The Secret of Life
Okinawans, the world's longest-lived people, have a lot to teach Americans on the art of reaching 100

From The Boston Globe, May 22, 2001

It's best known for the bloody US invasion near the end of World War II, but Okinawa's legacy is not mainly about death. In fact, the residents of Okinawa may be the healthiest and longest-lived people in the world, with a higher percentage of 100-year-olds than anyplace else.

On Okinawa, an island chain of 1.4 million people near Japan, heart disease, strokes and cancer are rare and even centenarians have impressively sharp minds.

Researchers say the people of Okinawa may have important lessons for fast-food-loving, couch-potato Americans, who typically die five years younger - and rarely make it to the century mark unless they are blessed with exceptional genes that protect them from the ravages of disease.

A 25-year study of elder Okinawans credits at least two-thirds of their robust health to lifestyle choices rather than good genes. In stark contrast to American habits, Okinawans eat a vegetable-based diet low in both calories and fats, and rich in soy foods, and they exercise regularly.

''Never in the history of nutrition research has the evidence been more clear and consistent,'' wrote Bradley J. and D. Craig Willcox, twin brothers who have written ''The Okinawa Program'' about the long-running study with co-author Dr. Makoto Suzuki. ''A high-carbohydrate, low-calorie, plant-based diet is the best for long-term health.''

Indeed, Okinawans seem to lose their longevity when they migrate to the West or adopt a US-style diet. For instance, the life expectancy of Okinawans living in Brazil drops 17 years, researchers say. Even young people remaining in Okinawa are succumbing to the lure of McDonald's and the fast-food way of life, the scientists say, driving up their cholesterol levels and other heart-disease risks.

But it's not just diet that has helped 400 living Okinawans reach age 100 - a rate three to six times higher than in the United States. Also in the Okinawans' favor, the researchers say, is their practice of martial arts exercises, a positive spiritual attitude, and a low-stress way of living with its own, slower pace they call ''Okinawa time.''

To be sure, other remote people have been held up as the longest-lived in the past, particularly residents of the Caucasuses region of the former Soviet Union who became such symbols of longevity that they were featured in yogurt advertisements. But researchers found that age exaggeration was rampant and that they weren't especially long-lived after all.

The people of Okinawa, by contrast, have been meticulously recording births and deaths in family registers since 1879, allowing researchers to verify every 100-year-old claim.

In some ways, it should come as no surprise that the highest rate of centenarians is among the Japanese, who have the longest life expectancy in the world. Researchers say that partly reflects genetic advantages: The Japanese tend to be smaller and less prone to obesity than other races, which means less exertion for the heart and other vital organs.

But researchers say the Okinawan experience underscores how many years of healthy living Americans squander through bad diets, smoking and other vices. Many of the same people living to 100 there would have died in their 80s or 90s in the United States.

''Generally, people have genes that should be getting them to their mid-80s. ... In our country, we live about 10 years less than that on average because of terrible health habits,'' explained Dr. Thomas Perls, director of the New England Centenarian Study at Beth Israel Deaconess Medical Center.

In general, Perls said New England's 100-year-olds are monuments to good genes that kept them alive in spite of bad habits. But there are clues to the importance of good lifestyle choices even among these rare individuals.

''None of our centenarians are significantly obese and you can't have a history of smoking,'' Perls said. ''We have very few centenarians who ever smoked.''

Dr. Bradley J. Willcox, currently a gerontology fellow at Beth Israel Deaconess Medical Center; his brother, D. Craig Willcox; and Dr. Makoto Suzuki, who heads the Okinawan study, are convinced that a look to the East will end any doubts that people have great control over how long they will live. Their book, published this month, contains guidelines and healthy recipes intended to help people adopt more of an Okinawan lifestyle in as little as four weeks.

They don't guarantee that everyone would reach the century mark by following the Okinawan example, but Americans could become more robust in their later years.

Older Okinawans, the study revealed, eat an average of seven servings of vegetables and fruits daily, along with seven servings of grain, two servings of soy products (rich in healthful compounds called flavonoids), fish rich in Omega-3 fatty acids several times a week, and very little dairy products or meat.

Exercise is a way of life for Okinawans and it's connected to their spiritual beliefs, which combine a reverence for nature with celebration of elders and ancestors and a ''help your neighbor'' ethic in the community.

As a strategy for long life, it works: One part of the Okinawa Centenarian study found that, of 32 100-year-olds, just four were in nursing homes. ''The other 28 were all free-living,'' Suzuki said during a recent interview.

But would Americans make the lifestyle sacrifice? Even younger Okinawans are going astray, said Suzuki, a professor of gerontology at Okinawa International University, with the invasion of McDonald's and other Western lifestyle fads. Rapidly, they're getting Western-style health problems, too.

''Their way of thinking has changed,'' Suzuki said. With husband and wife both working, they're relying more on convenience foods and becoming less involved in their communities, he said. But the elders, he said, ''are still eating the traditional foods,'' such as sweet potatoes, tofu, and melon.

Americans won't change overnight, the authors say, but they note that a shift toward somewhat more healthy lifestyles has already resulted in less disability among the elderly.

It's not necessary to recreate the Okinawan way of life. ''You can slip soy into practically anything,'' said Willcox, who is a first-year fellow in the gerontology department headed by Dr. Thomas Perls at Beth Israel Deaconess Medical Center.

For breakfast one recent day, said Willcox, ''I had scrambled eggs with tofu and a little spinach - and two pieces of toast.'' It's not necessary to give up America-style food, he said, but it should be prepared with less oil, salt and sugar and eaten in smaller proportions than the ''super-size'' meals at fast-food restaurants.

Eating fewer calories has been shown in animal experiments to boost longevity. The Okinawans do this naturally: They eat until they are about 80 percent full, and after 20 or 30 minutes, their stomachs have adjusted to the smaller meal.

Still, the diet may be the toughest part for Westerners to swallow: It makes the US government's Food Pyramid look almost indulgent. To advocates of the Okinawan diet, the food pyramid allows too much red meat and doesn't emphasize vegetables and fruits enough.

Here's a visual formula for the Okinawan diet: Think of the plate as a pie chart with three-fourths of it blacked in - that's the right proportion of vegetables at each meal. The one-fourth remaining - that's for animal products.

For Americans, the biggest benefits of adopting a healthy diet and avoiding illness appears to be better health in their 70s and 80s, rather than an increase in 100-year-olds, according to Perls, the Beth Israel Deaconess gerontologist. His study of New England centenarians showed that good genes were increasingly important in the oldest decades. In other words, he said, ''to get that last 15 or 20 years, you need genetic booster rockets.''

Now, Perls is planning to collaborate with Willcox and his colleagues to combine findings of the Okinawan and New England projects.

If Americans could adopt some of the Okinawan practices, such as a healthier diet, along with stopping smoking, taking up strength training, and reducing obesity, he said, ''The benefits would be huge in terms of the health of our society.''

Richard Saltus, Globe Staff
May 22, 2001
© Copyright 2001 Globe Newspaper Company.