What Are Blue Zones and Could They Help You Live to 100?
Over the past two decades, the Blue Zone Project has morphed from health guidance into a for-profit branded juggernaut owned by the largest U.S. digital health business
Are there really secrets to living to 100 in good health, and do people need to live in specific communities to accomplish this goal? In the early 2000s, the Blue Zone Project tried to answer these questions by studying and reporting on five world regions with higher-than-average numbers of healthy centenarians.
Blue Zones emerged into public consciousness as interesting tourist destinations and cookbooks with healthy recipes, but today, they’ve become a heavily-branded for-profit business owned by the largest digital health corporation in the United States.
The Blue Zone concept began two decades ago as a research project sponsored by the National Geographic Society and AARP.Blue Zone researchhas inspired a series of NYT bestselling cookbooks and the health-influencer career of their author, Dan Buettner.
Although I didn’t know it at the time, I grew up living near one of the original five Blue Zones.Coincidentally, I also learned that I live in a newly-certified Blue Zone Community in Southwest Florida.
So, what is a Blue Zone?
Blue Zones, as originally conceived, are five world regions with a higher-than-expected concentration of healthy people in their 90s and older.The project reports that people in Blue Zones tend to live longer in better health in general, even if the majority do not reach age 100. However, the Blue Zone Project’s claims have not convinced skeptics.
The original Blue Zones were:
Ikaria, Greece
Loma Linda, CA
Sardinia, Italy
Okinawa, Japan
Nicoya, Costa Rica
The Blue Zone Project identified nine diverse health and longevity-promoting factors found among Blue Zone centenarians. The good news is that most of these factors are under our own control and aren’t exclusively found in any geographic area.
What are the Power 9 health & longevity factors?
The original Blue Zone research in the early 2000s enabled Blue Zone creator and U.S.-based champion Dan Buettner to create a coherent marketing and branding structure.
Blue Zone branding started with what Buettner calls the Power 9 — nine life principles or factors identified as common elements among most, not all, Blue Zone longevity hotspots.
Four of the recommended factors involve diet, nutrition, and activity levels:
Move naturally: walking and daily activity through life
80% rule: eating until 80%, not 100% full
Plant slant: eating meat only 3 to 4 times a month
Wine at 5: drinking alcohol in moderate levels
The other five Power 9 factors involve social and behavioral wellness:
Purpose: having a sense of purpose
Downshift: taking regular time to relax every day
Belong: belonging to a faith-based community
Loved ones first: living near family, investing consistently in children and long-term relationships
Right tribe: forming and staying close to healthy social circles
The original U.S. Blue Zone
With all the bad news about U.S. health metrics, I was particularly curious aboutthe original U.S. Blue Zone, Loma Linda, California. It’s a small town in Southern California with about 25,000 residents. Since I grew up near this community and had friends and neighbors who belonged to the Seventh-Day Adventist church, I noticed both similarities and differences between the way Seventh-Day Adventists typically live and the Blue Zone Power 9 longevity factors.
Seventh-Day Adventists do have strong faith and family communities, but the majority of Adventists don’t drink alcohol at all. Many eat an exclusively plant-based diet.
To date, no studies have drilled down into the longevity and health impacts of specific versions of recommended Adventist diets— with or without processed food or meat.
Are Blue Zones real or a marketing phenomenon?
Taken one a time, it’s hard to argue with the health benefits that the Power 9 factors can produce. It’s common knowledge among nutritionists that a Mediterranean or well-balanced vegetarian or vegan diet contributes to health, as one example.
In 2000, Blue Zone founder Dan Buettner introduced Blue Zones to the public. He said, “People were reaching age 100 at a rate 10 times greater than in the United States, and with lower rates of chronic disease.” People in the United States have high rates of chronic disease as they age, but U.S. centenarians have been steadily increasing since 1950 at a rate about a third that of Japan or other Blue Zone regions, not 10%.
Yet Blue Zone statistics were already being questioned in 2004 when Japanese health authorities reported that Okinawa, which had been №1 in longevity measures for years, had declined to 26th place in longevity out of the nation’s 47 prefectures.
Evolution of the Blue Zones
Over time, Blue Zones evolved, changing ownership and emphasis. Adventist Health, the nonprofit healthcare network which is based in the Southern California Seventh-Day Adventist community, became affiliated with the project and still has some involvement. Buettner, the project founder and primary advocate, began to focus more on traveling and writing cookbooks.
In 2009, the project introduced the opportunity for U.S. communities to “certify” and become Blue Zone Communities. According to the Blue Zone Project, when communities become certified, the Project “uplevels the approach to taking on the downstream issues cities face such as homelessness, obesity, diabetes and healthcare.” If this sounds vague, it is. Each community decides its Blue Zone health priorities and actions.
Brevard, North Carolina, is one of 51 certified Blue Zone Communities (as of 2023). Most local health authorities and businesses support Brevard’s Blue Zone Project, but its concrete, measurable outcomes have proven difficult to identify. According to a February 2023 report in the Transylvania Times, resident reports of thriving in daily life “rose 14.1% to 73.6%.” “Self-reporting” is common throughout certified Blue Zone communities.
Brevard became a Blue Zone Community in 2019 after its local nonprofit hospital was purchased by HCA, Hospital Corporation of America. As part of the sale, HCA provided $5 million to the Transylvania Regional Hospital Foundation. Of these funds, $3 million have been used to pay three staff members and establish the Brevard Blue Zone Project. The staff members have attracted $3.8 million in grant funding to pay for local trails and community gardens.
The Blue Zone onboarding experience
As a former nonprofit development officer, I quickly realized that the Brevard Blue Zone would find it difficult, and likely impossible to connect staff salaries and grant funding with a health outcome of more local residents reaching age 100 in good health, if only because it would take years to document longevity impacts.Trails, gardens, and staff members are great, but they’re also not the same as the Blue Zone Power 9 factors.
However, I’d discovered that I live in another recently-certified Blue Zone in Southwest Florida, centered on Naples, a wealthy Gulf Coast retirement community.
As a Florida Blue member, I discovered I was eligible to take a “Real Age” onboarding test to become part of the local Blue Zone Project. From the pulldown menu, I could see that the test was open to local residents who worked for major employers, government organizations, the local sports arena, supermarkets, large resorts, and Florida Blue members.
The 10-minute test covered my height, weight, activity levels, diet, and personal habits. However, after completing a few segments, I recognized the questions as the same ones I already answer every six months for my existing Florida Blue wellness program. This wellness program doesn’t really help me except for occasionally providing insurance premium rebates or discounts.
The Blue Zone organization also offers the True Vitality Test, a more complex survey that adds and subtracts days to your life expectancy using actuarial questions. Both tests are similar to the ones used by many insurance company-designed wellness initiatives.
The end of the questionnaire
When I completed my Real Age Blue Zone questionnaire, it said that my biological age was 57 (I’m 61).
I was slightly disappointed in this result, as my activity levels, health metrics, and diet are all in the top 5% for my age, and the fitness tracker I’ve used for almost five years says that my biological age is 37.
Then the questionnaire directed me to a screen where it said I should visit my doctor…
… and ask for blood pressure medication.
My blood pressure is normal.
Then the screen advanced, “recommending” a colonoscopy and a mammogram.
Strangely, I found that my Real Age test results did not highlight or recommend any of the Power 9 factors, and it didn’t ask questions pertaining to two or three of them either. I follow most, but not all of the nine recommendations, so there were a couple of opportunities there.
I then took the True Vitality Test created by the Blue Zone organization. It told me that my potential life expectancy was 97.7 years, about a month less than my total life expectancy of 97.8 years. Your guess as to how this result came out is as good as mine; my grandmother did live to be about 97.7 years old, her sister to age 99, and her mother, to age 98: but the True Vitality Test didn’t know that.
Sales and marketing vs. you and your health
Blue Zone founder Dan Buettner told Forbes, “there are evidence-based ways to shape your social life, the way you set up your home, your work life, and your neighborhood surroundings that we know over time will yield high life expectancy and higher life satisfaction. And because these aren’t marketed to us, they’re not top of mind.”
There’s no lack of marketing in the Blue Zone organization and the myriad sales and email funnels found on the Blue Zone website. Only a few days after taking the two tests, I have received multiple sales emails from the Blue Zone organization.
The Blue Zone Project was formerly affiliated with AARP or National Geographic and in its early incarnation, had a nonprofit component. It is now exclusively for-profit and is owned by Sharecare, a 3,200-employee Fortune 500 business, which bought the Blue Zone Project from Adventist Health and Buettner in 2020.
I also learned why the Blue Zone Real Age test I took seemed familiar: Sharecare also owns Real Age. The Real Age test was authored by Dr. Mehmet Oz and the Cleveland Clinic’s Dr. Mike Roizen. In 2009, the New York Times reported that the Real Age test served as a sales funnel for prescription drugs, which explains why the Blue Zone Real Age test I took advised me to visit my medical provider and ask for blood pressure medication.
Dr. Oz is one of the two co-founders of Sharecare along with serial digital health entrepreneur and founder of WebMD, Jeff Arnold.Dr. Oz left the company in 2021 to run for the U.S. Senate. Sharecare took its “tech unicorn”($1 billion valuation) company public in 2021. With a market cap of over $600 million, considerably less than its pre-IPO valuation of $1.2 billion, Sharecare earns money from “ad sponsorships and content delivery.” Its primary customers are pharmaceutical and insurance companies.
What did I get out of the Blue Zone Project questionnaires? Advice to take unnecessary blood pressure medication and a new crop of medication, book, and video marketing emails.
Blue Zones deliver value: to investors and influencers
The valuable Blue Zone name is being used by South Florida developers who are proposing a massive 220,000-square-foot Blue Zone Center in Miami, which is also where Blue Zone founder Dan Buettner lives. The Center is envisioned as condominiums, a hotel, and a nine-component medical complex. However, it doesn’t yet exist.
Fitfluencers, longevity experts, and health podcasters including Dr. Andrew Huberman and Dr. Peter Attia frequently invoke the Blue Zones as proof the ideas they peddle are sound. However, hard data about the benefits of later evolutions of the project, like Blue Zone Communities, doesn’t exist. Life expectancy has been declining steadily in one of the original Blue Zones: Okinawa.
Recommended Blue Zone health habits and longevity factors are well-supported by decades of research into diet, activity levels, and social and behavioral influences on health.
Over 50 U.S. communities have been certified as Blue Zones, but all I got from enrolling in my local project was the opportunity to fill out a questionnaire that turned out to be co-authored by a doctor who Scientific American called a “celebrity pseudoscientist.”
The Blue Zone organization and its proponents don’t seem to have an answer for another well-documented contributor to longevity in good health: wealth. In 2020, researchers from University College London published a study in the Journals of Gerontology Series A which found that in the United States and United Kingdom, wealthy people will live eight to nine years more disability-free life after age 50 than poorer adults.
Some have suggested that Blue Zones are mythical regions similar to Shangri-La. Others have extensively analyzed Blue Zone dietary recommendations and found that while some recommendations are well-supported, others are contradictory: for example, Okinawans eat more than one can of Spam a week.
Like many other health movements of the past 50 years, Blue Zones promise the secrets to a long and healthy life but deliver little else beyond health questionnaires, millions of dollars for celebrities like Dr. Oz, and data-rich marketing channels for prescription drug makers.
reprinted from Wise & Well on Medium.