123. Progress Note #12: Live to 100 - Secrets of the Blue Zones

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Dr. Darsha, how goes it? It's up, Dr. Altamash, doing well, can't complain, how about you? You know, I'm tempted to start about talking about the weather because it's just, it's my favorite time of the year, especially when I first leave in the morning, and it's like a nice breezy, 58, 57, but I feel like you just get really old when you start conversations talking about that. Is that true? It's really funny, where did I, somebody messaged me, I forget who it was, oh, it was a moonlighting tomorrow, and so one of the doctors today actually was like, hey, hope you're enjoying the beautiful weather out there, so I think fall is a lot of people's favorites, especially as the pumpkin season and just the weather and all that too, so yeah, I think it's fair point, especially with the hot summer that we've had that a lot of people are actually very much looking forward to this beautiful weather we're having here on the east coast at least. For sure. So what's going to be the discussion of, or the topic of discussion today, rather, so just to say, it stays for a little bit, you know, we were a lot of ideas in terms of current events, and so I, we reached out to some of our network, and one of my amazing students has suggested that people have been really interested in this living to a hundred docuseries, I suppose, right, a four episode, a little mini series that's going on on Netflix, and what's curious about that? So we said, hey, why not? That kind of falls in line with the things that we really need to talk about here. And so maybe I'll just set the stage for the audience, right? And the premise of this is it's a gentleman, Dan Butner, who is also an author and has kind of directed this, who's been collaborating with National Geographic for quite some time to reverse engineer this formula for longevity, right? That's a word that people have heard time and time and basically he's been to different parts of the world everywhere from from Japan to California and all across and looked at these areas called the Blue Zones. Certainly places that we've referenced before, but basically it's these Blue Zones are pockets on, I think there's maybe a total of seven actually, right? Although they, they really kind of five now. I think it's going down now. Oh, is that right? Okay, so it used to be seven at some point, but now it's five major ones. The area where has the largest population of people who are living to 100. So the largest amount of centenarians. And so that's why it's interesting. Okay, what are their secrets, so to speak, right? And the reason it's particularly interesting now is for the first time in the longest time, over the last 50, 60, 70, 100 years, the life expectancy has gone down over the past couple of years. I'm sure at this point people are thinking, oh yeah, COVID, you know, and and that's one of the reasons the last couple of years that the numbers have gone down, but it's actually goes beyond that, right? Sameer to factors, it's the poor healthcare system, particularly in this country, poor city planning, ease of access to firearms, and how that's possible, drug overdose, and that kind of thing, things that we've talked about and some recent guess. And so rather than thinking about what's killing us over the last couple of years and decreasing the life expectancy, people wanted to take more of an approach and or rather this gentleman right here, and the whole Blue Zones movement said, okay, well, what is it that's allowing people to live and thrive? And that's where it's set off. So full disclosure for the audience, I was lazy and did not get a chance to to look at this, but I am I think informed enough that we can have a meaningful conversation here. So Darsh, you've watched it all for all of them, right? Yes, all for episodes of the documentary, so tell us what you learned and maybe in any order that you choose, but one thing I haven't done for the people is highlight what those five areas are, but I'm sure you can do that for us. Yeah, sure thing. So let me go over this, right? So the Netflix documentary is called Live to 100. It's a bit it's right now in like the top 10 most watched, so right when I went on Netflix, boom, saw it as like the first or second thing that came up. As you mentioned, Dan Butner, who is a very interesting story. So growing up, he became very interested in cycling and not competitively, but mainly just breaking world records by doing like a transcontinental bike ride. And after he's done this going through so many different continents, he wanted a bigger purpose in life. And though, he started to meet different people, different villages, things like that. And then he started to realize, what's the secret behind some of these regions that you know, call blue zones where people are living to 100, 100 plus. And so like you said, I think there used to be seven or maybe even nine back in the day. And now that we know globally that the blue zones are shrinking, right? So we'll get into that too. So there's five of them. So the five are number one, Okinawa, Japan. Then you have Sardinia, Italy, Loma Linda here in the US in California. You have Nikoya Costa Rica, and then you have Icaria Greece. So those are the five two in the Mediterranean, one obviously East Asia, one here in our homeland US, and then one just south of us in Costa Rica. And so the four parts of the documentary, the first one really goes into the culture of these blue zones and really just talking to the people and figuring out, hey, what are some of these concepts that they're doing? Then he'll go from blue zone to blue zone and compare contrast some of those ideals and morals and values that each of the blue zones go through. So for instance, nutrition is a big thing, right? On processed foods, especially as a commonality. But they're not all eating the same types of foods, right? Like Japan is heavy on tofu. Costa Rica is actually having on beans and corn. You go to Greece where they actually drink wine almost every day. And so what he sees are these common patterns. But within these patterns, every blue zone is celebrating it differently. And then later on in the documentary, he goes through why these blue zones are shrinking, right? So this is one of the craziest things that Okinawa, Japan actually has the highest rate of obesity in Japan out of any city now. So there are still pockets of blue zones within the blue zone. But now overall, it's taken over Japan as a leading, leading zone of obesity. And he talks, it's crazy. And he talks about how when you go into these cities, I mean, the amount of urbanization that's happening, you see fast street restaurants right when you take the exit. You know, he takes the exit off to go to Loma Linda where the 7th Adventist are and you see a Del Taco just right there. So obviously globally, you know, we're in a pandemic of obesity and chronic disease. And so he kind of goes through that. And then the last part of the documentary, that fourth episode is what we were just talking about blue zone 2.0, right? And talk about Singapore and how the government of Singapore has really taken into their own hands to make sure that their own national identity and the people who live underneath that Singapore flag have a chance to get to 100 with lifespan, with lifespan. And so they're instituting a lot of different cool things. But anything you want to add there, or we mean, we can even jump to the power, the power nine, but I'll pin it off to you. Yeah, no, I think I want to, I certainly want to dive a little bit deeper into what your thoughts are about the maybe more of an obesity crisis in Okinawa, right? Considering people pointing at what the secrets are and what we can extract from that to apply to our longevity. What I think is worth emphasizing the point that you made is that these different cultures have different diets yet all seem to be arriving at one common thing, right? The longevity thing that's really, really interesting. And the important thing about that is, well, first of all, you highlighted the fact that all their anger engaging is some type of whole food pattern, right? Some of the articles that I was reading in preparation for this have talked about, oh, it has to be a plant-based diet. And certainly, we've talked about multiple times how plants are good for you, right? Circa back to Dr. Will Bolshewitz, right? We've talked about the life, several lifetime medicine experts. We've just talked about how vegetables are good for you in every, and E.C. Sinkowski, 800, Graham Challenge. So, I do think that's certainly important. But I think, again, coming back to the fact that it's not necessarily one particular diet, but it's all these things in concert with each other that are really, really important. And so, you know, this CBS article that I came across that I thought was really interesting where they quoted Putin or talking about. And I quote here, at the essence of the Blue Zones people, living a long time is not because of the things that we think, right? It's not on diets. It's not on specific exercise programs. It's not on the supplements that we can take. I can supplement one of the main questions that we get asked, right? They do not pursue health, he talks about, right? Which is a big disconnect in America, right? We're always thinking about, hey, what can we do to get healthy, what can we take, what type, or what can we avoid, right? Lately, we've been talking about oatmeal, I think, is getting asked on the media a lot. I miss that, by the way. I don't know what's happening, but I see everybody quoting and retweeting and whatnot. But he goes on to say that, quote, it ensues by setting up your surroundings the right way and the blue zones through the surroundings are naturally set up, right? So, basically, these people are, this is the way of life. They just know that this is how it is, right? Whether it's the power of social connection, whether it's just movement spurts throughout the day and how their cities are set up, set up how they're working and the whole foods that you've already talked about, or whether it's having a purpose, like when they get up, what their day is going to look like and just long, for short term and long term outlook of life. And so, it's a byproduct of their way of living, not necessarily something they're searching where you plan, exercise into 60, 90 minute bouts throughout the day and you have to be intentional about that. So, I think that's something that's really important is, and we've talked about this before, is one of the things that, over my career, I've become more interested in is, when you listen to different people and sometimes people have contrasting opinions as well, it's like, what are the common themes, right, or the middle? And that's what's really interesting to me, rather than like the polarized opposite ends or what's really, really different about different people's opinions. So, that's the only thing that I wanted to highlight there. Yeah, so I think that's a great segue to go into the power nine, right, so the blue zones have characterized those nine commonalities and there's four main topics that they go through. So, the first one is moving, right, second is having the right outlook, third is eating wisely, so nutrition, and then fourth is connection. And then let's go through the nine that are involved in these and then I'll kind of go through US versus what I've realized happens in the blue zone. So, within the move topic, right, so there is moving naturally, right, this is what you're talking about here, we think of movement as something that's forced, right, it's not necessarily play, but something we have to do in order to live longer. Whereas in the blue zones, movement is a daily part of their lives. I mean, for the minute they wake up, whether it has to do with work, either they have to go into the fields and go farming or in sardinia, there's steep steps, so they're always climbing, whether it's running a bicycle, and it's also functional patterns, right, I think that's one thing that people miss a lot of times. They're squatting there, they're getting their hips in different ranges of movement, right, they're speeding up, they're slowing down here in the US. I mean, there's such a focus, I think, on just fitness that we oftentimes forget that our bodies are made to be moving and relaxing in different positions, right, and I think that's just something we don't really grasp too well here, but it almost seems like fitness. Luckily for us, I feel like fitness is play, right, like we go to the gym and we enjoy it, but for a lot of people, that's not the case, and so that's why there's a huge push to telling people, find something you enjoy, find something you enjoy, because that's what's going to give that longevity throughout time. And one of the reasons things like CrossFit has been so successful, right, camaraderie, social connection, you compile social connection, with play, with competition, like, you know what I mean, and that's the recipe for success. Yeah, and again, let me back to the power nine works as a web, right, I mean, nothing works in isolation, you can't just be moving naturally and that's it. You can't just eat healthy and that's it. Everything here relates, and as I go through these, I think the audience will start to figure that out. So within the right outlook, we have two different commonalities. One is purpose, and in Japan, they'll call this icky guy, right, so you wake up, you have a meaning, there's purpose to life, and you can do it through prayer meditation with other people, right, that web, and then the second part is downshift. So there's some sort of down regulation that they're doing, whether it's through meditation, whether it's just through hanging out with people, but there's some sort of stress relief, right, and that was one of the major things that popped out to me while watching Lift 100 is just the way blue zones respond to stress, right, and they mention their stressors are the same as hours. They go through the exact same thing, and maybe even a little bit more, because they actually have to go out and get their food, they have to be more agricultural, they don't rely as much on efficiency, AI, and machines to do their jobs for them. But the way they talk about stress is very you let it go, right, and you know that it's more of a cacronic type stress, whereas here it's like quick, cute, you're stressed out, you got to do something about it, quick fix, quick fix, and there's that difference that I saw, and just the way they handle stress was very almost like nonchalant in a way, which is really cool to see. Okay, so then the third one, nutrition, eating wisely. So the first one is the 80% rule, this is big in Japan actually, I forget what the quote they have is, but before every meal, they'll say these three words that pretty much translate into eight out of 10. So you want to eat until you're at eight out of 10, and that's the children, the elderly, and even like the middle age population will all say this, and that's the one thing I noticed too, they're all eating together, they're all on the ground, they all have their banana leaves or plates or whatever it might be outside in front of them, and they all eat together and chant this at the same time. So you also have this like social accountability as far as not overeating, which is cool. The second one, which you mentioned, was it's called plant slant, so being more heavily favored towards plants, the documentary, I believe they said the amount of meat that they would eat in their diet is probably less than 5% in each of the zones. But more so, it's the variety of plants that they eat, right? I think they have this focus on mixing beans and corn, or mixing the different types of teas that they will have. So they understand in these blue zones from ancient history of times that they lived in that every plant will have a different reason, will have a different beneficial effect for the body. And then the last one here is called wine at five. So especially in Sardinia Greece, they make this very amazing wine apparently, this white wine, very long process to make, and also just very organic. And so what they've started to realize too throughout these blue zones is they're all moderate drinkers, but they all do it out of celebration. And I think that's the one thing here in the US where very don't drink, don't drink. And again, I'm not here to endorse moderate drinking even, but I think it's we view alcohol and isolation here in the US, in my opinion, and which is a big cause, right? Alcohol abuse and things like that. We've seen in the hospitals, but over there it's moderate drinking together. And I think it's more that social connection that fuels the longevity more so than the alcohol and, you know, quote, the toxins itself, right? So I think that's just an important point to make. Reservatrol. That's right. Right. Right. Anything red wine and things like that. But yeah, the drinking white wine don't agree. So okay. And the last one is connection, right? So big one here. First part of that is having the right tribe. I think it's safe to say, as we all know, when you have good friends, you have a good life, right? Second is loved ones first. So they are very heavy on taking care of their closest ones. Being mortal, which is a book by a tool Gawande actually goes over this when he talks about the elder, how elderly care in India versus here. Now, India is not a blue zone, but I think the concept of the layers or translates is that in the blue zones, they don't have anything called a skilled nursing facility, right? They don't have an elderly home. Whereas the US, I think they were showing that about 30% of our parents once they've reached over 65 go into nursing homes. And this was back in like the 50s. And now it's more than 50% families will put their parents into nursing homes. And once you reach a nursing home, you have like a 50% chance. I mean, I'm going to mess up the stats here, but it's about a 50% chance decrease in the health span or my span that you might have. So we do know that skilled nursing facilities aren't the best option. If you're able to take care of a parent at home, they are going to have a better chance at developing longevity. And then the last one here is belonging. So a lot of these blue zones had something that was faith-based, right? The seventh day Adventists had their church in Japan. They had the icky guy social connection. They would in Sardinia, Italy and Greece also dance together to have the sense of belonging. They would dance for hours and that was part of their movement and as well as Costa Rica. So those are the nine. And again, those are the four subtopics within it. But those are essentially the commonalities that they have found which they're staying on the blue zone's website has been evidence-based. So yeah, I want to come back to this eating wisely thing in terms of quantity. You travel a lot more than I do, but my recent experience when I went over to Europe, what I found was so interesting after going eating out in a couple of restaurants, I felt less than satisfied. Let me tell you what I mean. The feeling of not at the end of my meal, at the end of my meal, feeling stuffed was almost borderline unsettling. I'm not used to that, right? So I would have these meals and I'm like, I still feel like I don't feel just like, you know, I feel like I can just walk out and not feel like I'm dragging an extra stomach across. And I was like, that's, I don't, I'm not used to that when I go to cheesecake factory or, hey, listen, I love cheesecake factories. Nothing against them, but really any restaurant here, right? You get these large portion sizes. And it's just like, I feel like, is this what normal meals are supposed to be like? Same thing with coffee, we had noticed that, you know, we had breakfast whatever in order to coffee to go. Like the concept of ordering coffee to go at least in London, it's really not a thing. And we were staying at this area museum with, I think, as King College or whatever it was. And so we're walking down the street with university students, like you have university students in King's College. And nobody's walking around with like Starbucks cups and stuff in their hand. How is the only person out of maybe hundreds of people who walk by me who was holding that? And I just like looked at my wife and I was like, that's not weird. Can you imagine going to a college campus or a medical school campus and people not running around like with coffee and stuff like that? And she said, yeah, it's just because people sit down and enjoy their coffee and then they'll go about, right? So it's kind of that mindful eating that we had talked about, we're not like running on our phones, checking email while we're sipping coffee and running through and stuff. And so jacking up the stress response and then, you know, kind of messing all that. So you're being very mindful of every single thing that you're doing in your patient. It's not go, go, go, I found that to be very interesting, but also because I've been conditioned to be in this go-go model and eat as fast as I found that to be very, very interesting. Has that been your experience in pretty much every country that you've been to? Or would you say, are there some countries where you felt and you were like, yeah, it's the very US-based mentality in terms of eat till your stuff to that kind of stuff, not to bash any countries. But no, no, I think, yeah, for the most part, let's see, I was just counting today. So you're up by business Singapore, which we'll talk about in the like Columbia and South America. No, all those countries, I think, have been a similar experience where there is no such thing as, yeah, holding a cup of coffee and walking down the street. It's enjoying it, having somebody being off your phone and enjoying the conversation and the meal in front of you. And I think the fact that they just use better processed foods there, right? I mean, unless you're going to a fast food restaurant, but if you're sitting down a restaurant, most of the meals there are just like fresh food and like the gluten there is different, right? You can even ask, like, Dr. Wilbur Bush talks about this, how the gluten here in America versus Europe is just different. And so when people think they have a gluten allergy, they can go to Europe and be fine, but over here in the US, they have something else. So it's a different protein, actually. But yeah, overall, I mean, you walk out of there having like three bowls of pasta and be like, wow, I feel great, you know, and like the amount of walking that they do too, it's like what you said, it's the environment overall. A lot of people will say like, oh, they don't even need gyms over there. Whereas in the US, we have gyms. And I think that's a whole different take given the money in the business with Mr. Olympia and how fitness took off in the US. I think it's more about that rather than us needing gyms, because fitness really came out in the early 1900s here in the US, whereas in Europe, it wasn't really a big thing. I mean, Arnold Schwarzenegger over there in Europe and Germany. They'll build a dive. Anyways, I digress there. But yeah, I think the environment is much well supported in Europe and other countries as far as not having this acute go-go-go lifestyle and they tend to enjoy their work and life and, you know, kind of just day by day, minute by minute, moment by moment. Yeah. And so I think, you know, as we kind of come to a little bit of close here and we're going to talk about the future and things that we can apply to our lives, I think it's important to understand that there's nothing crazy, there's nothing novel about this stuff, right? There's no real secret, so to speak, right? And so I'm sure that that's how you have to sell the documentary so people can tune in. But we've known about the Blue Zones for quite some time and it's, again, as you've highlighted that the Blue Zones are actually shrinking and they're diminishing and, you know, the rest of the world in terms of whatever the zones there are, the obesity zones, so to speak, are winning and spreading. But a couple things that I think are important for us to keep in mind is that these people, it's, again, it's their way of life, right? And it's really these small habits that are interwoven into their environment and whatnot, and they're doing them consistently over long periods of time. And this had repeated action that you were talking about often over time that yields these positive results of longevity. Something interesting that Butiner talked about in one of the articles that I was reading is that he was mentioning that, you know, there may be probably over 200 decisions a day that we make, and really about 10% of them are about conscious decisions, right? Am I going to have this cookie in the break room with the staff room that you're in? Am I going to the gym today, as you just spoke about? Am I going to watch this Netflix documentary instead of going to bed on time, right? So there's a handful of decisions, but really most of them at the subconscious level, right? The other 200 or so that you're making. And so these are the ones that are going to over time accumulate on daily basis to have a profound impact on your lifestyle. And, you know, whether that's going to add years to your life towards the end, or it's going to subtract years to words towards the end of your life. And so by setting ourselves up in the environment, like natural movement, right? Every 20 minutes, right? That you can engage in or not having large portions or social media, things that you talked about is, is a way for us to be able to make those decisions better decisions through and, and also be closer to living a life closer to the individuals in blue zones, right? And, and incorporate blue zones into, uh, into our lives. Something that I read that him talking about, he said that maybe there is about 20% responsibility that genes play a role in this 10% of personal choices. He says 10% is a healthcare system and really the 60% environment. I don't know if the evidence really supports that, right? I think that if you, if you have an individual whose parents die in their early to late 70s, that person is going to have a pretty darn hard time no matter what the environment is to get to be 100. It's not impossible, but I'm willing to bet if everybody in their families passed away. So, but what is interesting about this thing he talks about something we've chatted about before is epigenetics, right? We'll start to appreciate the epigenetics, pretty strong influence, your environment, your behaviors, your thought processes, on your actual physiology. I don't know, again, if that's going to complete you supersede genes, genes are pretty strong influencers of what's going to happen to you as well, but I do think it's, we're starting to appreciate that it does play a large role. We've talked about Dr. Will Bolshevik a couple of times. He talked about how it can take a matter of like two or three days, maybe even less to completely change your gut microbiome, right? In terms of when you do change your appetite. Do you remember what that time frame was? In terms of like, yeah, I think it's almost like a day, right? It really depends. So even if you have alcohol, he says within like, yeah, hours, your whole gut microbiome changes with fiber and things, it's about yeah, even like hours to days where your microbiome starts to recycle and start to pick up new information. So I think hopefully that's actionable for people. The sense of purpose thing, that's the most abstract concept. I would describe that as being clear with your values, knowing who you are, and what you get out of this life that we're here at, and what your outlets are, and how can you provide good for yourself, for the people around you, and how can you help other people? That's how I would describe that. I'm curious how you would describe sense of purpose. I know you've thought about this deeply. Yeah, I think for me it's going through life searching, like not having an answer, but searching for it, right? I don't think you're ever going to get the answer, but I think the process of searching for the truth or searching for something and that purpose, because you know, when you're five years old, 10 years old, you're just focused on so much more of the moment in school, not getting bullied, getting an A on the test, right? Like that's your purpose. Your purpose is make your parents proud. When you get to high school, your purpose is let me get into a good college and then figure out maybe the next 10 years. And then once you graduate, your sense of purpose develops as you absorb more and more of the world. And I think one of the best things we can do is not be so siloed in our minds as not to be so siloed at our desks or, you know, just with what's in front of us with these four walls, but rather get outside of that, get outside your comfort zone in your mindset and just start to explore what else is out there in the world. And I think that purpose starts to kind of carve itself out a little bit. And I think that's what makes life enjoyable really is really trying to find that purpose from that truth. So the lab's right there too. No, no, but it's right, right? So the evolving thing that you've talked about before, right? It shifts. I was thinking about this a lot because I did have a patient today was going through a difficult time with low back pain and stuff. And she's young, man, an early in her 40s. And she was just talking about how the volcano got a pain controlling her life. And she just lost her sense of purpose and doesn't have. So the challenge here is aside from dogs, aside from pets, which can be social, but, you know, we're more than that social creatures. No, no other close family, nothing like that. And was questioning her purpose. And that was something we spent a lot of time talking about her social connection in terms of friends how often she saw them. And we're going to continue talking about that more the next time I see her. But that one's an interesting one. But I really like what you're talking about how continues evolving, right? Like my sense of purpose is different when I didn't have a child versus when I do have a child. And, you know, now that I have students and more of a mentor on a daily basis. And then tomorrow might be different. When you're a podcaster and you're talking to maybe hundreds, thousands, hopefully more than that. Someday people like you sense of purpose might evolve. So yeah, and kudos to you, man. For oh, sorry, I'll just say kudos to you for taking on that role of speaking about purpose, right? I mean, there's so many physicians who think that's the role of like the psychiatrist, right? Like, oh, that's not me. I don't know what to do with that, right? But with that, you're also learning from her, right? And learning what other people think about purpose. And so that itself is searching for purpose. Everyone's everyone's kind of in it together as that human connection. So yeah, yeah, I'm gonna, this is a different discussion for a different day. And maybe even one of the most recent ones with GMU banks and Dr. Standard, but it was wild that she has two separate doctors who helped deal with her pain. And she told me she was like, you know, when I go to my other doctor, so we don't, there's no conversation like what we're having now. And this was two minutes into a conversation. Anyways, we've talked about that. So let's, let's bring it back here and let's close because I think one of the exciting things that comes from this and for me reading that book is kind of these blue zones organizations. Did you, did you come across that in your research? If not, I can talk about that. Yeah, so yeah, I like to talk about it in the documentary. I forget what where he did it in the US, but he was able to increase the community's life expectancy by three years. And overall, his goal was actually was a couple places. Okay, that's not one. I can't even remember where it was, man, my mind's blanking. But it's cool. Yeah, what we'll do is we'll put this website in there. But you guys can go check this out on your own because I think they're making some really cool things happening. And I didn't even know about this, but they're trying to incorporate blue zones into cities within the US. And multiple cities have been pilot projects. There is Fort Worth, Texas is one of them where they were able to lower the obesity rates and drop smoking rates by 31% and more than 58% of the residents in Fort Worth, Texas are now characterized as thriving over a couple of years. I think the pilot location was in a place in Minnesota. The city escapes me. I'm actually going to pull this up right here. Give me a second. I know beat cities, California is one of them. So anyways, what these organizations are doing is helping revamp the healthcare model, how they're thinking about the healthcare policies, the government policies within the local ordinances and how they can improve the quality of life, the function. And again, extract some of those knowledge that we've gotten from the blue zones, everything that we've already talked about in the first 20, 20 minutes or so or 25 minutes or so and bring it here. And then certainly he's incorporated that into his own life by moving to Miami Beach, Florida. So he can swim daily. He can walk the neighborhood and surround himself with health-focused friends. You can have to whether it's not an excuse, right? This is one of things that we talked about. This is why we've talked about the Sunshine Tax in California. I love California. My first trip going out to Northern California, I just remember my first thing that stuck out to me was wow, there are a lot of people on bikes right now, right? And there are a lot of people just running and stuff. And you know, we unfortunately on the East Coast don't have that. We've got excuses to kind of, you know, if you're going to go from A to B, you should get in the car. It just seems to be a bit more convenient work creatures of convenience, right? We like that. But it's just seemed these cities seem to be more bike friendly. Your future destination, you know, I'm sure that had a lot to do with it, right? 100%. So yeah, any more thing to add there? And if not, let's talk about Singapore a little bit. Just a quick question. When they're making these man-made blue zones, who's distilling the information down in the population? Is it through health care or is it through like town hall meetings? Like, do you know what the intervention is really? I don't know that deep into it. I mean, this is a whole organization that works with local ordinances. So yeah, actually, some of the cities, so actually, I pulled it up right. Alberta, Lima, Minnesota was the first one. Beach City, California, Fort Worth, Texas. They have a couple other ones. And like, you know, they have a cooking bundle, they have speakers, beer, and stuff. And so I think the local officers and the local government professionals in that area will probably hand by reaching out to them and show initiative. And then they will do that probably because of something like, okay, like, for instance, Alberta Lee, the county of, is it Alberta Lee or is it? What is it? What did I just said? I forgot it. This location in Minnesota, rather, like they were the 68th out of 87th County in terms of their health care costs and just health care in general. And then or after maybe a year or two, they were down to 34. Don't quote me, guys, I'll put this up so you guys can look at it, but they were down to 34 out of 87, right? So significant improvement there, saving millions of dollars in health care costs in terms of chronic disease burden and whatnot. And increasing the average life expectancy by, you know, north of two to three years on most of these communities when I was looking at the research. So I think that's pretty profound. And what's another important thing to remember is because most of the patients that I do see and these are conversations I had today where there were people like, you know, in their 60s or 70s, they're like, oh, it's too late for me. I'm too old. It's really never too late, right? The evidence when we talk about exercise, how strikingly clear it is that really at any point in life when you start, it's going to pay dividends down the road. And so, sure, if you start at the age of 60 and you're making these small daily habits, maybe you end up adding two or three years to the end of your life, right? But if you start at 20, it could be 10, 15 years or so, right? So it's just again, it's like that, what's the analogy people end up using? It's like saving for a retirement account, right? And so the earlier you start, the compound interest is going to pay. The later you start, it's still a good time to start. It's just not going to be as big of a reward that you're going to get down the road. So that's another important thing for people to keep in mind as well as like, okay, there's no such time as too late. Yeah, for sure. Cool. Talk about Luzon 2.0 Singapore. Let's do that. Awesome. Cool. Yeah. So the fourth episode of this documentary is all about Singapore and how the government there is really making an effort to instill health and good community amongst its population. So I was fortunate enough to go to Singapore last year in March for five days. And the cool part about our trip was this was pre-wedding. We had to go to India actually for a wedding. So these five days in Singapore were really just chill, let's just live like Singaporeans and kind of just go around. There was no real agenda behind what we were doing. And Singapore is kind of a city state. So it's very small and very densely populated in just some major roads essentially. But the government there is really doing a lot of things from different aspects. So from the nutrition aspect, they are putting signs up for healthier choices. When you go to these hawker centers, which are essentially like food courts in Singapore, they have so many different, first of all, when you go to Singapore, it's like New York City. There are bars and restaurants everywhere. Like anywhere you go, you turn your head left or right, you're just seeing food and drink everywhere. And so there's this really big appeal to just keep eating and keep going to these places. But yeah, when you walk around, you're not seeing people who are morbidly obese. I mean, everyone's relatively thin. Everyone's walking. So from a nutritional standpoint, the government has now allowed these hawker centers to say, hey, healthier choice. Get this brown rice instead of this type of rice or get this thing with less oil than this with more oil. And I guess it accused people, right? And what they call it nudges, right? So they're really just trying to nudge people to make better decisions from a movement standpoint. I mean, the city is small enough, but there is a higher tax on cars. So a lot of people in Singapore don't actually own cars. They use public transport and they walk the city. But when you're walking the city, you're not just walking on bleak roads. You're walking through parks. You're walking through gardens. You're walking through water fountain. So it's such a beautiful place to just like go and roam around, which is why when we were in Singapore, we probably got like 25,000 steps a day, just walking everywhere. They have this massive botanical gardens, where you just see people run up and down the hills and animals come out. And there's just so much there that makes you part of nature, even though there's so much like architecture and stuff going on too. So it's cool how they incorporated it too. And then from a connection standpoint, they are, especially with the elderly, since they have a really big aging population there right now, they have build almost these like skill nursing facility community assisted living homes, where they're kind of like skyscrapers, and at the top is where the elderly will live. And they have these walkways that connect from building a building with just gardens. And then on the lower levels of these apartments are actually health care facilities. So if they ever need to go get something fixed up, they can kind of just go down there. So it really just integrates the whole nation as one. And I think it's kind of just all these nudges and everyone's rubbing off on another. So it's very cool to see the progress that they're making. But they even admit when they interview the governmental official saying like, where is city state? What's easier for us to do this compared to the states, right? Which is why we have to start city by city. And you know, I guess we're making some progress like New York City, having bike lanes and Philadelphia, putting city bikes and birds and there's better modes of transportation, but that's just transportation. We're not really addressing kind of the rest of those power nine. So yeah, so well, thank you for sharing that man. And I think, you know, interesting to talk about the nature in that piece that was built in. And again, we've talked about forest bathing and that kind of stuff and the role that I had is on your mood, your overall health. But ultimately, I think to summarize, right? So essentially an internationally engineered community to be the next version of the blue zone, right? Or the current version of the blue zone. Right? Let me 60 years ago, you should be an extremely unhealthy island. And now all the things you're talked about, you know, we can label people as thriving. So it's really a proof of concept that creating the right environment gives people the chance to measurably live longer with a fraction of the rate of diseases that we hear in the United States suffer and that we've been dealing with as a country and part of the reasons why our life expectancy is going down. So I think a lot of amazing things that we can extract from that certainly change as we've talked about systemic change is going to start with policy change conversations that are had all the time when you tune into politics. But you know, again, are they really about change or are they about something else? So we're not going to we're not going to dive into that too much. But what we can, I think as individuals extract from this, right? We're always looking at that is just talk about the small daily things consistently over a lifetime built its compound interest. So I think Amanda, if you're listening, I know that you wanted to know about this a little bit more. Those are the lessons that that I've learned of that I've walked away from and Darsh, I'll give you the mic to close it off, man. Yeah, and let me just add to right a lot of this has to do with politics, right? I mean, when you talk about policy change, obviously it's a name, but usually when there's an Netflix documentary, we always think like, what's the agenda here? What's the hate in agenda? And going through lift to 100, I truly didn't see one besides Dan butner really just trying to promote the simple life, really just trying to say, individuals need to take control into their own hands, which we talk about so often. But yes, at some point, we're going to need systemic change and he's taking it into his own hands, which I found very impressive, starting up new blue zones. So yeah, I think it's a safe documentary to watch. I don't think in any way it's going to corrupt your mind, quote unquote, like game changers was really trying to promote something versus the other, and there's other documentaries up to, but this one I thought was very just neutral and it was good and you get to learn about different cultures and see kind of what works, but it all boils down to this simplicity. So yeah, some like key takeaways play tennis. They actually show that people who played tennis have the highest life expectancy. I guess we can pick a ball just still at pickle ball. Yeah, I was going to say we can distill that down the pickle ball. And on the boob tennis has the highest strain of all the activities out there. So I don't know, maybe that's correlated in some way, but we I think the most important thing that I've learned is how do I have it stack these things or not necessarily have it stack? How do I pick an activity that can help me check off the boxes from connection and meeting people and fitness and nutrition and whatnot, right? So I was thinking like, okay, tennis is great, right? Because most people play doubles when they get older. So now you're talking to three people who also enjoy that community and you're getting movement in different functional patterns. You can join a fitness club, right? You talked about CrossFit. You can do like a run club and have somebody that's more, you know, you run in zone two, you're still able to talk, but you're getting some exercise. You can do things like cooking classes, right? A lot of people I've heard or eat fast food because the one don't have time or two feel like they don't have time or don't know how to cook. So taking cooking classes, I think is a great way, you know, if you can afford that to meet other people and just learn different recipes and just kind of have fun. I mean, that's something I'm trying to get into. So still need help from me around that one. Meditation classes is a really big one. I used to go to one back in undergrad and I was actually with older people I was right the youngest one and mostly everyone was 40, 56 years old, but just learning that wisdom from like older people was kind of cool. So doing things like meditation classes to down-regulate and just bonding and think with this is that when you go to these types of classes, you're meeting like-minded people and you know, we all know that adage of you are the average of the five people you're closest with, right? But the more and more you hang out with people who promote health, you are going to start incorporating that into your own life. And I think that can be the most powerful identity shift for all of us is saying that, hey, I am someone who can be healthy and I'm going to choose to be around healthier people and foster my relationships and community as well as, you know, that purpose in life that we talk about. So I think overall that's kind of the biggest things I took away with and one other thing I really took away with is like not eating processed foods, right? I mean, I've talked about this. I have longevity genes, I guess, you know, genes typically do, but the one key fact that I see like that's different from my life than my grandparents is that it's the nutrition. I mean, there was nothing processed. I mean, they probably got 20, 30 grams of protein a day if that, right? So this big talk on protein, they barely got it protein, but the food that they eat was so clean, right? It's like straight being straight lentils right off the farm and it's like farm to table essentially. And so I know a lot of people say nutrition, you know, we can't really categorize it, quantify it. We don't know how much of a big deal it is. In my opinion, I think it actually is a bigger deal than than we say. But I don't know. So that's just my thought. I love it, man. Eating wisely. Eating wisely. Yes. Yeah. All right. All right, guys. Until next time. That's good. Thanks for listening to another episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this. You can follow us on Instagram, Twitter, and TikTok at Med Redefined. We want to take a moment to thank our team for the production of this podcast, specifically Ethan, Jew, and Herita Yipri. Lastly, please remember the important disclaimer that everything in this podcast is for educational purposes only. It does not constitute the practice of medicine nor should it be construed as medical advice. No physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues. However, if you enjoy the show, please be sure to subscribe, review, and share with anyone who you would think will gain value from this as well. Until next time, thank you for listening.