The Blue Zone Diet: The Secret to a Long Life?

The Blue Zone diet has gained a lot of attention for its association with longevity and improved health outcomes. Characterized by plant-centric eating, moderate physical activity, and strong social connections, this dietary pattern offers a compelling approach to preventive medicine. Let’s unpack what this dietary pattern is and how we can help our patients incorporate some of its principles to increase their longevity.

A Background on the Blue Zone Diet

A person’s lifespan is influenced by several factors: diet, genetics, lifestyle, stress, sleep, and physical activity. Interestingly, the Danish Twin Study revealed that a staggering 80% of longevity is influenced by our lifestyle and environment. This insight inspired Dan Buettner, the pioneer behind the Blue Zones concept, to embark on a quest to understand the secrets of long, healthy lives and to identify actionable principles that could be applied globally. Partnering with National Geographic and supported by the National Institute on Aging, Buettner identified five regions where people consistently live incredibly long lives: Ikaria, Greece; Loma Linda, California; Nicoya, Costa Rica; Okinawa, Japan; and Sardinia, Italy. Believe it or not, the term "Blue Zones" has nothing to do with science or a fancy discovery. Researchers literally circled these longevity hotspots with a blue pen on a map during their initial studies.

What is the Blue Zone Diet?

While further research is needed to establish definitive clinical guidelines, these areas share common dietary patterns rich in whole grains, legumes, vegetables, fruits, and healthy fats. Red meat and processed foods are typically consumed sparingly, while moderate amounts of wine and dairy products are often included. The diet's emphasis on whole, minimally processed foods provide essential nutrients, antioxidants, and fiber, which contribute to overall well-being. Additionally, the social connections fostered within Blue Zone communities may play a role in stress reduction and mental health support.

Blue Zones Power 9

Regardless of location, the same nine lifestyle characteristics were identified across all five blue zone environments, which Buettner termed the “Power 9®” principles. I want to highlight a few here:

1. Down Shift. Stress is part of life and no one, regardless of location and culture, is immune to the stress of life. However, the people living in blue zones incorporate daily routines that reduce stress. Okinawans remember their ancestors daily, Adventists pray, Ikarians take a nap and Sardinians do happy hour.

• • Clinical Application: Your patient is stressed. Guaranteed. Ask them how they manage their stress? What coping mechanisms do they have? Most people resort to food to cope with emotions like stress. But this only leads to excessive calorie intake, weight gain and a feeling of guilt and shame. This is a great opportunity for you to offer some practical suggestions: suggest they start a stress journal to track their feelings and responses, avoid unnecessary stress like triggering people or topics, reframe the problem to have a positive spin on it, go for a walk with your favorite music, delegate responsibilities and prioritize your tasks better, and lastly, connect with others.

2. Purpose. In the blue zones, people have specific vocabulary for purpose: The Okinawans call it “Ikigai” and the Nicoyans call it “plan de vida;” both translate to “why I wake up in the morning.” A recent study from the National Institute on Aging, found that people who could articulate their sense of purpose were living up to 7 years longer.

• • Clinical Application:  Dear friend, pause here and reflect on that. Why do I wake up in the morning?  Ask your patients to consider that question as well.

3. Wine at 5. Except for the Adventists, people in blue zones consumed moderate amounts of alcohol, usually wine. The focus remains on community and connection. They enjoy 1-2 glasses per day with friends, during meals.  

• • Clinical Application:  If your patient does not drink, do not encourage them to start. However, patients can enjoy the appropriate amount of alcohol. The 2020-2025 U.S. Dietary Guidelines recommend that adults who drink alcohol limit their intake to two drinks or less per day for men and one drink or less per day for women. One standard drink is equal to any one of the following:
    • 12 oz. regular beer (5% alcohol)
    • 8-9 oz. malt liquor (7% alcohol)
    • 5 oz. glass of wine (12% alcohol)
    • 1.5 oz. 80-proof hard liquor (40% alcohol)

4. Plant Slant A meta-analysis by Buettner of 154 dietary surveys in all five blue zones found that 95 percent of 100-year-olds ate plant-based diets. Beans, including soy and lentils, happen to the be cornerstone of most centenarian diets. Beans are inexpensive and are packed with fiber and protein. The 100-year-olds also eat a lot of carbohydrates, but in the form of whole grains and sourdough breads. Regarding meat, mostly pork is consumed, but on average only five times per month in 3-4 ounce servings.

• • Clinical Application: Encourage your patient to eat more plants! Decades of research show that a plant-based diet can significantly reduce the risk of chronic diseases like cancer, heart disease, diabetes, and obesity, while also improving blood pressure, blood sugar control, and digestive health. Don’t overwhelm your patient and tell them to become a vegetarian. They can still eat meat but focus on fruits and vegetables! Meet them where they are and help them take 1 step forward. Ask your patient questions like, “do you eat any fruits or vegetables? What fruit/vegetables do you like? What are some ways you can try to include 1 more fruit/vegetable every day?”

5. 80 Percent Rule The longest-lived people practice mindfulness when eating. The Confucian mantra, “Hara hachi bu,” said before meals reminds them to stop eating when their stomachs are 80 percent full.  There is clinical evidence that strategies such as stopping to say a prayer before meals, eating with family, eating slowly, not eating with distractions, like TV or the phone, lead to a decrease in food intake. In all five blue zones, people eat a large breakfast and a smaller lunch, and dinner is the smallest meal of the day.

• • Clinical Application: Don’t misinterpret this and tell your patients to stop eating after 8PM, like it’s this magical time when our digestion and metabolism stop working. Especially for patients who binge or emotionally eat at night, encouraging them to focus on eating balanced meals throughout the day can help them with cravings at night. Teach them mindfulness and how to slow down and enjoy the meal when they eat. I have an entire podcast episode on Mindfulness, you can listen to here: https://www.examroomnutritionpodcast.com/33-end-emotional-eating-a-providers-guide-to-helping-patients-lose-weight-part-3/

An interesting observation: In no case did individuals in the Blue Zones reach middle age and then all of the sudden choose to pursue longevity through a change in diet, taking up exercise, or finding some nutritional supplement.

The longevity occurred because they were in the right environment—an environment that fostered a lifestyle of longevity. However, it’s never too late to encourage your patient to focus on their health. Refer your patients to a Registered Dietitian who can provide comprehensive and personalized nutrition guidance.

The Blue Zone diet offers a promising framework for promoting overall health and preventing chronic diseases. By incorporating key elements of this dietary pattern into clinical practice, we can support patients in achieving optimal well-being.

Resources:

https://www.ncbi.nlm.nih.gov/books/NBK298903/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844621/

https://pubmed.ncbi.nlm.nih.gov/38566378/

https://www.bluezones.com/2016/11/power-9/