Blue Zones Or Bad Data?
Wandering Wednesdays #29
Careful readers of my blog may remember an ‘extra’ prediction I made recently about tech bros seeking immortality.1
Netflix released a documentary on Blue Zones several months ago — these are regions in the world like Okinawa, Japan; Nuoro Province, Sardinia, Italy; the Nicoya Peninsula, Costa Rica; Icaria, Greece; and Loma Linda, California where people live ‘extraordinarily long and vibrant lives.’
What are the secrets of the Blue Zones?
Blue Zones first started to be discussed in the early 2000s meaning that people aged 100 or older then were born sometime around 1900. Researchers seeking a life-extending elixir have long looked to Okinawans for their secret. Eating a vegetable-rich diet, staying active and having a sense of purpose have all been suggested as candidates.
Mixing olive oil & snake oil?
What do we know about that period of history, the early 1900’s? It was before birth/death records were properly established.
And what happens when state-wide mandatory records go into effect? Saul Newman of Oxford University shows that the number of supercentarians [100+] drops sharply a hundred or so years later.
Puzzling conclusion at first — but keep reading and you’ll experience an ‘elementary, my dear Watson’ moment — guaranteed.
Few very old people have birth certificates. Some do not know their true age. And public records used to be woefully unreliable. A government audit in 2010 uncovered 230,000 supposedly living Japanese centenarians who were dead or missing. Some errors were genuine mistakes, but others may be the result of fraud.
Dr Newman set out to test whether such errors could explain why some places appear to be longevity hotspots. He gathered data on the numbers of centenarians, semi-supercentenarians (those over 105 years old) and supercentenarians (those over 110) living in areas of America, Britain, Italy, France and Japan using a patchwork of death records, census data and databases logging old people.
Dr Newman found that clusters of high reported longevity tended to occur in areas where record-keeping might conceivably be more lax, or where residents might have more incentive to claim pensions fraudulently. In Britain, Italy, France and Japan records showed old people living in poorer, crime-ridden areas as more likely to reach extraordinary ages.2 Okinawa, for example, has a poverty rate nearly twice the Japanese average and has 1.6 times as many listed centenarians for each reported nonagenarian.
The most concrete evidence that mistakes could be causing variations in the numbers of very old people came from America. Between 1841 and 1919, states introduced birth certificates, making age estimates more accurate and error/fraud more difficult. By aligning data on the numbers of old people in each state with the date that birth registration was introduced, Dr Newman found that it resulted in a 69% drop in the prevalence of supercentenarians.
Differences in diets, lifestyle and health care certainly cause variability in life expectancy across countries, but they cannot fully explain why some places appear to have so many centenarians.
One secret to a longer life? Throw away that birth certificate.
Healthspan vs Lifespan
Life expectancy for men averages 80 these days in most parts of the world (women live 3-4 years longer) — medical advances (Medicine 2.0) along with better hygiene, clean water, indoor plumbing and so on have caused life expectancy to double over the past century or so. But this progress has plateaud for the past decade and some countries (like the US, remarkably) are sliding backwards now.
At the same time, medical expenditure in the last 1 month (0.001% of a normal lifespan) of a person’s life is ~20% of lifetime expenditure (US data) and growing. I have listened to several experts who are exploring new ways out of this impasse — including Dr Peter Attia who recently published a book on the subject Outlive: The Science and Art of Longevity. His main argument is that for all its successes, mainstream medicine has failed to make much progress against the diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes.
Too often, it intervenes with treatments too late to help, prolonging lifespan at the expense of healthspan, or quality of life. Dr. Attia argues we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now3, rather than waiting. Dr Attia also makes a compelling case for Medicine 3.0, a complete rethink of the practice of medicine to fous on prevention. Research institutions like The Buck Institute are focused on a similar mission — understanding ‘health care’ vs ‘sickness care’. Pharma and bio-medical outfits spot a goldmine here along with tech bros (who passionately wish to make everlasting contributions to society).
While researching this piece, I stumbled upon an anecdote about this place called Vilacamba in Ecuador. It had a brief blue zone reputation back in the 80’s.
I met a man who claimed to be 99 and was Russian. He said he'd fought for the White Army during the Bolshevik revolution. He told me a joke:
After a National Geographic article about the old people here, the town became inundated with tourists. One such fellow, visiting the church, sees a very old man at the altar crying. He goes up and asks ‘How old are you and why are you crying?’
’I'm 101 and my mother beat me this morning.’
’101! And your mother! But why did she beat you?’
’Because I forgot to take breakfast to my grandmother.’
Stay vibrant. Keep smiling. Maintain a healthy beat.
Wishful Thinking — With impending medical breakthroughs, more tech bros decide on cryogenic burials, expecting to be defrosted when a cure for the disease that caused their demise is discovered. Cryo funeral homes (not to be confused with crypto) have a campaign slogan ready ‘It’s Really Nice To Be On Ice’.
In 1900 the UK had eight million more inhabitants than Italy, a 1.22-fold larger population. Citizens of the UK also enjoyed 2.5 times the GDP per capita, earned 3.5 times higher wages in real terms, had 1.25 times lower income inequality, received 2.2 times the average education (with just 5.3 years of schooling), were four times less likely to be murdered, were 3.8cm taller, and lived 5.3 years longer on average than people in Italy. Given these indicators and the long history of birth records in both countries, it is difficult to reconcile why the healthier, wealthier, better-educated, taller, and longer-lived population of the UK produced roughly a quarter as many SSCs per capita. One explanation is that remarkable age records result, not from better health or greater longevity, but from the historical accumulation of illiteracy-driven errors and the modern dynamics of poverty-driven fraud.
Dr Attia believes that exercise is the most potent action most people can take to extend the quantity of life and improve its quality. The second most powerful tool he says is getting enough sleep. Adequate exercise (3-9 hrs/week) & sleep (7-8 hrs/day) can increase healthy lifepan by 8 years. Roger Silk, an investor, made an ROI estimate based on Dr Attia’s recommendation: a pretty decent 5.8% p.a. (over 30 years) — more details here.