Fraud accusation: New pushback on well-known blue zones data
Key Takeaways
“Blue zones” are parts of the world where people tend to live to very old ages while maintaining good health.
The concept has been called into question by some, including one researcher who has cited fraud in prior (widely shared) studies.
Despite these issues, it remains worthwhile to examine areas where people tend to reach older ages to uncover clues about how to live longer and healthier.
After traveling to Okinawa, Dan Buettner, a National Geographic explorer and journalist, helped coin the term “blue zones” to refer to parts of the world with unusual concentrations of people with very long lifespans and good health into old age.[]
These zones have been found in Sardinia, Italy (the first location to be studied); Ikaria, Greece; Loma Linda, CA; Nicoya, Costa Rica; and the Netherlands.[][] An industry has been built up around the concept, and Buettner even released a Netflix series on the topic: Live to 100: Secrets of the Blue Zones.
The blue zone concept has come to encompass a range of ideas related to extreme longevity, but it’s becoming more popular to question the concept in general—most notably by Saul Justin Newman, PhD, a demographer with the Centre for Longitudinal Studies at University College London, who, in 2019, wrote that “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.”[]
Buettner’s team has since pushed back on Newman’s claims, underscoring that the paper has never been peer reviewed or published in a scientific journal.[] “His failure to be accepted by any credible, peer-reviewed journal for so long indicates that his theories are not taken seriously by actual experts in the field,” they said.
Thomas Perls, MD, of Boston University, who is founder and director of the New England Centenarian Study, a principal investigator of the Long Life Family Study (funded by the National Institute on Aging), and a “vocal critic of the ‘anti-aging’ industry,” according to his bio, weighed in on the controversy for MDLinx.
What’s the truth?
Regarding the original blue zone research in Sardinia, Dr. Perls said, “I'm not sure that anybody's adequately determined if those persist or if they're just kind of by chance. [...] I will say that, generally speaking, I think in terms of particular areas that are persistently showing an increased number of centenarians, I don't buy it.”
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Nevertheless, Dr. Perls said the messages that have come out of the movement, which pivoted more to the idea of examining regions where average life expectancy and health span were longer than average, have been positive. He cited identification of the Seventh-day Adventist community in Loma Linda, CA, as a blue zone as an example: “They don't have more centenarians, but they have health habits dictated by their religion that naturally lead to a higher average life expectancy for that group.”
Overall, Dr. Perls said, “What Dan Buettner has done in terms of using this blue zone concept to promote the notion of healthy behaviors and the idea of expanding health span, which means the period of your life that you're healthy, I think has been terrific.” Indeed, he added, there is a lot of evidence showing that by adhering to a handful of health habits, the average person can reach close to 90 years old, if not older.
He pointed to one paper published in Circulation in 2018, which examined the impact of healthy lifestyle factors on life expectancy in the US population.[] Data on roughly 120,000 people followed for up to 34 years showed that risks of death from all causes, cancer, and cardiovascular disease were lower for those who had all five of the following low-risk factors: never smoking, normal body mass index, adequate levels of moderate to vigorous physical activity, moderate alcohol intake, and a high-quality diet. By meeting all those criteria, 50-year-old women and men added 14 and 12 years, respectively, to their life expectancy.
“I think that's remarkable and amazing,” Dr. Perls said. “And you're not just increasing life expectancy, but you're also increasing health span because you can't really add unhealthy years by virtue of having healthy behaviors. I really think that it's that notion that [Buettner] is mostly pushing. [...] I think that the blue zones have really morphed from this idea of high concentrations of centenarians to much more the notion of parts of the world that embrace healthy habits.”
Not such a sham idea
So is the blue zone concept a sham? Dr. Perls says no, but with some nuance.
“Some of the claims of areas that have high concentrations of centenarians because of specific environmental traits I think are unproven. I wouldn't call it a sham, though,” he said. “I think it's a little damning to call something a complete scam like this when there's still room for further investigation and the ultimate goal of the work is, I think, really quite laudable.”
It is still worth investigating areas of the world where people tend to live longer, healthier lives to gain insights into increasing health spans, Dr. Perls said.
In particular, “there is room for much more research in trying to understand the genetic component of what it takes to live to 100, but even more so living to 105 or 110, and understanding how people of different backgrounds may have different genetic signatures that facilitate that,” he said, touting the importance of having racially and ethnically diverse research samples.
The blue zone concept, Dr. Perls said, “is spot on when it comes to describing centenarians as this human model of avoiding or delaying age-related diseases and of expanding your health span or the period of time you're healthy.”
But when regions with increased rates of exceptional longevity are proven to exist, “I don't think it's going to be because of some special sauce, whether it is being in the Andes and drinking glacial milk or being in a region of China that claims they have particularly wonderful air and if you go there for a week, you're going to live longer,” Dr. Perls said.
More likely, what will be driving better health spans in these areas will be sociodemographic and cultural forces, like not smoking, Dr. Perls speculated. “And then the question is, what proportion of the population has what it takes to get to 100 when the sociodemographic forces enable a lot more people to get to very, very old age. That's unknown. But I think it's very much worth investigating.”
What this means for you
There are questions about whether blue zones, or regions with particular characteristics that encourage extreme longevity, exist. It is, however, worthwhile to study these areas to gain insights into how we can all lead healthier lives. If your patients ask about how they can improve their chances of reaching old age with good health, you can point them to research showing that adhering to just a handful of healthy habits can go a long way.