What Do All the Blue Zones Have in Common?

Image Credit: Sally Plank

What Do All the Blue Zones Have in Common?

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains, and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So, we need to optimize the food environment to support whole grains, vegetables, fruit, and plant-based proteins.

That’s one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally, they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn’t eat any meat at all.

So, if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a “provegetarian” scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people to “eat more plant-based foods and fewer animal-based foods.” But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a “gentle approach” to vegetarianism, figuring that if it improved survival, it would be an easily understandable message for health promotion: more plant foods, fewer animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil, and potatoes, but get docked points for any animal fats, eggs, fish, dairy, or any type of meat or meat products. Of course, that means you get a higher score the more potato chips and French fries you eat. That’s why I prefer the term “whole-food, plant-based diet”, since it’s defined by what you eat, not by what you don’t eat. When I taught at Cornell, I had “vegan” students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, “this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy.” A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

Here are some of my previous videos on the Mediterranean diet:

I’ve done a few videos on the health of so-called semi-vegetarians or flexitarians (“flexible” vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

84 responses to “What Do All the Blue Zones Have in Common?

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  1. RE: “When I taught at Cornell I had “vegan” students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.”

    Well, I don’t want to be associated with those French Fry eating, Beer drinking college students, so I’m changing my name from “HaltheVegan” to “WFPB-Hal” ;-)

        1. Funny! Just the other day I was reading about all the acronyms around food choices, and one of the names mentioned made me think of a deplorable doctor who actually told me “don’t be a jerk” when I told him I was going to try following a diet like the one in Forks Over Knives! Needless to say I never went back, but I still fantasize about walking into his office with my own personal acronym to sling back at him, and say, “you were right, I AM a JERK, I Just Eat Real K……….but couldn’t think of a Food related K besides kibble, or even a hard C sound, and the thesaurus didn’t help, besides cuisine and comestibles, which kinda miss the boat. So I guess I could tell him he was close, I’m a JERF, or even better, a JERP? (Plants) I know other people think it too, so it would be fun to use. Yeah, I know, groan. ;)

  2. A healthy diet/lifestyle is not good for the pocketbook of corporate America who buys the political system to implement through power mechanism profitability over lives of everything on the planet. Animal based diets is not good for humans nor animals as millions of innocent creatures are slaughtered every day for consumption in addition to generating horrible environmental impacts for all species due to poisoned earth, water, air. Clean alternative energy and plant based diet means less profits for corporations. Hence, laws are being passed to protect corporations against human encroachment. Look at GMO patents of Monsanto who force many farmers into suicide because they are sued by inhuman corporation for cross fertilizing their fields with Monsanto products….
    To bring changes in our diets in a meaningful way, consumers must organize to force the power machinery to put life over destructive profiteers….Until that happens, planetary systems based on profiteering at any cost will be careening towards long term death spirals…..

    1. I am “organized” in that I no longer purchase processed products or meat/dairy; it’s “the power of the purse.” As more people join this club, we will move in the appropriate direction.

  3. To me, a more important concern is the quality of those longer lives. If you’re sick for the last 10 or 15 years of your life that does not seem like an advantage to me. I do understand the significance of the statistics though as well as the reason for compiling the data. So my question is…. are those people who make modest changes toward eating less meat and more plants actually better off overall?

    1. Use the search box on this website to enter any chronic disease you wish and watch a few videos about the benefits of a WFPBD and I believe it will answer your question. I know that in patients whom I see who have made the switch and most at ages beyond 65, they feel so much energy and a greater sense of well being. I just wish it were more of them.

    2. For myself, I’m convinced that switching to a plant based diet has improved my health so much I can hardly believe it. At near 70 I’ve never felt better, I know that’s hard to believe but its true. Been mostly eating wfpb foods for almost 3 years now and highly recommend it. Of course exercise is also a regular part of my life experience. All the best to everyone who aspires to be well in mind and body. AG

      1. At near 70 I’ve never felt better, I know that’s hard to believe but its true.

        Not hard to believe at all… You want to win, you stick with the winners… I’m in your age bracket, mostly WFPB diet for years and healthy as an ox.. Just back from the yearly physical.. Blood work perfect, BP normal and just a touch over weight (I love beer). The doc asked me how I did it and I just spouted what Greger, Esselstyn, Cooper, McDougal and Fuhrman have taught me over the years… If you have the resolve to take control of your diet and your life, it’s do-able.
        Some can not.. and I understand that..

      2. More power to you AG. Learned about the WFPBD concept about 3 1/2 years ago, first with Dr. Fuhrman and more recently w/NuritionFacts.org. Wished I’d learned about it a couple of decades ago as I know that the deleterious effects of the SAD diet (lots of meat, ice cream, pasta etc.) are cumulative. I am know 69 yrs old, exercise 6-7 days a week (power yoga, other cardio, weights, and WingTsun). I firmly believe that a WFPBD is key and has made a tremendous difference in our lives.

    3. James Fries, a professor of medicine at Stanford University School of Medicine, developed a theory called The Compression of Morbidity. His theory may help make the understanding of a living a healthy lifestyle more clear.

      Think of compression of morbidity like this: if a person’s life expectancy is 80 years but they develop diabetes and congestive heart failure at age 60, that person will spend some 20 years with serious chronic conditions that likely will impact their ability to live independently and enjoy life.

      If instead the person adopts a healthier lifestyle and delays the onset of diabetes and congestive heart failure until age 70, then that person will have compressed the “sick” time into a much shorter time period.

      In other words, we want to minimize the number of years that a person spends suffering from chronic illnesses while maximizing that person’s total number of years.

      It’s possible that adopting a healthier lifestyle earlier could increase the person’s life expectancy, too, but medical research has shown it may not increase lifespan more than a few years. Therefore, the main idea is to shrink the bad months and years between the onset of illness/disability and death.

    4. Yep, moderate diet means moderate illness. I always hear we are living longer, in the past we died younger, but this is misleading and very conditional. We actually had the potential to live longer, healthier lives, like they still do today in the “blue zones”, just living and eating simply, IF you could escape infections, plagues, starvation, accidents, childbirth and infancy. Because we have sanitation and other advances, we are spared from infectious diseases like cholera that decimated populations, but the decline in infant mortality, especially the interventional support of preemies, accounts for the biggest increase in life span. For every person who lives to 100, an infant death drops the life expectancy stats to 50. We aren’t living longer, we are dying slower. What makes me the saddest is, even with our “advances”, the current generation is expected to live measurably shorter lives than their parents with a dramatic increase in illnesses. Our genes are the same folks, it’s the food and our environment!

      1. You know after doing some geneology I found out we have been getting handed a line of bull. My family was living well into their 90’s before antibiotics and packaged weaponized food that came around in the 40’s. They are all barely making it to their 60’s and they are all sick. Coincidence? My ancestors were not vegans but poor farmers who did not eat cheese [that was fancy city folk food] and meat was to expensive. Yep, plant based diets whether they liked it or not.

  4. Another thing to mention about Seventh Day Adventists is they don’t drink alcohol or smoke. We all know the dangers of smoking but few know the dangers of alcohol, alcohol is a pro-oxidant that destroys most of the healthy anti-oxidants you eat. Alcohol also damages the pancreas, liver and kidneys. Heavy drinking of alcohol(>2 drinks per day) has been associated with many types of cancer.

    Dr Gregor has a great video about alcohol use and skin cancer, those who drink heavily and get sunburned are more likely to get skin cancer.

    1. Thank you Jeff. One reads so much hype about ‘moderate’ (2 drinks per day or less) alcoholic consumption being OK. I do enjoy beer (2 or < per day, most days) and nuts or an occasional glass of wine, however I think you're correct. It would be good to phase it out or reduce consumption drastically.

  5. One thing I find curious about the 7th day Adventists living the longest is I assume they still eat dairy as they are not WFPB/vegan. Considering that casein is a significant cancer promoter and folks might also be consuming saturated fat in dairy, it is interesting to hear they live the longest. Well it seems all those plants they eat despite the dairy keeps the cancer and heart disease at bay.

    1. Drjembe, although not every 7th Day Adventist fully adheres to all the teachings of the religion, the SDA religion as a whole does promote a WFPB diet. True, some SDAs do eat dairy, however from what I’ve read, many of the SDAs that are studied as part of the “Blue Zone” do adhere religiously (pun intended) to a 100% plant based diet.

      1. I was just reading through one of the Adventist studies and it appears many of them still eat meat, though not as much as the general population. Apparently only about 8% of them were vegan. Thanks for replying.

          1. Thanks for your input. I did look up 1 study on the Adventists and was surprised to see a substantial percentage still eating animals. Perhaps they take more seriously the no tobacco/alchohol than WFPB.

            1. I don’t know if it helps you guys figure out what you are discussing but the SDA in CALIFORNIA that are always talked about are the ones around 30-35,000 strong.

              I do remember Dr G saying he wished they did a study to single out the vegans to see if they had a longevity advantage over the SDA vegetarians. this may have been during that old video, “40 year vegan dies of a heart attack”.

              that may have been a long time ago and they may already have done a study like this but that is what I vaguely remember.

              I wish nutritionfacts.org would post that video on their site because right now only Michael Lanfield is the only one posting it and if he takes it down, it’s gone.

              ( of course NOW that I check there are a couple of others but just as recently as last year he was the only one )

        1. I’m having a hard time with this. Clearly Dr. Greger (who I love dearly and think is one of the greatest humans on the planet) appears to be completely wrong stating “In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn’t eat any meat at all.” because I cannot find ANYWHERE ANYTHING SUPPORTING THIS. Everywhere I look it appears that SDA’s are not vegan.

    2. There are many videos on the Loma Linda Adventists. Many are WFPB some eat meat. They largely are WFPB. Get some popcorn (pop it yourself, no salt or oil), sit back, and watch a few!

  6. I like Dr. Dean Ornish’s approach to healthy living better than I do Dr. Greger’s approach. Dr. Greger is only concerned about nutrition as the only key to long life and good health. Dr. Ornish has a 3 prong approach which is nutrition, exercise, and spirituality ( placebo effect ). Dr. Greger minimizes exercise in his videos and never talks about the power of harnessing the placebo effect through spirituality to improve one’s life.

      1. WFPBRunner: I will second that. I will also add that even though this is a nutrition website, Dr. Greger includes exercise in his Daily Dozen and walks on a treadmill for interviews to model good exercise. This website has also covered the placebo effect in a positive way.

        1. Since I have your ear…what have you read about supplementing with CoQ10? I tested really low in my last blood work. So now I am sitting in the sun trying to convert those greens I ate!! But still wondering………

          1. WFPBRunner: I haven’t read much about it. I’ve been skeptical of the whole recent push for the CoQ10 supplements, but that could just be my inner conspiracy theorist coming out. I don’t have a lot of data either way. The authors of Becoming Vegan do not even cover CoQ10, at least not that I could find. That says a lot to me, because I think they cover all the bits that they find important and the authors of Becoming Vegan are quire knowledgeable of the science. Have you seen any studies showing that low levels are actually leading to harm?

            1. No. Nothing. Seems to be linked to higher BP. I ran in shorts instead of leggings today! Sunshine before the next set of storms in California.

    1. As WFPBRunner and Thea explained this website Dr Greger has developed to provide evidence based scientific information about nutrition and life style. In fact these wonderful drs such as Dr Greger and Dr Dean Ornish that provide educational website for us, they appreciate each others work. Oh and I thought I refer you to another video that Dr G. provided that you might find interesting.

      Are Happier People Actually Healthier?

    2. Have you ever seen Dr Greger being interviewed? He’s always on his treadmill, where he walks 15 or so miles daily while working. He doesn’t eschew other aspects of promoting health. But on this site he promotes health through nutrition. Just the facts, John, just the nutrition facts…

    3. But Gabriel Cousens, of raw vegan fame does, and is emphatic that these rigorously austere regimes do not work over the longer term unless there is a higher reason (power) than physical wellbeing driving it. Which of course there is for the 7th Day people… Not that eating the conventional rubbish will be better then for those whose focus is relentlessly upon transient physical concerns, just that whether you are indulging yourself through excess or denial (and many people swing from one to the other) will not make much difference to your longer term physical outcomes unless you can find a more meaningful driver for your life choices that physical wellbeing.

  7. Although I agree a whole food, plant based died would be optimal for reducing risk for chronic disease, my question is about food in powdered form. Do powdered foods such as ginger, etc. (which have been dehydrated and ground into powder) have the exact same optimal nutrition benefit as compared to their “whole” food plant counterparts?

  8. This is missing from the discussions… How long generally does it take to lower blood pressure? How long should I expect to be on drugs to reduce it? I need a discussion of what other factors influence blood pressure… Mine is spiking at night…I have followed web to the letter for 2 months… Not enough time??????

    1. Hi Janice, it’s hard to say with exact precision how long it will take you to lower your BP. There are multiple factors at play, such as, how high was your BP prior to starting your diet? The stiffer and narrower your arteries were, the more damage you need to undo with your new diet. Stress can also temporarily raise your blood pressure. If you’re anything but fully relaxed when checking your BP, you may get a higher than baseline reading. Aerobic exercise will also help you lower your BP in addition to diet. Are you getting this in to your daily life? Are you “cheating” at all with your diet and allowing animal products, oil, or salt to “sneak” in to your diet? If you’re doing all of the above and that still isn’t enough, Dr. G recommends foods such as flax seeds, watermelon, beans, lots of veggies to further help you lower your BP. http://nutritionfacts.org/video/how-to-treat-high-blood-pressure-with-diet/ Hope that helps!

    1. I have not found any calculator , but I did find this link describing the provegetatrian food categories and scoring method. http://m.ajcn.nutrition.org/content/100/Supplement_1/320S.full?cited-by=yesl100/Supplement_1/320S
      Table 1 describes the diet scoring method in detail. Also, Dr Greger’s daily dozen goes above and beyond the diet described in the predimed study.. You can find the daily dozen as a free app , or in his ‘How Not to Die’ book.

  9. When I told my doctor I was going vegan she said, the blood chemistries are already perfect on your vegetarian diet. Now that you are vegan is there any reason to even do your blood chemistries? So I skipped a year and sure enough at 75 years old they were even more perfect, the only thing I take is B12.

  10. Loved this article on the vegan diet and plant based foods. Our family live this way and have done so for most of our life. Yesterday (terrible endless heatwave) we rang for an ambulance. They went searching through the house for a 75 year old lady but they coudn’t find one. I was sitting there quietly in the Family room, waiting for them, but they could not pick me as any old lady. Could not believe their eyes. They did not take me away. But do go for the plant based diet with nuts and legumes.. We swim twice a day, once in the pool, once at the reef on the beach. Pam Shell

  11. I’ve been trying to learn about water only fasting and longevity, and I’m having a hard time finding factual data. Could you put “Fasting” or “Water only extended fasting” on your list of topics to do a series of videos on.

    Thanks! I love the fact based information here!!

          1. I’ve watched a few of the TrueNorth videos, and they’re great! So is Dr. Klaper. Dr. Goldhammer says you can go 30-40 days with no problem, and only positive results, and I haven’t seen any science to the contrary.

      1. I’m looking for the best way to promote health Ray. I’ve been on several fasts from 6-20 days, and the worst part is the first 3 days, so I have to disagree with you about length of fast. After day 5 water only, it becomes a piece of cake (First 5 aren’t bad). Eating (or juicing) 500 Kcal a day may keep your body from the process of Autophagy, so I try for water only.

          1. it never made a lick of sense to me either ray but the true north center run by dr mcdougal and goldhamer seem to have miraculous results I think going as long as a month with certain patients.

            me: I gotta eat every hour it seems, I can’t even imagine not eating.

            for the last year I got weekly routine bloodwork that I was supposed to fast for but I never did since I only eat fruit in the morning anyway and since I don’t eat fat It never affected anything except the glucose readings.

          2. You should read up on the science of fasting Ray. I don’t think there is a “reset” that you speak about. Extended water only fasts cause the body to use cells that are old or mutated, or other unhealthy cells. Read up on Autophagy to learn more. Hopefully, we can get a video series on the subject from Dr. G soon!!

    1. the longest lived peoples, the okinawans, also ate meat but it was only 1% of their total diet so are you going to call them meat eaters?

      once a month they would slaughter a hog and everyone in the tribe got a few slices. are you really trying to compare that with our western diet mainly of animal origin?

      did you even read the article above? {but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions}

    1. how many people out of the thousands of residents did you actually see eating *copious* amounts of meat as opposed to a condiment?

      were they just people eating a regular western diet or people who *occasionally* ate an animal meal?

      did they eat huge steaks making up the main meal like at the texas steakhouse?

      can you give us a percentage?

      were they the ones with cholesterol levels below 150 or the ones with levels way above 200?

      so many questions, so little answers in a short one sentence statement….

  12. I just saw this and thought it was relevant. Here is a medical study where a patient reversed or managed her lymphoma with a 21 day water only fast. Go to TrueNorth Health and look in the Learning Center // Articles to find the article.

  13. How did the blue zones get enough b12 every day from their food if they only ate meat a few times a month? Were they eating dairy and eggs every day? How did the Okinawans get enough? From spring waters or contaminated produce?

  14. I don’t know how to read that table at 1:16 in the video. Just for fun i used Cronometer and put grams of suitable foods in each food group. The calories are about 1400 kcal but not enough protein; it’s about 35 grams. Maybe suitable for small children or pygmies. Am i using Cronometer wrong, is the table is wrong or is Cronometer wrong? From the table there’s only 0.3mcg of b12. Most vitamins and minerals are too low. Including potassium. Sorry i just want better understanding of the diet.

  15. Hi Arthur- That’s a good point. It’s not clear from this where the B12 came from nor what the participants’ serum B12 levels were.

  16. Hi! I have checked the Blue Zones website and in spite of Dan Buettner and other pro-vegetarian researchers sayging that these people are 95% vegan,according to my calculation, they are not. I have taken the data from the Blue Zones website and this is the amount of animal protein each zone consume (fish, different types of meat, eggs and dairy): Greece 11%, Loma Linda 16%, Okinawa 2%, Nicoya 29% and Sardinia 31%. With the exception of Okinawa, the average amount of protein is similar to what is recommended in the Mediterranean Diet (15%). Actually the average in the Blue Zones is closer to 20%. What surprised me most is that in spite of the bad press that dairy get, Sardinia for example, consume big amounts of dairy from goat and sheep. Any thoughts on this? Can someone explain to me why we are told that these populations are nearly 100% on a WFPB? Thank you.

    1. Yeah I noticed the same thing actually. Obviously their diets are heavily plant based, and we all agree that is healthy, but they simply are not remotely close to being ONLY plant based. I feel it’s a misleading play by the veganatics to support an agenda.

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