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In the United States, when it comes to improving health, people tend to focus on exercise and what we put into our mouths — organic foods, omega-3’s, micronutrients. We spend nearly $30 billion a year on vitamins and supplements alone. Yet in Ikaria and the other places like it, diet only partly explained higher life expectancy. Exercise — at least the way we think of it, as willful, dutiful, physical activity — played a small role at best.
Social structure might turn out to be more important. In Sardinia, a cultural attitude that celebrated the elderly kept them engaged in the community and in extended-family homes until they were in their 100s. Studies have linked early retirement among some workers in industrialized economies to reduced life expectancy. In Okinawa, there’s none of this artificial punctuation of life. Instead, the notion of ikigai — “the reason for which you wake up in the morning” — suffuses people’s entire adult lives. It gets centenarians out of bed and out of the easy chair to teach karate, or to guide the village spiritually, or to pass down traditions to children. The Nicoyans in Costa Rica use the term plan de vida to describe a lifelong sense of purpose. As Dr. Robert Butler, the first director of the National Institute on Aging, once told me, being able to define your life meaning adds to your life expectancy.
The healthful plant-based diet that Seventh-day Adventists eat has been associated with an extra decade of life expectancy. It has also been linked to reduced rates of diabetes and heart disease. Adventists’ diet is inspired by the Bible — Genesis 1:29. (“And God said: ‘Behold, I have given you every herb yielding seed . . . and every tree, in which is the fruit of a tree yielding seed; to you it shall be for food.’ ”) But again, the key insight might be more about social structure than about the diet itself. While for most people, diets eventually fail, the Adventists eat the way they do for decades. How? Adventists hang out with other Adventists. When you go to an Adventist picnic, there’s no steak grilling on the barbecue; it’s a vegetarian potluck. No one is drinking alcohol or smoking. As Nicholas Christakis, a physician and social scientist at Harvard, found when examining data from a long-term study of the residents of Framingham, Mass., health habits can be as contagious as a cold virus. By his calculation, a Framingham individual’s chances of becoming obese shot up by 57 percent if a friend became obese. Among the Adventists we looked at, it was mostly positive social contagions that were in circulation.
Ask the very old on Ikaria how they managed to live past 90, and they’ll usually talk about the clean air and the wine. Or, as one 101-year-old woman put it to me with a shrug, “We just forget to die.” The reality is they have no idea how they got to be so old. And neither do we. To answer that question would require carefully tracking the lifestyles of a study group and a control group for an entire human lifetime (and then some). We do know from reliable data that people on Ikaria are outliving those on surrounding islands (a control group, of sorts). Samos, for instance, is just eight miles away. People there with the same genetic background eat yogurt, drink wine, breathe the same air, fish from the same sea as their neighbors on Ikaria. But people on Samos tend to live no longer than average Greeks. This is what makes the Ikarian formula so tantalizing.
If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several g.lasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat.
Every one of these factors can be tied to longevity. That’s what the $70 billion diet industry and $20 billion health-club industry do in their efforts to persuade us that if we eat the right food or do the right workout, we’ll be healthier, lose weight and live longer. But these strategies rarely work. Not because they’re wrong-minded: it’s a good idea for people to do any of these healthful activities. The problem is, it’s difficult to change individual behaviors when community behaviors stay the same. In the United States, you can’t go to a movie, walk through the airport or buy cough medicine without being routed through a gantlet of candy bars, salty snacks and sugar-sweetened beverages. The processed-food industry spends more than $4 billion a year tempting us to eat. How do you combat that? Discipline is a good thing, but discipline is a muscle that fatigues. Sooner or later, most people cave in to relentless temptation.
As our access to calories has increased, we’ve decreased the amount of physical activity in our lives. In 1970, about 40 percent of all children in the U.S. walked to school; now fewer than 12 percent do. Our grandparents, without exercising, burned up about five times as many calories a day in physical activity as we do. At the same time, access to food has exploded.
Despite the island’s relative isolation, its tortuous roads and the fierce independence of its inhabitants, the American food culture, among other forces, is beginning to take root in Ikaria. Village markets are now selling potato chips and soda, which in my experience is replacing tea as the drink of choice among younger Ikarians. As the island’s ancient traditions give way before globalization, the gap between Ikarian life spans and those of the rest of the world seems to be gradually disappearing, as the next generations of old people become less likely to live quite so long.
The big aha for me, having studied populations of the long-lived for nearly a decade, is how the factors that encourage longevity reinforce one another over the long term. For people to adopt a healthful lifestyle, I have become convinced, they need to live in an ecosystem, so to speak, that makes it possible. As soon as you take culture, belonging, purpose or religion out of the picture, the foundation for long healthy lives collapses. The power of such an environment lies in the mutually reinforcing relationships among lots of small nudges and default choices. There’s no silver bullet to keep death and the diseases of old age at bay. If there’s anything close to a secret, it’s silver buckshot.
