Blue Zones … Or Twilight Zone? (Part 2)

In the previous article, we learned how Blue Zones author Dan Beuttner has an anti-meat bias. We learned how he included the Seventh-day Adventist stronghold of Loma Linda as a longevous Blue Zone, even though there is nothing in the way of reliable evidence to justify its inclusion. The only logical explanation for including this Californian town is that Seventh-day Adventism preaches abstinence from meat, among other things. It seems Buettner was so desperate to feature a vegetarian population in his book that he included Loma Linda on the flimsiest of evidence, while blatantly ignoring the above-average and rigorously documented longevity of Utah and Californian Mormons, who ate a meat-rich diet.

But Buettner didn’t stop at including a supposedly vegetarian population that allegedly enjoyed “astoundingly long” life expectancy based on zero verifiable records.

Heck no.

He also set about trying to reframe the remaining Blue Zones as near-vegetarian. To listen to Buettner, residents of The Blue Zones rarely eat meat, and even when they do, they eat it in tiny amounts. According to Buettner, those of us who wish to enjoy long lives should follow their example.

Like most of what Buettner has written on the topic, this is utter nonsense.

Nicoya, and the Vegetarians that Never Were

If we’re to believe Buettner, the Nicoyans are near-vegetarians who “who avoided meat – or more accurately, didn’t have access to it – except on rare occasions” (Buettner also claims the same for Sardinian and Okinawan centenarians)[1].

But when Rosero-Bixby, Dow, and Rehkopf analysed data from the ongoing Costa Rican Study of Longevity and Healthy Ageing (CRELES), they found the Nicoyans were anything but vegetarians.

Compared to other Costa Ricans, the diets of elderly Nicoyans included more beef, fish, chicken, light cheese, rice, and beans. They also contained more soft drinks, but less cookies and hamburgers. There were no differences in consumption of fresh fruits, eggs, sugar, pastries and potato chips. Elderly Nicoyans drank slightly less milk (an average 0.5 glass per day compared to 0.7 glass by other Costa Ricans).

Overall, older Nicoyans consumed more calories, carbohydrates, proteins (mostly of animal origin) and fibre. Although they did not differ in the consumption of total fat, they consumed higher levels of saturated and trans fats, but lower levels of linoleate-rich polyunsaturated fats. While consuming less omega-6, they consumed more omega-3 fatty acids. They also had a higher intake of cholesterol and the important vitamin E isomer gamma-tocopherol.

Buettner proudly displayed his woeful ignorance by claiming we should all be following the CDCs antiquated recommendation of 46 to 56 grams of protein per day.

Because we all know how much the criminally corrupt CDC can be trusted, right?

He clearly wasn’t paying much attention to Louis Rosero-Bixby when he visited Costa Rica to learn the results of the CRELES study, and nor does he seem to have read the his 2013 paper. Because, if he had, he would have learned elderly Nicoyans consume an average of seventy-three grams of protein daily, 3 grams/day more protein than the Costa Rican average.

As the researchers noted, “The data do not show that Nicoyans eat more of reputedly healthy foods like salads, fruits, olive oil or nuts, nor that they eat less fat, animal protein and sugars among other foods associated with worse health.”[2].

The Real Sardinian Diet

Published research on Sardinian dietary habits has been relatively sparse; most of the studies conducted to date have focused on genetics and heredity. These studies have detected strong family lineage among Sardinian centenarians and super-centenarians and strongly suggest the area’s long-lived residents were endowed with especially robust and favourable genetics[3-5].

So genetic predisposition seems to play a major role in the area’s unusually high population of centenarians.

The role of diet is less clear, hyperbolic proclamations of popular book authors and press articles notwithstanding. Recently, Pes and Poulain gathered up what dietary surveys and studies of Sardinian dietary habits they could find. This data indicated that prior to World War I, Sardinian shepherds and their families (the demographic that predominates in the East-Central Blue Zone) ate more animal protein, less vegetable protein, slightly more total protein, more animal fats, less calories, and less red wine than those living in lowland areas. This, of course, contradicts just about every politically correct dietary edict found in The Blue Zones.

Even a century ago, Sardinians were eating amounts of protein that would send Buettner and the CDC into a tailspin. Members of shepherd families averaged 118 grams of protein daily, of which 29.3% was derived from animal protein; the corresponding figures for those in the lowlands were 116 grams and 16.8%, respectively. Members of shepherd households averaged 46.6 grams of animal fat daily, compared to 32.1 grams among lowland household members. Not only did this animal protein and fat consumption not hurt their longevity prospects, but Pes et al believe it largely explains why shepherds and their wives achieved greater height and muscle mass than their lowland counterparts.

By the early 1950s, when the modernization sweeping through Italy trickled over to Sardinia, meat consumption on the island increased to 16.6 kilograms per person, per year (equivalent to 319 grams of meat per week). This was 77% of mainland consumption but, as Pes et al state, in the Sardinian Blue Zone the real figure was likely much higher owing to consumption of sheep and goat meat not registered in official statistics.

Since this time, the Sardinian Blue Zone has seen increased consumption of vegetables, olive oil and meat, with a prevalence of chicken over beef, and reduced consumption of milk (–18%) in favour of soft cheese, cottage cheese and yoghurt[6].

Red wine consumption in Sardinia is worthy of further comment. Meeting with Sardinian seniors Tonino, Sebastiano and Giovanni, who – like most Italians – all drank wine moderately, clearly left a lasting impression on Buettner. Ever since, one of his key nutritional recommendations has been to “Drink a glass or two of red wine daily” because, he keeps telling us, it contains “artery-scrubbing polyphenols.”[7,8] (Bold emphasis in original).

“For an extra antioxidant bump,” says Buettner, “choose a Sardinian Canonau.”[9]

I can’t help be dismayed by someone who warns against meat - a substance for which no science worth a damn has shown any harm to humans – yet encourages people to consume alcohol, a substance for which the potentially harmful and even lethal effects are beyond dispute. Yes, Buettner recommends moderate alcohol consumption, and he gives the dangers of excess consumption a cursory nod in Chapter 6 of The Blue Zones. But his advice is still fraught with danger.

If you already drink, and do so in a temperate, responsible manner (i.e., no binge drinking, no drink-driving, and no drinking more than 1-2 glasses daily), then the research to date provides little reason to stop. That’s assuming, of course, you are not a minor, pregnant, or suffering from any physical or mental health condition that could be exacerbated by even small amounts of alcohol.

However, if you do not currently drink, or already drink other alcoholic beverages and are now contemplating developing a red wine habit based on the writings of folks like Buettner, there are a few things you must keep in mind.

The first is that, in every sizeable cohort of people who start drinking, some will almost certainly go onto become excessive and/or binge drinkers, and some will develop alcohol dependence. As to just how many will end up in this unfortunate state, we can look to a recent study of 138,100 adult respondents from all 50 US states and Washington, DC, who were interviewed between 2009-2011. When surveyed, some 70% of respondents reported drinking alcohol in the previous 12 months. Of these, 42% reported excessive drinking in the previous month, 39% reported past-month binge drinking, and 5% met the official criteria for past-year alcohol dependence.

The risks were greatest among men and younger age groups (18-34), but were spread fairly evenly across all categories of education and income. When ranked according to ethnic group, Asians were at lowest risk of developing dysfunctional drinking patterns[10].

Needless to say, these are worrying figures showing a significant proportion of Americans who consume alcohol do so in anything but a moderate manner.

As for Australians … don’t get me started.

As such, the risks of alcohol abuse warrant more than a few token lines about moderation if one is recommending the consumption of wine or any other alcoholic beverage for health purposes. They need to be emphasized in no uncertain terms by the person/s making the recommendation, and given serious consideration by anyone contemplating their adoption.

Another important fact to remember, even if you are confident in your ability to drink responsibly, is that there exists no reliable evidence red wine has ever prevented a single heart attack or extended lifespan by a single day. The “red wine is heart healthy” dogma arose decades ago when cholesterol-phobic health authorities were presented with the embarrassing contradiction posed by France, where high saturated fat consumption was (and still is) accompanied by relatively low rates of heart disease. The rationalization settled on by our reality-evading guardians of health was to label this observation the “French Paradox” and to pronounce red wine as the mitigating factor. A polyphenol in red wine known as resveratrol, so the official story goes, was the specific factor protecting the naughty French against their dietary misdeeds.

The drinking public and the wine industry eagerly embraced this theory (people always love being told what they want to hear) but, as with most mainstream dietary assertions, there was little scientific evidence to back it up.

In all likelihood, it’s a load of cobblers.

As Pes, Poulain and colleagues note:

“… red wine consumption has been postulated as one of the possible factors involved in longevity of [Blue Zone] Sardinians because of its content in resveratrol and proanthocyanidins. Actually, resveratrol shows antioxidant properties only in vitro [i.e. in test tubes] and is not capable of extending the life span of Caenorhabditis elegans [a worm species] or of rodents under conditions of oxidative stress, and therefore it is hardly probable that it can do this in humans. Moreover, in the ecological study, we have shown that the average intake of red wine was the same in the Sardinian [Blue Zone] as in the rest of the island, and the spatial distribution of wine consumption in the municipalities of the island does not exhibit a direct relationship to the longevity index. Awaiting further data, no scientific evidence of any benefit of red wine consumption on Sardinian longevity is currently available.”[11]

As the researchers point out, those in the Blue Zones drink similar amounts of wine as those on the lowlands. Furthermore, the data from 1952 - when the long-lived Blue Zone cohort was in the 60-80 age bracket - showed Sardinians didn’t even average a standard glass per day of wine, and that their wine consumption was significantly lower than that seen on the mainland: 79 versus 142 millilitres daily, respectively (a “standard” glass of wine is 100 ml)[12].

If you truly are a moderate and responsible drinker, then by all means continue to enjoy red wine – I certainly will. But if you are chasing longevity, don’t go swapping out red meat for red wine based on the pseudoscientific nonsense presented in books like The Blue Zones.

Will the Real Okinawan Diet Please Stand Up?

Buettner was not the first popular health book author to write about the Okinawans – nor to downplay the role of meat in their diet. Back in 2001, a book called The Okinawa Program: How the World’s Longest-Lived People Achieve Everlasting Health--and How You Can Too became a New York Times bestseller[13]. Written by American researchers Bradley and Craig Willcox and Japanese cardiologist and geriatrician Makoto Suzuki, the book also portrayed the Okinawans as near-vegetarians and seemed to go out of its way to diminish the role of pork, an important staple food in Okinawa.

But while the aforementioned authors and Buettner are quick to dismiss pork, numerous Japanese researchers are just as quick to classify it as a longevity food.

“The first key to long life here is pork,” explains Kazuhiko Tahiro, a gerontologist from Okinawa’s University of the Ryukyus, who makes his living studying the long-lived of Okinawa. “Okinawan cuisine,” he says, “is very healthy - and very, very greasy.”[14]

A reverence for pig flesh and the regular use of lard for cooking completely fly in the face of Western dietary guidelines, which may be why American authors have opted to create their own politically-correct versions of Okinawan nutrition.

“The relationship between ‘pork and sweet potato’”, writes Hiroko Sho, Director of the University of the Air Okinawa Study Center, “occupies a special position in Okinawan food culture, favourable geographical conditions helping the combination to become by far the most important food items.”

“We tend to avoid pork in this present era of overeating,” notes Sho, “but in Okinawa it is a major pillar of the longevity diet.”

Pigs were first brought into the Ryukyus (the chain of Japanese islands that includes Okinawa) by Chinese immigrants in 1392, but failed to become widespread due to lack of food in the farms at the time. But when sweet potatoes were introduced from China some 200 years later, pig breeding spread rapidly, “marking the beginning of the meat eating culture.”

Okinawans eat the entire pig, including the fat, leaving little behind. Nothing is off-limits: The legs and feet, ears, skin of the face, heart, kidneys, lungs and other organs all find their way into the cooking pot. “In Okinawa”, writes Sho, “they have sayings such as, ‘Eat the entire pig and leave nothing, and ‘You can eat every part of a pig apart from its oink’.”

One recipe you won’t find in the heavily sanitized Western portrayals of Okinawan eating is the method of preserving pig’s blood practised in the south of Okinawa’s main island. Fresh pig’s blood is mixed with salt and starch, placed in a basket lined with a cloth, and steamed for around thirty minutes. Once the mixture sets like jelly, it is cooled then kept in a jar containing pork fat. Other Okinawan pork dishes include leg tibichi (soup made with leg of pork, konbu seaweed and daikon radish or gourd melon), ear skin sashimi (pig skin from the face or ear in a vinegar and miso salad with cucumber, beanshoots and peanuts), and nakami suimono (soup made with pig stomach or intestine, cooked with mushrooms until soft). These dishes all contain large amounts of collagen and elastin which, Sho speculates, may exert health-enhancing effects[15].

Interestingly, in a 2001 paper, the Willcox brothers and Suzuki reported unusually high blood levels of the amino acid hydroxyproline in a sample of Okinawan male and female centenarians[16]. Hydroxyproline, as the trio noted, is an important component of collagen fibres, such as arterial wall and bone matrix. It is also plays a key role in wound recovery. As such, it is possible that higher-than-average hydroxyproline levels may play a role in Okinawan longevity. But, as with their popular format book released that same year, they just couldn’t bring themselves to acknowledge the dietary contributions made by pork. Instead, soy was given credit for boosting hydroxyproline levels, even though Japanese researchers had long since demonstrated pork was a far richer source of this amino acid than soybeans or soy protein could ever dream of being[17].

Published dietary surveys of just what long-lived Okinawans eat have been few and far between. The Willcoxes and Suzuki are fond of referring to Okinawan food intake data for the year 1949, which they claim represents the “traditional” Okinawan diet. This 1949 data suggests the Okinawans subsisted on a low-calorie diet comprised of only 9% protein, a measly 6% fat, and 85% carbohydrate[18].

However, this data was compiled by the US military just four years after the end of World War II, during its occupation of Japan[19]. Whether dietary intake in Okinawa was truly “traditional” at a time when the Japanese economy was in such a decimated state is highly debatable. Consumption of “luxury” foods like meat and sugar declined in many countries during the war, and it is not at all unreasonable to suspect the decline may have been especially pronounced and protracted in a country that had just been atomic-bombed into submission, its economy destroyed, and occupied by a foreign force.

So what did Okinawans eat before the war, and afterwards during Japan’s economic recovery? Again, first-hand pre-war data is scarcer than honesty in politics. According to Sho, the oldest existing public record of Japanese everyday diets is the Survey of Japanese People’s Diets, prepared in 1880 by the then Department of Agriculture and Commerce. According to this report, sweet potato made up some 93% of the everyday diet in the Ryukyu fiefdom, considerably more than any other region. A report of the everyday diet of Okinawans in 1919 found a similar eating pattern. If accurate, then these results show the Okinawan diet at that time was indeed near-vegetarian. However, they also contradict claims the “traditional” Okinawan diet was a chronically calorie-restricted affair; daily caloric intakes among teachers and full-time farmers in 1919 were 2,395 and 3,650, respectively.

Low average daily protein and fat intakes were reported, but as Sho points out, some form of festival occurred nearly every month in which “consumption of animal protein in the form of fish, pork or goat was always a feature, helping build stamina and resistance to disease.”

Pork has also cemented a place in Okinawan medicinal lore, says Sho, the most widely used dietary remedy being a concoction of pig’s liver and vegetables such as island carrot or garlic. The resultant broth is given to people when they are sick, and to this day many believe it is effective against all illnesses[20].

Goat is a rarely discussed component of the Okinawan diet. It gets little mention in books and research papers, but a 1990 paper by Shiroma and colleagues (from the University of the Ryukyus’ Department of Animal Sciences) reported that goat flesh comprised 25% of Okinawan meat consumption in 1935. In 1936, approximately 155,000 goats were raised on the island. By 1988, this figure had declined to 17,200 due to diminishing weight gain, lower feed efficiency, higher kid mortality, and insufficient research concerning feeding and management. Despite this, demand for goat meat remained “very high”, necessitating the import of around 7,500 heads annually from other prefectures and foreign countries[21].

According to the USDA, the average 2013 live weight for a goat sent to slaughter in the US was 30 kilograms[22]. Research from Australia – involving goats that were raised on grass, just like those of 1930s Okinawa – also cited an average slaughter live weight of 30 kilograms. Of this, 16.4 kilograms was considered edible[23]. This indicates mid-1930s edible goat meat production in Okinawa was in the vicinity of 2,542,000 kilograms per year.

According to Japanese census statistics, there were 592,464 people living in Okinawa in 1935[24]. Assuming one-third of the island’s goat heard was slaughtered and eaten annually, that would equate to an annual per capita consumption of 520 grams. While demand for goat may be high in Okinawa, these figures are in line with portrayals of goat as a delicacy whose consumption was primarily reserved for festivals.

As Japan recovered from the aftermath of WWII, its economy and culture experienced marked changes. The 1960s and 1970s were a period of rapid economic growth, to such an extent that Japan eventually grew to become the world’s second biggest economy, a position it ceded in 2010 to China.

This economic growth spurt was accompanied by marked dietary and health changes. Life expectancy during the 60s and 70s jumped by 12 years for males and 14 for females; the number of centenarians increased 4-fold and 6-fold among men and women, respectively. Age-adjusted rates of breast, colon and lung cancers increased, while those of stomach and uterus decreased. The incidence of stroke (both ischemic and hemorrhagic) in men aged 40-69 years dropped from 32 to 8 per 100,000 people as animal fat intake increased from 5% to 12% of the total energy intake. As blood cholesterol levels rose, mortality from stroke declined[25].

In fact, study after study in Japan has shown no mortality risk from high cholesterol; it is at the lowest cholesterol levels that increased overall mortality risk occurs, and the effect cannot be explained away by the cholesterol-lowering effects of disease in those who fall prematurely ill. As a recent review in the Annals of Nutrition and Metabolism stated:

“… almost all Japanese epidemiological studies show that high cholesterol levels are a good marker of longevity. Unfortunately, however, many Japanese doctors try to reduce patients’ cholesterol levels without due consideration of these overall findings.”[26]

Once again, this all goes against everything preached by Buettner, brothers Willcox, and the Western Medical Industrial Complex. So it is simply ignored, as is the observation that by 1972 Okinawans were consuming twice as much meat than the average Japanese citizen. Data from the Japanese Government’s 1972 dietary survey of the Okinawa Prefecture also showed Okinawans ate three times more green vegetables, but less sugar, cereals, and calories[27].

In 1996, Masafumi Akisaka and colleagues from Okinawa’s University of the Ryukyus took a more direct approach, surveying 21 centenarians on the island (17 women and 4 men). The dietary survey employed the 24-hour recall method, and its findings were compared with those of similarly-surveyed centenarians throughout Japan.

Overall caloric – and hence protein, fat and carbohydrate – intakes were quite low, but similar between the Okinawan centenarians and those from the rest of Japan (a mean 1,110 calories per day). The participants were very small in stature; average heights and body weights for the Okinawan men and women were 148 cm and 50.5 kg, and 137 cm and 37.9 kg, respectively.

Okinawan centenarians capable of normal daily activities consumed significantly more meat (+113%) and green vegetables (+220%) than centenarians in the rest of Japan, mirroring the results of the 1972 Okinawa Prefecture survey. The Okinawan centenarians consumed much lower amounts of dairy, fruits and seaweed than centenarians throughout Japan. Their intake of fish was also lower, although the difference was not statistically significant[28].

A 1997 report by a group of University of the Ryukyus researchers examined the health and dietary status of 39 centenarians and 44 septuagenarians. Not surprisingly, the former were shorter and weighed less than the latter, but self-reported caloric intakes were similar between the two groups. Male centenarians reported a mean 1,407 calories per day, of which 16% was protein, and 31% fat. The corresponding figures for female centenarians were 1,096 calories, 17% protein, and 26% fat. As with the Akisaka et al study, food intakes were derived by administering 24-hour dietary recalls[29]. Given the well-established phenomenon of under-reporting in such studies, these figures should be treated with caution given the advanced age of the participants. Interestingly, among the researchers who compiled the 1997 report was The Okinawa Program co-author Makoto Suzuki; one has to wonder just how much (or little) influence he exerted over the content of the meat-phobic and PC-centric book.

The Longevity Business: A Grifter’s Paradise

Pardon my bluntness, but most of what you read about diet and health is complete and utter bullshit.

Much of it is written by people who have no clue what they are talking about, but instead have an agenda.

Good science means following where the evidence takes you, and then forming a conclusion. Bad science means starting out with a preordained conclusion and constructing your ‘evidence’ in a manner that supports that preexisting agenda.

The first approach is known as the scientific method; the second is known as dishonesty and fraud.

What I find especially disgraceful about Buettner’s Blue Zones charade is that it was funded by taxpayers.

Buettner was given a US $300,000 “research grant” to fund his Blue Zone trips, which kicked off in 2003(30). Thanks to the US taxpayer, Buettner got to travel around the world and became a wealthy celebrity author. He repaid the hapless taxpayers of America for their forced generosity by feeding them a bunch of anti-meat pseudoscience, designed not to extend their lives but to ensure his book conformed to the reigning anti-meat agenda.

"He works the room as well as the finest of politicians," said Dean Phillips, Buettner's neighbor and the CEO of Phillips Distilling Company. "If there were any babies there, I'm sure he would have held the babies."

No doubt.

 

Interestingly, as these photos show, Buettner doesn’t seem to be ageing particularly well for a guy whose travels supposedly unlocked the keys to youthful longevity. At 65, he’s only 7 years older than yours truly, yet looks older than my uncles.

 

In Conclusion

As you’ve seen, determining the true dietary intake of Blue Zone inhabitants, and just what role this intake plays in their longevity, is not an easy task. There is, however, one thing we can say with certainty about the inhabitants of real Blue Zones:

They do not avoid meat.

And if it’s increased lifespan you’re after, neither should you.

I rate the Blue Zones (and The Okinawa Program) five steaming piles of Okinawan pig shit.

Anyhow, have some Prosciutto di Parma,

ciao,

Anthony.

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References

1. Buettner D. The Blue Zones Solution: Eating and Living Like the World’s Healthiest People. National Geographic Books, Apr 7, 2015: 239.
2. Rosero-Bixby L, et al. The Nicoya region of Costa Rica: a high longevity island for elderly males. Vienna Yearbook of Population Research, 2013; 11: 109–136. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241350/ (accessed Jul 11, 206).
3. Lio D, et al. Association between the HLA-DR alleles and longevity: a study in Sardinian population. Experimental Gerontology, 2003; 38: 313–318.
4. Pes GM, et al. Association between longevity and cytokine gene polymorphisms. A study in Sardinian centenarians. Aging Clinical and Experimental Research, 2004; 16: 244-248.
5. Caselli G, et al. Family clustering in Sardinian longevity: A genealogical approach. Experimental Gerontology, 2006; 41: 727–736.
6. Pes GM, et al. Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors. European Journal of Clinical Nutrition, Apr, 2015; 69 (4): 411-418.
7. Buettner D. The Blue Zones: Lessons For Living Longer From The People Who’ve Lived The Longest. National Geographic, Washington D.C., 2008: 63.
8. Ibid: 244.
9. Ibid.
10. Esser MB. Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011. Preventing Chronic Disease, 2014; 11: 140329. Available online: http://www.cdc.gov/pcd/issues/2014/14_0329.htm (accessed Jul 23, 2016).
11. Pes GM, et al. Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors. European Journal of Clinical Nutrition, Apr, 2015; 69 (4): 411-418.
12. Ibid.
13. Willcox B, et al. The Okinawa Program : How the World’s Longest-Lived People Achieve Everlasting Health--And How You Can Too. Clarkson Potter, May 1, 2001.
14. Franklin D. The Healthiest Women in the World. Health Magazine, Sep, 1996; 10 (5): 56-63.
15. Sho H. History and characteristics of Okinawan longevity food. Asia Pacific Journal of Clinical Nutrition, 2001; 10 (2): 159–164.
16. Suzuki M, et al. Implications from and for food cultures for cardiovascular disease: longevity. Asia Pacific Journal of Clinical Nutrition, 2001; 10 (2): 165–171.
17. Fukuda M, Yamaguchi T. Hydroxyproline Content in Several Foods. Nippon Shokuhin Kogyo Gakkaishi, 1980; 27 (11): 576-578. Available online: https://www.jstage.jst.go.jp/article/nskkk1962/27/11/27_11_576/_pdf (accessed Jul 24, 2016).
18. Willcox, Willcox and Suzki have cited this data in numerous papers, for a frequently-cited example see Willcox BJ, et al. Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging. The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span. Annals of the New York Academy of Sciences, 1114: 443 (Table 1).
19. U.S. Department of the Office of the Civil Administrator of the Ryukyu Islands: Records Of Health, Education And Welfare. 1949. U.S. Occupation Headquarters, World War II. Record Group 260.12.5. National Archives at College Park, 8601 Adelphi Road, College Park, MD 20740-6001.
20. Sho H. History and characteristics of Okinawan longevity food. Asia Pacific Journal of Clinical Nutrition, 2001; 10 (2): 159–164.
21. Shiroma S, et al. Study on Okinawan Meat Goat Production and Meat Quality as Influenced by Diets. The Science Bulletin of the Faculty of Agriculture. University of the Ryukyus, 1990; (37): 191-201. Available online: http://ir.lib.u-ryukyu.ac.jp/bitstream/123456789/3862/1/KJ00000161642.pdf (accessed Jul 25, 2016).
22. USDA. Livestock Slaughter 2013 Summary. April 2014. National Agricultural Statistics Service. Available online: http://usda.mannlib.cornell.edu/usda/nass/LiveSlauSu//2010s/2014/LiveSlauSu-04-21-2014.pdf (accessed Jul 25, 2016).
23. McGregor B. Meat and Offal Yields of Goats. AG0999. Agriculture Victoria. Available online: http://agriculture.vic.gov.au/agriculture/livestock/goats/goat-produce-and-industry/meat-and-offal-yields-of-goats (accessed Jul 25, 2016).
24. See Annexes 2a and 2b in: Poulain M. Exceptional longevity in Okinawa: A plea for in-depth validation. Demographic Research, Jul 21, 2011; 25, Article 7: 245-284. Available online: http://www.demographic-research.org/volumes/vol25/7/25-7.pdf (accessed Jul 25, 2016).
25. Kagawa Y. Impact of Westernization on the Nutrition of Japanese: Changes in Physique, Cancer, Longevity and Centenarians. Preventive Medicine, 1978; 7: 205-217.
26. Hamazaki T, et al. Chapter 1 Cholesterol and Mortality, in: Towards a Paradigm Shift in Cholesterol Treatment. A Re-examination of the Cholesterol Issue in Japan. Annals of Nutrition and Metabolism, 2015; 66 (suppl 4): 6.
27. Kagawa Y. Impact of Westernization on the Nutrition of Japanese: Changes in Physique, Cancer, Longevity and Centenarians. Preventive Medicine, 1978; 7: 205-217.
28. Akisaka M, et al. Energy and Nutrient Intakes of Okinawan Centenarians. Journal of Nutritional Science and Vitaminology, 1996; 42: 241-248.
29. Chan YC, et al. Dietary, anthropometric, hematological and biochemical assessment of the nutritional status of centenarians and elderly people in Okinawa, Japan. Journal of the American College of Nutrition, 1997; 16: 229–235.
30. Carlyle E. Dan Buettner’s Blue Zones teach nine secrets of a longer life. City Pages, Wed, Feb 3, 2010. Available online: https://web.archive.org/web/20150709212120/http://www.citypages.com/news/dan-buettners-blue-zones-teach-nine-secrets-of-a-longer-life-6744222 (accessed Jul 19, 2016).