Amanda Dinsmore (00:01.428):
Hey guys, welcome back to the podcast. I'm Amanda, and today is part five of our Blue Zones book club, and we are going to drop some knowledge about Okinawa.
Laura Cazier (00:05.1):
I'm Laura.
Kendra Morrison (00:06.255):
And I'm Kendra.
Kendra Morrison (00:16.559):
Yeah, so we've been talking about the Blue Zones here, and so we are traveling to a different part of the world and visiting Okinawa. Part of our motivation behind this is because we want to take care of you, and, you know, we want you to feel your best. Anything that we come across—books, articles—we always like to bring here and discuss because we feel like it can contribute or elevate your life in the way we’re going to bring it here.
We know you spend all your time taking care of others, but we are here to take care of you. Just a disclaimer, like we've said, we are doctors, but we're not your doctors, and this really isn't medical advice. It's purely educational—this is knowledge. So take it all in as information giving and information gathering, and apply it as you see fit.
So, just a reminder about the Blue Zones: These are pockets throughout the world where a greater-than-expected percentage of people live to 100. Not just reaching the centenarian status, but also living with their health intact. That's what makes them different. They are not just reaching 100; they are actually flourishing at 100. They're living long, healthy lives with sharp brains up until the end.
In this series, we're using the book called The Blue Zones: Secrets for Living Longer—Lessons from the Healthiest Places on Earth. We'll have the link to the book, or you can watch the Netflix series. Go ahead, binge it. We give you permission. We will mention that there are some people out there, though, who actually believe the Blue Zones are a hoax. Everybody's got an opinion, right? They are citing that it's actually non-existent or people have inaccurate birth certificates—all the things. But keep in mind, regardless, these people are actually old. They're living until they are old.
Kendra Morrison (02:07.869):
And they're actually very active up until the end—something that the three of us really aspire to do. So when we talk about the Blue Zone, something that they have in common is that they eat a whole food, plant-forward diet. They don't go to the gym or CrossFit every day. They actually just move naturally and frequently throughout their day. They've integrated movement in every aspect of their life on the regular.
They have daily rituals like prayer, honoring ancestors, taking naps (#goals), that actually help them downshift and lower stress, which, once again, is another goal. They honor their elders, keep them close, and there's a real sense of community where they are taking care of multi-generations in a family. They have social support systems. So it may not be blood family; they might actually have a neighborhood that's multi-generational, and they have adopted them as family or close social supports. They maintain a sense of purpose. So every day, they get up, they know exactly what they're doing, and they go for it. We've already talked about Sardinia and Nicoya, Costa Rica, Loma Linda, California, Singapore, and Ikaria, Greece. So today we're going to visit Okinawa.
Laura Cazier (03:33.6):
Yes, so some interesting facts about Okinawa. The Blue Zone of Okinawa is actually fading.
Laura Cazier (03:45.976):
Probably guess why. For decades, it had the longest-living women on the planet. They got breast cancer at half the rate of American women, and both men and women there had a fraction of the rates of heart disease and dementia. But as you might imagine, since Okinawa is a military base and there is a large Western presence there, unfortunately, it brought Westernization. It brought inhabitants with a taste for processed foods and fast food like Spam and McDonald's. The purple sweet potato, known as Beni Imo, had been a staple of the Islanders' diet for centuries, but now it has largely been replaced with white rice.
So, while it might or might not be too late for Okinawa to regain its Blue Zone status, we can still learn some things from them while we can. Like many Blue Zones, they typically would work hard outside, gardening and picking their own food. They have a positive attitude and a sense of purpose. They honor their gods and their ancestors, and they know their ikigai. Ikigai roughly means "reason for being" or "the reason they get up in the morning." The Western way we think of ikigai is the confluence of what we're good at, what we love, what society needs, and what we can make money at. What's in the middle of that Venn diagram is our ikigai.
One interesting thing is that their houses are pretty Spartan. They have rollaway futons, they have cushions and a low table for eating. Other than that, they're completely uncluttered, and that makes it far less likely for them to fall and break a hip. Another reason that they're less likely to break a hip is they get a lot of vitamin D from being out in the sun.
Laura Cazier (06:09.41):
They don't take a lot of medicines, which, you know, we take medicines for a variety of reasons, but many of them have unintended side effects, some of which can be bone demineralization or other issues like balance problems and bladder issues. So not taking medicine as they get older can definitely be a good thing. It helps them. They have good balance and good lower body strength since they have to get up and down from those low tables. Every time they eat, they're sitting on the floor, and that ability to get yourself up and down from the floor is a great anti-aging exercise. Peter Attia actually mentions that in his book Outlive, about the idea that if you can get up off the floor without using your hands, it's a wonderful anti-aging exercise.
Okinawans have suffered many hardships, including famine, but one food they could always count on was that purple sweet potato, Beni Imo. Luckily, it might just be one of the healthiest foods on the planet, with vitamin C, fiber, carotenoids, flavonoids, and slow-burning carbohydrates. Do you guys eat many purple sweet potatoes?
Amanda Dinsmore (07:33.241):
I don't even know. You know, I don't have the fanciest grocery store right next to me, unfortunately, but...
Laura Cazier (07:35.628):
Yeah. Well, in the Pacific, they have them everywhere. In Hawaii, they use them a lot. They even use them in this dessert. It's like a shave ice dessert. I get it from a shave ice place called Halo-Halo. It's from the Philippines, and they have sweet potato ice cream, which is called Ube ice cream, and they put actual sweet potato on this dessert—the purple sweet potato. Yeah, and some cantaloupe. They put all kinds of things in this halo-halo dessert. I think halo-halo means "a bunch of everything." It's so good, and those sweet potatoes are so, so delicious.
Amanda Dinsmore (08:32.308):
Do they taste similar to regular sweet potatoes?
Laura Cazier (08:34.844):
They do. They're maybe just a little more intense in flavor. Something about the purple makes them feel healthier. Interestingly, in the Philippines, they make those sweet potatoes into jam. Ube jam is what it's called. It's fascinating. Sometimes you can see it at Trader Joe's—Trader Joe's had Ube ice cream for a while. It's delicious. Yeah, those purple sweet potatoes traditionally provided more than 60 percent of the calories Okinawans consumed prior to World War II, before 1940. They also traditionally consumed vegetables, small amounts of grain, soy in the form of tofu, and occasional eggs and fish when they were available.
They consume twice the amount of tofu as other Japanese, typically eating it twice a day. They also ate a lot of turmeric, which we know is thought to be a potent anti-inflammatory. Bitter melon is another island staple called Goya, which is thought to be an anti-diabetic food that helps regulate blood sugar. We also talk about social networks in these Blue Zones.
Laura Cazier (10:21.498):
And many times in other Blue Zones, it's family, but in Okinawa, there's something called Moai, M-O-A-I, which means "a committed social circle." These groups meet with one another a couple of times a month. They pool money to help whoever needs it the most, and they help each other through hard times.
Amanda Dinsmore (10:31.704):
It is, yeah.
Laura Cazier (10:35.764):
Yeah, it is. Because not always is your family of origin the most healthy—hopefully it is—but what are you supposed to do if that's not the case? They have these Moai groups, which are like the family that you've created. It's funny that it's a lifelong thing, though. They do life together as a little social circle that's created.
Amanda Dinsmore (11:05.676):
Yeah, that's
sweet. I love it.
Amanda Dinsmore (11:31.68):
Okay, so at the end of each chapter, Dan Buettner always gives some takeaways. Sometimes they're spot on, and sometimes they leave me scratching my head, but these
are pretty good. So, the takeaways from Okinawa: Number one, find your ikigai. The older Okinawans can easily tell you why they're getting up in the morning, what their purpose is. They have purpose-filled lives, both filled with responsibility and a feeling of being needed. That's what, like, we're all just gunning to retire, which is great. I'm not saying don't retire, but retiring and then having nothing that gets you up in the morning is not ideal. Retiring and having something else that gives you a sense of purpose is the idea.
Number two, they rely on a plant-based diet. The traditional foods were stir-fried veggies, the purple sweet potatoes that we talked about, and tofu. This combination is very high in nutrients and low in calories. Goya, the bitter melon we talked about, potentially acts as both an antioxidant and an anti-diabetic food, which would be helpful for most of us eating the standard American diet.
Laura Cazier (12:23.701):
Yep.
Amanda Dinsmore (12:26.908):
Number three, eat more soy. Okinawans' diets are full of soy-rich foods like tofu and miso. Soy helps protect the heart, guard against breast cancer, and the fermented soy contributes to a healthy gut microbiome.
Number four, garden. At one time, almost all Okinawans gardened and ate their food from their gardens. It was a regular daily activity that helped with range of motion and reduced stress—a multi-benefit activity. It provided movement, fresh food, and, there's something about working outside in your garden that reduces stress. I'm trying to think of a way to get myself worked up over gardening, but I think for most people it's relaxing.
Laura Cazier (13:14.071):
Yes.
Amanda Dinsmore (13:17.684):
Number five, build your Moai. This tradition built a secure social network. It was a safety net for needed financial and emotional support, and it decreases stress, knowing that there's somebody there for you. It gives you security that you've got a person, you've got a network. I do like that you can create your own. You don't have to be a blood relative to create a situation like this. If your blood relatives are perfect, great, but it gives hope to those who don't have that.
Number six, enjoy the sunshine. Vitamin D from sunshine gives us strong bones, healthy bodies, and reduces your chance of depression. Okinawans have generally been outside gardening, so they get a lot of vitamin D year-round. Luckily, they are in a climate that allows for year-round outdoor activity.
Number seven, activate your home environment. Older Okinawans are active walkers and gardeners. They eat their meals on tatami mats on the floor. That's something to think about—when's the last time you saw grandma get up and down off the ground? We just don't do it very often here. Sitting on tatami mats on the floor for eating and other activities means they're getting up and down off the floor dozens of times daily.
Laura Cazier (14:41.069):
I'm thinking of your average 85-year-old grandma or grandpa who comes into the ER. If you're like, "Hey, get up and down off the floor 12 times," could they even do it once?
Laura Cazier (14:49.462):
No, they a lot of times can barely get up and down off a chair.
Amanda Dinsmore (14:53.832):
Right. Side note: I would sometimes have patients where, at some point decades ago, it was the last time they got out of a chair. You can tell there's no muscle tone whatsoever. One day was the last day they ever got up again. It's interesting, and sad.
Laura Cazier (15:15.863):
Yeah.
Amanda Dinsmore (15:16.004):
It also reminded me of WALL-E, the movie, where they're just riding around in their chairs, drinking their drinks. One accidentally falls off and can’t get back up.
Laura Cazier (15:29.036):
Yikes, I know—that's a terrifying thing to think about.
Laura Cazier (15:35.53):
Yes, oh gosh, yes.
Laura Cazier (15:45.472):
Yeah, sad.
Amanda Dinsmore (15:45.982):
Anyway, same sort of idea. All right, I went way off there. Number eight, plant kitchen herbs. Okinawans have mugwort, ginger, and turmeric—all staples in their gardens, which also have medicinal properties.
Number nine, be interested and interesting. Dan Buettner says older Okinawans have a generosity of spirit and likability. They are quick to offer tea or snacks to visitors, ask questions, and are happy to share their stories. Once again, it comes back to how important connections with others are.
Laura Cazier (16:33.878):
I think it's so interesting that he says "be interesting and ask questions." Have you guys ever read How to Win Friends and Influence People? I read it last year. I listened to it in the car with my kids during a long road trip, and it is such a good book. That's one of the hallmarks—just ask a lot of questions and listen. It makes you the most interesting person in the room.
Amanda Dinsmore (17:15.312):
I like that. It reminds me of the saying, "If you want to make friends, be a good friend." If you want people to ask questions about you, ask questions about them. Be the person that you’re trying to attract.
Laura Cazier (17:23.757):
Yeah.
Amanda Dinsmore (17:42.858):
That's what I meant, yes.
Kendra Morrison (17:50.727):
Well, we're closing another Blue Zone. We hope that you've enjoyed that journey. If anything in this podcast has helped you, please leave us a review. Scroll to the bottom, rate us five stars, and leave a review. It helps make our ripple just a little bit bigger and helps other doctors find us.
Laura Cazier (18:20.448):
Can I say something about that, too, Kendra? It's so interesting because we can see how many people listen, and a lot of people are listening. Don’t be afraid—nobody's going to know you're listening to a physician wellness podcast unless you want them to know it. Just go on there and give us a review—it will help us. Thank you so much.
Kendra Morrison (18:44.761):
Yep, I second that. And Amanda, Laura, will you guys be at ACEP this fall in Las Vegas in September?
Laura Cazier (18:54.91):
Yes ma’am, can’t wait.
Kendra Morrison (18:57.797):
We're going to be there. So why don’t you all join us? We are hosting, along with our good friend Linda from Revitalize Women Physician Circle, the second annual networking event at the Libertine Social Lounge in Mandalay Bay, where ACEP is, on Monday, September 30th, from 5 to 7 p.m. This is going to be an amazing time, y’all. We're going to connect, ask lots of interesting questions, and really get to know each other. But it’s just an opportunity for EM physicians to come together, support each other, connect, and network, because that’s what makes the difference.
We have the link in the show notes—scroll down, click it, buy your tickets now. Last year, what happened, ladies?
Amanda Dinsmore (19:42.624):
Sold out!
Laura Cazier (19:43.274):
Sold out!
Kendra Morrison (20:05.733):
We almost missed the bus—it sold out. We also want to mention one of our gold sponsors, Brault. Brault offers scalable services to support your emergency medicine practice. Whether you’re looking for a full-service RCM partner, a support team to manage your business functions, or a group of experts to advise and help grow your practice, Brault has everything you need under one umbrella. So thank you, Brault, for being a gold sponsor, and we are looking forward to that event. Join us in Vegas—it’s coming up soon, so get your tickets now.
Amanda Dinsmore (20:17.179):
How do you spell Brault, if somebody wanted to search it up?
Kendra Morrison (20:20.465):
Yeah, sure. It’s B-R-A-U-L-T, Brault. Dr. Brault is a fellow EM colleague, and we always love to support colleagues who have diversified their careers and are doing great things outside of the emergency department. So, okay, guys, until next time—you know what it is: You are whole, you are a gift to medicine, and the work you do matters.
