This systematic review published in GeroScience investigated the factors contributing to healthy longevity in centenarians and near-centenarians. By analyzing their dietary patterns, medication use, and lifestyle factors, the study found that these individuals typically follow a plant-based diet, consume fewer calories, and engage in regular physical activity. While medication use is often minimal, antihypertensives and cardiovascular drugs are sometimes prescribed. Key factors contributing to longevity include strong social bonds, spiritual practices, and healthy weight management. The findings highlight the importance of dietary interventions and lifestyle modifications in promoting healthy aging.

Key points

1. Healthy Diet: Centenarians primarily consume plant-based diets, emphasizing whole grains, legumes, fruits, vegetables, and healthy fats.

2. Caloric Restriction: Many centenarians practice caloric restriction or intermittent fasting, contributing to improved metabolism and cellular health.

3. Minimal Medication Use: Centenarians tend to use fewer medications compared to the broader elderly population, often managing chronic conditions through lifestyle interventions.

4. Active Lifestyle: Regular physical activity, such as walking, gardening, and farming, is a common characteristic of centenarians.

5. Strong Social Bonds: Emotional well-being is fostered through strong familial ties, communal living, and a sense of purpose.

6. Spiritual and Religious Engagement: Many centenarians engage in spiritual or religious practices, which promote mental resilience and stress reduction.

7. Weight Management: Centenarians often maintain a healthy body weight throughout their lives, reducing the risk of chronic diseases.

Comprehensive Review: Diet and Medication Use Among Centenarians and Near-Centenarians

Longevity has long captivated researchers, and the study of centenarians—those who live to or beyond 100 years—and near-centenarians provides invaluable insights into aging. These individuals represent a remarkable group that, despite genetic diversity and differing environmental conditions, consistently defy the conventional limits of the human lifespan. By examining their dietary patterns, medication use, and broader lifestyle choices, we can better understand how to extend both lifespan and health span.

The overarching goal of this article is to dissect the intricate factors related to diet and medication that contribute to the exceptional longevity observed in centenarians across the globe. By focusing on key dietary components, medication usage trends, and the influence of lifestyle, we will uncover what enables these individuals to live so long and remain relatively healthy throughout their lives.

Global Distribution of Centenarians: A Brief Overview

The global concentration of centenarians is not uniform; some regions have disproportionately high numbers of long-lived individuals. These areas, often referred to as "Blue Zones," include:

• Okinawa, Japan

• Sardinia, Italy

• Nicoya Peninsula, Costa Rica

• Ikaria, Greece

• Loma Linda, California, USA

These regions provide a natural laboratory to study longevity and health, with dietary patterns being one of the most consistent factors across all populations.

Key Characteristics of Centenarian Populations

1. Active Lifestyles: Rather than structured exercise routines, centenarians tend to engage in consistent, moderate physical activity through daily life. Activities like walking, gardening, and farming are integral parts of their routines.

2. Strong Social Bonds: Emotional well-being is maintained through strong familial ties, communal living, and a sense of purpose, all of which mitigate stress and foster psychological health.

3. Spiritual and Religious Engagement: A shared characteristic is spiritual or religious practices, which offer mental resilience, reduce stress, and promote a balanced approach to life.

Beyond these shared behavioral traits, diet and medication usage are critical factors that significantly influence health outcomes and longevity.

The Role of Diet in Longevity: A Detailed Exploration

Predominantly Plant-Based Diets

The cornerstone of centenarian diets is their reliance on whole, unprocessed foods, with an emphasis on plant-based nutrition. This contrasts sharply with the high consumption of ultra-processed foods in modern Western diets, which are linked to higher rates of chronic diseases such as obesity, cardiovascular disease, and diabetes.

Nutritional Composition

1. Whole Grains: The diets of centenarians often feature whole grains like brown rice, oats, barley, and quinoa. These grains provide fiber, essential B vitamins, and antioxidants that support metabolic and cardiovascular health. They also help to maintain stable blood sugar levels, reducing the risk of type 2 diabetes.

2. Legumes: Beans, lentils, and chickpeas are common staples. These foods are nutrient-dense, offering a balance of protein, fiber, and vitamins without contributing to unhealthy fats. Legumes have been shown to improve cholesterol levels and reduce the risk of heart disease.

3. Vegetables and Fruits: Brightly colored vegetables (e.g., carrots, spinach, kale) and fruits (e.g., berries, apples, citrus) are high in vitamins (C, E), minerals, and antioxidants, which help to mitigate the oxidative stress linked to aging. The antioxidants neutralize free radicals, preventing cell damage and inflammation, which are precursors to many age-related diseases.

4. Healthy Fats: Centenarian diets commonly include sources of healthy fats, particularly from olive oil, nuts, seeds, and fatty fish (like sardines and mackerel). These fats are rich in omega-3 fatty acids, which reduce inflammation, improve heart health, and are linked to cognitive preservation in aging.

5. Herbs and Spices: Natural anti-inflammatory agents such as turmeric, garlic, and ginger are frequently consumed. These herbs contain bioactive compounds that can improve immune function, reduce inflammation, and lower the risk of chronic conditions like arthritis and certain cancers.

The Importance of Caloric Restriction

Caloric restriction—without malnutrition—has been widely studied for its potential to extend lifespan. Centenarians tend to consume fewer calories, with many practicing intermittent fasting, intentionally or naturally. This leads to several physiological benefits:

• Improved Metabolism: Lower calorie intake enhances metabolic efficiency and promotes healthy insulin sensitivity, reducing the risk of type 2 diabetes.

• Autophagy Activation: Caloric restriction activates autophagy, a cellular mechanism that clears damaged proteins and regenerates healthy cells, thereby slowing the aging process at the molecular level.

Fasting Practices

• Okinawan Example: In Okinawa, Japan, a traditional saying "Hara hachi bu" reflects the practice of eating only until one is 80% full. This habitual caloric limitation contributes to their longer lifespan.

• Mediterranean and Nicoya Practices: Similar principles of portion control and seasonal eating are observed in other Blue Zones, where people naturally consume smaller, nutrient-dense meals.

Regional Variations in Longevity Diets

Each longevity region has a distinct dietary pattern that reflects its geography and culture, but all share common health-promoting characteristics:

• Mediterranean Diet (Sardinia and Ikaria): This diet emphasizes vegetables, fruits, whole grains, olive oil, and moderate wine consumption. Rich in monounsaturated fats and polyphenols, the Mediterranean diet promotes cardiovascular health and reduces the risk of age-related diseases.

• Okinawan Diet: Characterized by low-calorie consumption and high intake of vegetables (particularly sweet potatoes), tofu, and seafood, the Okinawan diet is rich in antioxidants and anti-inflammatory compounds that protect against cancer and heart disease.

• Nicoya Diet: The Costa Rican Nicoya Peninsula features a diet centered on maize (corn), beans, squash, and tropical fruits, providing abundant fiber and plant-based proteins that support digestive health and reduce the risk of chronic diseases.

Medication Use: A Minimalistic Approach

Lower Medication Usage Among Centenarians

Centenarians tend to use fewer medications compared to the broader elderly population. Many manage chronic conditions, such as high blood pressure or arthritis, through dietary and lifestyle interventions rather than relying heavily on pharmaceuticals.

Common Medications

1. Low-Dose Aspirin: Often used for its anti-clotting properties, aspirin helps prevent cardiovascular events like heart attacks or strokes in centenarians who are at higher risk due to age-related changes in the cardiovascular system.

2. Antihypertensive Drugs: Blood pressure medications are occasionally used, but centenarians often require lower doses due to a combination of good vascular health and lifestyle factors that naturally mitigate hypertension.

3. Statins: Used to manage cholesterol levels and reduce cardiovascular risk, statins are sometimes prescribed, but their use is not as widespread in centenarians due to lower rates of cardiovascular disease.

4. Vitamin D and Calcium Supplements: Due to limited sun exposure in old age, some centenarians take vitamin D and calcium supplements to maintain bone health and prevent fractures or osteoporosis.

5. Probiotics and Multivitamins: In some regions, centenarians supplement their diet with probiotics to promote gut health and multivitamins to fill any nutritional gaps, although this is not a universal practice.

Minimizing Polypharmacy

Centenarians are less likely to be subjected to polypharmacy, which refers to the use of multiple medications to manage various conditions. This is significant because polypharmacy can lead to adverse drug interactions, diminished organ function (especially liver and kidney), and reduced quality of life. Avoiding unnecessary medications minimizes the risks of side effects and supports healthier aging.

Lifestyle and its Influence on Medication Use

Disease Prevention Through Lifestyle Choices

Centenarians largely avoid medications by focusing on disease prevention through lifestyle choices. Key factors include:

• Weight Management: Centenarians maintain healthy body weight throughout life, significantly reducing the risk of diseases like diabetes, hypertension, and cardiovascular diseases that often require pharmaceutical intervention.

• Consistent Physical Activity: Regular movement through daily activities strengthens the cardiovascular system, maintains muscular strength, and supports cognitive health.

• Stress Management: Mindful living, spirituality, and strong social networks contribute to emotional well-being, reducing stress-induced inflammation, which is a precursor to many chronic illnesses.

Personalized Medicine in Longevity Research

Emerging fields such as pharmacogenomics—the study of how genes influence a person’s response to drugs—shed light on why some centenarians thrive with minimal pharmaceutical intervention. Personalized medicine could revolutionize healthcare by tailoring drug therapies based on genetic profiles, minimizing side effects while optimizing therapeutic benefits.

The Future of Longevity Science

Looking ahead, longevity science will focus on further unraveling the biological mechanisms that allow some individuals to live exceptionally long lives. Emerging fields such as nutrigenomics—the study of how diet interacts with genes—are beginning to explore how personalized dietary recommendations might help extend health span and prevent age-related diseases. Similarly, advances in biomarker research will help identify early indicators of aging, allowing individuals to adopt preventive strategies long before they manifest diseases.

Conclusion

Longevity is the result of a multifaceted combination of genetics, diet, medication, and lifestyle choices. Centenarians offer us a roadmap to a longer and healthier life, grounded in the power of whole, nutrient-dense diets, minimal medication use, and a strong focus on lifestyle interventions. As science progresses, these principles could be adapted to various populations, paving the way for a future where longevity is achievable for a broader segment of society.

Journal Reference

Dai, Z., Lee, S.Y., Sharma, S. et al. A systematic review of diet and medication use among centenarians and near-centenarians worldwide. GeroScience (2024). https://doi.org/10.1007/s11357-024-01247-4

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