s important to draw some lessons, but without turning these accounts into proof that this is the secret key to longevity,” the specialist cautions.

Oliva argues that in the medical community, Blue Zones have always been seen as epidemiological observations that end up generating hypotheses. “The habits observed in the Blue Zones can be checked against evidence from other studies, such as longitudinal studies, clinical trials and even biological research. And what’s interesting is that several of the behaviors described (such as regular physical activity, natural foods, social interaction and low smoking rates) are supported by different lines of scientific evidence,” he observes.

Oliva emphasizes that healthy aging is multifactorial and that no researcher should champion isolated aspects as the explanation for longevity. “Factors such as sanitation, vaccination, education, income, access to health care, control of cardiovascular risk factors and childhood living conditions are, without a doubt, fundamental to longevity and aging,” Oliva says. In his view, the real insight of the Blue Zones is bringing behavioral and lifestyle factors into the spotlight of the debate.

Camiz agrees and argues that even with the methodological questions surrounding the concept, we can’t dismiss the items raised in the Power 9. “These habits already match recommendations that medicine fully endorses. The pillars of healthy aging already cover all of this,” he stresses.

For both geriatricians, the ideal is to guide patients without promises or myths. “These habits, behaviors and choices we make throughout life should complement, not replace, evidence-based medicine, because patients absolutely need to keep controlling hypertension, diabetes and cholesterol, and keep getting screened for cancers that are well documented as requiring this kind of approach,” the SBGG president emphasizes.