Okinawan Longevity "Pearls'...My Experiences from Honolulu to Okinawa

Kirk's video overview of his interview with Dr. Bradley Willcox (9:57 min)
Kirk's Interview with Bradley Willcox, MD, in Honolulu, Hawaii (video or audio min 50:37)

Kirk Hamilton interviews Bradley Willcox, MD
regarding the "old" and "new" Okinawa Centenarian diet still supporting remarkable longevity and function compared to the modern Okinawan diet which is high in processed foods, more processed carbohydrates, more animal foods and higher intakes of inflammatory types of fat resulting in an epidemic of chronic diseases.

Specific topics discussed are types and amounts of carbohydrates consumed by the Centenarians in the early years which was mainly sweet potato and soy bean foods versus the increased consumption of rice and bread products presently; the use of soy and canola oils for cooking presently compared to the very low-fat diet coming from pig lard in the early Centenarians; significant consumption of soy products such as tofu, edamame and miso by early and current Centenarians; daily consumption of small quantities of fish products or meat such as pork, which is currently increasing, but still consumed more as a condiment than a significant portion size; large amounts of colored vegetables such as goya (bitter melon); the consistent daily consumption of seaweed throughout all the years; the higher amounts of herbs and spices, including turmeric, in the Okinawan cuisine compared to traditional Japanese cooking; and the small but increasing amounts of dairy products being consumed.

The elders are still very physically active. Walking, gardening, farming, fishing, etc... Try getting up from the floor in a cross-legged sitting position 10-20 times per day at the age of 90 plus! I can't even get my 70 plus year old patients up once every half hour from their chairs during a television advertisement!


Interview Summary ...

Dr. Willcox's Background...

Bradley Willcox, MD, is an internist and gerontologist at the Department of Geriatrics,  University of Hawaii, John A. Burns School of Medicine, Kuakini Medical Center.  He is co-principle investigator of the Okinawan Centenarian Study and co-author of the books "The Okinawa Program" (2002) and "Okanawa Diet Plan" (2005) with Makoto Suzuki, MD and brother Craig Willcox, PhD.

Dr. Bradley Willcox has been studying centenarians since 1994 working with Makoto Suzuki, MD creator of the Okinawan Centenarian Study (1976) and his brother Craig Willcox, PhD.

How Bradley Willcox, MD Got Interested in Longevity and Okinawan Health...

He always had an interest in sports and health and in 1992 went to University of Toronto Medical School.  Prior to his first year in medical school he went to Japan and became very interested in the health and longevity of Japanese people. In medical school he worked with David Jenkins, MD, PhD (creator of the Glycemic Index and Dietary Portfolio) and Craig Willcox, PhD (twin brother, Okinawa International University), on a project studying prostate cancer and diet in Japanese men who had an 80% lower incidence of prostate cancer than men in North America.

They compared Japanese men in Canada to those in Japan. He discovered a 105 year old Japanese, Okinawan, who was Canadian. He was always very active and it was difficult to recruit him for the study because he was always doing something. His wife was 90 plus years of age.

It was noted that the health of Okinawan, Japanese was better than the general Japanese population. He did a research exchange in 1994 and he and his brother, along with Dr. David Jenkins, went to study Okinawan longevity.

He and his brother met Dr. Makoto Suzuki, a cardiologist and geriatrician from Tokyo. Dr. Suzuki came from Japan to Okinawa to help with rural health when Okinawan went back to Japanese control from U.S. control in 1972. He found the elder Okinawans were extremely healthy. He became very interested in the differences in the health of the Okinawans versus other Japanese. The Okinawans were the healthiest of all the Japanese. Dr.Suzuki started the Okinawan Centenarian Study in 1975-76.

Okinawans - The Healthiest of All Japanese...

Okinawans were the healthiest from all of the 47 prefectures (or states) in Japan. There is an improving health gradient from the northeast to southwest in Japan. Those who live in the northeast are the least healthy because they consumed more salt and had more hypertension. As you go more southwest the population becomes more healthy, of which the Okinawans are the most healthy. They have two growing seasons. Eat more vegetables. Eat less salt and they live the longest. Since the 1880s the Okinawans have had higher numbers of 80 to 100 year-olds compared to the rest of Japan.

Japanese Standing on Longevity...

Japan didn't become the world's longest lived country until the 1970s and early 1980s when they past the Nordic countries, Sweden and Norway, because they previously had a higher incidence of stroke and hypertension, and, they had more infectious diseases (i.e tuberculosis, parasites, etc.) because of a poor public health system.

They did not develop a good public health system until after World War II and then got rid of infectious diseases, parasites and reduced infant mortality and stroke rates (by controlling salt intake and hypertension), then the Japanese', and Okinawans' in particular, with their good lifestyle, exercise and dietary patterns increased Japan's overall life expectancy, and then they became the country with the longest life expectancy.

Birth Cohort Effects of Japanese Health...

The "early" elders who were born before WWII, were the first cohort of the 20th century. They had very healthy diets and living habits. They survived to middle age, then got good health care and this propelled them to the top of the longevity charts around the world.

Younger Okinawans Lifestyle Reduces Overall Life Expectancy in Okinawa...

Modern Okinawan elders still have the longest life expectancy in Japan, which is still the world's longest lived country. But as you go down in generations the life expectancy, versus other prefectures in Japan, drops because the younger generation of Okinawans are more obese, eating unhealthy and drinking and smoking more.

Okinawan women at birth are "number 4" in life expectancy in Japan, but used to be "number 1." Men at birth were "number 1" in life expectancy and now they are 26th in Japan within the 47 prefectures because of the unhealthy lifestyle habits of the younger Okinawans males. This was called the "26 Shock" because of younger Okinawan males poor lifestyle pulling down the overall lifespan of Okinawan males.

Okinawan Life Expectancy...

Unhealthy Okinawan youth aside, today any Okinawan over the age of 65 still has the longest remaining life expectancy in Japan. Okinawan women over 50 still are "number 1" in Japan for life expectancy. Okinawan men are in the middle of the 47 prefectures in life expectancy in Japan. The younger Okinawan generation has a significant reduction in life expectancy.

Diet of the Okinawan Elders - Post War and Today...

In 1950-1960s the diet of the elders was largely plant-based diet. 80% from carbohydrates, 6% (5-10%) fat (pig fat), and 5-10% protein. Types of carbohydrates for the early elders had a low glycemic index and load. The majority were vegetables and root vegetables, such as sweet potatoes. More than 60% of the calories came from sweet potatoes. The rest of Japan consumed white rice along with lots of vegetables. There used to be sweet potato trucks, like ice cream trucks. (The elders of today have partially replaced the sweet potato calories with white rice and white bread).

The early elders for breakfast consumed low sodium miso, vegetables and chunks of very healthful tofu. Elder females were farmers "number 1" and "tofu makers" "number 2". There is lots of water in tofu. Some fat. But generally tofu is a low calorie food.

In older times meat was consumed maybe on average at 3-4 grams per day. Slaughtering of a pig occurred at the beginning of the year and the pig was eaten from "voice to tail."

Protein content of elders of today has doubled by eating more fish and pork. Some meat, fish or pork, is eaten daily. The elders of today eat small amounts of fish every day. In the early days maybe 15 grams of fish was eaten daily, mainly in miso soup.

Now the elders diet is 25-30% fat from fish and vegetable oils (canola and soy oil). In the older days the fat was 1/4 monounsaturated, 1/4 saturated and 1/2 polyunsaturated fats (high omega 3s in their diet) from pig fat.

Fatty acids have been measured in the elders and they have good omega-3:6 ratio. C-reactive protein, a marker of inflammation in the blood vessels, is low in the older Okinawans.

Edamame, tofu and miso are health foods. The elders of today still consume a large amount of tofu, though not as much as the early elders.

Elder's Basic Diet - Older Days...

Breakfast - Miso soup and side dish of sweat potatoes
Lunch - Stir fry tofu, bitter melon and side of sweet potatoes
Dinner - Vegetables and sweet potatoes

They dad some fish daily (15 gm/d). But smaller amounts than today, usually in miso soup. Sweet potatoes was their "bread or rice." Their grains were millet and brown rice. 9-10% of calories came from protein. 3-4 grams per day on average of pork were consumed. It was in very small amounts. The older Okinawans were very poor. Pork was eaten more at times of celebration. Generally not daily. In the beginning of the year they would slaughter a pig and eat it "from voice to tail."

Elder's Diet - Modern Days...

For breakfast it is miso soup with more fish. Now they eat less sweet potato and more white rice. Seaweed is consumed daily generally in miso soup. The protein content hasgone up to 18-20% of diet for the modern elders which is almost doubled from the early centenarians. Some meat is consumed every day from fish or pork. The modern elders are slower to change than younger generation so they still are "hanging on" to some of the old and healthier dietary patterns. While they are eating more fish and pork, it is not as much as the younger generation.

Dr. Willcox notes for longevity protein restriction is valuable when you are younger. But you may need more protein requirements as one gets older. In animal models of aging, the animals do better with lower protein in their younger years and higher protein intake in their middle ages and beyond.

"Bringing Back the Old Ways" In Okinawa...

There is a Government movement in Okinawa for health prevention on "Bringing Back the Old Ways." Scientists are working with the politicians on how to do this. Craig Willcox, PhD is on one of these committees.

Some of the "Old Ways"...

- Eat more sweet potatoes
- Eat more bitter melon (traditional vegetables)
- Eat more seaweed
- Eat more fish
- Eat more green and yellow vegetables
- Use more spices - different type of garnishes (turmeric, mugwort, etc.) - the Okinawan foods
are more vibrant than other parts of Japan. Okinawan food is "Japanese food with salsa".

Aging Research at the University of Hawaii...

The Kuakini Honolulu Heart Program from the University of Hawaii on Japanese males has spawned many longevity studies.

- Hawaii Life Span Study
- Hawaii Health Span Study

The NI-HON-SAN Study (started 1965 - now the youngest participant is 95 and the oldest was 106) became a longevity study. Originally there was 8006 Japanese and Okinawan males that were mostly born in Hawaii (Ohau), except 12% born Japan. In Japan there was a high incidence of stroke and very low heart disease. By the third generation of Japanese immigrants in the U.S.they had increased rates of heart disease and less stroke.

Top Things to Prevent Heart Disease...

There is 90% less heart disease in Okinawa than in the United States. But younger Okinawans are now getting heart disease at an alarming rate.

Things to Do...

- Eat a "plant heavy" diet
- Consume omega-3 fatty acids from fish, sea food, tofu (oils and phytoactive compounds)
- Be very active - the Okinawan farmer or fisherman walked miles each day
- Eat more green and yellow vegetables
- Carbohydrates are still the major of source of calories of the diet - eat low glycemic, high fiber carbohydrates like the sweet potato

Bone Health, Dairy and Calcium...

Older Okinawans did not consume much dairy but had strong bones. They were very physically active. Phytoestrogens from tofu were good for bone health. They ate some goat meat and goat's milk. There was very little dairy foods in the original Okinawan diet. They didn't have to have dairy to have strong bones. Okinawans had higher bone density than other areas of Japanese.

Alzheimer's Disease and Cognitive Decline...

Okinawans tend to maintain cognition longer and have less Alzheimer’s and dementia than other areas of Japan and the West. Alzheimer's and dementia are a strong vascular component. The brain gets "clogged" arteries.

The Kuakini Honolulu Aging Study (has spawned several hundred studies on dementia), which is an off-shoot study of the original Honolulu Heart Program (other "spin-off" studies include cancer, diabetes, Alzheimer's (AD) and dementia as areas of focus).

There are classically plaques and tangles in AD and dementia. There is a strong vascular component in AD and dementia. They (Kuakini Honolulu Aging Study) have done over a thousand brain autopsies and found some people with plaques and tangles who had perfect cognition. They have found others with multiple mini-strokes in their brains, but they still had good cognition. When they have a combination of the plaques and tangles along with the vascular lesions in the hippocampus (mini-strokes) AD and dementia can present themselves.

Dr. Bradley Willcox's believes there is a strong vascular component to AD and cognitive decline. Both have a strong inflammatory component (vascular disease and AD/cognitive) as well.

Dr. Bradley Willcox's Final Comments...

At the University of Hawaii, Kuakini Medical Center, Department of Geriatric Medicine, they are doing lots of studies on the chronic diseases of aging. There is a lot which can do to prevent these diseases of aging. By any measure the healthy Okinawan elders are a model for healthy aging to be learned from.


Bradley Willcox MD, MS is Co-Principal Investigator of the Okinawa Centenarian Study and "Kuakini Hawaii Lifespan Study", funded by NIH-NIA. He received his Bachelor and Master of Science from the University of Calgary and his MD from the University of Toronto andsubsequently trained in internal medicine at the Mayo Clinic and geriatrics at Harvard Medical School. He has published and lectured extensively in aging, nutrition and health, especially with reference to Okinawan longevity and has won numerous awards for his work. Dr. Willcox is currently funded by several research grants from the US National Institutes of Health including the Hawaii Lifespan Study (NIA) and the Prostate, Lung, Colon, Ovarian Cancer Trial (NCI) to study genetic and environmental factors that lead to healthy aging lower cancer risk. He is also part of the "Okinawa Research Center for Longevity Science" research team.

Be and Stay Well,


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