Heather Bedard, C.H.E.
One would think that finding the optimal diet would be easy based on the plethora of articles, papers, books, and magazines on the topic. However, conflicting messages abound despite decades of research and “expert” conclusions on the topic. It would seem that every generation continues to ask, “What is a truly healthy diet and how can I live the longest and do it while remaining active and independent?”
With all the claims out there, where could one even begin to look to find something that comes remotely close to an answer? Enter the Blue Zones. The name, coined by Dan Buettner in his popular book “The Blue Zones”, refers to five groups of people who boast the world’s largest communities of people who are active past 100 years old. These remarkable groups of people are of different races and places ranging from Loma Linda in California, U.S.A to Okinawa, Japan, but they also share similar characteristics. Do these differences and similarities offer us any clues to what it takes to be healthy and active long into our senior years? Can we extrapolate meaningful data that will give us a starting point by which we develop an idea of what it means to have a healthy diet that gives us this opportunity? As we dive deeper into the diets and lifestyles of the beautiful people of Ikaria, Greece, Okinawa, Japan, Sardinia, Italy, Loma Linda, California, and the Nicoya Peninsula, the hope is to do just that. This paper will explore each group of people, what makes them unique and compare the differences and similarities that are exposed. Perhaps in the end we will find the ever-elusive answer to the age-old question, “What should I eat for optimal health?”.
Ikaria, Greece
Our quest leads us first to the island of Ikaria, Greece. Ikaria is located off the west coast of Greece surrounded by the beautiful Aegean Sea. Its inhabitants possess a rich tradition of tight knit communities, hard work, and long life. The people of Ikaria appear to benefit from the island’s isolation from the mainland as they are forced by necessity to be self-sustaining, eat seasonably and in moderation. This isolation has prevented a major influx of western-influenced high-fat, processed diary products and fried foods, and the poor eating habits that generally follow closely behind. Most of the island’s centenarians closely follow the traditional Ikarian diet of fruits, vegetables, goat milk, olive oil and moderate consumption of meats. To them, moderate means 1-2 times per week. Many studies on Ikaria record that wine and coffee are consumed in moderate amounts. Although “moderate” is not defined in any study that I read in regard to Ikaria and wine, articles from travelers that have been there, report that multiple glasses of wine are consumed daily with food.[1],[2] This is an interesting point that could have a part to play in their health. A study titled, “Effect of Food and Food Composition on Alcohol Elimination Rates in Healthy Men and Women” found that drinking alcohol with food helped with the elimination of alcohol from the body.[3] Furthermore, the locals tend to drink regional wines devoid of the toxic preservatives contained in the more main-stream wines found in other parts of the world. Another big player in the beverage category is coffee. Coffee is consumed in the amount of 2-3 cups a day with the majority of that coffee being Greek. Greek coffee is associated with improved endothelial function which in turn increases cardiovascular health.[4] Lastly, in regard to beverages, goat milk is consumed preferentially to cow milk. Although it is technically considered dairy, goat milk differs greatly from cow milk in its composition. Goat milk contains little to none of A-1 casein found in most cow milk and contains instead the A-2 casein. This, in addition to the make-up of its fatty acids, would affect its digestibility . [5],[6],[7]
While a diet consisting primarily of fresh fruits, vegetables and minimal meat intake is helpful to anyone wanting to live a longer life, there are other factors that seem to play a symbiotic role for the Ikarian people. The “Ikaria Study”[8], published in 2011, identified other key considerations for longevity on this beautiful island. These include daily physical activity like walking, frequent social engagements, and taking naps. A comparative study on the effects of napping in an elderly population showed increased cognitive performance when taking at least a 1hr nap.[9] Alongside a laid-back lifestyle, the Ikarian elderly population prioritize their social life and many of them are married or live with relatives, further decreasing loneliness. Having a social life and strong community are important for keeping cognitive function as people age as found in a systematic review and meta-analysis done in 2019.[10]While the quality of research studies reflect the subjective nature of the experience of “enjoying life”, the data seems to point to perceived enjoyment having a part to play in mortality rates.[11] Furthermore, the low depression rate could also be a major contributing factor to longevity as depression and cognitive function often go hand in hand.[12] Although cognitive function alone does not equate to long and healthy living, it certainly does help![13]
At first glance health and longevity may seem like a given for the Ikarians, but subtle contradictions are exposed at a closer look. Ikaria boasts eight radioactive saline springs that many believe have curative power and the people of Ikaria drink and bathe in them. Many of the residents are exposed to serious radiological risk due to elevated radiation levels on the island.[14] Radiation exposure contributes to many types of cancer and one would think you would see elevated occurrences of cancer.[15],[16] However, that isn’t the case. In addition to this natural cancer risk, according to the Ikaria Study, 99% of men in Ikaria smoked at one time and about 32% of women were past smokers. Lung cancer and cardiovascular events are rare, nonetheless. Is it possible these elderly Ikarians have escaped the effects of what most health advocates would deem poor health choices? It turns out they may.
One of the most incredible findings in researching the diet and lifestyle of the Ikarian people is the extent to which food is their medicine. As the elderly population adheres tightly to their traditional diet high in whole, fresh produce and preservative free, unprocessed meats and beverages, their bodies are extremely well equipped to counter the negative effects of less than desirable habits and toxic exposures. For example, local honey is a resident favorite and over 40 types of greens are grown on the island in addition to many herbs and spices. Pure
honey has amazing antibiotic, anti-oxidant, and anti-viral properties as found in a review published in 2013.[17] Containing over 300 bioactive substances, honey can play an integral part in the health of those who consume it. The consumption of honey potentially provides a measure of protection against cancer, neurological disease and inflammatory disorders due to its antioxidant properties.[18],[19],[20],[21] Alongside the local honey that residents enjoy as a part of their diet, they also engage in drinking high amounts of herbal teas made from herbs freshly grown in their family gardens. These teas include herbs such as artemisia, which helps relieve fatigue, dyspepsia, and airway infections and dandelion root, which some studies show to aid digestion, boost the immune system, and reduce the risk of some types of cancer.[22],[23],[24],[25] An analysis of over 300 research articles on the Artemisia plant show promising proof of efficacy. However, more studies need to be performed on humans to completely legitimize these findings.[26] Favorite tea compounds of the Ikarians also include sage tea and pennyroyal tea, which is used as an antibiotic.[27],[28] Most of these teas also have diuretic properties which could contribute to the general low rate of hypertension in this locale.[29]
Overall, one could surmise that despite some less-than-optimal habits, the elder Ikarian population surmounts these choices with foods and beverages that naturally act as medicine and protection for their bodies without even trying for that objective.
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[1] https://www.thewinebuzz.com/wines-ikaria-travel-odyssey/
[2] https://kalebrock.com.au/longevity-wine/?v=ef10366317f4
[3] Ramchandani VA, Kwo PY, Li TK. Effect of food and food composition on alcohol elimination rates in healthy men and women. J Clin Pharmacol. 2001;41(12):1345-1350. doi:10.1177/00912700122012814
[4] Siasos G, Oikonomou E, Chrysohoou C, et al. Consumption of a boiled Greek type of coffee is associated with improved endothelial function: The Ikaria Study. Vascular Medicine. 2013;18(2):55-62. doi:10.1177/1358863X13480258
[5] Tomotake H, Okuyama R, Katagiri M, Fuzita M, Yamato M, Ota F. Comparison between Holstein cow's milk and Japanese-Saanen goat's milk in fatty acid composition, lipid digestibility and protein profile. Biosci Biotechnol Biochem. 2006;70(11):2771-2774. doi:10.1271/bbb.60267
[6] Costa WK, Souza EL, Beltrão-Filho EM, et al. Comparative protein composition analysis of goat milk produced by the Alpine and Saanen breeds in northeastern Brazil and related antibacterial activities. PLoS One. 2014;9(3):e93361. Published 2014 Mar 27. doi:10.1371/journal.pone.0093361
[7] http://www.dieteticai.ufba.br/temas/leitederivados/cabra%20e%20ovelha.pdf
[8] Panagiotakos DB, Chrysohoou C, Siasos G, et al. Sociodemographic and lifestyle statistics of oldest old people (>80 years) living in ikaria island: the ikaria study. Cardiol Res Pract. 2011;2011:679187. Published 2011 Feb 24. doi:10.4061/2011/679187
[9] Campbell SS, Stanchina MD, Schlang JR, Murphy PJ. Effects of a month-long napping regimen in older individuals. J Am Geriatr Soc. 2011;59(2):224-232. doi:10.1111/j.1532-5415.2010.03264.x
[10] Evans IEM, Martyr A, Collins R, Brayne C, Clare L. Social Isolation and Cognitive Function in Later Life: A Systematic Review and Meta-Analysis. J Alzheimers Dis. 2019;70(s1):S119-S144. doi:10.3233/JAD-180501
[11] Zaninotto, Paola & Wardle, Jane & Steptoe, Andrew. (2016). Sustained enjoyment of life and mortality at older ages: Analysis of the English Longitudinal Study of Ageing. BMJ. 355. 10.1136/bmj.i6267.
[12] Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019;15:1249-1258. Published 2019 May 10. doi:10.2147/NDT.S199746
[13] Hayat SA, Luben R, Dalzell N, et al. Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality. Eur J Epidemiol. 2018;33(11):1049-1062. doi:10.1007/s10654-018-0439-z
[14] Trabidou G, Florou H. Estimation of dose rates to humans exposed to elevated natural radioactivity through different pathways in the island of Ikaria, Greece. Radiat Prot Dosimetry. 2010;142(2-4):378-384. doi:10.1093/rpd/ncq269
[15] Gawełek E, Drozdzowska B, Fuchs A. Radon as a risk factor of lung cancer. Przegl Epidemiol. 2017;71(1):90-98.
[16] Maier A, Wiedemann J, Rapp F, et al. Radon Exposure-Therapeutic Effect and Cancer Risk. Int J Mol Sci. 2020;22(1):316. Published 2020 Dec 30. doi:10.3390/ijms22010316
[17] Yaghoobi R, Kazerouni A, Kazerouni O. Evidence for Clinical Use of Honey in Wound Healing as an Anti-bacterial, Anti-inflammatory Anti-oxidant and Anti-viral Agent: A Review. Jundishapur J Nat Pharm Prod. 2013;8(3):100-104. doi:10.17795/jjnpp-9487
[18] Ajibola, Abdulwahid. (2015). Novel Insights into the Health Importance of Natural Honey. Malaysian Journal of Medical Sciences. 22. 7-22.
[19] Saravana Kumar Jaganathan, mahitosh Mandal, “Antiproliferative Effects of Honey and of its Polyphenols: A Review”, BioMed Research International, vol. 2009, Article ID 830616, 13 pages, 2009. Doi.org/10.1155/2009/830616
[20] Nor Hayati Othman, “Honey and Cancer: Sustainable Inverse Relationship Particularly for Developing Nations – A Review”, Evidence-Based Complementary and Alternative medicine, vol. 2012, Article ID 410406, 10 pages, 2012. Doi.org/10.1155/2012/410406
[21] Fukuda M, Kobayashi K, Hirono Y, et al. Jungle honey enhances immune function and antitumor activity. Evid Based Complement Alternat Med. 2011;2011:908743. doi:10.1093/ecam/nen086
[22] Vouillamoz JF, Carlen C, Taglialatela-Scafati O, Pollastro F, Appendino G. The génépi Artemisia species. Ethnopharmacology, cultivation, phytochemistry, and bioactivity. Fitoterapia. 2015;106:231-241. doi:10.1016/j.fitote.2015.09.007
[23] Jin YR, Jin J, Piao XX, Jin NG. The effect of Taraxacum officinale on gastric emptying and smooth muscle motility in Rodents. Neurogastroenterol Motil. 2011;23(8):766-e333. doi:10.1111/j.1365-2982.2011.01704.x
[24] Jia YY, Guan RF, Wu YH, et al. Taraxacum mongolicum extract exhibits a protective effect on hepatocytes and an antiviral effect against hepatitis B virus in animal and human cells. Mol Med Rep. 2014;9(4):1381-1387. doi:10.3892/mmr.2014.1925
[25] Rehman G, Hamayun M, Iqbal A, et al. Effect of Methanolic Extract of Dandelion Roots on Cancer Cell Lines and AMP-Activated Protein Kinase Pathway. Front Pharmacol. 2017;8:875. Published 2017 Nov 28. doi:10.3389/fphar.2017.00875
[26] Trendafilova A, Moujir LM, Sousa PMC, Seca AML. Research Advances on Health Effects of Edible Artemisia Species and Some Sesquiterpene Lactones Constituents. Foods. 2020;10(1):65. Published 2020 Dec 30. doi:10.3390/foods10010065
[27] Azevedo MF, Lima CF, Fernandes-Ferreira M, Almeida MJ, Wilson JM, Pereira-Wilson C. Rosmarinic acid, major phenolic constituent of Greek sage herbal tea, modulates rat intestinal SGLT1 levels with effects on blood glucose. Mol Nutr Food Res. 2011;55 Suppl 1:S15-S25. doi:10.1002/mnfr.201000472
[28] Aires A, Marrinhas E, Carvalho R, Dias C, Saavedra MJ. Phytochemical Composition and Antibacterial Activity of Hydroalcoholic Extracts of Pterospartum tridentatum and Mentha pulegium against Staphylococcus aureus Isolates. Biomed Res Int. 2016;2016:5201879. doi:10.1155/2016/5201879
[29] Mishra S. Diuretics in primary hypertension - Reloaded. Indian Heart J. 2016;68(5):720-723. doi:10.1016/j.ihj.2016.08.013