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29 Jan 2017 15:17
Dr. Maisel

Giuseppe Vassallo thinks “clean living" is overrated. He scoffs at the idea that cigarettes are harmful to his health. He has smoked for almost his entire adult life. He's 94.

He has many friends who are over 100. A lot of them smoke, too. What's more, they drink every day, never worry about their weight, and they stay in the sun without bothering with sunscreen. And they are still going strong.

Giuseppe Vassallo
Giuseppe Vassallo, age 94

Giuseppe hasn't been sick or slowed down much, despite his advanced age. The only time he felt bad was six years ago, when his wife died.4

He fell into a deep depression. “But then I thought, ‘I should go on living.'"

So Giuseppe found a girlfriend.

When you ask for his secrets to healthy aging, he has two answers:

  • Eating vegetables from his own garden
  • Sex

“Sex is indispensable," he says. “It makes you happy, more cheerful."

When asked if he was still capable of being sexually active, Giuseppe seemed surprised someone would even ask.

“Of course!" he replied.

Giuseppe's attitude about sex is typical among the older folks in Acciaroli, says Dr. Maisel.

Besides his work at the University of California, San Diego, Dr. Maisel is director of the Coronary Care Unit and Heart Failure Program at the VA San Diego Healthcare System.5

Dr. Alan S. Maisel
Dr. Alan S. Maisel

In an exclusive interview with Independent Healing, he recounted the incident that triggered his Acciaroli longevity study:

“I went to a public well in Acciaroli. This is a place where they pump water just like they did in many places before running water was installed.

“I met a woman there. She must have been in her mid-80s at least. But she was in great shape for her age. In her broken English she made it very clear that she wanted me to go home with her and have some fun! She was coming on to me even though my wife was with me! It was very surprising."

After the incident, Dr. Maisel started paying closer attention to the lifestyle and diet of the seniors in the village.

“I noticed that there were all these old people who were very active," he told Independent Healing. “They had bellies. Many of them smoked. Their skin was like leather from the sun. They were extremely old but still enjoying life.

“Their minds were sharp. They loved to drink wine and have sex. They behaved just like young people. They certainly didn't seem to work very hard to stay in shape. Nobody jogs, or does yoga, or swims laps.

“When I saw this, I wondered, ‘What the heck is going on here?'"

Acciaroli is a seaside village 85 miles south of  Naples
Acciaroli is a seaside village 85 miles south of Naples

With the help of the local doctors, Dr. Maisel gathered some demographic information on Acciaroli. He was astonished by what he found.

He discovered that about 15% of the villagers live past 100.

Previously, Okinawa, Japan, was believed to have the world's highest concentration of centenarians.

Its percentage of 100-year-olds? 0.05%.6

That means Acciaroli residents have a 300 times greater chance to live to 100 than residents of Okinawa.

Besides long lifespan, conditions considered “diseases of aging," such as Alzheimer's and heart disease, are practically absent in Acciaroli.

“We noticed they don't suffer from cataracts," said Dr. Maisel. “Most of the people in the U.S. over 80 have them. We saw none.


“There was obviously something going on in Acciaroli, with so many people aging so well," said Dr. Maisel. “We wanted to find out what it was."

So the doctor assembled a research team from the San Diego School of Medicine and Sapienza University of Rome. They spent six months in the village. Using a mobile lab, scientists took blood and sputum samples from the residents. They analyzed the villagers' diet, genetics, and lifestyle.7

Researchers concluded that genetics do not account for the great longevity of the people of Acciaroli. There are no major differences in their ancestry compared to other parts of Italy where lifespans are shorter. 

But scientists did find something unusual in their blood.

Hormonal Clue to ‘Super-Aging'

Dr. Maisel and his colleagues discovered that elderly Acciaroli residents have extremely low blood levels of a hormone called adrenomedullin, or ADM.8

Adrenomedullin was discovered in 1993. It was initially found to be made by the adrenal glands. But later research showed it is produced by organs and tissues throughout the body. ADM is a vasodilator. That means it widens blood vessels.9

You might think lots of ADM would be good for blood circulation. After all, the wider your blood vessels, the more blood can move through them.

But high levels of ADM are a marker of circulatory distress. Your body produces more of it when it senses your organs and tissues are not getting enough blood.

For example, people with heart failure and atherosclerosis (hardening of the arteries) have elevated levels of ADM. This is because their bodies are furiously trying to widen their blood vessels in an effort to get more blood to their organs.10 Older people also have more ADM to compensate for the loss of circulation that comes with age.

When you have low levels of ADM, it's a sign your blood vessels are healthy, open, and functioning well.

The low ADM readings in Acciaroli residents led researchers to take a closer look at the villagers' blood vessels. They found that the elderly people in the town have remarkably strong microcirculation.11

Microcirculation: Key to a Long, Healthy Life

The circulatory system is actually two systems. One sends blood to and from the heart through large blood vessels, arteries and veins. This is macrocirculation.

The other system moves blood through the smallest vessels, capillaries. This is microcirculation.12

Here's another way to think about it: Macrocirculation is like the large water main that brings water to your house and the sewer that takes away waste water. Microcirculation is like the smaller pipes in your home that bring water from the main to your faucets and drain it into the sewer.

Microcirculation is fundamental to good health because it is the link between your blood and all the tissue in your body. It is responsible for delivering oxygen and nutrients directly to cells, as well as removing waste and other toxins from them.13, 14

When microcirculation is strong, it keeps the organs in your body youthful and operating at peak efficiency. Poor microcirculation is linked to the diseases of aging, including heart problems, sepsis, diabetes, dementia, high blood pressure, kidney disease, erectile dysfunction, and eye problems—such as macular degeneration and cataracts.15, 16

Researchers concluded that the microcirculation of the elderly residents of Acciaroli is as efficient as people who are 30 years younger. Scientists say it's the key to their longevity and good health.17

Said Dr. Maisel: “What we saw in these patients was amazingly adequate small blood vessels."

Dr. Maisel and colleagues identified a group of lifestyle factors they believe are responsible for robust microcirculation in the people of Acciaroli.

Acciaroli's 7 Anti-Aging Secrets

1. Rosemary

“Everybody in Acciaroli eats rosemary," said Dr. Maisel. “They use rosemary on everything they cook. They all grow it. They use it as a garnish. They use it in infused oils.18

“It has compounds that help microcirculation."19


Research has shown the herb has an exceptional ORAC value of 165,280. ORAC stands for Oxygen Radical Absorbance Capacity. It's a measurement of the antioxidant capacity of foods.20

Only three other foods have more antioxidant potency: sumac bran, cloves, and oregano.

Rosemary increases blood flow, particularly to the brain. Researchers have found it can ward off Alzheimer's and improve memory.

A study in the International Journal of Neuroscience of 144 seniors concluded: “Rosemary produced a significant enhancement of performance for overall quality of memory."

Another study in the journal Psychogeriatrics of 28 dementia sufferers found that rosemary led to “significant improvement" of brain function.21

Rosemary's brain benefits may explain the active sex lives of the old people of Acciaroli, according to Dr. Salvatore Di Somma. He's a professor of medicine at Sapienza University and a lead author of the Acciaroli study.

“At 95, they have brains more like someone who is 50," he said. “And at 50, you're still thinking about sex a lot."

Adding rosemary to your cooking is beneficial, but you may not want to eat rosemary in every meal like Acciaroli residents. Rosemary tea is good way to get a strong dose of the herb. Simply steep two teaspoons of fresh or dried rosemary in hot water for 10 minutes. Strain and drink.

Rosemary supplements are another option. One brand we recommend is Swanson Superior Herbs. Take one capsule two times a day.

2. Fatty fish

Acciaroli is a fishing village. By far, the most frequently eaten fish is anchovies.

“Virtually every meal they're eating anchovies," said Dr. Maisel.22

The anchovy is one of the most nutrient-dense species of fish. European anchovies, like those eaten in Acciaroli, have the highest levels of omega-3 fatty acids of any fish.23


Many studies show that the omega-3s in fish are good for your heart. Research has found they:

  • Reduce bad cholesterol
  • Ease inflammation in the arteries
  • Lower risk of arteriosclerosis, heart attack, and stroke
  • Rid the body of toxins
  • Reduce risk of osteoporosis
  • Fight macular degeneration
  • Boost cell metabolism

There is also strong evidence omega-3s promote microcirculation. A study in the journal Advances in Experimental Medicine and Biology showed that mice fed omega-3 fatty acids had increased microcirculatory flow.24

A 2009 Russian study found the same effect in humans. After one month of taking a daily 1.5 mg omega-3 supplement, subjects had improved microcirculation and endothelial function.25

Another benefit of anchovies is that they are very low in mercury, a pollutant toxic to the brain even at low levels.26

The people of Acciaroli eat both fresh and canned anchovies. Fresh can be difficult to find in the U.S. But canned or jarred anchovies are widely available, and their nutrition profile is similar to fresh anchovies.27

Some people don't like the strong flavor of anchovies. Good alternatives are wild-caught salmon, Pacific mackerel (not King mackerel), and sardines. All of these are high in omega-3s and low in mercury.28

3. Clean air and sun exposure

The weather in Acciaroli is mild. There is plenty of sunshine and Mediterranean breezes. The villagers spend most of the day outdoors.

“There isn't a lot of industry here," said Dr. Maisel. “So the air they breathe is unpolluted."29

Acciaroli's air quality gets the highest rating from Legambiente, an Italian environmental group that monitors pollution.30

A 2013 study from the Massachusetts Institute of Technology found that people living in areas with air pollution lose three to five years of lifespan.31

Another study found that polluted air impairs microcirculation. A 2010 research project published in PLOS Medicine showed that air pollution causes narrowing of the fine blood vessels in the eye. Researchers concluded that it was of sign of impaired microcirculation throughout the body.32

Being outside so much means the villagers get a lot of sun. And they don't generally use sunscreen. The older residents have skin “like leather," according to Dr. Maisel. Yet they rarely get skin cancer.

Since sun exposure causes the body to produce vitamin D, the Acciaroli study found high blood levels of the nutrient in the residents.

Several studies have linked sun exposure and vitamin D with healthy aging:

  • A 2013 study at the University of California, Berkeley, found that vitamin D prevents premature bone aging. Osteoporosis is rare in Acciaroli.33
  • A 2014 study at Queen Mary University of London found that vitamin D improved microcirculation in kidney patients.34
  • A 2016 Swedish study found that people with the highest sun exposure gained an average of 2.1 years of life expectancy.35

Have your doctor check your vitamin D level. The optimal range is 50-80 ng/mL.36 If you test low, there are three ways you can naturally increase your levels:37

  1. Get 20 minutes of sunlight each day with your arms and legs exposed. You don't have to do it all in one session. It's best to get sun between the hours of 10 a.m. and 3 p.m.38
  2. Increase your intake of foods high in vitamin D. They include anchovies, wild-caught salmon, pastured eggs, mushrooms, beef, liver, and pork.39
  3. Take a vitamin D3 supplement. We recommend a dosage of 5,000 IUs a day.40

After a month of getting more sunlight, eating vitamin D-rich foods, or taking a supplement, ask your doctor to test you again to make sure your levels have increased to at least 50 ng/mL.41

Take these steps to protect yourself from polluted air:

  1. If you live in an area with smog, check daily air pollution forecasts. The Environmental Protection Agency provides national air quality forecasts at airnow.gov.
  2. Avoid exercising outside on days when pollution levels are high. Exercise indoors instead.
  3. Never exercise near high-traffic areas. Busy highways create high pollution levels up to a third of a mile away.42
  4. Change the filters in your heating and air conditioning systems regularly.
  5. Get an indoor air filter. Make sure you get one labeled HEPA (high-efficiency particulate air). It can capture ultrafine particles.43

4. Low stress

Life moves at a slow pace in Acciaroli. “It's a stress-free life," said Dr. Maisel. “There's a joie de vivre. They are relaxed."44

Men don't have much career pressure. Most of them work short, leisurely days as fishermen, farmers, or in the tourism industry. Women generally don't work outside the home. People spend long hours socializing at outdoor cafes with their friends and family.

According to the American Psychological Association, chronic stress is linked to the six leading causes of death in the U.S.: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.45

More than 75% of all physician office visits in the U.S. are for stress-related ailments.46


Stress is a major risk factor for heart attacks. When you feel anxiety, your body releases adrenaline and cortisol. These two hormones raise blood pressure, constrict arteries, and increase blood clotting.47


Stress is also linked to poor microcirculation. A study published in the American Journal of Cardiology found that mental stress damages circulation in the small blood vessels of the heart muscle.48 Research published in the journal Metabolism found that stress shrinks capillaries throughout the body.49

Yoga, meditation, and exercise are all tried-and-true ways to decrease mental stress. But for the people of Acciaroli, low stress comes naturally. The simple stress-reducing aspects of their lifestyle are things most of us can incorporate into our lives to at least some degree:

  • Take a break. A January 2017 study in the journal Health Affairs  found that long hours in a stressful workplace increases mortality risk by up to 19%.50

    Most of us cannot leave our jobs to become farmers or fishermen. But we may be able to do a better job controlling workplace stress. When you can, avoid working long stretches of uninterrupted hours in high-pressure situations. Try to break up the work-day with short walks or brief periods of downtime to unwind.

  • Spend your leisure time with others. Renowned brain expert Dr. Paul Nussbaum notes that research shows loneliness is linked to higher levels of the stress hormone cortisol. It raises the risk of premature death by 14%. This is about the same risk as being overweight.51

    The people of Acciaroli don't spend their leisure time in solo pursuits. Their social lives revolve around cafés and churches. It's easy for many of us to spend our off-hours reclusively with our favorite digital device. Instead, make an effort to spend more time with friends and family sharing a laugh, a drink, or your faith.

5. Coffee and red wine

The elderly residents of Acciaroli are fond of two beverages, coffee and wine.

“During the day, they sit around and drink coffee, which turns into wine in the evening," said Dr. Maisel.

Both coffee and red wine consumption are linked to increased microcirculation:52

  • A 2015 Japanese study found that even a small amount of caffeine—the equivalent of less than half a cup of coffee a day—improves microcirculation.53
  • A 2006 study in the journal Heart examined the effects of red wine on heart disease patients. Researchers found that one glass of red wine a day improved heart patients' microcirculation to the point that it was as strong as people with no heart disease.54

In addition to caffeine and alcohol, researchers believe the health benefits from coffee and red wine derive from a group of antioxidants called polyphenols.

Resveratrol is a polyphenol in red wine that has received a lot of attention in recent years. It's linked lower risk of heart disease, Alzheimer's, and diabetes.55 But both red wine and coffee contain many polyphenols. It is this complex mixture, not just one compound, that is believed to promote microcirculation.56

The red wine with the highest polyphenol levels is Madiran. It's made in the southwest of France primarily from the Tannat grape.57 It's not easy to find in the U.S. But most big wine shops have it. Otherwise, go for cabernet sauvignon. It's also high in polyphenols. And it's widely available.

Researchers advise drinking red wine in moderation. That means one to two glasses a night. Higher amounts have been linked to increased cancer risk.58

Researchers at the University of British Columbia found that dark roasted coffees have higher polyphenol levels.59 Look for single source organic coffee beans. Blends are more likely to contain harmful mycotoxins that attack the immune system.60

If you don't like coffee or wine, take a quality polyphenol supplement. They are widely available at health food stores and online.

6. Diet

The people of Acciaroli eat a traditional Mediterranean diet. Their food is almost all produced locally. There is little processed food in the town. The closest fast food restaurant is 40 miles away.

The Mediterranean diet emphasizes:61

  • Fruits and vegetables, legumes, and nuts
  • Olive oil
  • Herbs and spices
  • Fish
  • Low meat consumption
  • Enjoying meals with family and friends
  • Red wine in moderation

Studies show the Mediterranean diet increases lifespan while reducing the risk of heart disease, cancer, Parkinson's, and Alzheimer's.62

A 2015 Harvard study found that people eating a Mediterranean diet have longer telomeres. These are protective caps at the end of your chromosomes that protect your DNA. They shorten with age. Shorter telomeres are associated with lower life expectancy. They also are linked to age-related diseases such as hardening of the arteries, cancer, and liver disease.63

The study found that the Mediterranean diet can add more than 13 years to a person's telomere lifespan. Researchers concluded the benefits are due to the strong antioxidant and anti-inflammatory effects of olive oil, fruits, vegetables, nuts, and fish.64

In Acciaroli, there are a few local twists on the Mediterranean diet that may provide extra anti-aging benefits. We've already mentioned two of them...rosemary and anchovies. These are eaten throughout the Mediterranean region, but not always in the large quantities consumed by Acciarolians.

There's another local diet staple that sets Acciaroli apart. In Acciaroli they eat a lot of meat. Specifically, they eat large quantities of rabbit they raise themselves. It's considered a local delicacy.65

Rabbit is extremely high in protein. It has more protein per serving than beef, lamb, pork, or chicken. Yet it is lower in calories than those other meats.66 Essentially, the people of Acciaroli eat a traditional Mediterranean diet, but with extra protein from the local rabbit.

A 2015 study in the American Journal of Clinical Nutrition showed that seniors who eat more protein have more muscle mass as they age. The researchers found that the added muscle allows them to stay mobile, live independently longer, and avoid debilitating falls.67

Because Acciaroli residents raise the rabbits themselves, their protein comes from a “clean" source. Unlike factory-farmed meats, it has no antibiotics or growth hormones. It is organic. 

Organic rabbit can be difficult to find in the U.S. But organic, grass-fed beef is a good substitute. Eat it two to three times a week.

Scientist Tests Mediterranean Anti-Aging Secrets on Himself

Dr. Ancel Keys was a nutrition researcher who became a war hero.

In the buildup to World War II, U.S. military leaders were looking for a way to feed troops without pulling them off the battlefield. They needed mobile, nonperishable meals that would keep soldiers healthy and strong.68

Dr. Ancel Keys, father of the Mediterranean diet
Dr. Ancel Keys, father of the
Mediterranean diet

Keys solved the problem by inventing K-rations. They provided troops with 3,200 daily calories and a healthy balance of nutrients while being portable enough to carry into battle.69

After the war, Keys turned his attention to another American problem. He noticed that heart disease was becoming rampant in the U.S. And he blamed it on the American diet.

Keys, then a researcher at the University of Minnesota, launched what he called “The Seven Countries Study." It examined the relationships between diet, lifestyle, heart disease, stroke, and longevity among 16 groups of people in seven nations (the U.S., Finland, the Netherlands, Italy, Yugoslavia, Greece, and Japan).70

Keys used the study findings to write a best-selling book called How to Eat Well and Stay Well the Mediterranean Way. The diet advice in his book was later popularized as the Mediterranean diet.71, 72

Keys was so convinced of the health benefits of the Mediterranean lifestyle that he moved from Minnesota to a tiny hamlet in southern Italy called Pioppi. It's Acciaroli's closest neighbor to the south, about 5 miles away.

There Keys tested his dietary theory on himself, while continuing to write books in an effort to get Americans to eat and live more like residents of the Mediterranean region. He lived in Pioppi for 28 years.

Keys died in 2004. He was two months short of his 101st birthday.73


7. Walking

Exercising for fitness is virtually unknown in Acciaroli. There are no health clubs. People don't jog. No one goes to yoga classes.

Like many ancient European villages, the streets of Acciaroli were built long before cars were invented. Some are so narrow cars can't fit through them. So residents walk or use bicycles instead.

Because the city is built amid hills, getting around requires exertion. And just about everybody does the physical labor required to raise a vegetable garden and rabbits.

“The residents are very, very active," said Dr. Maisel. “But you don't see any yoga classes. You don't see them jogging. But they have to move up and down the hills."74

Exercise in the form of walking and gardening are part of daily life. Studies show that walking improves both macro- and microcirculation.

A 2014 study by Northwestern University researchers examined the effects of walking on patients with poor circulation from peripheral artery disease. After a year of walking five days a week for 50 minutes a day, patients had better circulation in both large and small blood vessels. And they could walk faster, farther, with less fatigue and leg pain.75

Try to walk for at least a half hour every day. Do it outside so you can get the benefits of sunshine-created vitamin D. 

The Acciaroli Anti-Aging Protocol

Your microcirculatory network contains more than 60,000 miles of capillaries and other small blood vessels. Research shows your health and longevity are largely dependent on the condition of this vital oxygen and nutrient delivery system.

The Acciaroli study reveals how the residents of one small town preserve their small blood vessels to an extraordinary degree, allowing them to enjoy lives unprecedented in length and health:

  1. Eat rosemary. Add it to your cooking as often as you can. Or take a quality rosemary supplement.
  2. Eat fatty fish. The best choices are anchovies, wild-caught salmon, sardines, and Pacific mackerel.
  3. Breathe clean air and get sun exposure every day.
  4. Reduce stress.
  5. Drink coffee and red wine in moderation.
  6. Add organic meat to the Mediterranean diet.
  7. Walk for a half hour every day.