The Okinawa Program
How the World's Longest Lived People Achieve Everlasting Health - and How You Can Too
by Bradley J. Willcox, M.D., M.Sc.
D. Craig Willcox, Ph. D.
Makoto Suzuki, M.D., Ph. D.
The "Okinawa Program" represents much more than 25-year research study of Okinawa's many centenarians. This book translates the lessons of this research into a comprehensive health manual for a Western audience. This critical distinction forces the reader to evaluate the text on two levels. What did the authors find out and how do they project their insights into a complete program?
My short answer is that I give the authors four and a half out of five stars on both accounts. The book will assume an honored place in my treasury of nutrition and health books. I may want to return to it for several more reads. Regardless of this book's shortcomings as a health and longevity manifesto, the Okinawan centenarians have made a profound impression on the authors, an impression that permeates and regularly revives the text.
The Okinawans suffered great hardship in the first half of the twentieth century. First, they had crushing poverty that led many to migrate to foreign lands for greater economic opportunity. Second, they suffered a devastating battle on their land in WWII in which a quarter of their population perished. Third, many of them retreated to caves and subsisted on berries during that war.
Under these circumstances (and in past centuries, when typhoons wiped out their crops), Okinawans turned to the yam, a sweet potato, for as much as 80% of their nutritional intake. Thus the diet of many of these centenarians may be considered less than ideal for the first fifty years of their lives. However two indications emerge. They practiced calorie restriction because they had to, and they consumed a big variety of vegetables, fruits, and herbs (unrefined carbohydrate in modern parlance).
Perhaps long-standing cultural traditions stood the Okinawans in good stead during times of famine, when they resorted to gathering edible foods from the rain forest. Whatever the case, their precarious existence seems to have stood them in good stead, until a fortuitous confluence of events shifted luck to their favor. The United States retained control of Okinawa from WWII until 1972. Political stability, economic growth, and Western technology enabled Okinawans to set new standards for longevity.
This unique confluence of events must be analysed with the precision of stop-action photography, because Okinawan health and longevity may be transitory. Whereas the elders adopted only the advantages of Western technology that helped them, following generations have adopted some disadvantages of the new technology as well. The coming generation of elders has less health, and many young professionals have abandoned traditional ways in favor of cosmopolitan lifestyles. The authors concede that their "Shangri-la" (this is how they refer to Okinawa in the first chapter) is being paved over.
Details about food percentages may bore some readers. However, forward-thinking nutritionist debate this subject intensely. The Willcox's and Suzuki fervently proclaim their "Shangri-la" and they criticise Barry Sears. They say he takes their information out of context in the "Soy Zone" and suggest that his "followers" might consume dangerous amounts of protein.
In 1995, Barry Sears was the first to promote his "Zone" as an ideal health condition akin to nirvana (engaging in some hyperbole in the process). In supplying optimal food ratios, he set the standard for nutritional debate. Further, he furnished a complete system of food amounts that can accurately produce ANY food ratio for a meal.
Interestingly in 2001, authors Willcox, Willcox and Suzuki entitle their first chapter, "Okinawa, the real Shangri-la". Then in a footnote at the back of the book they refer their title as only a "metaphor." In a subsequent chapter, they supply food percentages by calorie and weight. Then they provide a Western analysis of this eating plan. They refer to "U.S. Unified Guidelines", formulated in 1999 by scientific authorites, including the American Heart Association, The American Dietetic Association, and the National Institutes of Health.
The information as presented begs the question of how the Okinawan elders ever followed the U.S. Unified Guidelines or the "program" named for them. Does this program recommend occasional fasting or famine?
The exact food ratios consumed by Okinawan elders can be difficult to discern from the text. However, based on information in pages 70-72, the total calories appear to be Protein 22%, Carbohydrate 54%, and Fat 24%. These figures produce a Protein/Carbohydrate ratio of .41.
For reference, Barry Sears' Zone diet recommends a P/C ratio of .5 to 1.0, so the ratios come close, but they do not overlap. However, the Zone diet assumes that common food supply includes a significant amount of processed sugar and flour - as much as 25% of the total carbohydrate intake. Meanwhile, the Okinawan elders do not consume refined carbohydrates in that quantity. They eat a preponderance, and a great variety, of unrefined complex carbohydrates.
Returning to page 71 of the "Okinawan Program" the pie charts show Okinawan intake by weight (not calories). Their intake consists of Vegetables 34%, Grains 32%, Fruits 6%, Soy-type foods 12%, Fish 11%, Meat/Dairy/Seaweed 5%.
At first, these numbers suggest overwhelming quantities of carbohydrates. However, vegetarians will tell you that vegetables, grains, and fruit provide protein as well. Consider that these foods, consisting 80% of water, have been measured by weight. Then, observe that these items do not include white flour or sugar.
This difference between types of carbohydrates in the food supply offers a clue for us to find our own optimal state of health. Many meals in the Okinawan diet may be closer to Barry Sears' Zone than they first appear to be.
While the "Okinawan Program" provides a rigorous assessment of diet for the Westerner, some incongruities seem worthy of mention. First, the text has prevalent mention of the use of canola oil by Okinawans. A footnote purports the superiority of canola oil to olive oil. Certainly, the Okinawans should be credited with making good use of a product originating in the West. In that regard, canola oil is genetically engineered and originates in Canada. Coauthors Willcox and Willcox are Canadian.
The third author, Suzuki comes from Japan. The text reveals that he suffered a stroke in his fifties, and credits the "Okinawan Program" for his complete recovery. While it is encouraging to find that lifestyle changes have made a difference for him, it would be more encouraging to have evidence of him putting the program into practice for a longer time.
At some point, mention is made of a ninety-five-year-old Okinawan quitting smoking ten years earlier. This mention presumably is geared for a lesson in moderation to an older audience, yet it underlines the reality that Okinawan elders have not all followed the program as presented.
Another interesting fact lies in the longevity of women. They outlive the men by eight years and may be responsible for Okinawa's impressive statistics on health and longevity.
The nutrition part of the "Okinawan Program" proceeds to until page 178, then resumes from pages 296 to 400. The first part breaks down the strengths of the Okinawan diet (including foods, herbs, spices, vitamins, and minerals) in Western terms. The second part provides a four-week dietary schedule with pantry recommendations and a recipe section. Each recipe contains a listing of macronutrient percentages (Protein, Carbohydrate, Fat).
The section between pages 178 and 296 contains an "everything but the kitchen sink" approach to physical fitness, spirituality, and philosophy. Some of it is clearly geared to a retired audience with sufficient leisure time to pattern their life rhythm after this program.
While it is tempting to skim over this section, it contains some useful, concentrated, and compelling information. Here is a short list of subjects: the range of martial arts and their origins, which martial art can be adapted for an exercise regimen, the 7 steps of becoming a changed person, attitudes toward healing, the psychology of optimism, the benefits of a social network, and learning "Okinawan" time.
Again, the material makes the reader wonder which centenarian ever followed a program like this, with so many layers of Western thinking. However, the authors have treated the material with depth and thoughtfulness. They have set themselves the ambitious task of writing a comprehensive health and longevity manual. Perhaps they seek to honor their centenarians, who have until recently been ignored by their own. The authors have largely succeded.