Opinion: The cloudy truth about ‘blue zones’

OpinionFirst Opinion Podcast The cloudy truth about ‘blue zones’ Eric Topol and Shelley Wood on the complicated reality about a favorite longevity concept Manage alerts for this article Email this article Share this article By Torie BoschMay 16, 2026 Editor, First Opinion Torie Bosch[email protected]Torie Bosch is the First Opinion editor at STAT. Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Shelley Wood and Eric Topol. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday. Torie Bosch: Twenty-five years ago, before peptides and biohackers were mainstream conversation, there were the blue zones: communities isolated geographically where residents reportedly lived far longer than average. Since then, the concept of the blue zone has exploded, influencing today’s longevity movement. But does the science hold up?Advertisement Welcome to STAT’s “First Opinion Podcast.” I’m Torie Bosch, editor of First Opinion. First Opinion is STAT’s platform for big, bold ideas from health care providers, researchers, patients, and others who have something to say about health and medicine’s most important and interesting topics. This season, we’re focused on the intersection of medicine and culture. Today, I’m speaking with Shelley Wood and Eric Topol. Shelley Wood is a medical journalist and author. Her most recent novel is “The Leap Year Gene of Kit McKinley.” Eric Topol is a cardiologist, executive vice president, and professor at Scripps Research. His most recent book is “Super Agers: An Evidence-Based Approach to Longevity.” After a quick break, I’ll bring you our conversation about the science and business behind blue zones. Shelley Wood and Eric Topol, welcome to the “First Opinion Podcast.” So my first question is a pretty basic one for whoever would like to take it. What is a blue zone?Advertisement Shelley Wood: Oh, let’s have you do that one, Eric. Eric Topol: Well, this kind of got its legs 25 years ago, and it wasn’t with the blue zone so-called founder who basically became the leader, Dan Buettner, but rather a couple of people in Europe who had been studying and basically using blue dots to mark where these people of extreme longevity were from. And that led to that concept of the blue zone. Bosch: And so that’s a small geographic area where people seem to live longer. Is that about right? Wood: Yeah, they were researching in Ogliastra, Sardinia, at the time, and I think it was Gianni Pes who was the first one to say, “hey, people are living longer in these remote mountains of Sardinia.” And then it was Michel Poulain, who I think is Belgian originally, who was the one who went in and validated some of that. But those two were the first ones to come up with this idea of blue zone based on, as Eric says, putting a dot on a map each time they validated on this island in Italy. Bosch: And the blue was just completely accidental? It just happened to be a blue dot rather than the blue signifying something important? Wood: Yeah, just the ink color. Good thing they didn’t use yellow, it wouldn’t have the same ring to it. Topol: Yeah, it’s actually why I wore a blue shirt today. Yeah. No, it sounded good — the blue zones. You know, there’s something special, secretive, you know, mystical about these zones. And of course, they proliferated after that first one. Bosch: Eric, do you remember the first time you heard about the concept of the blue zone? Topol: You know, that’s a really good question, Torie. It’s a ways back because this has been around for so long. I’d heard about it quite a bit over the years, but it really came alive with that Netflix 2023 multipart series. That’s when it really hit home because it was brought to life, if you will, from that whole thing. And, you know, I saw, wherever I went, these books about the blue zones, but I never read any of them. And I had always wondered about them. And so actually, when I was writing “Super Agers,” I purposely didn’t put anything in the book about blue zones because I didn’t know what was really going on. And Shelley and I connected about that, saying, why don’t we find out what’s really going on here?Advertisement Bosch: Shelley, what was what are some of your early thoughts or memories about blue zones before you started digging in? Wood: I think this is one reason that Eric and I wanted to dig into it is because they sort of seeped into the public consciousness. And I do this now, I just ask random friends, do you know what a blue zone is? Have you heard of it? And for sure, I had it in my head. And it might have been because I went to Sardinia on holiday about, I don’t know, 12 years ago. So maybe I saw something there. But when I was working on my novel, I had a character who was a blue zone researcher. And that’s what sent me sort of tumbling down the rabbit hole. This whole storyline ended up being cut from my book. I think blue zone is mentioned in there in just one place, but it must have been in my head already if I thought there had to be someone, a character, if I’m writing a book about a character that lives a very long time, there has to be a blue zone in it. And then maybe the same thing as Eric. I just thought it was too much. It’s too big and too unknown to me. I can’t casually drop this researcher into my storyline. So in addition to saving about 20,000 words that weren’t needed that got cut and I didn’t have to delve too deeply. Bosch: I’m so glad you turned the research into a First Opinion article at the very least. Wood: It didn’t go to waste yet. Bosch: So once the Netflix documentary came out and you started looking more into the idea, what were your sort of first reactions to maybe the science behind the concept of a blue zone? Topol: The conclusions seem right. That is, you know, how a lifestyle is really important, physical activity, what we eat, you know, being connected with other people. The question was, did the data support that? Because we see a lot of times when you have a paper published and the conclusions are not exactly aligned with the data. So that’s what kind of got me intrigued in the beginning. And I couldn’t think of anybody better to work with than Shelley because we’d been previously connected with theheart.org and Medscape, and I knew that if anybody could help you really drill down on this, she was the best journalist I could ever have a chance to work with.Advertisement Wood: Ah, you’re making me blush. But he raises an important point, which is that we had worked together in cardiology, which was where, you know, 98% of my medical journalism career was in writing about heart disease and writing about cardiovascular research. And compared to the rigor of what I had been writing about for 25 years, I couldn’t get my mind around this idea that this research held up. How could you possibly be sure that these people were really the ages? And, you know, this is like throwing fuel on a fire if you say this to the blue zone’s original researchers, the diehards, because they are very touchy about the idea that this information couldn’t be validated. But compared to a randomized clinical trial of 18,000 people with hard endpoints, this just seems flaky, even though the message, as Eric says, is totally common sense, that data should prove what they found. But to try to attach the origin story to the outcome was tricky. And then add to that, that there’s this quite financial motive behind some of it, which is a separate issue to some degree, but the advice of journalism is to follow the money. And it’s hard not to. Look at blue zones, common sense. Yes, we should all be living this way, but not have some question marks that have popped into your head. Bosch: So to step back for a second, as I understand it, originally, about 25 years ago, there was the study in Sardinia. And then there was a National Geographic cover story that looked at the Sardinian mountains, as well as a couple of other places, one in Japan, in Okinawa, and one in California, with the idea being that these so-called blue zones could help us all understand how to live longer. And then the term was trademarked to get to Shelley’s point about the money. How was the idea of a blue zone evolved since it kind of first emerged about 25 years ago? Wood: Well, we might need more than 30 minutes for that one. But I want to just go back to the trademarking because as much as that immediately, you kind of think: trademark, what?Advertisement But if you talk to Dan Buettner, he said he did it to protect it because it was being used in very loosey-goosey ways. So that rings true for me. You wouldn’t want this term that people were attaching scientific meaning to to be used for facial serums and hair oils or whatever. But it did at least set it up then that the term was trademarked for future use in ways that might seem a little more questionable. But in terms of how the term blue zone then got perpetuated beyond those original places, I mean, that’s, there’s so many ways in which that happened. And I think it’s got the interesting, two things: It’s got the scientists on the one side, but then it has a journalist for National Geographic writing about it and writing books about it on the other side. And the popularity just exploded. I don’t know, Eric, I’m dancing around it a bit, perhaps. Topol: Well, I mean, we’re still not seeing the end of being named blue zones. I mean there’s potentially the Singapore considered as a blue zone. There’s Martinique island. And there’s a paper coming out, apparently, about new definitions of blue zones. So we haven’t seen the last of these. The problem, Torie, is, for example, you touched on Loma Linda in California, and it really wasn’t a legitimate blue zone. It’s not an island that’s protected. It was, I think, even admittedly, it was [included] because there wasn’t any blue zone in the United States. And it doesn’t make any sense, actually. But there’s lots of debate to what constitutes a blue zone, and that fuzziness and the connection with the business of the Blue Zones LLC and the company owner Adventist Health, which of course is [in] Loma Linda. So there’s all this complex web here of what’s a blue zone. And what I didn’t know before we got into this, whether it was the interviews … multiple people and the podcast and various things we did to understand what’s going on here. We had no idea how big the business was, you know, to the point that Adventist was going to open up this huge tower in Miami where you could be in an apartment building blue zone with a longevity clinic in it and spa stuff … the endless promotion. And what really got me as we were doing the research is here in San Diego, there’s two very large universities. One of them is San Diego State University. The company, Blue Zones LLC, was pitching San Diego State to become a blue zone. Why is a university becoming a blue zone? And these contracts to become a blue zone are very expensive. As in the piece, we documented that one was $25 million in Iowa. And then there’s the renewals and, you know, this big …Advertisement Wood: Certification ongoing — Topol: Yes, yes. And a lot of people are involved to make them into a into a blue zone. So that is what I think is disconcerting is, you know, the combination of some of the fuzziness in the data, and then the financial benefits, which, you could say, if everything was locked in regarding the data, you say, “Well, maybe it all fits together, but there’s something here that’s a little loose.” Wood: Even if we could be absolutely confident that these original blue zones existed because of the lifestyles and diet that were there and not some other component or some random chance, even if we were sure of that, how can you replicate that and how can you know that replicating that will yield the same outcomes? Well, actually, it does seem like it ought to work, but that’s not the same thing as proving that it can work. Topol: Yeah, and one other key point is that this all predated the current longevity craze. I mean, there’s been interest in longevity, promoting it, for millennia. But this 25-year campaign really brought it to the forefront that there’s all these people in these various places around the world that are living to 100-plus. You know, that was even the title of the Netflix series is [“Live to 100: Secrets of the Blue Zones”]. So that, I think, awoke a lot of the interest that’s currently, you know, a fever for, and so it’s especially important to get to this foundational movement. Bosch: Yeah, and I want to get to how this all interplays with the current longevity movement in a minute, because I think that’s really important. But to go back to the fuzzy data really quickly, Shelley, you dug into that a bit. What makes you say that the data is fuzzy? Wood: Well, I wanna give credit to the people before me that dug into it. I’m doing this as a freelance thing with Eric right now. So it would take teams of people to really go back and try to reassess the data that was originally validated. But a huge amount of the skepticism about it came from a biologist from Australia called Saul Newman, who works as a demographer now in the U.K. And he was the one who dug into this and really said, “How can we be sure that when those records were reconstructed after World War II, that they actually validated the exact correct age of the people?”Advertisement So even though the blue zone scientists will tell you, “No, no, we went door to door, we looked at birth records, we looked at school records, we looked at death records and we checked them by knocking on the people’s doors.” But to me — sure, it’s an incredible effort, hats off, but I just can’t believe that means it was true. And so if we look at those different parts of the world and see how problematic some of the data was in Ikaria, Greece, which is named as a blue zone, where there was records of pension fraud in order to sort of receive your dad’s pension after he died, there’s just too much fuzziness, as Eric’s now coined the term, for us to not have big question marks in our heads. Bosch: I like that. It feels like that can be a guiding principle around so much in health, but especially around longevity, I think, which is such a strange space, especially right now. Eric, you recently wrote a book called “Super Agers,” which talks a lot about how people really can shape their own longevity. You argue that it’s not really about genetics. It’s about choices you make. It’s about where you live. It’s about how you live, not necessarily in the mountains of Sardinia, but how you choose to and how you are able to have the opportunity to live that life. Could you maybe talk a little bit about how your thesis there interacts or sort of compares with the idea of the blue zones as inspiration for how to live a healthier, longer life? Topol: That’s where there’s a lot of alignment with Dan Buettner and this blue zone movement, if you will, because a lot of the things that they described have since been reinforced with great data, whether it’s randomized trials with the Mediterranean diet or Mediterranean light diet or all the work that’s been extensive on physical activity, on social connection, on sleep health, which wasn’t one of the things that he got into. I mean, there were some things that didn’t fit, like wine time at 5 p.m. And alcohol, which doesn’t exactly hit the mark.Advertisement But for the most part, they were pretty well aligned. The difference is that now we really have solid data to support these. But the other thing is we understand the biology and a lot of those lifestyle factors have a great impact favorable on our immune system. And every week now we’re learning how the immune system, whether it’s the thymus or whether it is all the ways we can study the immune system, that’s what’s particularly noteworthy in people who have healthy aging that extends to their ninth and tenth decade of life. So a lot of these factors that we just described are things that modulate the immune system in a very favorable way. Bosch: So this is going to sound like a joking question, but I mean it sincerely, which is: Do you think the idea of wine at 5 may have sort of played into the popularity of the blue zone? Whenever I hear about those sorts of man on the street or person in the retirement home interviews with someone over 100, they say, “well, I lived this long because I ate chocolate every day” or “because I had bacon every Sunday.” So I mean, could that be a little bit of it? This idea that pleasure helps us live longer is something people seized on? Wood: People are always trying to attach, you know, if one piece of dark chocolate a day or two coffees is good, three coffees is bad. I’ve written about that through my entire career, but I do think that if you stick to some of the specifics of Dan Buettner’s Power Nine, it’s hard for me to stomach. One of them is being a member of a faith-based community. There’s another one that’s prioritizing families. So for an atheist who doesn’t have kids, I saw those and I was like, “Well, great, now I’m screwed.” But no, I think that if you back away from the specific slightly and you think about the notion of having a community, having people to support you, doing things that’s pleasurable in your social group, you can see that there are benefits. And I do think, not that I’m as familiar with the data as Eric would be, but there are studies that show the importance of social connection, the importance of, you know, people who are married live longer. There’s other data that plays into that at a certain level, but I think wine at 5 might almost be a different way of saying, “get together with friends, don’t stay at home on your phone and eat crappy food.” But the specific nature of it, I think, if you’re using it as a criteria for health, it’s the specificity is the problem.Advertisement Bosch: Eric, does that jibe with your thinking about the idea of wine at 5? Topol: Yeah, I think, as you pointed out, Torie, aptly, it does make it more alluring that, oh, this recipe fits in with the interest of having alcohol. But so certainly the data that’s come up that have come out, which are mixed, as [is] covered a lot in STAT, isn’t so supportive of that. So there are some things in that list of the essential things that [are] hard to support with real data, like the problem of really documenting that these people were 100 years old or whatever in the Netflix [series]. It’s just hard to know. Really, were they so extreme? Or could we find those people in our communities? You know, like the ones that I wrote about in “Super Agers.” They’re around, and they may not be in islands necessarily. And we haven’t heard the last of this because there’s still going to be these other places that are declared as blue zones. And I think one of the reasons we worked on this was just to try to set the record straight of what we know and what we don’t. Bosch: Now, I would like to talk a little bit about the longevity field, which has just so exploded in the past quarter-century, as you say, possibly inspired by the blue zones. Having written your own book about longevity, Eric, what do you think about the way longevity is spoken about at this moment? Topol: Well, I look at it as three different buckets or paths. One is the pseudoscience with all these things like the anti-aging supplements and the peptides and the long list that you know. And then there’s some really exciting kind of avant-garde science to rejuvenate and basically reverse aging that’s in the biotech field. A lot of that is supported by billionaires. When they were young, they wanted to be rich. And when they’re old, they want to live forever. And now we have this other group, which is this other path, which is maybe we should accept that we’re going to age but maybe we can have an impact on age-related diseases. Which is I think what we’re talking about here. Unless we really can reverse aging, [longevity is] tentative and certainly not gonna be likely from a supplement or a peptide, but we should be really focused on the health span, the healthy aging story. And we have a lot of momentum right now, which is different than the longevity movement. So, hopefully we can make a dent in these, whether it’s Alzheimer’s, cardiovascular disease, and certainly cancers, that we can start preventing and extending lifespan. So, right now it’s about a 15-year gap, and let’s close that gap. So, instead of getting people to live much, much longer, let’s let them live healthier while they’re enjoying their lifespan. Wood: I think it’s that distinction between all of the influencers and the snake oil salesmen that are trying to sell you a way to stay young, as opposed to, and this is something that I actually found quite appealing in the Netflix documentary, is to venerate the healthy elderly, instead of trying to have the photos of the 80-year-old who’s running marathon and is way more muscular than most humans. Let’s tip our hats to the people who are aging with grace and doing it in a healthy, social way. And I think it’s a distinction. We can’t stay young. It’s impossible, but we could, as Eric says, do more to try to age healthily, age well, and have that be something that can be visible and feted, because otherwise it’s a little bit, you know, you’re kind of pushed to the side. Bosch: Shelley, as you mentioned, you’ve written your own novel about longevity. What’s been the difference between how you’ve researched longevity as a journalist versus how you researched it as a fiction author? Wood: So I did not research longevity as a journalist. I’ve written about people who’ve lived long lives by avoiding cardiovascular disease or that type of thing, but it was going out on a limb to research it for a novel. But I had a really funny early conversation with Eric when I first had the idea for the novel. I called him up and I wanted to know how genetically you could be, what could happen to you at a sort of embryonic level that would alter your aging. And we talked for a while, and I kept on asking all these very stupid questions. And then Eric said, “It is fiction you’re writing, correct?” And I was sort of like, “Oh, right. I don’t need to get this scientifically correct. I just need to make a good story.” But I think that’s for any journalist who starts doing fact-based writing to try to break away from that. That’s a separate podcast topic altogether. But for me, I didn’t research longevity until we embarked down this path of working on this project together. Bosch: So having now written about longevity, both of you in different ways, do you get approached by people asking you about your personal longevity much or for advice on their personal longevity? Topol: That happened to me unknowingly. When I had the book come out just about a year ago, I didn’t think that was going to become a subject of lots of conversations about what do you eat, what do your exercise, all this stuff, but it did. And I was happy because, to give at least what I do just because I learned from the research for the book. For example, I really wasn’t doing much of resistance strength training. I was always big on aerobic and changed and really focused on sleep health, not realizing how vital deep sleep was each night to get the toxic metabolites out of our brain so we don’t incite inflammation. So those things that I learned, I tried to incorporate and, yeah, they came out. I didn’t expect it. I guess I should have, but you know I thought the book was more about what we all can do, not what I can do. Bosch: To kind of continue this idea, forgive me, are there any changes you have talked about in your book that you’ve decided are not worth it to make in your own life? Topol: That’s a good one. I don’t know. What do you think about that? Bosch: I don’t know. I, for instance, I get some pleasure out of junk food. So I will eat junk food, even though I know it’s bad for me. Like, is there anything that you’re like, “I know, I probably shouldn’t do this”? A guilty pleasure, perhaps. Topol: Oh, yeah, I mean, I think you can’t be 100%. We all have these guilty pleasures, whatever. It’s just that you kind of know it and you feel that you’re kind of getting off track. But I think we do have a lot of determinism of our own in keeping that momentum of healthy aging. I mean, the data shows if you start at age 50, you can at seven to even more years of true healthy aging without a chronic disease. And so if you start early or even more. So, yeah, are you going to have some days where you just, you know, abandon your your plan? Sure. But I think we do know we have a lot of power and we have great substantiation of that. And to give credit to the blue zones, they were on the mark with a lot of these things, not all, as we suggest. They just were doing it more in a qualitative way. Without the solid data. I think it’s been reaffirmed. And so there are some positive things. Had it not gone into, you know, such a mega financial business thing, it probably would be a different assessment of it. But they were there early. And it’s good to see many of the things that were being advocated were supported. Not all but many. Wood: And I would add to that, because we have been a bit critical of blue zones and Blue Zones LLC here, is that they also saw the need to get in at a municipal level. That some of these things are, we are in control of, we can make the choice of what we’re going to eat or how we’re going to spend our evenings, but at some level we’re up against some really big barriers and some communities much more than others. So for some of the work that, and I’m no expert in, but that Blue Zones LLC is trying to do in order to make your communities more walkable to make fresh food more available. Those are other things that have been studied and have been shown to make a difference. And so that balance between, yeah, don’t eat that bad thing, you know, quit smoking, but at the same time, can I walk to work? Can I ride my bike without getting struck by a car? Like there are things that can make a difference at a sort of systemic level. And you don’t hear a lot of longevity influencers nattering on about those. But you might hear some of the original Blue Zones folks telling you that if you can get out and walk more and you can do more of your daily activities manually, that’s not a bad thing. And I do try to think about that a bit now, more than I might have in the past. Topol: And to Shelley’s point, which is so critical, is the things that everyone can do that don’t cost anything, not like getting plasmapheresis or hyperbaric oxygen treatment or, you know, we’re talking about you going for walks, eating foods that don’t necessarily add to expense. You know, most everything that are practical. Dan calls it peasant food, and I don’t know that these frozen foods, they’re expensive, they are not peasant food. Bosch: Blues Zone LLC sells some frozen foods, right? Topol: Yes, that’s right. But even that’s not like for the affluenza that are, you know, getting these crazy treatments that are undocumented, plasmapheresis and whatnot, stem cells. So I think at least [Blue Zones LLC] sticks to basics that would be applicable for everyone that, you know has access to these things. I mean, exercise, physical activity is free. And a lot of these things are not costly. So those are the things that matter. And that’s where we can see a significant improvement in health span just to get these into much more people’s daily lives. Bosch: Well, I think that’s a great note to end on. Eric Topol and Shelley Wood, thank you so much for coming on the “First Opinion Podcast” today. Topol: Thank you. Wood: Thank you so much for having us. Bosch: And thank you for listening to the First Opinion podcast. It’s produced by Hyacinth Empinado. Alissa Ambrose is the senior producer, and Rick Berke is the executive producer. You can share your opinion on the show by emailing me at [email protected]. And please leave a review or rating on whatever platform you use to get your podcasts. Until next time, I’m Torie Bosch, and please don’t keep your opinions to yourself. aging, Policy, public health Submit a correction requestReprints Torie Bosch Editor, First Opinion Torie Bosch is the First Opinion editor at STAT. 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