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Blue zone
Region with claims of unusual longevity

Blue zones are regions where people reportedly live exceptionally long lives, often beyond 100 years, due to a combination of physical activity, low stress, strong social connections, a whole foods diet, and low disease rates. The term blue zones originated from scientists marking these areas with a blue pen on a map during their initial research. Notable examples include Okinawa Prefecture in Japan, Nuoro Province in Sardinia, Italy, the Nicoya Peninsula in Costa Rica, and Icaria, Greece. However, scientific evidence challenges this concept, noting declining life expectancy in Okinawa and comparable longevity in Nicoya for those born after 1930.

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History

A 1999 study of elderly people living on Sardinia found a prevalence of 13 centenarians per 100,000 population, indicating unusual longevity.11 A 2004 followup report showed that longevity was concentrated in the Nuoro province of Sardinia, specifically in its mountain regions where locally born men lived longer than those in the rest of Sardinia, although reasons for the longevity were unknown.12

Beginning in 2005 in collaboration with American author Dan Buettner, the list of blue zone regions was extended from Sardinia to include Okinawa, Nicoya in Costa Rica, and Icaria in Greece.1314 Belgian demographer Michel Poulain, who coauthored the 2004 report on Sardinia's longevity, added the French Caribbean island of Martinique as a new blue zone in 2019,15 while Buettner subsequently added Loma Linda, United States in 2008—which was first featured in his 2005 National Geographic article on blue zones—and Singapore in 2023.1617 However, only the initial four blue zones—Sardinia, Okinawa, Nicoya, and Icaria—are recognized mutually by Poulain and Buettner.18

Estimating population longevity

In the original study of centenarians living in 14 mountain villages of Sardinia (the first proposed blue zone), the research team developed an Extreme Longevity Index (ELI) representing the ratio between the number of eventual centenarians born between 1880 and 1900, and the total number of births recorded during the same time interval for the region.19 The ELI was defined as the number of centenarians per 10,000 newborns, and was used to determine the probability that any person born in that municipality would reach 100 years old while remaining mentally and physically functional.20

Another longevity index applied was the Centenarian rate (CR) for the 1900 birth group (number of persons surviving to 100 years old per 10,000 people alive at age 60) in December 2000.21 The Sardinia and Okinawa blue zones had CR values for men substantially higher compared to several other countries, whereas values for women were mostly above those in other countries, while comparable to others.22

Several possible errors or limitations exist for these estimates, such as failure to validate accuracy of ages, unreliable interviews or missing birth records.232425

Business ventures

Dan Buettner trademarked the term "blue zone" in the United States in 2005.26 In 2008, he established the marketing company, Blue Zones LLC, with the intent to "[create] healthy communities across the United States" by partnering with municipalities to implement programs and policies based on principles derived from blue zones; cities deemed to have successfully enacted such changes receive a "Blue Zone Community" certificate.27

The company recognizes Loma Linda, California as a blue zone after it was featured in Buettner's 2008 book, The Blue Zones, which described the city's Seventh-Day Adventist community as having unusual longevity due putatively to a healthy lifestyle and plant-based diet.2829 However, Buettner admitted to featuring Loma Linda to his 2005 National Geographic article on blue zones because his editor wanted a U.S. location and Buettner "never bothered to delist it".30 In 2020, Blue Zones, LLC was acquired by the Seventh-Day Adventist health care system, Adventist Health,31 with Buettner remaining a consultant.32

In 2024, the blue zone concept was featured in business promotion.3334

Critiques

See also: List of Japanese prefectures by life expectancy

The concept of blue zone communities having exceptional longevity has been challenged by the absence of evidence.3536

It has also been questioned by the substantial decline of life expectancy during the 21st century in Okinawa, with a 2008 analysis concluding that "male longevity is now ranked 26th among the 47 prefectures of Japan".3738 Michel Poulain, one of the authors of the original paper about blue zones, conducted a study in 2011 to validate the claims of longevity in Okinawa, and was unable to verify whether residents were as old as they reported due to many records not surviving World War II.39 After the case of Sogen Kato in 2010, whose death in c. 1978 went unreported to pension authorities for over three decades, the Japanese Ministry of Justice reviewed the koseki family records and discovered approximately 230,000 unverifiable records of people aged 100 years or older, or 82% of the total records for this age group.40 Most of these people likely died or emigrated and were not reported to local authorities, or they died in World War II and went unnoticed in subsequent reparations. The jūminhyō registry, which is based on census data and pensions rather than self-reporting, recorded about 44,000 centenarians in the same year.4142 Many of the koseki records in Okinawa were destroyed in World War II, and the (mostly American) authorities tasked to replace them often had to rely on people's memory and didn't speak Japanese or use the Japanese calendar.4344

In 2023, Okinawa ranked only 42nd among Japan's 47 prefectures in terms of life expectancy. Okinawa has become the only prefecture in Japan where life expectancy had decreased over the past 10 years amid overall growth.45 The region scores very low on national health surveys, especially for diet and alcohol consumption.4647

Costa Rica's "blue zone" is questioned, apparently resulting from a cohort effect, with people born before 1930 often living longer than thos born later.48

Harriet Hall, writing for Science-Based Medicine, stated that there are no controlled studies of elderly people in the blue zones, and that blue zone diets are based on speculation, not evidence through a rigorous scientific method.49 In 2024, Saul Justin Newman of the University of Oxford received the Ig Nobel Prize for discovering sloppy methodology within the study of extreme longevity and persistent errors in government birth and death records. Frequency rates of supercentenarians are negatively correlated with life expectancy and most indicators of health or income, and concentrate in regions with unreliable records or ubiquitous pension fraud. He found that researchers in the field rely almost exclusively on documents and often ignore evidence of their unreliability, and that there is a deficit of document-independent age measurements such as epigenetic markers; such methods consistently report younger ages for the oldest people than documents do.505152

See also

References

  1. Poulain M, Herm A, Pes G (2013). "The Blue Zones: areas of exceptional longevity around the world" (PDF). Vienna Yearbook of Population Research. 11: 87–108. doi:10.1553/populationyearbook2013s87. Archived from the original (PDF) on 2 March 2020. These populations succeeded in maintaining a traditional lifestyle implying an intense physical activity that extends beyond the age of 80, a reduced level of stress and intensive family and community support for their oldest olds as well as the consumption of locally produced food. https://web.archive.org/web/20200302043123/http://austriaca.at/0xc1aa500e_0x00307bb6.pdf

  2. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  3. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  4. Poulain M, Herm A, Pes G (2013). "The Blue Zones: areas of exceptional longevity around the world" (PDF). Vienna Yearbook of Population Research. 11: 87–108. doi:10.1553/populationyearbook2013s87. Archived from the original (PDF) on 2 March 2020. These populations succeeded in maintaining a traditional lifestyle implying an intense physical activity that extends beyond the age of 80, a reduced level of stress and intensive family and community support for their oldest olds as well as the consumption of locally produced food. https://web.archive.org/web/20200302043123/http://austriaca.at/0xc1aa500e_0x00307bb6.pdf

  5. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  6. Hall, Harriet (October 12, 2021). "Blue Zones Diet: Speculation Based on Misinformation". Science-Based Medicine. Retrieved 15 October 2021. /wiki/Harriet_Hall

  7. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  8. Hokama, Tomiko; Binns, Colin (October 2008). "Declining longevity advantage and low birthweight in Okinawa". Asia-Pacific Journal of Public Health. 20 Suppl: 95–101. PMID 19533867. /wiki/Colin_Binns

  9. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  10. Rosero-Bixby, Luis (2023-10-18). "The vanishing advantage of longevity in Nicoya, Costa Rica: A cohort shift". Demographic Research. 49 (27): 723–736. doi:10.4054/DemRes.2023.49.27. ISSN 1435-9871. Retrieved 2024-10-17. https://www.demographic-research.org/volumes/vol49/27/

  11. Deiana L, Ferrucci L, Pes GM, et al. (June 1999). "AKEntAnnos. The Sardinia Study of Extreme Longevity". Aging. 11 (3): 142–9. PMID 10476308. /wiki/PMID_(identifier)

  12. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  13. Poulain, Michel (21 July 2011). "Exceptional Longevity in Okinawa:: A Plea for In-depth Validation". Demographic Research. 25 (7): 245–284. doi:10.4054/DemRes.2011.25.7. https://www.researchgate.net/publication/227409038

  14. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  15. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  16. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  17. Mikhail, Alexa. "The longevity secrets of Singapore, the 6th blue zone city where people are living the longest, happiest lives". Fortune Well. Retrieved 2025-02-18. https://fortune.com/well/2023/08/29/singapore-sixth-blue-zone-longevity-secrets-dan-buettner/

  18. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  19. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  20. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  21. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  22. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  23. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  24. Poulain M, Pes GM, Grasland C, et al. (September 2004). "Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study" (PDF). Experimental Gerontology. 39 (9): 1423–9. doi:10.1016/j.exger.2004.06.016. PMID 15489066. https://halshs.archives-ouvertes.fr/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf

  25. Poulain, Michel (21 July 2011). "Exceptional Longevity in Okinawa:: A Plea for In-depth Validation". Demographic Research. 25 (7): 245–284. doi:10.4054/DemRes.2011.25.7. https://www.researchgate.net/publication/227409038

  26. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  27. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  28. Mikhail, Alexa (2 April 2023). "A look inside America's only blue zone city—home to some of the world's longest-living people". Fortune. Retrieved 2 January 2024. https://fortune.com/well/2023/04/02/longevity-tips-loma-linda-california-blue-zone-city/

  29. Wendorf, Marcia (10 February 2022). "People routinely live over 100 years in global "blue zones". Should you move?". Interesting Engineering. Retrieved 4 January 2024. https://interestingengineering.com/health/people-routinely-live-beyond-the-age-of-100-in-these-rare-blue-zones

  30. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  31. "Adventist Health acquires Blue Zones as part of transformation into catalyst for overall community health and wellbeing". Adventist Health. 8 April 2020. Archived from the original on 7 March 2023. Retrieved 2 January 2024. https://web.archive.org/web/20230307081809/https://www.adventisthealth.org/blog/2020/april/adventist-health-acquires-blue-zones-as-part-of-/

  32. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  33. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  34. Fonstein, Claire A. (25 July 2024). "The business of longevity. What does it mean to 'Go Blue'?". Silicon Valley Business Journal. The Business Journals. Retrieved 25 October 2024. https://www.bizjournals.com/sanjose/news/2024/07/25/blue-zones-san-jose.html

  35. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  36. Hall, Harriet (October 12, 2021). "Blue Zones Diet: Speculation Based on Misinformation". Science-Based Medicine. Retrieved 15 October 2021. /wiki/Harriet_Hall

  37. Amigo, Ignacio (21 November 2024). "Shades of blue". Science. doi:10.1126/science.znw477z. Retrieved 2025-02-18. https://www.science.org/content/article/do-blue-zones-supposed-havens-longevity-rest-shaky-science

  38. Hokama, Tomiko; Binns, Colin (October 2008). "Declining longevity advantage and low birthweight in Okinawa". Asia-Pacific Journal of Public Health. 20 Suppl: 95–101. PMID 19533867. /wiki/Colin_Binns

  39. Poulain, Michel (21 July 2011). "Exceptional Longevity in Okinawa:: A Plea for In-depth Validation". Demographic Research. 25 (7): 245–284. doi:10.4054/DemRes.2011.25.7. https://www.researchgate.net/publication/227409038

  40. Newman, Saul Justin (13 September 2024). "'The data on extreme human ageing is rotten from the inside out' – Ig Nobel winner Saul Justin Newman". The Conversation. https://theconversation.com/the-data-on-extreme-human-ageing-is-rotten-from-the-inside-out-ig-nobel-winner-saul-justin-newman-239023

  41. "The mystery of Japan's missing centenarians". BBC News. 21 September 2010. Retrieved 25 June 2025. https://www.bbc.com/news/world-asia-pacific-11299646

  42. Mackinnon, Mark (7 October 2010). "Japanese living longer, lonelier". The Globe and Mail. Archived from the original on 13 September 2016. Retrieved 16 January 2011. https://www.theglobeandmail.com/news/world/asia-pacific/japanese-living-longer-lonelier/article1746791/

  43. Newman, Saul Justin (2024). "Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors and pension fraud". bioRxiv. doi:10.1101/704080. https://doi.org/10.1101%2F704080

  44. Newman, Saul Justin (13 September 2024). "'The data on extreme human ageing is rotten from the inside out' – Ig Nobel winner Saul Justin Newman". The Conversation. https://theconversation.com/the-data-on-extreme-human-ageing-is-rotten-from-the-inside-out-ig-nobel-winner-saul-justin-newman-239023

  45. "The Japanese Mortality Database". National Institute of Population and Social Security Research. 30 March 2025. Retrieved 12 May 2025. https://www.ipss.go.jp/p-toukei/JMD/index-en.asp

  46. Newman, Saul Justin (13 September 2024). "'The data on extreme human ageing is rotten from the inside out' – Ig Nobel winner Saul Justin Newman". The Conversation. https://theconversation.com/the-data-on-extreme-human-ageing-is-rotten-from-the-inside-out-ig-nobel-winner-saul-justin-newman-239023

  47. Newman, Saul Justin (2024). "Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors and pension fraud". bioRxiv. doi:10.1101/704080. https://doi.org/10.1101%2F704080

  48. Rosero-Bixby, Luis (2023-10-18). "The vanishing advantage of longevity in Nicoya, Costa Rica: A cohort shift". Demographic Research. 49 (27): 723–736. doi:10.4054/DemRes.2023.49.27. ISSN 1435-9871. Retrieved 2024-10-17. https://www.demographic-research.org/volumes/vol49/27/

  49. Hall, Harriet (October 12, 2021). "Blue Zones Diet: Speculation Based on Misinformation". Science-Based Medicine. Retrieved 15 October 2021. /wiki/Harriet_Hall

  50. Newman, Saul Justin (2024). "Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors and pension fraud". bioRxiv. doi:10.1101/704080. https://doi.org/10.1101%2F704080

  51. Newman, Saul Justin (13 September 2024). "'The data on extreme human ageing is rotten from the inside out' – Ig Nobel winner Saul Justin Newman". The Conversation. https://theconversation.com/the-data-on-extreme-human-ageing-is-rotten-from-the-inside-out-ig-nobel-winner-saul-justin-newman-239023

  52. Newman, Saul Justin (2024 September 6). medRxiv. doi:10.1101/2024.09.06.24313170. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |date= (help); Missing or empty |title= (help) /wiki/Doi_(identifier)