“Tell me doctor, how do I live to be 100 years old?”

This question was posed to me in a kitchen in a small village in the mountains of southern Greece. The year was 1988 and I was visiting Greece for the first time. I traveled with my cousin to our ancestral home, the village of Mavromati, where two of my grandparents and several aunts and uncles were born. The village was located on the side of a mountain, surrounded by olive groves and sheep pastures. We met my grandmother’s sister, my great aunt, who showed us the homes where my grandparents were born. We then hiked about 1,000 feet down the side of the mountain to an archeological site where an ancient city was being unearthed. My great aunt, who I guessed was about 80 years old, was quite spry, likely from the daily routine of walking with the sheep up and down the mountain. As we went back up the mountain to the village, I huffed and puffed as I tried to keep up with her. Back in her kitchen, we enjoyed a splendid meal of local fruits and vegetables, homemade yogurt and fresh mountain water, obtained from the spring in the center of the village a few feet from where we were sitting. She described her life in the village, surrounded by many family members and friends. When she found out that I was a doctor, she asked me her famous question, “Tell me doctor, how do I live to be 100 years old?” I looked around, noted her lifestyle and replied to her, “Just keep doing what you are doing.”

I returned to Greece in 2009 with my wife and our three children and of course our trip included a pilgrimage to the village. The village had changed, but the mountain spring in the village center was still providing water and I was able to find my great aunt’s house.  The house looked abandoned. In the village center, the proprietor of the coffee house told me that my great aunt had passed away a few months earlier, at the age of 98! I guess she followed my advice.

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What do people who live a long life, people from villages in Greece, from Japan, Switzerland and San Marino, have in common? Beyond having good genetics, there seem to be several recurring themes when the lives of nonagenarians and centenarians are researched. First, there is diet and exercise. Jack LaLanne, who passed away at age 96, said, “Exercise is king. Nutrition is queen. Put them together and you have a kingdom.” Following a Mediterranean diet, which is rich in olive oil, fruits and vegetables, as well as fish, has been shown to decrease heart attacks, improve overall heart health and increase longevity. People who follow a Mediterranean diet can live up to 15 years longer compared to those who don’t. Diets high in tree nuts, like walnuts and almonds, can increase life span. Patients who ate three servings of nuts per week were less likely to have heart disease or cancer. Fiber, especially fiber from grains, is important as well. Patients who met their daily recommended doses of fiber, 25 grams for women and 38 grams for men, had a lower risk of dying over a nine-year period. Diets high in omega-3 fatty acids, found in fish, can increase longevity by 2.2 years. Moderate alcohol consumption, such as one glass of red wine per day, can increase longevity as well. On the other hand, what foods should we avoid? Diets high in processed meats increase the risk for cancer and heart disease. Processed sugars and sugary drinks should be avoided due to the risk for diabetes and obesity. Lastly, how we eat seems to make a difference in how long we live. Cultures where emphasis is placed on preparing and cooking meals and where sitting and savoring the food rather than rushing through the meal as if it is another task are cultures with some of the best longevity data. For example, think French cuisine and the whole French dining experience.

Exercise is clearly another factor in longevity. It has been shown that Olympic medalists and elite cyclists live longer. A recent study showed that Tour de France winners outlived their appropriately matched French counterparts. However, you don’t have to be a world-class athlete to live a long life. Moderate walking every day will increase lifespan by one and a half years while more vigorous walking will increase it by three years. A daily regimen of walking reduces the risk for heart attack, stroke, atrial fibrillation, colon cancer, hypertension, diabetes, depression, obesity and Alzheimer’s disease. Walking lowers total cholesterol levels, raises good cholesterol levels (HDL), maintains healthy bones and lowers stress levels. On the other hand, being sedentary is detrimental to health. For example, every hour of TV watching after the age of 25 can decrease life span by 22 minutes.

Another factor in living a long life includes getting the proper amount of sleep. People who get less than six hours per night or more than nine hours tend to die younger than people who get seven to eight hours of sleep. Just as important as the amount of sleep is the quality of sleep. Patients with obstructive sleep apnea are at increased risk for high blood pressure and heart disease. In addition, waking up naturally, ie waking up when one has had enough sleep and not with an alarm, improves the quality of sleep and adds to longevity.

Stress, or rather how a person perceives stress, is a factor in living a long life. Clearly a less stressful life is optimal, but resilience - the ability to cope with stress rather than being beaten down by stress - has been shown to improve longevity. Social support is a major factor as well in reducing stress and in improving longevity. Having supportive friends and family can make life easier by providing emotional support, providing help when needed and giving a purpose to life. When analyzed, people with adequate social relationships, including friends, family and community involvement, tended to live nearly four years longer than those without support. Often, the trifecta of socializing, food and exercise are bound together in cultures with longevity. Entire towns will be out walking before or after the evening meal and food is enjoyed over several hours, both being shared with others.

Lastly, people who marry, who have families, who have a pet, who laugh at least once per day, who are well educated, who are optimistic, who are generally “happy people” tend to live longer than those who do not possess these qualities.

It is easy to see how many of these factors for a long life are incorporated into life in a in a small, tightly knit community like my grandparent’s village, but these factors occur in many other places in Europe and throughout the world. So how does one live to 100 years in the modern, western world? It may be impossible to incorporate all of these factors into our current life style, but with some effort, many of the ideals can be achieved. Alternatively, find yourself a nice Greek island.