Being 101 years old hasn’t stopped this Loma Linda resident from being physically active – one of the common key behaviours in Blue Zone areas. — TNS
Longevity is a target for many humans.
While it is still a target for most, there are some areas in the world where people have not only long, but also, healthy lives.
In the early 2000s, Dan Buettner, working with the National Geographic magazine and a team of demographers, scientists and anthropologists, explored five such areas in Okinawa, Japan; Ikaria, Greece; Sardinia, Italy; Nicoya, Costa Rica; and Loma Linda, United States.
Their findings were published in the book The Blue Zones: Lessons for Living Longer from the People Who’ve Lived the Longest.
People in the Blue Zones have among the world’s highest proportions of centenarians (people who live to 100 or more years).
Not only that, they also have lower rates of chronic diseases like cancer, cardiovascular (heart) disease, diabetes and dementia.
The lessons from the Blue Zones should be of particular interest to anyone concerned about ill health in Malaysians.
Years of ill health
According to the World Health Organization (WHO), life expectancy at birth in Malaysia in 2000 was 75.5 years for females and 70.7 years for males.
It improved to 78.6 years for females and 75.5 years for males in 2020, but took a dip to 75.3 years for females and 70.6 years for males in 2021 with the Covid-19 pandemic wiping out previous gains.
However, what is important is not life expectancy, but healthy life expectancy (HALE).
WHO defines this as the “average number of years that a person can expect to live in ‘full health’, if he or she were to pass through the remaining years of life exposed to the sex- and age-specific mortality and morbidity prevailing at the time, for a specific year, in a given country, territory or geographic area”.
Malaysia’s HALE in 2000 was 65.3 years for females and 63 years for males.
In 2020, it was 67.6 years for females and 66.7 years for males, decreasing in 2021 to 65.1 years for females and 63 years for males.
The gap between Malaysians’ life expectancy and HALE at birth in 2021 was 10.2 years for females and 7.6 years for males.
These are the average number of years Malaysians are likely to spend in ill health.
This is not surprising as many Malaysians are unhealthy.
According to the 2023 National Health and Morbidity Survey (NHMS), the frequency of non-communicable diseases (NCDs) is high.
The survey found that 29.2% (one in three) adults have high blood pressure; 15.6% (one in six) are diabetic; 33.3% (one in three) have high cholesterol and 54.4% (one in two) are obese or overweight.
More than 500,000 Malaysian adults (2.5%) have four NCDs (i.e. diabetes, high blood pressure, high cholesterol and obesity) and about 2.3 million (11.5%) have three.
Ignorance is high with two in five diabetics or hypertensives not knowing they have the condition.
For high cholesterol, it is one in two affected persons.
Only about half of diabetics and hypertensives have their condition under control.
One in three adults are not physically active, which exacerbates these conditions.
A predominantly plant-based diet appears to be another key element in living a long, healthy life as seen in Blue Zone areas.— Filepic
Nine habits for longevity
Buettner and his colleagues identified nine common practices that could contribute to the longer, healthier lives in the Blue Zones.
These were termed the “Power 9” and are:
- Eating a primarily plant-based diet.
- Monitoring calorie intake, including doing intermittent fasting.
- Avoiding alcohol entirely or drinking in moderation, primarily red wine.
- Embracing a sense of purpose in life.
- Following a daily lifestyle that encourages natural, vigorous movement.
- Adopting some form of daily stress relief.
- Incorporating religion or spirituality in life.
- Establishing stable and extended family structures, such as young and old relatives living together.
- Developing supportive social networks and lifelong friendships.
Needless to say, not everyone in the Blue Zones adhere to all these practices equally.
Some aspects are more prominent than others.
For example, the Okinawans have strong social networks formed in childhood and sustained throughout their lives.
Their lives are guided by the Japanese understanding of a life well-lived termed “ikigai”, which is often translated as “that which makes life worth living”.
The Okinawans also practise mindful eating termed “hara hachi bu” (a Confucian teaching to eat only until 80% full).
Loma Linda has a large population of Seventh Day Adventists who are vegetarians with a faith-centred lifestyle.
The Nicoya peninsula community in Costa Rica have a strong sense of purpose and are faith-centred.
The highest number of centenarians globally are in Sardinia where many walk up and down the surrounding mountains tending to their sheep.
Lessons to learn?
Are the Blue Zones real or wellness hype?
This depends on who and what one reads.
However, it is difficult to deny that the Power 9 behaviours are broadly consistent with current understanding about how diet, exercise, social connections and emotional well-being affect health and longevity.
Diet is interesting.
Because of their diverse diets, there is no particular diet in the Blue Zones that one can emulate.
It is pertinent to note that numerous studies report an association between plant-based foods like the Mediterranean and DASH diets, and health benefits like lower likelihood of cardiovascular disease and cancer.
For example, the DASH (Dietary Approaches to Stop Hypertension) diet is one that is low in salt and rich in fruits, vegetables, whole grains, low-fat dairy and lean protein.
Incidentally, this diet is also a healthy way to lose weight.
In a review of the physical activities of Blue Zone residents, it was found that: “(1) Overall, centenarians are performing consistent and continuous movements daily that are predominantly moderate intensity activities, (2) their modes of physical activity are influenced by environment, geography and culture”.
The study concluded that “the homogeneous environment in Blue Zones creates a demand for living a traditional lifestyle. For example, walking to commute, working labour-intensive occupations, participating in outdoor hobbies, and navigating complex terrain with constant exposure to uneven surfaces”.
It also noted that: “Overall, Blue Zones centenarians are highly active, perform continuous and consistent movements daily, maintain daily hobbies, and work beyond the expected age of retirement.”
The message is clear: Physical activity is important.
And one does not have to be a agriculturist to be active.
Although some have attributed the longevity of the Blue Zones residents to genetics, there has been little evidence in support.
Others have attributed longevity to the Blue Zones’ insulation from modern technology with many aspects of their traditional way of life maintained.
While this may be so, there is no reason why we cannot learn from the Blue Zones.
Management consulting firm McKinsey stated in its 2022 article titled Adding years to life and life to years, that at least six years of higher quality life for everyone is within reach.
Everyone can make a start for a longer HALE by embracing something old from the Blue Zones.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
