By Karen Collins, MS, RDN, CDN, FAND; Registered Dietitian Nutritionist

Using stories provides one of the most effective ways to engage patients and enhance their retention of what you teach. Stories about people in the Blue Zones of the world may add a fresh perspective to your discussions about the power of healthy lifestyle choices.

The Blue Zones are five longevity hotspots where people commonly not only live – but thrive – into their 100s. They are: Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Ikaria, Greece; and Loma Linda, California. Despite vastly different geographical locations, the Blue Zones project, originally developed with National Geographic, has found nine specific lifestyle habits they all share. These common habits fall into four categories: movement as part of everyday life, mental outlook, connection with others, and wise eating.

How to Tweak Our Eating Habits: Lessons from Blue Zones

Countries as diverse as those of the five Blue Zones feature vastly different foods and flavorings. Yet they share common threads, showing patients that they can implement nutrition recommendations provided in cardiac rehabilitation in a variety of ways to fit their personal and cultural food preferences.

Tweak #1: More Beans

Dried beans, lentils and other legumes are a daily feature of diets in the Blue Zones. In these areas, meat is usually an occasional part of big celebrations, but not part of everyday meals. Even people who include meat a little more often use small amounts as a side dish or minor ingredient in a mixed dish – not the star of the plate.

>> The payoff: Pulses (like dried beans and lentils) and soyfoods are top sources of the viscous form of soluble dietary fiber. A daily serving can lower LDL cholesterol an additional 4-5% beyond that achieved by limiting saturated fat in a general heart-healthy diet. In addition, pulses’ fermentable fiber and resistant starch serve as prebiotics, nurturing a gut microbiome that helps fight inflammation and promote vascular health. And on the practical side, when patients contend that heart-healthy eating is too expensive, remind them that by swapping beans for some of the meat they currently consume, eating beans saves money.

>> How-to tips: Although preparing dried beans is even more inexpensive, for convenience, canned beans are the uber-convenient choice. Purchase canned without salt, or simply drain and rinse to significantly lower sodium content.

• Add canned beans to soup, pasta, stew, or chili. You can also purée chickpeas or white beans before adding them to create a rich, creamy thickness without using cream. Experiment with new recipes.
• Swap cubed tofu to replace of all or part of the meat or chicken in a stir-fry.
• Choose chickpeas, lentils, edamame, or other beans to add texture and satisfying fullness to salads.

Tweak #2: Highlight Vegetables and Fruits

In Blue Zones, vegetables are not a bland “eat them because they’re good for you” tiny portion on plates. Vegetables enliven breakfast burritos, hearty soups and stews, salads, and stir-fries. And the typical dessert or snack food is fruit, not ultra-processed sugary or salty packaged snacks and sweets.

>> The pay-off: Vegetables and fruits provide antioxidant vitamins, natural phytocompounds like polyphenols and nitrates that support vascular health, and potassium and magnesium to help control blood pressure even beyond the reductions achieved with medications.

>> How-to tips: To include more fruits and vegetables on a budget, shop by what’s in season. And for many people, frozen and canned options (without added salt or sugar) can offer a better deal, allowing them to buy smaller quantities or to pull just part of a frozen package to use at one time.

• Double the usual amount of vegetables when making typical American versions of soup, pasta, casseroles, and main dish salads. Combining this adjustment with cutting in half the refined grains (white rice, enriched pasta) is an easy trick for healthier proportions in a meal. Make vegetables major features in dishes like chicken or tuna salad that typically include just a few tablespoons of chopped celery.
• Switch to fruit as an automatic choice at breakfast and lunch, instead of a double portion of cereal or a side of chips.
• Copy the example of Blue Zones communities – and many cuisines around the world – that make vegetables tantalizingly delicious, often flavored with garlic, herbs, fruit, or vinegars. Blue Zones’ cuisines provide a great example to emphasize that enjoying flavorful vegetables does not require loading them with salt and high-sodium sauces for flavor.

Tweak #3: When to Stop

”What determines when you stop eating?” That’s a question that can open a lively and enlightening discussion with patients. Typically, you’ll hear about being “full”, clean plates, or clean pans (no leftovers). But in Okinawa, you’d hear people intone the phrase “hara hachi bu”. That’s a phrase repeated before each meal as a reminder to stop eating when their stomachs are 80 percent full. People are often surprised to find how satisfied they are when they stop eating sooner than usual.

>> The pay-off: The difference between stopping when you are “no longer hungry” versus when you are “full” could reportedly cut total daily calories about 20 percent… without counting or measuring… and without going hungry. We know that a 5-10% weight loss is enough to bring clinically meaningful reductions in blood pressure, blood sugar and lipids. Compared to the myriad diets people go on and fall off, developing an internal awareness of hunger and satiety cues offers a positive, non-deprivation approach.

>> How-to tips: When people set triggers for a “pause” to stop and check their hunger level, it makes adopting this approach to eating much easier. Using smaller plates limits the size of a first serving; developing the habit of pausing a few minutes and then checking hunger before going back for more creates opportunity to check internal cues.

Another way to build in a pause opportunity is for someone to start with a smaller portion of food on their plate (perhaps a quarter less than usual for everything but vegetables), again understanding that getting more is fine, as long as they check hunger first. Keeping serving bowls off the table is another way to help build in a pause to tune in to body signals before getting more food.

• Is someone resisting this idea because of long-ago training in the “Clean Plate Club”, or an understandable reluctance to waste food? Emphasize that there’s a bigger picture, and multiple ways to avoid wasting food. If someone consistently has leftover food when they stop eating more than they need, this can be the prompt to learn new ways to use leftovers (in the next few days, or frozen for easy future meals). Alternatively, it can be the prompt to buy and prepare smaller amounts. Either way, they will save money – a result worth highlighting.
• Is someone fearful that this approach to eating will leave them hungry? Especially for people with a history of restrictive diets, there is a tendency to eat extra “just in case” they get hungry. Clarify that going hungry is not the goal; and in most cases, food is available if they become hungry later.
• Does it sound like someone imagines missing out on pleasure if they stop eating earlier than usual? Actually, studies consistently show a phenomenon called “hedonic adaptation”, in which the pleasure of tasting any food decreases continuously after the first few bites. Encourage people to test this with their favorite food. Most are surprised to find that even special treats taste best in the first few bites. People often stop even paying attention to savor their last few bites – so skipping those is not missing any pleasure moments at all. 

Key Practice Pearl

As you talk to people about healthy eating habits, it’s easy for them to view your suggestions through the lens of how different this eating is from what they’re used to and how people in their closest circles eat. Flip their perspective on heart-healthy eating using stories and examples from areas like the Blue Zones – where people don’t feel deprived and live long, vibrant lives.

Eating habits built around vegetables, fruits, whole grains, beans, and nuts – in portions that satisfy but don’t overstuff – can be a pleasure. They fit like pieces in a jigsaw puzzle as part of a lifestyle that also includes activity integrated into everyday life and emotional resilience developed when cultures build in support of a circle of friends and family.

– Karen Collins is a speaker and writer whose website - KarenCollinsNutrition.com - provides review articles that discuss new studies in context of overall nutrition research, and free downloadable tip sheets that put key messages in patient-friendly language.