Oh I look old?

You look amazing.

Yeah, you look amazing. You must need glasses.

You're listening to Ester Van den Hoven. And as you can hear, she's been kind of hard on herself as she prepares to speak to us for the podcast, despite the fact that it's audio only.

My head is getting less and it ain't as nice as it was. But here again, this is negative, and I don't want to be negative.

You know, all season on the podcast, we've been asking everyone these two questions How old you are and how old do you feel? Think about that quick. How old are you? How old do you feel? Well, I'm in my early fifties, and honestly, some days I feel like I'm in my mid-thirties. Ester...

I don't know how old I feel. I've never felt this old, but I am going to be 99 in August. And I have to say I'm grateful that I feel as well as I do at this age.

That's right. Ester was 98 when she spoke to us and celebrated her 99th birthday just one day before we dropped this episode. And, you know, any time I do feel more my age, I realize Ester has essentially already lived two of my lives.

I really never stood still on the thoughts of feeling extra good or less good, or I just lived.

So the question is this what do we learn from Ester about not just living long, but living well, living healthy? For starters, I think someone like Esther shows us what is possible, which is deeply inspiring, what it means for someone like me. What it means for my own parents. And it makes us ask the next question, which is what is it that allows someone like Ester to live to 99? How much does a healthy diet really play a role? What about movement and rest? How important really are those things? How important is fulfilling work and your personal life to your longevity? What about simply positive attitude? Well, my guest today says a lot of it comes down to the right environment. Now, why is that? Living in the right environment makes you far more likely to unconsciously make healthier choices. That's the argument. So what exactly, then, is the best or right environment? It's something my guest has learned traveling the world.

We simply looked at the environments of blue zones and we tried to apply them to an American context. And it's worked every time we've tried it.

Today on our season finale, the author and I will say probably the best version of a sort of modern day explorer, Dan Buettner. He's been on the move now for decades, and he's going to tell us about the five places he has identified around the globe where people like Ester live the longest and healthiest lives. You've probably heard about blue zones. But today, we're going to really dive into what makes these places unique and what they can teach us. No matter where you live. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.

Dan Buettner. How are you, my friend? How are you?

If I were any better, there'd be something illegal going on.

You know that. That's exactly the sort of response I'd expect from you. Life is always good in Buettner world, isn't it?

Kind of.

Seems like it.

Clean body, clean mind, catch a fish every time, Sanjay.

That's my friend, longevity researcher and author Dan Buettner. Decades ago, Dan identified five places where people live the longest and are the healthiest. Grab a pencil. I'm going to tell you what they are. Those special places are Okinawa, Japan. Sardinia, Italy. The Nicoya Peninsula of Costa Rica. Ikaria, Greece. And Loma Linda, California. They are the blue zones. But the question is why?

A-ha. Now there's a good mystery. We did try to answer from an anthropological point of view. In other words, try to look at what this culture has been doing differently than other places around the world that might explain this high disability free life expectancy. And I was fascinated with it. These people don't have superior genes. You know, they're not superhumans. They're they have an average set of genes. For the most part, Sardinia may be a little bit differently. And we we hired demographers to identify geographically defined, demographically confirmed areas where people have the lowest rate of middle age mortality or the highest centenarian rate. And those are two really important markers of longevity. And the first round we found Sardinia. Thanks to Gianni Pes, I know you've been to Sardinia. And then later on, I got National Geographic grants to identify Ikaria and of Greece. And then Costa Rica. Nicoya Peninsula of Costa Rica, which I think is probably the most extraordinary blue zone today. You know, I keep thinking the story's going to die, but it keeps crescendoing, actually. And I think part of the reason it keeps crescendoing is because it stands on a mountain of really good research and incredible data. And and secondly, the amount of money we spend on health care in this country has careened past the $4 trillion mark. And we keep trying this this sick care model in America. And I think increasingly we're realizing that we need to look at preventing disease in the first place. And that's what, you know, people in blue zones are living a long time because they're not getting the diseases that foreshortened our lives like diabetes, metabolic syndrome, cardiovascular disease, cancers of the GI tract. And now we're even finding much lower rates of dementia. So we ought to be paying attention to these places who manifestly are doing it better than America at a fraction of the cost that we spend trying to stay healthy.

Let let me let me pick one of these places and I'll just pick Nicoya Peninsula of Costa Rica. Since you said that's perhaps the most extraordinary. What is what is it about this place? What is it about this environment? Again, the pretense is that the people there, they may be not that different than other people genetically. It's not like they have some super ager genes, it sounds like you're saying. So what is it about a place like Nicoya Peninsula?

You know, there is no silver bullet in any of these blue zones. I call it call it silver buckshot. So a 60 year old in the Nicoya Peninsula of Costa Rica has an eightfold better chance of reaching age 100 than an American does. Well, what are they doing? Well, first of all, they're eating a messo American staple diet, or they have for most of their life, which is is consists of three foods. I argue it's the best diet humans have ever invented. Corn, beans and squash. You bring those three foods together, anybody can afford them. High and complex carbohydrates, high in niacin, high in folate, and have all the amino acids necessary for human sustenance without all the saturated fat and the pesticides and the hormones, etc.. And that was about 80% of their diet. So that's part of it. Second, the lot of tropical fruits. Everybody had a had a garden around their homes for papaya and mango and peillon and and year round they were eating, eating tropical fruits like all blue zones. They were remote from the rest of of Costa Rica. So they haven't experienced the corrosive impacts of the standard American diet and. Mechanized conveniences like cars and iPhones and so forth. I mean, starting to creep in right now, but never 30 or 40 year delay. You know, the onset of fast food restaurants and chips and sodas and and cars, you know, and none of these centenarians have driven. They've walked their whole lives. People look out for each other more so than the rest of Costa Rica. Very outsized sense of family, outsized sense of religion. Most of them are very religious, which gives them a sense of purpose, but also a healthy community to to rally around. And, you know, they're less likely to engage in in risky behaviors. But also and this is something that's overlooked in Costa Rica, they have these basic health teams. They've had it since 1990. So, you know, 33 years where every person on the Nicoya Peninsula has the right to one visit a year from a health ambassador and that health ambassadors are going to have your health records. They're going to come take your blood pressure, check your blood sugar levels, screen you for depression. They're going to look in your backyard and look for standing water. You know, where mosquitoes can breed. And mosquitoes carry dengue and and Zika and malaria there. And they're going to catch a chronic disease before it shows up in the emergency room 15 years later with a $100,000 bill and a life of disability after it. You know, it's it's the additive of the right diet, the right social environment, the right physical environment, the right medical environment that is producing these extraordinary outsized life expectancy numbers.

Can that what you just described in Nicoya peninsula, can that be adapted to a community in Miami, for example, where you live now?

Not only can, but it does. You know, I built a business around changing the environments of cities and then measuring them rigorously. We have Gallup measuring and you take Fort Worth, Texas, one of our biggest cities. We worked there for five years. Gallup measured BMI. They measured vegetable consumption. They measured physical activity. They measured childhood obesity. And after five years against Texas controls, we saw a drop in obesity by about 3%. Life satisfaction went up, vegetable consumption went up, physical activity went up. Not because we went in and tried to convince beef crazed Fort Worth to eat more beans. But because we went to all the restaurants and the schools and the grocery stores and convinced them to make the healthy foods cheaper and more accessible. We got Mayor Betsy Price and Texas Health Resources, the hospital system, to help us get the city to adopt policies to make that city more walkable and more bikeable and more of a more social connection and to favor health food over junk food in their city policies. And we got about 10% of the local populations to agree to create what we call my most committed social circles and take purpose workshops and to go into their homes and optimize their homes so they move more and eat less mindlessly. And it worked. And we've proven it can work now. Is it a full blue zone like Sardinia? No, but we got them 10 to 15% of the way towards a blue zone. It's just instead of focusing on a pharmaceutical or a better health care plan or, you know, some anti-aging nostrum, we simply looked at the environments of blue zones and we tried to apply them to an American context. And it's worked every time we've tried it.

One of the people that I met, again, as a result of reading your work, it was a guy named Ellsworth Wareham.

Yeah.

Ellsworth Wareham in Loma Linda, California. And I want you to tell us a little bit about him, but I just I'll share this with you. He's a surgeon and he was practicing, I think, well into his nineties, maybe even late nineties. When I met him. He was 100 years old.

I assisted till I was 95. I could I could do open heart surgery right now. My hands are steady, my eyes are good.

And he. He had been mowing his lawn that day and then wanted to meet me in the sort of town square, you know, sort of and and drove himself to come meet me. And then we sat down on a park bench and we just talked kind of like you and I are now. We just talked for about an hour and a half and I. Remember this. At one point he was just very sharp. And we were talking about a couple of surgical things where both surgeons and I mentioned this one book and I was having a hard time recalling the name of this book, and he remembered it right away. You were 100 years old.

Well, I'll have to say this. I have noticed no deterioration in my mental ability with my age.

So physically, cognitively, memory, all of that was was remarkable. The only thing that I noticed about him, he walked a little bit, stooped over. That was really the only thing that I noticed. Otherwise, he was it was kind of a remarkable thing. What were your what were your impressions of him?

So, you know, the way we tell stories at National Geographic, we do the the science reporting, but then we try to find an emblematic character. And the Adventists are longest lived Americans by some measures. They live about seven years longer than their Californian counterparts. And, you know, the reason they're living no longer are probably because they eat a plant based diet. They're very religious, they're very socially connected. They're very family oriented. So the poster boy we found was was Ellsworth. And when I first met him, he was in his early nineties. He was we we spent three days to kind of check in with him as he built a privacy fence around his house, you know, shoveling cement and hauling timbers. And then the fourth day, you know, he ended up in the in the in the hospital with open heart surgery, but doing open heart surgery. Not getting open heart surgery. And he captured our imaginations. I was friends with him until his death. While doing surgery, Ellsworth recalled when he was about age 40, feeling the femoral artery of of a of a meat eater and actually feeling the artery crunchy under his fingers from arteriosclerosis. Trying to try starting to build up as compared with the femoral artery of a vegan, which was soft and supple. And it was that tactile experience that made him go 100% vegan. Now, he didn't go vegan, you know, to save the animals. He went vegan because he was absolutely convinced that, well, you know, I mean, his religion supports it doesn't require but supports it, but also because he felt that that would favor his health over the long run. You know, there's a lot of enthusiasm thrown into intermittent fasting and there's some good research showing that eating a huge breakfast at ten and then a fairly big "linner", for lack of a better word, a kind of a late lunch or early dinner at about four, seems to be the best pattern for intermittent fasting in a sustainable way. And that's exactly the way Ellsworth Wareham ate, most days of his life.

Ellsworth was 104 when he died in 2018. Now Dan thinks that a plant based diet and eating during only certain hours of the day think of it as a sort of intermittent fasting program. Those were the things that made a huge difference for Ellsworth. But also then, what is the real role and impact of things like movement and flexibility and strength, especially as you get older?

I had a chance to interview former President Carter and Rosalynn several years ago, and they were I think he was already in his nineties. They were in their nineties.

I was an avid runner until I was 80 years old when I.

That's incredible.

My knees started swelling up so I had to get my both knees replaced.

Is that and how did you feel after you got your knees replaced? Were you able to.

Fine.

And they came into the interview. I was already there and there was these chairs that were set up for them.

You got to sit right here for me please. Thank you.

And I remember thinking they're kind of low chairs and they didn't have armrests on them. And I thought, Huh, that I feel like it might be a little hard for me to to sit there in that chair. They came in, no use of arms. Right. Sat down low, did the entire interview, got up at the end of the interview, stood straight up in their nineties and walked off.

So far I got eyesight and and hearing but I don't claim to be very good at memory.

I don't know, sir, I think you put most people to shame.

it was kind of amazing and I, I made a little point myself. Now whenever I sit in a chair to not use my arms to get up, I'm 53, you know, he was like 93. But, you know, there's little things like that that in your own environment, aside from even necessarily going to a gym or dedicating time to a workout that you can just incorporate into your life, that that can make a big difference, it seems.

Over time. Yes.

Over time.

You know, other things that. That really work. You know, this sounds like it's impossible for a lot of people, but living in a walkable neighborhood occasions about 20% more physical activity than living in a non walkable neighborhood. And by the way, as you get older, walking is probably one of the best exercises we can do. It's safe. It's cognitively.

Yeah.

It requires cognitive effort. You know, we move something like 200 different muscles when we walk and we have to think about our surroundings and are not tripping and moving all these bones and muscles. And it takes more than we think.

When we come back, more from Dan Buettner on what works to help you live longer, but also what really doesn't work.

You know, if you look at the history of these anti-aging interventions, over time, they've all failed. You're better off, quite frankly, eating beans every day. And by the way, everybody can afford them. And there's no downside except perhaps, you know, gas, which I can avoid that, too.

We'll be right back.

Now back to Chasing Life.

You know, Dan Buettner, his work really got me interested in healthy aging all those years ago, seeing him take what he learned in the blue zones and incorporate it into his own life. That's what it's all about. So, of course, I had to ask him the same questions that I've been asking everyone.

How old are you and how old do you feel?

I'm 63. And what it comes to sort of emotional maturity. I feel like I'm about 16. But but physically, I feel as good as I did when I was 35.

Is that right?

Yeah, I feel. Yeah. I have no problems that I know of.

How do you check in on yourself? Like if you. What was it, about 35 like? Is it a certain speed of cycling? Is it how much energy you have? How do you measure that?

One of the things I step on the scale every day. I'm a big believer in self weighing and I weigh the same. And I still, you know, I can bike 100 miles like I could back then. I'm probably not as fast. I can't I probably can't lift quite as much. But but the way I wake up in the morning, the way I feel right now, like I have no pain, I have energy, I have mental clarity. I feel great. I don't I don't know if I, I haven't done these genetic tests or methylation tests to find my biological age yet. I probably should.

Are you interested in that stuff? Does it does that sort of stuff matter to you?

I think recreationally it does. I think people get a little bit too wrapped up in it. But, you know, a lot of these anti-aging clinics and so forth, they're really heavy on diagnostics. They they'll you'll spend a lot of money finding out in these different biological ages or or your your telomere length and so forth. But what to do with that is more of a question mark. So I don't I don't really believe in these anti-aging interventions. I think they're dangerous.

Do you think they're dangerous? Because I've been curious about that. I spent some time with Nir Barzilai, but one of the things he told me is that he now regularly daily takes Metformin, which is a diabetes drug.

There are studies that showed that people of metformin don't get diabetes, that people on metformin don't get cardiovascular disease in clinical trials, get less cognitive impairment.

Can we say that at this point that if you take. Metformin that you will delay what are often referred to as age related diseases?

Yes.

He says the the data is pretty clear in terms of its anti-aging benefits. It it improves your immune system, decreases inflammation, all that stuff. Do you have an opinion on that sort of thing?

Well, you were talking about prospective studies. I don't know of any of that been done on metformin that they actually followed people. I mean, ideally, if if you're asserting it makes you live longer, you need a control group who in a study group and you need to follow them, you know, until they all die and see if their metformin group actually lived longer. And I think these are more of an experimental and I've just seen, you know, all the hype around resveratrol in the early days, and that didn't pan out to be anything. You know, if you look at the history of these anti-aging interventions over time, they've all failed over time. And so right now, metformin is hard. So people are taking it. And I think you're experimenting on your own body and you're better off, quite frankly, eating beans every day. And by the way, everybody can afford them. And there's no downside except perhaps, you know, gas, which I can avoid that, too.

How long how long do you want to live?

I Well, I indefinitely I guess. But but the you know, I've kind of thought about what's what's possible. And I think 100 is not only a plausible goal to shoot for, but a pretty nice one. You know, I'd love to see three digits before I check out.

One of the things that came up again in Loma Linda. A place that we we decided to to spend some time and spoke to a resident named Ester, 99 years old. And she's very interesting. Her hypothesis on all of this is that it's fundamentally the attitude that one has.

I think the town is not the difference, necessarily. The attitude and the face. And the spiritual situation has more to do with my longer life.

She thinks that's what it really is. That helps you live longer from that attitude. Everything else follows. And I got to say, you know, it was interesting. I thought about Ester. My mom, Dan, turned 80, and I. It was really interesting talking to her about this. First of all, I don't know that people sit down and really have conversations like you do, and I'm trying to do just about how people are aging. You know, it's just one of those things we all do it to sit down and have the conversation, like, what is it like to age? How are you sleeping? Do you have aches and pains? My mom will sleep 8 to 9 hours a night. She tells me she has no aches and pains. She cooks, mostly cooks her own food, very plant based. You know, growing up in India, there was a lot of plant based foods. And she's adopted that over here. And she is aging gracefully. But, you know, there's nothing special about her in terms of her genetics or anything else attitude seems to make the biggest difference. That's what Ester said. That's what my mom says. What do you think?

I think you're probably right. And we saw for sure, you know, I interviewed over 350 centenarians and there wasn't a grump in the bunch. They were all interested. And interesting, you know, they didn't yet yammer on about their own experience. They talked about you. And, you know, I think those types of people tend to get better health care as well. The problem with attitude is I'm not aware of a way to change it for the long term. I do know that if you change your environment, you can do that for everybody and they will mindlessly change their behavior for the long run. And you can even change the people's environment will impact on how much they socialize. If you live in a cul de sac in some solar suburb, you're going to be socializing much less than you will in a connected, walkable neighborhood with sidewalks and cafes and parks. And and you tell a thousand people to change their attitude and check back in a year. And, you know, maybe one or 2% of them will actually change. But move those thousand people in to a walkable neighborhood, I guarantee will see their physical activity level go up and their social connectedness go up and and their and their life satisfaction will also probably go up.

So, yes. How you nourish yourself, how you move, how you rest. All those things matter. Personal decisions matters. Attitude matters a lot. But just simply living in the right environment makes all those things a lot easier to do by making the healthy choices, the default choices. And on top of that, when a government makes an investment in people's health, like in Costa Rica, you can see the benefits tangibly, people become healthier. In fact, during our interview, Dan dropped some news about a place where the government took notice of all that we've been talking about and created new policies that in essence created a brand new blue zone.

Well, you know, I have this new book coming out, The Secrets of Long Life and and a Netflix series, and we announce a Blue Zone 2.0 in that, it's Singapore. So Singapore is producing the longest lived healthy people in the world right now by buy at least one metric a very cool stand up by others and they're not doing it coincidentally. First of all, it's one of the highest as a percentage of GDP expenditures on older people. And number two, there you actually get a tax break if your parents live with you or just live within 500 meters of you, because they know if your parents live closer, your parents are more likely to be over engaging with your family and you're going to be over there taking care of them. So here are some genius, almost cost free ways for us to raise, you know, life expectancy through honoring age. There are several really great lessons in places like Singapore for the bin longer.

There are great lessons all around us. If you just take the time to stop. Listen. Look. And yes, even explore like Dan Buettner is done. Sometimes those lessons are found in unexpected places, whether you're talking to New York Times bestselling author Dan Buettner or 99 year old Ester van den Hoven.

I don't plan on spending particular number of months or years yet. I'm grateful for every day that I can feel good and get up and still talk and have interviews. So I'm grateful for that. And I if you are grateful and happy and realize your benefits, then that alone seems to lead you to a longer and better life.

I completely agree with that. You know, gratitude for me is sort of an antidote to toxicity. Yes, we hear a lot about gratitude, but tangibly, for me, being grateful and feeling toxic cannot coexist in my brain. So when I'm feeling blue, I typically have a pretty good fix. And that gratitude then also makes me want to make healthier choices, move more and be around people. So above all else, I am grateful, grateful for all of you who've spent the time listening in on these amazing conversations we've had this season. On Chasing Life. I hope you got something out of it. Maybe something big, maybe something small, but almost assuredly something important. You see, I set out on this journey to find out how to age better. Simply put, how to do it in the healthiest way possible, with intention, with integrity, in a way that allows us to achieve a healthy longevity and to do it with grace and dignity. And while I found out that, yes, there are changes you can and probably should make in your nutrition and your movement time and time again, experts mention that other factors are also important to take into account our living environment, the people in our lives, our health care system. It all impacts our health. I got to tell you, you know, part of what inspired me to go on this journey were my own parents. I love seeing how even though they were getting older, they're doing pretty well. Call me selfish. I just want to spend as much time with them and my whole family as possible. I want my teenage girls to spend more time with their grandparents to have these wonderful interactions. And I want something like that for myself, to spend time with my grandkids one day maybe. And I want that for you as well. Because ultimately, isn't that what life is about at every age? Spending time with the people you love and being able to truly enjoy it, that is chasing life. Well, thank you so much for listening to this season of Chasing Life, and I hope you've enjoyed it as much as I have had making it. Check out our Better with Age playlist. Has a lot of great music that I think is really relevant to the themes. You're going to have some classic music in there, plus some eighties throwbacks from my own college years. You got to listen to this. You can find a link to the playlist in our show notes. Chasing Life is a production of CNN Audio. Our podcast is produced by David Rind. Xavier Lopez and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer and Tommy Barbarian is our engineer. Dan Dula is our technical director and the executive producer of CNN Audio is Steve Lickteig. Also, a special thanks to Ben Tinker, Amanda Sealey and Nadia Kounang of CNN Health.