The Okinawa factor
Unusually long, rich life spans lure doctors to see why the islanders thrive

From The Chicago Tribune, June 24, 2001

Imagine a land where people seem to have postponed the aging process and the debilitating diseases that plague the "golden years" of many Americans, where there are more centenarians than anywhere else in the world.

Sound like a fantasy? Another one of those bogus, media-hyped Shangri-Las such as the one with all the alleged centenarian yogurt eaters in the Caucasus Mountains region of the former Soviet Union?

Well, this one is real, with claims backed up with demographic and scientific documentation.

It is Okinawa, the largest in a collection of palm-shaded islands between mainland Japan and Taiwan, that has experienced unusual social turmoil.

On Easter Sunday 1945, it was invaded by U.S. military forces, marking the start of the bloodiest campaign of the Pacific theater of World War II. It also served as a base for bomber raids during the Vietnam War and continues to be a major U.S. military foothold in the region.

Despite this turbulent history, Okinawans enjoy better health and longevity than other Japanese and Americans. Centenarians number about 34 per 100,000 people on Okinawa, many of them still healthy and living independently, compared with 5 to 10 centenarians per 100,000 in America, where more are in poor health.

What are the Okinawans' secrets?

They don't do it with hormone replacement or arcane remedies. Genetic endowment plays a role, but their prescription for longevity is a familiar one: Diet, exercise, stress management, social and family ties and spirituality.

Doctors have been studying the Okinawa phenomenon for 25 years, and the results have been revealed in "The Okinawa Program" (Clarkson Potter, $24.95). It's a hefty book that sums up the scientific data (with lengthy notes for doctors and scientists) along with practical tips for non-scientists who might want to learn some lessons from these remarkable centenarians.

"A lot of the things they [Okinawans] do make good sense in terms of our current nutritional advice," said Dr. David Jenkins, professor of medicine and nutritional sciences at the University of Toronto, who is familiar with the Okinawa project. "You name the things we think of as important and they get them."

"They don't have difficulty consuming 10 servings of fruit and vegetables a day. We have difficulty getting two or three. We're now looking at the pharmacologic effects of phytochemicals in plant-based diets. A lot of these are the so-called antioxidant materials that may prevent DNA damage."

"A lot of the Okinawa approach to life has tremendous merit."

Dr. Makoto Suzuki, a cardiologist and geriatrician, began the Okinawa study in 1976, sponsored by the Japanese Health Ministry.

Bradley Willcox, a Mayo Clinic-trained internist and a geriatrics fellow in Harvard University's Division on Aging, and his brother D. Craig Willcox, a medical anthropologist and gerontologist, joined the study seven years ago.

There are lessons in what they found. Each day, Okinawan elders eat and average of seven servings of vegetables and fruit, seven servings of grain and two servings of soy products. They consume omega-3-rich fish several times a week and minimal dairy products and meat (amounting to 1 ounce of pork or poultry a day).

"We've seen studies on this type of diet that show cholesterol levels drop over one year," Bradley Willcox said. "And now we've seen what the outcome is with this type of diet over 25 years."

"And the outcome is very low mortality from almost every major cause."

According to the investigators, this is the type of diet that affords protection against most of the diseases associated with premature aging, including heart disease, cancer and stroke.

The main method of cooking is low-temperature stir-frying with canola oil. It's one of the healthiest oils on the market (particularly the cold-pressed type) because it's very low in saturated fat, the type that produces cholesterol in the body, the authors wrote.

"But it's high in the monounsaturates, which help reduce the amount of LDL, or bad cholesterol."

The diet also has heart-healthy omega-3 polyunsaturates, a feature of fish, especially salmon, tuna and mackerel.

Another difference between most Americans and Okinawan elders is a self-imposed habit of calorie restriction.

Okinawan elders tend to stop eating before they're full. They call this strategy hara hachi bu, which loosely translates to "eat until you are eight parts full [out of 10]."

Less can be good

"If you think of a single mechanism that would explain why caloric restriction seems to extend not only life span but health span," Willcox said, "it would be reduction of free radicals, because less food is being metabolized for energy."

"It's clear free radicals [molecules lacking an electron] do damage cells, DNA. They damage cell walls, they damage the little powerhouses in the cell, mitochondria, and it's clear that damage causes many of the things that happen in the aging process."

"Studies we've done on the oldest of the centenarians [show that] they do have long-lived brothers and sisters, so there's clearly a genetic component," Willcox said. "We think of the centenarians as having `longevity-enabling genes.'"

"It's how they live their lives [that determines] whether they're going to make it to 100 or not."

"Most of us have genes that are going to enable us to live to be 85 or 90. And if we have a very healthy lifestyle, maybe we'll make it to 100," he said.

Willcox noted that when Okinawans leave the islands and abandon the traditional ways, they suffer the consequences.

"There are over 100,000 Okinawans in Brazil," he said. "They eat 18 times more meat, almost double the processed meat, 3.4 times as much sugar, 2.5 times as much milk products, 1.2 times as much salt and only 70 percent of the fish and vegetables that Okinawans on Okinawa eat."

"The number of centenarians in Brazil is only one-fifth that in Okinawa."

"There are lots of factors that determine the number of centenarians per 100,000 in population, but the life expectancy figures corroborate those differences as well."

A slower pace

On Okinawa, the prevalence of fast-food restaurants and convenience stores that purvey snacks no doubt will exact a toll on the health of younger Okinawans who patronize them, while the middle-aged eat a mix of traditional foods and less healthy types, Willcox said.

Diet isn't the only thing that affords elder Okinawans more years of good health.

Personality testing found that the centenarians, when in the prime of life, scored low in feelings of "time urgency" and "tension" and high in "self-confidence."

Willcox said they operate on what they call "Okinawa time," which often means nothing starts on schedule.

Interviews showed that they had optimistic attitudes, adaptability and an easy-going approach to life. Moderation was a "key cultural value."

In addition to Western medicine, traditional shamanistic healing practices are part of the lives of the elders, with "a deep spirituality" particularly evident among the older women, who take an active role in worship and are the religious leaders of society.

"We've found that Okinawans firmly believe that they and their villages are naturally healthy," the authors write. "Health and longevity are celebrated, and health is the theme of most prayers."

Similarly, exercise is integrated into the lives of Okinawan elders. It may take the form of gardening, tai chi, traditional dance, which is similar to tai chi, and light martial arts.

"A lot of them belong to community centers," Willcox said. "Elder day care is subsidized by the government, so all these people can go to day-care programs and participate in things like croquet. And they're pretty competitive."

Spiritual connections

"They engage in a lot of other things. They play the traditional Okinawan guitar, a banjo type of instrument. A lot of the activities they do seem to have a spiritual component that connects the mind and the body."

Although younger Okinawans have moved south, where the jobs are, elders often are concentrated in the north, where friendship networks are a form of social support.

But not every centenarian is at the peak of health.

"People get more different as they age because time and their lifestyle have had that many years to work on them," Willcox said. "So those that have been having a healthy lifestyle for 100 years tend to be healthier centenarians than those that maybe had good genes but an unhealthy lifestyle."

"So you see about one-third of the centenarians that are unwell. They never leave their rooms. A third get around but need some help with shopping and dressing. And about one-third are in phenomenal shape. They look 70. You'd never know. They're cooking. They're flying to Tokyo to visit relatives."

"But even if you're 100 and you're in the third that's unwell for a couple months of your life, that's a better way to be than to be 60 and live to 75 and the last 15 years you're taking 18 pills and having chest pain all the time."

Okinawan elders do succumb to cardiovascular diseases and cancer, but Willcox said, "a higher percentage of them die of things that, in a sense, finish you off rather quickly, like pneumonia, where you're sick for a few weeks or shorter and you're gone."

"People have to die of something, but what's impressive is there's a higher percentage of people dying of no known cause, which we liken to dying of old age, wearing out."

By Connie Lauerman, Tribune staff reporter
June 24, 2001
© The Chicago Tribune