"Everything here lasts." Dr. Luca Deiana and I are sitting in his office in Cágliari, the capital of the Italian island of Sardinia, where everything is old. The island is old, a craggy hunk of geologically ancient granite and basalt carpeted with sheep pastures dating back to before the birth of Christ. "There is a wild olive grove that is 3,000 years old. And we know from our grandfathers that there have always been old people here. In the 1800s some lived to be over 100. There is this way that we greet each other: Akentannos. 'To 100 years.'" As in, may you live so long. And in Sardinia, it would seem, you very well may.
Dr. Deiana and his team of researchers from the University of Sássari have been studying Sardinia's centenarians, particularly those from the remote mountains in the interior of Núoro province. In 1999 his Akea project (from akentannos) found 66 people in Núoro who were 100 years old or more. In a regional population of 276,800, that's three times the average in the rest of the Western world. But even that wasn't the most astonishing fact. In most places, as men know only too well, women outlive us by a wide margin. "Everywhere else you have four woman centenarians to every man," Deiana says. In Sardinia, though, "you have two to one. And in central Sardinia the ratio is one to one."
The statistic is so extraordinary that at first the scientific community refused to believe it, dismissing it as just another of the apocryphal reports of clusters of very old men that periodically pop up. (Remember those 100-year-old guys in the Caucasus eating Dannon yogurt in those TV ads? A big hoax.) But in Sardinia the myth has stood up to the scrutiny of demographers, and when I went there myself it was easy to see why. The place is overrun with extremely old men. Everyone I speak to, even casually, seems to have a 90- or 100-year-old in the family. And they are more than just old: They are the youngest old people you've ever met. They live alone, cook for themselves, run shops, recite Dante from memory, go hunting, walk up and down hills after their sheep for miles every day, and are exceedingly slim. And that's not all. Deiana chuckles now over the case of a 102-year-old man he met who, after fondling a social worker, was sued for sexual harassment.
More important for us aspiring centenarians, they are starting to share their secrets with the scientists who have arrived from around the globe to poke and prod these ageless wonders. The researchers have discovered a nexus of surprising and surprisingly applicable factors at play: a vigorous work ethic, a certain dark pragmatism, a thirst for wine loaded with potent heart-protective polyphenols, a richly satisfying diet that has as much in common with Atkins as it does with typical Mediterranean fare, and an unexpected twist on an important recent discovery regarding the size of one's diet that suddenly makes it applicable to millions more men.
An acquaintance of mine in Rome had described Sardinia as a kind of magical island of "strange little brown people with mustaches and hats who live with sheep and drink wine and never die." What he failed to add was that we can all live like Sardinians if we want to.
The Right Attitude
Quirino demurtas is 96, elfin, clear- eyed, with a full head of suavely combed white hair, and he is happy to explain the reason for his long and healthy life: "I don't really believe in medicine." I am sitting with him in a particularly centenarian-rich part of Núoro called Ogliastra. Bounded by mountains on three sides and the sea on the fourth, some call the region an island within an island. It once took 12 hours to get here from Cágliari by train, but I drove up in two, along a perilous Roman road twisting through spirelike balding mountains of rosy granite, often with nothing but a wire or a hedge separating my Fiat from a deep ravine. I am still dizzy.
"For years I would not take any medicines at all," Demurtas tells me. "I don't think they do much, and lots of times the doctor is using you as a guinea pig." Like me Demurtas has asthma. Like me he has been known to smoke. Unlike me he still does. "But I never inhaled," he points out, with Clintonian pride. Given all this I am frankly amazed by his good health and confused about why he is here, in his town's bright new clinic, allowing himself to be treated like a guinea pig. He enjoys it here, Demurtas explains. Besides, he says, "I am friends with Dr. Pilia's mother."
Dr. Pilia is Giuseppe Pilia, a dashing young geneticist who, after several years at Washington University in St. Louis, returned to his native village with funds from the U.S. National Institute of Aging to tease out some of the factors contributing to his neighbors' extraordinary health. This clinic now occupies what was once Pilia's old elementary school, and with help from his mother ("She knows everyone!" he explains, with a quick roll of the eyes) he has already lined up 6,000 of the region's 10,000 residents as subjects.
Pilia takes me upstairs to show me the two new sonogram machines his staff is using to measure the thickness of the citizenry's artery walls. Typically, the older the person, the thicker and stiffer his arteries, and the more likely he is to suffer a heart attack. Some people, though, maintain svelte arteries well into their middle years, making arterial thickness a good indicator of a person's "real," or biological, age, as opposed to the one on his birth certificate. I ask Pilia if he can show me Demurtas's arteries, and he has an assistant pull the sonogram results. The thickness of a healthy artery falls within a range of .3–.8 mm; thicker than .8, you have trouble. Pilia and I see that Demurtas comes in at .62 mm.
"You mean he has the arteries of a 50-year-old?"
"Right," says Pilia, considering Demurtas's ranking for the first time himself. "Wow."
So then the question becomes, how is it that Demurtas's arteries (if not Demurtas himself) are aging at half the rate of those of a normal man? Pilia says that genetics undoubtedly plays a part, but if previous longevity studies are an indication it won't be a huge part. For example, in a 1997 study on the island of Okinawa (the site of another famous centenarian cluster), 94 percent of the centenarians had the same average-to-poor genetic profile as the rest of the population.
That leaves plenty of room for environmental factors. Factors, for instance, like Demurtas's less than buoyant outlook on life. "If you ask around they will say people in Ogliastra are, well, depressed," says Pilia with a dry laugh. But, he points out, it's a depression without anxiety or much artery-constricting stress. Sardinia has seen a great deal of hardship over the centuries. There have been earthquakes, famines, and a near-endless string of invaders, starting with the Phoenicians and the Romans and continuing through the Spanish, the House of Savoy, and today's tourists, scientists, and journalists. Along the way the people of the interior seem to have adopted the attitude that whatever the foreigners can screw up they usually will, so you might as well focus on the few acres of rock and lichen you can control. It's similar to the conclusion that came out of a big U.S. study earlier this year discounting the role of positive emotions on cancer survival. A relentlessly upbeat attitude has probably been overrated in our society. If you really want arteries that will let you live to 100, you'd do better to follow the example of a Sardinian peasant and respond to everything, good and bad, with the same sort of droll fatalism. As Demurtas put it to me, "A girl once asked me, 'How can I live to be your age?' I told her, 'Don't die too early.'"
Pass the Cheese
After we visit the clinic, pilia takes me up the hill to sample another mystifying factor presumably contributing to the Sardinians' longevity: traditional central Sardinian cuisine.
Many people would assume that because Sardinia is surrounded by the Mediterranean Sea the centenarians have benefited from a lifetime's immersion in the Mediterranean diet, recently lauded for its emphasis on fish, vegetables, and artery-scrubbing olive oil. But those people would be wrong. "You have to remember, a lot of these centenarians are shepherds," Pilia explains as we take our seats at a little restaurant called La Pineta. "If you talk to people 80 years old in the mountains, they don't know how to swim, even though the sea is at most 20 minutes from their home."
We start with young white blocks of sour cream cheese, which, Pilia explains, is cultured from fresh sheep's milk, right in the field. The bread, pistoccu, is flat and hard, designed for travel and meant to be moistened with water. This is followed by a chunky porcini soup, made from mushrooms that grow like kudzu in these hills. Then a main course of roast suckling pig and a stew of lamb meat, hearts, liver, and intestines. And then more cheese.
Although the average centenarian would probably enjoy a feast like this only once a week or so, some of these dishes, like the cheeses and pistoccu, can make an appearance at almost every meal. Thus, the first rule of traditional Sardinian cuisine is paradoxically the same as the recent advertising slogan of the American Dairy Association: "Ahh, the power of cheese."
The reason this works for the Sardinian centenarians has to do with what else they're eating on their nonfeast days, namely, loads of fresh fruit, nuts, seeds, fava beans, and artichokes and other vegetables, all of which serve to flush their systems with a purgative of fiber, phytoactive vitamins, and minerals. Much of their food is also locally grown and milled (if not plucked right from their own gardens or herds), further upping its nutrients. For those of you following at home, it's a good argument for buying organic, and, indeed, to this day Sardinia supplies Italy with two-thirds of its organic food. Even their cheese and meat are healthier than the standard non-grass-fed American Saran-wrapped varieties, because the emphasis on natural grazing methods heightens the concentration of heart-healthy omega 3 and conjugated linoleic acids.
Of course, some features of Sardinian cuisine seem designed less for their nutritional value than for their ability to shock unsuspecting foreigners. Take the famous casu marzu, or "walking cheese," a fresh pecorino dotted with live cheese mite larvae. (Thankfully, it's out of season when I'm there.) I mean, I know maggots are a source of protein, but wouldn't chopped almonds have sufficed? Still, maggot cheese is not the strangest food they eat. That title would have to go to tordi.
These are small, four-inch-long songbirds that feed on Sardinia's plentiful myrtle berries. They are netted and poached, then served cold, three or four at a time, garnished with myrtle leaves. Their eyes are black, haunting, their necks spindly. They look like a plateful of baby dinosaurs. You are supposed to eat them whole – everything but the beak, in a few greedy crunches – but I begin with a small nibble on a leg. The meat is both gamey and floral, deeply flavorful and surprisingly delicious.
Tordi are typically consumed only at celebrations, although, like caviar or pigs in the blanket, they can make their own fun. "Even if you have nothing to celebrate, it is a party," explains my server. They speak, in other words, to a particularly Sardinian philosophy that the centenarians seem to understand: Whenever the occasion presents itself, you are not to merely suck the marrow from the bones of life, meager though they may be; you must crush the bones between your teeth and eat life whole. Except, of course, for the beak.
What's in the Wine?
Consider efisio puddu, a former stonemason who has just celebrated his 102nd birthday. He lives in Selargius with his family, which surrounds us now in the tidy dining room. Among those gathered are his grandsons: round-faced Andrea, who sells magazines and flits into and out of the room, half listening; and Fabio, who is thin, intense, and observant, and isn't going anywhere.
"Please speak loudly," Puddu says. He went deaf in one ear when Cágliari was bombed during the second world war. He was a member of the state's military police at the time; it was his second tour of duty – he was already 42, after all.
"I never had any vices," says Puddu. "I never drank too much." If he had five lire in his pocket, he says, he would spend it on the operetta. "I always led a moderate life. A normal life." He chops the air with his hand and repeats: "Normalissima!"
This is not the first time I've heard this centenarian rejection of any suggestion of fanciness. It recalls a conversation I had yesterday with Antonio Argiolas, 97, a winemaker who first planted his vineyard in 1936 and during the grape harvest often slept there, while standing. "Work unceasingly," he advised, and as he said so a man walked straight into his house, money in hand, to buy a bottle of wine off him. Both Argiolas and Puddu seemed befuddled by the notion of desire. When I probed them for their favorite foods, their faces went blank, as if they didn't know the meaning of the word favorite.
I ask the members of the Puddu family if they will live as long as Efisio. They laugh. "We are going for 120," says his daughter Rosaria. But Fabio, the grandson, shakes his head. "Probably not," he says. "Genetics helps, but not without the lifestyle. My grandfather's life was very different, for many reasons. He was physically stressed, but not psychologically. The food is not the same as it used to be. There is pollution, genetic engineering, free radicals."
Fabio's mother explains that her son is a health food nut. She says this with a kind of fond exasperation, as if she were telling me he is mentally ill. "When my grandfather was young, everybody ate like this," Fabio says, picking up on her tone. "They ate meat once a week, at most." And, perhaps most important, "they ate less, and they drank less."
His grandfather nods along in agreement. How would you eat on an average day, I ask him.
"Normalmente!" he says (of course). Caffé latte in the morning, nothing more. For lunch, a fresh minestrone, followed by some pasta and beans, fruit, nuts, maybe a little meat, and cheese. The same for dinner, but less. And he has always had a glass of red wine with every meal.
A meager diet to be sure, by our standards – no wonder he never had any favorites. But I realize that Fabio may well be onto something. Over the past few years longevity researchers have identified calorie restriction as perhaps the most dramatic step an organism can take to extend its life span. The body, responding to the environmental stress of less energy, activates enzymes called sirtuins that boost the rate of cell repair, thus slowing the natural cellular deterioration at the crux of aging, and giving the undernourished subject some extra time to reproduce.
Some American longevity nuts have already been experimenting with a severely restricted 1,500-calorie-per-day diet, to try to mimic the life-lengthening results achieved in worms and primates. I don't know about you, but the thought of living to 110 with my stomach grumbling the whole time is my idea of hell. And that's what's so intriguing about the Sardinians: They seem to have achieved the same effect on 1,800 to 2,000 calories a day, or just 200 to 400 less than what I pig out on. As Lisa Walford, author of 'The CR Diet,' due out next spring, explains, they manage it by eating a healthful, satisfying diet that's consistently just a couple of slices of pistoccu short of what their body wants. Then they boost the effect by drinking glasses of rustic mountain-grown wine so teeming with polyphenols that it appears to trigger the release of more age-busting sirtuins.
Puddu and his fellow centenarians may well have unintentionally eaten and drunk and worked themselves into long, long lives – without wanting them, of course, or wanting anything. Just by being normalissima. While Fabio laments the decline of the traditional diet and lifestyle, his diet, which his parents view as trendy, shows how things may be coming full circle, and now I see the startling resemblance between the young man and the old. Fabio is sitting there, the same thin, angular face, depressed but without anxiety, 29 though everyone thinks he's 24 – a centenarian in training. He may not believe it, but if anyone in this room is going to make it to 100, I'd put my euros on him.
As I leave, Efisio grabs me with his mason's hands, still powerful, and puts a kiss on each of my cheeks. Fabio just shakes my hand solemnly. I say, "You look young, but you have an old soul."?Now he smiles, his face lit with the pleasure of being recognized. He searches for the words in English: "You look correct."