The Okinawa Diet Newsletter

March/April, 2008

In this issue:

The Okinawa Diet goes Mediterranean?

Dear Subscriber,

The Okinawa Diet goes Mediterranean? Well, not exactly but the creators of the Okinawa Diet program recently went Mediterranean to attend the 1st International Congress on Science in Nutrition in Rome, Italy. While in Rome, the Drs. Willcox were privy to a host of the latest findings in nutritional science, which they are happy to share with you here.

In this issue of the Okinawa Diet Newsletter, Drs. Bradley and Craig Willcox share their insights into the common elements of the Okinawan and Mediterranean diets. Are you getting enough Omega 3 fatty acids in your diet? Read Dr. Bradley Willcox's latest article to find out this and other related issues such as 'what is the difference between Omega 6 and Omega 3 fatty acids?'

How do your diet and lifestyle habits match up against the healthiest, longest lived peoples in the world from Okinawa and the Mediterranean? Read Dr. Craig Willcox's latest article to find out.

Also, our resident Okinawan food expert, Sayaka Mitsuhashi, offers her latest recipe: Watercress and Smoked Salmon Salad with Avocado Sauce. We hope you enjoy it!

Nuchi Gusui!

The Okinawa Diet Team

Medical News and Views

The Omega-3 Connection: A Common Factor that Links the Okinawan Diet to the Mediterranean Diet and May Improve your Health

Dr. Bradley Willcox
by Dr. Bradley Willcox

Buongiorno from Italy, fellow readers! As Dr. Craig Willcox has mentioned in this newsletter, one reason why the Italians are among the world's longest-lived people is their healthy traditional diet. What is their secret? Well, it turns out that there are several secrets. And these secrets are shared by some other traditional diets around the globe, such as the Okinawan diet. One secret that we highlight here is an abundance of omega-3 fat in the diet.

What is Omega-3 Fat?

In scientific jargon, omega-3 fats are labeled as such because the first double bond, of which fats can have several, is at carbon atom number 3. Omega-6 fat has a double bond at carbon atom number 6. Omega-9 (a type of monounsaturated fat) has a double bond at carbon atom number 9. Pretty simple. All are considered good fats since they don't increase risk for heart disease.

Omega-3 and omega-6 are considered "polyunsaturated." Why is this important? All fats are built from a backbone of several carbon atoms, strung together like beads. Poly "unsaturated" fat means that the multi (poly) carbon backbone is not completely surrounded (or "saturated") by hydrogen atoms. As you may recall, being saturated by hydrogen atoms or "hydrogenated", when it comes to fat, is not good. Remember "trans" fat? Trans fat is an unsaturated fat that has been artificially saturated in the lab (for commercial reasons) and has pretty nasty metabolic consequences. For reasons that are not completely clear it raises bad cholesterol and simultaneously lowers good cholesterol-a double whammy.

One reason that saturation with hydrogen is not good is because hydrogen atoms tend to slip off during metabolism and expose areas that can take part in free radical chemical reactions that damage our cells and tissues (including the walls of our arteries). The body's natural reaction is to fix the damage. In the arteries, repair is accomplished with the body's own "cement mortar," which happens to be cholesterol. Since bad cholesterol is a major cause of blockage in arteries and causes heart disease this is not good. In fact, this process, when combined with a few other nasty processes, is how "atherosclerosis" (cholesterol build-up in arteries) begins. Unfortunately, we know too well how that ends.

What does all this have to do with omega-3 fat? Well, omega-3 fat is a stable fat that helps prevent all this. Omega-3 fatty acids have very long stable carbon chains and that come as alpha-linolenic acid (ALA [18:3N-3]), EPA (20:5N-3) and DHA (22:6N-3), which have 18, 20 and 22 carbon atoms, respectively. Why is length important? Because the varying lengths of carbon strings affects their function and stability. The metabolic reasons are complicated but in the world of fatty acids, size does matter. And longer is better.

Size Matters

Some fatty acids have short carbon chains with less than six carbons. This is not good. For example, butyric acid is a four-carbon fatty acid found in butterfat. And it is highly atherogenic (causes serious cholesterol build-up in the arteries). Even with "short chain" saturated (bad) fatty acids, longer chain saturated fats are less atherogenic than shorter chain saturated fats.

Medium chain fatty acids usually have six to 12 carbons. Medium chain fats live up to their name, they are "average" or "medium," neither serious bad actors nor particularly good actors, with regard to cardiovascular disease risk (CVD). CVD, which includes coronary heart disease, stroke and other diseases of the blood vessels, is one of the most common killer diseases. Coconut oil is a case in point. Lauric acid, a 12-carbon (medium) chain fatty acid is the main component of coconut oil. It certainly tastes good but it is considered neutral with regard to heart disease. Doesn't seem to be a serious cause or a serious preventive agent.

Longer is Better

Once you get into long chain territory things start to get interesting again. Long chain-omega-3--fatty acids, called ALA, EPA and DHA, are all considered long-chain fatty acids because all have 12 or more carbon atoms. Since the longer the chain, the better they behave with regard to CVD risk, these are all healthy oils.

In fact, ALA is essential to human life. It is classified as an essential fatty acid because it cannot be made by the human body and must be obtained from dietary sources. ALA comes from plants and can be converted to EPA and DHA in mammals. The conversion rate of ALA to EPA in mammals is usually modest (less than 1%) and the subsequent conversion of EPA to DHA is also low. Therefore, while EPA and DHA are not by definition "essential" fatty acids, EPA and DHA are very important, and they are best obtained preformed in foods.

The Polyunsaturated Fats: Why the Omega-3 to Omega-6 Ratio is Important

We briefly mentioned the bad fats (Saturated and Trans fats) and touched on the good fats (polyunsaturated and monounsaturated). And there is little doubt in the scientific community that we should eat more polyunsaturated and monounsaturated fat than saturated. In fact, the goal has been to reduce heart disease by replacing harmful saturated fat with fats that have beneficial or at least neutral effects on total cholesterol---that is, fats that lower LDL (lethal cholesterol) but maintain high HDL (healthy cholesterol).

While this might seem like an intelligent strategy to lower the risk of heart disease, recent studies suggest a more sinister side to the omega-6 polyunsaturates (found in vegetable oils and animal products). Although they are generally considered healthy fats we eat too much of this type of fat.

When we have too much polyunsaturated omega-6 fat in our diet, it can promote inflammation, blood clotting and possibly cancer cell growth. At the same time, these fats are necessary for health, since they form part of the essential fatty acid group. It is when the ratio of omega-6 fat to omega-3 fat is too high that we may be at increased risk for the previously mentioned problems. When it's too low or reversed we may be at increased risk for bleeding and its complications such as hemorrhagic stroke. Ideally we should consume between three and ten times more omega-6 fats than omega-3.

The typical American consumes an average of ten to twenty times more omega-6 than omega-3 because we use the wrong types of vegetable oils for cooking, eat too much margarine and eat too much meat, among other issues. When we switch to healthier cooking oils such as canola oil or olive oil, eat more fish and nuts, and eat less meat our ratio corrects itself. Our studies of the Okinawans reveal that the elders have a ratio (omega 6:3) between 2:1 and 4:1, which is likely another factor in their outstanding health.

Obviously we need to achieve a more healthy balance. Since it's rather difficult to consume too much omega-3---unless you're on a traditional Inuit diet of fish and other marine animals--the smartest thing to do to balance your ratio is to lower your omega-6 intake while modestly increasing your omega-3 intake. A healthy ratio of omega-6 to omega-3 (in the range of 3:1) may be especially relevant for heart health, the health of the developing infant brain, and possibly for cancer prevention.

Certain omega-6 fatty acids, such as alpha-linolenic acid from meat, have been a prime suspect in prostate cancer. Interestingly, this doesn't hold true for the same fat from plants. It may be that there are other protective compounds in plants that reduce this effect. Indeed, diets high in soy oil, which consists of omega-6 but are counter-balanced by high levels of omega-3 and monounsaturated fat, seem to have a cancer-inhibiting effect. We give several good strategies in the Okinawa Program and Okinawa Diet plan for naturally obtaining a nice ratio but a few specific omega-3 rich foods are listed below.

What are the Best Dietary Sources of Omega-3?

Good sources of EPA and DHA are fatty or oily fish, including salmon, herring, mackerel, halibut and tuna. There also fresh water that contain healthy amounts of omega-3 fatty acids, such as lake herring and trout, freshwater salmon and whitefish. It appears that the omega-3 fat of these fish is increased with farming. However, the impact on the environment, residual pesticide and antibiotic content of selected types of fish and the transfer of certain parasites to wild species has been of concern. Nevertheless, any food choice has risks and benefits. The health risk from contaminants potentially contained in oily fish consumption may be outweighed by the potential benefits and environmental practices are improving.

For vegetarians, we suggest consumption of tofu and other forms of soybeans, canola oil, nuts and seeds such as walnut and flaxseed, and their oils. There are excellent guides in both the Okinawa Program and the Okinawa Diet Plan for both non-vegetarian and vegetarian sources of omega-3. Vegetarian sources contain alpha-linolenic acid (LNA), some of which is converted to omega-3 fatty acid after digestion and metabolism. As mentioned previously, there is modest conversion of this fat into EPA and DHA in the body.

The American Heart Association (AHA), after expert review, has concluded that EPA and DHA seem to stabilize irregular heart rhythms. This decreases risk for sudden cardiac death, which most often occurs from an irregular heart beat. These fatty acids also decrease the build up of fatty plaque in the arteries (atherosclerosis), partly because they lower triglyceride level (a form of bad cholesterol) and they slightly lower blood pressure. The AHA has recommended fish consumption or fish oil supplementation as a therapeutic strategy to minimize cardiovascular disease (coronary heart disease and stroke).

People who have high levels of triglycerides (TG) are at high risk for CVD, especially women. Omega-3 fat can lower TG and has other healthful consequences for blood cholesterol profiles. Most research suggests that omega-3 fatty acids reduce the synthesis and secretion of very-low-density lipoprotein (VLDL) particles and increase TG removal from VLDL particles. VLDL is a particularly lethal form of bad cholesterol. Omega-3 fat does this partly through the upregulation of enzymes, such as lipoprotein lipase. Omega-3 fatty acids differ from other lipid-altering therapies, such as statins (e.g. Lipitor, Simvastatin, Crestor, etc).

Omega-3 fat and statins have complementary mechanisms of action and complementary lipid benefits when administered with statins. Additional studies are needed to more fully understand the cellular and molecular basis for the TG lowering effects of omega-3 fatty acids and their cardiovascular benefits.

The Bottom Line

The bottom line is that getting your omega-6: omega-3 ratio closer to 3:1 is easier than it sounds. Rather than attempting to find a lab that actually measures the ratio, if you eat at least one food per day that is high in omega-3 fat, eat less omega-6 fat, and/or take supplemental omega-3 you are likely to get close. Monitoring the level of inflammation in your body by measuring your C-reactive protein (CRP) level can also help you tell if your ratio is off. One of the metabolic consequences of having too little omega-3 is inflammation, which is picked up by measuring CRP. This test is available in most physician offices.

Helpful guidelines from the AHA can be found below and more information can be found on the American Heart Association website at

Summary of AHA Recommendations for Omega-3 Fatty Acid Intake

Population Recommendations:

1) Patients without documented coronary heart disease (CHD).

Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).

2) Patients with documented CHD

Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.

3) Patients who need to lower triglycerides.

2 to 4 grams of EPA+DHA per day provided as capsules under a physician's care.

Note: Taking more than 3 grams of omega-3 fatty acids from capsules should only be done under a physician's care. High intakes could cause excessive bleeding in some people.

Nuchi Gusui!

Dr. Bradley Willcox

News from Okinawa

The Okinawa Diet and The Mediterranean Diet: Commonalties

Dr. Craig Willcox
by Dr. Craig Willcox

Ciao da Roma,

A Roman holiday for me conjures up images of Audrey Hepburn and Gregory Peck romance on the Spanish Steps, and scenes of the Trevi Fountain, the Colosseum, Pantheon, and the Vatican, among other. However, Rome is also situated in the Mediterranean region, known also for the healthy regional cuisine.

On March 7th and 8th Rome was also the site for the 1st International Congress on Science in Nutrition sponsored by the Paolo Sorbini Foundation where all three authors of The Okinawa Diet Plan (myself included) and other researchers spoke about the healthful effects of traditional dietary patterns such as the Okinawa diet and the Mediterranean diet.

Many famous researchers, such as Dr. David Jenkins (developer of the Glycemic Index), Dr. Jennie-Brand Miller (who has done much to research and promote practical applications of the Glycemic Index) well as some popular diet gurus such as Barry Sears (Zone Diet) made presentations.

Much debate centered around the most healthy dietary approach to follow (Okinawan, Mediterranean, Zone) and each researcher had their own perspective yet, despite differences in philosophy, all agreed that distinct similarities are present between the traditional dietary and lifestyle practices of Mediterranean and Okinawan cultures.

Commonalties include the following:

1) Abundant amounts of plant foods such as whole grains, vegetables, fruits, legumes (beans, peas and lentils) and nuts;
2) Regular fish consumption;
3) Small amounts lean red meat;
4) Mono and Polyunsaturated oils from plant and fish sources are the main dietary source of fats;
5) Alcohol is consumed regularly in moderation (usually with meals);
6) Physical activity is woven into the fabric of daily life;
7) Strong social networks and a more relaxed and optimistic view of life;

According to a large body of scientific research it's these similar dietary and lifestyle practices that help explain why Okinawan and Mediterranean peoples also share the same low rates of chronic disease and long life expectancy and vibrant good health.

Perhaps it comes as no surprise that one of the top publishers in Italy recently picked up the foreign language rights for both The Okinawa Program and The Okinawa Diet Plan. For those able to read Italian or those with Italian friends or relatives, you can now explain your interest in the Okinawa Way by directing them to Okinawa, L'isola dei Centenari available at the following website:


Yours in Good Health!

Dr. Craig Willcox

Sayaka's Kitchen

Watercress and Smoked Salmon Salad with Avocado Sauce

Sayaka Mitsuhashi
by Sayaka Mitsuhashi

Watercress and Smoked Salmon Salad with Avocado Sauce

Serves 4


1 avocado
2 1/2 tsp. lemon juice
2 tsp. miso
1 clove garlic
1/4 tsp. cayenne pepper
4 cups chopped watercress
6 oz. smoked salmon


1. Process avocado, lemon juice, miso, garlic and cayenne pepper in a blender until smooth.
2. Arrange watercress on 4 salad plates and top decoratively with smoked salmon.
3. Place a quarter amount of avocado sauce over each salad plate.

For more great tasting and healthy recipes, cooking tips, plus personalized meal plans and much more, join us at The Okinawa Diet Program today!

We hope you enjoyed this issue of the Okinawa Diet Newsletter
-The Okinawa Diet Team

To find out more about The Okinawa Diet go to To find out more about The Okinawa Centenarian Study go to

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