Modeling life after blue zone communities for the sake of longevity and lasting vision

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Longevity has remained an important topic to most people. As communities strive to live longer and feel better, people are seeking solutions to live healthier, be stronger, and even see better. As a society, we are constantly looking for the magic pill to achieve a utopian state of being. The truth: There is no single pill, diet, or activity leading to a state of wellness. Instead, wellness should be a personalized holistic journey to “feeling younger while growing older,” as tagged by wellness expert Dana Frost.¹

Drawing attention to the recent phenomenon of the blue zones (BZs), Dan Buettner led research, with the support of National Geographic, that identified key communities around the world with the longest-lived and happiest populations. He pursued a better understanding of how lifestyle and environment led to those individuals out-living people in other parts of the world, while enjoying a higher quality of life. These BZ areas shared Buettner’s Power 9 principles,² as follows:

1. Move naturally.
2. Maintain purpose.
3. Downshift or keep stress to a minimum.
4. Follow the 80% rule, ie, stop eating before feeling full.
5. Consume a plant-based diet with more than 90% of its calories from plant-based sources with few to no processed foods or sugar. Include lots of fava beans, black beans, lentils, and soy, and limit meat consumption on average to 5 times a month.
6. Drink an average of 1 to 2 glasses of alcohol a day (an exception is made for Adventists).
7. Belong to a faith-based community.
8. Put family first.
9. Belong to communities that promote healthy behaviors.

We can learn from these BZs while we work toward the goal of preserving our vision within an aging population. As the evidence of a connection between nutritional support and eye health continues to build, we can gain insight from those following the blue zones diet. These communities teach us that adopting a balanced lifestyle can reduce the risk of chronic disease and inflammation as we aim to achieve visual wellness, or a stable eye health status.

To begin, physical activity is key to disease prevention. Studies have associated physical activity with a reduced risk of glaucoma, diabetes, Alzheimer disease, and macular degeneration.³ There is also increasing evidence linking outdoor time with a lower progression of myopia.⁴ In contrast, physical inactivity leads to reduced energy or mitochondrial function. According to experts, exercise remains the strongest behavioral therapeutic approach for the improvement of mitochondrial health, not only in muscle, but also in other tissues. As we know, mitochondria are crucial for providing energy-rich adenosine triphosphate and regulating cellular longevity across multiple organ systems.⁵ In addition, neurotrophins released during exercise, including brain-derived neurotrophic factor, neurotrophic growth factor, and insulin-like growth factor-1, have demonstrated neuroprotective effects on retinal ganglion cells in cases of glaucoma.⁶ By living in a BZ, natural daily movement proved to contribute to longevity.

Inflammation is often a consequence when any body system fails to function optimally, resulting in a cascade of complications, that often lead to chronic disease. How did the BZ communities avoid chronic inflammation? Factors such as refined sugar, ultraprocessed foods, chronic stress, poor sleep, and smoking—which lead to metabolic disease and inflammation—were absent. Removing these factors that potentially cause inflammation can lead to a life with less chronic disease. People who have chronic disease have a higher prevalence of stress and that stress increases their risk of chronic disease. By downshifting the day-to-day nuances of their busy schedules and external factors, people living in the BZs had lower rates of inflammation.

Nutrition, as we know today, is extremely vital to our survival. With regard to eye health, specific nutrients such as carotenoids, ω-3 fatty acids, and vitamins A, D, and E can all have profound effects on the prevention and treatment of eye disease.

Within the BZs, food is locally sourced and minimally processed. Pesticides and other toxic ingredients found in packaged foods and conventional produce in a standard American grocer are not readily available in these communities. A BZ diet is rich in ω-3 fatty acids, citrus, curcumin, flavonoids (found in berries), carotenoids (abundant in plants and algae), green tea, saffron, and resveratrol—all known for their anti-inflammatory, antioxidant and anticarcinogenic properties.^6,7 The members of each BZ community eat a combination of foods—which vary based on the available diet within each specific BZ regions— delivering fiber, nutrients and carbohydrates in proportions that provide a synergistic balanced diet. BZ-residing individuals eat plant-based diets, including beans, which are inexpensive and rich in fiber and protein. The centenarians also focus on carbohydrates in the form of whole grains and sourdough breads, rather than breads leavened with yeast. Polyphenols (plant compounds), β-glucans (soluble fibers within cell walls of bacteria and fungi), and unsaturated fatty acids represent the Mediterranean diet as well as the BZ diet, given their anti-inflammatory and antioxidant properties that prevent or attenuate the inflammaging.⁸

Members of most BZ communities enjoy a daily average of 1 to 2 glasses of alcohol, specifically red wine. (Adventist communities do not follow this principle.) One of the benefits of red wine is its resveratrol, a polyphenol that delivers neuroprotective, antioxidant, and anti-inflammatory properties against retinal ganglion cell damage common in glaucoma and macular degeneration.8 Resveratrol is also a hydrophilic small molecule with the ability to enter the retina cells, downregulating the VEGF—an angiogenic factor—and improving the antioxidant properties of the cells. Other lesser concentrated natural sources of resveratrol include pistachios, peanuts, blueberries, raw cranberry juice, chocolate, strawberries, cocoa, red currants, and Japanese (knotweed) itadori tea. The bioavailability and absorption of resveratrol are fairly low due to the metabolic activity of the intestinal microbiome and liver functions that differ among individuals. With studies aimed at verifying therapeutic benefits, improving stability and bioavailability are necessary for successful treatments in the future.⁹ So, it could be the synergistic effect along with a balanced lifestyle that contribute the overall benefits of wine to longevity.

We can apply the principles of the BZ areas while freeing time for daily movement, nourishing our bodies and minds, and shifting our focus away from food and more toward family while fulfilling a purposeful life. As we move into a “food is medicine” mindset, we can better address root causes for common eye conditions. We can learn from these communities, educate patients, and witness the commitment toward better lifestyle choices in our patients. An integrative solution to wellness is often the best place to begin. Furthermore, it is important to not to lose sight beyond nutrition alone and to also incorporate exercise, adequate sleep, nutritious food, stress reduction, and all other factors that positively influence a state of wellness.

The BZ phenomenon should encourage practitioners to expand their approach to eye care. By promoting vision preservation while living longer, happier lives, eye care professionals can improve overall health by making the connection between lifestyle choices and good vision habits. A community mindset can also help support local businesses that have similar goals in transforming holistic wellness practices. We can give to the community in ways that foster relationships, sustain healthy business models, and provide the most comprehensive care for patients.

References:

1. Vitally you: feeling younger while growing older. Dana Frost. November 1, 2018. Accessed July 15, 2024. https://danafrost.com/2018/11/feeling-younger-while-growing-older/

2. We empower everyone, everywhere to live better, longer. Blue Zones. Accessed July 9, 2024. https://www.bluezones.com

3. Ong SR, Crowston JG, Loprinzi PD, Ramulu PY. Physical activity, visual impairment, and eye disease. Eye (Lond). 2018;32(8):1296-1303. doi:10.1038/s41433-018-0081-8

4. Gupta S, Joshi A, Saxena H, Chatterjee A. Outdoor activity and myopia progression in children: a follow-up study using mixed-effects model. Indian J Ophthalmol. 2021;69(12):3446-3450. doi:10.4103/ijo.IJO_3602_20

5. Memme JM, Erlich AT, Phukan G, Hood DA. Exercise and mitochondrial health. J Physiol. 2021;599(3): 803-817. https://doi.org/10.1113/JP278853

6. Tribble JR, Hui F, Jöe M, et al. Targeting diet and exercise for neuroprotection and neurorecovery in glaucoma. Cells. 2021;10(2):295. doi:10.3390/cells10020295

7. Sim RH, Sirasanagandla SR, Das S, Teoh SL. Treatment of glaucoma with natural products and their mechanism of action: an update. Nutrients. 2022;14(3):534. doi:10.3390/nu14030534

8. Santacroce L, Bottalico L, Charitos IA, Haxhirexha K, Topi S, Jirillo E. Healthy diets and lifestyles in the world: Mediterranean and blue zone people live longer: special focus on gut microbiota and some food components. Endocr Metab Immune Disord Drug Targets. Published online April 2, 2024. doi:10.2174/0118715303271634240319054728

9. Pop R, Daescu A, Rugina D, Pintea A. Resveratrol: its path from isolation to therapeutic action in eye diseases. Antioxidants. 2022;11(12):2447. doi:10.3390/antiox11122447