I am often amazed at how some patients have aged so gracefully well into their 80s and 90s, active with a sharp memory, fully ambulatory and self-sufficient, while others (often quite younger), seem so debilitated.  While good genes and family history are important, disposition and lifestyle influence these outcomes as well.  Social scientists have studied different societies and cultures to see if there are common characteristics which can predict longevity. These “blue zones” cultures, which have rates of centenarians 10 times higher than the U.S., include Sardinia (Italy), Okinawa (Japan), and Loma Linda, California (7th Day Adventist community). After reviewing much of the data, I have distilled the findings into the 4P’s: People, Purpose, Plants, and Pedestrian.


  1. People

A Harvard study of aging recently found that satisfaction with social relationships at age 50 was the biggest predictor of health and longevity – more important than cholesterol, blood pressure, exercise or family history! Loneliness is as detrimental to health as smoking and alcohol. The more friends and social bonds you have, the longer you will live. As a corollary, blue zone cultures tend to have reverence for the elderly, keeping them fully engaged and integrated.  Their societies also maintain communal rituals. For example, the 7th day Adventists observe the Sabbath together, have weekly congregational prayers and go for communal walks. In America today, we are finding more isolation – the average American had 3 good friends 20 years ago, now it’s down to 1.6 (and no Facebook doesn’t count).

  1. Purpose

Maintaining a sense of purpose in life even with advanced age is integral for longevity. Blue zone cultures often don’t have a word corresponding to “retirement” as we do. These cultures are rich with stories of fisherman, farmers and yes, even surgeons active into their 90’s and into 100s.  In fact, researchers have found that in the U.S. the two riskiest years for mortality are the year of birth and the year of retirement.  In Okinawa, there is a word that encompasses this sense of purpose – ikigai, roughly translated, “a reason for being”, which embodies their core societal principle.

  1. Plants

A plant-based diet is a universal contributor for longevity. This doesn’t imply that all centenarians are vegan or vegetarian, but it’s well established that emphasizing plants (fruits, nuts, vegetables) as the cornerstone of diet results in fewer chronic illnesses, including heart disease and cancers.

In fact, cultures where American fast food companies are expanding are showing alarmingly increased rates of diabetes and obesity. The Middle East, the Far East, and South Asia in particular have been bombarded with American fast foods (Hardee’s, Carl’s Jr, Pizza Hutt, Burger King, McDonald’s are all part of  a new landscape in some of these ancient cultures; Think the Tobacco company model – cigarette use down in the America, go find a new market; Same with Fast food).

Portion control is also characteristic in these cultures. Confucious, Buddha and the Prophet Muhammad all emphasized ending meals before satiety sets in, and this ancient philosophy is embedded in many of these cultures.


  1. Pedestrian

Regular walking, as part of an active lifestyle, is prevalent in blue zone cultures (gardening is common as well).  The billions of dollars spent on the fitness industry in our society and increasing numbers of ultra-athletes (marathoners, tri-athletes, etc) hasn’t improved health – to the contrary, there is ample evidence that exercise and longevity follows a “U-shaped” curve (very little and too much exercise both lead to increased mortality). Outdoor exercise also creates a higher sense of vitality and well-being than being indoors, likely from sun and natural Vitamin D exposure.

To conclude, while it is important to address the chronic illnesses that beleaguer our culture by pushing and creating medications (the hallmark of our current medical system), these are not the themes of “aging gracefully”. I encourage everyone to  emphasize the comparatively simple practices outlined here.

For more information on blue zone cultures, check out :


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