Longevity Blue Zone Centenarians: An Expository Paper

Centenarians have apparently discovered the fountain of youth. Ironically, their secret recipe is not a restricted diet or high-impact exercise regimen. The world’s most aged people have many things to teach us. Centenarians hold the secret that all humans want– the prescription to live 100 years. Areas of the world found to harbor the people with exceptional lifespans are known as a ‘Longevity Blue Zone’ (LBZ) (Pes et al.,2014). The LBZ’s display the highest concentrations of centenarians globally. Furthermore, this population's longevity shows noticeable gender equality instead of the usual women's advantage. These LBZ’s are located in Sardinia, Italy, Okinawa, Japan, Loma Linda, CA, USA, Nicoya Peninsula, Costa Rica, and Ikaria, Greece.

Centenarians possess genetic and environmental attributes that allow them to survive to exceptional ages, and many appear to delay or avoid major age-related diseases and disability. (Pes et al.,2014). The oldest known person is Jeanne L. Calment, born in France on February 21, 1875, and lived for 122 years until she died on August 4, 1997 (Harman., 1998). The United Nations estimates that over 316,000 centenarians worldwide and 3.7 million people will reach 100 years old by 2050. By 2050, China will have the largest centenarian population, followed by Japan, the U.S., Italy, and India (United Nations, 2017).

Centenarians focus on eating what they grow, tending to their livestock, and spending quality time with family. Furthermore, they practice their religious faith and have a purpose for each day. The highest concentrations of centenarians reside globally in Sardinia, Italy, Okinawa, Japan, Ikaria, Greece, the Nicoya Peninsula, Costa Rica, and Loma Linda, California (Buettner, 2012). Recent literature on centenarians has focused on these LBZ’s.

There is limited information on the relationship between health and health care in the Blue Zones, indicating that the two are not the same. Health care for the centenarians does not seem to be the focus. A healthy lifestyle takes priority. Therefore, this exposé aims to provide a clear and concise explanation of the five LBZ areas in the world. Furthermore, this paper assesses the hypothesis that wellness and health services are oftentwo distinct entities in the LBZ’s. The LBZ’s represent the keys to understanding how to live better and longer. As a result, further information can be gained by exploring centenarians' viewpoints on various choices involving wellness and healthcare while residing in these zones.

Longevity Blue Zones

LBZ’s are areas around the world that have an unusual concentration of centenarians. Poulain et al. (2004) identified areas of the world where a high rate of centenarians live. These so-called “blue zones” are Sardinia, Italy, Okinawa, Japan, Loma Linda, CA, USA, Nicoya Peninsula, Costa Rica, and Ikaria, Greece. The name "blue zones" derived merely from the researchers labeling the “longevity hotspots” with blue circles on a world map. Most of these hotspots are located in mountainous regions of the world, indicating isolated areas, free from outside disease and immigration, which promote longevity (Poulain et al., 2004). Additionally, longevity in the LBZ’s may relate to the food sources, culture, and socialization of the area, which illustrates the multifactorial nature of healthy aging.

Centenarians living in these primarily isolated parts of the world have discovered lessons for longevity (Buettner, 2012). These lessons include living an active lifestyle, faith and family, a plant-based diet, solid social connections, and above all, a purpose for living every day. Each LBZ has its reason for longevity; however, each LBZ population contains shared habits. The island of Sardinia, Italy, is the first LBZ explored in this exposé detailing the Sardinia centenarians’ formula for longevity.

Sardinia, Italy

A mountainous dwelling population in Sardinia, Italy, is known for having a high concentration of centenarians (Pes et al., 2014). This assemblage also demonstrates gender equality, as men achieve an equal length of life compared to women. Sardinia, Italy, was the first discovered LBZ (Poulain et al., 2004).

Sardinia is an island located in the western Mediterranean, 120 miles west of mainland Italy and contains 1.6 million people. The LBZ area on the Sardinian island is situated on the island's mountainous region and encompasses 14 villages in Barbagia and Ogliastra (Poulain et al., 2013).

Poulain et al. (2004) determined that 17,965 people were born within the LBZ area from 1890-1900, and of this group, 91 persons (47 men and 44 women) reached the age of 100. Pes et al. (2014) determined a possible reason for male longevity on Sardinia due to a high protein diet, primarily livestock and animal-derived foods. Along with the Sardinian's high protein diet, they consumed large amounts of locally prepared bread and cereals. Therefore, the Sardinians likely balanced their carbohydrate intake with their intense physical activity of shepherding.

The Sardinians experience a purposeful life in their daily work and are surrounded by family constantly (Poulain et al., 2013). In an ironic twist, the elders help with childcare, giving them added purpose and a feeling of contribution, possibly adding to their longevity. Sardinians share similar living practices for longevity with centenarians living on the Japanese island of Okinawa.

Okinawa, Japan

Okinawa, Japan, is comprised of hundreds of islands. The main island is about 15 miles wide and 60 miles long. According to Pew Research, Japan has the most centenarians per capita globally at 4.8 per 10,000 people (Pew Research, 2016). The Okinawan centenarians offer a great example in health and longevity. The reason for their better health is lifestyle, not genes. The lessons of the Okinawan LBZ include eating a diet of mostly vegetables, having family and social networking, and maintaining a sense of purpose in their life.

Centenarians in Okinawa, Japan, have found the prescription for longevity. Buettner (2012) found that Okinawans have eaten a plant-based diet for most of their lives and only eat meat on special occasions. Okinawans are active walkers, gardeners and practice ‘ikigai’ (purpose in life) - a desire to have a reason to wake up in the morning. Like the Sardinian centenarians, the Okinawans have clear family responsibility roles by taking care of the children in their old age.

Information on the Okinawan centenarians and their use of health care services and support systems are limited. Buettner (2012) observed that the Okinawans and most of Asia regard prevention as medicine rather than reactive treatment. Okinawans share many of the same lessons as centenarians in Loma Linda, California, an American LBZ.

Loma Linda, California

Loma Linda, California, is a rare LBZ. In comparison to other LBZ centenarians, Loma Linda centenarians are unique. Loma Linda, California, is not as isolated geographically as the previously discussed LBZ. Loma Linda does, however, have a high concentration of members of the Seventh Day Adventist religion. This Adventist community in California outlives the average American by a decade. Taking their diet directly from the Bible, they consume a vegan diet of leafy greens, nuts, and legumes (Buettner & Skemp, 2016). Butler et al. (2008) investigated a 2002 report on dietary behaviors of Seventh-Day Adventists, which discovered that the Adventist lifestyle was associated with lower rates of death, cardiac disease, and diabetes. When opposed to the general California populace, females lived 4.4 years longer and males lived 7.3 years longer among the 34,000 Californian Adventists in the survey. This study, however, is not specific only to Loma Linda Adventists. Nevertheless, Loma Linda residents are a good sample of longevity and have created a longevity culture.

Butler et al. (2008) discovered that Adventists were vegetarians with a lower risk of cardiovascular disease. Adventists’ focus on their faith practices and are conservative in their eating and drinking habits. They slow down and rest on their Sabbath Day. Similar to the previously explored LBZ’s in Italy and Japan, there is limited information on the relationship between health and health care in the LBZ’s. Health treatment for centenarians does not seem to be a priority. A balanced diet and lifestyle take precedence. Loma Linda centenarians share many of the same lessons as centenarians in the Nicoya region of Costa Rica. The LBZ in Costa Rica offers another reason to get a daily dose of calcium.

Nicoya Region, Costa Rica

The Nicoya region, an isolated area of Cost Rica in Central America, has been found to have a large population of centenarians. Rosero-Bixby et al. (2013) found that Costa Rica has excellent health indicators despite limited economic development. According to United Nations (2012), Costa Rica has the second-highest life expectancy in North and South America. Furthermore, elderly Costa Ricans, particularly males, have been among the world's lowest mortality rates.

The Nicoya region borders the Pacific Ocean in northeastern Costa Rica. As of the 2011 Census, the Nicoya region had 161,000 people. Forty-seven percent of this population resides in three urban cities within the area: Nicoya, Santa Cruz, and Philadelphia. Eight percent of this population was 65 years or older, with 32 centenarians counted in the census (Rosero-Bixby et al., 2013).

Nicoya region in Costa Rica is identified as a LBZ (Buettner, 2012). This area had exceptional longevity and a significantly lower death rate compared to the rest of Costa Rica. Males in Cost Rica, 60 years of age, are seven times more likely than Japanese males the same age to become a centenarian (Rosero-Bixby et al. (, 2013). Furthermore, the Nicoya region’s water has Costa Rica's highest calcium content, giving them strong bones and lower heart disease rates. The Nicoya diet of fortified maize and beans yielded a longevity recipe. Next, we explore Ikaria, Greece, an LBZ found to have numerous prescriptions for longevity.

Interestingly, the region has excellent health care services. Rosero-Bixby et al. (2013) found that Nicoyans show a high utilization of preventative public health services. However, there is limited information on whether the Nicoyans use long-term care services.

Ikaria, Greece

Ikaria, Greece, is the last LBZ to explore with exceptional longevity. Due to absent birth records, there is no evidence of any centenarians on Ikaria. However, (Poulain et al., 2013) found that Ikaria had up to three times as many people over the age of 90 as the rest of Greece. This statistic established the island of Ikaria as an LBZ, a place where the world's healthiest, longest-lived people exist.

Ikaria, Greece, is an island approximately 30 miles off Turkey's western coast in the Aegean Sea. The total population of the island is about 8,000 people. The people of Ikaria follow the traditional Mediterranean diet of plant foods. They also experience mountain living, including low stress, daily naps, a physically active lifestyle, and a low amount of depression. (Panagiotakos et al., 2011).

The Ikarian Study evaluated various demographic and lifestyle characteristics of 187 people who were over the 80-year life expectancy of the Greek population (Panagiotakos et al., 2011). The Ikarian Study mentions that the researchers did not interview individuals living in assisted living centers, indicating an assisted living center existed on the island. Other than this information, there is no mention of any health care services available to the Ikarians. Again, isolation reappears as a reason for the aging population to practice preventative health habits and to rely on family and social networks to provide care late in life.

Conclusion

The LBZ’s may represent the keys to understanding how to live better and longer. As a result, further information can be gained by exploring various lifestyle and diet choices LBZ populations have made during their lives.

LBZ’s include Sardinia, Italy, Okinawa, Japan, Loma Linda, California, Nicoya region, Costa Rica, and Ikaria, Greece. The life journey of centenarians in each of the LBZ areas is similar and matches characteristics of diet, activity, family and social networks, faith-based living, and a sense of purpose. An additional observation of centenarians includes that they rely on the family and community for care in their later years of life. There is limited research on whether centenarians in the LBZ's use health care services, mainly long-term care institutional services and supports. An analysis to determine if LBZ centenarians truly do not utilize institutional long-term care supports. This analysis would advance our knowledge of how lifestyle habits and preventative health care create a healthier life span.

Based on the literature referred to in this exposé, centenarians seem to defy illness and prevent disease by living in the world's LBZ areas.

---

References

Buettner, D., & Skemp, S. (2016). Blue zones: lessons from the world's longest-lived. American Journal of Lifestyle Medicine, 10(5), 318-321.

Buettner, D. (2012). The Blue Zones, Second Edition: 9 Lessons for Living Longer From the People Who’ve Lived the Longest (2 edition). National Geographic.

Butler, T. L., Fraser, G. E., Beeson, W. L., Knutsen, S. F., Herring, R. P., Chan, J., … Jaceldo-Siegl, K. (2008). Cohort Profile: The Adventist Health Study-2 (AHS-2). International Journal of Epidemiology, 37(2), 260–265. https://doi.org/10.1093/ije/dym165

Harman, D. (1998). Aging: phenomena and theories. Annals of the New York Academy of Sciences, 854(1), 1-7.

Panagiotakos, D. B., Chrysohoou, C., Siasos, G., Zisimos, K., Skoumas, J., Pitsavos, C., & Stefanadis, C. (2011). Sociodemographic and lifestyle statistics of oldest-old people (>80 years) living in Ikaria Island: The Ikaria Study [Research article]. https://doi.org/10.4061/2011/679187

Pes, G. M., Tolu, F., Dore, M. P., Sechi, G. P., Errigo, A., Canelada, A., & Poulain, M. (2014). Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors. European Journal of Clinical Nutrition, 69(4), https://doi.org/10.1038/ejcn.2014.230

Pew Research (2016). World’s centenarian population projected to grow eightfold by 2050. Retrieved from: http://www.pewresearch.org/fact-tank/2016/04/21/worlds-centenarian-population-projected-to-grow-eightfold-by-2050/

Poulain, M., Herm, A., & Pes, G. (2013). The Blue Zones: Areas of exceptional longevity around the world. Vienna Yearbook of Population Research, 11, 87–108. DOI or URL?

Poulain, M., Pes, G. M., Grasland, C., Carru, C., Ferrucci, L., Baggio, G., … Deiana, L. (2004). Identification of a geographic area characterized by extreme longevity in the Sardinia island: The AKEA study. Experimental Gerontology, 39(9), 1423–1429. https://doi.org/10.1016/j.exger.2004.06.016

Rosero-Bixby, L., Dow, W. H., & Rehkopf, D. H. (2013). The Nicoya region of Costa Rica: A high longevity island for elderly males. Vienna Yearbook of Population Research / Vienna Institute of Demography, Austrian Academy of Sciences, 11, 109–136. DOI or URL?

United Nations, Department of Economic and Social Affairs (2015). “World Population Prospects: 2015 Revision.” Retrieved from: http://www.un.org/en/development/desa/population/