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1:25

This is In The Bubble with Andy Slavitt. Welcome to

1:27

the show. Thanks for

1:29

all your emails and staying in touch. Andy

1:31

at LemonadaMedia.com is how you can reach me.

1:36

So yesterday, there was a big

1:38

announcement at the White House. I'm not sure if you caught

1:40

it, but it featured President Biden

1:43

talking about the drug price negotiations.

1:46

For the first time, we've now named 10 drugs

1:50

that are due to be negotiated

1:52

between the

1:54

government and the pharma company.

1:58

And look, if you're someone like me who's...

1:59

been watching this for a couple of decades, this

2:02

is something that has been a major

2:05

battle of whether this could and would

2:07

eventually ever happen between the pharmaceutical

2:10

industry and people who think

2:12

that we should have lower prescription drug

2:14

costs. Big debates, big

2:16

fighting, hundreds of millions of dollars spent,

2:19

sometimes in a single year, by the pharmaceutical

2:21

industry lobbyists.

2:23

And

2:24

you may recall, if you listen to it, on July

2:26

12th we had on our show Mina

2:29

Seshamani, who is the woman

2:31

who is leading the negotiation. She

2:33

is setting the course. You can go back and

2:35

listen to it in the context of yesterday's

2:38

announcement from the president, but

2:40

we're on our way.

2:41

Today will be the seventh,

2:44

I've counted now, of our eight

2:47

shows this summer on

2:49

health and healthcare we have been

2:52

bringing to you. We have

2:53

really featured some really important shows

2:55

including the first podcast from

2:57

the new CDC director, Mandy Cohn,

2:59

this episode on drug costs, as I talked about,

3:02

a couple of episodes on new boosters coming,

3:05

some updates on the COVID wave,

3:07

Zeke Emanuel was on

3:09

to talk about how the healthcare system is

3:12

changing and will change in the future,

3:14

and Monday's episode was

3:17

on some very specific proposed changes

3:19

to the healthcare system. And

3:22

we've also had plenty of non-healthcare

3:24

shows this summer, but I think all

3:27

of them in some way impact our well-being.

3:30

Probably the most notable show

3:32

was the one we did with Congressman

3:35

Adam Smith on his

3:37

battle with debilitating anxiety that's

3:40

been going on for about 20 years. That's,

3:43

by the way, our June 14 show, if you

3:45

want to hear it. There's probably no more bubbly

3:47

episode than the one with

3:49

Adam Smith because we really

3:51

kind of get to explore someone's interior life,

3:54

who's a very well-known, prominent person, and

3:57

discuss things that I think almost everybody

3:59

can relate to. And if you know someone

4:01

who's struggling with any kind of mental

4:03

health issue Or if you

4:05

know anybody you want to introduce to this show, that's probably the

4:07

episode I would send them also episodes

4:10

on climate on the border on

4:12

Affordable housing one

4:14

with Samantha be where we talk about just about everything

4:17

one on Crypto and

4:20

all the Hollywood stars that have been hawking crypto

4:22

and the debt ceiling one

4:24

with Anita Dunn the president's closest advisor

4:26

and One on Trump's

4:29

attacks in the Justice Department a pretty good slate

4:31

this summer

4:33

So I'd ask you to leave a review on Apple

4:35

also Make sure you let me know and you email

4:37

me which of those shows you want to see more

4:39

of that would be interesting to you today's

4:43

show is

4:44

with Dan Buettner

4:46

and Dan has been studying

4:48

a

4:49

Element of health that is very different

4:51

even from what we've talked been talking about so far. It's

4:54

not a

4:55

Conversation about our healthcare system.

4:57

It's not a conversation about a threat like kovat

5:00

or Alzheimer's. It's not about policy

5:03

Put all that aside what Dan

5:05

Buettner began doing a couple of

5:07

decades ago is asking

5:10

a very simple question

5:12

Where on the globe do people

5:14

live the longest and

5:16

why? What habits cause

5:19

people to stay healthy and active

5:22

into their 90s and 100s?

5:24

He's written four bestsellers on

5:27

the topic all around the theme of blue

5:29

zones including a cookbook on blue zones

5:32

And he has a new Netflix show that it's

5:34

out now as

5:35

Well as an organization that works with communities

5:37

to help them get healthier

5:40

Lana and I had a friend who lived to 113 and she passed away last

5:42

year in Minnesota but

5:47

led the most vibrant life of many

5:49

of our friends and a healthy one well

5:51

into

5:53

past 110 So

5:55

I'm fascinated by this topic and

5:57

I want to know what we can learn from it and

5:59

look whatever your health status, whether you're

6:02

bothered by something chronic,

6:04

something that disadvantages

6:06

you or causes you pain of

6:09

any kind, mental, physical, or emotional,

6:11

I want you to be able

6:14

to get the most out of life. And

6:16

I think this episode really allows

6:18

us to think in those terms. So I hope you'll

6:21

be inspired by listening to the

6:23

stories of what happens

6:25

in those rare communities where

6:28

health prevails. Couple

6:30

hints, it's becoming harder to

6:32

do

6:33

with technology and all the trappings of

6:35

modern society and

6:37

you can't do it alone.

6:39

It takes all of us together to create

6:42

something healthy. I know Dan,

6:45

you'll be able to tell as we get into this

6:47

that we've had some interesting interactions before.

6:51

I think you're going to enjoy this and hopefully get a

6:53

lot out of it. Let's

6:55

bring him in.

7:06

Welcome to the bubble, by

7:08

the way. It's good to be in the bubble. We

7:11

have the bubble, we'll talk about those. But we were

7:13

just, before we were setting our mics up, we were having an interesting

7:17

chat and maybe a good place to begin, which

7:19

is that, you know, so

7:21

many of us who get to, you

7:25

know, I'm 56, you spend a

7:27

lot of our lives asking a lot of questions.

7:29

How do I become successful? How do I have a family? How

7:31

do I make ends meet? How

7:33

do I,

7:35

you know, do this or that? And

7:37

it's only for many of us, you don't actually

7:39

ever ask the question, what can

7:42

I do to be happy? And that's

7:44

a harder question. Yeah.

7:47

E.B. White once wrote that when

7:49

you wake up trying to find

7:51

the right mix between saving the world and savoring,

7:53

it's hard to plan your day. And I think

7:55

especially, you know, you reach

7:57

a certain age, finding that sweet.

7:59

spot is ever more important. Of course you want to

8:02

be relevant and you want to be productive and you

8:04

want to feel like you're useful, but

8:06

on the other hand there's so many other dimensions

8:08

that make up a good life that we often overlook

8:11

in our pursuit for success. And I've

8:13

been very interested in that lately, mostly

8:16

a personal quest. Will

8:18

you someone who

8:20

thought about your own happiness

8:22

and well-being, or were you like

8:24

the rest of us and you kind of thought about

8:26

it but not, you know, as a major, major

8:28

focus?

8:29

I thought about it more than most people.

8:32

I spent about 10 years studying

8:34

the statistical underpinnings of happiness,

8:37

so not anecdotal or not positive

8:39

psychology. I worked with worldwide

8:42

surveying organizations, mostly the World

8:45

Poll. I wrote a cover story for National

8:47

Geographic and two books on

8:49

happiness and much of

8:51

what we think drives happiness

8:53

is misguided or just plain wrong. And

8:56

I was interested in, you know, what exactly

8:59

can

8:59

we do to stack the deck in

9:01

favor of happiness? Now

9:05

you've written a lot about it. I want

9:07

to get into the blue zones, maybe

9:10

as the right entry point to come back to that conversation,

9:13

about the importance of communities

9:16

and kind

9:17

of what surrounds you and

9:20

your relationships with others in those communities and

9:22

those habits that

9:25

get formed by building the right community.

9:28

How much of that really is the key?

9:31

Because, you know, we tend to think about the unit of

9:33

measurement as ourselves. And

9:36

as I've read things you've written over the years, you

9:38

know, you've kind of been saying there's a

9:41

whole lot about what surrounds us

9:43

that's really, really important.

9:45

Yes. So kind

9:47

of spoiler alert here, I'm jumping right

9:49

to the bottom line. I spent 20

9:51

years identifying

9:53

and studying these populations that live statistically

9:56

longer and found that,

9:58

you know, most of what we do,

10:00

behavior modification, diets,

10:03

exercise programs, getting the right

10:05

health plan, taking the right supplement,

10:09

counts very little in the overall picture

10:11

of our health and indeed happiness.

10:13

In places where people are actually achieving

10:16

disease-free, long

10:18

life expectancy, in other words, making it into their

10:21

90s and 100s without type 2 diabetes,

10:24

heart disease, dementia, or much lower

10:26

levels, it's never because they

10:28

try. They're never pursuing

10:31

health, it ensues. And

10:34

it ensues from part of what

10:36

you say, the right community, it's hard to define exactly

10:38

community, but I argue more,

10:41

it ensues from the right environment,

10:43

your food environment, your built environment,

10:45

your social environment.

10:47

And if we really want to bend the curve

10:49

on obesity and chronic disease in this

10:51

country and start to tackle the $4 trillion

10:54

problem we have every year, we have

10:57

to shift the focus from

10:58

trying to change people's behaviors, trying

11:01

to spend the money mopping

11:03

up the problem after it happens and

11:06

get out in front of it by optimizing

11:08

the environments, the ecosystems we

11:11

live in. And that's mostly what

11:13

I've been studying the past 20 years. And

11:16

for those who aren't familiar with your work, and I think

11:18

everybody by now knows

11:21

the concept of blue zones, but I'll have you

11:23

explain it better for us. You

11:26

identified five and

11:29

subsequently a sixth

11:30

community where people live

11:32

disease free or relatively disease free,

11:35

oftentimes to 100 or more, but into their

11:37

90s. And I'm going to mention the

11:40

places so you don't have to, but I would love

11:42

you to pick on a couple of those

11:44

places that you could really express

11:46

and illustrate what you're talking about. So

11:49

the places are

11:50

Sardinia, Italy, Nicoya,

11:54

Costa Rica, Loma

11:56

Linda, California, which was a real surprise

11:58

to me, not very far away.

12:00

An interesting one. Okinawa, Japan. Ikaria,

12:03

Greece. And then the

12:06

sixth is Singapore,

12:08

which you call Blue Zone 2.0. We'll

12:11

get to that later.

12:12

So tell us what these places have in common and maybe

12:14

illustrate what you've learned.

12:17

Well, we started first working

12:19

with demographers to confirm ages

12:21

in a lot of places we've thought were long lived,

12:24

have been debunked, places like the Vilcabamba

12:27

Valley or the Caucasus and former Soviet

12:29

Union. So we

12:31

know for sure that these people have achieved the

12:33

outcomes we want, which

12:35

is living to the capacity of the human

12:38

machine. So if

12:40

we do everything right, the

12:42

average maximum life expectancy

12:45

for the human species is to the current

12:47

state of science is probably 94. But

12:50

in America, life expectancy is 78 or 79. So

12:54

we're losing about 15 good years of life.

12:56

And so most of my pursuit is

13:00

what they've done. So once you've identified the five

13:02

places, I recruited a team

13:05

of basically medical advisors to help

13:07

me deploy scientific

13:10

processes to find the correlations

13:14

or to put in easier terms, the common

13:16

denominators. That's the best

13:18

we can do to kind of tease out

13:20

the features or the characteristics

13:23

of longevity. So to

13:26

get at the diet, you can't just ask

13:28

a hundred year old what they've been eating because

13:31

people don't remember. Andy, if I

13:33

asked you what you ate for lunch

13:36

a week ago Tuesday, you

13:38

probably couldn't tell me. So

13:41

you can't really ask a hundred year old, what have you been eating

13:43

over the course of your lifetime? And

13:46

to get at that, we found 155 dietary surveys done

13:50

in all five blue zones over the past 80

13:52

years. They only go back about 80

13:54

years. And then with Harvard

13:57

did a meta analysis. And

13:59

we found...

15:59

overly focused on that. But

16:02

do we think it's because of

16:05

the health properties of the wine, or

16:07

do we think that there's something else

16:09

going on relative to stress,

16:12

relief, or relaxation, or

16:14

the social elements? Do you have

16:16

a

16:17

perspective on that?

16:18

You bring up a good point, because people

16:21

aren't sitting alone in their house and drinking to

16:23

their favorite TV show. Wine

16:25

is almost always a social activity,

16:28

so it may be that wine

16:31

and social connections are going together. Also,

16:34

there's some pretty good evidence that drinking red wine with

16:37

a plant-based or Blue Zone diet, you

16:41

about quadruple the antioxidant

16:44

absorption than you would get from just

16:46

drinking water. Or it

16:48

could be the alcohol lowers cortisol,

16:50

which is a primary stress-inducing

16:54

compound. We don't know for

16:56

sure, but all

16:58

this recent research hasn't convinced me at all

17:01

to not enjoy my glass

17:04

or two of red wine every night.

17:05

So,

17:07

amazing. You did a lot of work to find these commonalities,

17:11

which I think you just laid down for us,

17:13

and at least on the diet side. You

17:15

also visited these communities, and you've

17:17

got a wonderful

17:19

book, which I really enjoyed, that

17:21

has

17:23

just breathtaking photographs of

17:25

these communities and the people in them. Blue

17:27

Zone Secrets for Living Longer. What

17:30

else did you observe by being there,

17:32

by talking to people that

17:34

were some of the intangibles besides

17:37

just the diet components? And

17:39

how important are they relative to the diet components?

17:42

Okay, so I would say diet's 50% overall,

17:46

but it's more nuanced

17:49

and complex

17:52

than just that. So, I work

17:54

for National Geographic. I write for them,

17:56

and they don't let you write anything that's

17:58

not underpinned with evidence or... or

18:01

at least a recognized expert opinion. And

18:05

my approach is not to go to blue zones and interview

18:08

a bunch of people and draw conclusions. I

18:10

aggregated the available academic research

18:13

to find sort of the profile of

18:15

longevity or to put another way,

18:18

the ingredients to the recipe

18:22

for living a long life. And

18:25

again, it's not at all what you think. They're

18:27

not on diets. They're

18:29

not doing CrossFit or yoga

18:32

or running marathons. But

18:34

they're all in orange theory, right? Yeah,

18:37

very funny. They

18:39

don't exercise in the way we exercise,

18:42

which is a big epiphany to me. You don't

18:44

see any of them exercising. If you ask

18:46

them how many hours a day they spend exercising,

18:48

they'll tell you zero. Yet they get

18:50

more physical activity than us. How did they do

18:53

that? Well, every time they go to work

18:56

or a friend's house or out to eat, it occasions

18:58

a walk.

18:59

They have gardens out back.

19:01

Gardens are big parts of their culture, far

19:04

more powerful than we think. It's not only a source

19:06

of fresh fruits and vegetables, but

19:09

every day they're out there in their 80s, 90s, 100, doing

19:12

low intensity physical activity, range

19:14

of motion, keeping their lower body

19:17

strong and their balance ups or they're

19:19

not falling down and breaking their hips at rates

19:21

anywhere near the rates we have in the

19:23

United States. They're out there about

19:25

an hour a day. And their houses

19:28

aren't

19:28

full of the mechanical conveniences

19:30

we use that engineers

19:33

natural physical activity out of our lives.

19:36

They're still doing yard work by hand and

19:39

housework by hand and kneading bread and

19:41

grinding corn with a crank.

19:44

And we fail to recognize

19:46

the very significant caloric

19:48

burn of

19:51

the sum of all these small physical

19:53

tasks, but more important the fact

19:56

that it keeps your metabolism operated at

19:58

a much higher rate throughout.

19:59

the day, we evolved

20:02

to be in constant motion. We didn't

20:04

evolve to be weekend

20:06

warriors and try to make up for

20:09

intense exercise after

20:11

hours and hours of sedentary life. And in

20:13

Blue Zone, my team figures

20:15

they were nudged into movement every 20 minutes

20:18

or so. And that seems to be ideal

20:20

for humans.

20:21

All right, so we've talked about diet, we've

20:23

talked about movement and physical exercise.

20:27

Let's take a break and I wanna come back.

20:29

And I really wanna ask you about Loma Linda, California,

20:31

cause it's right here in the US. What's

20:34

different about Loma Linda? And I wanna talk about

20:36

the role that we all play

20:39

in our social lives and social

20:41

support system in health

20:43

and longevity. We'll be right back.

20:55

If you haven't tried factory yet, you really should. Especially

20:58

if you're as busy as I am. I really

21:00

can't get enough of the meals they've been sending

21:02

to Loma and me. Each dish has

21:05

tasted restaurant quality,

21:07

but with absolutely no prep or

21:09

planning involved. And with exactly the right amount of calories

21:11

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21:13

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21:15

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21:17

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21:26

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21:31

if anyone else is trying to up their protein intake,

21:34

Factor is for you. Just

21:36

recently we've had some really

21:38

amazing dishes sent to us, a

21:41

couple of really good Mexican dishes

21:43

which we really like. Something that had cauliflower

21:46

rice or broccoli rice, calorie smart, vegan

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if anyone else is trying to up their protein intake,

21:54

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21:55

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21:58

really amazing dishes

21:59

to us a couple of really

22:02

good Mexican dishes, which we really like,

22:04

something that had cauliflower rice or broccoli

22:07

rice, which is so good. And they

22:09

even sent me smoothies to drink in the morning,

22:12

which are super healthy, prepared by

22:14

chefs

22:15

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22:57

That's

22:57

how we share our wisdom, our values.

23:00

That's how we take our country to the place

23:02

it should be. Listen to Velshe Band Book

23:04

Club now, wherever you get your podcasts,

23:06

new episodes Thursdays.

23:21

What about the social, emotional

23:24

components? I'm keeping

23:26

this sort of rough formula in my head that 50%

23:29

is kind of what we put in our bodies. It

23:32

sounds like there's a big portion of this, which

23:34

is leading a non-sedentary life,

23:37

carrying things, walking, being

23:39

physical.

23:42

And then maybe this is harder to study, but

23:44

did you find that there were elements

23:47

of

23:48

friendship, socialization or other

23:51

things that were influencers here

23:53

as well?

23:54

So the

23:56

one thing you have to remember when it comes to longevity,

23:59

there's no... short-term fix. There's

24:02

nothing you can do today or this month that's

24:05

going to help you live longer than 50 years. You

24:07

have to think of terms of things you're going to

24:09

do for years or decades

24:11

or a lifetime. So a useful

24:14

metaphor here we draw from the blue zones

24:16

is to imagine a mutually

24:19

supporting web of factors and

24:21

let's just for the fun of it let's put diet

24:23

in the middle of this web. And around

24:25

this web you also have a purpose.

24:28

Their lives are underpinned with purpose

24:29

they surround themselves

24:32

with a social circle that

24:34

helps them move

24:37

naturally and eat this sort of whole

24:39

food plant-based diet. And

24:41

they live in places where

24:43

the healthy choice is not only

24:46

the easy choice, you know, the aforementioned

24:48

foods are the most available, they're the cheapest

24:51

and they know how to make them taste the most delicious.

24:54

That it's the default. So

24:56

you have this mutually supporting

24:59

cluster

24:59

of factors that help people

25:03

do the right things and

25:05

avoid the wrong things for long

25:07

enough so they're not developing type 2

25:10

diabetes or cardiovascular disease

25:12

or dementia. All of which are largely

25:15

avoidable.

25:16

Let's let's let's stone in on Loma

25:19

Linda if you would because I think

25:21

what's useful about it is

25:24

without Loma Linda you know I can imagine

25:26

people coming to your work and saying okay

25:30

great but these are idealized communities

25:32

far away they're lower technology

25:35

they're more social fabric they

25:37

don't have all the distractions that we have in the US

25:40

we can't do that here in the US

25:42

quite as easily and maybe

25:44

that's the case maybe that's not the case but

25:47

Loma Linda is a very interesting example

25:50

maybe you can explain what this community

25:52

is and what makes it tick and what what we can

25:54

learn from it.

25:56

First of all let me

25:58

just point out in the blue zone of Sargent

25:59

Sardinia, which is in the highlands, you can

26:02

see the coast. And

26:05

the highlands of Sardinia, they produce 11

26:07

times more male centenarian than any place in

26:10

the United States, for example. Yet

26:12

where you can see on the coast of Sardinia, their

26:15

life expectancy is no greater than the rest of Italy.

26:18

Similarly, in Ikari, Greece, you can

26:20

stand on the shore, look across

26:22

the Aegean Sea, and within eyesight,

26:24

you can see Samos. Samos

26:27

doesn't experience. To

26:30

the outside world, they're the same culture

26:32

and the same idealized faraway

26:35

spot, but no, there's special things going on.

26:38

Part of it is these blue zones have

26:40

been somewhat remote. So

26:42

the corrosive impacts of

26:45

the standard American diet and the American

26:47

way of using

26:49

gadgets and electronics to do

26:52

our work for us have not invaded

26:55

these places as much. Similarly, the Adventists,

26:57

you know, they celebrate their Sabbath on

27:00

Saturday from Friday night until Saturday night,

27:03

and they're pretty strict about that. Their

27:06

kids aren't going to dances

27:09

on Friday night. They're not playing

27:11

football on Saturday morning. So

27:13

what you have is a culture slightly

27:16

apart, and that's kind

27:18

of kept, I think, some of the corrosive

27:20

trends at bay. But Adventists

27:22

also take their diet directly from

27:24

the Bible, Genesis chapter 1,

27:27

verses 26 through 28,

27:30

every plant that bears seed,

27:32

every tree that bears fruit, and green

27:35

plants. This is right in the Bible, or the

27:37

Old Testament, and they actually

27:39

follow that. So most of them are plant-based

27:42

eaters. And also, Loma Linda

27:45

University is one of the top

27:47

academic centers in the country,

27:50

and they expend their, you

27:53

know, a lot of research, a lot of church resources,

27:55

by the way, on

27:56

studying and

27:58

promoting eating plant-based seed. The

28:01

Adventist Health System, I run 25

28:03

hospitals on the West Coast,

28:06

it's a value driven healthcare

28:08

system that has very good outcomes compared

28:11

to other hospitals in America. So

28:15

yeah, I guess they're outliers, but they

28:17

achieve extraordinary longevity

28:19

by the same means that people in

28:22

places like Saturday Day at Okinawa do. I

28:25

guess you're getting to one of my principal

28:27

questions, Dan, which is,

28:31

for all of the

28:32

positive things that they do in these communities,

28:35

it also sounds like a lot of

28:37

their success comes

28:40

from keeping stuff out.

28:42

And, you

28:44

know, as you've pointed out, keeping

28:46

out

28:47

things like the technology

28:51

that allows us to be more dormant, keeping

28:53

out things like

28:55

the car, which we

28:58

drive four blocks instead of walk, keeping

29:01

out things like more processed

29:03

foods, et cetera, et cetera, all

29:05

the modern conveniences is

29:09

really difficult in a modern society.

29:12

And when I

29:14

look at these communities and I listen

29:16

to you, I wonder how much is

29:19

it sort of through the stroke of kind

29:21

of either the geography where they live

29:23

or their religious beliefs or some other reason,

29:26

they've just kept all this other stuff out. And

29:28

it's actually that stuff

29:31

that's leading to more chronic disease

29:33

and shorter lifespan.

29:35

Well, yes, that's true.

29:38

But

29:39

we have plenty of

29:41

tools in our communities to keep that

29:43

stuff out if we want. Since 2009,

29:46

I've run the Blue Zones LLC.

29:49

We've now worked in 72 American

29:52

cities to bring the insights

29:54

from Blue Zones into American

29:57

cities. And we have in every

30:00

case improve the health outcomes or

30:02

improve the health of these communities

30:04

as measured by Gallup. And

30:08

cities have the power to keep junk

30:10

food at bay by limiting

30:12

the number of licenses they give to new

30:15

McDonald's and KFCs. They

30:18

have the power to curb

30:20

the usage by ordinances

30:23

that prohibit drive-throughs at fast

30:25

food restaurants, at limiting

30:27

the size of signs, at

30:30

limiting billboard advertising.

30:32

By the way, billboard advertising is when

30:35

you have two identical neighborhoods

30:39

and one neighborhood allows billboard

30:41

signs, that neighborhood has a BMI of about 10%

30:44

higher than the same neighborhood

30:47

that forbids them. Body mass index. Yeah, body

30:49

mass index or obesity rate. So

30:52

what I've tried to do is aggregate all the

30:54

things that help keep

30:56

the unhealthy influences at

30:58

bay. And I

31:01

show up

31:01

not

31:02

wagging my finger and telling cities what to

31:04

do, but I take them through

31:06

a consensus process where each of these policies

31:09

are assessed for one, effectiveness

31:11

in their community. I don't tell them.

31:15

But number two, feasibility. Is

31:17

there a political possibility

31:20

of getting this passed in five years? And then my

31:23

team, once the bundle

31:25

of policies are selected, we

31:28

can help get them passed. And in most cases,

31:31

the objective of this policy is to keep

31:34

the unhealthy thing at bay or else

31:36

make the healthy thing more salient,

31:39

cheaper, more accessible, more

31:41

attractive. And I'll tell

31:44

you in America,

31:45

we're not going to get any healthier

31:47

by not trying some new things.

31:50

If you look at the trends and Andy, you're on top

31:52

of these, obesity, overweight,

31:55

we're now at about 73% of people who are obese are

31:58

overweight, diabetes, type two diabetes. diabetes

32:00

is on the rise, the chronic disease

32:02

is on the rise, what we're doing ain't

32:04

working. And I make

32:06

the argument that, well, wait

32:08

a minute, here we have populations

32:10

of human beings with the same

32:11

biology and genetic diversity that

32:14

we have in Asia,

32:16

Europe, Latin America, and even in the United

32:18

States. Why aren't

32:21

policymakers paying attention

32:23

to what is working in these policies

32:25

and putting it to work in our communities?

32:28

And we overlooked that in this sort of pharmaceutical

32:30

lurch or biohacking or

32:33

better healthcare plan where

32:36

there are much more cost-effective ways

32:38

to produce a healthier country.

32:40

You know, does the fact that there's only six Blue

32:43

Zone communities,

32:45

should that create cause for pessimism?

32:47

No. But wait, Blue

32:49

Zone is a construct I created. And

32:52

I just tried to highlight the pinnacle

32:55

because it makes for an interesting story. You

32:57

know, Sardinia is part of Italy. Italy's

33:00

life expectancy is five years greater

33:02

than that of the United States. Nicoya

33:05

Costa Rica. Costa

33:07

Rica spends

33:09

1.15th the amount we do on healthcare

33:11

and they have half the rate of middle-aged

33:13

cardiovascular mortality, about

33:15

a 2.5 times better chance of

33:18

reaching a healthy age 90. Blue

33:21

Zones are just the best example of

33:23

a lot of better examples around the world.

33:26

You started talking about Singapore. Singapore,

33:29

I call Blue Zone 2.0. It's

33:32

not like the other five Blue Zones.

33:34

1965, Singapore

33:38

was a fishing village, the end of the Malay

33:40

Peninsula. Had a life

33:42

expectancy of about 25 fewer

33:44

years than they have today. It

33:47

is a melting pot, almost as diverse

33:49

as the United States. It's mostly Indian,

33:52

the Malay, Muslims and the Chinese.

33:56

Lee Kuan Yew, the prime minister

33:59

there and his minister.

33:59

many of his ministers

34:02

come from places like MIT and Harvard. They're

34:05

paid well. They went about to methodically

34:08

create an environment where

34:10

human beings can thrive. And today

34:12

they enjoy the longest

34:15

health adjusted life expectancy in the world. So

34:18

they're getting about a dozen more years

34:21

in full health than we do in

34:24

America. And it's not some

34:26

idealized Mediterranean Island.

34:29

This is one of the most successful economies

34:31

in the world on top

34:33

of technology. And we

34:35

ought to be paying attention to what they do

34:38

instead of thinking, well, if it isn't made in America,

34:41

it doesn't work. It's an amazing story. And that

34:43

is an optimistic story. What are some of the most

34:45

important things that they did in Singapore?

34:47

First of all, they made car

34:49

driving very expensive. If

34:52

you want to buy a car, it's two or three times

34:54

as expensive as the same automobile in

34:57

the United States. Gas is not subsidized

35:00

like it is here in the United States. If you

35:02

want to drive downtown, there's heavy tolls.

35:05

But what that does is, okay, 90% of Singaporeans

35:09

don't have a car, 89%, but within a few hundred yards

35:13

of every home, there's a fast, clean,

35:15

and efficient subway system.

35:17

It goes very quickly. And

35:20

that's been paid for by gasoline

35:23

and car tax dollars. So instead

35:25

of people sitting behind their car wheel, they're

35:27

on their feet walking. And by

35:29

the way, when they're walking, the sidewalks

35:32

are safe. They're tree covered. They're

35:34

often covered with water. It's very hot in Singapore.

35:37

It's a very safe place. So

35:40

the people are about half the BMI

35:42

of that in the United States, largely

35:44

because they're getting this non-exercise physical activity.

35:48

If you buy a Coca-Cola, Coca-Cola is

35:50

not encouraged. In fact,

35:52

it's dissuaded, it's sugar-sweetened beverages.

35:55

But they have rather ingeniously

35:58

mandated that Coca-Cola is not encouraged.

35:59

and Singapore has about 20%

36:02

less sugar than the same Coca-Cola

36:04

in Great Britain. They

36:07

subsidize brown rice, which

36:09

is healthier than white rice. You pay full price for

36:11

white rice. If you want to enjoy chocolate,

36:15

there's tax on chocolate. They

36:17

were one of the first countries

36:19

in the world to heavily tax cigarettes

36:23

and put these lured pictures

36:25

of what mouth and lung cancer

36:27

looked like right on the package instead of a

36:30

cartoon character of a camel. And

36:32

interestingly,

36:33

and we often overlook this, they're very

36:35

hard on drugs.

36:37

If you have more than 15 grams

36:39

of an opiate, you could be put to death. Sounds

36:42

draconian. But last year,

36:44

about 18 people died

36:46

of drug overdoses, whereas in the

36:49

United States, we had over 100,000. The

36:53

other thing, they've made the decision. I know this is

36:55

controversial in the United States, but you

36:57

can't own a gun in Singapore.

37:00

Yes, they don't have the freedom to have their

37:02

pistol or their semi-automatic

37:04

machine gun, but only about

37:07

a dozen people die every year in violent

37:09

gun deaths and accidents. And here in the United

37:11

States, there's about 155,000 people. So

37:16

when you look at the statistics, you

37:18

tell me what society is

37:20

safer. The one that's armed or the

37:22

one that's not armed?

37:24

Okay, Dan, let me take one final break,

37:26

and then I want to come back and answer the question.

37:28

But I want to be as Blue Zone. How

37:31

do I make my city or state

37:33

or street or country into

37:35

a Blue Zone? And

37:37

there's good news. There's people who are already putting this

37:39

research into action where they live, and we'll

37:42

have some good tips for you. We'll be right back after this.

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39:03

As your proof point, you mentioned

39:05

that there are some 70-plus communities in the U.S. that

39:10

have

39:18

essentially decided that

39:21

they really want to move in this direction, that

39:23

they want to be informed, and have

39:25

at least some of their policies informed by this.

39:28

And you've pointed out that they've made a difference. And

39:31

I really take your point that you don't have to be

39:33

Sardinia to call it a success. You've

39:36

got to make progress. There's

39:38

one community in particular in Minnesota

39:41

that I'm aware of that's sort of one of

39:43

the poster children, if not the poster child, for

39:46

this effort. I'm wondering if you can either

39:49

talk about that community or select

39:51

a different one and just talk about what that

39:53

journey has been like as

39:56

communities try to say, hey, we're

39:58

going to put the place in place. the things that

40:01

allow our people to live healthier, longer

40:03

and better lives.

40:05

So Albert Lee was our first Blue

40:07

Zone project and it

40:09

was largely funded by AARP and somewhat

40:11

by your old company, UnitedHealthcare. And

40:15

we partnered with the University of Minnesota

40:17

and I brought this key insight

40:19

that if you want to make places healthier, don't

40:22

try to convince everybody to change their behavior,

40:25

change their environment so the healthy choice is the easy

40:28

choice. When we set up a program

40:30

that we now have scaled, we come

40:32

in with three separate teams. The

40:34

first team is a policy team. We

40:37

have policy bundles that favor healthy

40:39

food over junk food, that favor the

40:41

pedestrian over the motorist and favor the nonsmoker

40:44

over the smoker. We do a consensus

40:46

process for feasibility and effectiveness.

40:49

And then we, the city itself

40:52

chooses eight or 10 policies in

40:54

each of those areas that they feel would help them.

40:57

My team helps make sure it gets implemented

40:59

and enforced. A second

41:01

squad has a Blue Zone certification

41:05

program for schools, restaurants,

41:07

grocery stores, workplaces, and

41:10

churches. And we

41:13

give Blue Zone certification for places

41:16

who optimize their policies

41:18

and their designs so

41:21

that

41:22

people move more,

41:24

eat better, socialize more,

41:26

and know and live out their purpose. And

41:29

again, we're sort of engineering unconscious

41:32

behavior, not conscious behavior, and

41:34

then kind of a Blue Zone ambassador program

41:37

for people. And we help them choose

41:40

new friends to spend time with,

41:42

healthier friends, know their sense of

41:44

purpose, and then go into their home with

41:47

checklists to optimize their kitchen and their

41:49

home so they mindlessly move

41:51

more. And we found

41:54

that if using that same

41:57

process, if we can get

41:59

into a city...

41:59

for three to five years. In

42:02

every case, we lower the BMI. In

42:05

the case of Albert Lee, we

42:07

saw life expectancy go up by three years

42:10

and the city government

42:13

reported about 30% lower health

42:15

care costs. And this is, by the way, very well documented.

42:18

So we've now scaled it to 72

42:21

cities. One of the biggest we've

42:23

completed is Fort Worth, Texas, almost

42:26

a million people. They reported

42:28

a BMI drop of about 3%,

42:31

which doesn't sound like a lot, but it occasioned

42:33

about a quarter of a billion dollars of

42:37

lower health care costs, projected lower health

42:39

care costs. And now

42:41

we're working in Scottsdale,

42:43

Arizona, Naples, Florida, Jacksonville,

42:46

Florida. And in every case,

42:49

we only go into the city when

42:52

the public sector says, yes,

42:54

we want this. The mayor, city council,

42:56

they understand what we're doing and they

42:59

agree to work with us, otherwise we don't come

43:01

in. And we're always funded

43:04

now by either the insurance

43:06

companies, Blue Cross Blue Shield plans, hospital

43:10

systems, or local health foundations.

43:13

And all of our work is at risk.

43:16

Gallup measures it. And if we don't

43:19

produce an outcome, our fees

43:21

are at risk. And we set

43:24

off to change the environment for the long run

43:26

so that when we leave, the healthful

43:29

impact continues to live on for years

43:31

or decades to come. It's incredibly exciting.

43:34

And it strikes me that

43:37

A to B taking yourself from wherever you are as

43:39

a community and moving yourself to

43:42

a different place, whether the topic

43:44

is health, whether the topic is anything,

43:47

is incredibly challenging. And I think it's so

43:50

commendable and so encouraging

43:53

for people to feel like

43:55

they can control their own destiny, that this isn't

43:57

just some abstraction or some idealized

43:59

set of

43:59

circumstances. And the other

44:02

thing I noticed, and correct me if I'm wrong here, Dan,

44:04

is that

44:05

this isn't the kind of thing

44:07

that requires a lot of privilege

44:09

or wealth. It strikes

44:12

me, for example, looking at the diet, that

44:14

we're not talking about rarefied,

44:17

expensive foods.

44:20

We're talking, for the most part, at least from what I

44:22

see, fairly simple foods.

44:25

We're not talking about gym memberships. We're

44:27

talking about communities

44:30

set up so that people can walk and bike and do things

44:32

that aren't prohibitively expensive playgrounds

44:35

and such. Am I wrong to reach that conclusion?

44:38

You're absolutely right. I mean, we're

44:41

marketed all the time of some packaged

44:43

superfood or, you know, you have to

44:45

go to a boutique grocery store

44:47

and buy organic food. But when

44:50

you look at the diets in Blue

44:52

Zones, and I actually wrote a book called the Blue Zone Kitchen

44:55

where I gathered 100 recipes,

44:57

they're eating peasant food. The

45:00

beans and whole grains, and

45:02

these are the things you can buy for two bucks

45:04

a pound and then the bottom shelf at the grocery

45:06

store.

45:07

An important thing is those paying attention

45:10

to taste. And the true

45:12

genius of the Blue Zone is they know how to make these

45:14

simple peasant foods taste delicious.

45:17

To your point about gym memberships and yoga

45:19

and Pilates, you know, they're not a bad idea

45:22

and we should do them. But

45:24

I hate to say it. Exercise has been an unmitigated

45:27

public health failure in this country.

45:30

Fewer than 24% of Americans

45:32

get even the, you know, the minimum

45:35

amount of physical activity, which is a 20 minute

45:37

walk a day. It ain't working. On

45:39

the other hand, a community that is in

45:41

the highest quintile of walkability,

45:44

and there's something called the walk score, which is

45:46

a very good metric. Those people are

45:48

getting about 20% more physical activity

45:51

than those people in the lowest quintile. And

45:53

they don't even realize they're getting it. It's just that

45:56

it's pleasant to walk down and pick up your

45:58

coffee. It is so. safe to

46:00

go over to your neighbor's house. And

46:02

that's what we ought to be spending our money on instead

46:04

of expensive gyms, if we really want

46:06

America to be more physically active.

46:09

So I do have a couple more questions as we wind down.

46:12

And one of my principle questions is about stress.

46:15

It seems like, you

46:17

know, we all

46:19

know,

46:20

and we're learning more and more about the physical

46:22

effects of stress,

46:24

of trauma,

46:26

of kind of the things

46:28

that affect us that create inflammation

46:31

and so on. I'm curious

46:33

both in what you've observed

46:36

in these communities. These can't

46:38

be stress-free communities. I mean, I know we like

46:40

to think that there's ideal places in the world, but everybody has

46:42

stress. What, in your view,

46:44

are the things that you've

46:47

seen people do or that you do

46:49

even, that are most effective at managing

46:52

stress,

46:53

keeping stress away, dealing

46:55

with it appropriately?

46:57

Yeah, Andy, your question is insightful.

47:00

These people are humans just like that, and

47:02

they worry about their kids. They worry

47:04

about their health. They worry about their finances.

47:07

The same way we do. They're not different people. They

47:10

do have sacred daily rituals that help

47:12

unwind some of the stress and the

47:14

accompanying inflammation.

47:18

Stress triggers inflammation, which is

47:20

the root of every age-related disease. In

47:24

some of these communities, the Adventists have

47:26

prayer. Prayer works at

47:28

lowering stress. People who go to church have

47:31

higher life expectancy. The

47:33

Ikari in Costa Rica, they take a nap. We

47:36

know napping is associated with lower

47:38

dementia and also lower rates of heart disease.

47:42

The Okinawans have ancestor veneration.

47:44

So if you nap in church, you're

47:46

gonna doubly win.

47:48

I know it works for me. Yeah,

47:51

okay. That's my dad joke.

47:54

I like it. I'm

47:57

gonna license that from you. I'll

47:59

give you a royalty.

47:59

license fee, zero fee. Thank you. Happy

48:03

Hour, I actually, and a drink, I

48:06

hate to say it for as unpopular as alcohol

48:08

right now at Lores Cortison if you're doing it with your

48:11

friends. That's the last time we were together with syndication

48:13

like that. That's right. We were sitting on Mark

48:15

Green's porch having

48:17

a glass of wine and chewing the fat as it

48:19

were. But you know,

48:21

in America here, Daniel Kahneman,

48:24

Nobel Prize winner, did a very

48:27

careful study of our daily activities. The activity

48:30

that creates the most

48:33

unhappiness or generates the most stress

48:36

is our

48:36

automobile commute

48:38

to and from work every day. The

48:41

best way to get rid of that is a walkable

48:43

community where it's safe, easy, and

48:46

you know, there's enough concentration density that

48:48

we can walk. And there are cities that have become

48:51

miraculously walkable in the United States,

48:53

Santa Barbara, California, Pasadena,

48:55

by the way, look at pictures of Pasadena where you

48:58

are right now in the 1980s

49:00

and look at it today. It's a pleasant place to walk.

49:03

Actually, a guy in my team, Dan Burden

49:05

was partially responsible for

49:07

the design

49:07

that created walkable Pasadena. We

49:10

can do it in America. So I

49:12

argue that much if not the majority

49:14

of our stress in this country is

49:17

from the environment we live in,

49:19

social environment and the built environment.

49:21

And those are all

49:23

changeable.

49:24

And that's what we ought to be focusing on.

49:26

So Dan, as of today,

49:28

as of today, you joined

49:31

the elite, elite,

49:35

elite, elite,

49:36

having your own show on Netflix. First

49:39

of all, congratulations. You know, that is the

49:41

modern day talisman. And

49:43

look, I've been a little bit tongue in cheek. But the truth is,

49:45

I think it is a pretty

49:48

remarkable statement about the need

49:50

and the hunger for people to look

49:52

beyond the quick fixes and

49:55

try to understand

49:56

this a little bit better and

49:59

some of the success.

49:59

that you've had in communities over the year. Can

50:02

you just spend a minute just telling us about the

50:04

show that people can tune into?

50:06

Sure, it's a four-part series,

50:10

a docu-series. I'm

50:12

very grateful. The idea

50:14

of Blue Zones, I've been at it for 20 years

50:17

and people don't immediately

50:20

grasp it and you can't really sell

50:22

purpose and it's not the way we

50:25

think of hell. So it's been

50:27

slow to get traction. But

50:29

the beauty of doing this Netflix

50:32

show, I don't know if you've ever seen Chef's Table, but

50:35

they're shot gorgeously, very high

50:37

production values. We got the

50:39

director from Chef's Table,

50:42

Clay Jeter. We got the

50:44

director from photography. So

50:46

it's shot gorgeously. And

50:49

a lot of, I would say the

50:51

candy or the sugar that helps

50:53

the medicine go down is the cinematography

50:56

here. But

50:57

it's also a good

51:00

kind of hero's journey, quite honestly. Not that

51:02

I'm a hero, but I did go on a hero's journey.

51:05

I went out into the world and

51:07

tried to bring back something that would be

51:09

useful for the community. And this

51:12

documentary series captures

51:14

discovering these Blue Zones, bringing

51:17

back their wisdom and their insights. And

51:20

as you get into the third and fourth

51:23

episodes, it shows how

51:25

you can put those insights to work in your

51:27

life and how American

51:29

cities are actually putting these insights to

51:31

work and lowering chronic

51:33

disease and obesity. And

51:36

I'm very proud of the outcome. Well,

51:38

whether it's

51:39

your Netflix series,

51:41

your beautiful books, your wonderful

51:43

cookbook, there's a lot that's accessible

51:46

about the work you've done over the

51:48

last few decades. It's been quite a contribution,

51:50

I'll be honest. It's a unique contribution.

51:53

It's moved the dialogue.

51:55

And the ultimate compliment I can give

51:57

you is,

51:59

this will have...

52:00

unpredictable, positive consequences

52:03

beyond which you could have imagined, well

52:05

beyond your and my time. So

52:07

congratulations, and thanks for being in

52:10

the bubble.

52:11

Well, you know, I lament that you've left

52:13

my neighborhood, but very happy to be in your bubble.

52:16

And by the way, if anybody has questions,

52:19

I'm at Dan Butner on Instagram,

52:22

and I always answer people's direct

52:24

messages and be very happy to answer

52:26

any questions people might have. It's a great honor

52:28

to see you, and hopefully next time it'll

52:30

be on a porch somewhere with a glass

52:32

of wine. Fantastic. That's

52:35

a great ending, and that's a great offer. Thank

52:37

you, Dan.

52:50

Okay, thank you to Dan. And

52:53

look, we've got a Labor Day weekend coming up.

52:56

I hope you have a great one.

52:58

On Wednesday, we are picking right

53:00

up with a show with Elizabeth Cripps with

53:03

a show about

53:04

parenting in the age of climate

53:07

change. And it's

53:09

a very interesting topic to me.

53:11

How do we talk to our kids about this,

53:14

particularly as our kids get older and realize

53:18

that we're giving them a world very different

53:20

than the ones our parents gave us and

53:22

very different than the ones that we've lived in? Yeah,

53:24

that's right. Now you're the boomer or the

53:27

Gen Xer or whatever in

53:29

their eyes, and it's a really important

53:31

conversation and topic.

53:33

And then Caitlin Jettilino will be coming along

53:35

to talk about this very mysterious

53:38

news at a variance

53:40

that we are seeing and what they could mean

53:43

for COVID and for a winter wave.

53:46

So enjoy your

53:48

time off. Thank you to everyone

53:50

who works so hard in

53:53

this country and around the world. And

53:55

we'll talk to you next Wednesday.

54:02

Thank you for listening to In the Bubble. If

54:05

you like what you heard, rate and review,

54:07

and most importantly, tell a friend

54:09

about the show. Tell anyone about the show.

54:12

We're a production of Lemonada Media. Kyle

54:14

Shealy is the senior producer of our show. He's

54:16

the main guy, and he rocks it with me

54:18

every week. The Mix is by Noah

54:21

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54:23

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54:25

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54:28

He's well above average. And of course, the

54:30

ultimate big bosses are Jessica

54:32

Cordova-Kramer and Stephanie Wittleswax.

54:35

They are wonderful, inspiring, and

54:38

they put the sugar in the lemonade. The

54:40

executive produced the show along with me. Our

54:42

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54:45

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54:47

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54:49

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54:52

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54:56

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54:59

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55:01

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