Sun, Palm Trees and a Long Life
On a warm Thursday at around noon, a converted school bus rolls into the bus terminal in the Costa Rican town of Nicoya, the capital of the peninsula bearing the same name. I manage to confirm that this is my bus and I join the growing line of locals waiting to get on: young mothers, elderly couples, middle-aged women and laughing schoolchildren. We all get in place and soon the bus winds its way out through the concrete jungle of Nicoya and further into the lush Costa Rican countryside. Along the traffic-free road are small, colourful houses, and on the horizon a deep green landscape appears.
Inside the bus, the lone gringo quickly attracts attention. I have to disappoint: ‘No hablo español’. However, that doesn’t prevent a basic conversation from developing anyway. Through a combination of hand gestures, guidebook Spanish and a little Google Translate, we’re able to communicate.
After a while, a woman turns to me cautiously and addresses me in broken English: ‘Are you going to Hojancha?’
I am.
But why? Am I going hiking?
No, not really. ‘I’m here to see the Blue Zone,’ I explain.
The woman laughs and translates for a few of the others. Then she looks at me more seriously. ‘It’s true what they say.’
Half an hour later the bus rolls into the central square of the sleepy village of Hojancha. When I get off the bus, a local man shows me the best restaurant in town while thanking me several times for my visit. Then, while I’m enjoying my casado, everyday life in rural Costa Rica unfolds around me.
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Pessimists might claim that we will never be able to win the fight against ageing or even to seriously prolong life. But that view is hard to share when you know about ageing in nature. Other animals, just as complex as us in their own right, can live for significantly longer than us, go long periods without ageing, or even age backwards. That makes it hard to believe there are fundamental biological limits anywhere close to our current lifespans. With some ingenuity, we have the ball at our feet.
But while inspiration from the natural world might one day help us combat ageing, it is not the only place to look for ideas. We can learn a lot from our fellow humans as well. We’re obviously all very similar, but there are still differences in how well we age and how long we live. And this is where the Nicoya Peninsula comes into the picture. The mountainous Costa Rican region is a popular tourist destination due to its incredible scenery: pristine rainforest, beautiful sandy beaches and a warm, pleasant climate. But in addition, the Nicoya Peninsula is known thanks to its featured role in the book The Blue Zones by American journalist Dan Buettner. In the book, Buettner visits regions of the globe known as ‘Blue Zones’ where locals have a particularly high probability of attaining advanced ages.
Besides the Nicoya Peninsula, there are four other Blue Zones: the Barbagia region of Sardinia (Italy), the island of Ikaria (Greece), the prefecture of Okinawa (Japan) and the city of Loma Linda (California, USA). The inhabitants of all these places boast some pretty incredible lifespan statistics. Take, for instance, those born in the year 1900. Okinawan women born that year were over seven-and-a-half times more likely to become centenarians (reach 100 years old) than women from my native Denmark. And for men, the probability of becoming a centenarian was almost six times higher in Okinawa than in Denmark.
So the question is, what is it about these seemingly random areas of the globe that produces such long-lived inhabitants? Either there’s something special about the people or there is something special about their lifestyles and surroundings.
At first glance, we might be tempted by a genetic explanation. It’s noticeable that all five Blue Zones are somewhat isolated. Even today, many of the transport routes on Nicoya are small jungle trails or dirt roads, where your best bet for getting around is an ATV. This means that the inhabitants have been historically isolated and married locally. If favourable ageing genetics existed in Nicoya, they would have made the rounds for many generations. However, relatedness cannot be the sole explanation. Studies show that when locals move away from the Nicoya Peninsula, they don’t live as long as those who have stayed.
Dan Buettner’s attempt at an explanation revolves around the cultures of these regions: the tightness of families there, the food that’s eaten, the active yet relaxed way of life, and the strong sense of meaning among the inhabitants.
Buettner might be right, but we don’t have much time to find out. In the last decades, the long arm of globalisation has taken a firm grip on the Blue Zones. Today, the lifestyle of a person on the Nicoya Peninsula is converging with that of the rest of the world. There’s lots of fast food, sedentary work, and most people use motorised transportation. In remote mountain villages, you can still find hints of the old way of life, but even here there are satellite dishes on the rooftops and cars in the driveways.
The Okinawa prefecture in Japan is a particularly good example of the deflation of the Blue Zones. Right up until the turn of the millennium, the people of Okinawa had the longest average life expectancy in all of Japan. That’s saying something when the Japanese are already notoriously long-lived. However, since then, this Blue Zone has disappeared before our eyes. Today, Okinawans have one of the highest average BMIs among Japanese prefectures and eat the most KFC, while the island has dropped drastically in longevity rankings and is now among the lowest ranked prefectures in Japan.
By and large, the developments in Okinawa and the other Blue Zones are, of course, a form of progress. Globalisation might have brought obesity and health problems, but it has also ushered in access to modern medicine, clean drinking water and safety from the pain of starvation. Life on the Nicoya Peninsula is probably better today than it used to be. But the rapid economic development of the region makes it hard for us to understand what the secrets of the Blue Zones are. Or rather, what they were.
* * *
Critics of the Blue Zone concept argue that globalisation hasn’t hurt these places at all. Perhaps they were never long-lived to begin with. You see, after the US introduced state-wide birth certificates, the number of very old people dropped sharply. That’s not because birth certificates kill people. It turns out a lot of ‘centenarians’ were just innumerate people unaware of their actual age – or, if you adopt the harsher perspective, straight-up frauds. Critics argue that most of the Blue Zones could be seeing fraud of this kind, too. They reason that
Sardinia, Okinawa and Ikaria are curious places for attaining a high age. They’re remote and poor provinces, characterised by low education levels, relatively high crime rates, high alcohol consumption and high smoking rates.
Now, Blue Zone researchers are not naive and have obviously thought of this angle. They have worked hard to validate the actual ages of the people they study using official documents, interviews with family members and lots of cross-checking. However, it is hard to rule out fraud completely. Fraud has definitely been the cause of other ‘longevity hotspots’ in the past. And one thing is certain: lying about your age is one of the oldest forms of fraud there is. Myths, legends and even historical sources are littered with people who supposedly lived 200, 500 or even 1,000 years. This fact is important to keep in mind going forwards as we discuss studies of centenarians.
If we want to learn about human longevity, it might be safer to look at country-level data instead. In this case, our best bet is the list of average life expectancies around the world published by the World Health Organization. At the time of writing, this list is topped by Japan, followed by Switzerland, South Korea, Singapore and Spain. Positions change from year to year, but in general, the list is a Who’s Who of the world’s rich democracies. Besides that, it is noticeable that developed Asian countries do particularly well. While Japan, South Korea and Singapore are all rich countries, their inhabitants live even longer than might be expected from their wealth alone. The reason for this is currently unknown. One explanation could be healthy lifestyles. Asian countries tend to have healthier food cultures and lower obesity rates than Western countries. But on the other hand, they also tend to have higher smoking rates and higher levels of pollution. Another explanation could be extensive pension fraud. For instance, in 2010, Japanese authorities found that 230,000 of the people listed as centenarians were unaccounted for. Some of these people might have died long ago without being reported so that their relatives could keep receiving their pensions. But then again, there’s nothing to suggest pension fraud should be more common in Asia than in the rest of the world. And besides, Asian immigrants and their descendants also live long lives in the United States. In fact, they are the longest-lived ethnicity in the country, living longer than Americans of European descent.
Zooming in on my own corner of the world, it is also noticeable that Southern European countries tend to outperform their Northern neighbours. At the time of writing, Spain, Cyprus and Italy are numbers two, three and four in Europe. These countries have life expectancies around two years higher on average than some of the more poorly performing Northern European countries, such as Germany, the UK and – it saddens me to say – my native Denmark. The European Blue Zones, Ikaria and Sardinia, are both located in Southern Europe, and I think the rankings accurately reflect the stereotypes held by most Europeans. The ‘Mediterranean diet’ has long been touted as especially health-promoting, for instance.
So while it is no surprise that the inhabitants of rich countries generally live longer than those of poor countries, it seems we should particularly look to East Asia and Southern Europe if we really want to learn about human longevity.