Why do Okinawans live so long: an Okinawan elder smiling above Brehan Crawford, L.Ac., explaining the gut connection

Why Do Okinawans Live So Long?

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    Is it possible to live like the longest-living people on Earth, even in the West? Most people assume Okinawans live so long because of their genes. It is much more intricate than that, and a great deal of it comes down to the gut. Here is what the research shows, and a simple 21-day reset you can start this week.

    The short answer

    Okinawans did not live long because of genetics alone. Researchers found that Okinawan elders carry beneficial gut bacteria that are scarce in the Western gut, and two things wipe those bacteria out: antibiotics and ultra-processed food. Copying their diet works best once you rebuild the gut underneath it: remove ultra-processed food, replace cold food with warm cooked meals, and restore good bacteria with a small daily serving of fermented food, for 21 days.

    The short version, on video.

    Why do Okinawans live so long?

    In America, about two out of every 10,000 people make it to 100 years old. In Okinawa, Japan, that number used to be three times as high, until Okinawans shifted to a more Western diet. That last part is the clue. A population's genes do not change in a generation or two. What changed was the food, and with it the gut.

    The long-term research on older Okinawans points the same way. Elders who grew up on the traditional diet ate a mild caloric deficit of roughly 10 to 15 percent for close to half their lives, and ate large amounts of sweet potato, marine foods rich in carotenoids, and turmeric. They showed less age-related chronic disease, including cardiovascular disease, cancer and dementia, and a longer mean and maximum lifespan[1]. Every one of those foods passes through the gut first, and it is in the gut that the story becomes interesting.

    This is the kind of thing we work through, step by step, inside Gut Brain Synchrony, my community on Skool, where the courses start from the gut and work outward.

    Is Okinawan longevity genetic?

    Not mainly. Most people think long life runs in the family because of genes, but the numbers do not support that. A study of pedigree data covering hundreds of millions of historical people found that nominal heritability of lifespan sits around 15 to 30 percent, and that most of that family resemblance was also shared by in-laws, who are not blood relatives. Once the researchers corrected for the fact that people tend to marry partners with similar lifestyles and environments, the true heritability of human longevity came out well below 10 percent[2].

    If genes explain less than a tenth of how long we live, the rest is how we live: what we eat, how we eat it, and what lives inside us as a result. Reviews of centenarians, people aged 100 or older, describe them as the most successful model of human aging, with low rates of chronic disease and good independence late in life, and name the gut microbiota as a factor that helps establish that healthy phenotype[3].

    What is different about the gut of Okinawan centenarians?

    Researchers studied Okinawan elders and found that their microbiome contained beneficial bacteria that are scarce in the Western gut. Long-living people appear to be the ones whose gut bacteria keep re-establishing a cooperative relationship with the body as it ages, adapting to changes inside and outside it[4]. Their gut is not a fixed inheritance. It is a living ecosystem that has been looked after.

    The Ogimi study

    Ogimi is one of Japan's famous longevity villages, in the north of Okinawa Prefecture. A Japanese team compared elderly women living there, splitting them by whether or not they had lived in Ogimi during the first three years of life. The women raised in the village from infancy had a higher rate of colonization by Akkermansia muciniphila[5]. The early-life environment, the food and the land a child grows up with, left a lasting mark on the gut decades later.

    Why Akkermansia matters

    Akkermansia muciniphila lives in the mucus layer that lines the gut. Over the past twenty years it has been studied for its role in metabolism, inflammation and immunity, and a growing body of research links it to aging and to age-related diseases including vascular degeneration, neurodegeneration, osteoporosis, chronic kidney disease and type 2 diabetes[6]. In old mice, where Akkermansia was almost undetectable, a transplant of gut bacteria from young mice brought it back and improved glucose sensitivity, inflammation, antioxidant capacity and the intestinal barrier. Giving Akkermansia alone produced similar benefits, working through the acetic acid it produces[7].

    In Chinese medicine we would say the Okinawan elders kept their Spleen and Stomach strong: the digestive center that turns food into Qi and Blood. The modern language is microbes and short-chain fatty acids. The principle is the same. Strong digestion is the root of a long life.

    Why is the Western gut missing these bacteria?

    There are two reasons: antibiotics and processed food.

    Antibiotics

    Antibiotics do not choose between good and bad bacteria. In a Stanford study that followed three people's gut bacteria for ten months across two courses of ciprofloxacin, the effect was profound and fast: a loss of diversity and a shift in community makeup within three to four days of starting the drug. A week after each course, the communities began to return, but the return was often incomplete. By the end of the study every subject's gut had stabilized in a state that was altered from where it began[8]. Each course leaves its mark.

    Ultra-processed food

    About 60 percent of calories in the typical American diet come from ultra-processed foods. A nationally representative analysis of US eating data put the figure at 58 percent of energy intake, along with 89 percent of added sugars[9]. You can see it on the shelves: a database of more than 50,000 items sold at Walmart, Target and Whole Foods was built to map how processed the American grocery supply is, and to quantify how each of more than 1,000 ingredients contributes to ultra-processing[10].

    These foods kill many good bacteria, and they often seed many bad ones. A double-blind controlled-feeding trial gave healthy adults an identical diet with or without carboxymethylcellulose, a common emulsifier in processed foods, for 11 days. The emulsifier reduced the diversity of the gut bacteria, lowered short-chain fatty acids, and increased abdominal discomfort after meals. In two people, bacteria pushed into the inner mucus layer of the gut, which is normally kept sterile, a central feature of gut inflammation[11]. The damage reaches beyond the gut. In nearly 9,000 middle-aged American adults followed for a median of 13 years, those eating the most ultra-processed food had a 15 percent higher risk of developing high blood pressure, and every extra serving of minimally processed food was linked to a 2 percent lower risk[12].

    So copying a healthy diet without fixing your gut first is like building a house on a broken foundation. You can buy the sweet potatoes and the seaweed, but if the bacteria that thrive on them have been cleared out, the food cannot do its full work.

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    What is the traditional Okinawan diet?

    The traditional Okinawan diet is anchored by root vegetables, principally sweet potatoes, along with green and yellow vegetables, soybean foods and medicinal plants. Marine foods, lean meats, fruit, medicinal garnishes and spices, and tea were eaten in moderation[13]. It is high in unrefined carbohydrates, moderate in protein with an emphasis on vegetables, legumes and fish, and low in caloric density, which brings a high intake of phytonutrients and antioxidants along with less inflammation and oxidative stress[13].

    Notice how much of that plate is plant. That matters for the gut, because the variety of plants you eat shapes your bacteria. The American Gut project, built on samples from more than 10,000 people, found that the diversity of plants people consumed was associated with the makeup of their microbiome and metabolome, more so than broad labels such as vegan or not[14]. Okinawans did not eat a few superfoods. They ate many plants, every day, cooked.

    Longevity in East Asia was never about one food. The same tradition gave rise to daily movement practices for long life, which I cover in what are Chinese longevity exercises.

    How to eat like an Okinawan: the 21-day gut reset

    Here is a very simple reset you can use to rebuild your gut, using a remove, replace, restore method. Try it for 21 days and see if you get better energy, clearer skin and even deeper sleep. Everyone's body is different, so treat it as something to explore on your own body.

    01 Remove: toss out ultra-processed foods. Clear the packaged snacks, sweetened drinks and ready meals with long ingredient lists. Focus on whole foods, with plants making up about 80 to 90 percent of what you eat by volume. Aim for variety: different vegetables, beans, roots, greens and seaweeds across the week, the way the Okinawan plate was built.
    02 Replace: change to warm food. In traditional Chinese medicine, cold food weakens digestion. The Spleen and Stomach work like a cooking pot, and cold food and iced drinks put out the fire under it. For 21 days, stick to warm, cooked meals such as soups and stews to stop bloating. Yes, even in the summertime. Physiology agrees that temperature matters: in healthy volunteers, an ice-cold drink at 4°C disturbed the coordinated movement of the stomach and its outlet more than any other temperature tested, with a body-temperature drink causing the least disruption[15]. I went deeper into cold drinks and digestion in is iced matcha good for you.
    03 Restore: add a small portion of fermented food. Eat a small portion, just a garnish, of kimchi or sauerkraut, or, if you are okay with dairy, yogurt or kefir, to introduce beneficial lactobacillus bacteria. In a 17-week randomized study at Stanford, a high-fermented-food diet steadily increased gut microbiota diversity and decreased inflammatory markers[16]. Lacto-fermented vegetables such as kimchi and sauerkraut carry live beneficial microbes along with lactic and acetic acids and other bioactive compounds, and kimchi alone has been tested in at least 11 human studies[17]. This is food, not a capsule: a spoonful beside a warm meal, every day.

    Warm, mostly plant, home-cooked, with a little fermented food on the side. That is the whole reset.

    Frequently asked questions

    Why do Japanese people live longer than Americans?

    The research points to how they live and eat far more than to their genes. True heritability of lifespan is well below 10 percent[2], and Americans get close to 60 percent of their calories from ultra-processed food[9], which damages the gut bacteria that long-living people keep.

    Do Okinawans eat meat?

    Yes, in moderation. The traditional diet included marine foods and lean meats, but the base of the plate was sweet potato, vegetables, soy foods and medicinal plants[13]. That is why I suggest plants make up about 80 to 90 percent of what you eat by volume.

    Does gut health affect longevity?

    Yes. Reviews of centenarians identify the gut microbiota as a factor in the healthy, independent aging they show[3], and Okinawan elders raised in a longevity village carry beneficial bacteria such as Akkermansia muciniphila at higher rates[5].

    Your genes are not your destiny. Your gut is something you can rebuild, one warm meal at a time.

    — Brehan Crawford, L.Ac.

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    References

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    2. Ruby JG, Wright KM, Rand KA, et al. Estimates of the heritability of human longevity are substantially inflated due to assortative mating. Genetics. 2018;210(3):1109-1124. doi:10.1534/genetics.118.301613
    3. Lozada-Martinez ID, Lozada-Martinez LM, Anaya JM. Gut microbiota in centenarians: a potential metabolic and aging regulator in the study of extreme longevity. Aging Med (Milton). 2024;7(3):406-413. doi:10.1002/agm2.12336
    4. Biagi E, Rampelli S, Turroni S, Quercia S, Candela M, Brigidi P. The gut microbiota of centenarians: signatures of longevity in the gut microbiota profile. Mech Ageing Dev. 2017;165(Pt B):180-184. doi:10.1016/j.mad.2016.12.013
    5. Morita H, Ichishima M, Tada I, et al. Gut microbial composition of elderly women born in the Japanese longevity village Ogimi. Biosci Microbiota Food Health. 2021;40(1):75-79. doi:10.12938/bmfh.2019-055
    6. Zeng SY, Liu YF, Liu JH, Zeng ZL, Xie H, Liu JH. Potential effects of Akkermansia muciniphila in aging and aging-related diseases: current evidence and perspectives. Aging Dis. 2023;14(6):2015-2027. doi:10.14336/AD.2023.0325
    7. Ma J, Liu Z, Gao X, et al. Gut microbiota remodeling improves natural aging-related disorders through Akkermansia muciniphila and its derived acetic acid. Pharmacol Res. 2023;189:106687. doi:10.1016/j.phrs.2023.106687
    8. Dethlefsen L, Relman DA. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc Natl Acad Sci U S A. 2011;108(Suppl 1):4554-4561. doi:10.1073/pnas.1000087107
    9. Juul F, Martinez-Steele E, Parekh N, Monteiro CA, Chang VW. Ultra-processed food consumption and excess weight among US adults. Br J Nutr. 2018;120(1):90-100. doi:10.1017/S0007114518001046
    10. Ravandi B, Ispirova G, Sebek M, Mehler P, Barabási AL, Menichetti G. Prevalence of processed foods in major US grocery stores. Nat Food. 2025;6(3):296-308. doi:10.1038/s43016-024-01095-7
    11. Chassaing B, Compher C, Bonhomme B, et al. Randomized controlled-feeding study of dietary emulsifier carboxymethylcellulose reveals detrimental impacts on the gut microbiota and metabolome. Gastroenterology. 2022;162(3):743-756. doi:10.1053/j.gastro.2021.11.006
    12. Rivera N, Du S, Bernard L, Kim H, Matsushita K, Rebholz CM. Ultra-processed food consumption and risk of incident hypertension in US middle-aged adults. J Am Heart Assoc. 2024;13(17):e035189. doi:10.1161/JAHA.124.035189
    13. Willcox DC, Scapagnini G, Willcox BJ. Healthy aging diets other than the Mediterranean: a focus on the Okinawan diet. Mech Ageing Dev. 2014;136-137:148-162. doi:10.1016/j.mad.2014.01.002
    14. McDonald D, Hyde E, Debelius JW, et al. American Gut: an open platform for citizen science microbiome research. mSystems. 2018;3(3):e00031-18. doi:10.1128/mSystems.00031-18
    15. Sun WM, Penagini R, Hebbard G, et al. Effect of drink temperature on antropyloroduodenal motility and gastric electrical activity in humans. Gut. 1995;37(3):329-334. doi:10.1136/gut.37.3.329
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