On the longevity and extended health of Icarians, among others

Via the Washington Post I came across a 2012 article in The New York Times Magazine by Dan Buettner, "The Island Where People Forget to Die". In this article, Buettner highlights the longevity and good health of the inhabitants of Icaria, a small Greek island in the Aegean Sea several dozen kilometres away from the Anatolian mainland where the average inhabitant can expect to live a decade longer than the average American. While many factors seem to contribute to the Icarians' situation--an abundance of exercise, a healthy diet, and so on--it seems that all these individual elements are reinforced by Icarian society as a whole.

In the United States, when it comes to improving health, people tend to focus on exercise and what we put into our mouths — organic foods, omega-3’s, micronutrients. We spend nearly $30 billion a year on vitamins and supplements alone. Yet in Ikaria and the other places like it, diet only partly explained higher life expectancy. Exercise — at least the way we think of it, as willful, dutiful, physical activity — played a small role at best.

Social structure might turn out to be more important. In Sardinia, a cultural attitude that celebrated the elderly kept them engaged in the community and in extended-family homes until they were in their 100s. Studies have linked early retirement among some workers in industrialized economies to reduced life expectancy. In Okinawa, there’s none of this artificial punctuation of life. Instead, the notion of ikigai — “the reason for which you wake up in the morning” — suffuses people’s entire adult lives. It gets centenarians out of bed and out of the easy chair to teach karate, or to guide the village spiritually, or to pass down traditions to children. The Nicoyans in Costa Rica use the term plan de vida to describe a lifelong sense of purpose. As Dr. Robert Butler, the first director of the National Institute on Aging, once told me, being able to define your life meaning adds to your life expectancy.

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If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat.

Every one of these factors can be tied to longevity. That’s what the $70 billion diet industry and $20 billion health-club industry do in their efforts to persuade us that if we eat the right food or do the right workout, we’ll be healthier, lose weight and live longer. But these strategies rarely work. Not because they’re wrong-minded: it’s a good idea for people to do any of these healthful activities. The problem is, it’s difficult to change individual behaviors when community behaviors stay the same. In the United States, you can’t go to a movie, walk through the airport or buy cough medicine without being routed through a gantlet of candy bars, salty snacks and sugar-sweetened beverages. The processed-food industry spends more than $4 billion a year tempting us to eat. How do you combat that? Discipline is a good thing, but discipline is a muscle that fatigues. Sooner or later, most people cave in to relentless temptation.

This message was emphasized by an 2013 article in The Guardian by Andrew Anthony, based at least in part on the author's interviews with Buettner.

The phrase "blue zone" was first coined by [author Dan] Buettner's colleague, the Belgian demographer Michel Poulain. "He was drawing blue circles on a map in Sardinia and then referring to the area inside the circle as the blue zone," Buettner says. "When we started working together, I extended it to Okinawa, Costa Rica and Ikaria. If you Google it now, it's entered the lexicon as a demographically confirmed geographical area where people live measurably longer." So what does it take to qualify? "It's a variation," Buettner says. "It's either the highest centenarian rate, so the most centenarians per 1,000. Or it has the highest life expectancy at middle age."

All the blue zones are slightly austere environments where life has traditionally required hard work. But they also tend to be very social, and none more so than Ikaria. At the heart of the island's social scene is a series of 24-hour festivals, known as paniyiri, which all age groups attend. They last right through the night and the centrepieces are mass dances in which everyone – teenagers, parents, the elderly, young children – takes part. Kostas Sponsas tells me he no longer has the energy to go on until dawn. He will now usually take his leave by 2am.

One evening, the island's star violin player, whom we met at Gregoris Tsahas's favourite cafe, invites Buettner, me and several others back to his house to hear him play. He says he often grows exhausted while performing at festivals, but the energy and enthusiasm of the people keep him going. He plays some traditional folk tunes, full of passion and yearning and heart-rending beauty, and mentions with pride that Mikis Theodorakis, the composer of Zorba The Greek, was among the leftists exiled on the island in the late 1940s. Theodorakis later recalled the experience with pleasure. "How could this be?" he asked. "The answer is simple: it's the beauty of the island in combination with the warmth of the locals. They risked their lives to be generous to us, something that helped us more than anything bear the burden of the hardship."

One of the things Buettner has found that unites the elderly inhabitants of all the blue zones is that they are unintentionally old: they didn't set out to extend their lives. "Longevity happened to these people," he says. "The centenarians didn't all of a sudden at 40 say, 'I'm going to become 100; I'm going to start getting exercise and eating these ingredients.' It ensues from their surroundings. So my argument is that the environmental components of places such as Ikaria are portable if you pay attention. And the value proposition in the real world is maybe a decade more life expectancy. It's not living to 100. But I think the real benefit is that the same things that yield this healthy longevity also yield happiness."

I ask a number of men in their 90s and 100s if they do any keep-fit exercise. The answer is always the same: "Yes, digging the earth." Nikos Fountoulis, for example, is a 93-year-old who looks 20 years younger. He still has a smallholding in the hills of the island's interior. Each morning he goes out at 8am to feed his animals and tend his garden. He used to dig charcoal as a younger man. "I never thought about getting old," he says. "I feel good. I feel 93, but on Ikaria that's OK."

Long-time readers of Demography Matters may remember that I visited the phenomenon of extended life expectancy and relatively gentle aging before, in a February 2010 post taking a look at the position and numbers of the aged in Abkhazia. Fantastic claims that Abkhazians regularly lived past the century mark have been debunked. Conversely, traditional Abkhazian culture does seem to have not only promoted good health, but helped integrate aging Abkhaz into their society in a way that allowed them to continue to be productive. (I know nothing about the current situation in Abkhazia. Anyone informed on this subject, please advise in the comments.)

Is it possible to learn from the lessons of Icarians and similar populations? Maybe. As commented in the articles I linked to above, Icarians' longevity appears to be the product of a complex mesh of social factors that can't be easily replicated. Whether the relaxed lifestyle of Icarians and others can be replicated in our contemporary world is very open to question, for instance. If nothing else, the Icarian experience does provide fascinating hints towards a possible futuree.