Lt. Col. Chad Gregory Kahl MD SFS CMA FAAFP is the chief flight surgeon at the Pentagon's Flight Medicine Clinic and an assistant professor in the Department of Family Medicine at the Uniformed Services University and Walter Reed Military Medical Center.
What would be greater than living until your 100th birthday? How about running until that age? Increasingly, researchers are looking at ways that can extend our lives, and quality of life, well into our latter decades.
Having the privilege to consult with the chairman and other members of the Joint Staff on diet, exercise and general health has provided me unique insight into the endeavor of longevity and exercise endurance -- particularly in the setting of military operators and Defense Department personnel with a history of chronic exposures to austere and stressful environments.
One such insight comes from Olympian and running coach Jeff Galloway, who just might have uncovered a secret to help in the endeavor of 100 years of running. Galloway’s pinpointed strategies have allowed avid runners to engage in low-impact, short-stride distance running that incorporates walking intervals. Galloway suggests not just walking when you're tired but, instead, taking brief walk breaks when you're not.
"Taking these breaks makes marathon or half-marathon training less grueling and reduces the risk of injury," says Galloway, in his book "Running Until You're 100," because it gives the muscles regular recovery time during a long run.
Anecdotally, I have observed many of my patients who are or were avid runners struggle with knee, hip and ankle pain, but are now able to enjoy running with less pain by implementing Galloway’s simple techniques. The best part is that nearly all of the helpful tips can be accessed by Galloway’s free newsletter and other online resources.
That being said, let's not put the cart before the horse. The first step in running until you are 100 is making it to that age, and that is where Dan Buettner's research on Blue Zone populations comes into play.
Buettner, a National Geographic Fellow, has crossed the globe for years in pursuit of places where people live much longer than average, and he's dubbed these regions "Blue Zones."
These locations boast the highest population of centennials, people who live to be 100 years old. Incidentally, these populations have amazingly low rates of diabetes, obesity, heart disease and other preventable diseases.
To date, he's pinpointed five Blue Zones: Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Nicoya, Costa Rica; and Loma Linda, California. Yes, the U.S. made the list!
Buettner examined these places to learn the habits of their unusually healthy residents and describes their lifestyles at length in his TED talks. Amazingly, he found, for example, in the Supramonte and Barbagia mountains in Sardinia, there are 21 centenarians per 10,000 population, versus only 4 per 10,000 Americans. Also, the male-to-female ratio was about even, unlike in America where it is 1 to 4. In the village of Perdasdefogu, nine living siblings in the Melis family hold the Guinness world record of combined age, 828 years.
Here is a brief synopsis of some of the things these people do on a daily basis, many of which overlap nicely with Galloway's running theories:
They Incorporate Exercise into Their Everyday Activities
As observed in previous studies, Buettner recognized something that I preach to my patients here at the Pentagon every day: "Blue Zone people are nudged into moving on a daily basis." Blue Zone inhabitants engage in physical activity throughout the day, in their natural surroundings, rather than dedicated trips to the gym. Because most of us are confined to an office or stuck behind a steering wheel for prolonged periods, moving throughout the day can be increasingly effective. Taking the stairs instead of escalators can be a good start, or finding a few seconds to do a push-up or plank at your desk every couple of hours can offer great cardiovascular health benefits. Harvard researchers recently proved for the first time that limited push-up capacity is linked to heart disease. They found that middle-aged men who can log more than 40 push-ups in a single try have a 96 percent reduced risk of developing heart disease and other related ailments, such as heart failure, compared to those who can complete no more than 10 push-ups.
They Eat Mostly Plants
Fresh fruits, vegetables and whole grains make up the majority of their diet, and beans are also a cornerstone (think fava, black, soy and lentils). Nuts are another staple. Studies have shown that eating a handful a day may add two to three years of life expectancy. These eating habits lend weight to my daily mantra to all of my patients on the importance of getting close to 30 grams of fiber a day. Most people in Blue Zones will eat meat occasionally, usually pork, and on average just five times a month. Fish is also consumed, but in moderation. The longest living Americans -- in Loma Linda, California -- are pescatarians, which are basically vegans who also eat fish. There is an obvious synergy in removing red meat and processed foods from our diets, as they contribute to hardening of arteries and the buildup of plaques in our coronary vessels, and replacing them with free-radical fighting, antioxidant-rich cruciform vegetables and colorful fruits that do the opposite.
They Stop Eating Before They're Full
Okinawans abide by the 2,500-year-old Confucian mantra of "hara hachi bu," which reminds them to push their plates away when they feel 80 percent full. The reason this aids longevity: When you stop eating after not feeling hungry, but before feeling full, it helps keep insulin levels stable and keeps unwanted weight off. When you begin eating, it takes about 20 minutes for the stomach to communicate with the brain just how full it is. Also, it takes sometimes 15 to 20 meals to reset the stomach's muscle memory to get used to less food. People need to trust that it will happen. Most are used to eating until they are full, which is past satiation and which keeps weight on and can contribute to diabetes and postprandial fatigue.
They Engage in Moderate Coffee and Wine Consumption
Separate studies have shown red wine and coffee reduce the risk of heart disease and certain cancers, and slow the progression of neurological disorders such as Alzheimer's and Parkinson's disease. Recent evidence highlights the beneficial role of red wine against oxidative stress, attributed to its phytochemical compounds, called polyphenols, that protect the lining of blood vessels in your heart. A polyphenol called resveratrol is one substance in red wine that's gotten attention and may prevent degenerative diseases; the tannin-rich polyphenols in coffee act similarly. Recent research from the University of California Irvine Institute for Memory Impairments and Neurological Disorders (UCI MIND, supports these findings. The 90+ Study evaluated more than 1,600 people over the age of 90 for their lifestyle habits and other qualities that might have contributed to their longevity. The researchers found that those who drank moderate amounts of alcohol or coffee every day were likely to live longer than those who abstained. This all comes with one obvious caveat: Overindulging may negate the positive effects.
They Mitigate Stress
The impetus of nearly every disease, and the root of why we age, is inflammation. Most of this chronic inflammation comes from poor dietary intake and the worries of everyday life. Centenarians have daily rituals that reverse this, such as short naps in Ikaria, meditative communal bread-making rituals in Sardinia and weaving the practice of ancestral remembrance into everyday life in Okinawa. Meditation can also be powerful and simple. One great way to get started quickly is the phone app Headspace. The basic version is free, and you can start with three-minute breathing exercises that have been proven to reduce heart rate and blood pressure. And, of course, try going back to simple regular daily exercise. The mental benefits of aerobic exercise have a powerful, neurochemical basis. Exercise can immediately reduce levels of the body's stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body's natural painkillers and mood elevators. Endorphins are responsible for the "runner's high" and for the feelings of relaxation and optimism that accompany many hard workouts.
Their Life Has Purpose
Buettner posits that knowing your sense of purpose is worth up to seven years of extra life expectancy. In Okinawa, it's called "Ikigai," and in Nicoya, it's "plan de vida." Both translate roughly to "why I wake up in the morning." Interestingly, this overlaps perfectly with Dr. Viktor Frankl's study of Logotherapy. Frankl, a neuropsychiatrist and holocaust survivor, described Logotherapy as the premise that a person is motivated by a "will to meaning," an inner pull to find a meaning in life. Frankl's existential exploration reaffirms Buettner's Blue Zone findings that when life has meaning, the human condition and life expectancy improve.
They Belong to Tight-Knit Social Circles
In the Blue Zones, Buettner observed the overwhelming importance of camaraderie and kinship. Surrounding yourself with others who promote healthy behaviors and enhanced community engagement can add years to your life. Buettner found that Okinawans form "moai" pods of five friends who commit to each other for life, while the Ikarians build larger communities that socialize frequently.
We are designed to be social creatures; it is woven into the fabric of our DNA. There are some current military 501c3 organizations providing much-needed group enrichment activities to veterans and active-duty members alike. These groups have shown a commitment to helping active-duty and retired military members bond with their communities during and after military service. One that is near and dear to my heart, Team Red White and Blue, has developed a comprehensive community-based model committed to building opportunities for social interaction, community fitness events and finding purposeful relationships.
They're Also Part of a Larger Faith-Based Community
All but five of the 263 centenarians involved in the original Blue Zone studies belonged to a faith-based community. While the specific type of spirituality varied, the data revealed that attending faith-based services four times per month can add up to 14 years of life expectancy. Current data supports this unique finding. Religious interventions such as intercessory prayer have been shown to improve success rates of in vitro fertilization, decrease length of hospital stay and the duration of fever in septic patients, increase immune function, improve rheumatoid arthritis, and reduce anxiety. Studies have also shown that attendance at religious services likely improves health behaviors, and that prayer may decrease adverse outcomes in patients with cardiac disease.
They Prioritize Family
Being in a positive, committed relationship can add up to six years of life expectancy, and Blue Zone people go out of their way to cultivate deep relationships with their children, as well as parents and grandparents. Their cultures value their elders, and aging family members are often cared for in their families' homes. Current research supports that marriage is associated with longer survival. More than 35 years ago, cardiologist James Lynch published "The Broken Heart," which explored the medical consequences of loneliness. Lynch argued that premature death from heart disease was more common among people who lived alone or were never married. A variety of studies have suggested that supportive social networks promote longer life expectancy.
In the post-modern world, time seems in increasingly short supply. But it has been shown that in nearly every community surveyed, people want to carve out time in their day to improve their health habits. Living to 100, and even running to that age, is a lofty goal. By creating social networks of health-conscious people who encourage wellness, a greater sense of purpose and belonging may take root. Adopting some of Buettner and Galloway's proven methods, and weaving them into our daily routines, may lead to greater longevity, ultimately leading to more healthy and meaningful lives.
-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com, the Department of Defense, the Joint Staff, the United States Air Force, the Uniformed Services University, Walter Reed Military Medical Center, or any other DoD components. If you would like to submit your own commentary, please send your article to firstname.lastname@example.org for consideration.