WHAT WOMEN LIVING IN "BLUE ZONES" CAN TEACH US ABOUT MENOPAUSE & HEALTHY AGING
While technological breakthroughs in health have dominated headlines during the past thirty years, equally innovative research into longevity and healthy aging also blossomed. This culminated in the discovery of "Blue Zones," or regions across the globe where people - regardless of sex - were living past 100 years old and defying the aging process.
These areas, which include places like Okinawa, Japan and Nicoya, Costa Rica, offer us insight into how daily behaviors can effectively slow down the aging process. And though extensive studies have been conducted on aging, there is a notable lack of research on the effects that menopause, specifically, has on aging. This raises the question about what information menopausal women can gather from women living in Blue Zones, and how it can improve their lives.
What are the Blue Zones?
A fascination with places in the world where people live into the triple digits is not a recent phenomenon. In fact, Okinawa, Japan is possibly the place that people most often associate as the site where centenarians live thanks to news coverage. But it wasn't until researchers explored additional regions, cataloged and studied the locals' daily habits beyond dietary consumption and then compared behaviors among the different regions, that they identified common traits among all centenarians.
Two notable European researchers, Michel Poulin and Giovanni Mario Pes, set out in early 2000 to understand why denizens of Sardinia were living longer. Over the following years, their research also identified other areas with a rich concentration of centenarians living in them. They started circling these areas with a blue highlighter and began referencing them as "Blue Zones" in conversation. At around the same time, Dan Buettner, a self-described explorer, found out about these hot spots around the planet and began traveling to them to understand what it took to defy the odds of dying from preventable diseases.
That was when he had a thought, which he shared in his recent Netflix documentary, Live to 100: Secrets of the Blue Zones: "What if we could reverse engineer longevity?" For the last two decades, Buettner has done just that. "But instead of looking for answers in petri dishes or test tubes, I found five places around the world where people are getting the outcomes we want," he says. Buettner's research identified and organized a set of principles - among them a plant-based diet, regular exercise, consistent social interactions, hobbies - in areas with people living long lives. If applied correctly, he argues, people living in other settings, be they cities or the countryside, would also be able to improve and lengthen their own lives.
The three men would join forces to develop a certification process that established a "statistically significant" better and longer life as a function of lifestyle, nutrition, genetics and both human and physical environmental conditions that might be considered as determinants for living longer and better.
So what does this mean for women entering or living through menopause? As Buettner tells Flow, "We don't have any information or direct connections to menopause." However, menopause experts around the globe are looking to Blue Zones for clues about cultural and lifestyle practices that can improve and lengthen women's lives during menopause.
What can Blue Zones teach women about menopause?
One of those experts is Wendy Sweet, PhD, a former registered nurse based in New Zealand. She first became aware of the Blue Zones research when presenting her PhD on women's health, aging and exercise at the first WHO Congress on active aging in Melbourne, Australia in 2016. "There were numerous presentations about the role of inflammatory changes, especially cardiovascular changes for women and how the menopause transition was the start of this," she remembers. "This emerging evidence on ‘inflammageing' - inflammation in body tissue as women age, which is believed to trigger other diseases and premature death - offered me academic insight into taking a life-course approach to aging."
As Sweet looked into Blue Zones' comparative studies, she became interested in cultural approaches to the midlife transition. "I explored research about countries and cultures where menopause does not have a biomedical focus, but instead is celebrated as the biological gateway to the next phase of life, women's aging." Sweet credits the work of Professor Margie Lachman, an American psychologist and scholar, with helping her to understand that menopause is a pivotal stage in a woman's development, which she calls "the bookend to puberty." She also says that one of the main health challenges for women moving into post-menopause is not breast cancer, but cardiovascular disease. "These changes start in menopause, however, the Blue Zones research allowed me to look at the long lives of women in those geographical locations, where heart disease in post-menopause wasn't as problematic as it is in many western cultures."
The Blue Zones lifestyle
So how can women in midlife incorporate Blue Zones principles into daily life to protect their hearts and help prevent cancer? "We always encourage people to check out the Power 9," says Buettner, referring to the nine common habits of the world's oldest and healthiest people, which include having a life purpose and slowing down. "But if I had to pick three to start, I would suggest: First, surround yourself with other like-minded healthy friends who eat-plant-based food, whose idea of recreation is biking or playing tennis or gardening, and who challenge you to keep your mind engaged. If your three best friends are obese, there's a 150% better chance you'll be overweight. So, hang out with people who have the health you aspire to."
That may sound controversial to some, but to Susan B. Hurson, MD, OB-GYN, the advice is "valid." "A lot of studies have all been saying the same thing for a while: the diet is fundamental. Activity is critical, and we know social interaction is huge," she says. "All those things that they're doing in terms of eating well, living well, and having the social support are all factors. No question." Additionally, says Hurson, there is general resistance, in the United States, to the idea that our food source is part of the problem. While Blue Zones research, she points out, may not directly address menopause, "menopause is about aging and menopause happens because we are older."
Here are the four biggest takeaways menopausal women can learn from their counterparts living in Blue Zones.
Eat a Plant-Based Diet
For starters, Buettner recommends purchasing a plant-based cookbook and spending time trying a few recipes that you can add to your weekly rotation. "A huge meta-analysis followed hundreds of thousands of people for decades, and it found that switching to a plant-based diet [from a standard American diet] can add an average of 10 years of life for women, or 13 years for men."
A dietary approach that emphasizes nutrient-dense foods, such as nuts, beans, legumes and whole grains is key for managing menopause symptoms (and aging symptoms), according to Sweet. Specifically, Buettner's research and work, she says, led her to explore both the Okinawan Diet and the Mediterranean Diet. "I was already exploring nutrients that offer anti-inflammatory benefits, however, the Okinawan Diet opened up my mind towards the differing emphasis on protein for women. There is much emphasis on high protein diets in many Western countries, however, the Okinawan ratio showed that this was much lower than what is suggested in countries that have a higher emphasis on animal protein, including America, New Zealand, Australia and the UK."
She goes on to note that research on cancers, especially colon cancer, reveals a direct relationship between countries with a higher intake of animal proteins and cancer rates. "The Mediterranean Diet is also well evidenced in relation to brain, bone and metabolic research," she adds. "Extra virgin olive oil is the ‘gold-standard' for preventing inflammation and improving brain and bone health."
Get moving
Beyond diet, Buettner emphasizes regular movement of any kind. "Take multiple trips up and down stairs for laundry, have walking meetings at work, garden and shed some stress doing what you love," he tells Flow. "As you continue to make these small changes over time, you will curate an environment that promotes your health and wellbeing."
For Sweet, this aspect of Blue Zones research was pivotal for women entering and living through menopause. As she explored the role of physical activity in her doctoral research, it became clear to her that women from the Baby Boomer generation were the first to go into menopause within the context of the changing physical landscape. "We've moved from following Jane Fonda to pushing heavy weights and doing CrossFit workouts," she says, while also pointing out that workout programs are often designed for men.
According to the American Heart Association's evidenced guidelines for cardiovascular health and her research, Sweet notes "there are gaps in the knowledge of practitioners about the right type of exercise to do during a woman's menopause transition." Sweet's sports science background also made it clear to her that the emphasis on intense exercise "may throw women into exercise-induced anemia and over-training syndrome, and the symptoms of this mimic perimenopause symptoms." Exercise during menopause, she clarifies, "should be energizing, not exhausting."
Prioritize sleep
In terms of a lifestyle intervention to manage stress and inflammaging, sleep may be the most important. "Sleep enough," writes Buettner in a blog post. "People in Blue Zone regions rise with the sun and sleep with night. They sleep the eight to ten hours experts say is the optimal amount to revitalize our brains and bodies." They also take daily naps. "Take a cue from Ikarians and take a mid-afternoon break," he adds. "Napping lowers stress hormones and rests the heart."
For women in menopause, the lack of sleep may spiral "into increased oxidative stress and inflammation," explains Sweet. "So slowing down the rate of inflammaging is key and this can be achieved through dietary change and exercise as well as sleep and stress management." One sleep management intervention is cognitive behavioral therapy. "There's good data on it for both sleep and the anxiety that is hormonally linked [to menopause]," notes Dr. Hurson.
Cultivate relationships
When we asked Buettner if there was anything surprising he learned about the women he interviewed during the process of making the film, he said it was ultimately "the power of friendship." Yes, they relied on a plant-based diet, gardened daily and enjoyed the sun, but there was something else that seemed to be tying together the many good daily habits.
"I spent a lot of time with the women of Okinawa who are the oldest in the world, [and they] keep a close group of friends known as their ‘Moai.' These safety nets lend financial and emotional support in times of need, and give all of their members the stress-shedding security of knowing that there is always someone there for them," he says. "They also have an attitude. They've learned to be likable and to keep younger people in their company well into their old age."