Longevity

What the longest-lived regions have in common

Five regions have carried the label Blue Zones since 2004: the mountains of central Sardinia, the Japanese islands of Okinawa, the Nicoya peninsula of Costa Rica, the Greek island of Ikaria and the Adventist community of Loma Linda in California. According to the team that named them, people there reach 100 at about 10 times the rate seen in the United States, and 9 habits recur in all five: daily unplanned movement, a plant-heavy diet with meat about 5 times a month, stopping at 80% full, a sense of purpose, routines that shed stress, and close family, faith and friendship ties. The best-documented advantage is modest, a death rate 20% lower among Nicoyan men over 21 years, and a 2018 analysis of 123,219 US adults puts the habits themselves at 12 to 14 extra years at age 50 wherever you live.

How five places became the Blue Zones

The story starts with paperwork rather than diet. In 2004 a team led by the demographer Michel Poulain and the physician Gianni Pes published a study of Sardinian centenarians in Experimental Gerontology. They took everyone born on the island between 1880 and 1900, checked the municipal records, and calculated the share who had reached 100. Smoothed on a map, the results showed a cluster in the mountainous centre and east of the island. The striking feature was the number of men: in the cluster there were 1.35 female centenarians for every male, against 2.43 in the rest of Sardinia. The authors called it the Blue Zone.

That same year the writer Dan Buettner, working with National Geographic and the US National Institute on Aging, used census data, birth certificates and local records to find comparable places and settled on the 5 named above. In their 2016 summary in the American Journal of Lifestyle Medicine, Buettner and Sam Skemp write that people in these regions reach 100 at 10 times the rate seen in the United States, and distil the field teams' findings into 9 habits, the Power 9.

What the demographic data show for each region

The evidence differs a great deal between the 5 regions; Nicoya is the best measured. Luis Rosero-Bixby and colleagues followed 16,300 Costa Ricans aged 60 and over between 1990 and 2011, using birth dates from a civil registry in place since 1883 rather than self-reported ages. Men from Nicoya had a death rate ratio of 0.80 compared with the rest of the country (95% confidence interval 0.69 to 0.93), driven by a cardiovascular death rate 35% lower. A 60-year-old Nicoyan man could expect to live 2.2 years longer than a Japanese man of the same age and had 7 times the chance of reaching 100. Two details matter: the advantage did not exist in women, and it disappeared in men who moved away, which points to the place rather than to genes.

For the other regions the figures are mostly the Blue Zones authors' own. They report that Ikarians live 8 years longer than Americans with half the rate of heart disease, 20% less cancer and almost no dementia, that Loma Linda Adventists outlive the average American by about a decade, and that Okinawa has the longest-lived women in the world. The Sardinian validation stands, though its authors noted that most longevity hot spots claimed around the world had never been fully validated, and that the surplus of very old men might reflect centuries of marriage within isolated villages as much as habits.

The 9 habits the regions share

Buettner and Skemp group the common ground into 9 habits. Movement is built into the day rather than scheduled: Sardinian shepherds walk 5 miles (about 8 km) of hills a day or more, and households in all 5 regions garden and do housework without machines. Food leans towards plants. Beans and lentils sit at the centre of most centenarian diets; meat is eaten on average only 5 times a month, in portions of 3 to 4 oz (85 to 113 g). Okinawans say hara hachi bu before meals, a 2,500-year-old Confucian reminder to stop at 80% full, and people across the regions eat their smallest meal in the late afternoon or early evening and nothing after it.

The remaining habits concern mind and company. The Okinawan ikigai and the Nicoyan plan de vida both mean roughly why I get up in the morning, and the authors put a sense of purpose at up to 7 years of extra life expectancy. Everyone has a routine to shed stress: Ikarians nap, Adventists keep a 24-hour Sabbath. All but 5 of the 263 centenarians the team interviewed belonged to a faith community. Families keep ageing parents close and commit to a partner, which the authors put at up to 3 years. And people live in small, lifelong groups: Okinawan moais are circles of 5 friends formed in childhood, and one group the team met had been together for 97 years with an average age of 102. The 7 years for purpose and the 3 for partnership are estimates drawn from other research, not measurements taken in the Blue Zones.

Do the habits work outside the Blue Zones

You do not need a Greek island to test the habits; large cohorts elsewhere have measured them. In 2018 Yanping Li and colleagues, writing in Circulation, combined 78,865 women from the Nurses' Health Study (1980 to 2014) and 44,354 men from the Health Professionals Follow-up Study (1986 to 2014), with 42,167 deaths recorded. They scored 5 low-risk factors, 4 of which mirror the Blue Zones: never smoking, a body mass index between 18.5 and 24.9, at least 30 minutes a day of moderate to vigorous activity, and a diet in the top 40% on a quality index. Adults who met all 5 had a 74% lower risk of death than those who met none (hazard ratio 0.26, 95% CI 0.22 to 0.31), 65% lower for cancer and 82% lower for cardiovascular disease. Projected onto the US population, life expectancy at 50 rose from 29.0 to 43.1 years for women and from 25.5 to 37.6 years for men.

The Blue Zones authors' own answer is that willpower is the wrong tool: they cite figures that more than 90% of people abandon a diet within 7 months and spend about 90% of their lives within 5 miles of home. Their pilot in Albert Lea, Minnesota, a town of 9,000, rebuilt that radius with a lakeside walking path and 3 plant-based dishes on every menu, and after about a year and a half reported a 3.2-year rise in calculated life expectancy, a project's own figure without a control town. Our guides on how many steps a day the studies support and social connection and health cover two of the habits, and the Mediterranean diet guide covers the Ikarian and Sardinian plate.

What the evidence cannot tell you

Three cautions. First, all of it is observational, so association is not cause: people who eat beans and walk hills also tend to be poorer, more religious and more rooted. Second, the ages. A preprint by the demographer Saul Newman, first posted in 2019 and revised in 2024, found that the introduction of birth certificates in US states was followed by a 69 to 82% fall in records of people aged 110 or over, that only 18% of exhaustively validated supercentenarians worldwide have a birth certificate (0% in the USA), and that their recorded birthdays cluster on days divisible by 5, a signature of guesswork. In Italy, England and France, remarkable ages were predicted by poverty, and Sardinia, Okinawa and Ikaria all sat below their national averages on income, literacy and life expectancy. The paper is not peer reviewed and does not touch the Nicoya cohort, but it is a reason to trust the measured habits more than the centenarian counts. Third, interest: the 2016 summary was written by the chief executive of a company that sells the Blue Zones programme to cities.

Some safety notes. If you take insulin or another glucose-lowering medicine, talk to your doctor before eating less or dropping evening food, because the 80% rule and an early last meal can bring on low blood sugar. If you have heart disease or have been inactive, build up towards 8 km of hills over weeks, not days. Eating less is not appropriate in pregnancy, under 18, or with a history of an eating disorder, and if you have kidney disease ask about protein sources before switching to a bean-heavy plate. The Longevity Habits Score shows how many of the 9 you already have.

Blue Zone habits you can copy this month

Frequently asked

Are the Blue Zones real?

Sardinia's cluster was validated from municipal records for people born between 1880 and 1900, and Nicoya's advantage was measured in 16,300 older Costa Ricans with registered birth dates. For Ikaria, Okinawa and Loma Linda the headline figures come from the Blue Zones team, and a preprint revised in 2024 argues that poor age records inflate centenarian counts in several regions.

Which Blue Zone has the strongest evidence?

Nicoya. Men there had a death rate ratio of 0.80 over 21 years of follow-up, a cardiovascular death rate 35% lower and 2.2 years more life expectancy at 60 than Japanese men, though the advantage did not appear in women.

Is long life mostly genes or lifestyle?

The Blue Zones authors quote a Danish twin estimate of about 20% genes and 80% lifestyle. That is a population average; the researchers who found the Sardinian cluster suggested genetic isolation in mountain villages as one explanation for its unusual number of male centenarians.

Do I need to move to one of these regions?

No. In 123,219 US adults, meeting 5 low-risk habits, including never smoking, 30 minutes of daily activity, a healthy weight and a high-quality diet, went with 14.0 extra years at age 50 for women and 12.2 for men compared with meeting none.

What is the 80% rule and is it safe?

Hara hachi bu is the Okinawan habit of stopping a meal when you feel about 80% full, combined with a small early evening meal and nothing after it. It is safe for most healthy adults, but if you take insulin or other glucose-lowering drugs, are pregnant, under 18 or have had an eating disorder, do not restrict food without medical advice.

How much meat do people in the Blue Zones eat?

According to the Blue Zones authors, meat appears on average about 5 times a month in portions of 3 to 4 oz (85 to 113 g), with beans as the staple protein. Nicoya is the exception in the cohort data, with a plain diet of rice, beans and animal protein that is nonetheless low in glycaemic index and high in fibre.

Sources

• Buettner and Skemp 2016, American Journal of Lifestyle Medicine: Blue Zones, lessons from the world's longest lived · The five regions; 10 times the US rate of reaching 100; Power 9 with meat 5 times a month in 3 to 4 oz portions, 80% rule, purpose up to 7 years, partner up to 3 years, 258 of 263 centenarians in a faith community, moai of 5 friends, one group together 97 years with average age 102; Sardinian shepherds 5 miles a day; Ikaria 8 years, half the heart disease, 20% less cancer; Loma Linda a decade; Albert Lea 9,000 people, 3.2 years, costs down 40%; 90% abandon diets in 7 months, gym attendance down 70% in 2 years, 90% of life within 5 miles; Danish twin 20/80 figure. First author is chief executive of Blue Zones LLC
• Poulain et al. 2004, Experimental Gerontology: Identification of a geographic area characterized by extreme longevity in the Sardinia island, the AKEA study · Extreme longevity index for people born 1880 to 1900; Blue Zone in the mountainous centre and east; 1.35 female centenarians per male in the zone versus 2.43 elsewhere; authors note most claimed longevity hot spots are not fully validated and raise a genetic isolation hypothesis. Abstract open via the DOI link
• Rosero-Bixby, Dow and Rehkopf 2013, Vienna Yearbook of Population Research: The Nicoya region of Costa Rica, a high longevity island for elderly males · 16,300 elderly Costa Ricans followed 1990 to 2011; male death rate ratio 0.80 (0.69 to 0.93); cardiovascular 0.65; 7 times the probability of reaching 100 and 2.2 years more life expectancy at 60 than Japanese men; no advantage in women, lost in out-migrants; leaner, taller, fewer disabilities, longer telomeres; civil registration since 1883; diet of rice, beans, animal protein
• Li et al. 2018, Circulation: Impact of healthy lifestyle factors on life expectancies in the US population · 78,865 women (Nurses' Health Study 1980 to 2014) and 44,354 men (Health Professionals Follow-up Study 1986 to 2014), 42,167 deaths; five low-risk factors; hazard ratios 0.26 all-cause, 0.35 cancer, 0.18 cardiovascular for 5 versus 0 factors; life expectancy at 50 of 29.0 versus 43.1 years for women and 25.5 versus 37.6 for men. One of the five factors concerns drinking and is left out here
• Newman, bioRxiv preprint (posted 2019, revised 2024), listed at Europe PMC: Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors and pension fraud · Introduction of birth certificates in US states associated with a 69 to 82% fall in supercentenarian records; 18% of exhaustively validated supercentenarians have a birth certificate, 0% in the USA; birthdates cluster on days divisible by five; poverty predicts remarkable age in Italy, England and France; Sardinia, Okinawa and Ikaria below national averages on income, literacy and life expectancy. Not peer reviewed; bioRxiv itself rate-limits automated requests, hence the Europe PMC record

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This guide is for general information. It does not replace medical advice or an examination.