Can Cincinnati Become a Blue Zone?

Illustration by Samuel Chen

It’s been 21 years since Dan Buettner wrote a cover story for National Geographic magazine, “The Secrets of Long Life,” seeking to identify common lifestyle habits among the world’s healthiest 100-year-olds. An earlier study in Sardinia, Italy, had circled villages full of long-lived residents in blue ink on a paper map, and similar communities were dubbed Blue Zones. Along with scientists and a photographer, Buettner visited these areas to do more than 400 interviews and found they all featured healthy eating, low levels of chronic disease, and a zest for life.

He went on to write six best-selling books on the topic, eventually distilling his research into nine principles for living a longer, healthier life—from making wise food, drink, and portion choices and moving naturally to having a purpose in later life and enjoying a caring community of friends and family. Because the five original Blue Zones (Okinawa, Japan; Nicoya Peninsula, Costa Rica; Ikaria, Greece; Loma Linda, California; and Sardinia) are located in a narrow band across the Northern Hemisphere and four of the five are on the ocean, it was also thought that perhaps geography and climate contributed to longer, healthier lives.

In 2009 Buettner, in partnership with AARP and the United Health Foundation, set out to prove that Blue Zone principles could be applied anywhere to improve people’s health and longevity, and they launched a community-wide initiative in Albert Lea, Minnesota, a small town south of Minneapolis/St. Paul. Now under the Blue Zones Project umbrella, 75 U.S. cities currently are working on group diet and exercise programs while also changing the community’s culture so that residents are encouraged to make healthy choices.

Cincinnati is not an official Blue Zones Project city yet—most are in California—but Florence Rothenberg, M.D., professor of internal medicine and cardiovascular disease at the University of Cincinnati and the Cincinnati VA Medical Center, is leading one public effort to encourage a Blue Zone lifestyle here. She launched the Heart of Northside community health center in the old North Presbyterian Church on Hamilton Avenue to house several of her programs as well as likeminded organizations.

Photograph by Aaron M. Conway

Rothenberg is energetic and animated in describing her dedication to Blue Zone principles. She often greets guests at the old church door and leads them straight to a long rope hanging from the bell tower, encouraging visitors to pull the rope. “Ring the bell and let the neighbors know we’re here,” she says.

Besides the working bell tower, Heart of Northside maintains the church’s glorious stained glass windows and intricate woodwork. In an eclectic neighborhood, it offers numerous opportunities to obtain whole foods, participate in natural exercise, and make connections in order to build a sense of purpose, all recommendations from the original research on longevity.

“Our society gives people more information on what deodorant to use than how to take care of their own hearts,” says Rothenberg. “In fact, much of the heart disease we see in our VA clinics could have been prevented had people had proper information and tools.”

Her plans for the community hub include a preventative medicine consultancy, cardiac rehab exercise facilities, a rooftop farm called Food for Thought Cincy, a pollinator garden to support organic food production, and a aquaponic system to grow vegetables for the sort of Mediterranean diet that supports heart health and longevity. At present she has three grow towers, with room for expansion. Students from a local 4-H Urban Initiative are helping test which vegetable varieties can grow easily and quickly from seed under the aquaponic conditions.

“Our goal is to grow food to help our community become healthier, and anything nutritious that grows quickly and easily is what we’d like to start growing at scale,” says Rothenberg. “Watching the plant shoots get bigger is so exciting. Every day, we’re one step closer to improving community health and wellbeing.”

Photograph by Alison Ford

The concept of Blue Zones is firmly established in the public consciousness at this point. Buettner starred in a four-part Netflix documentary, Live to 100: Secrets of the Blue Zones, in 2023, leading viewers on a tour of the five original communities.

In Okinawa, the world’s longest-lived women have spent their lives enjoying a diet rich in sweet potatoes, soybeans, and vegetables. Most sip green tea throughout the day. Buettner found that, since his first visit in 2009, traditional local food had been gradually replaced with convenient processed food, and as a result obesity and heart disease have increased there.

Sardinia is known for having the highest concentration of male centenarians, most of whom are farmers and shepherds, and their diet consists of locally sourced bread, cheese, fresh garden vegetables, and minestrone soup. They usually enjoy a glass of wine with friends after work. Their work is low stress and involves walking up and down steep terrain each day.

Nicoya Peninsula is a mountainous region in Costa Rica, and most people live in multigenerational families where they have a sense of belonging and purpose. Residents spend much of their lives in gardens, where corn stalks support climbing bean plants as squash vines spread across the ground and keep it moist. Families often eat an early, light dinner together.

Most inhabitants of Ikaria enjoy a stress-free life tending fruit orchards and vineyards or goat herding on the mountainous island. Afternoon naps are the norm and help lower stress hormones, which may be one reason residents have half the rate of heart disease and one-fifth the rate of dementia as Americans do. Strong coffee and herbal teas are enjoyed daily along with a Mediterranean diet, plus regular fasting for religious reasons.

One fascinating person Buettner highlighted from his travels to Greece was Stamatis Moraitis, who lived and worked as a typical American most of his life. He was diagnosed with terminal lung cancer and given less than a year to live, and then he and his wife moved back to Ikaria to live with his parents and take care of their orchards and vineyards. When Buettner met him in Ikaria 30 years after he moved back, Moraitis was a jovial 97-year-old who simply said he “forgot to die.”

The only original Blue Zone in the U.S. is Loma Linda, a Seventh-Day Adventist community near San Bernadino in Southern California. Adventists are mostly vegetarian and nonsmokers and exercise daily, all of which contribute to a healthier lifestyle.

Communities participating in the Blue Zones Project have sought ways to embrace Buettner’s nine longevity principles:

• 80 Percent Rule: Stop eating when 80 percent full. Mindful eating supports less consumption and results in maintaining a healthy weight. Blue Zone residents typically eat their largest daily meal before noon and smallest meal in the late afternoon or early evening.
• Plant Slant: Eat mostly fresh greens, nuts, tubers, beans, and whole grains. Eat meat about once a week.
• Wine at 5: Blue Zone folks tend to gather with friends for meals and wine at 5 p.m. Except for the Adventists, who abstain from alcoholic beverages, one glass of wine a day is the norm. Red wine contains polyphenols, which lower inflammation and the risk of cardiovascular disease.
• Move Naturally: Daily activities such as cleaning, gardening, preparing food, and walking to church, community events, or for work add up to miles of low-impact stress free exercise. Okinawans sit on the floor, necessitating dozens of leg squats each day that keep their muscles and balance strong. Walking at least 30 minutes per day can help prevent heart disease, depression, and obesity.
• Family First: Many Blue Zone folks live in multigenerational homes or gather frequently with family for meals, celebrations, games, or visits, which help both the oldest and the youngest family members lower disease and mortality rates. Most centenarians have a life partner and spend time with their children and grandchildren caring for each other.
• Right Tribe: Lifelong friends and family who are healthy and happy have an enormous impact on quality of life, and a lack of these social connections can lower life expectancy by eight years. My mother had a magnet on her refrigerator, which is now on my refrigerator, that quotes Ralph Waldo Emerson: “The only way to have a friend is to be one.”
• Belong: My mom was a lifelong volunteer, and I too have made many friends through volunteer work, joining community groups, and arranging social gatherings. Vivek Murthy, M.D., former U.S. surgeon general, famously said that loneliness is as bad for health as smoking 15 cigarettes a day. The vast majority of centenarians interviewed by Buettner belong to a faith community, and regular attendance at faith-based services has been shown to increase life expectancy by several years.
• Purpose: Pursuing the previous principles can give your life purpose, since the flow of harmonious life rituals often provide a reason to get up each morning and go out with loved ones to do meaningful work, enjoy conversations, and love and support each other.
• Downshift: And it can all be accomplished in a slow-paced rhythm that helps you enjoy each day. Buettner recommends a daily meditation practice to reverse the effects of stress, which can result in lower blood pressure, less inflammation, and improved sleep.

The Heart of Northside and tenant organizations embrace these principles, offering health screening services and education for all who want it. Free blood pressure screenings occur during the weekly Northside Farmers Market, for instance, and Rothenberg runs her Ounce of Prevention consultancy in the building.

Photograph courtesy Heart of Northside

Tenants include Queen City Commons, which partners with local farms and gardens to turn food waste into compost, and Sages of Grief, offering counseling and training services. Brick Gardens, which converts vacant land into urban farms to help fight food insecurity, has garden beds there. And Moonrise Music Hall brings acoustic musicians from all over the world to play a handful of concerts in the sanctuary.

Among Rothenberg’s community connections, University of Cincinnati CCM students stop by on the first Wednesday of each month to play the pipe organ in the beautiful old sanctuary. After discovering several artifacts left behind at the North Church over 140 years, Rothenberg is working with community members to build a museum in honor of its history. Community-driven events have included Kwanzaa Ujima Celebration, Krampus Afterparty, Flavors of Freedom Festival, Black Men’s Support Group, Urban Sketchers, SingOutCincy, Banned Book Bingo, Record Fair, 4-H Urban Initiative, Vintage Fest, Puppet Cabaret, and BeforeIDie, an educational day offering information on death doulas and green burials.

Rothenberg has divided the building into several venues of different sizes, the largest being a multifunctional “gymatorium” that holds 412 people standing or 319 seated with a commercial kitchen located across the hall. The parlor room holds 50 seated guests, and the Parisian room seats 40. There are also several smaller spaces used for gathering, offices, teaching, and meetings.

Photograph courtesy OLLI

Lots of area residents are embracing health and longevity principles in their daily lives, whether or not they’re familiar with the Blue Zones movement. I’ve met a number of them through the University of Cincinnati’s Osher Lifelong Learning Institute (OLLI), which hosts hundreds of personal enrichment classes for adults taught by educators, professionals, and volunteers. Most are offered on weekdays between 9 a.m. and 3 p.m., making them perfect for retirees like me.

Taking an OLLI class can help fulfill the Blue Zone concepts of belonging, building purpose, and downshifting while establishing connections and helping us find a supportive tribe. But Cincinnati offers a wide range of similar learning and connecting opportunities in parks, museums, libraries, meetups, and other third places. I picked up a new favorite mantra from an online yoga tutorial: My decisions today will define my tomorrow.

Nancy Creaghead, a retired UC professor in the department of communication sciences and disorders, personifies the Blue Zone lifestyle here in Cincinnati even if she isn’t familiar with Buettner’s work. Her mother lived to 104, and she says she’s hoping to do the same.

She shows me around her Clifton home and discusses the yard work she’s been doing. After hearing about the Blue Zone principle of natural movement, Creaghead demonstrates her flexibility by stretching out her legs, touching her toes, and then raising her legs up over her head to touch her toes on the floor above her head. “My mother and I would do these stretching exercises when I was a young girl,” she says, “and she was still walking up and down steps easily at age 104.”

She prepares a healthy meal for us, mentioning that she loves gourmet cooking and entertaining. Her daily food plan includes a variety of fresh fruits, greens, and veggies and a glass of wine in the evening. She also has frequent girls’ nights out at local jazz clubs, including regular outings with a group of five friends who have been in her life since kindergarten as well as connections with former students, UC colleagues, and neighbors.

Liz and Ron Gorley are retirees living their best lives in West Chester Township. Liz, formerly a pediatric and geriatric nurse is a volunteer at Cincinnati Nature Center with a focus on native plants and foraging. Independently, she started her own free, monthly nature journaling group, Nature Journaling Connections. “My quality of life has improved because I chose to start living my life how I truly want to,” she tells me. “I’m actively learning, growing, exploring, leading, and creating. All of that activity has been challenging in many ways but truly life-changing and affirming.”

Ron, a former Procter & Gamble engineer, served on the Little Miami Scenic Trail board for 10 years and volunteers with a group to maintain the trail. He began helping Friends of the Little Miami State Park in 2013 and has been involved in a variety of activities from cleaning mud and rocks out of blocked culverts to giving testimony to legislative committees in Columbus.

“I’ve worked alongside scores of like-minded volunteers, and I’m very grateful,” he says. “My work helps others enjoy exercising and experiencing the great outdoors, and it’s helped me grow personally and make new friends.”

Robin Bratt of Paddock Hills found new friends at OLLI classes after retiring from a career in healthcare. She struggled with finding meaning in her new life and says her husband—a moderator at several OLLI music classes—encouraged her to join him.

Bratt has now taken classes on gardening, personal empowerment, and death doulas, each of which enriched her social and spiritual life. She says she’s no longer depressed and is actually considering a retirement vocation by pursuing a death doula certification.

Back in Northside, Rothenberg is enthusiastically embracing Blue Zone principles in order to reorganize healthcare delivery into a community-centered approach. “I want to eliminate as many challenges and barriers to adopting a longevity lifestyle as possible,” she says. “This old building is a wonderful space and we have a great plan in place. There’s plenty of work to be done to improve both the quality and the quantity of our lives.”