Paper:
https://www.biorxiv.org/content/10.1101/704080v1
Abstract:
> The observation of individuals attaining remarkable ages, and their concentration into geographic sub-regions or ‘blue zones’, has generated considerable scientific interest. Proposed drivers of remarkable longevity include high vegetable intake, strong social connections, and genetic markers. Here, we reveal new predictors of remarkable longevity and ‘supercentenarian’ status. In the United States, supercentenarian status is predicted by the absence of vital registration. The state-specific introduction of birth certificates is associated with a 69-82% fall in the number of supercentenarian records. In Italy, which has more uniform vital registration, remarkable longevity is instead predicted by low per capita incomes and a short life expectancy. Finally, the designated ‘blue zones’ of Sardinia, Okinawa, and Ikaria corresponded to regions with low incomes, low literacy, high crime rate and short life expectancy relative to their national average. As such, relative poverty and short lifespan constitute unexpected predictors of centenarian and supercentenarian status, and support a primary role of fraud and error in generating remarkable human age records.
Nice work. It just won a 2024 Ig Nobel Prize. Well-deserved, I'd say:
So there's this short little book "Food rules" by Michael Pollan. Not much content but seems like the author went through a lot of research. He comes to conclusion based on this tons of data that all we really know for sure is that people living in these blue regions are living much longer and it seems to be related to what they eat. That it is basically the only solid and stable data point we have. Welp. (I'm overstating it a bit, but not by that much)
The one thing that this paper does is demolish the claim that people living in these blue regions are living much longer than average.
I think a lot of commenters either didn't read the abstract or assumed from its tone that it was supportive of the idea of blue zones.
What always seemed questionable to me about Blue Zones is how they account for unnatural causes of death. A decade ago centenarians would've had to live through two world wars and the devastation and famine they caused. How do you compare a population that went through that to a population that didn't?
This doesn't really address Loma Linda, California, the Adventist blue zone.
The researcher's criticism of Loma Linda isn't that people don't live longer there; it's that Adventist Health purchased Dan Buettner's marketing company Blue Zones LLC in 2020.
Adventists are teetotalers, so he questions why they'd want to be associated with the Blue Zones guideline of drinking "every day at twice the NHS heavy drinking guidelines."
Which is a fair question -- but it doesn't have anything to do with whether Loma Linda is an area with greater longevity.
From the paper: For example, the Centres for Disease Control generated an independent estimate of average longevity across the USA: they found that Loma Linda, a Blue Zone supposedly characterised by a ‘remarkable’ average lifespan 10 years above the national average, instead has an unremarkable average lifespan29 (27th-75th percentile; Fig S6).
This misses the forest for the trees.
The CDC looked at average life expectancy in Loma Linda across all demographics. Purely geographical and on average.
The blue zones focused on the greater longevity specifically of Adventists in Loma Linda.
It wasn't a question of whether living inside the municipal boundaries of Loma Linda automatically conferred some special health benefits -- clearly it doesn't.
It was, "Why is there an unusually high concentration of outliers living here, and what behaviors cause them to live longer than average?"
I don't get your point.
Who's claiming that living inside the boundaries of such zones would confer health benefits?
The paper is pointing out that if you actually look at the data there is nothing remarkable about the region's average lifespan (actually lower than the entire country of Japan), which is what's being discussed here.
> The paper is pointing out that if you actually look at the data there is nothing remarkable about the region's average lifespan
That's my point -- the region's average lifespan is irrelevant. It's only relevant given the misconception that Loma Linda itself has some special properties of rejuvenation.
Even if the average lifespan there were lower than normal -- say a large number of unhealthy people moved there -- it still wouldn't negate it being a longevity hotspot, if an abnormally high number of healthy centenarians also lived there.
> This misses the forest for the trees.
In a large enough forest, there's always one or two randomly weird trees.
So first it was Sardinia, Okinawa, Ikaria, Loma Linda. Then it's not even Loma Linda but specifically Loma Linda Adventists. That looks like XKCD-level p-hacking
Yeah, if the point is really about Adventists, I think it's better made with statistics on them. Ditto teetotalers or vegetarians (Adventists are often both). Or if it's about studying individuals with long lifespans, then great, let's do that.
> It was, "Why is there an unusually high concentration of outliers living here, and what behaviors cause them to live longer than average?"
Blue Zones LLC also provided a set of answers to that question, and one of those answers (“drinking 1-2 glasses of wine per day”) is clearly not true in this case.
And honestly, it’s just Bayesian statistics—if they present 5 data points, and 4 of those data points are floating somewhere between data errors and fraud, then odds are, that last data point is flawed somehow as well. Certainly they would need to do some extra work to prove that it isn’t.
This seems pretty explainable by Seventh Day Adventists' behavioral factors leading to increased life, a group with very little smoking and drinking living longer isn't surprising.
It does if you read it.
Loma Linda residents don't have a notable longer life span than the other residents of California.
The idea wasn't that averaging out the lifespan of all Loma Linda residents, regardless of lifestyle, would yield a higher number than everywhere else. It was that there was an unusually high number of outliers living there, and the question was why.
The CDC's average was purely geographic and irrespective of lifestyle, which is different.
I come from one of these blue zones on the southern coast of Europe. That low income low literacy people live longer, provided they have good genetics seems plausible to me. These people tend to lead a semi-agrarian life and remain active well into their 80s. Their more educated higher income counterparts will probably have spent their life being sedentary and their retirement in a coffee shop indulging themselves. If food plays a role, it's only insofar as them being less indulgent. Otherwise I believe the obsession on diet is only because it is one factor that is relatively easy for people to change. Genetics plays a huge role, because if your body betrays you early on, you won't be able to remain active and focused on life in your later years. Climate probably also plays a role because again, you need good climate to remain active all year round. So does family. Seeing your family everyday keeps you planted in life. Healthcare might also play a role. Our healthcare is much more caring than the one in the northern European states.
They should make a study focusing on northern European retirees who decide to live here on the coast. We have quite a few of those and I wonder whether they tend to live longer compared to their counterparts back home.
The allegation that its simply fraud is ridiculous. If someone in the village dies, the whole village would know before sunset, and pretty much nobody dies at home anyway. And what about inheritance? Or paying rent? No, that's completely ridiculous. Not to mention that pretty much everyone is highly religious around those parts and not giving your relatives a proper Catholic burial is one of the worst things you could do. Not even a staunch atheist would stoop that low.
> The allegation that [it is] fraud is ridiculous.
No? Even the writeup gives specific examples. Number of pension payouts to Greek 100+ year olds was cut by 72% after an audit.
Even if they had a proper Catholic burial. Never underestimate the power of greed. In a predominantly low-income area great-grandpa's pension might be what is keeping you from losing your home.
> That low income low literacy people live longer, provided they have good genetics seems plausible to me.
That it seems plausible is why the story has circulated for so long, but that doesn't make it true. We do research precisely to check what seems plausible against actual data.
Since you're using a throwaway anyway, can you share which part of the Southern coast of Europe you live in? Maybe together we can find data that would help.
> drinking 1-2 glasses of wine per day
> the astounding thing is that one of the guidelines is that you should drink every day at twice the NHS heavy drinking guidelines. That is a recipe for alcoholism.
Say what? The article implies that 1 glass of wine every day or two (i.e., half of 1–2 per day) is heavy. That seems frankly insane to me.
> The UK government's guidelines on how much it is safe to drink are based on numbers "plucked out of the air" by a committee that met in 1987. According to The Times newspaper, the limits are not based on any science whatsoever, rather "a feeling that you had to say something" about what would be a safe drinking level. This is all according to Richard Smith, a member of the Royal College of Physicians working party who produced the guidelines. [1]
One might think that having admitted this Smith would be circumspect, apologetic and more careful with his claims about health in future. Of course he did the exact opposite:
> However, Mr Smith says this doesn't mean alcohol is not dangerous. He later told The Guardian that this would be a "serious misinterpretation" of his comments. He also argued that the figures were "in the right ball park", and called for heavier taxes to cut consumption
The numbers were based on no evidence but also amazingly in the right ballpark. No contradiction there if you work in public health. Sure enough, ten years later the guidance had become even more extreme [2], with men and women now becoming biologically identical and the government telling citizens that even one drop of alcohol was dangerous:
> The report recommend an upper limit of 14 units per week for both adult men and women, and then included the much-derided “no safe limits” observation.
This highly ideological guidance might have been because:
> Members of the expert group include prohibitionists and anti-alcohol campaigners
[1] https://www.theregister.com/2007/10/22/drinking_made_it_all_...
[2] https://www.theregister.com/2016/01/22/stats_gurus_open_fire...
My guess is blue zones are countries that have good social programs and medical systems. Also helpful are regions where the environment isn't going to kill you.
So what are the real Blue Zones if there are any? Where do people actually live the longest in other words?
Highly developed countries with access to affordable or free healthcare seem to be real blue zones. Especially in highly urban areas. Hong Kong, Singapore, and the big cities of some countries (Tokyo, Sydney) have very high life expectancy numbers.
Seems like getting treatment when you're sick, and having regular check ups to induce lifestyle changes are what makes a place a blue zone.
"having regular check ups to induce lifestyle changes"
More likely that those areas have society level positive lifestyles by default, especially relating to foods (eg Okinawa eating until 80% full, Italy and the mederteranian diet, Loma Linda plant heavy diet, etc).
Plenty of people get at least an annual covered checkup, but that doesn't mean they will make lifestyle changes. Even the ones that try end up like a new years resolution - not being strict about it or giving up after a month or two.
Edit: why disagree?
Isn’t the whole point of this research that people Okinawa and Italy probably don’t live any longer. In fact these areas have shorter average life span? So, all the stories about the benefit of the Mediterranean fish heavy diet are post-hoc rationalizations of bad data?
"Isn’t the whole point of this research that people Okinawa and Italy probably don’t live any longer."
I didn't see that claim in the article. What I did see is that the data on centarians was shown to be invalid. It's certainly possible that the overall life expectancy stats could be distorted. In most cases (excluding Okinawa), I doubt that the mistakes or fraud are that rampant. The problem with the blue zone studies is that they explicitly focused on outliers from the beginning. Any mistakes or fraud become a big impact in a small population like that. If you use population level life expectancy, the impact should become much smaller, or at the very least any systemic fraud and mistakes should become readily visible and be able to be corrected in the numbers if further studies are done to measure it.
The article is very emotional and seems to mischaracterize some things, such as claiming that every blue zone must fit each piece of the suggestions. The idea of drinking every day is probably not a good suggestion as there is some research contesting the benefits of a glass of wine a day. But let's take Okinawa as an example. It's uncontested that the records have problems, it's trending in the wrong direction (younger generations, probably better records), and it doesn't fit all the practices (eg religion). But does this invalidate the longevity recommendation of eating to 80% full that comes out of the blue zone recommendation? No. There are independent studies showing the benefits of this practice to reduce cardiovascular disease, insulin resistance, and obesity.
So even if the blue zone centarian data is wrong (it is), that doesn't say anything about the suggested practices. Those have always needed their own studies to validate the suggested practices anyways. Fot example, there are numerous studies on the mederteranian diet that shows it is beneficial compared to a typical western diet and especially compared to the typical American diet.
The real Blue Zones are the friends we made along the way.
The problem will always be that you need to find places that keep good records, and have done so for the last century.
What they set out to do was to find correlations between lifestyle and longevity, and what they ended up finding was a great tool for spotting pension fraud.
The levels of fraud aren't that rampant. Focusing on life expectancy in those regions still seems to have some valid correlation. It was a mistake from the beginning to try to focus on outliers (people living over 100).
Part of the research shows that when you drop the outliers these regions have a lower than average life expectancy.
Yeah, it does show that for some of the areas, but not others. The problem with these population studies is they do not give you answers, only new variables. In my view, the whole blue zone study is moot, at least in the way it is typically applied. What it does give us are new variables to study. Those smaller studied can control for variables that the population level cannot. They can also apply those studies to populations of different decent (genetics).
The glass of wine recommendation has had many studies done and the results are conflicting.
The eating guidelines like heavy in plants, mederteranian, eating to 80% full all have multiple studies showing benefits over the typical western diet and especially the typical American diet. It's a no brainer that if you want to live a long life you have a better chance of doing that if you have a reduced risk of heart attack, stroke, diabetes, etc.
Right, I have no problem with dietary recommendations that are inspired by "blue zones" and then validated with research in other populations.
> what they ended up finding was a great tool for spotting pension fraud
I mean, that’s not nothing, y’know?
so no correlations between lifestyle and longevity? doubt
There are it's just the outlier blue zones where people are supposed to be reaching very hugh maximum ages at a surprising rate that are probably not real. There are still plenty of correlations between healthier lifestyles generally you just shouldn't attempt to live past 100 by emulating what people in an alleged blue zone do.
That is no way shape or form invalidates any actual link between lifestyle and longevity. It just means you can't simply assume that any given example of longevity, or data indicating longevity, must be due to lifestyle.
There is correlation (and maybe even causal relation) between lifestyle and longevity. It's just the lifestyle in those "Blue Zones" is not different from the lifestyle of surrounding areas (or as in Okinawa - gradient points in the wrong direction), so cannot serve as the sure way to longevity.
It's likely the most significant zones simply aren't geographical.
The numbers probably look better in the Affluent Alliance versus the Protectorate of Poverty, for starters.
Reminds me of the South Park episode where they discover Magic Johnson's secret for curing his HIV.
There’s extensive literature on the lack of modern disease in hunter gatherers. Frontier doctors could get a case report published when they found cancer.
Some lived long but on average their lives were short because they didn’t have antibiotics or emergency medicine and lived in harsh environments that few of us would be able to survive today.
Their wisdom appropriately coupled to a modern less harsh environment might lead to greater longevity. But the harshness is what ensures exercise, movement, unprocessed food, etc.
Their "wisdom" of avoiding cancer amounts to dying young. Cancer rates shoot up well beyond 50 years.
Do you have any evidence you can point to for this assertion? The book Good Calories Bad Calories has a section that reviews the literature on the subject. Disease and Western Civilization reviews specific populations in detail. Nutrition and Physical Degeneration for a geographically diverse primary source although it’s not about cancer or longevity.
The assertion that older people get cancer more than young people? You could try any medical source whatsoever that deals with cancer or longevity, instead of picking one that doesn't, e.g. [0]
> Advancing age is the most important risk factor for cancer overall and for many individual cancer types. The incidence rates for cancer overall climb steadily as age increases, from fewer than 25 cases per 100,000 people in age groups under age 20, to about 350 per 100,000 people among those aged 45–49, to more than 1,000 per 100,000 people in age groups 60 years and older.
[0] https://www.cancer.gov/about-cancer/causes-prevention/risk/a...
That study doesn’t include hunter gathers. Certainly cancer rates increase for them as they age as well. The point is the rate is orders of magnitude less than we experience today.
You can look to the Amish for some answers. They aren't hunter gatherers but they do live a more primitive lifestyle. Some studies seem to show they have lower rates of cancers. It's not really a secret that if you are active, eat fairly healthy, aeent obese, and don't drink or smoke that you will be significantly healthier than the baseline rates in the US.
There’s extensive literature on the lack of modern disease in hunter gatherers.
Well yeah because their life expectancy is about 45 years
Well we seem to now be doing worse than the hunter gatherer's who "had a life expectancy of about 45 years" with the rise in early onset cancers.
https://www.yalemedicine.org/news/early-onset-cancer-in-youn...
And on your "had a life expectancy of about 45 years", you have a math problem. The average life span was closer to 25 years but was dragged down but the huge amount of infant mortality which is normal in humans.
The Tsimané of the Amazon are know to live well into their 70s.
> The Tsimané of the Amazon are know to live well into their 70s.
Some of them do, but those are filtered to the most healthy if the lot. It's not really surprising that if you lose the sickly ones while they're infants the ones who make it to adulthood are less likely to get sick.
This is further confounded when you have generations that have lived longer, as we do in the first world, because now not only do the sickly ones live long enough to get modern diseases, they also live long enough to reproduce and pass on the previously-non-viable genes. So generation after generation gets added that would never have survived without modern medicine.
I consider it to be a good thing that we can optimize our evolution for different traits now besides raw survivability, but it does mean that we should expect our disease numbers to be higher.
My point was that when someone says the "life expectancy is 45" that does not mean that everyone dies at 45.
> I consider it to be a good thing that we can optimize our evolution
We cannot "optimize" our evolution for different traits. Evolution is optimization to the environment. We cannot use human thought to optimize evolution, and that is eugenics anyway so no thanks.
I was anthropomorphizing the natural process of evolution, not suggesting eugenics. I thought that would be obvious, but apparently not.
A marketing term to push TV shows, books, Business Insider articles, clicks/engagement, etc.
I wonder if there was anything historically equivalent to the Antediluvian lifespans described in the Old Testament. If, for example, there was something in the food a few thousand years ago in the area of the Persian/Arabian Gulf, now underwater, that could extend lifespan.
You're wondering if there was any ancient food that allowed people to live to 800 or 900 years old. There wasn't.
I also don't think there was, its more of a scifi kind of musing.
Possibly a parallel in New Orleans? Anne Rice documents unusual individuals that can live well into the hundreds of years.
The whole Blue Zone thing cracks me up. They think everyone will live longer on a plant based diet? Tell that to the Inuit and Sami who have genetically adapted after generations of eating very few, if any, plants.
If they Blue Zones do exists, they exist because people are eating their traditional genetic diet.
And if they eat plants, what plants? Should someone of Irish decent eat wheat even though they are more likely to have Celiac?
I have Sami heritage. I was also a Vegan at one time. A healthy Vegan. The plant based diet was literally killing me with hyperglycemia and immune issues. These people who think there is one true diet are dangerous adn do not know the first thing about nutritional genetics.
Longevity is a poor metric anyway - we need to emphasize quality * years
The two are greatly correlated, so at a population level it's a distinction without a difference. There's no population of people all living to be 100 but spending their 90s on a respirator.
The distinction matters for individual health decisions, and for comparing different interventions, where you can extend someone's life at the cost of their quality of life.
Yes, someone always says this. Health span is the term. Maybe we can all use the term and skip this discussion
https://www.merriam-webster.com/wordplay/what-is-health-span
Quality of Life Years, QALYs, is a commonly used term in epidemiology/biostatistics.
In theory that is a reasonable distinction (and that type of trade-off can come up in very specific situations like treatment of terminal disease in elderly people) but in terms of lifestyle choices there is currently no known difference between lifestyle choices that increase expected longevity and lifestyle choices that increase expected quality years.
Blue Zones were supposed to be examples of that too.