When Juan Ponce de León landed on the northeast coast of Florida on April 2, 1513, he was searching, it's been said, for a Fountain of Youth — a fabled spring of water that could bestow everlasting life. Historians now know there was more to the story. The reason the Spanish explorer set out to investigate lands north of the Bahamas was probably because Spain had reinstated Christopher Columbus's son Diego as military governor, effectively removing Ponce de León from the office. Nevertheless, the legend behind Ponce de León's voyage stuck.
The idea of discovering a magic source of long life still has so much appeal today, five centuries later, that charlatans and fools perpetuate the same boneheaded quest, whether it comes disguised as a pill, diet, or medical procedure. In an all-out effort to squash the charlatans forever, demographer S. Jay Olshansky of the University of Illinois at Chicago and more than 50 of the world's top longevity experts issued a position statement in 2002 that was as blunt as they could fashion it.
"Our language on this matter must be unambiguous," they wrote. "There are no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones, or techniques of genetic engineering available today that have been demonstrated to influence the processes of aging."
The brutal reality about aging is that it has only an accelerator pedal. We have yet to discover whether a brake exists for people. The name of the game is to keep from pushing the accelerator pedal so hard that we speed up the aging process. The average American, however, by living a fast and furious lifestyle, pushes that accelerator too hard and too much.
This book is about discovering the world's best practices in health and longevity and putting them to work in our lives. Most of us have more control over how long we live than we think. In fact, experts say that if we adopted the right lifestyle, we could add at least ten good years and suffer a fraction of the diseases that kill us prematurely. This could mean an extra quality decade of life!
To identify the secrets of longevity, our team of demographers, medical scientists, and journalists went straight to the best sources. We traveled to the Blue Zones — four of the healthiest corners of the globe — where a remarkably high rate of the longest-living people manage to avoid many of the diseases that kill Americans. These are the places where people enjoy up to a 3 times better chance of reaching 100 than we do.
In each of the Blue Zones, we used a survey developed in collaboration with the National Institute on Aging to identify the lifestyle components that help explain the area's longevity — what the inhabitants choose to eat, how much physical activity they get, how they socialize, what traditional medicines they use, and so forth. We looked for the common denominators — the practices found in all four populations — and came up with what I consider to be a cross-cultural distillation of the best practices of health, a de facto formula for longevity.
Herein lies the premise of The Blue Zones: If you can optimize your lifestyle, you may gain back an extra decade of good life you'd otherwise miss. What's the best way to optimize your lifestyle? Emulate the practices we found in each one of the Blue Zones.
Facts ABOUT Aging
When taken together, the Blue Zones yielded nine powerful lessons to achieve a longer, better life. But before we get into the details, I think it's crucial to understand a few things about just how people age and establish some basic principles and definitions. How long can each of us expect to live? What really happens to our bodies when we age?
Why can't we just take a pill to extend our lives? How can we live longer? How can we live better? And why does changing our lifestyles add more good years?
To answer these and other fundamental questions, I've asked some of the world's experts to describe their latest research in everyday terms. Together these scientists represent the best thinking in biology, geriatrics, and the science of longevity.
Steven N. Austad, Ph.D., studies the cellular and molecular mechanisms of aging at the University of Texas Health Center at San Antonio. A professor at the Sam and Ann Barshop Center for Longevity and Aging, he is the author of Why We Age: What Science is Discovering About the Body's Journey Through Life.
Robert N. Butler, M.D., is President and CEO of the International Longevity Center-U.S.A., a policy and education research center in New York City. A professor of geriatrics and adult development at Mount Sinai Medical Center, he is the author of Why Survive: Being Old in America.
Jack M. Guralnik, M.D., Ph.D., is chief of the laboratory of epidemiology, demography, and biometery at the National Institute on Aging in Bethesda, Maryland.
Robert Kane, M.D., is director of the Center on Aging and the Minnesota Geriatric Education Center at the University of Minnesota in Minneapolis. He is a professor in the School of Public Health, where he holds an endowed chair in Long-term Care and Aging.
Thomas T. Perls, M.D., M.P.H., is director of the New England Centenarian Study, an associate professor of medicine and geriatrics at the Boston University School of Medicine, and author of Living to 100: Lessons in Living to Your Maximum Potential at Any Age.
I interviewed each of these experts separately, then sorted the best of their answers to each question. Here's what they told me.
What exactly is aging?
Robert Kane: That is a very profound question. Number one, aging starts at birth. If you think about it, there is a constant development that occurs within all species. You can think of it as the balance between the individual and the environment. In essence, we can think of aging as a loss of coping mechanism, a failure to be able to maintain internal control and balance.
We start out as children, and we gradually accrue various changes in our characteristics. Children are susceptible to the environment and must be protected. In the case of humans, we probably peak in our mid-20s. We hold our own for a while, then at some point, perhaps in our mid-40s, we start to decline. Some people would say we actually begin to decline at age 30. It depends on the system that you track.
Old age is another period when the balance favors the environment; older people need help in protecting themselves. The frailty we associate with old age is basically the loss of autonomy, the inability to withstand external pressures and perturbations.
Aging includes both the positive and negative changes that occur. A gerontologist would define aging as the risk of dying. Irrespective of the presence of disease, there is, given this finiteness of a life span, a continuous risk of dying. In most cases this increases as our age increases. Other factors can change your risk of dying as well as aging, so it's not that aging alone is the determiner, but it is the overarching change. People have been searching for biological markers of aging, and so far nobody has found any that are absolutely constant and separate from the onset of diseases.
People look at, for example, the loss of accommodation in the lens of the eye. Most people become farsighted, usually in their early 40s. It doesn't happen to everyone, so you can't say it's a universal sign of aging. Graying of hair, loss of collagen in the skin, all of these are changes that have been described with regard to aging. There's a change in body composition as people get older. It can obviously be influenced by exercise and diet, but in general, we lose muscle mass and gain body fat. The immune system changes with age and becomes less competent, but again, not in any universal way that we can say is a characteristic of aging.
Steven Austad: I would define aging as the gradual loss of physical capabilities, whether you're talking about the ability to run, to think, all those things. It's a gradual and progressive loss of physical and mental abilities, the ability to do things that you previously could do. What it means is that basically, you're not designed to maintain your physical integrity forever.
Robert Kane: There are several theories about aging. One is that there are genes in your system that turn on and turn off, either to ameliorate or to expedite aging. Another theory is the "Garbage-Dump Syndrome," which theorizes that you accumulate toxins as you go along and things happen.
But again, the question you have to ask is why does the body accumulate toxins? Well, you probably accumulate toxins because some of the intracellular mechanisms that were working at one point have stopped working. So are the toxins really a sign of aging or merely a concomitant of some other biological process that has changed, presumably driven by some genetic clock that exists inside the body? We honestly just don't know.
What is the average American lifespan?
Robert Kane: I would imagine that a 30-year-old person today has a reasonable chance of living — depending on whether a man or a woman — to his or her late 70s or early 80s. If you took away major risk factors such as heart disease, cancer, and stroke, you would be adding, I would guess, maybe 5 to 10 years to that initial life expectancy.
Tom Perls: For most of us, our bodies are like cars built to go 100,000 miles. A few cars can go 150,000 or more miles with the right genetic makeup. But they do deteriorate over time, even with the best upkeep. With that deterioration comes frailty. When you hit a bump in the road, you are less capable of bouncing back. There comes a point, with continued decline, where there's no bounce back, and that's when you pass away.
What are the chances of living to 100?
Jack Guralnik: Well, they are small of course, probably less than one percent. Again, figuring it out depends on what age you currently are. If you're talking about someone at birth, it's a different estimation than for someone who's already made it to 80. Also, if you want to consider health status, that plays a large role. Most people who make it to be centenarians when you look back, they were quite healthy at 80.
Tom Perls: I used to equate living to 100 to picking all five numbers in the lottery: The odds are pretty small. If you have longevity running in your family paired with good health behaviors, your chances are greater.
Centenarians today are the fastest growing segment of our population, partly because we're doing a better job of screening for high blood pressure. That's one important lottery ball that we don't need to leave to chance. Now instead of five numbers, it's down to four.
Another one that we've pretty much gotten rid of is substantial childhood mortality. With much better public health measures like cleaner water supplies, more years of education, improved social-economic status, these things are all reducing the number of lottery balls.
The best way to think about reaching 100 is: "The older you get, the healthier you've been."
Steven Austad: The question is — and here's where I think the best health practices are really important — if you live to be 100 years old, what sort of 100-year-old are you going to be? Are you going to be bedridden and unable to take care of yourself? Or are you going to be reasonably independent and alert? To me, that's what the best health practices can really have an impact on.
Is there a pill that can extend Life?
Robert Kane: There are a lot of nostrums out there. None of them has credibility. None of them has been even close to rigorously tested, everything from to human growth hormone to antioxidants. Every time anyone has studied them with any degree of rigor, they do not pan out. That does not mean that some new discovery may not be just over the horizon, but at the moment that is probably not the path.
Just think about it: If antioxidants were so healthful, the whole generation that grew up eating Twinkies, Wonder Bread, and the like (the kinds of foods that are loaded with antioxidants to assure that they had a long shelf life and would never spoil) should never grow old.
Robert Butler: DHEA, human growth hormone, and melatonin are all extremely questionable, and are probably ill advised.
Using human growth hormone in human beings bulks them up. But it does not just mean more muscle mass. With it can come hypertrophy of the heart, fluid retention, and other problems. And of course there's a disease, acromegaly, which is actually characterized by an excess of human growth hormone. DHEA is what's for years been called the "junk hormone." In large quantities in our bodies, it converts to both testosterone and estrogen. Most of the studies on almost all of these hormones have been very short-lived, that is six months to a year. So the long-term effects are not well known.
The best source of information on hormones is Marc Blackman at the Washington, D.C., Veterans Affairs Medical Center, or Mitchell Harman at the Kronos Longevity Research Institute in Phoenix, Arizona. They've done the most sophisticated studies and probably the best ones we presently have on the hormone story.
Are vitamin supplements helpful?
Robert Butler: Of course you should maintain your basic daily vitamin requirements. But you shouldn't get carried away either. Vitamin E was under study by the National Institute on Aging in the hopes that it would prove to be very valuable with Alzheimer's disease. But it was not. So I think, like so many things in nature, it's a matter of amount, what might be called proportionality, or just plain wisdom. People used to think if a multivitamin was good for them, then more of it would be even better, but that's just not true, unfortunately.
Most vitamin requirements are best achieved by eating six to nine servings of fruits and vegetables a day. Very few people do that, so probably the cheapest, least expensive multivitamin you can buy is not a bad idea to help achieve them. If you're an older man, you should not have a supplement with iron because iron accumulates in the heart and can lead to a condition called hemosiderosis. Look on the market for vitamin supplements that do not have iron that are designed specifically for men.
What's a smart diet for longevity?
Robert Kane: Eating a reasonable diet makes a lot of sense. Again, it doesn't mean that I think you have to be a vegetarian. One of the goals to a healthy lifestyle is moderation in all things. What one is looking for is moderation, taking in a level of calories that is necessary and balancing those calories across carbohydrates, fats, and proteins. Taking in really what you need. There are some things we know that are just generally bad. Most fast foods are not necessarily healthy. We seem to like a lot of the things that are bad for us: salt, sugar, fat. There is something about humans that is inherently self-destructive, at least when it comes to eating.
The best diet is basically one of moderation. You hear about all these people that live on legumes and plant foods and that's probably okay, but I don't think it's necessary.
One certainly can metabolize a certain amount of meat, but again it's a question of are you eating European portions or American portions? Are you eating meat a couple of times a week, or are you eating it every day for two meals a day? Are you eating processed meats that are filled with fat? Or are you eating good cuts of fairly lean meat?
To me, I just come back to moderation. Assuming that you were in pretty good shape in your 20s, if you could maintain that weight, you would be in good shape. The truth is at 20, you could for all sorts of reasons, eat all sorts of terrible things and maintain that weight, because you were more physically active, because your system was just more resilient. As you get older, you lose that resilience. So you are more susceptible to lifestyle behaviors that can do you harm than you were when you were younger.
What can add on more good years?
Robert Kane: Rather than exercising for the sake of exercising, try to make changes to your lifestyle. Ride a bicycle instead of driving. Walk to the store instead of driving. Use the stairs instead of the elevator. Build that into your lifestyle. The chances are that you will sustain that behavior for a much longer time.
And the name of the game here is sustaining. These things that we try — usually after some cataclysmic event has occurred, and we now want to ward off what seems to be the more perceptible threat of dying — don't hold up over the long haul. We find all sorts of reasons not to do it.
The second thing I'd tell you is don't take up smoking. The biggest threat to improving our lifestyles has been cigarette smoking. That trumps everything else. Once you're a nonsmoker, I would try to get you to learn to develop a moderate lifestyle in regard to your weight to build into your daily routine enough exercise to keep you going.
Does going to the gym help?
Robert Kane: Exercise has several quite distinct functions. You have cardiovascular exercise, which we describe as aerobic exercise, which increases your body's capacity to process oxygen. That's where you go out and work really hard and raise your heart rate. Swimming would be a good way to get that kind of exercise.
There's also antigravity exercise. For example, if you're trying to prevent osteoporosis, swimming isn't the optimal activity, because it doesn't increase the strength of your bones. There, working against gravity, walking, standing does more to increase bone metabolism than swimming does.
Then there are exercises designed to improve your balance. Tai Chi is one people talk about, or yoga. Those are exercises that have been associated with reducing the risk of falls. Then there are strength exercises, which run all the way from weightlifters, who probably put themselves into a disadvantageous state from overdeveloping their muscles, to people who do some modest amount of weightlifting or antigravity exercise that strengthens their muscles.
The data suggest that a moderate level of sustained exercise is quite helpful. There are studies that show that people who run marathons tend to have much better cardiovascular systems than people who don't. You could say that that says more is better, but those exercises generally take a toll on your joints. So marathoners have good cardiovascular systems, but they will probably have to have their joints replaced. But in general, if somebody could do a minimum of 30 minutes — maybe we could raise it to 60 — of exercise at least five times a week that would help. And it doesn't appear to have to be all at one time, although that seems to be better. If you did that and you could sustain it, that would be good.
How can we maximize the good years?
Robert Kane: Again, there are two issues here. How long can I live? The other is: How well can I live? And those are different questions. Living an extra two years on life support may not necessarily be your goal. The question is: Can you delay the onset of disability? "Good years" is a very important concept.
There are some things I'd certainly recommend for what people would call successful aging. One of them is, in fact, to have a sense of social connectedness. Most people enjoy the company of other people, particularly other people who they feel care about them. That seems to give you a sense of well being, whether that raises your endorphin level or lowers your cortisol level. We don't know why. People have looked for biological markers, and they haven't been successful at finding them. But something happens that makes life more worthwhile. The days take on more meaning.
The other thing that helps a lot of people is doing something they feel is either interesting or worthwhile. Again, different people have different things they like to do. For instance, people talk about workaholics as being at higher risk for stress-related illness. But there is no evidence that workaholics are necessarily a higher risk if they really are enjoying what they're doing. If they are driven by some externality and feel like they have to earn more money, it creates stress in their lives, which is probably not very healthy. So it's very individual when it comes to what people want to do.
For example, you can't just say family support is good, because some family support is good for some people, and some isn't for others. There are people who derive great satisfaction from being with their families. And then there are those who become very anxious and upset when they are with their families. It is a complex model, which is also very interactive.
But if we're talking about things that give you a sense of fulfillment, a good life, the sense of being valued, the sense of being cared for, and the sense that you are liked — these are all very positive.
Tom Perls: A good start to adding more good years to your life would be to get rid of the anti-aging quackery. Some people provide this very pernicious, ugly view of old people that's completely false in order to get you worried about getting older. They say they can stop — and even reverse — aging, claims which are absolutely false. You've got a bunch of people who are professing to be physicians or scientists, who are saying that they can stop or reverse the aging process. I will tell you that real scientists cannot do such a thing, so what makes the public think that these people can?
It is mostly hucksterism and charlatanism. They will cost you a lot of money, and these things do not work and, in some instances, can be bad for you. So stay away from it. These guys are just trying to sell you stuff. What does work is living the lifestyle of those who we know are living longer, like those people, I suppose, living in the Blue Zones.
Into the Blue Zones
Which brings us back to the Blue Zones project. Over the course of seven years, my team circled the globe, making several trips to each of the four Blue Zones and meeting the remarkable people who lived there. In each place we confirmed that people were as old as they said they were, interviewed dozens of centenarians, worked with local medical experts, and methodically studied each of the local lifestyles, habits, and practices.
Each Blue Zone revealed its own recipe for longevity, but, as we were to discover, many of the fundamental ingredients were the same. These common ingredients, our nine lessons of living longer, are deeply embedded in the cultures we studied. I suppose you could say that our quest was for a true fountain of youth, though this fountain does not spring from the ground but comes to us through centuries of trial and error.
For us, it all began on a small island off the coast of Italy.
Reprinted with permission of the National Geographic Society from the book The Blue Zones: Lessons for Living Longer from the People Who've Lived the Longest by Dan Buettner. Copyright © 2008 Dan Buettner. Available where all books are sold.