As we continue on our journey discovering insights from the longest, healthiest lived people in the world, we leave Sardinia (featured in the previous Blog) and embark upon Okinawa, which researchers from National Geographic and the National Institute on Aging, along with Dan Buettner, author of Blue Zones, claim is home to the best practices of health and longevity — enabling people to thrive in advanced age.

While many Americans likely associate Okinawa with WWII, there are other aspects to consider that can provide a different perspective of its culture and people. Currently they enjoy one of the highest ratios of centenarians, and not only the highest life expectancy in the world, but perhaps more importantly, the most years of healthy life – disability free life expectancy. Yet while they too, suffer from diseases that kill Americans, they do so at a significantly lower rate: a fifth the rate of cardiovascular disease, one-fourth the rate of breast and prostate cancer, and a third the rate of dementia.

Certainly lifestyle plays a predominant role. However, there may be a more prominent factor that is relatively foreign in practice among most Americans — the role of prevention. We seem to focus far more on battling disease once it occurs, whereas traditional Asian culture’s highest, most honored form of medicine is prevention – treatment, is the lowest.

Okinawa’s island climate, often referred to as a Japanese Hawaii, is obviously conducive to growing vegetables and herbs in gardens all year long, which they do. In fact they often refer to their garden as their kitchen – a likely longevity secret.

But it’s more than just what they eat, it’s about how much they eat, too. Before each meal, a long Okinawan tradition is to say, “Hara hachi bu,” which basically means ‘Eat until you are 80 percent full. Not only does it take 20 minutes for the stomach to tell the brain it’s full, but restricting calories is believed to slow down the body’s metabolism in such a way that it produces less damaging oxidants – agents that rust the body from within.

Okinawans traditional diet is very simple — nothing processed — which disrupts the natural balance in the body, and contributes to systemic inflammation that increases the risk for all diseases of aging, like osteoporosis, heart disease and dementia.  Their intake of vegetables is like a natural pharmacy of anti-inflammatory, antioxidant, antiviral, anticancer drugs. Cancer doesn’t’ happen overnight, it’s a process. And this form of diet is prevention that promotes and protects good health.

But there are other aspects of the Okinawan lifestyle that may be equally important to their longevity and good health. Like the fact that there is no word for retirement – nor do they show any signs of believing in it or practicing it. Their word is “ikigai” – the reason for waking up in the morning. Regardless of age, roles are very important here — everybody needs something to do, to feel needed, and to have a purpose because the loss of a person’s role can have a measurable effect on mortality. Not only does this contribute to longevity, it’s a reason to live.

“Moai” is another key longevity concept that refers to a lifelong group of friends who they see and visit with on a daily basis. It means “meeting for a common purpose” and whether that’s just to talk, share, laugh or consume sake, it is sacred time that provides great health benefits too, through stress reduction and companionship. Some even refer to it as their “ikigai” as these are friends they can count on no matter what. They share their problems with each other, thus eliminating the need to worry and benefiting by helping take care of others. Going through life knowing you have a safety net makes the journey easier.

What is of significant interest with regard to “moai” is that this social support network is established very early in life among all Okinawans. Around the age of 5, children meet their lifelong group of friends and maintain this relationship throughout their entire life … through all the different phases of their life. The concept also assures families that if something were to happen to them, no family member would ever be left alone – there would always be a back-up family to provide support.

Okinawans also gain great strength and support from their spiritual connection. They give gratitude for each day and making daily offerings to their ancestors is a ritual that is a cornerstone of their spiritual life. They have an altar area in their homes that holds a collection of vases with flowers, urns and old photographs where they light incense and recite a series of prayers. Older Okinawan women in particular, have great respect for their deceased ancestors, and believe by making their morning offerings, the ancestors will watch over them for the rest of the day. If something bad happens, then it was meant to be; if something good happens, it’s because the ancestors were looking out for them. They relinquish worries to a higher power – believed by many to be a healthy way of living.

Stress-coping mechanisms are a key component of longevity, as it’s estimated that 60-80% of all health problems in the U.S. are stress related. So while there are all different variations of centenarians, the healthiest Okinawans generally possess similar lifestyles and temperaments. Additionally, they have a good sense of humor, appreciate what is vs. not what could have been, and maintain a purpose-driven, tradition-based lifestyle.

For many Okinawa centenarians, their “ikigai,” their sense of purpose is likely longevity itself – it’s their reason for being.