Blue Zones and Check The Life: Lessons from the Blue Zones
In this article
A map not of long life, but of living well
From the mountain villages of Sardinia to the islands of Okinawa, people in five widely separated corners of the world live long, healthy, purposeful lives around a crowded table. These places, called Blue Zones, inspired Check The Life's founding philosophy. In this article, we explain what we have learned from the Blue Zones, what we have consciously chosen not to adopt, and how we can build "our own Blue Zone" in urban life.
- Key idea: In Blue Zones, health does not come from a single food, a single test, or a single habit; it comes from living movement, nutrition, purpose, rest, and relationships together. Check The Life likewise approaches health as a whole in which five disciplines examine it at the same table.
- What does the science say: Each of the nine principles of the Blue Zones is supported by independent large-scale studies. For example, the risk of mortality is 2.4 times higher among those with the lowest sense of purpose in life and 32% higher in cases of social isolation; in the group in the highest quartile for daily step count, the risk is half as high.
- What we have not adopted: We consciously leave out the principle of "one or two glasses of wine in the late afternoon." There is no safe level of alcohol for cancer. In addition, age records in some Blue Zones are disputed; our goal is not to reach one hundred, but to achieve healthy years.
- What we have added: In Blue Zones, the environment regulates healthy living automatically. In the city, this needs to be built by measuring, planning, and managing it together: "Let's measure together, let's manage together."
Why does this matter?
Life expectancy is increasing in Türkiye, but a significant portion of these years is spent with illness. According to TURKSTAT data, there is a difference of approximately 20 years between life expectancy at birth and healthy life expectancy in Türkiye. In an analysis examining 183 countries, this difference was 9.6 years globally and had increased by 13% since 2000. In other words, people are living longer, but they are spending an increasingly larger share of these additional years with chronic diseases. In Türkiye, one out of every two deaths is caused by cardiovascular disease or cancer; yet a significant proportion of cancers is preventable.
The good news is this: Genes account for less of long and healthy life than commonly believed. Twin studies in Denmark found the heritability of lifespan to be 23–26%; another analysis based on genealogical data from 400 million people suggests that this share does not exceed 7%. In Harvard studies that followed more than 120,000 people, 50-year-old women who maintained five healthy habits together (not smoking, normal weight, at least 30 minutes of activity per day, healthy eating, and moderate alcohol consumption as defined in the study) lived 14 years longer, while men lived 12 years longer; most of these years were spent without cancer, heart disease, or diabetes. Blue Zones are living examples of this reality: Genes are the foundation, while lifestyle is the lever. The difference between chronological and biological age is also determined to a great extent by our lifestyle.
What are Blue Zones?
Blue Zones are regions where people live healthy, long lives well above the average, and where those who exceed one hundred are frequently seen: Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Ikaria (Greece), and Loma Linda (USA). The shared lifestyle in these regions is summarized in nine principles: natural movement, purpose, rest, eating in moderation, a plant-centered diet, belonging, family, and a strong social network.
Blue circles on a map
The story began in the early 2000s on the Italian island of Sardinia. Demographer Michel Poulain and physician Gianni Pes marked on a map, with a blue pen, the mountain villages where men over one hundred were exceptionally common and published their findings in 2004. In this region of Sardinia, there were approximately 1.35 women for every centenarian man; in most parts of the world, however, the vast majority of centenarians are women. Journalist Dan Buettner expanded the concept to Okinawa and Loma Linda in his 2005 article for National Geographic, "The Secrets of Long Life"; with his book published in 2008, "Blue Zones" spread around the world.
| Region | Notable finding | Essence of the lifestyle |
|---|---|---|
| Sardinia, Italy (the mountain villages of Ogliastra and Barbagia) | The exceptional frequency of men reaching one hundred; approximately 1.35 women for every centenarian man | Shepherding and mountain walking, family ties, respect for older people, beans, and whole-grain bread |
| Okinawa, Japan | Japan's longest-living region in 1975 and 1985 | "Ikigai" (reason for living), "moai" (lifelong friendship groups), "hara hachi bu" (stopping when 80% full), sweet potatoes, and soy |
| Nicoya, Costa Rica | Life expectancy among 60-year-old men is approximately 2.2 years higher than the national average | "Plan de vida" (life plan), physical work, aging within the family, corn, and beans |
| Ikaria, Greece | According to Buettner, approximately 1 in 3 people reaches the age of 90 | Afternoon naps, herbal teas, olive oil and vegetables, and a sense of time free from haste |
| Loma Linda, USA (Seventh-day Adventists) | Adventist men live 7.3 years longer and women 4.4 years longer; among vegetarians, the differences are 9.5 and 6.1 years | Faith community, a weekly day of rest, plant-based eating, staying away from smoking and alcohol |
Blue Zones are not in the genes but in the lifestyle: Okinawa's cautionary story
The most striking example showing that Blue Zones are not the product of "lucky genes" is Okinawa's loss of its crown. After 1945, rice replaced sweet potatoes, followed by American-style processed foods. Today, Okinawa has Japan's highest obesity rate. Among generations born after the 1950s, mortality rates rose above the Japanese average.
There is a similar picture in Nicoya: The life-expectancy advantage is not seen among those born after approximately 1930. This is an encouraging lesson for us: If a Blue Zone fades when the lifestyle changes, it can also be built by changing the lifestyle. Indeed, Buettner describes Singapore as a "designed Blue Zone" through urban policies that make healthy choices easier.
Nine principles, five tables: how do the Blue Zones translate into Check The Life?
Buettner and his team brought together the lifestyle shared by the five regions in nine principles they called "Power 9." When founding Check The Life, we tested each of these nine principles with two questions: Does science support it? And how can we measure and manage it in a busy person living in a city? The resulting alignment also explains why the five clinics in our program (internal medicine, cardiology, psychology, nutrition, and physiotherapy) sit at the same table.
| Blue Zone principle | In the Blue Zone | What does the science say? | At Check The Life |
|---|---|---|---|
| 1. Natural movement | No gym; gardening, hills, walking, handicrafts | The risk of death was 53% lower in the top quartile for daily step count; low fitness is a stronger risk factor than smoking | Physiotherapy and cardiology: exercise testing, grip strength, functional tests, personalized step target |
| 2. Purpose | “Ikigai” in Okinawa, “plan de vida” in Nicoya | The risk of death was 2.4 times higher in those with the lowest sense of purpose; 1.5 times higher in people without an ikigai in Japan | Psychology: discussing meaning, motivation, and goals |
| 3. Slowing down | Afternoon naps in Ikaria, time devoted to ancestors in Okinawa, a weekly day of rest among Adventists | Death from coronary heart disease was 37% lower among those who took regular midday rests; stroke risk was 1.35 times higher when working 55 hours or more per week | Psychology and cardiology: stress, burnout, sleep, blood pressure, and rhythm |
| 4. The 80% rule | “Hara hachi bu” in Okinawa: leaving the table before feeling completely full | In the CALERIE study, reducing calorie intake by approximately 12% slowed the rate of biological aging by 2–3% | Nutrition: body composition, waist circumference, visceral fat, personalized plan |
| 5. Plant-based eating | Beans, chickpeas, lentils, vegetables; meat a few times a month | Every 20 g of legumes per day reduces the risk of death by approximately 8%; switching from a Western-style diet to the healthiest diet at age 20 is estimated to add 10–13 years | Nutrition and internal medicine: dietary pattern, metabolic risk, microbiome analysis |
| 6. Wine in the late afternoon | One or two glasses a day in Sardinia and Ikaria, with friends | There is no safe level of alcohol consumption with respect to cancer; an analysis of 107 studies could not demonstrate a lifespan benefit from drinking small amounts | We do not include it. Instead of the wine, we take the table and the conversation (below) |
| 7. Belonging | Regular participation in faith communities | The risk of death was 33% lower among women who attended religious services more than once a week; death from cancer was 21% lower among those who attended at least once a week | Psychology: meaning, belonging, and support networks; grounded in each individual’s own beliefs and values |
| 8. Our loved ones first | Living in the same home as, or near, elderly parents; making time for family | In Harvard’s study, which has continued since 1938, those who were most satisfied with their relationships at age 50 were the healthiest at age 80 | Psychology: relationships and family; family tree and family health history |
| 9. The right environment | Lifelong groups of five friends called “moai” in Okinawa | The likelihood of survival was 50% higher among those with strong social relationships; social isolation was associated with a 32% higher risk of death and a 24% higher risk of death from cancer | A team that stays with you for 12 months; app, video consultations, and a month-6 check-in |
Factors that increase the risk of death: opposites of the Blue Zone principles
Hazard ratio (1.0 = reference). The red bar represents the absence of Blue Zone principles; the gray bar represents classic risk factors.
Sources: Mandsager 2018 (122,007 people; fitness, smoking, diabetes), Alimujiang 2019 (purpose), Sone 2008 (ikigai), Wang 2023 (90 cohorts; isolation and loneliness). Comparisons between different studies are indirect; patient groups, prior treatments, and follow-up periods differ.
This table tells us something important: loneliness, lack of purpose, and physical inactivity are risk factors as serious as smoking and diabetes. A conventional check-up measures none of these. That is why, at Check The Life, psychology, physiotherapy, and nutrition sit at the same table as cardiology and internal medicine.
Movement in the Blue Zones: not exercise, but life itself
No one in the Blue Zones “goes to the gym”; people climb hills, dig in gardens, and walk to visit neighbors. Science confirms this as well: in an analysis involving more than 47,000 people, the risk of death decreased as daily step count increased, with the greatest benefit reached at 6,000–8,000 steps per day in people over 60 and 8,000–10,000 steps in younger people. that moderate physical activity extends lifespan and how inactivity increases the risk of colon cancer We wrote earlier. In short, exercise is medicine.
Daily step count and risk of death
Risk ratio; the quartile with the fewest steps = 1.00. 15 cohorts, 47,471 people.
The greatest benefit is reached at approximately 6,000–8,000 steps per day in people over 60 and 8,000–10,000 steps in younger people (Paluch, Lancet Public Health 2022).
The table in the Blue Zones: what is on the plate, and who are we eating with?
The cuisines of the Blue Zones differ greatly, but their common features are clear: legumes, vegetables, whole grains, olive or other plant oils, little meat, and little sugar. This is very close to our Mediterranean cuisine . Aegean dishes made with olive oil, Anatolian lentil soup, chickpeas, and whole-grain bulgur are actually relatives of Blue Zone plates. What we should avoid is also clear: ultra-processed foods, sugary drinks, and processed meat.
The Okinawan principle of “hara hachi bu” also has an equivalent in Anatolia: “Do not eat before you are hungry; leave before you are full.” This moderation is also the simplest way to protect against obesity and abdominal fat . But the real secret of the table in the Blue Zones is not only on the plate; it is in eating slowly, as a family, and while talking. The gut microbiota also changes within days with a fiber-rich and varied plant-based diet; for this reason, at Check The Life we use microbiome analysis as the starting point for the nutrition plan.
Years gained through lifestyle
Years; average time added to lifespan. Colored bar: women; dark bar: men.
Li 2018 (Circulation; US, more than 120,000 people), Fadnes 2022 (PLoS Med; modeling study, not an individual prediction), Adventist Health Study-1 (Loma Linda). Comparisons between different studies are indirect; patient groups, prior treatments, and follow-up periods differ.
What we did not take from the Blue Zones
Adopting a philosophy does not mean accepting it without question. We consciously did not take three things from the Blue Zones.
1. Not “wine at five,” but “the table at five”
One of the nine principles of the Blue Zones is one or two glasses of wine a day with friends. As an oncology program, we cannot recommend this. According to the World Health Organization, alcohol is classified as a confirmed carcinogen in humans, is associated with at least 7 types of cancer, and has no safe level with respect to cancer. In January 2025, the US Surgeon General identified alcohol as the third leading preventable cause of cancer, after tobacco and obesity. An analysis covering 107 studies and 4.8 million people also could not demonstrate a lifespan benefit from small amounts of alcohol. that red wine is not an exception We had also written separately.
In our view, what is valuable about this principle is not the wine, but getting together with friends at five o’clock. That is why we adapted it as “the five o’clock table”: A cup of tea, a handful of walnuts, good conversation. Just be careful not to drink the tea very hot: very hot tea increases the risk of esophageal cancer; waiting a few minutes is enough.
2. Not a goal of living to 100, but healthy years
Blue Zones have also become the subject of scientific debate in recent years. UCL demographer Saul Newman argued that a significant portion of records of people aged 100 and older came from regions where birth records were incomplete, poverty was prevalent, and pension fraud could occur; this study received the 2024 Ig Nobel Prize. In an audit conducted in Japan in 2010, the whereabouts of more than 230,000 centenarians who appeared to be alive in the records were unknown (no missing centenarian was found in Okinawa during this audit). On the other hand, Blue Zone researchers state that ages in Sardinia were individually verified using population and church records dating back to 1866, and they published a detailed response in a peer-reviewed journal in 2025. The same response also acknowledges that Okinawa no longer meets the criteria for a Blue Zone.
For us, this debate means the following: The value of the Blue Zone principles does not depend on the number of centenarians. Each principle is supported by independent, large-scale studies. Check The Life does not see itself as a “longevity” program either; our goal is not to reverse biological age or promise that people will live to 100, but to ensure that the years added to life are healthy.
3. Not a commercial brand, but a way of life
“Blue Zones” has now become a major commercial structure, with a registered trademark, certification programs sold to cities, ready-made meals, and a documentary series. We took not a product but a perspective from the Blue Zones: Health is too holistic to be purchased with a single product.
What Blue Zones do not know: measuring
The shepherd in Sardinia does not count steps, and the grandmother in Okinawa does not know her cholesterol level. Their environment naturally creates healthy living: hilly streets, seasonal vegetables, large families, and a pace of life with no room for rushing. Chronic stress is also lower in this environment; the relationship between stress and cancer is a separate subject of debate. Buettner also says that the main lesson of the Blue Zones is the environment, not willpower.
But the environment of a manager in Istanbul who works 55 hours a week, takes the elevator to the office, and eats dinner in front of a screen does not do this. Moreover, there is something else that Blue Zones do not know: Cancer and cardiovascular diseases begin silently, years earlier. Healthy living reduces risk but does not eliminate it; therefore, evidence-based cancer screenings, family history, and, in patients who need them, next-generation early-detection tests are also part of this whole.
Check The Life was founded to fill this gap: to consciously create in the city what the Blue Zones experience naturally. We do this in three steps: measuring, planning together, and managing together for 12 months. This is also where our slogan comes from: “Measure together, manage together,” or “Let’s measure together, let’s manage together.”
Figure 1 · Creating your own Blue Zone in the city
The cycle in which Check The Life measures and jointly manages what Blue Zones experience naturally.
9 steps to create your own Blue Zone
You do not need to move to a Blue Zone; you can bring it to where you are. A practical, measurable step in the city for each principle:
- Integrate movement into your life: Take the stairs instead of the elevator, hold meetings while walking, and take a 15-minute walk during lunch. Goal: 7,000–10,000 steps per day and strength training 2 days a week.
- Write down your purpose: Write the answer to “Why do I get up in the morning?” in one sentence. Have a purpose outside work as well: grandchildren, volunteering, or a craft.
- One moment of slowing down each day: A brief 15–20-minute rest, a moment of silence such as prayer or meditation or an evening walk without your phone. Stay completely away from work at least one day a week.
- Get up before you are full: Use smaller plates, eat slowly, and do not eat in front of screens. Keep dinner early and light; an early dinner also has a positive effect on blood sugar.
- Legumes at least 4 meals a week: Lentils, chickpeas, dried beans, and borlotti beans. Limit red meat to once or twice a week and minimize processed meat. The relationship between nutrition and cancer also points in this direction.
- The five o’clock table: An alcohol-free gathering with friends or family several times a week.
- Belong to a community: A faith community, neighborhood association, choir, or walking group; any community that meets regularly.
- Put your loved ones first: Eat at least several dinners together as a family; spend regular time with elderly parents.
- Create your own “moai”: A group of 3–5 friends who share healthy habits. Walk together, eat together, and keep one another accountable.
And the tenth step, one that Blue Zones do not know: measure. Blood pressure, blood sugar and insulin resistance, cholesterol, waist circumference, fitness, sleep, and mood; cancer screenings appropriate for your age and family history. You cannot manage what you do not measure.
- According to the 2025 Turkish Statistical Institute Turkey Health Survey, obesity among people over age 15 is 21.8%, and daily tobacco use is 30.1%; according to the data presented in the Check The Life presentation, the vast majority of adults do not engage in regular physical activity, and approximately half of those with hypertension are unaware of their condition.
- In Türkiye, 36% of deaths are caused by diseases of the circulatory system, and 16.3% by cancer (TurkStat 2024).
- On the other hand, our traditional way of life is very close to the Blue Zones: Aegean and Mediterranean cuisine, legumes, neighborly ties, crowded tables, neighborhood and community culture, and respect for older people. Preserving this heritage, which we are losing, may be the most powerful prevention program of all.
Frequently asked questions
- What are Blue Zones?
- Blue Zones are five regions where people live healthy, long lives and centenarians are frequently observed: Okinawa, Sardinia, Nicoya, Ikaria, and Loma Linda. The lifestyle these regions have in common includes natural movement, a sense of purpose, rest, moderate and plant-based eating, belonging, family, and strong social relationships.
- Do Blue Zones really exist?
- Records of exceptionally advanced ages in some regions are controversial, and Okinawa no longer meets the criteria for a Blue Zone. However, each of the Blue Zone principles is supported by large independent studies demonstrating the effects of movement, a sense of purpose, social relationships, and plant-based eating on lifespan.
- Is the secret to a long and healthy life in our genes?
- Largely, no. According to twin studies, genes account for approximately one quarter of lifespan; some analyses suggest that this proportion is even lower. The disappearance of Okinawa's lifespan advantage when its diet and lifestyle changed indicates that lifestyle is the determining factor.
- Should I drink a glass of wine every day, as people do in the Blue Zones?
- No. Alcohol is a definite carcinogen and there is no safe level of alcohol consumption with respect to cancer; large analyses have not demonstrated a lifespan benefit from drinking small amounts. The valuable aspect of this principle is gathering with friends; you can experience this around an alcohol-free table as well.
Glossary
- Blue Zone
- A geographical region where people live healthy and long lives well above the average.
- Ikigai
- Japanese for “reason for living”; having a reason to get up in the morning.
- Plan de vida
- “Life plan” in Costa Rica’s Nicoya region; the Spanish equivalent of ikigai.
- Hara hachi bu
- A phrase said before meals in Okinawa that reminds people to stop when they are 80 percent full.
- Moai
- Small groups of friends in Okinawa who support one another throughout their lives.
- Healthy lifespan (healthspan)
- The length of life spent without serious disease or disability.
DROZDOGAN Academy Commentary
Blue Zones show us not a diet list, but an architecture of life. Check The Life’s contribution is to make this architecture measurable and manageable.
⚡ Why it matters
A significant proportion of chronic diseases and cancers can be prevented or delayed through lifestyle. Blue Zones are natural laboratories showing that health is the product not of a single organ, but of an entire life.
✅ Strengths
Each of the nine principles is supported by independent, large cohort studies. The intergenerational changes in Okinawa and Nicoya show the effect of lifestyle like a natural experiment.
⚠️ Limitations
Most data concerning Blue Zones are observational; some records of advanced age are controversial. The wine recommendation conflicts with current knowledge about cancer. Lifestyle alone does not eliminate inherited risks or screen-detectable cancers.
🩺 In practice
Movement, nutrition, sleep, stress, purpose, and relationships should be assessed and monitored as closely as blood pressure, cholesterol, and blood glucose. Lifestyle recommendations should be considered together with appropriate cancer screening and cardiovascular risk assessment.
❓ Open questions
How much does healthy lifespan increase when Blue Zone principles are systematically implemented in cities? How effective are personalized measurement and follow-up in making behavioral change lasting? Do social connections and a sense of purpose directly affect cancer risk?
Conclusion: The most important thing we learn from Blue Zones is that health cannot be divided into separate parts. Check The Life seeks to bring this wholeness to the city: by aiming not for longevity, but for a good life.
- This article was prepared in October 2026.
- Check The Life is a health program founded by Prof. Dr. Mustafa Özdoğan; this article describes the program’s philosophy.
- The Blue Zone principles and numerical claims concerning the regions (e.g., “one in every three people reaches the age of 90”) are based on Dan Buettner’s publications. Showing different studies side by side in the graphics is an indirect comparison.
- The diagram was derived from statements in the text; it contains no new data. Academy commentary is ours.
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