Why Women Outlive Men ... Everywhere but Sardinia

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Women across the globe tend to live an average of seven years longer than men, except on a mountainous island 200 miles west of Italy. In Sardinia exceptional health and longevity are common in both genders, and the likelihood of living to be 100 years old is about 10-fold higher than for us in America. What’s the Sardinians’ secret? Well, scientists have done DNA analysis of the people in Sardinia and found their genes don’t account for their phenomenal health and longev­ity. Instead it was their lifestyle that held the secrets.

The Sardinians spend their days surrounded by neigh­bors, friends and family. They live immersed in a tight-knit community and stay close to each other, often socializing while tending gardens, olive trees, vineyards and herding their sheep. People frequently drop by to visit each other; nobody is left to live a solitary life. Men, in particular, have uncharacteristically rich social networks with their male cronies, prioritizing time to visit with their friends and family in the late afternoon while sipping a glass of red wine. This is unlike the rest of the developed world, whereas George Burns said, “Happiness is having a large, loving, caring, close-knit family … in another city.” Furthermore, the Sardinian man tends to share his life stresses with his spouse, rather than be the strong silent “lone wolf.”

Sadly, social isolation may be the biggest health risk of our day. In some ways we are more connected than ever, through texting, email, Facebook, other internet sites, TV, etc. Yet, one-third of the population says they have two or fewer people that they could lean on in the event of a tragedy.

So why do women tend to outlive the men everywhere except Sardinia? Women instinctively tend to build and prioritize interpersonal relationships, and are more likely to invest time and energy into face-to-face real-life interactions. Fascinating new stud­ies show that in-person friendships construct a bio­logical force field that helps to protect us against illness and early death. And this friendship effect that shields us against disease isn’t a phenomenon seen only in Homo sapiens, it’s also appar­ent in our primate relatives. Female baboons who belong to a group of female friends have reduced stress as measured by cortisol levels, and they, too, tend to live longer and have more surviving offspring than the female baboons who were more socially iso­lated. Three face-to-face friendships are the magic number for baboons, and it might be a good target for us, humans, as well.

Many people are not surprised to hear that interpersonal relationships are the most important factor in preventing premature death. Do you have people who know and trust you well enough that you could ask to borrow money from them if an unex­pected financial bind arose? Do you have family members or neighbors who would phone your doctor or drive you to the hospital if you suddenly felt ill? Or do you have friends you could talk to if you were in deep despair? My colleagues at the Mayo Clinic in Minnesota informally use what they call the Rochester Index: the higher the number of family and friends who are in the hospital room the better the likelihood that the patient will survive and do well; whereas hospital­ized patients who are alone are at the highest risk of serious complications and death.

You don’t need a lot of those kinds of confidants, just a few - three at least. Having these kinds of family members or friends or neighbors is the single strongest predictor of longevity. Surprisingly, another kind of interper­sonal support also is a strong predic­tor of life expectancy - and it’s called social integration. This refers to how much you interact with people in your day-to-day life.

How many people do you greet or chat with as you move through your typical day? This encompasses both your close friends and superficial acquaintances. Do you thank your postman, or ask the lady who makes your coffee how her day is going? Do you visit with neighbors when you see them out in their yard, or smile and greet the lady who walks with her dog by your home regularly? Do you ask people who seem lost if they need directions? Do you play cards with a group, or attend a book club, or go to a religious service regularly? The cumulative effects of those seem­ingly inconsequential and sometimes even superficial interactions are also turning out to be one of the strongest determinates of how long you will survive.

Like Sardinians we are all hard-wired from birth to want to feel like we be­long. Traditionally, we lived in a small cohesive tribe, and we knew, “I am who I am because of who we all are.” Building in-person interaction into our day-to-day lives boosts our mood, strengthens the immune system, keeps the heart calm and healthy, and pumps feel-good hormones through our bloodstream, all of which helps us to live longer. Susan Pinker calls this “building your village” and this turns out to be our most important task - indeed it’s a matter of life and death.

My family and I will be living in a small village in Sardinia for a week this summer to experience their culture first hand. To be clear the Sardinians traditionally have done many things right when it comes to a longevity-promoting lifestyle. Besides their social connectedness, other factors in their remarkable health include:

A Good Diet

They eat a lots of vegetables, nuts and fruits, along with plenty of beans, goat's milk and bread made from unleavened durum wheat, often only eating meat on special occasions (just once or twice per week). The Cannonau wine made from a local grape has three times higher levels of antioxidants compared to most other red wines.

Family Values

The island of Sardinia has been conquered repeatedly through the centuries and thus they tend to rely on family and community values. Individ­uals who have strong family ties have reduced rates of stress, depression and suicide.

Laughter

Sardinian men are notorious for gathering together in the streets every afternoon to visit with friends, trade stories and laugh often, which is very effective at relieving stress.

A Good Walk

One more reason that Sardinian men live as long as the women, is that many of them are shepherds and often walk about five miles (10,000 steps) a day. Walking is a wonderful exercise for conferring longevity.

Share the Stress

Tonino and Giovanna were married 51 years ago in Silanus, a village in the mountainous central region of Sar­dinia where they still live today. While Tonino is out tending the garden and orchard, and caring for his sheep, Giovanna shoulders the burdens of being in charge of the household and managing the family finances. Sardin­ian couples traditionally have shared the stress of these responsibilities. For the men, a lighter stress burden reduces their risk of heart disease, which may explain why the ratio of female to male centenarians is about one-to-one in Sardinia, compared with a four-to-one ratio favoring women in the United States. “I do the work,” admits Tonino, “my ragazza (Italian for girl) does the worrying.”

Bottom line: The two most impor­tant predictors of longevity are both related to interpersonal connections. Having at least a few close relation­ships (high social support) and feeling like you belong in your neighborhood, work and community (social integra­tion) are the two strongest predictors of longevity. Other factors such as not abusing tobacco or alcohol, stay­ing physically active, maintaining a healthy weight and blood pressure are also important, but not as powerful in promoting longevity as having good social support.

In Good Health,

James O'Keefe, MD