Last November I had the pleasure of being ‘guest nutritionist’ at Lynn Ogyzlo’s FOOD 101 class in Niagara. I chose to speak on healthy eating and lifestyle patterns. Lynn is a several-times award-winning author, Ontario Local Food Ambassador, passionate educator, and treasured friend. We had had a lively group that night, and a lot of fun. I hope to participate again next March, when Lynn’s FOOD 101 class will focus on weight-loss and the keto diet.
Healthy Eating and Lifestyle Patterns for Longevity:
The Frugal South-Mediterranean Diets of Ikaria, Greece and Sardinia, Italy
While there is no ‘one’ single ‘Healthy Diet’ to suit the biochemical differences of all individuals, across all geographic realities, one very simple thing we can do for ourselves is to observe the healthy eating patterns of some of the longest-lived cultures on earth.
Longevity scientists have dubbed these regions, “Blue Zones”, to highlight, geographically, (with a blue marker), where inhabitants live active, fulfilling lives into their nineties (and even a decade beyond), while remaining healthy.¹
‘Blue Zone’ areas include: Ikaria, Greece; Sardinia, Italy; Loma Linda, California; Okinawa, Japan; and the Nicoya Peninsula of Costa Rica. Although geographically very different from each other, the inhabitants from these areas seem less affected by illnesses such as cardiovascular disease, diabetes, dementia and cancer. It’s often said that these cultures have preventative medicine embedded into their lives.
Interest in the Mediterranean diet gained momentum in the 1950s after scientists observed that heart disease was leading to fewer deaths in Italy and Greece, in comparison to other the United States, Northern Europe. Subsequent reviews confirmed that the Mediterranean Diet was indeed associated with reduced risk factors all of the above mentioned chronic and acute illnesses.²
Much later – around 2004 – Dr. Gianni Pes, a physician at the University of Sessari, Sardinia, teamed up with National Geographic explorers, The National Institute of Aging and a large group of scientists to locate the longest-lived people and to study them.
The Barbagia region in Ogliastra, Sardinia, was the first Blue Zone area to be studied, due to interest that there were at least ten times more centenarians living there, than in the United States.³ Much later (in 2019), another Mediterranean zone was identified – that of Ikaria, Greece.
Like Sardinia, Ikaria, is located in an isolated region – an island which is home to about 8,500 people. Ikaria has the highest percentage of individuals on earth aged 90 or more years. Nearly one in three people make it into their nineties. Also, cancer rates are 20 percent lower than in North America, heart disease is 50 percent lower and dementia is virtually unknown. Just like the Sardinians, this traditional society values time spent with family and friends. They drink wine, play games, laugh, and socialize with people in the community.
People from Ikaria and Sardinia practice what is known as, ‘La cucina de povera’. Translated, this means, ‘Kitchen of the Poor’ in Italian. Fortunately, this frugal eating at its best — rustic, traditional cooking methods using humble, fresh ingredients. Food is minimally prepared, and flavoured with fresh herbs, extra-virgin olive oil, lemon juice (or red vinegar), and sea salt. There is an absence of the richer sauces one might find in Athens, France or Florence. Nothing is wasted. Whey from making cheese is used next to make ricotta.
These frugal, long-lived people know where their food comes from. They also know what’s in the soil because, they have most likely planted and tended that garden themselves. It seems fruitless to ask what factor is ‘key’ in keeping these individuals moving and thriving into their nineties and beyond. Its clear there is some type of synergy going on.
Poverty and isolation can sometimes be a very good thing for health. Sardinia lies about 75 miles off the coast of Italy, in a very rocky terrain. Because of its extreme isolation and poverty, Sardinians have also shielded from purchasing factory-made foods that are available to more affluent parts of Italy.⁴
As is the norm in isolated communities, if you don’t have an ingredient, you knock on the door of your neighbour to borrow, or arrange a trade – my onions for your peaches, and so on. These cash-free interactions also ensure that neighbors checked up on each other socially. Walking up a hill and practical exercise (i.e., tending sheep or tending a garden), is also part of the deal.
If I could distill the Healthy Eating AND lifestyle patterns of these regions into just 5 points, I would say:
That’s the quick-read version. If you have time, please read on …
Sardinians and Ikarians eat relatively small amounts of animal protein in comparison to more affluent, northern regions in Europe and North America. Collagen and muscle-building foods are eaten, but almost as a condiment. In both diets, there also enjoyment of bitter, wild greens such as dandelion, and detoxifying herbs.
In Sardinia, from the mid-19th to mid-20th century, meat (pork, poultry and sheep) consumption was low – it rarely exceeded two to four times a month.⁵ In more recent times, beef and fish consumption has risen. It used to be that only people in the coastal regions ate fish, but this is changing. Today Sardinians are eating fish up to twice a week. The serving size for proteins is 3 to 4 ounces- the size of a deck of cards. Beef consumption today has risen by 55 percent.
In Ikaria, Greece, animal protein is generally eaten four or five times a month. During times of religious observance for their Greek Orthodox faith, Ikarians follow a vegan diet several times a year, combined with periods of fasting.
Fish is normally an important component in the Mediterranean diet, however Ikarians eat much less fish than other Greek regions – around two times a week. Small amounts of oily, wild-caught low-mercury fish such as sardines, herring, and anchovies, and lake trout, are typical choices. Salmon, squid and octopus are also eaten, but less frequently.
As a side-note: with such low red meat intake, ferritin (stored iron) levels would also tend to be low or moderate. In practical terms, blood would be less viscous or thick, a situation which is protective against formation of blood clots that could lead to stroke.⁶ Some would argue that this benefit alone, might explain why overall mortality risk is lower in these Blue Zone areas.
In Season – Produce is local, pesticide-free, and in-season in both cultures.
Ikarians are known for regularly eating at least 100 types of wild and garden greens like mustard, chicory, fennel and dandelion. Greens make up 17 percent of the diet and ‘Other Vegetables’ make up another 20 percent.
Vegetable intake in Sardinia during the 1950s was only 12 percent of daily dietary intake, but that figure has doubled in more recent times. A daily vegetable-rich staple, however was a minestrone soup made with dried chickpeas and other pulses, carrots, potatoes, fennel, celery, tomatoes and onions. Any uneaten vegetables from the day before, were added to the pot.
Diversity – The diverse diets of the Sardinia and Ikaria include an abundance of liver-cleansing and gut-bacteria-feeding wild greens. Wild greens contain at least ten times the artery-protective antioxidants of red wine, and are important for intestinal health, and immunity.
Many foods are wild and foraged, such as mushrooms, dandelion, berries wild garlic and leeks. Closer to home, spinach, kale, beets, turnips, chard and collards help to round out meals. All are good choices for longevity.
For sustenance throughout the winter, vegetables are dried, fermented or pickled. Raisins and figs are dried. In Ikaria, a type of seaweed is pickled and used as one might use capers to flavor dishes.
Prebiotic-Rich Chicory – Both cultures enjoy eating vegetables in the chicory family – which, interestingly, happens to be the favourite food of a beneficial gut bacteria called ‘Akkermansia muciniphilia. It seems that this gut bacteria associated with people that live past 100. The Akkermansia strain is also protective against pathogenic microbes.
If you would like to nurture your own Akkermansia municiphilia bacteria, eat vegetables in the chicory and endive family. They include: Belgian endive, radicchio, escarole, curly endive, and arugula. Onions, garlic and leeks, also keep this species of bacteria happy.
Organic Eggs – All six of the Blue Zone cultures enjoyed organic, free-range, antibiotic-free eggs two to four times per week. In Ikaria and Sardinia, eggs are served at breakfast alongside bread, olives and almonds. At other times, eggs are eaten with vegetables and an accompanying starch.
Beans and Legumes – Fava, black beans, soy and lentils make up the cornerstone of most centenarian diets around the world. To mimic what the longest-lived people are eating, enjoy at least a cup a day.
Beans contain about 21 percent protein, and the rest is complex, slow-release carbohydrate, together with a small amount of fat. Protein helps to minimize muscle loss as we get older.
Some caveats apply. If you have an auto-immune condition, or are trying to reverse type 2 diabetes with a ketogenic diet, starchy beans and legumes may not be your best friend. Not everyone does well with legumes. Individuals with a digestive disorder such as small intestinal bacterial overgrowth, may find beans and legume problematic.
Over the centuries, many Mediterranean and Middle-Eastern cultures have adapted to eating chickpeas, Gigantes beans and navy beans. If you have difficulty digesting beans, you may benefit from phytase (a type of digestive enzyme that helps break down the starches and sugars in beans).
Nuts and Seeds – Seeds such as sesame, fennel, anise, onion (black seed), are enjoyed in Ikarian and Sardinian cuisine. People eat lots of chestnuts, and walnuts, (high in monosaturated fats), hazelnuts, and almonds. Eat at least a variety from this list daily – a handful (2 ounces) should do it. If you are not on a weight-loss diet, two handfuls of nuts a day are fine.
In Ikaria and Sardinia, zero (or very low) amounts of vegetable oils are used. In Ikaria, by 2009, at least six percent of the dietary intake, was olive oil. Subsequent studies have shown that just 4 tablespoons of olive oil daily, reduces the risk of cardiovascular disease by at least 30 percent in middle-aged individuals, and the risk of dying by half.
Olive oil is high in a fat called, ‘Squalene’ which is cancer-protective. Its oleic acid and phenols help to lower inflammation and keep cholesterol in check. Question: where else can you get squalene? (Shark liver oil).
In some parts of the island, Sardinians prepare food with ‘mastic oil’, which is made from the berries of the pistachio tree. They also flavor their foods with an essential oil made from the sap. The taste is reminiscent of licorice and pine. Mastica is an excellent digestive, and its terpenes helps to kill H. pylori bacteria which is associated with development of ulcers.
In Sardinia, dairy consumption is higher than meat consumption, especially amongst the shepherds on the island. At the time of the observational study, inhabitants drank mostly raw goats and sheep milk, (plain and as yoghurt), and ate grass-fed ricotta cheese. It’s thought that Sardinian shepherds eat about 15 pounds of cheese a year. ⁷ Sodium is not viewed as a dietary villain.
For some reason, the research team did not supply data on how much cheese and dairy Ikarians were eating. In 2004 it was thought to be under 1 percent of daily intake. Having said that, homemade ricotta and pecorino and feta cheeses are eaten in Ikaria. Feta and Pecorino contain ‘Lacto bacillus’ and other beneficial bacteria.
Soft drinks were unknown to Blue Zone centenarians. For the most part, they drank spring water and supplemented with some of the beverages below:
Antioxidant-rich herbal teas of Iron Wort (Sideritis), wild rosemary, sage, oregano, rosemary and pennyroyal, are enjoyed daily, especially In Ikaria, where they are enjoyed several times a day. Many of these teas are associated with protection against Alzheimer’s Disease, (especially Sideritis/Iron Wort). The diuretic properties in all of these teas help to remove sodium from the kidneys and keep blood pressure down. Milk thistle tea is also enjoyed by both cultures for detoxification of organs.
Coffee – Ikarians drink 3 or more cups of strong coffee a day. While there are many arguments for and against coffee in general, a 2018 study from the Krembil Brain Institute found that ‘phenylindanes’, a group of compounds created during the roasting process, help to inhibit beta amyloid and tau – protein fragments common with Alzheimer’s and Parkinson’s disease.⁸ The antioxidant ditirpenes and caffeic acids in coffee are also confer health benefits. Caffeic acids, in particular, help to reduce the insulin spike one normally experiences 2 hours after eating. The study authors stress, however that coffee is not a cure, and more research needs to be done, as to how the research might translate into therapeutic applications.
Red Wine – The famous Cannonau variety red grapes from Sardinia are deeply pigmented with proanthocyanadin antioxidants. Cannonau is the name Sardinians have given to the Grenache grape. Three times more proanthocyanadins are found in this wine than any other wine in the world. Its complex flavor is reminiscent of plums, raspberries, strawberries, leather and spice.
It might be a case of the ethanol alcohol in wine, that is keeping people less stressed and living longer, however. While red wine contains an antiaging compound called, ‘resveratrol’ one would have to drink a barrel a day to consume what one could take in supplemental form.
Ikarians drink more wine than the people living in other parts of the Mediterranean. They average 2 to 3.5 glasses of wine daily). Sardinians, on average, drink one or two glasses daily. Before the 1950s, the amount was less.
Limited Sweets – Generally, people do not consume sugar in Ikaria or Sardinia. Dessert is generally, a piece of fruit. In Sardinia, where fruit is less prevalent, fruit may be grapes or nopal (the fruit of a prickly pear cactus).
A small amount of thyme honey might be taken. Sweets are not generally not made unless there is a special occasion that calls for them. Even then, the recipe is made chestnut or nut flours, walnuts, honey, and antioxidant-rich spices such as clove and cinnamon.
Carta de Musica – In Sardinia, ‘Carta de musica’ (a non-leavened cracker-bread so thin, that it is reminiscent of sheets of music) is enjoyed. Its light weight makes it easy for sheepherders to stack and carry into the mountains. Durum wheat found in Sardinia considered the best in the whole of Italy thanks to the quality of its water and fertile land.
Sourdough Bread – In both Sardinia and Ikaria, sourdough or stone-ground bread is made from a variety of grains such as barley, rye, or durum wheat – each providing amino acids such as Tryptophan, and minerals such as selenium and magnesium. Many families use the same ‘mother’ (starter yeast) that their grandparents used. By fermenting (souring) the dough, lactobacilli bacteria digest some of the starches and gluten, making the bread more digestible, and lower on the glycemic load scale. Souring dough before baking it also means that the finished loaf has an extended shelf life. (Now isn’t that frugal?)
These long-lived cultures understand the importance of enjoying themselves, whether they are connecting with family over home-cooked meals, bartering with a neighbour, or walking alone in nature. Having strong friend and family networks helps during times of stress.
Natural movement is important. Ikarians and Sardinians are always on the move, whether they are tilling soil, walking up mountains. They walk 5 miles or more a day, even into old age. Daily low-intensity activities, such as walking to the market, tending their gardens, and fixing things themselves, are undertaken even into their eighties and nineties. We know from studies, that caring about a garden and animals is linked to longevity.
They don’t overeat. Instead they eat just to the point of feeling full (or about 80 percent full). In Okinawa Japan, this is referred to as Hari Hatchi Bu. This practice has the same effect as a 20 percent caloric reduction.
They eat slowly, with friends and family. They also undertake occasional fasting, for religious purposes, or just to ‘spring clean’ themselves. When you cut back on food consumption, fewer demands are made on your mitochondria. Production of damaging free-radicals declines. That not only enhances mitochondrial efficiency, but also turns on SIRT1 genes, which encode proteins that boost cellular function. The result is better health and a longer life.⁹
Ikarians take daily naps – at least five times a week, on average. Naptime is usually after the main family meal, around two p.m. A 2008 joint study by the University of Athens Medical School and the Harvard School of Public Health found that daily naps can decrease your risk of heart disease by 37 percent. (In another post I’ll get into the longer explanation of how we ‘wash our brains’ during certain cycles of sleep).
They laugh together. The men of Sardinia in particular, like to get together in the street or in a bar, every day around 5 pm, just so that they can laugh. (The women are at home, cooking. Interestingly, there are not as many centenarian women in Sardinia).
They have a system of belief – whether or not this means a formal church service.
Sardinians and Ikarians treat their elders and family well. Grandparents and great-grandparents help with the raising of children. Later, when children grow old, they know that someone will return the honour, and look after them. It is so clearly evident that these long-lived people have a purpose in life – whether it is looking after a great-grandchild, planting the harvest, or looking after the community.
Wherever and whenever there is a sense of being needed, longevity is yet another reward.
1 Centennial Health Magazine, “The Science of Longevity”, Centennial Media, 2019. New York, NY. pp. 1-25.
2 Gretchen Benson, RD, LD, CDE, Raquel Franzina Pereira, MS, RD, LD, and Jackie L. Boucher, MS, RD, LD, CDE, Rationale for the use of a Mediterranean diet in diabetes management. Diabetes Spectrum 2011, Feb; 24(1): 36-40. https://spectrum.diabetesjournals.org/content/24/1/36
3 Poulaine, Michel; Pes, Giovanni Mario; Grasland, Claude, Carru, Ciriaco; Ferrucci, Luigi; Baggio, Giovanella; Franchesci, Claudio; Deiana, Luca (2004-09-01). Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study. Experimental Gerontology. 39(9): 1423-1429.
4 According to Swedish scientists, shortage of food for the paternal grandfather, between the ages of nine and twelve, resulted in a longer, healthier lifespan of his grandchildren. For further reading, see: Kaati G., Bygren L.O., Pembrey M., Sjostrum M. (2007) Transgenerational response to nutrition, early life circumstances, and longevity. European Journal of Human Genetics, 15: 784-790. https://www.nature.com/articles/5201832
5 Dinicolantonio, Dr. James, Fung, Dr. Jason, The Longevity Solution: Rediscovering Centuries-old secrets to a Healthy, Long Life. Victory Belt Publishing, Inc. Las Vegas. Printed in Canada. P. 196.
6 One study showed that in Sardinian men aged 100 or older, serum levels or iron were 40 percent lower than those in middle-aged control group. See: G. Forte et al. Metals in plasma of nonagenarians and centenarians living in a key are of longevity. Experimental Gerontology, Volume 60, December 2014, pages 197-206. https://www.sciencedirect.com/science/pii/S0531556514002952. Accessed on October 31, 2019.
7 Eliza Barklay, ‘Eating to break 100: Longevity tips from the Blue Zone’. April 11. 2015. https://www.npr.org/sections/thesalt/2015/14/11398325030/eating-to-break-100-longevity-tips-from-the-blue-zones Accessed October 30, 2019.
8 University Health Network. “Drinking coffee may reduce your chances of developing Alzheimer’s, Parkinson’s.” ScienceDaily, November 5, 2018. https://www.sciencedaily.com/releases/2018/18110516025.htm
9 Resveratrol, an antioxidant from the skin of dark red grapes or berries, also activates SIRT1 genes.