Blue Zones Project Blog

No doubt treatment has never been better for various forms of cancer such as leukemia, lymphoma, Hodgkin’s disease, and testicular cancer. But the best treatment will be prevention by embracing healthy lifestyles such as avoiding tobacco use, maintaining a good body weight, and moderate use of alcohol.

No one wants to be a patient, but if you are—or if you have a family member who is—it would be nice to know what to ask and how best to be treated well.

“Eating Better for Less: A National Discount Program for Healthy Food Purchases in South Africa,” is the title of a paper published in the American Journal of Health Behavior, proving that diet quality can be improved by reducing prices of healthy foods.

You have probably heard about a vaccine being able to prevent shingles. This painful, localized recurrence of chicken pox always occurs on only one side of the body, usually later in life, in people who have had chicken pox as a child. About one in three people used to get shingles prior to the availability of the vaccine according to the Centers for Disease Control and Prevention. Should you ask your pharmacist or physician for this prevention?

Obesity is America’s epidemic. We are what we eat is a thought which we all need to take even more seriously than we ever have before in our current civilized society.

A major opportunity to improve the value of healthcare lies in eliminating unnecessary tests. A few years ago the American Board of Internal Medicine (ABIM Foundation) issued a comprehensive report entitled Choosing Wisely. The focus of this broad and somewhat controversial report was on medical tests and procedures that may be unnecessary and, in some instances, can cause harm.

As individuals gain weight, many myths and presumptions about obesity have also grown– despite the lack of objective evidence. A New England Journal of Medicine article (“Myths, Presumptions, and Facts about Obesity”) helped separate facts from these many myths and presumptions. Our nation has the distinction of being the second fattest nation in the history of the world. Nauru is the fattest.

Forty-three percent of the increase in daily calories Americans consumed over the last 30 years has come from sugary drinks, according to Dr. Harold Goldstein, Executive Director of the non-profit California Center for Public Health Advocacy.

Most everyone is concerned about the predicted epidemic of Alzheimer’s disease. Epidemiologists expect the 5.4 million Americans over 65 presently diagnosed with memory loss will grow to 13.5 million by 2050. Alzheimer’s is the sixth leading cause of death in our country.

Nearly half of the physicians in our country think we are delivering too much care. In a survey conducted by the Dartmouth Institute for Health Policy and Clinical Practice, in association with Dr. Brenda Sirovich from the Outcomes Group at a Veterans Medical Center, 627 physicians from an American Medical Association database were asked to share their thoughts. More than 40 percent thought their own patients received too much care, six percent thought too little care, and the remaining thought just the right amount of care.

The recent multiple tragedies involving gun violence have rekindled the concerns Americans have over the public health hazard of easy availability of guns. “In 2020, the most recent year for which complete data is available, 45,222 people died from gun-related injuries in the U.S., according to the CDC. That figure includes gun murders and gun suicides, along with three other, less common types of gun-related deaths tracked by the CDC: those that were unintentional, those that involved law enforcement, and those whose circumstances could not be determined.”

The article below was created in seconds by Chat GPT in Costa Rica during a dinner conversation about AI. I shared the following phrases to create the article: Blue Zones Project, Nicoya Peninsula, diet. Magically the article below appeared. Thinking broader, content may be created quickly and easily, although creativity may dim and suffer.

According to a recent Harvard Chan School of Public Health recent seminar entitled Inside Costa Rica’s healthcare success story the “average life expectancy in Costa Rica has steadily increased from 55 years in 1950 to 81 years today—far outpacing the U.S. Even more notable: the country has achieved this success while spending far less than the U.S. as a share of income. What’s behind Costa Rica’s remarkable success? How has its progress in health care improved its resilience? And what lessons can we learn for other nations?”

Nicoya Peninsula on the Pacific side of Costa Rica is one of the five original Blue Zones. Although I have been privileged to visit and work with many Blue Zones Projects in the U.S., this was my first experience with one of the earliest regions where more people live to be 100. During spring break my three generational family embraced surfing—two of us had modest previous experience but the rest of us were new to the challenging and enjoyable sport.

The American Cancer Society has excellent statistics showing the overall cancer death rate has decreased. Among males, age-adjusted cancer deaths per 100,000 population decreased from 210.9 in 2009 to 172.9 in 2019. Among females, age-adjusted cancer deaths per 100,000 population decreased from 147.4 in 2009 to 134.0 in 2016, and then decreased at a faster rate to 126.2 in 2019. This decrease is far better than an increase, but we have tremendous opportunity to continue this improvement.

On average, three of every ten Americans did not feel well-rested last night according to the CDC.

Complementary and alternative medicine (CAM) continues to thrive as numerous physicians and very credible institutions—including the Mayo Clinic—embrace many of the therapies. A surprisingly large number of Americans, estimated as high as 70%, have tried CAM—acupuncture/acupressure, herb/vitamin therapy, hypnosis, chiropractic/massage, aromatherapy, magnetic therapy, and reflexology—to cure their ills. A relatively new term—integrative medicine—is now being employed as traditional evidence-based medicine is combined with CAM for better treatment outcomes.

Sadly, the incidence of fractured families seems to be more prevalent today than ever before. Too many family groups—children, adult children, siblings, parents, and grandparents—are not enjoying the natural bonds of love, support, or at least communication, which were so necessary in olden times but now appear more commonly to be broken.

A Copenhagen City Heart study reported that people who jog at least an hour per week live an average of six years longer—6.2 years for men and 5.6 years in women.

Medicine is changing dramatically! Since the dawn of the age of genetics—which officially started in 2001 with the unraveling of the human genome—recent advances have led to an explosion of new diseases. These illnesses and conditions are better defined by their molecular composition and, therefore, are more easily diagnosed and better treated.

Want to look “cut and trim?” Depend on exercise, good diet, and avoid shortcuts—they can have adverse effects on your body and overall health.

No one wants to consider their own mortality—their final chapter. Yet, as it’s been said, no one leaves this world alive. As we grow older, this subject becomes more and more relevant and has recently been highlighted, as medical care for the elderly becomes more efficacious and expensive.

Time to get up and move is the theme of an Exercise and Sports Science Reviews paper entitled, “Too Much Sitting, The Population Health Science of Sedentary Behavior.” Considering the amount of time everyone sits at work, school, driving, glued to screens, and even recreation when passively watching TV, we have room to improve our health.

Your level of physical fitness is important in avoiding body frailty and delaying brain aging states the Center for Disease Control and Prevention. Many studies have confirmed these findings in scores of men and women by comparing physically fit people in different age groups with those who had not exercised. They discovered that lack of exercise, in this latter group, had caused their muscles to be infiltrated with fat and their brains to atrophy.

Many prescription drug ads and commercials directed to consumers can be confusing and scary. But they are effective! This was the finding of a U.S. Food and Drug Administration article, “The Impact of Direct-to-Consumer Advertising,” evaluating the agencies allowing TV advertising starting in 1997.

Each year everyone is encouraged to get a flu shot. This year is no exception, and it isn’t too late to get the almost painless injection. The formula for the vaccine is unique to the anticipated strain of flu that is circulating that year. Usually, the epidemiologists are correct in their predictions as to what elements will effectively fight the current strain, but there is always uncertainty. Scientists are now developing a “super antibody” called F16 that can fight all types of influenza A viruses so that the vaccine would be the same each year. In fact, immunity might last even longer than a year so that one shot could last many years.

Caregiver “burnout” is all too common among the one in five Americans attending to the health care needs of a loved one with a chronic illness. As a former practicing geriatrician, internist, and rheumatologist for twenty-three years, I had the privilege of caring for many folks over the course of a chronic illness—from first diagnosis to either remission or not surviving. These illnesses ranged from rheumatoid arthritis to progressive dementia. Helping not only the patient, but those around the patient who suffer as well can all be assisted. By caring for the entire milieu—patient, caregiver, family, and the environment that engulfs them—all will have potentially better outcomes. Society will also benefit by enjoying a better quality of life while using fewer resources.

As much as we enjoy the family time together during Thanksgiving and the holiday season watching our weight remains important. The average non-obese healthy American gains about five pounds during this otherwise joyous time according to a New England Journal of Medicine article. Obesity is defined as being 20% over your ideal body weight for your height.

Supporting the health needs of older Americans has been a major goal of our country since the passage of the landmark Medicare Act in 1965. The passing of the Patient Protection and Affordable Care Act (ACA) in 2010 recognizes the critical role of preventive services to improve the unique social, economic, quality of life and health needs for those over 65 years old. About half of all health care expenditures are for those 65 and older.

Knowing how to best help yourself or a loved one thrive in today’s complicated and confusing healthcare system is important to your health. We have access to the best healthcare in the world, but most patients and their families do not maximize their potential benefits because they do not understand the system.

The esteemed political columnist George Will shares his opinions in the Washington Post. He described America as “a giant all you can eat buffet” offering calories, credit, drugs, sex, and other intoxicants in excess.

Preventive care is more important than an annual physical, according to both an Archives of Internal Medicine article and the past president of the American Academy of Family Physicians. Preventive care is incorporated into an annual exam only about 20% of the time with the remaining 80% of prevention occurring during other office visits or venues.

Cancer is still too common and deadly—even though early diagnosis and better treatments are available. Cancer death rates downward trends in mortality (cancer death rates) are the gold standard for evidence of progress against cancer. Adults overall, cancer death rates decreased 2.2% per year (on average) among males and 1.7% per year (on average) among females. In fact, for ages under 65, neoplasms (cancer) account for 26 percent of deaths while heart disease only 18 percent. For individuals over age 65, cancer fatalities drop to 22 percent, while cardiac disease deaths increase to 29 percent. Although both cancer and heart disease prognoses have improved since 1975, the rate of improvement for cancer lags behind that of heart disease.

It is said, “We are what we eat,” and, as a nation, we are eating too much! Further, we don’t fully understand what we are consuming. Americans increasingly rely on restaurant dining. In 1970, we spent just 26% of our food dollars on eating out whereas today’s modern family spends 44% on away-from-home meals. The average American today consumes about one-third of his or her food calories at restaurants and other food-service establishments, while 30 years ago only 18% of our calories were consumed in restaurants.

When we’re feeling stressed or pressed for time, many of us are tempted to give up a few precious hours of sleep to tick a few more items off our to-do lists. But trading too much sleep for wakefulness comes at a cost.

Being able to comprehend your own health issues makes a significant difference in your overall health outcomes. By following instructions, reading, correctly administering prescriptions, understanding your diagnosis, prognosis, and treatment—you will determine what happens to you and how well you live... perhaps even how long you live.

Taking your prescription and over-the-counter medications faithfully will help you stay healthier, live longer, be more productive, and reduce cost. Former U. S. Surgeon General C. Everett Koop stated the obvious: “Drugs don’t work in people who don’t use them.” There are 3 billion prescriptions written each year but only about 50% are taken correctly. With only about half of all people for whom medications are prescribed adhering to the regimens, more than one hundred billion dollars is spent each year on avoidable hospitalizations—according to a New England Journal of Medicine article. An estimated 89,000 premature deaths from high blood pressure could be avoided if patients took their anti-hypertensive medicines faithfully.

Prostate cancer is the most common cancer among men, except for skin cancer that is generally not as serious except for melanoma. This year, an estimated 164,690 men in the United States will be diagnosed with prostate cancer. Understanding how to best detect prostate cancer is the first step to helping.

Osteoporosis is a disease which discriminates against women. One half of all women and one fourth of all men over age fifty will have a fracture due to osteoporosis at some time during their lives. Approximately 19 billion dollars per year is spent in the United States to repair two million fractures (broken bones). Of these, 297,000 are hip fractures, 547,000 vertebral fractures, 397,000 wrists, 135,000 pelvic and 675,000 are fractures at other sites.

An estimated 20% of Americans use prescription drugs for non-medical reasons. This overuse or abuse of pain medications, sedatives, or stimulants can easily seduce the brain’s “reward pathways” into desiring more medications than are needed or are therapeutic.

August is Happiness Happens month. Happiness is an essential quality for a good life and a positive measure in successful Blue Zones Project communities. But what exactly is happiness?  

Over the years, coffee has had a variety of reputations from the very negative—allegedly stunting your growth, causing anxiety, elevating blood pressure, inducing miscarriages, causing heartburn—to the very positive: improved athletic prowess, reducing the risks of gallstones, Parkinson’s disease, Alzheimer’s disease, diabetes, and some forms of cancer.  

“Can relationships boost longevity and well-being? You probably know there are many ways to improve your well-being and chances of living longer such as exercising more or eating better. But did you know that maintaining meaningful relationships also may play an important role in health, happiness, and longevity?” These thoughts were shared in a Harvard Public Health article based on eight decades of research reminding us of the important connection between our physical and emotional health.

Brevard, North Carolina answered the question, “What is the price of poor well-being?” by investing in the work to make a lifestyle change for the entire community. Much like a pebble tossed into a pond causing ripples, a small group of leaders including Lex Green, Mark Burrows, Sarah Hankey, Tammy Hopkins, and CEO of Gaia Herbs Jim Geikie transformed people, organizations, and entire regions.

Ever have trouble recalling a word or a name? Have you or a loved one ever been concerned about mental deterioration or Alzheimer’s disease? If you answered “yes,” you are in the majority! Most people have had these concerns. The question is: what is part of the normal aging process, or what may become a progressive, debilitating disease?

Does complementary and alternative (CAM) medicine have any efficacy? The answer is that no one knows for sure but most everyone has an opinion, and many are making a handsome living from the gullibility and naivety of the public combined with the lack of scientific evidence. 

One out of every three Americans over the age of 65 falls each year. Fortunately, most falls do not result in serious injuries, yet almost half of these falls can be prevented. There are many causes for falling but the primary trigger is loss of balance. In fact, about forty-five percent of people over age 45 experience dizziness or balance problems.

Winston Churchill once said, “We shape our buildings, and afterwards our buildings shape us.” While this quote was part of a statement following the WWII destruction of Britain’s House of Commons, many have shifted the words over the years to read, “We shape our homes and then our homes shape us.” Not exactly a historically accurate quote, but no less true today.

We are gaining weight as a nation. About eighty percent of illnesses are self-induced, with diet contributing heavily to our misery. About seventy-four percent of Americans are currently overweight. Our country spends $147 billion a year to treat obesity, $116 billion to treat diabetes, and hundreds of billions more on cardiovascular disease therapies. The many types of cancer that have been linked to the so-called “Western diet” that accounts for billions more, according to a recent Nature article.

Among the most difficult and uncomfortable topics to discuss is, “How am I going to die?” Yet no one leaves this earth alive. As part of the national debate on health care reform, thinking about the cost of the last year of life and dying itself has moved to the forefront.

Do you ever feel sad or irritable, lose interest in usual activities, not been able to experience pleasure, feel guilty or worthless, and have thoughts of death or suicide? Or have you had difficulty concentrating or making decisions? How about fatigue, feeling restless, slowed down, insomnia, change in appetite or activity?

When we hear the term, “spring cleaning,” we all know what this means - it’s that time of year again when deep cleaning and decluttering of our living spaces are in order. Why is it that spring is the best time to clean our homes, and why do we need to do this anyway?

This beginning of this century may be known as the “Age of Genetics,” just as the end of the last century was known as the “Information Age.”

The decision to start a new exercise routine can be downright daunting. Even more so if you’re juggling a full-time job, a family, and all the other time and energy life can demand. But you don’t need to spend a lot on an expensive gym membership or a monthly stationary bike rental to move your fitness needle. Here are a few tips for establishing an effective fitness routine in the comfort of your own home.

The harmful effects of smoking have been known since the mid-1950s when the link between smoking and lung cancer was statistically proven. Dr. Morton L. Levin of the Roswell Park Memorial Institute in Buffalo, NY a state cancer research-treatment center, made this connection. Subsequently, he boldly wrote to the presidents of seven leading tobacco companies suggesting that they voluntarily label all cigarette packaging with a warning that excessive smoking is dangerous to health. At that time, it created a firestorm of controversy, with the tobacco companies defending their positions. I had the good fortune to work under Dr. Levin during the summer of 1965 in a National Summer Science program. Packages were finally labeled in 1964.

Our mental health—how we consider the world and our role in it—is every bit as important as our physical health. And just as we must work to stay physically fit, so, too, must we work to keep our minds “in shape.”

We are the second fattest nation in the world. (Nauru, the third smallest nation in the world, is fatter.) What can we do about this? What diet is best? How can we best motivate people to lose weight, keep it off, or—better still—not become overweight in the first place? Statistics show that in 2017, more than two-thirds of the U.S. adult population were considered overweight or obese. Obesity is the second most common cause of preventable death in our country, ranked just after smoking.

The importance of spending time together as a family (or chosen family) is pretty indisputable. Fostering healthy connections with family members is crucial for our social well-being, and for our overall wellness. 

The human body is amazing. We take for granted the underlying, almost autonomous functions that keep us healthy and functional. Most times, with a casual nonchalance, we don’t even realize what goes on second by second inside our bodies as we direct our conscious attention to interaction with the outside surrounding environment. Our bodies are more complex than most computers. Organ system examples are fascinating.

May is Mediterranean Diet Month, a campaign started in 2019 by the Mediterranean Foods Alliance to celebrate the good-for-you foods associated with this region of the world.

What is the value of making lives longer and healthier? Is living longer no matter what more valuable than staying healthy? How does the value of treating aging comprehensively compare to eradicating diseases specifically? These thoughtful questions were addressed using an economic model rather than the traditional biological model in a University of Oxford study, “The Economic Value of Targeting Aging,” and a McKinsey Health Institute paper entitled “Adding Years to Life and Life to Years.”

The month of May brings warmer temperatures and longer days as well as many delicious fresh fruits and vegetables at their peak. It’s no wonder then that May is also National Salad Month.

Over 70% of illnesses are caused by our own behaviors. Most everyone knows there is an association among heart disease, diabetes, obesity, and hypertension with high lipids (fats in the blood). Equally understandable is the concept that we are what we eat.

Rethinking Community Benefit Programs—A New Vision for Hospital Investment in Community Health, co-authored by Dr. Jay Bhatt, a friend and former Chief Medical Officer of the American Hospital Association (AHA), makes the case for healthcare systems to invest in the community outside their walls. Moving upstream from a “repair shop” to a “prevention program” will eliminate unnecessary misery, decrease cost, and ultimately save the healthcare industry from bankrupting itself and the nation.

If you are you interested in your life expectancy based on your location, place your ZIP code into Robert Wood Johnson Foundation’s internet site. You can easily compare ZIP codes’ results if you are thinking of relocating.

Diversity, equity, and inclusion (DEI) are appropriately top-of-mind in America today, particularly for health professionals, governmental officials, influential leaders, and concerned others—all who have witnessed the disproportionate devastation of socio-economically disadvantaged populations from the pandemic as well as those who desire to eradicate systemic racism.

The word “selfish” carries a negative meaning which is appropriate in most respects. In the case of volunteerism, selfish is good! We’d like to think of volunteering as a selfless good deed, but at its core, we are being rewarded and know it.

Earlier this week, Pete Delgado, President and CEO of Salinas Valley Memorial Health System (SVMH), and Dr. Steve Packer, President and CEO of Montage Health, shared their success with almost a hundred senior healthcare executives at the annual American College of Healthcare Executives Congress.

If you hadn’t made the leap before, the COVID-19 pandemic and shutdown aggressively shoved most everyone into the virtual world, whether it was by streaming movies at home instead of going to a theater, or buying dinner via a food delivery app. Some of these things will no doubt be ditched ASAP, but others will be permanently woven into our culture going forward. 

Understanding poverty, unemployment, homelessness, drug-addiction, or any other socio-economic stress was a topic addressed last week. How well would you survive in poverty is the subject of this week’s Blue Zones Bulletin. Ruby Payne’s “Understanding Poverty” quiz is revealing.

Understanding poverty, unemployment, homelessness, drug-addiction, or any other socio-economic stress and unfortunate situation is a challenge for those of us who are so fortunate not have such an affliction. This essay is the first of two raising awareness to those living nearby folks with these overwhelming conditions.

"Up and Down with ecology—the issue-attention cycle” by Anthony Downs is celebrating a golden anniversary this year. The example fifty years ago relates to ecology, but the principles are the same for current and re-emergent issues such as Civil Rights, HIV/AIDS, obesity, immigration, natural disasters, homeland security, global warming, and oil spills, as well as COVID.    

Sustainability is a timely, important, and complex subject. Thoughts, shared last week in the first of three BZP Bulletins on the topic, are summarized as follows: Sustaining well-being and good health for people, organizations, and communities is mission critical for equity, diversity, social cohesion, and quality of life.

Dan Buettner did all of us a great favor when he set out to answer the perennial question: what keeps some people healthier, longer?  By finding the longest-lived people on earth, and spending time with them, observing their habits and lifestyles, he isolated specific commonalities among these groups.  His books grace us with the wisdom he and his team gleaned from this research.¹

Well-being and good health are mission critical for individuals, organizations, and communities. Equally important is sustainability once the quintessential qualities that add healthy life expectancy have been accomplished. The quote, “The ability of a community to develop processes and structures which not only meet the needs of its current members but also support the ability of future generations to maintain a healthy community,” captures the need for a long view according to the Business Dictionary.

There's no doubt about it: We are smack-dab in the middle of winter. As beautiful and fun as these colder months can be, they can also bring challenges to our physical and mental health. Some can be mild, like dry skin or holding a few extra pounds, and others can be more serious, like seasonal depression.

What is brain health?” is the first question asked in a National Institute on Aging article addressing cognitive health in older adults. Defining brain health includes the following:

“Good genes are nice, but joy is better” is a summary thought of an ongoing 75-year-old Harvard longitudinal study that followed the lives of 268 Harvard educated men, the majority of whom were members of the undergraduate classes of 1942, 1943, and 1944. This informative survey has run in tandem with The Glueck Study," which included a second cohort of 456 disadvantaged, non-delinquent inner-city youths who grew up in Boston neighborhoods between 1940 and 1945. 

Defining the Need for New Forms of Therapy, an Ode to Dr. Beck

Leading a happy, healthy retired life is a goal regardless of one’s current stage during a journey to retirement. Most of us want to have had successful careers followed by a long, enjoyable, and satisfying dividend at the end of our formal working years.

Sure, the kitchen is where you cook, but it can also be the heart of your home. It may be where you gather with family to share stories about your day over a meal. Or your kitchen may be the place where you share recipes, and good times with friends.  

Following her own sage advice and life-long professional career of helping others, Terri Merritt-Worden, Vice President of Operations of the Blue Zones Project by Sharecare, celebrated the start of retirement. Upon request for advice about wisdom accumulated during her career, Terri shared her top ten suggestions for leadership, well-being and health during a final good-bye with the Blue Zones Project team. Senior Project Manager, Mandy Butters codified these recommendations, which are good for anyone from youth to old age. Terri was a big fan of David Letterman, so in his style, here is her Top 10 List:

Positive emotions, calm feelings, warm connections, and good thoughts all contribute to excellent health. Healthy people typically enjoy good mental attitudes. The opposite is also true—namely, sad folks have more disease and misery. 

Third party validation based on legitimate metrics makes accepting positive change essential for altruistic leaders. Well-being and health can be measured and statistically improved using proven principles and processes. No longer will the tyranny of the present nor learned helplessness validate persistent misery and disease.

Therapies are constantly advancing, spurred on not only by new enabling technology but also sadly by increasing need. Two weeks ago, a paper entitled “Clinical Efficacy and Psychological Mechanisms of App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Control Trial,” was published showing for the first time that digitally delivered mindfulness can be effective for treatment of anxiety.    

Why are some folks more creative, charismatic, and energetic at various times of the day? Are you a morning person or a night creature? If you have a difficult problem to solve, do you try to do it first thing in the morning or hold it until the still of the night? Do you fall to sleep easily or have trouble getting out of bed in the morning? 

It may be more deadly than obesity. It is a major risk factor for dying prematurely.  

This malady is called loneliness. It has been described as social pain, a psychological mechanism meant to alert an individual of isolation and motivate him or her to seek social connections. Loneliness is a complex and usually unpleasant emotional response to isolation or lack of companionship. Concerningly, COVID has exacerbated the misery.  

Science has unlocked innumerable possibilities for people to live better lives. From the rapid development of a highly effective COVID-19 vaccine to constant advances in medical treatments, living without suffering has become an attainable goal for groups who never would have dreamed it possible even a few years ago.