The Longevity Solution

by Jason Fung

  Tea/coffee/wine: Like most Italians, they drink plenty of red wine.

  Salt: They have high sodium intake from milk and cheese.

  Fat: They eat lots of chestnuts and walnuts, which are high in monounsaturated fats. The diet is higher in dairy fats.

  Loma Linda, California

  Loma Linda, California, which is just 60 miles east of the sprawling metropolis of Los Angeles, is an unlikely place to find one of the world’s highest rates of longevity. Its residents, who live as much as a decade longer than the average American, largely belong to the Seventh-day Adventist Church, a theology that recommends vegetarianism and abstinence from smoking and alcohol.

  Loma Linda University, operated by the Seventh-day Adventist Church, first began its study of the dietary and lifestyle habits of close to 25,000 residents in 1960. The original study, the Adventist Mortality Study (1960 to 1965), showed a significantly lower rate of cancer and heart disease compared to non-Adventists in the United States, which translated into a longevity advantage of 6.2 years for men and 3.7 years for women. The next study, the Adventist Health Study I (1974 to 1988), confirmed this finding; Adventist men lived 7.3 years more than the average Californian and women lived 4.4 years longer. The five main behaviors to which researchers attributed the benefits were not smoking, regular exercise, maintaining healthy body weight, eating more nuts, and eating a plant-based diet.

  Although there is no controversy about the first three behaviors being healthy, the importance of eating nuts, which are high in natural fats, was highly controversial at the time the results were published. Since then, multiple other studies have confirmed those results. Although much of the benefits in the Adventist study in the popular press has been ascribed to the plant-based diet, it is likely the lack of tobacco use that is the most important factor.

  The latest major Adventist Health Study (AHS-2), which started in 2002 and is ongoing, has analyzed the diets of 96,000 church members around North America. So far, the researchers have concluded that those members who’ve followed a vegetarian diet (a little more than half the population) are less likely to develop high cholesterol, high blood pressure, diabetes, metabolic syndrome, and even various types of cancer.10 In particular, Adventists who eat more fruits, legumes, and tomatoes have shown lower rates of certain cancers.11

  Longevity Checklist: Loma Linda

  Calorie restriction/fasting: Residents of Loma Linda eat a vegetarian diet that’s often lower in calories than a diet that includes meat.

  mTOR: Residents of Loma Linda eat a diet high in plant protein and low in animal protein.

  Tea/coffee/wine: Tea and coffeeare not specifically encouraged or prohibited. (The Adventists do not drink alcohol.)

  Salt: The diet includes a normal level of salt.

  Fat: The diet includes nuts, which means people consume a high level of natural fats.

  Nicoya Peninsula, Costa Rica

  Further south, along the sunny northern Pacific coast of Costa Rica, lies the Nicoya region. Its residents, especially the men, reach the age of 90 at a rate 2.5 times greater than people in the United States.12 The probability of a 60-year-old Nicoyan man celebrating his 100th birthday is seven times that of a Japanese and Sardinian male, and he has a lower risk of cardiovascular disease.

  The traditional Nicoyan diet is high in fiber; it’s largely plant-based with staple foods like freshly made corn tortillas, black beans, papayas, bananas, and yams. Nicoyans might eat chicken, pork, and beef, but mostly their plates are filled with starches like rice and beans.13 They do consume slightly more calories, carbohydrates, proteins, and fiber than the average Costa Rican, who also rank fairly high on the longevity spectrum. Nicoyans’ protein intake is 73 grams per day, which is much lower than the 100 grams of the average American. Overall, the residents of the Nicoya peninsula tend to stick to their traditional foods rather than eating processed and refined varieties.

  Longevity Checklist: Nicoya Peninsula

  Calorie restriction/fasting: Nicoyans eat a plant-based diet that’s typically very low in overall calories. They tend to eat very little in the evening.

  mTOR: Nicoyans eat a plant-based diet that is low in meat.

  Tea/coffee/wine: Nicoyans are heavy coffee drinkers. They usually drink it daily.

  Salt: Nicoyans eat a normal amount of salt.

  Fat: Because of the vegetable-based diet, Nicoyans have a lower fat intake overall, but they get some fat from animal sources. They do not use vegetable oils.

  Ikaria, Greece

  The small, mountainous island of Ikaria, named for the legend of Icarus, sits in the Aegean Sea between the mainland of Greece and Turkey. Its population of nearly 8,500 inhabitants follows mostly Greek Orthodox Christian traditions. They live to be 90 years old around three times as often as Americans, and many are unaffected by dementia and age-related chronic diseases.14 Ikaria’s reputation as a health destination dates back 2,500 years; the ancient Greeks would travel to this small island to soak in the hot springs.

  Anyone following a Mediterranean-style diet should look straight to the plate of the Ikarians, who eat an abundance of fresh fruits and vegetables, whole grains, beans, potatoes, and plenty of olive oil. They also indulge in antioxidant-rich herbal teas of wild rosemary, sage, and oregano. A typical breakfast consisted of bread and honey with wine, coffee, or a local mountain tea. Lunch was almost always beans (lentils, garbanzo) and local, seasonal vegetables. Dinner was typically bread and goat’s milk. Ikarians would eat meat on special occasions.15 The local Ikarian diet, typical of other Mediterranean diets, included plenty of olive oil, wine, and vegetables, and it’s lower in meat protein than other Western diets. On average, Ikarians eat fish twice per week, and they eat meat only five times per month. They frequently drink coffee (averaging 2 to 3 cups per day) and wine (about 2 to 3.5 glasses per day). Ikarians consume only about a quarter of the refined sugar that Americans eat. Bread tends to be sourdough, although they also eat stone ground wheat bread. Probably more importantly, one resident notes that “Food is always enjoyed in combination with conversation.”16

  As devout Greek Orthodox Christians, many Ikarians also follow a religious calendar that includes many periods of fasting. One study that looked at fasting in particular found that those who regularly fasted reported lower blood cholesterol and body mass index (BMI).17 Of course, we already know the other impressive benefits that come with calorie restriction and fasting, including reduced blood pressure, cholesterol, the risk of several chronic diseases, and the potential to live a much longer, healthier life.

  Longevity Checklist: Ikaria

  Calorie restriction/fasting: Ikarians follow the Greek Orthodox tradition of fasting.

  mTOR: Ikarians eat a diet low in animal protein.

  Tea/coffee/wine: Ikarians drink lots of coffee and red wine.

  Salt: There are natural salt springs in Therma. The diet includes high levels of salt from milk, cheese, and olives.

  Fat: The sources of fat include lots of olive oil and fish.

  The UnBlue Zone: The Southern United States

  In contrast to the healthy Blue Zones, certain diets in parts of the world are associated with increased risk of heart disease and decreased longevity. It is just as useful to look at these diets to learn what not to do as it is to look at the Blue Zones to determine what to do. The best-studied example comes from the southeastern area of the United States. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study18 followed more than 17,000 adult participants over five years to look at various dietary patterns, including a so-called “Southern diet.” The Southern pattern of eating was high in fried foods and added fats (mostly vegetable oils), eggs, organ meats, processed meats, and sugar-sweetened beverages. Where most diet patterns studied were neutral on cardiovascular health, the Southern diet stood out as especially harmful to human health, with a huge 56 percent increase in the risk of cardiovascular disease, 50 percent increase in kidney disease, and 30 percent inc
rease in stroke. This group also had more obesity, high blood pressure, and type 2 diabetes than the rest of the United States.

  The Southern diet was not particularly high in calories; the average was about 1,500 calories per day. The macronutrient composition also wasn’t particularly different from the rest of the United States—about 50 percent carbohydrates and 35 percent fat. This finding emphasizes that we must do more than look at the general categories of macronutrients; we also must look at specific foods for their effect.

  The total amount of red meat in the Southern diet was not particularly high, but the quantities of processed meats were off the charts. There is a huge difference between rib eye steak and a hot dog. The processing of meat introduces numerous chemicals and other additives (such as sugar, sweeteners, nitrates, and phosphates) that may adversely affect health. Also, the Southern dietary pattern contained large amounts of bread.

  The Southern Diet is an example of a diet that does not promote longevity. There is no calorie restriction or fasting, and the high sugar intake means that insulin levels are high, which contributes to the excessive obesity rates that are common in the southeast United States. Indeed, the three most obese states in the United States in 2014 were Mississippi, West Virginia, and Louisiana.

  The relatively high American meat consumption means that mTOR is kept high. Instead of eating natural fats, the Southern diet includes added fats, almost all of which are vegetable oils. People commonly cook fried foods in industrial seed oils, which are inexpensive and readily available.

  Longevity Checklist: Southern U.S.

  Calorie restriction/fasting: The Southern diet doesn’t include any calorie restriction or fasting. The usual American dietary advice is to eat more than three times per day.

  mTOR: The Southern diet is high in meats and processed meats.

  Tea/coffee/wine: There’s no specific emphasis on these beverages in this diet. People drink iced tea, but it’s very high in sugar.

  Salt: This diet is high in salt, mostly from processed foods.

  Fat: Vegetable oils are a prominent part of this diet.

  What If You Don’t Live in a Blue Zone?

  The Blue Zone areas share more than just diet. In this book, we’ve focused intentionally on dietary determinants of longevity, but there is more to it than that. A healthy dose of sun and sea, some mountainous terrain, and a dedication to natural movement are integral to the longevity of people in these areas. The healthiest people in the world don’t go to the gym. They don’t sweat to the oldies. They don’t use a treadmill. They don’t pump iron. They don’t run marathons. They include movement as part of their natural way of life.

  In these Blue Zones, movement is life. People walk. They climb mountains, not because they are there but to tend their sheep. They tend their gardens. They dance. They play games: soccer when they’re young and lawn bowling when they’re older. They don’t use stand-up desks. The healthiest people not only eat natural foods but they follow natural movements. When sharks stop swimming, they die. When people stop moving, we, too, die a little at a time.

  Socializing and maintaining tight-knit communities also plays a significant role in longevity. The healthiest people in the world don’t eat in front of the TV. They eat with their family and friends. They linger over shared meals because they are enjoyable. They don’t grab a quick bite simply to eat.

  What lessons can you learn from people in Blue Zones if you’re not lucky enough to live in one? Keeping insulin, calories, and mTOR low is a great start. You can do this with plant-based diets, but none of the Blue Zones are completely vegetarian or vegan; each includes some animal foods. This fact is important to note because there is a risk for vitamin A and vitamin B12 deficiency on a vegan diet if you don’t use appropriate supplementation. Vegetarians and vegans eat more fiber and less protein on average—and little to no animal protein. A French study finds that vegetarians and vegans ate 33 percent and 75 percent more fiber than meat-eaters, respectively, but both groups eat fewer overall calories, total protein, and fats.19

  Although many Blue Zones share this plant-based diet, this is not proof that eating plants is healthier than eating meat. It’s possible that meat was limited in the diets of these areas not by choice but simply because people couldn’t afford to eat a meat-based diet. Many other areas of the world also eat a primarily plant-based diet without having a specific longevity advantage. For example, many people in India eat a vegetarian diet, yet the life expectancy of Indian citizens in 2018 ranked 165th in the world at an unremarkable 69.1 years. Eating meat is not necessarily unhealthy; Hong Kong has now surpassed the rest of Asia in longevity although its residents eat a diet comparatively high in meat. As in life, the importance is balance. Eating sufficient meat is just as important as avoiding excessive meat intake.

  Eating a plant-based diet does not guarantee that the diet is healthy, just as eating a meat-based diet does not guarantee that it’s unhealthy. The key is eating the right vegetables and meats. Vegetarians in the Adventist Health Study typically increased their consumption of fruits, vegetables, avocados, whole grains, legumes, soy, nuts, and seeds while reducing their intake of refined grains, added fats, sweets, snack foods, and non-water beverages. Eating a chocolate donut can be 100 percent vegan. Drinking sugary soda is 100 percent vegan. Eating potato chips (fried in vegetable oil) is 100 percent vegan. But few would argue that eating and drinking these things are inherently healthy just because they are of plant origin. Long-term maintenance of a vegetarian or low-meat diet can reduce the risk of diabetes, cancer, hypertension, cardiovascular diseases, and mortality from all causes if you do it properly.20 If you do it improperly—using refined grains, refined vegetable oils, and sugars—a vegetarian diet may be a health nightmare.

  As far as total protein intake, if you follow the traditional Mediterranean diet of the Sardinians and Ikarians—which does allow for some animal products—you’d still be consuming only about 15 percent total protein and 43 percent carbohydrates.21 Or if you want to take lessons from the Okinawan centenarians, you’d be reserving only about 9 percent of your diet for protein with a whopping 85 percent for carbohydrates.

  Less Protein, Longer Life?

  We can’t eliminate protein, of course. Too little protein at any age can lead to malnutrition. As we age, protein becomes just as crucial as it was when we were younger—just for different reasons. Most elderly people don’t get enough protein to maintain a strong, healthy muscle mass. A lack of certain amino acids, like cysteine (a crucial player in the body’s internal antioxidant system), can also promote aging and oxidative stress.

  Calorie restriction and fasting have long been proven as likely tools for longevity, but the intricacies behind why is still a mystery. Balance, of course, is essential, and being mindful of the type and amount of protein—and carbohydrates—you consume could be the key to a longer, healthier life. Promises of longevity are complicated; IGF-1 and mTOR, both of which promote growth, could be significant factors (refer to Chapter 3). Reducing protein consumption has been shown to lower both IGF-1 and mTOR, even lowering IGF-1 significantly in just three weeks.

  Unfortunately, we can’t give you any exact numbers that tell you the magical amount of macronutrients to guarantee a long, disease-free life. From the evidence we have now, we can propose that a normal, healthy person should consume anywhere from 1.0 to 1.8 grams of protein per kilogram of body weight per day. Where you fall in that range depends on myriad factors—your current age, health, activity level, and even your overall diet itself.

  Importantly, quantity is not the only variable that matters. Quality and the source of protein—animal versus plant—may be just as significant as the proteins themselves. We can look to the healthy centenarians in the Blue Zones of Okinawa, Sardinia, Loma Linda, Nikoya, or Ikaria for some real-life evidence and inspiration. Their traditional, largely plant-based and lower-protein diets have kept their populations living longer and healthier for centuries. But even in some
of these areas, those eating patterns are quickly fading, and so are their enviable health and longevity stats, thanks to some unfortunate Western-inspired habits.

  There is no single secret to healthy aging and longevity. As discussed in Chapter 12, those people who live in the various Blue Zones have taken completely different paths to living past 100 years of age. But all these people share some common dietary practices. In this chapter, we outline five steps that make up our Longevity Solution checklist. Following most, if not all, of these steps, may dramatically improve your overall health.

  Step 1: CalorieRestriction/Fasting

  Calorie restriction has the potential to increase longevity and improve health, but it’s very difficult to implement in daily practice. Certainly, there has been no shortage of ways we’ve tried to reduce calories, including mandatory calorie labels and calorie counting books and apps. The Okinawans demonstrate that it’s possible to follow a plan of deliberate calorie restriction, but they remind themselves daily to do this by stopping before being full. A more practical solution may be fasting. Intermittent fasting has almost as many variations as there are practitioners. With intermittent fasting, you can decrease protein intake without altering much of anything about the food you eat.