Maggie McKay (Host): Where do people live the longest and why? Today we'll talk about Blue Zones and longevity and how you can adopt some lifestyle changes to live longer as well with Dr. Yasmeen Golzar.

Welcome to Total Health Talks, your Cook County health podcast, where we empower your journey to better health. I'm your host, Maggie McKay.

And today, we're going to talk with Dr. Yasmeen Golzar, non-invasive cardiologist, Director of Non-Invasive Imaging at Stroger Hospital of Cook County and Associate Professor of Medicine at Rush Medical College, about exploring heart-healthy habits, from the Blue Zones. Thank you so much for joining us today, Dr. Golzar.

Yasmeen Golzar, MD, MPH: Thank you so much for having me.

Host: So let's start with what are Blue Zones and what makes them unique in terms of heart health and longevity?

Yasmeen Golzar, MD, MPH: So, Blue Zones are geographic hotspots that researchers led by Dan Buetner and the National Geographic, that these researchers have identified as populations where people live the longest. So in particular, they have the highest proportion of the population reaching the age of a hundred.

There are five of these Blue Zones in the world. So, that's Sardinia, Italy; Ikaria, Greece; Nicoya, Costa Rica; Okinawa, Japan; and interestingly, Loma Linda, California. And what we found is that in these geographic locations, there's low incidence of chronic diseases, so less diabetes, less obesity, less cardiovascular disease as a consequence of that. And these are not only places where people live the longest, but they have great quality of life in their later years. So even though these populations differ from one another, researchers have tried to find that common thread that may be contributing to them having better heart health, living longer and being happier in their later years.

Host: And how do lifestyle factors like diet, physical activity, and social connections contribute to heart health in these Blue Zones?

Yasmeen Golzar, MD, MPH: So, diet is really interesting, I think. You know, these are different cultures. These are five different countries, three different continents. They have different dietary patterns and different foods that are available to them. What's interesting is that common thread is that these are mostly plant-based diets with very little consumption of meat.

So when we look at meat consumption, it is about once a week, so four or five times a month. And the serving sizes are actually no larger than the palm of your hand. There is more of an emphasis on legumes and beans as a source of plant-based protein. So, that could be fava beans in the Mediterranean or black beans in Costa Rica, soybeans in Japan, but it's really a cornerstone of the Blue Zone diet. So, we know that plant-based diets and those that have a good or large consumption of beans or legumes have been associated with a reduction in blood pressure, cholesterol levels, and obesity rates. It's really in the Blue Zones. It's a plant-based diet, with very low consumption of meat and really they don't consume ultra-processed foods and that seems to be a big component of it.

When it comes to exercise, and we know this from existing studies, that the association between exercise with total mortality, and particularly cardiovascular mortality, so dying from any cause and dying from a cardiovascular cause, it's a U-shaped curve. And some people are surprised by this, right? So with individuals who are very sedentary, they have poor health outcomes, but people who are at the extremes of endurance exercise, they actually do poorly as well, and there's a different mechanism for why that might be. But again, that sweet spot is somewhere in the middle. And that's what we see in Blue Zones, is that they are partaking in constant movement. There's low to moderate levels of activity throughout the day. It's important to note these are not gym cultures. People are not running marathons, they're not lifting weights. They are just being very active in their daily lives. So, it's whether they're shepherding or gardening or putting laundry on a line or walking to church or the corner store. There's just an emphasis on natural movement in Blue Zones.

And then, that third component that you brought up of social connection, we know that health status worsens when we're socially isolated. So, people who self-report being lonely or socially isolated, they have a higher risk of developing chronic diseases, they have higher incidence of cardiovascular disease and stroke. And unfortunately, when they get sick, they tend to do worse. So, those who self-report being lonely or socially isolated when they have a heart attack or stroke or certain cancers, we know they have poor outcomes.

And when we look at Blue Zones, these are communities where people are very strongly socially connected. And social connections tell you what your health behaviors are going to be. So, we know this from one of the longest observational studies that we have, which is the Framingham Heart Study, is that when you surround yourselves with people who eat healthy, you're more likely to eat healthy. When you are around people who are physically active, you're more likely to be physically active. And so, it really does, there's a contagiousness to healthy behaviors. So again, in Blue Zones, being part of a community, particularly in most of the places, being part of a faith-based community is an important part of daily life.

Host: And how can individuals outside of Blue Zones incorporate the principles of heart health and longevity into their own lives, even if we don't live in a Blue Zone?

Yasmeen Golzar, MD, MPH: I think the lessons from the Blue Zones should make us all feel a little bit better. One, I think it's about moderation. It turns out that, you know, sometimes, I think extreme lifestyle changes are not only difficult to sustain, but they're probably not really necessary, and the sweet spot tends to be somewhere in the middle.

I think another really important lesson from the Blue Zones is the fact that it's all about balance. So, lifestyle is multifaceted, and I find that we tend to compartmentalize lifestyle. And it's like, "All right, I am going to be vegan," right? And you just have this like, "I'm going to change everything. I'm never going to eat another animal-based protein." but then, your job is really stressful and you may not have meaningful relationships and maybe you're not getting a lot of exercise in. And so, I'm not sure you're deriving all of those benefits from that dietary change, if it's really not in balance with all of these other components. So, I do think it's about understanding that lifestyle is a balance of all of these factors.

Ultimately, with those sort of overarching lessons, I think the important thing is really we would do better limiting ultra-processed foods, eat more plants in whatever way that can be prepared in a healthy manner, and incorporating natural movement throughout the day. So, I think sometimes people feel like they need to have a gym membership to be healthy and it really is, I think the lessons from the Blue Zones is that we can incorporate movement throughout the day, and it's still beneficial to heart health and longevity; and investing in relationships and being part of a meaningful community. These are all the things we should be focusing on.

Host: Dr. Golzar, are there any misconceptions about heart health and longevity in Blue Zones that need to be addressed?

Yasmeen Golzar, MD, MPH: I find that whenever we have these international studies and we're like, "Oh, in Japan, they have these great outcomes" or "In Greece, this is happening," we sometimes think that there is something distinctly different about that country or that population that we can't replicate, or that you have to eat a particular cuisine, like, "Okay. Now, I'm just going to eat what they're eating in Sardinia, Italy." I mean, it'll be delicious, but again, you know, it's not about necessarily incorporating an exact type of cuisine from these countries to derive these benefits.

And I think a really good lesson for Americans is looking at Loma Linda, California, which is a Blue Zone. It is within the United States. The difference here is that it has the largest population of 7th Day Adventists in the U.S. So, the part of the faith is really incorporating healthy behaviors as part of this faith-based practice. What's different about this population is they consume mostly a vegetarian diet. Being part of a faith-based community is an important part of daily life, and they're a little more active than the average American. And just with those changes, this is within the United States, they tend to live at least 10 years longer than the average American.

So, it's important to know all it takes is shifting the way we live our lives and it is possible wherever we live.

Host: I like that idea of balance and shifting, so you don't have to go crazy and then it's not sustainable. Like you said, you can't change everything and do everything. One thing I heard Dan Buettner say once was, I think it was in Okinawa, when a baby was born, the community or neighborhood would assign five people to that baby to be with him or her for the rest of their lives. So, they'd always have like a network that they could count on. And I thought that was brilliant. Have you heard of that?

Yasmeen Golzar, MD, MPH: I have, and that's distinct to that population in Okinawa, but it really is the importance of all of these lifelong relationships, which you point out.

Another really interesting thing is in a lot of these places, there are multi-generational families living very close to one another or within the same household. And so, there are these relationships that lead to really tight social connections, and a really important part of it I think is people don't lose meaning in their lives later on in life. I think sometimes in our Western culture, we have this age of retirement. And it is sometimes arbitrary, you know. "At 65, this thing is going to happen." And I think the idea of not only having longevity, but having a lot of meaning in the later years is something distinct about the Blue Zones. So, these populations tend to older people are really important parts of the community. They're raising children and grandchildren. They're an important part of their faith-based communities. And I think that meaning that you have later on in life is really important as well.

Host: I think that's awesome. What actionable steps can listeners take to prioritize their heart health based on the insights of the Blue Zones?

Yasmeen Golzar, MD, MPH: So, I really like this phrase from the author Michael Pollan, and I'm totally paraphrasing here, but I use this all the time with my patients. And it's something to the effect of, If your great grandmother wouldn't recognize it as food, don't eat it. So if it's cheese coming out of a can, if it is neon in color in a package, if they weren't eating this a hundred years ago, we probably shouldn't be eating it. So, really limiting ultra-processed foods, I think, is really important.

Another thing I think we can take away is making sure that most of the food on our plate is from plants. I use the plate method with my patients. So, I say, "All right, we're looking at a plate, half of it should be colorful vegetables that are cooked in a healthy way. A quarter can be some sort of a lean protein. And again, beans and legumes are a great source of plant-based protein. And a quarter should be a whole grain." So again, just eating more plants and in whatever way. Again, these are shifts that we can make.

And also, you know, number three, physical activity, just being physically active throughout the day. You know, if you have a desk job, standing up once an hour, taking a walk around the hall, coming back, taking the stairs; if you live in a place where it's safe to do so, choosing to walk rather than drive where your destination is.

And another important thing is I think a lot of times when we gather with friends and family, we center our social interactions around food, and that's wonderful. But it's really interesting when we start centering our social interactions around physical movement. So, taking a walk with a neighbor, that builds social connection, but it's a great way to be accountable to each other about building in physical movement throughout the day.

And number four, build community in whatever way brings meaning to you. Technology is amazing, and it allows us to stay connected with people no matter where they live, but it doesn't take the place of being in the physical presence of others. And we know this from studies. I mean, when we are around other people, and these are beneficial relationships, our cortisol levels go lower, those stress hormones are lower. We have different parts of our brain that are activated, these are beneficial to us. And we have an epidemic of social isolation in the United States and it has direct negative effects on health. So, talk to your neighbors, check on your family members and making connections. It's just really important. It's not only going to lead to a healthier life and hopefully a longer life, but I think a happier one.

Host: Is there anything about sleep in this study? Like how important it is?

Yasmeen Golzar, MD, MPH: Not necessarily directly from Blue Zones. So when we look at the Blue Zones, I'm not sure we have data on sleep patterns. I suspect though, because these cultures are what I'd like to think of as like leading a gentle life, right? These are lifestyles where there's a lot of emphasis on taking time for the important things. And we know from studies that sleep and getting at least eight hours a night of uninterrupted sleep is really important for health overall. But in terms of coming from Blue Zones, I'm not sure we have that data.

Host: In closing, is there anything else you'd like to add that we didn't cover?

Yasmeen Golzar, MD, MPH: I think that it's important that we gain these insights from as many places that we can. You know, I think a lot of our earlier studies looked at things like the Mediterranean diet, or we looked at things in isolation like, "Okay, how much exercise will benefit us?" The benefit of looking at populations in totality allows us to look at things in a more whole way. And if we can try to incorporate that wholeness into our own lives, I think it will benefit all of us.

Host: Well, thank you so much. This has been so informative and fascinating and, you know, gives us some food for thought, so to speak.

Yasmeen Golzar, MD, MPH: It's been a pleasure. Thank you.

Host: As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.