Which is the World’s Healthiest Diet?

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Guest blog by Vicky Ware

The World’s Healthiest Diet and Cultures

Finding out which foods are healthy is really hard…

Finding out which foods are good for health and which are bad is really complicated. Each food is made up of lots of components – an egg is a mixture of different types of fat, protein and micronutrients like vitamin D and iron. Studying whether an egg is good for health means finding out not only whether those individual components are healthy, but what the combination of ingredients does to health. Then there’s the small matter of taking into account everything else the person eats in a day, week, month and year along with the egg.

Add to that other factors influencing health such as exercise, exposure to stressful events and living environment and you’ve got an extremely complex system. So, although it’s sometimes possible to determine that a specific nutrient is good for health, it’s often more helpful to look at populations who are healthy and then find out what their diets are like. This is also great because it takes the long term view – the time frame over which most nutritional choices have an impact on health. It’s what you eat every day for years and years that matters, not what you have eaten in the past week.

Although other lifestyle factors such as genetics will affect how long and healthy your life is, experts think diet is responsible for 30% of a long-lived person’s longevity1, with only around 10% being related to genetics2.

What do we mean by ‘healthiest’?

The key is healthy ageing. A lot of the symptoms that are described as ‘ageing’ could really be seen as ‘things that happen if you eat badly for 50 years’, or ‘things that happen if you don’t exercise for 50 years’. They are not necessarily an inevitable feature of getting older. Some diets and lifestyles enable people to thrive rather than just survive.

Which populations eat the healthiest diets?

Okinawa, Japan

Okinawa is an area of Japan known for having a healthy, long-lived population relative to the rest of the world3. When they do inevitably die, it tends to be in their sleep2. In Okinawan culture you are considered a child until you reach 55 years of age4. This highlights their healthy attitude to ageing – they don’t fear ageing or feel like they have less worth as they get older, but rather more worth as their experience gives them wisdom.

The people of Okinawa each have an ‘ikigai’ – roughly translated this means a reason for getting up in the morning. This may be their children, grandchildren or to tend their vegetable garden. They have a focus and reason to live each day.

Japan
Scene in Japan

The fact that they have a specific word for this shows they ensure they know why they’re here, and what their worth is5. These people also lack a word for, or the concept of, retirement. Instead, their ikigai is continued throughout their life. This is an important concept. In Western countries, the year you are born and the year you retire are the two years in your life you are most likely to die2. Retirement isn’t good for us.

Interestingly, the people of Okinawa are now less long-lived than they once were, even in 2005. This is thought to be the result of increased Westernisation of their diet6.

The traditional Okinawa diet had a strong base in:

  • root vegetables (especially sweet potato)
  • green and yellow vegetables
  • soybean-based foods and
  • medicinal plants

In addition to these foods, the diet consists of marine based foods, lean meats, fruit, medicinal garnishes and spices, tea and moderate consumption of alcohol7. They also start many if not all meals with miso soup – a probiotic containing broth. I discussed the health benefits of probiotic foods in a previous blog.

The diet is strongly based around grains, fish and vegetables and light on meat, eggs and dairy. They eat eight times the amount of Tofu than the typical American2. Although their diet is quite high in carbohydrates, it is low in refined carbohydrates1.

In Okinawa there is also a saying which means ‘only eat until I’m 80% full’ which people say when starting a meal. Sort of like we say ‘cheers’ when drinking alcohol, this is an integrated part of the culture. This ensures the people don’t overeat, and may be a crucial part of their longevity2.

Along with living a long time, the people of Okinawa are around 80% less likely to get heart disease than people in the UK, and 25% less likely to get prostate or breast cancer. They spend 97% of their lives free of disabilities4.

Another factor thought to be involved in the healthy ageing of Okinawa people is long-term caloric restriction. People born in this area before World War 2 had fairly severe caloric restriction for half their adult lives6.

Caloric restriction is thought to result in lower oxidative stress and inflammation, both of which are factors in age related diseases such as cardiovascular disease6.

Okinawa culture doesn’t involve specific time taken to ‘exercise’ as we tend to do on a treadmill or by going to a gym, but the people find ways to keep moving in a way which doesn’t change as they age. They sit on the ground rather than on chairs meaning they get up from the floor multiple times a day. They tend their gardens throughout their entire lives meaning daily low-intensity exercise2.

The thing with the Okinawa diet is that there isn’t much evidence of an advantage for using the diet outside of Japan – no one has shown that someone outside that specific cultural setting adopting the diet has the same longevity advantage as those who live in Okinawa. There’s more of an evidence base for the health benefits of adopting a…

Mediterranean Diet

Although on the surface it looks quite different, the Mediterranean diet is actually quite similar to the Okinawan diet in terms of the specific nutrients the people eat.

The diet has a strong basis in:

  • olive oil (unheated)
  • nuts
  • seeds
  • vegetables
  • fruits
  • fish
  • seafood
  • wholegrain cereals
  • potatoes and
  • beans

These populations also eat moderate amounts of dairy, poultry and eggs and very little red meat or refined carbohydrates. The diet results in a high intake of fibre8. Wine is consumed but only small amounts and usually with meals9. The dietary fat is mainly from plant sources such as olive oil, and makes up 25-35% of calories consumed9.

Courgetti & pesto salad
Courgetti & pesto salad

A Mediterranean diet has been shown to reduce risk of cognitive decline in old age including Alzheimer’s disease10. It also reduces the chance of developing cardiovascular disease and cancer11;9.

It’s thought that the low sugar intake, high antioxidant intake and high consumption of fibre act together to reduce long term inflammation and therefore risk of disease in old age8.

Ikaria, Greece

Ikaria is a Greek island so the diet is arguably ‘Mediterranean’ but with a larger intake of potatoes12. One third of the population will reach 90 years of age13. The people have one of the longest life spans in the world23.

Ikaria. Photo credit to "Ikaria-Karavostamo-img07683" by ArishG - Own work.
Ikaria.
Photo credit to “Ikaria-Karavostamo-img07683” by ArishG – Own work.

The people of Ikaria have a diet high in:

  • herbal teas (mint, Artemisia)
  • olive oil
  • fresh vegetables and
  • potatoes

They eat very little dairy produce or meat, not much coffee and their daily calorie intake isn’t high. The main source of animal protein is goat meat. When they do eat dairy or meat, it is all grass fed,meaning a high content of omega-3 fats2.

The income of a typical person living in Ikaria is low, and many people grow their own vegetables. This means foods are eaten in season as there is no way to get them otherwise. Along with growing foods, foraging for wild foods such as mushrooms is a normal part of Ikarian life14;12.

Studies have found that people in this region who live for the least time are those who do not adhere to the typical local diet15.

An afternoon nap is a part of the local culture and may contribute to their longevity and health. Naps reduce a person’s chance of heart disease possibly by reducing stress and therefore reducing inflammation16.

As with the Okinawa culture, there is no specific exercise taken but people in Ikaria are constantly moving. They tend their gardens and forage for food which means daily exercise2.

Due to the isolated nature of the island, the diet has remained relatively un-Westernised meaning refined and processed foods are almost unheard of13.

Cultures that may surprise you…

7th Day Adventists

A religious group who live in North America, 7th Day Adventists have some of the longest life expectancies in the world. Wholeness and health are a key feature of their culture.

They are vegetarian and take their diet from the Bible. It is based on:

  • vegetables
  • legumes
  • seeds and
  • green plants

As a part of their religion, these people spend a 24 hour period over every weekend as their time to rest and relax.

During this time they focus on friends and family, prayer and as a specific part of their religion they take long walks in nature2.

Sardinia

A specific region of Sardinia has a culture which means people live a long time. The people in this region are largely shepherds meaning regular low-intensity exercise.  They eat a largely ‘Mediterranean’ plant-based diet with some additional cheese and meat. Meat is usually only eaten on Sunday’s or special occasions. The meat and cheese is from grassfed animals meaning it is high in omega-3 fats. They are culturally isolated meaning traditional methods of getting food have remained intact, including hunting and fishing17.

They also drink a kind of wine which contains 3 times the concentration of polyphenols than any other wine in the world2. They also drink lots of herbal teas which contain further antioxidants17. This may contribute to lower levels of inflammation and cardiovascular disease in this culture.

Rather than ignoring older people, Sardinian culture celebrates age and wisdom over youth. This has also been found to be good for younger people. The ‘Grandparent effect’ has been shown to reduce childhood mortality in cultures where older people are venerated rather than dismissed18.

Celebrating age and wisdom
Celebrating age and wisdom

They also nap regularly and have a strong sense of humour, laughing lots and regularly with family and friends18.

Nordic Diet

The diet of people who live in Nordic regions is again relatively similar to other healthful diets, largely based on plants. The diet is based on:

  • Fruit
  • Vegetables
  • Whole grains and
  • Fish

These foods are organic and often sourced locally. When meat is eaten it is sparing, and always high quality19. In addition the diet includes dairy products and rapeseed oil and usually at least three servings of fish per week20.

Again, the diet is thought to reduce inflammation and therefore inflammatory diseases20, and is related to lower overall mortality meaning fewer deaths21.

What’s more, changing to the Nordic diet has been shown to reduce the weight and blood pressure of obese people who previously ate a typical Western diet19.

In Swedish culture if you stay at work after your allotted time to go home it is seen as a bad thing. Rather than garnering respect and potentially a promotion, you’re looked down upon for being bad at time management and unable to get your work done in the time you were given. Home time is home time, not ‘take my work home time’22.

Polynesian Diet

People who live on Polynesian Islands have a diet extremely high in sea food and coconuts, meaning their diets are high in saturated fat. However, unlike other sources of saturated fat, coconuts appear to reduce chances of developing heart disease and other inflammatory diseases to such an extent that a study in this region found no evidence of either heart disease or stroke24. The marine food found in this diet will also be a source of healthy omega-3 fats and other essential micronutrients.

Bringing it all together…

Common themes

Long-lived, healthy cultures tend to involve:

  • Having a daily routine which involves movement, rather than specifically exercising, and making that movement something you enjoy
  • Having a way to truly relax (meditation, prayer, social interaction and laughter)
  • Having a strong sense of purpose
  • Having a strong sense of community and belonging and a good social network
  • Eating a largely plant based diet with all food consumed in moderation

Time to chill

Learning how to relax is a key component to living a long and healthy life. Cultures where people live a long time often involve an integrated culture of relaxation and the ability to be in the moment and enjoy life. This is seen less and less in Western culture where a ‘working lunch’ and even ‘working holidays’ are not unfamiliar concepts. Learn to be a human being rather than a human doing.

Attitude to ageing

Cultures that live a long time don’t dread the ageing process. If you want to live a long and healthy life it seems that your attitude to ageing may be crucial. Do you think ‘I’m getting old now so I can’t do X, Y or Z’ or do you think ‘I’ve got more practice at  X, Y and Z, I’ll be better at it than I used to be’? Respect your wrinkles and be grateful for the long life you’ve been able to live to get them.

Conclusion

There are a number of hotspots in the world where people live long and healthy lives.

It should come as no surprise that there are no shortcuts to a long healthy life. Long lived, healthy people’s diets are often high in fresh vegetables, fruit and healthy fats while being low in refined carbohydrate.

Home-grown fruit & veg
Home-grown fruit & veg

When grains are eaten, they’re wholegrain so provide lots of fibre and other nutrients. Seafood and fish seem to predominate as protein (and fat) sources rather than red meat.

Long lived cultures involve a respect for age, relaxation and enjoying life along with strong social networks. A key to their exercise is that they don’t think of it as exercise, but as a way of life. Whether this involves nature walks or tending to a garden it is daily, low-intensity exercise that keeps people moving while doing something they enjoy. I’m off to eat a carrot, ring my Granny and take a nap…

Vicky,

Vicky has a degree in Biological Sciences with a focus on biochemistry and immunology and is currently studying for a  MSc in Drug Discovery and Protein Biotechnology.  She is also an endurance athlete.

 

References

  1. Booth (2013). The Okinawa diet – could it help you live to 100?
  2. Buettner (2009). How to live to be 100+ (Ted Talk).
  3. Willcox (2008). They Really Are That Old: A Validation Study of Centenarian Prevalence in Okinawa.
  4. Wilson (2001). Want to live to be 100?
  5. Shirai (2006). Factors associated with “Ikigai” among members of a public temporary employment agency for seniors (Silver Human Resources Centre) in Japan; gender differences.
  6. Gavrilova (2012). Comments on dietary restriction, Okinawa diet and longevity.
  7. Willcox (2014). Healthy aging diets other than the Mediterranean: A focus on the Okinawan diet.
  8. Castro-Quezada (2014). The Mediterranean Diet and Nutritional Adequacy: A Review.
  9. Willett (1995). Mediterranean diet pyramid: a cultural model for healthy eating.
  10. Lourida (2013). Mediterranean diet, cognitive function, and dementia: a systematic review.
  11. Estruch (2013). Primary prevention of cardiovascular disease with a Mediterranean diet.
  12. Panagiotakos (2011) Sociodemographic and Lifestyle Statistics of Oldest Old People (>80 Years) Living in Ikaria Island: The Ikaria Study.
  13. Anthony (2013). The island of long life.
  14. Kochilas (2014). Ikaria: The Mindful Mediterranean Diet on the Greek Island Where People Forget to Diet.
  15. Knoops (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.
  16. Naska (2007). Siesta in healthy adults and coronary mortality in the general population.
  17. Buettner (2006b). Sardinia Exploration Backgrounds.
  18. Buettner (2006). Sardinian Exploration Lessons.
  19. Poulsen (2014). Health effect of the New Nordic Diet in adults with increased waist circumference: a 6-mo randomised controlled trial.
  20. Kolemainen (2014). Healthy Nordic diet downregulates the expression of genes involved in inflammation in subcutaneous adipose tissue in individuals with features of the metabolic syndrome.
  21. Olsen (2011). Healthy aspects of the Nordic diet are related to lower total mortality.
  22. European Union (2015). Sweden: Successful reconciliation of work and family life.
  23. Prior (1981). Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau Island studies.
  24. Blue Zones (2015). http://www.bluezones.com/about-blue-zones/

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