Doctor's Review: Medicine on the Move

December 16, 2017

© Annarosa Sabbadini

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Meet the super-elderly

Just off mainland Japan, Okinawa lives and ages on its own island time

Sumiko Taira burst into a loud song. Maybe this bon vivant behaviour would be normal in an Irish pub, but this was a cosy restaurant in Ogimi Village in the sleepy north of Okinawa’s main island. Besides, Sumiko was 95 years old — albeit the winner of a singing tournament at a local festival.

Her song, which was later translated for me, was called “Hyakusai bushi,” (“The 100-Year-Olds’ Song”). It opens: “People in their 50s and 60s are babies. People in their 70s and 80s are adults. After they turn 97, then they start to bloom.” Your 97th birthday happens to be a milestone in Okinawa that starts with the elderly birthday boy or girl throwing a party and wraps up as they parade through the community in a convertible.

I was in Okinawa in January, visiting Japan’s beloved subtropical isles for the first time. Over the next week, I’d walk along white-sand beaches, do some of the best snorkelling of my life, meet quirky and hospitable people and never be too far from the sounds, smells and tastes of the ocean.

Okinawa’s main island is a fantastic cultural mix of ancient Ryukyuan traditions that thankfully never left, along with Japanese, Chinese, Southeast Asian and post-war American influences (taco rice is a popular dish and that legendary canned mystery known as Spam is sold in souvenir shops). Collectively, Japan’s southernmost prefecture is actually the chain of 160 Ryukyu Islands, of which Okinawa is the largest.

It existed as an independent kingdom until 1879 when it was annexed by Japan. Then 1945 came and the Americans invaded in a bloody battle, which left over 100,000 civilians dead. While the islands joined Japan in 1972, the US military bases held their ground and appear to be staying put.

National living treasures

For a traveller, many of the smaller islands naturally provide their own bragging rights, though you’ll want to start on the main island, where most Okinawans live in or around the lively capital of Naha. The north, where I met Sumiko, and her 93-year-old friend Shiko Miney, is largely peaceful farmland, easily accessed via a stunning coastal drive on either side of the island. I spent a couple of hours here following the wooden boardwalks of Gesashi Bay’s wild 10-hectare mangrove on the eastern coast. The tide was high and I had no problem picturing myself on an afternoon kayaking tour of this peaceful jungle.

You can also visit the Kijoka district on the west coast where Toshiko Taira, 92, a master weaver and now a so-called “national living treasure” set up a weaving factory after the war to sustain the ancient art of producing bashofu, a fabric woven from banana fibres. When I went, I was surprised to see Toshiko there, diligently at her post, albeit taking advantage of some downtime for a nap. Not far is Ogimi Village, population 3308, whose claim to fame is having the highest longevity record in the world. A lot of folks here — mostly women — qualify as super-elders, meaning they’re over 100. Sumiko and Shiko are mere semi-super-elders. They’ve not even made it to 97.

Sumiko and Shiko are, in many ways, role models. Here were two women in their early 90s — who arrived at the restaurant riding what appeared to be the front end of a bike welded onto a baby carriage — and who looked and acted like two women in their 70s. Maybe even younger.

They were alert and upbeat, answering questions with funny responses. Where Sumiko was gregarious — and willing to show off her vocal prowess — Shiko had mastered the art of dry humour. We spoke about things in life she did not have: pain, loneliness, time for ground-golf competitions. Yet when someone described the road-rage stress one feels when stuck in traffic, she simply said: “Oh yes, I have that,” and the conversation moved on.

Centanarian study

Dr Makoto Suzuki, the principal researcher behind the Okinawa Centenarian Study, tried to explain this younger-than-thou elderly personality. Suzuki, a cardiologist and geriatrician, has been overseeing the world’s longest continuous centenarian study for the past 36 years. In 1994, he was joined by Calgary-born Drs Craig and Bradley Willcox. Their findings were put into a book, The Okinawa Program: How the World's Longest-Lived People Achieve Everlasting Health — And How You Can Too (2001), which, thanks in part to Oprah Winfrey and its fetching title, became a bit of a bestseller.

In 1976, there were 32 super-elders in Okinawa, 28 of which Suzuki and his team labelled “extremely alert.” The team studied Japan's Koseki, the country's family registry kept since 1879, and examined over 600 Okinawan centenarians and a good number of "youngsters" in their 70s, 80s and 90s. The study, funded by the Japan Ministry of Health, looks at centenarian’s total health: physical, mental and spiritual. The latter, Suzuki explained, is trickier to explain.

Part of this good spiritual health comes from a certain island way of thinking: nankuru naisa, meaning don’t worry, be happy. It’s as if hardship never quite lodged itself under these people’s skin — no minor feat given that the super-elderly that Suzuki first examined, as well as the younger Sumiko and Shiko, all lived through relentless bombardments during the war and years of poverty in its aftermath.

Another factor is ikigai, a reason to get out of bed. Suzuki explains that for many Okinawan women, their ikigai is rooted in ancestor worship, or praying to dead ancestors for the health of younger generations. A typical day for Sumiko starts with making tea, stretching for five minutes (she follows an exercise radio show), saying hello to the ancestors, hello to the vegetable garden, then going out “to wave to the traffic,” which I took to mean saying hello to neighbours.

Which brought the conversation to another aspect of ikigai. Sumiko explains that to relieve stress, “we sing, dance, play, exercise.” Shiko used to compete in ground-golf tournaments, but quit as it interferes with vegetable growing. While government-subsidized elderly daycares are successful throughout Japan, Okinawa’s communities are fundamentally tight-knit. “People in cities like Kyoto and Osaka don’t know their neighbours,” explained Suzuki. Suddenly, waving to traffic and parading through the streets when you turn 97 didn’t seem so odd. While it’s a spirit that’s slowly disappearing even in Okinawa, for the moment it’s alive in Ogimi Village.

Eat like an Okinawan

Then there’s diet and exercise. The latter, I’m sad to report to the world’s gadget junkies, is treated like a no-brainer — it’s integrated into one’s day and is mainly gardening and walking a lot.

In terms of diet, the study looks at a person’s entire dietary culture. How foods are cooked is as relevant as the foods themselves. Suzuki explains: Okinawans love pork. When the meat is prepared traditionally — over many hours, every hour skimming away the fat that rises to the surface — what one ends up eating is simply protein.

And how delicious that protein is. We met our semi-super-elderly friends at Emi no Mise (Emi’s Restaurant), where owner-nutritionist Emiko Kinjo serves a traditional menu. The bento lunch I had contained a little bit of a lot: melt-in-your-mouth slow-cooked spare ribs seasoned with Okinawan shikuwasa lemon-lime believed to have anti-cancer properties, pond herring, millet rice mixed with pickled turmeric, tofu made with seaweed instead of soy, refreshing cold noodles made with shikuwasa, aloe vera and sunui seaweed, shrimp tempura with fennel and sautéed bamboo and sweet root. No Okinawan meal is complete without some purple sweet potato and a miso soup, this one made with the kale-like local handama. And for desert: green tea with turmeric, an Okinawan donut, made with the shikuwasa’s sweet-lemony skin and homemade yogurt. All this, by the way, cost $17.

Like exercise, eating seven servings of vegetables is integrated into one’s day. It’s a diet that’s poor in calories yet nutritionally rich.

But wait, there’s more. "Eight parts of a full stomach sustain the man; the other two sustain the doctor" is a proverb by which healthy elderly live. Though Sumiko and Shiko emphasize that they eat however much they want, they believe in the Confucian teaching of hara hachi bu, which says to stop when you’re 80 percent full. It’s an extremely ancient practice, which Suzuki would love to put under the modern microscope. He suspects that healthy elderly like Sumiko and Shiko may have altered Sirtuin/Sir2 proteins and FoxO levels.

After a couple of hours of pretty eye-opening conversation — albeit all translated for my benefit — Sumiko and Shiko escorted us back to our car. Sumiko was clapping and singing all the way. Something told me she may have been practising for another competition. It occurred to me to challenge Shiko to a round of ground golf, but I had read that elderly tournaments in Okinawa can get pretty competitive. On second thought, maybe an afternoon exploring the mangrove forest in a kayak would be better for my personal sense of nankuru naisa.

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Comments

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  1. On March 24, 2013, Joan Baldwin said:
    I loved this article. It was a joy to read. i wonder what happened to the print format of this journal. I haven't received it in years. Is it only online now.

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