Of Blue Zones and Bull…Dozers

Since first learning of the Blue Zones over a decade ago, I have held them up as the most luminous, decisive illustration of what lifestyle-as-medicine can do, adding a bounty of years to life, and of life to years.? I did so as President of the American College of Lifestyle Medicine; I did so as founder of the True Health Initiative, joined there by a global coalition of diverse experts.

I have long held up the Blue Zones as the definitive guide to living long and prospering with vitality- and I most assuredly still do.

I still do despite the current cottage industry in anti-Blue Zone-innuendo, involving contrarian speculation, armchair epidemiology, and inevitable, self-serving media amplification.? The narrative of these unsubstantiated aspersions is: maybe, just maybe, these famous centenarians aren’t really as old as they say they are?

In fact, they are.? We’ll get to that.? First: why the attempt to discredit Blue Zones, and why now?

The “now” answer may take us back much more than 100 years, to the story arcs of Greek tragedy.? Humans celebrate success up to a point, but then seem to expect, and perhaps require, a fall.? Maybe the luster of the Blue Zones imprimatur, its capacity to generate a clear, compelling message about the fundamentals of living and eating well for vitality, longevity, and sustainability- invited some brand of envy, some need to see the mighty fallen.?

Why the cottage industry in tarnishing what shines so bright?? First, we may accept that those who can answer important questions- with effort and expertise- do.? Those who can’t, just question answers instead.? This garners notoriety, a sorry pretender to the legitimacy of fame, but the modern world either can’t tell the difference or chooses not to care.? Notoriety comes easy, and all too many seem willing to settle for it.? Tainting the Blue Zones luster may have seemed just such an opportunity.? (This is speculation on my part, but so are all the disparagements of Blue Zones data.)

Second, our capricious attentions are drawn to scandal and conspiracy as they are drawn to a car wreck.? Anyone who has spent hours in traffic, only to learn that the blockage was a crash on the other side of a divided highway, understands the irresistible liability of “rubbernecking.”? So, too, with a cyberspatial collision of contentions, involving no vehicles other than electrons.? Every variety of click-bait allegation and innuendo is the equivalent of a car-wreck on the super-highway of information flow.? We can’t look away, and those seeking our views both know it, and exploit it.

Consequently, nothing in the modern age is easier to bulldoze than the truth (with implications far beyond the Blue Zones, of course).? The Internet is ever at the ready, engine idling.? Just feed it a crumb of doubt, a slim intimation of scandal, the vague hint of conspiracy, or a non-peer-reviewed preprint - and off it charges, pulverizing truth, and trust, as it proceeds.

I have not invoked the Blue Zones data as the quintessential illustration of what lifestyle can do for both years in life, and life in years for want of access to randomized controlled trials, systematic reviews, and meta-analyses establishing much the same case.? I have cited these, too- they are abundant, and tell compellingly in their own right the promise of lifestyle (and food) as the best of medicine.? But having published a bounty of papers predicated on just such methods myself- I know fully their important limitations.? They contribute to our understanding, but there is no substitute for observing what happens to entire populations over entire lifespans and generations.? The Blue Zones offer us this rarefied view.

The reliability of the Blue Zones data was never in doubt, and is not in doubt now.? The validation of ages involves transparently published, repeatedly peer-reviewed methods (see references, below); careful corroborations; and the work of highly credentialed experts.? The specific speculations about why the findings might be inaccurate have been lined up and knocked down.? Skeptical, expert demographers have traveled to the Blue Zones to challenge the claims, and come away convinced of their legitimacy.? The imprimatur of National Geographic in the mix, while not sacrosanct, is noteworthy.? There may be a more venerable publication, but none comes immediately to mind.? National Geographic and the National Institute on Aging funded the original Blue Zones work to ensure the rigor of age validation.

In other words, the validation of Blue Zones demographic data is sedulous, scrupulous, robust, transparent, and adjudicated by a jury of qualified peers (see references, below).? The challenge to it is not indictment, but innuendo.

So, to be clear: my faith in the Blue Zones is entirely intact.? I will continue to cite their shining example, as ever I have done.

But perhaps, despite all this, you are left with doubt.? OK, the assault on Blue Zones credibility is not actually credible, but it could still be right, couldn’t it?

It could not, and for a reason immune to innuendo.? That reason is: procreation.

Most adults one hundred or so years ago procreated; they had children.? Most adults 80 or so years ago did the same, meaning the older adults’ children had children.? And so, too, 60 years ago; and 40 years ago; and, for that matter, 20 years ago.? (The trend may now be ending in some parts of the world, but that’s a story for another day.) What this means is that Blue Zone centenarians are prone to have children, grandchildren, great grandchildren, and in some cases- another ‘great’ or two beyond that.? This is captured in Blue Zone reporting, and confirmed to me in personal communication by the person best known for spending years of his life in the villages and homes of these very people.? That bears repeating: the legitimacy of Blue Zones findings is not predicated only on data accessible from any armchair.? The clinching corroboration derives from field work and the time-honored, arduous brand of epidemiology referred to as “shoe-leather.”

Maybe you can allow yourself to doubt record keeping from 100 years ago, no matter how carefully confirmed.? Maybe you can still doubt it even when doubting demographers with expertise in just these matters wind up convinced after due diligence.? But I rather doubt you can doubt that a pair of 30-something parents is able to point to their children and their parents; that those parents can point to their parents; and so on.? If you want to doubt the veracity of Blue Zones demographics, you must doubt the ability of family members to identify one another.

When all of these generations are gathered around the same dinner table, the confirmation of centenarian status requires no faith in hand-written ledgers, however carefully vetted.? We need only trust that the digitized birth certificate from 10 years ago is reliable (with corroboration by looking at the 10-year-old child in front of us), and that there is something approximating 20 years on average separating the generations.? Standing in front of us is living, human evidence that the parents of said child are something in the neighborhood of 30; their parents, 50; their parents, 70; and their parents, 90.? If another generation, then we are well past age 100, with some slim margin of error.? Even absent that final generation, with a few extra years added at any step- an older child, a later pregnancy- we are already in the realm of centenarians.

Those seeking to refute the Blue Zones story can’t just make allegations about last-century record keeping and call it a day.? They need to stare down a multigenerational lineage of living, breathing evidence – and somehow dispute that those people are actually there.? Good luck with that.

There is a genuine threat to the luster of the Blue Zones, but it has nothing to do with pre-print allegations, and everything to do with pop culture intrusions.? Whatever one makes of their merits and liabilities, globalizing trends, giant tech companies, and web-based connectivity have a homogenizing influence, regressing us all to the mean of modern living.? The Blue Zonians are not immune to these influences; they are long-lived and vital by virtue of their native cultures, not superpowers.? As go those cultures, so go years in life, and life in years - alas.? We may hope that there are new Blue Zones to be named; but we should certainly worry that the blessings of those we know will succumb to the relentless onslaught of modern living.

The Blue Zones' connection to Greece is the inclusion of Ikaria’s population as one among its exemplars; there is no Greek tragedy here.? The mighty value of the Blue Zones example, and the reliability of the underlying data remain intact.? The only tragedy would be our failure to trust and follow this beacon, illuminating blessings we might hope to pursue, and propagate around the world: vitality, longevity, and a gentle exit in the fullness of time.? Our best hope of getting there from here begins by affirming that the Blue Zones have well and truly shown us where “there” is. Just follow the light.

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-fin

Dr. David L. Katz is a board-certified specialist in Preventive Medicine/Public Health, past president of the American College of Lifestyle Medicine, and the founder of the True Health Initiative.? He has co-authored multiple editions of a leading textbook in epidemiology and public health which covers, among many other things…demographics.? He serves as a science advisor to Blue Zones.

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References:

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2. National?Geographic, 2005.
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15. Poulain M, Pes GM, Carru C et al. The Validation of Exceptional Male Longevity in Sardinia. In: Robine, JM., Crimmins, E.M., Horiuchi, S., Yi, Z. (eds) Human Longevity, Individual Life Duration, and the Growth of the Oldest-Old Population. International Studies in Population, 2007, vol 4. Springer, Dordrecht.
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19. Willcox DC, Willcox BJ, He Q, et al. They Really Are That Old: A Validation Study of Centenarian Prevalence in Okinawa,?J Gerontol A Biol Sci Med Sci. 2008;63(4):338-49.

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